Pharm HESI

The nurse is caring for several patients. Which patient will need teaching about treatment for hypertension?

A patient with a systolic pressure consistently above 140 mm Hg Rationale: Hypertension is defined as a persistent systolic pressure of greater than 140 mm Hg and or a diastolic pressure greater than 90 mm Hg. A patient is not diagnosed with hypertension after one episode of an elevated pressure.

The nurse notes lithium on a patient's drug history upon admission. Which condition would the nurse suspect that this patient has been diagnosed with?

Bipolar disorder Rationale: Lithium is an antimanic drug used to treat manic episodes associated with bipolar disorders

Which factor is most important to ensure compliance when planning to teach a client about a drug regimen?

Client education

The nurse monitors a patient prescribed dicyclomine (Bentyl) for which therapeutic effect?

Decrease in gastrointestinal motility Rationale: Dicyclomine is an antispasmodic cholinergic blocker used to decrease gastrointestinal motility in patients with functional gastrointestinal disorders such as irritable bowel syndrome.

The nurse would question the order for estrogen replacement therapy in a patient with a history of which condition?

Deep vein thrombosis Rationale: Increased coagulation and risk of deep vein thrombosis are side effects of hormone replacement therapy

What are the common side effects of fenofibrate, a fibric acid derivative? Select all that apply.

Impotence, nausea, abdominal pain, and an increase in gallstone formation

A 4-year-old child is receiving chemotherapy for acute lymphocytic leukemia. Which laboratory result should the nurse examine to assess the child's risk for infection?

Neutrophil count Rationale: During chemotherapy, granulocytes are significantly suppressed. Because neutrophils comprise 60% to 70% of the granulocyte count, these levels are the most useful laboratory results of the options presented to determine the child's risk for infection.

A client receives an antihypertensive agent daily. Which action is most important for the nurse to implement prior to administering the medication?

Obtain the client's blood pressure.

A drug given by which route is altered by the first-pass effect?

Oral Rationale: Medications absorbed in the stomach and small intestine travel through the portal system and are metabolized by the liver before they reach the general circulation.

A patient is admitted to the emergency department after taking an overdose of a barbiturate 15 minutes prior to arrival. The nurse can anticipate that which drug will be prescribed?

activated charcoal Rationale: There is no antidote for barbiturates. The use of activated charcoal absorbs any drug in the gastrointestinal tract, preventing absorption.

Highly protein-bound drugs

increase drug-drug interactions Rationale: When administering two medications that are highly protein bound, the medications can compete for binding sites on plasma proteins. This competition results in either less of both or less of one of the drugs binding to the proteins, thus increasing the risk of toxicity.

What is the primary indication for the administration of morphine?

to relieve acute and chronic pain Rationale: The principal indication for morphine is the relief of moderate to severe acute and chronic pain, including postoperative pain and cancer pain. In addition, morphine is used during acute myocardial infarction to relieve pain, anxiety, and dyspnea and to promote relaxation of vascular smooth muscle. Morphine may also be administered before surgery for sedation. Nitroglycerin is used to treat ischemic pain.

The nurse is aware that the most appropriate time to begin patient education and begin the teaching-learning process is

upon the patient's admission to the health care setting. Rationale: The teaching-learning process begins with admission or contact with the health care setting. The teaching-learning process does not require an order and is within the nursing scope of practice. Waiting until discharge time is established may be too late depending on the needs of the patient.

During postoperative teaching, the nurse explains that the patient is receiving bethanechol (Urecholine) to treat

urinary atony. Rationale: Bethanechol is a direct-acting cholinergic agonist that stimulates the cholinergic receptors on the smooth muscle of the bladder, leading to bladder contraction and emptying.

The nurse would document which of the following most relevant predicted outcomes in a care plan for a client using St. John's wort?

"Client demonstrated knowledge of the need to wear protective clothing and apply sunscreen." Rationale: One of the side effects of St. John's wort is photosensitivity requiring the client to avoid direct excessive exposure to sunlight, especially if fair skinned.Because it may increase the toxic effects of MAOIs, food high in tyramines should be avoided. The drug's sedative effect is compounded by alcohol intake. The client should use a designated driver anytime ingesting alcoholic beverages. Associate the side effects of the drug with risks to the client.

What education and discharge information for a patient receiving an antilipemic medication would the nurse include for the patient?

"Continue your exercise program, and maintain a diet high in omega-3 fatty acids." Rationale: Antilipemic medications are an addition to, not a replacement of, the therapeutic regimen used to decrease serum cholesterol.

A patient is prescribed oxycodone extended release (ER) for pain management. What information is essential to include in the teaching plan? Select all that apply

"Do not dissolve the medication in water." "Do not crush the medication." "Swallow the medication whole." Rationale: Oxycodone ER is an extended-release dosage form. The nurse should instruct the patient not to chew or crush the medicine to prevent excessive sedation, urinary retention, and respiratory depression. The medication should be swallowed whole. Chewing or crushing or dissolving the medication in water would result in increased serum concentration of the drug, which may cause adverse effects. Rapid absorption of the drug results in severe opioid toxicity. The medication is not taken frequently, because it is an extended-release form. This means it works for longer periods of time. The patient should not increase the dose if there is no pain relief, but rather should call the primary health care provider.

What instruction does the nurse give when a patient receiving metformin therapy will undergo angiography?

"Do not take your metformin on the day of the test." Rationale: Angiography uses iodinated (iodine-containing) radiologic contrast media, which interact with metformin and may cause acute renal failure or lactic acidosis. Hence, the nurse instructs the patient to discontinue the drug on the day of the test. There are chances of renal failure after the test only if metformin is taken during the test. Blood glucose levels are regularly evaluated in diabetic patients, but it is not a priority in this case. Metformin can be taken 48 hours after the test to prevent any adverse effects.

The patient is prescribed 30 units regular insulin and 70 units NPH insulin subcutaneously every morning. The nurse will provide which instruction to the patient?

"Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." Rationale: Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin.

A mother of a 1-month-old infant calls the clinic and asks the nurse if the medication she is taking can be passed to her infant during breastfeeding. What is the appropriate response for this patient?

"Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking." Rationale: The nurse is aware that medications can pass in breast milk, but each medication is different. Women who take medication while breastfeeding should be assessed on a case-by-case basis, including assessment of the medication the patient is taking.

The nurse is assessing a patient with diabetes who has hyperlipidemia. The patient asks the nurse to suggest either an herbal medication or a dietary modification to reduce cholesterol levels. Which suggestion, given by the nurse would be most beneficial to the patient?

"Eat foods rich in omega-3 fatty acids." Rationale: The patient has diabetes and hyperlipidemia; therefore, the nurse should suggest that the patient include foods rich in omega-3 fatty acids, such as fish oil, in her diet. They are also available as fish oil products under the brand name Lovaza. This reduces cholesterol levels without altering blood glucose levels. Flax intake should not be suggested to a diabetic patient, because it may have potential hypoglycemic effects due to drug interactions. Garlic is contraindicated in diabetic patients; the nurse should not suggest that the patient eat an excessive amount of garlic. St. John's wort is an herb used to treat depression and the symptoms associated with depression, such as anxiety, loss of appetite, and insomnia. This is not helpful in reducing the cholesterol level.

The nurse is teaching the patient why hypertension must be treated. What information should be included in the teaching plan? Select all that apply.

"Hypertension is a risk factor for heart failure." "Hypertension is a risk factor for cardiovascular disease." "Hypertension is a risk factor for stroke." Rationale: Hypertension is a risk factor for stroke, heart failure, and cardiovascular disease. It is not a risk factor for diabetes or emphysema.

Which statement indicates that client teaching regarding the administration of the chemotherapeutic agent daunorubicin HCl has been effective?

"I expect my urine to be red for the next few days." Rationale: Daunorubicin HCl causes the urine to turn red in color.

A client is taking famotidine. Which client statement should the nurse further assess because it may indicate that the client is experiencing a side effect of this drug?

"I seem to be having difficulty thinking clearly." Rationale: A common side effect of of famotidine is confusion.

Which statement, made by the patient, demonstrates a knowledge deficit regarding colestipol (Colestid)?

"I should mix and stir the powder in a small an amount of fluid as possible in order to maintain potency of the medication." Rationale: Colestipol is available as a powder that must be well diluted in fluids before administration to avoid esophageal irritation or obstruction and intestinal obstruction. The powder should not be stirred because it may clump—it should be left to dissolve slowly for at least 1 minute.

What statement indicates to the nurse that the patient needs additional instruction about antihypertensive treatment?

"I will check my blood pressure daily and take my medication when it is over 140/90 mm Hg." Rationale: Antihypertensive medications need to be taken routinely to maintain a normotensive state and prevent complications. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, whereas the medication can cause some untoward effects. Patient teaching is essential. If the patient indicates an intention to take rest periods and change positions slowly to prevent orthostatic hypotension, this demonstrates compliance with the treatment regimen.

Which statement, if made by your patient, signifies that additional patient teaching regarding antihypertensive treatment is required?

"I will check my blood pressure every day and take my medication when it is over 140/90." Rationale: Antihypertensive medications need to be taken routinely in order to maintain a normotensive state and prevent occurrence of complications. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, whereas the medication can cause some untoward effects. Patient teaching is essential.

Which statement will indicate to the nurse that the patient understands the discharge instructions regarding cholestyramine (Questran)

"I will increase fiber in my diet." Rationale: Cholestyramine can cause constipation; thus increasing fiber in diet is appropriate. All other drugs should be taken 1 hour before or 4 hours after cholestyramine to facilitate proper absorption.

Which statement when made by the patient indicates deficient knowledge regarding warfarin?

"I will increase the dark green leafy vegetables in my diet." Rationale: Dark green leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Therefore, it is important to maintain a consistent daily intake of vitamin K and avoid eating large amounts of these foods.

The patient has been placed on midodrine an alpha1 adrenergic for orthostatic hypotension. Which patient statement indicates an understanding of the importance of administering the medication according to specified instructions?

"I will take the first dose in the morning with a full glass of water before I get out of bed." Rationale: Midodrine is usually ordered to be taken with forced fluids before the patient gets out of bed in the morning. There is no evidence that it must be taken with food or with just a sip of water.

The nurse is evaluating a client's understanding of the prescribed antilipemic drug lovastatin. Which client statement indicates that further teaching is needed?

"I will take the medication every day before breakfast." Rationale: The enzyme that helps metabolize cholesterol is activated at night, so this medication should be taken with the evening meal.

Which statement, made by the patient, indicates an understanding of discharge teaching regarding alendronate (Fosamax)?

"I will take the medication first thing in the morning with 8 ounces of water and remain upright for 30 minutes." Rationale: Alendronate can cause erosive esophagitis. To prevent this side effect, it is important to take the medication first thing in the morning on an empty stomach without any other medications and maintain an upright position for 30 minutes. These actions facilitate rapid absorption and prevent reflux into the esophagus.

Which statement indicates to the nurse that the patient needs additional teaching on oral hypoglycemic agents?

"I will take the medication only when I need it." Rationale: Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. When alcohol is ingested with certain oral hypoglycemic drugs, the hypoglycemic effect can be intensified. The patient may experience fatigue and loss of appetite as side effects of the medication, and these should be reported to the health care provider. The patient needs to closely monitor blood sugar.

Which statement by the patient demonstrates an understanding of discharge instructions on the use of levothyroxine (Synthroid)?

"I will take this medication in the morning so as not to interfere with sleep." Rationale: Levothyroxine increases basal metabolism and thus wakefulness. Patients should not double the dose or stop taking the medication abruptly. It may take up to 4 weeks for a therapeutic response to occur.

A client is receiving oral griseofulvin for a persistent tinea corporis infection. Which response by the client indicates an accurate understanding of the drug teaching conducted by the nurse?

"I'll wear sunscreen whenever I mow the lawn." Rationale: Photosensitivity is a side effect of griseofulvin, so clients should be cautioned to wear protective sunscreen during sun exposure.

Patient teaching for a patient being discharged on a beta blocker includes which statement?

"If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions." Rationale: Beta blockers have a negative chronotropic effect and could cause symptomatic bradycardia and/or heart block. The physician should be consulted before administering to a patient with bradycardia (heart rate <60 beats/min).

Which statement made by a patient demonstrates a lack of understanding of patient teaching regarding phenothiazine drug therapy?

"It is okay to take this drug with a small glass of wine to help relax me." Rationale: Drinking alcohol with phenothiazines puts the patient at risk for increased central nervous system depression.

A client is receiving antiinfective drug therapy for a postoperative infection. Which complaint should alert the nurse to the possibility that the client has contracted a superinfection?

"My mouth feels sore" Rationale: Stomatitis caused by a thrush infection, which can cause mouth pain, is a sign of superinfection.

Which instructions should the nurse provide to an adolescent female client who is initiating treatment with isotretinoin for acne vulgaris? (Select all that apply.)

"Notify the health care provider immediately if you think you are pregnant." "If you begin crying more than usual and feel sad, stop the drug and call the health care provider." "Before, during, and after therapy, two effective forms of birth control must be used at the same time." Rationale: Isotretinoin has been found to cause pregnancy category D drug-related birth defects, premature births, and fetal death, which necessitates the use of effective birth control methods before, during, and after therapy. Isotretinoin is associated with sadness, depression, suicidal ideations, and other serious mental health problems.

Which statement is accurate when discussing self-treatment options with a patient?

"Over-the-counter medications can, at times, be used in place of prescription drugs. It is important to discuss the use of these with your health care provider." Rationale: Over-the-counter medications can be appropriately used, but it is always best to use them in consultation with a health care provider.

A patient receiving propylthiouracil (PTU) asks the nurse how this medication will help relieve his symptoms. What is the nurse's best response?

"Propylthiouracil inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal." Rationale: Propylthiouracil is an antithyroid medication used to treat hyperthyroidism. It works by inhibiting the synthesis of new thyroid hormone. It does not inactivate present hormone.

What will the nurse teach a patient who is taking isoniazid?

"Pyridoxine (vitamin B6) will prevent numbness and tingling associated with taking isoniazid." Rationale: Isoniazid can cause peripheral neuropathy. Pyridoxine (vitamin B6) is the drug of choice to prevent this adverse reaction. It is not an antiinfective agent and thus will work to destroy the mycobacterium or prevent drug resistance. Vitamin C is not taken with this drug; the drug is appropriate for most patients, and isoniazid with pyridoxine is not multidrug therapy.

The nurse is preparing a teaching plan for a client who has received a new prescription for levothyroxine sodium. Which instruction should be included?

"Take your pulse daily, and if it exceeds 100 beats/min, contact the health care provider." Rationale: Levothyroxine sodium should be withheld if the pulse is over 100 beats/min. To prevent insomnia, the daily dose should be taken early in the morning before breakfast, not at bedtime. Product brands should not be changed without consulting the health care provider because the intended effects and side effects of different formulations of the medication can vary.

A patient telephones the clinic and asks the nurse if he should still take today's "heart pills" since he noticed a waxy shell that looked like a pill capsule in his bowel movement yesterday. What is the nurse's best response?

"The wax is part of the capsule shell, but the drug is still getting absorbed." Rationale: Some dosage forms are delivered in a sustained-released tablet or capsule that may be composed of a wax matrix, and this matrix may be visible in the patient's stool. This extended-release dosage form provides for a slow release of the medicine, and the wax substance may then be passed out of the body through the stool. The nurse should advise patients that the passing of the matrix through the stool occurs after the drug has been absorbed, and although the matrix is often visible to the naked eye, it is of no major concern. The patient does not need to wait 24 hours or for the next bowel movement to take the next dose. The waxy shell is an expected finding, and the prescriber does not need to be notified.

A patient who is taking sublingual nitroglycerin is complaining of flushing and headaches. What is the nurse's best response?

"These are the most common side effects of nitroglycerin. They should subside with continued use of nitroglycerin." Rationale: Headache and flushing are the most common side effects of nitroglycerin and will subside with continued use.

The patient has been ordered azithromycin and asks the nurse why the medication does not have to be taken as often as other antibiotics that have previously been ordered. What is the nurse's best response?

"This drug has a longer half life than some of the other antibiotics." Rationale: Azithromycin is one of the newer macrolide antibiotics. It has a longer duration of action, as well as fewer and less severe gastrointestinal side effects than erythromycin. The other responses do not address the patient's question, which was why azithromycin does not have to be taken as often.

Which patient statement demonstrates understanding of radioactive iodine (I-131) therapy?

"This drug will be taken up by the thyroid gland and destroy the cells to reduce my hyperthyroidism." Rationale: Radioactive iodine is an antithyroid medication that is administered orally for one or two doses only. It concentrates in the thyroid gland, enabling the radiation to destroy the hyperplastic cells.

A patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine. What information is essential for the nurse to teach this patient?

"This medication has a duration of action of 24 hours." Rationale: Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short-acting insulin. The patient may need to receive this medication for a long time.

A patient is receiving phenytoin. What information is essential to include in the discharge teaching plan? Select all that apply.

"This medication may cause confusion." "Good dental care is essential while on this medication." "Don't drive until you determine how the medication affects you." Rationale: The most common adverse effects are lethargy and cognitive changes as well as gingival hyperplasia. Confusion can be a result of this therapy. Good dental care is essential because the medication can cause gingival hyperplasia. The patient should evaluate how the drug affects him before driving. Cardiac and respiratory assessments are not necessary.

A patient taking oral contraceptives is being treated for a urinary tract infection with antibiotics. Which information should the nurse include as education related to the oral contraceptives?

"Use an alternative method of birth control this month during antibiotic use." Rationale: When a patient takes oral contraceptives and is prescribed an antibiotic, the oral contraceptive effectiveness can be decreased and an alternative method of birth control should be used for the month.

A patient questions the use of epinephrine for repair of a laceration, stating, "I thought that was the drug they use in the emergency room for patients who are coding." Which is the nurse's best response?

"Vasoconstriction caused by epinephrine enhances the duration of action for lidocaine and minimizes bleeding at the laceration site." Rationale: Epinephrine causes localized vasoconstriction, not only allowing for a bloodless field to suture but also delaying absorption of the lidocaine and thus enhancing its numbing effect.

The nurse has completed diabetic teaching for a client who has been newly diagnosed with diabetes mellitus. Which statement by this client would indicate to the nurse that further teaching is needed?

"When I exercise, I should plan to increase my insulin dosage." Rationale: Exercise helps facilitate the entry of glucose into the cell, so increasing insulin doses with exercise would place the client at high risk for a hypoglycemic reaction. Options A, B, and C reflect accurate statements about the use of insulin and management of hypoglycemic reactions.

The nurse notes that a medication was scheduled to be administered at 0900. A medication error has occurred if the medication was administered at which time?

0730 Rationale: Medications must be given no more than 30 minutes before or after the actual time specified in the prescriber's orders. If the medication was administered at 0730 but had been scheduled for 0900, then a medication error has occurred.

The nurse is providing care to a patient who is experiencing adverse reactions related to the administration of 5000 units of heparin. What is the appropriate dose of protamine sulfate, the antidote?

1 mg of protamine sulfate can reverse the effects of 100 units of heparin; therefore, 5000 units of heparin effects can be reversed by 50 mg of protamine sulfate.

New drugs must go through extensive research and testing before approval for use in humans. The nurse is providing education to a patient on a new medication and will inform the patient that the average length of time a medication is researched before being prescribed for humans is

10 to 12 years Rationale: The average length of time it takes for a drug to move from the application and research process to being prescribed for a patient is 10 to 12 years.

The patient receiving phenytoin (Dilantin) has a serum drug level drawn. Which level will the nurse note as therapeutic?

12 mcg/mL Rationale: Therapeutic serum drug levels for phenytoin are between 10 and 20 mcg/mL.

The nurse plans to draw blood samples for the determination of peak and trough levels of gentamicin sulfate in a client receiving IV doses of this medication. When should the nurse plan to obtain the peak level?

30 min after does is admin Rationale: Peak drug serum levels are achieved 30 minutes after the IV administration of aminoglycosides

Assuming the patient eats breakfast at 9:00 AM, lunch at noon, and dinner at 6:00 PM, he or she is at highest risk of hypoglycemia following an 8:30 AM dose of NPH insulin at what time?

3PM Rationale: Breakfast eaten at 9:00 AM would cover the onset of NPH insulin time frame. However, if the patient does not eat a mid-afternoon snack, the NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia.

Which would be the most appropriate application time for a patient prescribed a scopolamine patch for motion sickness?

4 to 5 hours before travel Rationale: For the prevention of motion sickness, scopolamine is available in a convenient transdermal delivery system (a patch) that can be applied just behind the ear 4 to 5 hours before travel. Each patch has a 72-hour duration of action, thus necessitating a change only every 3 days.

The nurse is administering the early morning dose of insulin aspart, 5 units subcutaneously, to a client with diabetes mellitus type 1. The client's fingerstick serum glucose level is 140 mg/dL. Considering the onset of insulin aspart, when should the nurse ensure that the client's breakfast be given?

5 minutes after subcutaneous administration Rationale: Insulin aspart is a very rapidly acting insulin, with an onset of 5 to 15 minutes. Insulin aspart should be administered when the client's tray is available. Insulin aspart peaks in 45 minutes to 1½ hours and has a duration of 3 to 4 hours. The client should have eaten to ensure absorption of the meal so that serum glucose levels will coincide with the peak. Insulin glargine has a flat peak of action and is usually given at bedtime.

A patient receives isophane suspension (neutral protamine Hagedorn [NPH]) insulin at 8:00 AM. The patient eats breakfast at 8:30 AM, lunch at 12:00PM, and dinner at 6:30 PM. At what time is this patient at the highest risk for hypoglycemia?

5:00 PM Rationale: Breakfast eaten at 8:30 AM would cover the onset of isophane suspension (NPH) insulin, and lunch will cover the 1:00 PM time frame. If the patient does not eat a mid-afternoon snack, however, the NPH insulin may peak just before dinner without sufficient glucose on hand to prevent hypoglycemia

The charge nurse is reviewing the admission history and physical data for four clients newly admitted to the unit. Which client is at greatest risk for adverse reactions to medications?

75-year-old woman with liver disease Rationale: Impaired hepatic metabolic pathways for drug and chemical degradation place at greatest risk for adverse reactions to medications based on advancing age and liver disease.

A male client with prostatic carcinoma has arrived for his scheduled dose of docetaxel chemotherapy. What symptom would indicate a need for an immediate response by the nurse prior to implementing another dose of this chemotherapeutic agent?

A cough that is new and persistent Rationale: Option A is an adverse effect that is immediately life threatening. Severe fluid retention can cause pleural effusion (requiring urgent drainage), dyspnea at rest, cardiac tamponade, or pronounced abdominal distention (caused by ascites).

A patient who has taken fluoxetine for 2 weeks to treat an anxiety disorder expresses dissatisfaction with the therapy. What is the best information for the nurse to include in patient education to promote adherence to the therapeutic regimen?

A therapeutic effect can be expected in another 2 to 4 weeks. Rationale: The full therapeutic effects of selective serotonin reuptake inhibitor (SSRI) therapy may take 4 to 6 weeks to occur, so this patient can anticipate experiencing a therapeutic effect in 2 to 4 more weeks. Knowing the time frame offers the patient realistic hope and provides a justification for adherence to therapy. Adverse effects can usually be managed, and relaxation exercises may provide some relief from anxiety. The patient must fulfill these tasks to get the full therapeutic effect of the medication, but it can be difficult for a patient with depression to do so. SSRIs can require considerable titration, but, because of the nature of the patient's illness, this information is unlikely to promote adherence to therapy.

In order to help prevent liver failure in a patient who drinks alcohol frequently, which drug will the nurse instruct the patient to avoid?

Acetaminophen Rationale: Taking acetaminophen when a serum alcohol level is present causes alterations in the metabolism of these substances, leading to the formation of toxic byproducts, as well as decreased drug clearance and an increased risk of serious liver damage and death. Methamphetamine is form of amphetamine, and it is a commonly abused substance. Although antianxiety agents do not cause liver failure when taken with alcohol, the nurse should instruct the patient who drinks alcohol frequently to avoid antianxiety agents as a means of preventing enhancement of the central nervous system depression that is characteristic of both agents. Antihypertensive drugs reduce blood pressure.

Which parameter is most important for the nurse to check prior to administering a subcutaneous injection of heparin?

Activated partial thromboplastin time (aPTT) Rational: The laboratory value that measures heparin's therapeutic anticoagulation time is the aPTT

The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin?

Activated partial thromboplastin time (aPTT) Rationale: Heparin dosing is based on aPTT results. The PT is reflective of warfarin's anticoagulant effect.

A patient has been admitted after overdosing on acetaminophen (Tylenol), with a total ingested dose of 14 g over a period of 1 hour. The nurse plans to monitor this patient for development of which of the following signs and symptoms related to the overdose?

Acute hepatic necrosis Rationale: Acetaminophen in large doses over a short period is extremely hepatotoxic. The long-term ingestion of large doses of acetaminophen is more likely to result in nephropathy.

A patient has been diagnosed with genital herpes. What drug will be used to treat and manage this infection?

Acyclovir Rationale: Acyclovir is indicated for the treatment of genital herpes. Ribavirin is used in the treatment of respiratory syncytial virus and in combination with simeprevir and interferon for the treatment of hepatitis C. Zidovudine is used to increase the life expectancy of patients suffering from acquired immune deficiency syndrome. Amantadine is used to prevent herpes simplex virus (HSV)-1 and HSV-2.

In order to produce asystole that quickly converts into a sinus rhythm, the nurse administers which drug?

Adenosine Rationale: Adenosine is an unclassified antidysrhythmic that slows electrical conduction time through the AV node. It commonly causes asystole for a period of seconds before ideally converting to normal sinus rhythm. Repeat doses may be necessary to achieve desired results. Atenolol is a Class II antidysrhythmic, or beta blocker. Diltiazem is a Class IV antidysrhythmic, or calcium channel blocker. Procainamide is a Class Ia antidysrhythmic drug.

The nurse plans which intervention to decrease flushing associated with niacin?

Administer aspirin 30 minutes before nicotinic acid. Rationale: Administration of an antiinflammatory agent such as aspirin has been shown to decrease the flushing reaction associated with niacin. Antacids do not prevent cutaneous flushing. Applying cold compresses to the patient's head and neck may not diminish flushing. H1 antagonists, including drugs such as diphenhydramine hydrochloride, are of greatest value in the treatment of nasal allergies, particularly seasonal hay fever.

The nurse plans which intervention to decrease the flushing reaction of niacin?

Administer aspirin 30 minutes before nicotinic acid. Rationale: Administration of an antiinflammatory drug such as aspirin has been shown to decrease the flushing reaction associated with niacin.

A patient with respiratory depression secondary to opioid toxicity is being treated in the emergency department. What is the nurse's priority action?

Administer naloxone. Rationale: Severe opioid toxicity causes respiratory depression. Naloxone is the best choice of treatment for the management of respiratory depression. Naloxone is an opioid antagonist, and it inhibits the action of opioids and improves the patient's respiratory status. Assessing blood gases and preparing for intubation would be interventions to implement if the naloxone does not reverse the respiratory depression. Calling the respiratory team would likewise be performed if the patient did not respond to the treatment.

The nurse is preparing to administer a secondary infusion of a dobutamine solution to a client. The nurse notes that the solution is brown in color. Which action should the nurse implement?

Administer the drug if the solution's reconstitution time is <24 hours. Rationale: The color of the dobutamine solution is normal, and the solution should be administered within 24 hours after reconstitution, so the time of reconstitution should be verified before administering the solution of medication.

Methylphenidate is prescribed for daily administration to a 10-year-old child with attention-deficit/hyperactivity disorder (ADHD). In preparing a teaching plan for the parents of this child newly diagnosed with ADHD, which instruction is most important for the nurse to provide to the parents?

Administer the medication in the morning before the child goes to school. Rationale: Methylphenidate is a central nervous system (CNS) stimulant. To be most effective in affecting the child's behavior, the dose of the drug should be administered in the morning before the child goes to school. Drug holidays are often prescribed to assess the child's degree of recovery; however, such interruptions are not conducted in the early phase of treatment and are usually implemented when side effects occur over a period of time.

The nurse performs a client assessment prior to the administration of a prescribed dose of dipyridamole and aspirin PO. The nurse notes that the client's carotid bruit is louder than previously assessed. Which action should the nurse implement?

Administer the prescribed dose as scheduled. Rationale: A carotid bruit reflects the degree of blood vessel turbulence, which is typically the result of atherosclerosis. Aspirin is prescribed to reduce platelet aggregation and should be administered to this client, who is at high risk for thrombus occlusion.

A female client who has started long-term corticosteroid therapy tells the nurse that she is careful to take her daily dose at bedtime with a snack of crackers and milk. Which is the best response by the nurse?

Advise the client to take the medication in the morning, rather than at bedtime. Rationale: Daily doses of long-term corticosteroid therapy should be administered in the morning to coincide with the body's normal secretion of cortisol. Clients receiving long-term corticosteroids need to increase their intake of calcium, which generally means an increase in dairy products. Corticosteroids can often cause gastrointestinal distress and should be administered with meals. The client has established a safe routine by taking the medication with a snack, but the routine will be more effective if done in the morning.

When alteplase is administered to a client diagnosed with a cerebrovascular accident (CVA or stroke) in the emergency department, the nurse determines that the priority nursing intervention(s) in this client's care should include which of the following? Select all that apply

After administration, assess vital signs every 15 minutes during the first hour. Report dysrhythmias noted on the cardiac monitor Rationale: .Activase is used in an emergency setting post stroke and myocardial infarction to dissolve clots and increase perfusion. Because of the risk of internal gastrointestinal, genitourinary, retroperitoneal, and cerebral bleeding, vital signs should be assessed frequently during the first hour after administration. Reperfusion cardiac dysrhythmias are a primary side effect of this drug. The client should be placed on a cardiac monitor during treatment. The monitoring of urinary output is not a priority unless underlying conditions regarding volume management exist. Hypothermia is not associated with administration of this drug. PTT is more likely to be increased because of drug effects rather than decreased.

Which beta2 agonist medication is used as a bronchodilator?

Albuterol Rationale: Albuterol has alpha1 receptor-agonistic activity and is used as a bronchodilator. Dopamine produces dopaminergic, beta1, or alpha1 effects. Epinephrine is a nonselective agonist, which acts at both the alpha and beta receptors. Phenylephrine is both an alpha1 agonist and a vasopressive drug (pressor). Dopamine, epinephrine, and phenylephrine are not used as bronchodilators.

A patient is admitted to the emergency department experiencing symptoms of a thrombolytic stroke. Which medication should the nurse expect to be prescribed for the patient?

Alteplase Rationale: Alteplase is a tissue plasminogen activator, which can be administered to treat a thrombolytic stroke within a specified time frame after symptom onset. Heparin is an anticoagulant, which prevents clot formation by inhibiting clotting factors IIa and Xa. Clopidogrel is an antiplatelet medication that interferes with platelet function, thereby preventing platelet aggregation. Fondaparinux is an anticoagulant medication, which prevents clot formation by inhibiting factor Xa.

The provider has ordered donepezil (Aricept) for the patient, and the patient states "I have no idea why I take this medication." What is the most common diagnosis associated with the administration of donepezil (Aricept)?

Alzheimer's disease Rationale: Donepezil (Aricept) is a cholinesterase inhibitor drug that works centrally in the brain to increase levels of acetylcholine by inhibiting acetylcholinesterase. It is used in the treatment of mild to moderate Alzheimer's disease.

Which drug indicated for Parkinson's disease acts by releasing dopamine and blocking the reuptake of dopamine into nerve fibers?

Amantadine Rationale: Amantadine is a dopamine modulator that acts by releasing dopamine and blocking the reuptake of dopamine into nerve fibers. It is indicated in the early stages of Parkinson's disease. Selegiline is a selective monoamine oxidase-B inhibitor, which is indicated for Parkinson's disease. Entacapone is a catechol-O-methyl transferase (COMT) inhibitor indicated for the adjunctive treatment of Parkinson's disease. It acts by blocking the COMT receptors. Bromocriptine is a direct-acting dopamine receptor agonist that is used to treat Parkinson's disease. These directly stimulate the release of dopamine from the pre- and postsynaptic dopamine receptors in the brain.

For which clients should the nurse withhold the initial dose of a cyclooxygenase 2 (COX-2) inhibitor until notifying the health care provider? (Select all that apply.)

An older adult with a history of a skin rash while taking glyburide (DiaBeta) An adolescent with a history of an anaphylactic reaction to penicillin An adolescent at 34 weeks of gestation experiencing 1+ pitting edema Rationale: COX-2 inhibitors are contraindicated for those who are allergic to sulfa drugs , aspirin, and nonsteroidal antiinflammatory drugs (NSAIDs). Drug safety for adolescents is not yet established, and COX-2 inhibitors, as well as NSAIDs, are contraindicated during the third trimester of pregnancy because they can cause a premature closure of the patent ductus arteriosus.

While instructing a patient about antibiotic therapy, the nurse explains to the patient that bacterial resistance to antibiotics can occur when what happens? Select all that apply.

Antibiotics are prescribed to treat a viral infection. Patients stop taking an antibiotic after they feel better Rationale: Not completing a full course of antibiotic therapy can allow bacteria that are not killed but have been exposed to the antibiotic to adapt their physiology to become resistant to that antibiotic. The same thing can occur when bacteria are exposed to antibiotics in the environment or when antibiotics are erroneously used to treat a viral infection. Antibiotics taken with water or vitamin C does not contribute to bacterial resistance. Acidic fluids, like juices, may nullify the antibacterial action of oral penicillin, but do not cause bacterial resistance.

The nurse is teaching a patient about therapy with anticoagulants. What is essential information to include in the teaching plan?

Anticoagulants prevent clots from forming Rationale: The patient needs to understand that anticoagulants will prevent new clots from forming but will not dissolve clots that are already formed. Anticoagulants inhibit clotting by acting on clotting factors and do not alter platelets or drug metabolism.

Which class of antineoplastic chemotherapy agents resembles the essential elements required for DNA and RNA synthesis and inhibits enzymes necessary for cellular function and replication?

Antimetabolites Rationale: Antimetabolites exert their action by inhibiting the enzymes necessary for cellular function and replication.

Which assessment is most important before administering digoxin?

Apical Pulse Rationale: It is crucial to measure the patient's apical pulse rate (auscultate the apical heart rate, found at the apical impulse located at the fifth left midclavicular intercostal space) for 1 full minute before administering digoxin. The Homans sign is checked to deduce clots. Breathing sounds are assessed to check chronic obstructive pulmonary disease. Weight is checked before administration of any medication related to cardiovascular disease.

Before administering a dose of an antidysrhythmic drug to an assigned patient, which assessments would be of highest priority?

Apical pulse and blood pressure Rationale: Antiarrhythmic drugs can cause both hypotension and bradycardia; therefore it is important to assess blood pressure and apical pulse before administration. Peripheral pulses are not as reliable as the apical pulse assessment.

An adult client hospitalized for heart failure is receiving digoxin IV push. The nurse obtains the following data on the client. Place the data in order from that of highest concern to least concern to the nurse.

Apical pulse is 53 beats per minute Potassium level is 3.2 mEq/L Client has been taking furosemide 20 mg daily for 2 days Rationale: The normal pulse rate for an adult is 60 to 100 beats per minute, and an adverse effect of digoxin is a low pulse rate. For this reason, the apical rate is assessed before each dose and and the dose is withheld (and the prescriber is notified) if the pulse rate falls below 60. A low potassium level (normal 3.5-5 mEq/L) increases the risk of digoxin toxicity so this is of concern next because it increases the potential of digoxin toxicity.Although furosemide can cause hypokalemia, this would be the third concern since the other data indicate actual risk, not potential risk, to the client.

In order to prevent the development of tolerance, the nurse instructs the patient to perform which action?

Apply the nitroglycerin patch for 16 hours each and remove for 8 hours at night Rationale: Tolerance can be prevented by maintaining an 8-hour nitrate-free period each day.

A patient is to be discharged with a transdermal nitroglycerin patch. Which instruction should the nurse include in the patient's teaching plan?

Apply the patch to a nonhairy area of the upper torso or arm Rationale: A nitroglycerin patch should be applied to a nonhairy area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation. Sublingual nitroglycerin should be used to treat chest pain, and the patient should only have one patch on at a time. The drug should be continued if headache occurs, because tolerance will develop.

Where are beta2-adrenergic receptors located in the body? Select all that apply.

Arterioles Bronchioles Visceral organs Rationale: Beta2-adrenergic receptors are located in the arterioles, the smooth muscles of the bronchioles, and the visceral organs. Alpha1 receptors are located in the bladder sphincter and pupillary muscles of the iris.

A mother brings her 18-month-old child to the community health center because the child has had "bad diarrhea" for the last 3 days. She states, "I bought some of this liquid at the pharmacy and gave my daughter a half-ounce." The nurse sees that the bottle contains loperamide. Which intervention is most important for the nurse to implement initially?

Ask the mother when the child last voided. Rationale: Determining when the child last voided is most important because urine output is decreased with dehydration and an 18-month-old with a 3-day history of diarrhea could be severely dehydrated. Although the manufacturer states that loperamide should not be given to a child younger than 2 years except under the direction of a health care provider, option A is not the best answer for this question. In addition, loperamide causes an anticholinergic effect of urinary retention.

Which nursing intervention has the highest priority during IV administration of mechlorethamine HCl and actinomycin?

Assess for extravasation at the IV site during infusion Rationale: Mechlorethamine HCl and actinomycin are vesicants; therefore, assessment for blister formation and/or tissue sloughing that can occur with leakage of these agents into surrounding subcutaneous tissues is essential to ensure client safety during the IV infusion.

A client with Tourette syndrome takes haloperidol to control tics and vocalizations. The client has become increasingly drowsy over the past 2 days and reports becoming dizzy when changing from a supine to sitting position. Which action should the nurse take?

Assess for poor skin turgor, sunken eyeballs, and concentrated urine output. Rationale: Because haloperidol causes CNS effects of sedation and decreased thirst, the nurse should assess for signs of dehydration.

When providing nursing care for a client receiving pyridostigmine bromide for myasthenia gravis, which nursing intervention has the highest priority?

Assess respiratory status and breath sounds often. Rationale: The client should be assessed often for signs of respiratory complications. The client with myasthenia gravis is at greatest risk for life-threatening respiratory complications because of the weakness of the diaphragm and ancillary respiratory muscles caused by the disease process. Cholinergic agents used to reduce muscle weakness can also cause hypersalivation, increased respiratory secretions, and possible bronchoconstriction.

The nurse is assessing a patient who has recently been diagnosed with Parkinson disease and was prescribed tolcapone. Which assessment is appropriate for this patient?

Assessment of liver function tests Rationale: Tolcapone is a catechol-ortho-methyltransferase inhibitor prescribed for the treatment of Parkinson's disease. It should be used with caution in patients with liver failure because it impairs hepatic functioning and worsens the symptoms. In these patients, drug doses should be adjusted and liver function should be monitored. Tolcapone is not associated with bruising, mood fluctuations, or kidney failure, so the nurse would not need to monitor for these conditions in this patient. It is prescribed only in cases where the patient does not respond to other therapy due to its potential toxicity.

Which condition in a patient's history is a contraindication to the administration of opioid analgesics?

Asthma Rationale: Administration of opioid analgesics is contraindicated in a patient who has asthma. Opioid analgesics can cause respiratory depression. Asthma causes airway inflammation, which results in difficulty breathing. If opioid analgesics are administered to a patient with asthma, it may result in severe complications. Administration of opioid analgesics is not contraindicated in patients with gout, diabetes, or skin disease.

The nurse is assessing a patient who has been prescribed alprazolam to treat panic disorder. Which adverse effects does the nurse monitor for in the patient? Select all that apply

Ataxia Dizziness Confusion Rationale: Ataxia, dizziness, and confusion are the adverse effects of alprazolam caused by the mechanism of action of the drug. Blurred vision and paradoxical anxiety are not the adverse effects of alprazolam. These are the adverse effects of buspirone.

What is the primary cause of ischemic heart disease?

Atherosclerosis Rationale: Atherosclerosis is a disease of the coronary arteries that involves fatty plaque deposits in the arterial walls. This disease process causes ischemic heart disease. Clotting, angina pectoris and myocardial infarction can be consequences of ischemic heart disease, but not the cause of the pathology.

Which medication should be administered to a patient who has a cholinergic crisis?

Atropine Rationale: Overdose of a cholinergic drug causes a cholinergic crisis. Atropine is a cholinergic antagonist; therefore it is administered to reverse the action of a cholinergic drug. Donepezil is used to treat Alzheimer's disease. Echothiophate is used to reduce intraocular pressure. Pyridostigmine is used as an antidote for neuromuscular blocker toxicity.

The health care provider prescribes ipratropium for a client. An allergic reaction to which other medication would cause the nurse to question the prescription for?

Atropine sulfate Rationale: Clients who have experienced allergic reactions to atropine sulfate and belladonna alkaloids may also be allergic to ipratropium, so the prescription for Atrovent should be questioned.

The nurse is preparing to apply a surface anesthetic agent for a client. Which action should the nurse implement to reduce the risk of systemic absorption?

Avoid abraded skin areas when applying the anesthetic. Rationale: To minimize systemic absorption of topical anesthetics, the anesthetic agent should be applied to the smallest surface area of intact skin.

A female client with trichomoniasis (Trichomonas vaginalis) receives a prescription for metronidazole. Which instruction is most important for the nurse to include in this client's teaching plan?

Avoid alcohol consumption. Rationale: Clients should be instructed to avoid alcohol and products containing alcohol while taking metronidazole because of the possibility of a disulfiram-like reaction. Option B helps prevent the development of metronidazole-resistant T. vaginalis. To prevent reinfection, clients should abstain from sexual contact or use a barrier contraceptive while taking metronidazole, and their partner(s) should be treated concurrently.

Which instruction is provided to a patient who is on a high dose of selegiline?

Avoid consuming red wine Rationale: Selegiline, a selective monoamine oxidase-B (MAO-B) inhibitor, is indicated for the treatment of Parkinson disease. Red wine is a tyramine-containing food, which interacts with MAO-B inhibitors and causes cheese effect; therefore the nurse should instruct the patient to avoid intake of tyramine-containing foods such as red wine, beer, cheese, and yogurt. The nurse instructs a patient to consume a moderate amount of fish and meat to meet the nutritional requirements. The nurse encourages the patient to consume prunes, as they are natural laxatives and help prevent constipation during the drug therapy.

The nurse is providing discharge instructions to a client who has received a prescription for an antibiotic that is hepatotoxic. Which information should the nurse include in the instructions?

Avoid ingesting any alcohol or acetaminophen. Rationale: Combining hepatotoxic drugs, such as acetaminophen and alcohol, increases the risk of liver damage

Because a healthcare provider prescribed levodopa for a client newly diagnosed with Parkinson's disease, the nurse should place a high priority on teaching which of the following prior to discharge?

Avoid taking medication with high-protein foods Rationale: High-protein foods significantly decrease absorption of levodopa. For this reason, clients are taught to take it with a low-protein food. Cushingoid symptoms are associated with ingesting cortisone derivatives. There is no need to avoid vaccinations. GI disturbances associated with the drug include anorexia and nausea and vomiting, but not mouth ulcerations. Associate levodopa with leave off the protein

Why is diazepam used for the treatment and prevention of alcohol withdrawal symptoms?

Because of the presence of benzodiazepine receptors adjacent to the receptors responsible for alcohol addiction Rationale: Benzodiazepine receptors in the central nervous system (CNS) are present in the same area as the receptors responsible for alcohol addiction. Diazepam blocks the receptors responsible for alcohol addiction and helps treat and prevent alcohol withdrawal symptoms. Benzodiazepines, not diazepam, have amnesic properties that are used for moderate sedation. Barbiturates such as pentobarbital inhibit the transmission of nerve impulses. Diazepam does not to inhibit nerve impulse transmission. Benzodiazepines, not diazepam, suppress the activity of GABA receptors to facilitate sleep during the treatment of insomnia.

A patient has received three times the ordered dose of propafenone in error. The charge nurse is called into the room and observes that the patient is unresponsive with no pulse. What is the nurse's priority action?

Begin CPR Rationale:The main effects of the antidysrhythmics involve the heart, circulation, and central nervous system (CNS). Specific antidotes (reversal agents) are not available, and the management of an overdose involves maintaining adequate circulation and respiration using general support measures (such as CPR) and providing any required symptomatic treatment. Early chest compressions and defibrillation, as indicated, are recommended ASAP by the American Heart Association 2015 guidelines. CPR beginning with chest compressions should be initiated right away. When help arrives, the patient can then be placed on the cardiac monitor and an IV line can be started.

The nurse notes lithium on a patient's drug history upon admission. Which condition would the nurse suspect that this patient has been diagnosed with?

Bipolar disorder Rationale: Lithium is an antimanic drug used to treat manic episodes associated with bipolar disorder. Therapeutic effects of the mood stabilizer lithium are decreased mania and stabilization of the patient's mood. Lithium is not used to treat absence seizures, paranoid schizophrenia, or obsessive-compulsive disorder.

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism?

Blocking the reuptake of neurotransmitters at nerve endings Rationale: SSRIs block the reuptake of serotonin. TCAs block the reuptake of norepinephrine and serotonin

When titrating intravenous nitroglycerin, which assessment findings does the nurse monitor? (Select all that apply.)

Blood pressure Heart rate Chest pain Rationale: Intravenous nitroglycerin can cause hypotension and tachycardia. Relief of chest pain and/or systolic blood pressure <90 mm Hg are typical parameters used for titrating nitroglycerin.

A healthcare provider orders nitroglycerin (NTG) to be administered by IV drip. The nurse carrying out the order would monitor for which of the following as a priority?

Blood pressure and heart rate Rationale: Because NTG is a vasodilator, the blood pressure and heart rate must be monitored closely during titration to prevent hypotension and tachycardia. Shortness of breath is generally important but is not directly related to NTG infusion.In addition, clients would normally have increased shortness of breath when the head of the bed is lowered, not raised. Measurement of urinary output is relevant to the client's care but is not directly related to NTG administration. Because of the cerebrovascular dilation, headache frequently occurs and is treated commonly with acetaminophen or another mild analgesic. Recall that the action of NTG is a vasodilator and select the option that focus es directly on cardiovascular status.

The nurse administers clonidine. What finding indicates the medication is therapeutic?

Blood pressure decrease from 150/100 mm Hg to 110/70 mm Hg Rationale: Clonidine is used primarily for its ability to decrease blood pressure. It is also useful in the management of opioid withdrawal. It is not used for angina. It is not a diuretic and will not increase urinary output. Clonidine is not used to decrease the heart rate.

The nurse is caring for a patient with systemic mycoses who is on amphotericin B. Which parameters should the nurse monitor for safe and effective care? Select all that apply.

Blood urea nitrogen levels Potassium levels Creatinine levels Rationale: Amphotericin B is a polyene antifungal drug that is used in the treatment of various fungal infections such as systemic mycoses and dermatomycoses. The major adverse effect associated with the use of amphotericin B is nephrotoxicity. Therefore, the nurse should monitor creatinine levels and blood urea nitrogen. Because nephrotoxicity is associated with electrolyte disturbances, it is important to monitor potassium, sodium, and magnesium levels. Hemoglobin levels should be monitored in patients who are on caspofungin therapy to reduce the risk of drug-induced anemia. Aspartate transaminase levels should be monitored in patients who are on voriconazole, because it causes increased liver enzyme levels.

A patient is prescribed digoxin for supraventricular dysrhythmia. The nurse instructs the patient to avoid consuming bran. What is the reason behind this instruction?

Bran decreases digoxin absorption. Rationale: Bran is a high-fiber food. It binds to the digoxin and affects the absorption and bioavailability of the drug. Bran decreases the absorption of digoxin, so the patient should avoid consuming bran while taking digoxin. Bran is a high-fiber food, and fiber treats constipation. Bran and digoxin do not affect urinary function and therefore do not cause urinary retention. Bran does not produce an additive effect and thus does not increase the digoxin concentration in the body.

When caring for a patient with angina, the nurse would question an order for a noncardioselective beta blocker in a patient with what coexisting medical diagnosis?

Bronchial asthma Rationale: Noncardioselective beta blockers should be used with caution in patients with bronchial asthma since any level of blockade of beta2-receptors can promote bronchoconstriction through unopposed parasympathetic (vagal) tone.

Which instruction should the nurse include in the teaching plan for a client who is receiving phenytoin for seizure control?

Brush and floss teeth daily. Rationale: Brushing and flossing the teeth daily prevent gingival hyperplasia (gum disease) that is common with long-term phenytoin therapy.

Which anxiolytic drug promotes agonistic activity at both the serotonin and dopamine receptors?

Buspirone Rationale: Buspirone is an anxiolytic drug, which has agonist activity at both the serotonin and dopamine receptors to exert its antianxiety effect. Alprazolam is a benzodiazepine that is commonly used as an anxiolytic. The drug elicits its effects by increasing the activity of gamma-aminobutyric acid (GABA) receptors that block nerve transmission in the central nervous system. Lorazepam is an intermediate-acting benzodiazepine that increases the activity of the GABA receptors. Amitriptyline is the most commonly used tricyclic antidepressant.

A 26-year-old primigravida client is experiencing increasing discomfort and anxiety during the active phase of labor. She requests something for pain. Which analgesic should the nurse anticipate administering?

Butorphanol Rationale: Butorphanol is a mixed agonist-antagonist analgesic resulting in good analgesia but with less respiratory depression, nausea, and vomiting compared with opioid agonist analgesics.

The nurse is assessing a patient who has developed watery diarrhea. After checking the patient's history, the nurse finds that the patient was recently treated with antibiotics. Which further testing might be needed in this patient?

C Diff test Rationale: If the patient was previously treated with antibiotics and developed watery diarrhea, then the patient needs to be tested for Clostridium difficile infection. If the result of this test is positive, then the patient needs to be treated for a serious superinfection. Infections with C. difficile are increasingly becoming resistant to standard therapy. Watery diarrhea is a common symptom of C. difficile infection. C. difficile bacteria are not present in sputum; therefore a sputum test is not indicated. A test for Acinetobacter is not helpful in this situation because the symptoms are not suggestive of an infection caused by this bacterium. Culture and sensitivity testing is helpful to optimize drug selection in individual cases, but not in this situation.

Which drug is most commonly used for the treatment of a spinal headache?

Caffeine Rationale: Caffeine is a xanthine cerebral stimulant used to treat spinal headache. It acts by antagonizing the purine receptors. Modafinil is a central nervous system stimulant used to treat narcolepsy. Sumatriptan is serotonin receptor agonist used to treat migraines. Atomoxetine is a selective norepinephrine reuptake inhibitor used to treat attention deficit hyperactivity disorder.

When teaching a patient about carbidopa-levodopa (Sinemet), what information will the nurse include in the teaching?

Carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier. Rationale: Adding carbidopa to levodopa decreases the breakdown of levodopa in the periphery, increasing the amount available to cross the blood-brain barrier and decreasing the extrapyramidal side effects caused by dopamine in the periphery.

The nurse explains to a patient using caffeine that which disease process/condition may be exacerbated by this drug?

Cardiac dysthymias Rationale: Caffeine stimulates the central nervous system, causing sympathomimetic effects, including cardiac dysrhythmias. It does not cause heart block, constipation, or myelin degeneration.

A client is receiving pyridostigmine bromide to control the symptoms of myasthenia gravis. Which client behavior would indicate that the drug therapy is effective?

Clear speech Rationale: Clear speech is the result of increased muscle strength. Muscle weakness characteristic of myasthenia gravis often first appears in the muscles of the neck and face.

Which assessment datum indicates to the nurse that a dose of granisetron administered IV prior to chemotherapy has had the desired effect?

Client denies nausea Rationale: Granisetron is an antiemetic administered before chemotherapy to prevent chemotherapy-induced nausea and vomiting. Chemotherapy can cause oral sores, but granisetron does not prevent this problem

Which medication has antiplatelet properties?

Clopidogrel Rationale: Clopidogrel (Plavix) is an antiplatelet drug indicated for thrombus prevention associated with strokes and myocardial infarction. Enoxaparin and heparin are anticoagulants. Alteplase is a thrombolytic drug.

The nurse is assessing a patient who has hyperlipidemia and who is treated with antihyperlipidemic medications. During the assessment, the patient tells the nurse, "These days, my urine has a burnt odor." Which medications prescribed for the patient may be responsible for such an adverse effect? Select all that apply.

Colestipol Cholestyramine Rationale: Urine with a burnt odor is an adverse effect of bile acid sequestrants such as colestipol and cholestyramine. Ezetimibe, fluvastatin, and gemfibrozil are antihyperlipidemics not associated with a burnt odor of the urine. Ezetimibe increases the risk of liver damage and discoloration of urine. Fluvastatin causes constipation, heartburn, and insomnia. Gemfibrozil may cause upset stomach, stomach pain, and diarrhea.

To evaluate whether the administration of an antihypertensive medication has caused a therapeutic effect, which action should the nurse implement?

Compare the client's blood pressure before and after the client takes the medication. Rationale: Therapeutic effects are the expected or predictable physiologic responses to a medication. An antihypertensive medication is administered to lower blood pressure, so to determine if the therapeutic effect has been achieved, the nurse should compare the client's blood pressure before and after the client takes the medication.

Which laboratory test should be monitored frequently to assess for a potential life-threatening adverse reaction to clozapine?

Complete Blood Count Rationale: Patients taking clozapine must be monitored for the life-threatening side effect of agranulocytosis, evidenced by a severe reduction in the number of white blood cells. Renal panels, liver function tests, and immunoglobulin levels are not factors.

Which laboratory test should be monitored frequently to assess for a potential life-threatening adverse reaction to clozapine (Clozaril)?

Complete blood count Rationale: Patients taking clozapine must be monitored for the life-threatening side effect of agranulocytosis, evidenced by a severe reduction in the number of white blood cells.

A patient has been ordered to receive a unit of packed red blood cells. What is the highest priority nursing action prior to initiating the infusion of the blood product?

Confirm the identity of the patient. Rationale: Although all of the actions listed are important, the highest-priority action is confirmation of the identity of the patient. Failure to do this is a major safety violation. Because blood types can vary individually, patient identification is the highest physiologic safety priority. A large bore IV is needed versus small bore for blood administration. If the patient is not correctly identified and blood type verified first, there is no need to obtain the blood from the blood bank. The permit is important for legal purposes; but physiological safety is the priority.

A nurse assesses a 75-year-old client for side effects of verapamil. Which of the following side effects would be most concern regarding this client?

Constipation Rationale: Verapamil is a calcium channel blocker used to treat angina. Significant constipation is a frequent complaint of clients taking the sustained release form of verapamil. Many elderly clients have difficulty with this, and the nurse must anticipate the need for teaching about increasing fiber and fluid intake. Hypotension is an adverse reaction to verapamil. Since the drug dilates coronary arteries, it is not likely that angina will occur. A common side effect is pruritis. It may be helpful to remember that verapamil causes constipation by recalling it is a calcium channel blocker. Both begin with the letter C.

A client who has trouble swallowing pills intermittently has been prescribed venlafaxine (XR) for depression. The medication comes in capsule form. What should the nurse include in the discharge teaching plan for this client?

Contact the health care provider for another form of medication. Rationale: Venlafaxine is administered PO in capsule form. Capsules that are extended-release (XR) or continuous-release (CR) contain delayed-release, enteric-coated granules to prevent decomposition of the drug in the acidic pH of the stomach. The client should notify the health care provider about the inability to swallow the capsule. This medication should not be chewed or opened so that the delayed-release, enteric-coated granules can remain intact. Water or juice will not affect the medication.

The health care provider has prescribed a low-molecular-weight heparin, enoxaparin prefilled syringe, 30 mg/0.3 mL IV every 12 hours, for a client following hip replacement. Prior to administering the first dose, which intervention is most important for the nurse to implement?

Contact the health care provider to clarify the prescription. Rationale: Enoxaparin is a low-molecular-weight heparin that should be administered subcutaneously when given as a prophylaxis for deep vein thrombosis, so the nurse should contact the health care provider to clarify the route of administration.

The nurse is caring for a patient with a phenytoin level of 12 mcg/mL. What is the nurse's best action?

Continue to monitor the patient on this medication. Rationale: A level of 12 mcg/mL is a therapeutic drug level. The nurse should continue to monitor the patient on this medication. There is no need to assess liver function, or increase or decrease the dose if the dose is within the therapeutic range. The nurse would call if the dose was too high or too low, and would assess liver function tests if there was a risk of toxicity with a high dose.

When developing a written nursing care plan for a client receiving chemotherapy for treatment of cancer, the nurse writes, "Assess each voiding for hematuria." The administration of which type of chemotherapeutic agent would prompt the nurse to add this intervention?

Cyclophosphamide Rationale: Hemorrhagic cystitis is the characteristic adverse reaction of cyclophosphamide

Which drug is the only muscle relaxant that acts directly on the skeletal muscle?

Dantrolene Rationale: Dantrolene works directly on the skeletal muscle by suppressing the release of calcium from the sarcoplasmic reticulum to ease contractions. The remaining medications are centrally acting muscle relaxants that work by means of central nervous system depression. Baclofen is considered to be a muscle relaxant that acts in the area of the central nervous system. Diazepam is a type of barbiturate. Cyclobenzaprine falls under the category of tricyclic antidepressants

A client with viral influenza is receiving vitamin C, 1000 mg PO daily, and acetaminophen elixir, 650 mg PO every 4 hours PRN. The nurse calls the health care provider to report that the client has developed diarrhea. Which change in prescriptions should the nurse anticipate?

Decrease dose of vitamin C Rationale: Diarrhea is an adverse effect of high doses of vitamin C, so the nurse should anticipate a reduction in the dose of vitamin C. Acetaminophen does not cause diarrhea and is not available in an injectable form

Following the administration of sublingual nitroglycerin, which assessment finding indicates that the medication was effective?

Decrease in level of chest pain Rationale: Nitroglycerin reduces myocardial oxygen consumption, which decreases ischemia and reduces chest pain.

Knowing that the albumin in neonates and infants has a lower binding capacity for medications, the nurse can expect the prescriber to perform which action to minimize the risk of toxicity?

Decrease the amount of drug given Rationale: A lower binding capacity leaves more drug available for action; thus a lower dose would be required to prevent toxicity

A patient receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's best action?

Decrease the intravenous nitroglycerin by 10 mcg/min Rationale: Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 minutes while changing the rate of the intravenous nitroglycerin infusion.

The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate, IM STAT. What is the primary purpose for administering this drug to the child at this time?

Decrease the oral secretions. Rationale: Atropine sulfate, an anticholinergic agent, is given to decrease oral secretions during a surgical procedure.

The primary health care provider instructs a nurse to administer intravenous vancomycin. During infusion, the patient has excessive sweating, flushes on the neck and head, and reports itching on the head, face, and upper trunk. What is the best nursing intervention in this situation?

Decrease the rate of infusion of vancomycin. Rationale: Rapid infusion of vancomycin results in red man syndrome. This syndrome is characterized by flushing and itching of the head, face, neck, and upper trunk. It is most commonly seen when the drug is infused too rapidly. The symptoms of red man syndrome can usually be alleviated by slowing the rate of infusion of the dose to at least 1 hour. Rapid infusions of vancomycin may cause hypotension; hence the patient sweats excessively. Rapid administration of the vancomycin infusion worsens the itching and hypotension. Stopping the administration of the vancomycin infusion may worsen the methicillin-resistant Staphylococcus aureus infection. Checking the blood pressure is a secondary intervention and is done once the patient is stabilized.

Which is an expected outcome associated with the administration of digoxin?

Decreased heart rate Rationale: Digoxin has a negative chronotropic effect (decreased heart rate).

What is the expected therapeutic effect after the administration of atropine to a patient with cholinergic-blocker poisoning?

Decreased heart rate Rationale: Atropine is used as an antidote for anticholinesterase inhibitor toxicity or poisoning and works immediately to cause increased heart rate; it is used to treat bradycardia and ventricular asystole. It is also used preoperatively to reduce salivation and gastrointestinal secretions, as is glycopyrrolate, but this is not why it is given in this case. A decreased heart rate or increased respiratory rate are not desired effects in a patient with cholinergic-blocker poisoning. The medication is given in this case to counteract the medication effects on the heart.

When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect?

Decreased paranoia and delusions Rationale: The therapeutic effects of the antipsychotic drugs include improvement in mood and affect, and alleviation or decrease in psychotic symptoms (decrease in hallucinations, paranoia, delusions, garbled speech). Tardive dyskinesia is a potential adverse effect of these drugs. The other options are incorrect.

Which finding would the nurse expect to see in a patient who is prescribed milrinone?

Decreased platelet count Rationale: Milrinone is a phosphodiesterase inhibitor. It decreases the number of platelets in the blood and results in thrombocytopenia. It increases, not decreases, liver enzyme levels. It decreases, not increases, serum potassium levels, which leads to hypokalemia. It does not interfere with serum magnesium levels.

After administering oxybutynin (Ditropan) to a patient with spina bifida, the nurse is assessing the patient for therapeutic effects. What is the nurse assessing for in the patient?

Decreased urinary frequency Rationale: Oxybutynin (Ditropan) is a synthetic antimuscarinic drug used for the treatment of overactive bladder. It is also used as an antispasmodic for neurogenic bladder associated with spinal cord injuries and congenital conditions such as spina bifida

A patient is prescribed tolterodine. What should the nurse assess to determine the therapeutic effect of this medication?

Decreased urination Rationale: Tolterodine is administered to treat overactive bladder. Decreased urination is a therapeutic effect. Heart rate, blood pressure, and bowel movements are not measures of the therapeutic effect of tolterodine.

A client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCl. Which assessment finding would require immediate intervention by the nurse?

Demonstrates Parkinson-like symptoms, such as cogwheel rigidity. Rationale: Metoclopramide HCl blocks dopamine receptors in the brain, which can cause the extrapyramidal symptoms associated with Parkinson disease

Which drug has antifibrinolytic properties?

Desmopressin Rationale: Desmopressin is an antifibrinolytic drug that prevents the lysis of fibrin. Heparin inactivates clotting factors but is not a "clot buster." Alteplase is a thrombolytic drug. Fondaparinux is a selective factor Xa inhibitor.

An older client is receiving a water-soluble drug that is more than the average dose for a young adult. Which action should the nurse implement first?

Determine the drug's serum levels for toxicity. Rationale: Older clients usually have a decline in lean body mass and total body water that causes water-soluble drugs to become distributed in fluid compartments, resulting in an increased concentration, so determining the drug's serum level for toxicity should be implemented first.

Which intervention is most important for a nurse to implement prior to administering atropine PO?

Determine the presence of 5 to 35 bowel sounds/min. Rationale: Anticholinergic drugs, such as atropine, have antispasmodic and antisecretory properties, which relax the gastrointestinal tract, and are therefore contraindicated in a client with intestinal atony. Oral care may be required after administration since atropine can dry secretions.

A female client with myasthenia gravis is taking a cholinesterase inhibitor and asks the nurse what can be done to remedy her fatigue and difficulty swallowing. What action should the nurse implement?

Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms Rationale: Maintaining optimal dosage for cholinesterase inhibitors can be challenging for clients with myasthenia gravis. Clients should be taught to recognize signs of overmedication and undermedication so that they can modify the dosage themselves based on a prescribed sliding scale.

The health care provider prescribes the anticonvulsant carbamazepine for an adolescent client with a seizure disorder. The nurse should instruct the client to notify the health care provider if which condition occurs?

Develops a sore throat. Rationale: Blood dyscrasias (aplastic anemia, leukopenia, anemia, and thrombocytopenia) can be an adverse effect of carbamazepine. Flulike symptoms, such as pallor, fatigue, sore throat, and fever, are indications of such dyscrasias. Options A and B are expected reactions.

A client experiencing dysrhythmias is given quinidine, 300 mg PO every 6 hours. The nurse plans to observe this client for which common side effect associated with the use of this medication?

Diarrhea Rationale: The most common side effects associated with quinidine therapy are gastrointestinal complaints, such as diarrhea

A 6-year-old child is admitted to the emergency department with status epilepticus. His parents report that his seizure disorder has been managed with phenytoin, 50 mg PO bid, for the past year. Which drug should the nurse plan to administer in the emergency department?

Diazepam Rationale: Diazepam is the drug of choice for treatment of status epilepticus.

Which medication is used to treat supraventricular dysrhythmia?

Digoxin Rationale: Digoxin is a cardiac glycoside used to treat supraventricular dysrhythmia. Verapamil is used to treat hypertension and angina. Nesiritide is used to treat acutely decompensated heart failure. Milrinone is used to treat heart failure.

A patient with irritable bowel syndrome (IBS) receiving 0.5 mg alosetron (Lotronex) bid orally develops constipation. What is the appropriate treatment strategy in this situation?

Discontinuing the medication Rationale: Alosetron (Lotronex) is a selective serotonin 5-HT3 receptor antagonist that helps in treating IBS and chronic diarrhea. Alosetron (Lotronex) reduces bowel movements and results in constipation. When the patient develops constipation or signs of ischemic colitis, the medication should be discontinued. Increasing the dose of medication will worsen the patient's condition. Changing the route of administration or decreasing the frequency of administration will not be beneficial for the patient.

What are potential side effects of administering high doses of a cholinergic-blocking medication? Select all that apply.

Disorientation Decreased gastric secretions Constriction of internal sphincter Rationale: Higher doses of cholinergic-blocking agents may affect the central nervous system and cause disorientation. Cholinergic blockers decrease gastric secretions by acting on the receptors present in the stomach. Cholinergic blockers affect the genitourinary system and cause constriction of the internal sphincter. Cholinergic blockers cause dilation of pupils, not constriction. Cholinergic blockers do not cause decreased heart rate.

The nurse is conducting a community education program. When explaining different medication regimens to treat hypertension, it would be accurate to state that African Americans probably respond best to which combination of medications?

Diuretics and calcium channel blockers Rationale: Research has demonstrated that African Americans do not typically respond therapeutically to beta blockers or ACE inhibitors. They respond better to diuretics and calcium channel blockers.

The nurse is caring for a patient who is taking rifampin. The patient has a heart rate of 90 beats/min, blood pressure of 100/89 mm Hg, and red-orange urine. What is the nurse's best action?

Document the findings and teach the patient. Rationale: Red-orange discoloration of body fluids is a common side effect of rifampin, but it is not harmful and does not indicate infection. There is no need to collect a urine culture, call the health care provider, or start a 24-hour urine collection.

Which substance, if out of balance with acetylcholine, leads to Parkinson disease?

Dopamine Rationale: The underlying cause of Parkinson disease is loss of dopaminergic neurons in the substantia nigra, resulting in a deficiency of dopamine and an imbalance between dopamine and acetylcholine. Because dopamine is an inhibitory neurotransmitter and acetylcholine is an excitatory neurotransmitter, the imbalance results in the effects of acetylcholine that dominate the patient's motor activity. These pathologic features include akinesia, bradykinesia, postural instability, rigidity, and tremors. Serotonin triggers serotonin syndrome. Both epinephrine and norepinephrine are catecholamines present in the body.

A client with mild parkinsonism is started on oral amantadine. Which statement accurately describes the action of this medication?

Dopamine in the central nervous system is increased. Rationale: Amantadine is a dopamine-releasing agent; therefore, this medication increases the amount of dopamine present in the central nervous system. Although this medication is also an antiviral agent, the antiviral effect is not significant in the treatment of parkinsonism.

When calculating pediatric dosages, what will the nurse take into consideration?

Dosage calculation by body surface area is the most accurate method because it takes into account the difference in size of the child and/or neonate. Rationale: The body surface area takes into account not only the child's weight but also the relationship with height and is therefore both the most accurate and most preferred method. Immature renal and hepatic function would necessitate a decrease in dose, not an increase.

A client is being discharged with a prescription for sulfasalazine to treat ulcerative colitis. Which instruction should the nurse provide to this client prior to discharge?

Drink at least eight glasses of fluid a day Rationale: Adequate hydration is important for all sulfa drugs because they can crystallize in the urine. If possible, the drug should be taken after eating to provide longer intestinal transit time.

When administering ophthalmic eyedrops, the nurse will perform which action?

Drop the prescribed number of drops into the conjunctival sac. Rationale: The eyedropper is held 1 to 2 cm above the conjunctival sac. The nurse should drop the prescribed number of drops into the conjunctival sac. Never apply eyedrops to the cornea. If the drops land on the outer lid margins (e.g., if the patient moved or blinked), the procedure should be repeated.

The nurse is caring for a patient who has been prescribed cefazolin sodium. Which nursing assessment is the priority?

Drug Allergy History Rationale: Antibiotic allergy is one of the most common drug allergies. These allergies also have the potential to cause severe anaphylaxis and death and, therefore, have more importance than assessing cardiac or neurologic function or the history of immunizations. *A pt can have cross sensitivty with a cephalisporin especially if they have an allergy to penicillin*

The physiologic changes that normally occur in the older adult have which implication for drug response in this patient?

Drug half-life is lengthened. Rationale: Drug half-life is extended secondary to diminished liver and renal function in the elderly.

A nurse working with elderly patients is concerned about the number of medications each patient is taking. Which will the nurse assess as the highest priority for the patients related to polypharmacy?

Drug interactions Rationale: The highest priority for patients with multiple medications, polypharmacy, is the assessment for drug interactions. The more medications a patient takes, the higher the risk for drug interactions.

What are the side effects of scopolamine? Select all that apply.

Dry mouth Blurred vision Drowsiness Rationale:

Which activity should the patient be cautioned to avoid while taking an MAO inhibitor?

Eating aged cheese Rationale: Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAO inhibitors

What common side effect would the nurse include in the discharge teaching for a patient receiving finasteride (Proscar)?

Ejaculatory dysfunction Rationale: Common side effects of finasteride include impotence, decreased libido, and decreased volume of ejaculate. It is also used to treat male pattern baldness and thus would cause hair growth, not hair loss.

A chemotherapeutic regimen with doxorubicin HCl is being planned for a client recently diagnosed with cancer. What diagnostic test results should the nurse review prior to initiating this treatment?

Electrocardiogram (ECG) Rationale:Baseline cardiac function studies are required to monitor the irreversible cardiotoxic effects of doxorubicin HCl.

A patient who was admitted with deep vein thrombophlebitis is complaining of difficulty breathing and chest pain. What is the most likely cause of these symptoms?

Embolus to the lungs Rationale: A thrombus can become an embolus and travel to the lungs. This pulmonary embolus can cause chest pain and difficulty breathing. It is not likely that anxiety, a medication reaction, or fatigue would cause chest pain and dyspnea in this case.

Which action assists the nurse in prevention of a potential medication error?

Encourage the patient to question medications if the medications are different than he or she expects. Rationale: The nurse should encourage patients to question any medication that they are not familiar with or are not expecting to take.

A patient received the first dose of an alpha-blocking medication 15 minutes ago. The charge nurse must intervene when observing a nursing student perform which action?

Encouraging the patient to ambulate in the hallway Rationale: First-dose phenomenon, which is a severe and sudden drop in blood pressure after the first dose of an alpha-adrenergic blocker, can cause patients to fall or pass out. Ambulating in the hallway is a safety risk for the patient at this time. It is appropriate to listen to an apical pulse and take the blood pressure while the patient is lying down, because alpha blockers cause vasodilation. Telling the patient to eat chicken is appropriate to encourage protein intake.

The nurse is preparing a patient for a surgical procedure. The primary health care provider plans to coadminister lidocaine with epinephrine as local anesthetics. Why is epinephrine used?

Epinephrine acts as a vasoconstrictor Rationale: Epinephrine is a vasoconstrictor; it is often coadministered with a local anesthetic to maintain the localized activity of the anesthetic. Epinephrine minimizes the chance of drug toxicity while administering local anesthesia. It also reduces local blood loss during minor surgical procedures. Epinephrine is not a sedative and does not induce sleep. Midazolam is used to induce mild amnesia. Skeletal and smooth muscles are paralyzed when spinal anesthesia is used.

It is most important to instruct a patient prescribed nitroglycerin to avoid which substance(s)?

Erectile dysfunction medications Rationale: Concurrent administration of erectile dysfunction medications such as sildenafil citrate (Viagra) can cause an acute exacerbation of nitrate-related hypotension

Which is a priority nursing diagnosis for a patient receiving desmopressin (DDAVP)?

Excess fluid volume Rationale: Desmopressin is a form of antidiuretic hormone, which increases sodium and water retention, leading to an alteration in fluid volume. Although the other nursing diagnoses may be appropriate, they are not a priority using Maslow's hierarchy of needs

A patient diagnosed with asthma just completed an albuterol nebulizer treatment. The patient tells the nurse, "I feel like my heart is fluttering, and my hands are very shaky." What is the nurse's most appropriate action?

Explain this sensation as a side effect. Rationale: Albuterol is a beta 2 agonist that predominantly acts on beta 2 receptors in the lungs to cause bronchodilation. Side effects include tachycardia and jitteriness because the medication is not 100% selective on beta 2 receptors. It is not necessary to notify the health care provider because the patient is describing side effects of the medication. The next treatment should not be held because the patient's breathing takes priority over side effects. A decreased dose of albuterol is not necessary.

A client who is hypertensive receives a prescription for hydrochlorothiazide. When teaching about the side effects of this drug, which symptoms are most important for the nurse to instruct the client to report?

Fatigue and muscle weakness Rationale: Thiazide diuretics, such as HCTZ, cause potassium wasting in the urine, so the client should be instructed to report fatigue and muscle weakness, which are characteristic of hypokalemia.

During an infusion of albumin, the nurse monitors the patient closely for the development of which adverse effect?

Fluid volume overload Rationale: During the infusion of albumin, the development of fluid volume overload must be monitored by the nurse, especially in those at risk for heart failure. The other options are incorrect.

Which drug is used as an antidote for overdose of oral benzodiazepine or excessive intravenous sedation?

Flumazenil Rationale: An antidote is a medication given to reduce the symptoms of drug overdose or toxicity. Flumazenil slightly reverses the adverse effects of benzodiazepines. Olanzapine may interact with benzodiazepines when administered simultaneously. However, olanzapine is not an antidote for benzodiazepines. Furosemide is commonly used to eliminate barbiturates by promoting diuresis. Activated charcoal is administered for an overdose of barbiturates. It prevents liver damage by quickly eliminating the barbiturates from the body.

Which drug creates a sleepy, relaxed, drunken feeling in patients?

Flunitrazepam Rationale: Flunitrazepam is benzodiazepine depressant commonly called a roofie, because it makes the person sleepy and relaxed. It is used for the treatment of insomnia in more than 60 countries, but is banned in the United States. Patients feel sleepy and drunken after consuming this drug. Naloxone is an opioid antagonist used for treating opioid abuse. Meperidine is an opioid used in the treatment of pain. Methamphetamine is a stimulant drug used for treating disorders such as narcolepsy.

A 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous hospitalizations have occurred since the diagnosis because of noncompliance with the prescribed medication regimen. Which drug might work best for this particular client?

Fluphenazine decanoate Rationale: Fluphenazine, an antipsychotic drug that can be given IM, has a rapid onset (1 to 2 hours) and a long duration of action (up to 3 or 4 weeks), so it would be the drug of choice for a noncompliant psychotic client

When administering intravenous phenytoin (Dilantin), which action will the nurse perform?

Flush the line with normal saline before and after administration to prevent precipitation Rationale: Phenytoin is very irritating to veins and incompatible with all fluids except normal saline. Flushing with normal saline before and after minimizes precipitation. You do not need an infusion pump when administering via IV push, and administration via central lines is preferred.

The nurse recognizes that patient teaching regarding warfarin (Coumadin) has been successful when the patient acknowledges an increased risk of bleeding with concurrent use of which herbal product? (Select all that apply.)

Garlic Ginkgo Dong quai St. John's wort Rationale: Garlic, ginkgo, dong quai, and St. John's wort alter blood coagulation and may increase the risk of bleeding when given concurrently with oral anticoagulants. Glucosamine does not affect coagulation.

The nurse is caring for a patient with hypertension who is prescribed a clonidine transdermal patch. What should the nurse teach this patient?

Get up slowly from a sitting to a standing position. Rationale: Clonidine can cause dizziness. Patient safety is a priority. The patch is left on for 7 days and can be left on while bathing. This medication is often prescribed with other drugs.

The nurse instructs a patient receiving phenytoin (Dilantin) to visit the dentist regularly and perform frequent oral hygiene. What common side effect is the nurse educating the patient about for this medication?

Gingival hyperplasia Rationale: A side effect of phenytoin is overgrowth of gum tissue, or gingival hyperplasia. This can be minimized by frequent oral hygiene

In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, the nurse writes a nursing diagnosis of alteration in nutrition: less than body requirements, related to inadequate digestion of nutrients. Which intervention would best meet this child's needs?

Give pancrelipase capsule mixed with applesauce before each meal. Rationale: Pancreatic enzyme replacement with pancrelipase is a major component of cystic fibrosis nutritional management.

Prior to administering a scheduled dose of digoxin, the nurse reviews the client's current serum digoxin level, which is 1.3 ng/dL. Which action should the nurse implement?

Give the dose of digoxin if the client's heart rate is within a safe range. Rationale: The client's digoxin level of 1.3 ng/dL is not above the upper range of its therapeutic index (toxic level is >2.0 ng/dL), so the dose should be administered after the client's heart rate is evaluated

The nurse is preparing to administer the disease-modifying antirheumatic drug (DMARD) methotrexate to a client diagnosed with rheumatoid arthritis. Which intervention is most important to implement prior to administering this medication?

Have another nurse check the prescription. Rationale: Double-checking the prescription is an important intervention because death can occur from an overdose. This medication is administered weekly and in low doses for rheumatoid arthritis and should not be confused with administration of the drug as a chemotherapeutic agent.

When planning care for an assigned patient, the nurse identifies the outcome of "Patient will be able to safely self-administer enoxaparin (Lovenox) subcutaneously upon discharge." Which method best evaluates the patient's achievement of this outcome?

Have the patient perform a return demonstration of the procedure. Rationale: Nurses should always validate whether learning has occurred by asking the patient questions related to the teaching session and having the patient provide a return demonstration of the skill. Although the other three responses are part of the teaching process, they do not validate the actual ability of the patient performing the procedure.

A client who is HIV-positive is receiving epoetin alfa for the management of anemia secondary to zidovudine (AZT) therapy. Which laboratory finding is most important for the nurse to report to the health care provider?

Hematocrit (HCT) of 58% Rationale: Option A should be reported to the health care provider immediately because of the likelihood of a hypertensive crisis and because seizure activity increases with an increase in HCT of more than 4 points, or an HCT above 36%. Epoetin alfa stimulates erythropoiesis (production of red blood cells), thereby decreasing the need for blood transfusions. Uncontrolled hypertension can occur if erythropoietin levels are too high.

The nurse would question an order for simvastatin (Zocor) in a patient with which condition?

Hepatic disease Rationale: Simvastatin (Zocor) can cause an increase in liver enzymes and thus should not be used in patients with preexisting liver disease.

Which condition would contraindicate the administration of naltrexone hydrochloride?

Hepatitis Rationale: Administration of naltrexone hydrochloride is contraindicated in a patient who has hepatitis or liver dysfunction. Administering naltrexone hydrochloride to these patients may produce severe complications, because the drug is metabolized in the liver. Naltrexone hydrochloride does not alter hemoglobin levels, respiratory function, or blood sugar levels. Thus the administration of naltrexone hydrochloride is safe in a patient who has anemia, asthma, or diabetes.

The nurse is caring for a patient who has coronary heart disease (CHD). The nurse tells the patient, "Your cholesterol levels are abnormal; you are at a high risk of having a heart attack." What did the nurse discover regarding the lipoprotein levels in the patient's blood report? Correct

High levels of low-density lipoproteins (LDL) Rationale: High levels of low-density lipoproteins (LDL) refer to high cholesterol levels in the blood, because LDL is almost entirely composed of cholesterol. This cholesterol is bad cholesterol, which promotes the formation of atherosclerotic plaque, resulting in CHD. High-density lipoproteins (HDL) are good cholesterol, which have a cardioprotective action. Low levels of very-low-density lipoproteins (VLDL) are due to a low-fat diet; however, these do not cause high cholesterol levels. Low levels of intermediate-density lipoproteins (IDL) do not increase the risk of CHD; they are useful for the production of bile acids.

A child is being treated with mebendazole for pinworms. Which type of diet should the mother be instructed to feed the child while the child is receiving this medication?

High-fat diet Rationale: A high-fat diet increases the absorption of mebendazole, which boosts the effectiveness of the medication in eliminating the pinworms

While the nurse is taking an admission history, the patient reports having a previous allergic reaction to penicillins. What will the nurse document as part of the patient's allergic reaction response to penicillins?

Hives Rationale: The hives reported by the patient are the only physiological symptom associated with a true allergic reaction. The others are possible side effects for many medications but do not demonstrate a true reaction from the drug to document in the chart.

The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 8 breaths/min. Which action will the nurse perform?

Hold drug administration and notify physician. Rationale: Respiratory depression is a side effect of narcotic analgesia. Therefore since the patient's respiratory rate is below normal, the nurse should withhold the morphine and notify the physician

A patient taking intravenous gentamicin has elevated blood urea nitrogen (BUN). What is the nurse's best course of action?

Hold the medication Rationale: Gentamicin has a high potential for nephrotoxicity and is thus contraindicated in patients with elevated renal function tests such as BUN and creatinine. The nurse should hold the medication and call the health care provider. Increasing fluids will not decrease the patient's BUN, and insertion of a Foley catheter will not impact the gentamicin level.

A client receives a prescription for theophylline PO to be initiated in the morning after the dose of theophylline IV is complete. The nurse determines that a theophylline level drawn yesterday was 22 mcg/mL. Based on this information, which action should the nurse implement?

Hold the theophylline dose and notify the health care provider Rationale: The therapeutic range for theophylline is 10 to 20 mcg/mL, so the theophylline dose should be held for fear of causing toxicity.

The health care provider prescribes the H2 antagonist famotidine, 20 mg PO in the morning and at bedtime. Which statement regarding the action of H2 antagonists offers the correct rationale for administering the medication at bedtime?

Hydrochloric acid secreted during the night is blocked. Rationale: H2 antagonists act on the parietal cells to inhibit gastric secretion. Some gastric secretion occurs all the time, even when the stomach is empty, unless medications are taken to inhibit this action

Which complication may be experienced by a patient who is prescribed lisinopril?

Hyperkalemia Rationale: Lisinopril is an angiotensin-converting enzyme inhibitor, which causes the kidney to retain potassium, leading to hyperkalemia. Insomnia and abdominal pain are known side effects of nesiritide, not lisinopril. Cardiac dysrhythmia is a side effect of milrinone, not lisinopril.

A nurse is preparing to administer a beta blocker to a patient. The nurse recognizes that beta blockers are used to treat which conditions? Select all that apply.

Hypertension Angina pectoris Heart failure (HF) Rationale: Beta blockers are effective in treating hypertension (secondary to negative inotropic effects) and angina pectoris (decreases cardiac workload when decreasing heart rate and contractility). Beta blockers have also been shown to reduce mortality in patients with HF. Beta blockers are not used to treat cardiogenic shock, sinus bradycardia, or COPD.

Which condition is a contraindication to the administration of bethanechol?

Hyperthyroidism Rationale: Contraindications to the administration of bethanechol include known drug allergy, hyperthyroidism, peptic ulcer, active bronchial asthma, cardiac disease or coronary artery disease, epilepsy, and parkinsonism. Bethanechol produces parasympathomimetic action and may exacerbate the symptoms of hyperthyroidism. Gastric atony, urinary retention, and chronic refractory heartburn are indications to administer bethanechol.

A primigravida at 34 weeks of gestation is admitted to labor and delivery in preterm labor. She is started on a terbutaline sulfate continuous IV infusion via pump. This therapy is ineffective, and the baby is delivered vaginally. For which complication should the nurse monitor in this infant during the first few hours after delivery?

Hypoglycemia Rationale: Hypoglycemia may occur in the neonate because a side effect of terbutaline sulfate is increased maternal serum glucose levels.

The nurse is reviewing a client's laboratory results before a procedure in which a neuromuscular blocking agent is prescribed. Which finding should the nurse report to the health care provider?

Hypokalemia Rationale: Low potassium levels enhance the effects of neuromuscular blocking agents, so the health care provider should be informed of the client's hypokalemia

When assessing for potential side effects of fludrocortisone (Florinef), the nurse monitors for signs and symptoms of which adverse effect?

Hypokalemia Rationale: Fludrocortisone has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion.

A community health nurse is providing education on clonidine to an elderly patient during a home visit. Which adverse effect should be emphasized as most concerning to this patient?

Hypotension Rationale: Clonidine falls under the class of adrenergic medications. Adverse effects include bradycardia with reflex tachycardia, dry mouth, drowsiness, dizziness, depression, edema, constipation, and male impotence. Because of the high incidence of postural hypotension with this medication and decreased mobility and reaction time in the elderly, this adverse effect places the patient at increased risk for falls and is thus the most concerning.

In addition to nitrate therapy, a client is receiving nifedipine, 10 mg PO every 6 hours. The nurse should plan to observe for which common side effect of this treatment regimen?

Hypotension Rationale: Nifedipine reduces peripheral vascular resistance and nitrates produce vasodilation, so concurrent use of nitrates with nifedipine can cause hypotension with the initial administration of these agents.

The nurse would question an order for a calcium channel blocker in a patient with which condition?

Hypotension Rationale: Calcium channel blockers cause vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension.

When administering nitroprusside (Nipride) intravenously, the nurse would monitor for which sign of toxicity?

Hypotension Rationale: The main symptom of sodium nitroprusside overdose or toxicity is excessive hypotension

The nurse evaluates and determines the patient has a good understanding of the discharge instructions regarding warfarin (Coumadin) when the patient responds with which statement?

I should use a soft toothbrush for dental hygiene Rationale: The patient should reduce the risk of bleeding, such as using a soft toothbrush.

A client is prescribed a cholinesterase inhibitor, and a family member asks the nurse how this medication works. Which pharmacophysiologic explanation should the nurse use to describe this class of drug?

Improves nerve impulse transmission. Rationale: Cholinesterase inhibitors work to increase the availability of acetylcholine at cholinergic synapses, which aids in neuronal transmission and assists in memory formation.

Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) are generally administered at which time?

In the evening Rationale: The liver produces the majority of cholesterol during the night. Thus statin drugs, which work to decrease this synthesis, are generally administered during the evening so that blood levels are highest coinciding with this production.

A client is receiving acyclovir sodium IV for a severe herpes simplex infection. Which intervention should the nurse implement during this drug therapy?

Increase daily fluids to 2000 to 4000 mL/day. Rationale: Increasing fluid intake during treatment prevents precipitation of the drug in the renal tubules, which could lead to obstructive problems that impair kidney function. Acute glomerulonephritis is a possible complication of acyclovir sodium therapy.

The nurse will advise a patient receiving opioid analgesics for chronic pain to perform which action to minimize the gastrointestinal (GI) side effects?

Increase fluid and fiber in the diet Rationale: Opioid analgesics decrease intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can prevent constipation. The nurse should advise the patient to take the opioid with meals, not on an empty stomach, to decrease GI side effects. Diphenoxylate/ atropine is an antidiarrheal preparation that will further decrease GI motility.

The nurse will advise a patient receiving opioid analgesics for chronic pain to perform which action to minimize the gastrointestinal (GI) side effects?

Increase fluid and fiber in the diet. Rationale: Opioid analgesics decrease intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can prevent constipation. The nurse should advise the patient to take the opioid with meals, not on an empty stomach, to decrease GI side effects. Diphenoxylate/ atropine is an antidiarrheal preparation that will further decrease GI motility.

Dopamine is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response?

Increase in urine output Rationale: Intropin activates dopamine receptors in the kidney and dilates blood vessels to improve renal perfusion, so an increase in urine output indicates an increase in glomerular filtration caused by increased arterial blood pressure.

Cholinergic (parasympathomimetic) drugs have which therapeutic effect?

Increased gastrointestinal motility Rationale: Cholinergic effects mimic the parasympathetic nervous system (rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing gastrointestinal (GI) motility helps the body digest. Urinary retention, mydriasis, and vasoconstriction are sympathetic nervous system responses.

Which assessment finding should the nurse interpret as a therapeutic effect of atropine?

Increased heart rate Rationale: Atropine, a muscarinic antagonist, works primarily on the heart, exocrine glands, smooth muscle, and eyes; it produces an increased heart rate. Atropine is likely to cause mydriasis. Lethargy is not a therapeutic effect of atropine. Because there is no parasympathetic innervation to muscarinic receptors in blood vessels, atropine has no effect on vascular smooth muscle tone and therefore no effect on blood pressure.

Epinephrine, as an adrenergic (sympathomimetic) drug, produces which therapeutic effect?

Increased heart rate and contractility Rationale: Epinephrine causes sympathomimetic actions, including increased heart rate and contractility. The other effects listed are parasympathomimetic in nature.

The nurse is caring for a patient who is undergoing treatment with an alpha-adrenergic drug. The nurse is monitoring daily laboratory test results on the patient. Because of the patient's treatment with the alpha-adrenergic drug, the nurse anticipates that the laboratory tests will show which result?

Increased level of glucose Rationale: The alpha-adrenergic drugs can cause an increase in serum levels of glucose. They do not cause an increase in calcium, potassium, or magnesium.

Which is a pharmacodynamic effect of exogenous androgens?

Increased protein synthesis Rationale: Androgens retard the breakdown of amino acids, contributing to an increased synthesis of body proteins, which aids in the formation and maintenance of muscle tissue. Additionally, they stimulate the production of erythropoietin by the kidney, resulting in enhanced erythropoiesis (red blood cell synthesis); increase the retention of nitrogen; and may suppress sperm production when given in large doses as a result of the feedback inhibition of pituitary follicle-stimulating hormone (FSH).

Patients taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently would be monitored for which adverse effect?

Increased risk of bleeding Rationale: Levothyroxine can compete with protein-binding sites of warfarin, allowing more warfarin to be unbound or free, thus increasing effects of warfarin and risk of bleeding.

Which is a priority nursing diagnosis for a patient taking an antihypertensive medication?

Ineffective cerebral tissue perfusion related to disease process and/or medication Rationale: Ineffective cerebral tissue perfusion is always a priority over fatigue, risk for injury, and/or knowledge deficit. Patients taking antihypertensive medication are also at risk for ineffective renal and cardiac perfusion.

Which is the most appropriate action for the nurse who is told that a patient typically takes his glipizide with food?

Inform the patient that it is better to take the medication 30 minutes before a meal. Rationale: Food inhibits the absorption of glipizide, the sulfonylurea agent that should be given 30 minutes before a meal. The health care provider does not have to be called; the nurse should intervene. The blood glucose level does not have to be taken right away. The medication is not to be taken after a meal.

By which action does atorvastatin (Lipitor) decrease lipid levels?

Inhibiting HMG-CoA reductase, the enzyme responsible for the biosynthesis of cholesterol in the liver Rationale: Atorvastatin (Lipitor) is an HMG-CoA reductase inhibitor, decreasing the synthesis of cholesterol in the liver

When assessing for side effects expected in a patient taking analeptics (CNS stimulants), the nurse would monitor for which effect?

Insomnia Rationale: Analeptics are CNS stimulants, which tend to "speed up" body systems. Adverse effects include hypertension, tachycardia, angina, anxiety, insomnia, headache, tremor, blurred vision, increased metabolic rate, gastrointestinal distress, and dry mouth.

A female client is receiving tamoxifen following surgery for breast cancer. She reports the onset of hot flashes to the nurse. Which intervention should the nurse implement?

Instruct the client that hot flashes are a side effect that often occurs with the use of this medication. Rationale: Tamoxifen is an estrogen receptor blocker used to treat breast carcinoma. Hot flashes are a common side effect. If the hot flashes become bothersome, the client can be instructed in measures to reduce the discomfort.

A client taking linezolid at home for an infected foot ulcer calls the home care nurse to report the onset of watery diarrhea. Which intervention should the nurse implement?

Instruct the client to obtain a stool specimen to be taken to the laboratory for analysis. Rationale: Antibiotics, such as linezolid, can cause pseudomembranous colitis, resulting in severe watery diarrhea. The prescriber should be notified, and a stool specimen should be obtained and analyzed for this complication

The nurse is scheduling a client's antibiotic peak and trough levels with the laboratory personnel. What is the best schedule for drawing the trough level?

Instruct the laboratory to draw the trough immediately before the next scheduled dose. Rationale: The best time to draw a trough is the closest time to the next administration.

Which type of anesthetic agent is administered into the subarachnoid space?

Intrathecal anesthesia Rationale: In intrathecal anesthesia, the anesthetic agent is injected into the subarachnoid space. In epidural anesthesia, the anesthetic agent is injected via a small catheter into the epidural space without puncturing the dura. In infiltration, the anesthetic solution is injected into the tissue that surrounds the operative site. In nerve block anesthesia, the anesthetic solution is injected at the site where a nerve innervates a specific area such as a tissue.

A patient reports swelling at the site of infusion of intravenous (IV) pentobarbital. Which event does the nurse suspect as the cause of swelling?

Intravenous infiltration Rationale: In the instance of an intravenous (IV) infiltration, the site may become swollen, erythematous, and tender. IV drugs such as amphotericin B, hydrocortisone, and hydromorphone are incompatible with pentobarbital. However, they may not cause swelling at the IV site. Too rapid an infusion may produce profound hypotension and marked respiratory depression. Infusing pentobarbital without dilution is not safe. However, it may not necessarily cause swelling

To achieve the most rapid onset of action, the health care provider will prescribe the medication to be administered by which route?

Intravenously Rationale: When a drug is administered intravenously, it does not need to be absorbed because it is placed directly into general circulation

What is dicyclomine typically administered to treat?

Irritable bowel disease Rationale: Dicyclomine is typically used to treat irritable bowel disease. Dicyclomine is not used to treat enterocolitis. Proper fluid intake and psyllium-based products are used to treat constipation. Glycopyrrolate is used to reverse neuromuscular blockade.

A client has a positive skin test for tuberculosis. Which prophylactic drug should the nurse expect to administer to this client?

Isoniazid

Nitrates relieve angina pain by reducing preload. How would the nurse explain the term preload to a patient?

It is the blood volume within the heart Rationale: Preload is determined by the amount of blood in the ventricle just before contraction

Calcium channel blockers reduce myocardial oxygen demand by reducing afterload. How would the nurse explain afterload to the patient?

It is the pressure against which the heart must pump. Rationale: Afterload is determined by the pressure in the aorta just before systole.

The nurse is providing education to a patient and his caregiver—his pregnant daughter—about dutasteride (Avodart), which he will be taking for benign prostatic hyperplasia (BPH). What important teaching would the nurse provide to the patient and his daughter about the administration of this medication?

It must not be touched or handled by his daughter due to teratogenic effects Rationale: Finasteride (Proscar) and dutasteride (Avodart) are indicated for BPH. Both drugs are contraindicated in patients who have shown hypersensitivity and in pregnant women and children. It is considered potentially dangerous for a pregnant woman even to handle crushed or broken tablets. Both drugs are classified as pregnancy category X

A patient is taking fludrocortisone (Florinef) for Addison's disease, and his wife is concerned about all of the problems that may occur with this therapy. When teaching them about therapy with this drug, the nurse will include which information?

It needs to be taken with food or milk to minimize gastrointestinal upset Rationale: Patients receiving fludrocortisone need to take it with food or milk to minimize gastrointestinal upset; weight gain of 5 pounds or more in 1 week needs to be reported to the physician; abrupt withdrawal is not recommended because it may precipitate an adrenal crisis. Adverse effects are related to the fluid retention and may include heart failure and hypertension.

The nurse is discussing with a patient the time of day for taking prednisone. What information would the nurse include in the teaching based on knowledge of glucocorticoids?

It should be administered with food to diminish the risk of gastric irritation. Rationale: Glucocorticoids can cause gastrointestinal distress and should be administered with food. The normal circadian secretion of the adrenal cortex is early morning to wake the person up, not early evening. These medications should be tapered off slowly to prevent adrenal crisis and can be administered intravenously. While glucocorticoids should be given in the morning, they should not be administered with coffee, which contains caffeine and may increase gastric irritation.

A 100-mg IV bolus of lidocaine is prescribed for a patient experiencing ventricular dysrhythmias. Which available lidocaine medication should the nurse use to prepare this bolus?

Lidocaine vial of clear solution Rationale: Lidocaine vials should contain clear solution labeled as cardiac or not for cardiac use. The plain solution is used for cardiac conditions. Lidocaine with epinephrine must never be used intravenously and is only to be used as a topical anesthetic. Parenteral solutions of these drugs are usually stable for only 24 hours.

Which adverse effects result from antipsychotic drugs' action on alpha-adrenergic receptors? Select all that apply.

Light headedness Reflex tachycardia Postural hypotension Rationale: Antipsychotics are a group of drugs used to treat serious mental illnesses. They act on the various receptors in the central nervous system to produce a therapeutic effect. Adverse effects of these drugs occur as a result of a blockage of certain receptors or because of abnormal activity. The action of antipsychotics on alpha-adrenergic receptors results in lightheadedness, reflex tachycardia, and postural hypotension. Weight gain is an adverse effect of antipsychotic drugs due to the involvement of histamine receptors. Tardive dyskinesia is an abnormal and uncontrollable movement that occurs because of the involvement of dopamine receptors.

Which class of drugs is prescribed for a patient who is obese to promote weight reduction?

Lipase inhibitors Rationale: Lipase is the enzyme helpful in the digestion of fats. Lipase inhibitors are a class of drugs that help in inhibiting the enzyme, causing excretion of excess fats from the body and resulting in weight reduction. Ergot alkaloids are useful drugs in the case of chronic migraine headache treatment. Serotonin receptor agonists are the class of the drugs used in the treatment of migraine headache. Phosphodiesterase inhibitors are the drugs useful in the treatment of respiratory depression and related disorders.

During therapy with isoniazid, it is most important for the nurse to monitor which laboratory value closely?

Liver enzyme levels Rationale: The client receiving isoniazid is at risk for the development of hepatitis; therefore, liver function test results should be monitored carefully during drug therapy

Which test will the nurse use to assess for adverse reactions to HMG-CoA reductase inhibitors?

Liver function tests Rationale: HMG-CoA reductase inhibitors can cause hepatic toxicity; thus it is necessary to monitor liver function tests every 3 months for the first year of treatment.

Enoxaparin sodium (Lovenox) is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This drug is in which drug group?

Low molecular weight heparin

When caring for a client on digoxin therapy, the nurse knows to be alert for digoxin toxicity. Which finding would predispose this client to developing digoxin toxicity?

Low serum potassium level Rationale: Hypokalemia predisposes the client on digoxin to digoxin toxicity, which usually presents as abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and atrioventricular (AV) dissociation. Assessment of serum potassium levels with prompt correction of hypokalemia is an important intervention for the client taking digoxin.

Cholinergic (parasympathomimetic) drugs are indicated for which situation?

Lowering intraocular pressure in patients with glaucoma Rationale: Cholinergic drugs stimulate the pupil to constrict (miosis), thus decreasing intraocular pressure

Assessment of a patient receiving a positive inotropic drug would include reviewing which values? (Select all that apply.)

Lung sounds Daily weights Apical pulse Serum electrolytes Rationale: All of these assessments are appropriate for patients receiving an inotropic drug. Lung sounds and daily weights are appropriate assessments related to the treatment of heart failure with inotropic drugs. The apical pulse and serum electrolytes are important assessments related to potential adverse reactions (bradycardia, toxicity with hypokalemia).

A pediatric client is discharged home with multiple prescriptions for medications. Which information should the nurse provide that is most helpful to the parents when managing the medication regimens?

Maintain a drug administration record.

What is appropriate information for the nurse to give the patient who is taking an antiepileptic drug with a narrow therapeutic index?

Make certain the drug is taken at the same time daily Rationale: A drug with a narrow therapeutic index has toxic and therapeutic levels that are very close together. Consistent dosing of the drug at the same time daily is essential for maintaining stable serum drug levels. The medication should not be taken every other day unless that is specifically how it is prescribed. It is not essential that the patient keep the medication with him at all times. Crushing the drug will change the absorption.

A patient with type 1 diabetes mellitus has been ordered insulin aspart 10 units at 7:00 AM. What nursing intervention will the nurse perform after administering this medication?

Make sure the patient eats breakfast immediately. Rationale: Insulin aspart is a rapid-acting insulin that acts in 15 minutes or less. It is imperative that the patient eat as it starts to work. This medication is given subcutaneously. The patient should have had a fingerstick blood sugar test done before receiving the medication. There is no need to check the urine.

While observing a patient self-administer enoxaparin (Lovenox), the nurse identifies the need for further teaching when the patient completes which action?

Massages the site after administration of the medication Rationale: It is not recommended to massage the area of injection of anticoagulants due to the increased risk of hematoma formation.

While teaching a patient newly diagnosed with a seizure disorder, what does the nurse state as the goal of pharmacologic therapy of this medication?

Maximally reducing seizure activity while minimizing side effects of medication therapy Rationale: Anticonvulsant medications have many adverse side effects. The goal of therapy is to control seizure activity while maintaining quality of life with minimal side effects.

What is the goal of antiepileptic therapy?

Maximally reducing seizure activity while minimizing side effects of medication therapy Rationale: Antiepileptic medications have many adverse side effects. The goal of therapy is to control seizure activity while maintaining quality of life with minimal side effects. It is not appropriate to put a limit on the number of seizures expected, such as one or two per week. The absolute goal is to control seizure activity as completely as possible. The goal is directed towards controlling the seizure activity, not maximizing drug dosages. If the medication is controlling the seizure activity, the patient should not be weaned off of the medication, as then seizures will most likely recur.

After a heathcare provider prescribes propranolol for a client with frequent premature ventricular contractions (PVC's), the nurse should include which of the following in the care plan?

Measure heart rate daily before taking dose Rationale: Because the drug is a beta adrenergic blocker, bradycardia is a common side effect. For this reason, the client should be taught to self-monitor the heart rate daily. Dyspnea is not primarily associated with PVC's, although some clients might experience a fleeting sense of not being able to catch their breath during a bout of PVC's. Agranulocytosis is a side effect that could result in decreased resistance to infection, but this drug does not offer increased protection against infection. Many skin erruptions are associated with the drug. First recall that the drug is a beta adrenergic blocking agent. Then select the option that most represents the the drug characteristics.

Which medication is a noncholinergic drug used in the treatment of Alzheimer's disease?

Memantine Rationale: Memantine is a noncholinergic drug that is used in the treatment of Alzheimer's disease. It helps by blocking the stimulation of the N-methyl-D-aspartate receptors. Atropine, donepezil, and rivastigmine are all cholinergic drugs. Atropine is a competitive antagonist to the acetylcholine receptor; it is used as the treatment for cholinergic overdose. Donepezil is usually prescribed for Alzheimer's patients. It inhibits acetylcholinesterase and increases the levels of acetylcholine. Rivastigmine is also a cholinesterase inhibitor that causes an increase in acetylcholine levels.

Which drug should be used with caution with the herbal drug ginseng to prevent possible drug interactions?

Metformin Rationale: Metformin is an antidiabetic drug that should be used with caution when the herbal drug ginseng is used, as it may cause possible drug interactions. Aspirin may cause complications when it is used along with ginkgo biloba, but not with ginseng. Ginkgo biloba, not ginseng, may affect clotting when taken with warfarin. The use of disulfiram may cause drug interactions when combined with the herbal drug guarana, not ginseng.

A patient is seen daily in a community clinic for treatment of a narcotic addiction. Which medication will assist the patient's recovery?

Methadone Rationale: Methadone is a synthetic opioid analgesic. Controlled distribution of this medication helps the patient to prevent symptoms of withdrawal and craving. Naloxone is used to reverse central nervous system depression that is sometimes caused by opioids. In patients who are treated with warfarin, vitamin K1 is used to reduce warfarin's ability to prevent clots. Protamine sulfate is used to reverse the effects of heparin.

A client with a dislocated shoulder is being prepared for a closed manual reduction using conscious sedation. Which medication should the nurse explain as a sedative used during the procedure?

Midazolam IV Rationale: Conscious sedation uses sedative-hypnotics that do not compromise the airway, so IV midazolam, a short-duration benzodiazepine sedative, provides conscious sedation with local and regional anesthesia and has an amnestic effect.

The patient's blood pressure is 200/120 mm Hg, and the health care provider prescribes sodium nitroprusside. What is the nurse's priority action?

Monitor blood pressure continuously Rationale: Sodium nitroprusside is a direct-acting peripheral vasodilator that works almost immediately. The patient needs continuous blood pressure monitoring. Hourly output measurement is not necessary. This medication is administered intravenously, not by mouth, and does not require a glass of water.

A patient is being treated for short-term management of heart failure with milrinone. What is the primary nursing action?

Monitor blood pressure continuously. Rationale: Milrinone lactate is a phosphodiesterase inhibitor administered intravenously for short-term treatment in patients with heart failure not responding adequately to digoxin, diuretics, or other vasodilators. Blood pressure and heart rate should be closely monitored. Digoxin is not administered with the milrinone but is usually tried before treatment with milrinone. Furosemide is not necessarily administered after the milrinone, although it could be. It is not, however, administered routinely via intravenous infusion. Lactated Ringer solution does not have to be administered with milrinone.

The nurse is caring for a patient who is taking levothyroxine and warfarin. Which intervention is the highest priority for the nurse?

Monitor the patient for increased risk of bleeding. Rationale: Levothyroxine can compete with protein-binding sites of warfarin, allowing more warfarin to be unbound or free, thus increasing the effects of warfarin and the risk of bleeding. This combination does not place the patient at increased risk of dysrhythmias, deep vein thrombosis, or weight loss.

What is the nurse's role in the development of new and investigational drugs?

Monitoring for and reporting any adverse effects noted during Phase IV studies Rationale: Phase IV studies rely on health care professionals to report adverse effects that may not have been apparent in previous phases. In most studies, neither the health care providers nor the patients know which patients are being given the real drug versus the placebo

Which enzyme is inhibited by the antiparkinson drug selegiline?

Monoamine oxidase Rationale: Selegiline is the selective inhibitor of the monoamine oxidase enzyme. Selegiline does not bind to cholinesterase, the enzyme useful in breaking down cholinergic neurotransmitters. SOD is an enzyme that has antioxidant activity and is useful in the prevention of Alzheimer's disease. Selegiline does not alter levels of the SOD enzyme. Selegiline does not show any action on the catechol-ortho-methyltransferase enzyme.

A client with HIV who was recently diagnosed with tuberculosis (TB) asks the nurse, "Why do I need to take all of these medications for TB?" What information should the nurse provide?

Multiple drugs prevent the development of resistant organisms. Rationale: A multidrug regimen is prescribed for a client with HIV and TB to prevent the development of resistance of the tubercle bacilli. Although antitubercular medications can inhibit some antiretrovirals, a multidrug regimen is needed to inhibit the proliferation of the virulent tubercle bacilli. The duration of antitubercular therapy is typically 6 to 9 months and is not shortened by the use of multiple medications. A client who is receiving HIV and TB therapy is at an increased risk of adverse reactions because of the complex medication regimens and complications secondary to immunosuppression.

Discharge teaching for a patient receiving simvastatin (Zocor) would include the importance of reporting which symptoms that might indicate a serious adverse reaction to the medication?

Muscle pain Rationale: Muscle pain must be reported because it could signify an uncommon but serious side effect of rhabdomyolysis associated with statin drugs.

The health care provider prescribes carbamazepine for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. The mother asks why so many blood tests are necessary. Which complication is assessed through frequent laboratory testing that the nurse should explain to this mother?

Myelosuppression Rationale: Myelosuppression is the highest priority complication that can potentially affect clients managed with carbamazepine therapy. The client requires close monitoring for this condition by weekly laboratory testing.

The nurse is assessing a stuporous client in the emergency department who is suspected of overdosing with opioids. Which agent should the nurse prepare to administer if the client becomes comatose?

Naloxone hydrochloride Rationale: Naloxone is an opioid antidote used in opioid overdose to reverse CNS and respiratory depression. Atropine is used for bradycardia, intestinal hypertonicity and hypermotility, muscarinic agonist poisoning, peptic ulcer disease, and biliary colic. Vitamin K is used to manage warfarin overdose and vitamin K deficiency in newborns. Flumazenil reduces the sedative effects of benzodiazepines following general anesthesia or overdose.

A 19-year-old male client who has sustained a severe head injury is intubated and placed on assisted mechanical ventilation. To facilitate optimal ventilation and prevent the client from "fighting" the ventilator, the health care provider administers pancuronium bromide IV, with adjunctive opioid analgesia. What medication should be immediately accessible for a potential complication with this drug?

Neostigmine bromide Rationale: Neostigmine bromide and atropine sulfate, both anticholinergic drugs, reverse the respiratory muscle paralysis caused by pancuronium bromide.

A patient has been taking sildenafil for erectile dysfunction. The patient reports episodes of dizziness and fainting spells after using this drug. For which other drug should the nurse assess while taking the drug history of the patient?

Nitrates Rationale: Dizziness and fainting spells are signs associated with low blood pressure. Sildenafil decreases blood pressure by releasing nitric oxide. Nitrates also decrease the workload of the heart by reducing the blood pressure. Administration of both drugs may cause severe hypotension in the patient. Thus, the nurse should determine whether the patient is taking nitrate drugs. Alpha-agonist drugs will cause hypertension, whereas sildenafil will be helpful in reducing blood pressure in patients taking an alpha agonist. Antibiotic drugs and anticoagulants do not interact with sildenafil. Antibiotics such as erythromycin and clarithromycin increase the concentration of tamsulosin in the blood. Anticoagulants interact with androgens, thereby causing increased or decreased activity of oral anticoagulant drugs.

A male client asks the nurse why condoms should not be lubricated with the spermicide nonoxynol-9. Which response is best for the nurse to provide?

Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of HIV. Rationale: The use of condoms and a water-based spermicide is recommended because nonoxynol-9 can cause a rash that allows viruses a portal of entry if the condom breaks, which increases the risk of transmission of sexually transmitted diseases (STDs), such as human immunodeficiency virus (HIV), herpes, human papillomavirus (HPV), or hepatitis B virus (HBV). Options A and B are inaccurate

The nurse notes that the hemoglobin level of a client receiving darbepoetin alfa has increased from 6 to 10 g/dL over the first 2 weeks of treatment. Which action should the nurse take?

Notify the health care provider of the change in the client's laboratory values. Rationale: Although an increase in the client's hemoglobin level is desired, a rapid increase (more than 1 g/dL in a 2-week period) may lead to hypertension, so the health care provider should be notified of this excessive increase.

A client with metastatic cancer who has been receiving fentanyl for several weeks reports to the nurse that the medication is not effectively controlling the pain. Which intervention should the nurse initiate?

Notify the health care provider of the need to increase the dose.

The nurse administers a medication to the wrong client. Which is the appropriate nursing action following this error?

Notify the provider and document the error on an incident report. Rationale: All medication errors that involved a patient need to be called to the health care provider's attention and documented on an incident report.

A patient prescribed prazosin (Minipress) does not have a history of hypertension. The nurse would assess for what disorder for which this medication is also used?

Obstructive benign prostatic hyperplasia Rationale: Alpha1 blockers have been useful in treating obstructive benign prostatic hyperplasia. The blocking of alpha-adrenergic receptors decreases the urine outflow obstruction related to benign prostatic hyperplasia by preventing smooth muscle contractions in the bladder neck and urethra.

The apical heart rate of an infant receiving digoxin for congestive heart failure is 80 beats/min. Which intervention should the nurse implement first?

Obtain a serum digoxin level. Rationale: Sinus bradycardia (rate <90 to 110 beats/min in an infant) is an indication of digoxin toxicity, so assessment of the client's digoxin level is the highest priority. Further doses of digoxin should be withheld until the serum level is obtained

When providing client teaching about the administration of methylphenidate (Ritalin) to a parent of a child diagnosed with ADHD, which instruction should the nurse include in the teaching plan?

Offer the child the medication with breakfast and after the child eats lunch. Rationale:Administering the medication at breakfast and after lunch provides the correct spacing of the doses to maximize the child's attention span and helps prevent the appetite suppression associated with the drug. Doses should be spaced at 6-hour intervals

Which form of nitroglycerin is likely to have a large first-pass effect?

Oral Rationale: Oral nitroglycerin travels first to the liver and is metabolized before it can become active in the body. As a result, a large amount of nitroglycerin is removed from the circulation. This is known as a large first-pass effect. Sublingual, intravenous, and transdermal preparations do not pass through the liver. Sublingual nitroglycerin has an onset of action of 2 to 3 minutes and is absorbed quickly, because the area under the tongue is highly vascular. Intravenous nitroglycerin is quickly absorbed in the blood, and it has an onset of action of 1 to 2 minutes. Transdermal nitroglycerin has an onset of action of 30 to 60 minutes. It is used for long-term management of angina pectoris, because it allows for the continuous slow delivery of nitroglycerin.

A female client is receiving tetracycline for acne. Which client teaching should the nurse include?

Oral contraceptives may not be effective.

The nurse is reviewing prescribed medications with a female client who is preparing for discharge. The client asks the nurse why the oral dose of an opioid analgesic is higher than the IV dose that she received during hospitalization. Which response is best for the nurse to provide?

Oral forms of drugs must pass through the liver first, where more of the dose is metabolized. Rationale: Oral doses of medication are usually larger than parenteral doses to compensate for the first-pass effect in the liver after oral administration, which metabolizes more of the drug's dose before affecting its therapeutic response. Although recommended dose ranges for adults should be individualized, a client's pain should be controlled at discharge

Which health complication will the nurse expect in a patient who is on proton pump inhibitor therapy for a prolonged time?

Osteoporosis Rationale: Proton pump inhibitors inhibit stomach acid secretion and speed up bone mineral loss. Therefore, prolonged use of proton pump inhibitors increases the risk of osteoporosis. Aluminum-containing antacids cause constipation. An adverse effect of cimetidine (Tagamet) is gynecomastia. Vaginal bleeding is an adverse effect of misoprostol (Cytotec).

Adenosine is used to treat which condition?

Paroxysmal supraventricular tachycardia (PSVT) Rationale: The only therapeutic indication of use for adenosine is the treatment of PSVT.

Alteration of which laboratory finding represents the achievement of a therapeutic goal for heparin administration?

Partial thromboplastin time (PTT) Rationale: Heparin therapy is guided by changes in the partial thromboplastin time (PTT).

Which patients who have which conditions are contraindicated for anorexiant therapy? Select all that apply.

Patients who have glaucoma Patients who have drug allergies Patients who have bulimia nervosa Rationale: An anorexiant is a drug that decreases body weight and suppresses the appetite. It is contraindicated for patients who have bulimia nervosa, an eating disorder. Anorexiants are also contraindicated for patients who have glaucoma and drug allergies. They are contraindicated for patients who have severe hypertension, not hypotension, and hyperthyroidism, not hypothyroidism.

A patient with a history of asthma frequently receives prednisone for acute bronchitis. Which adverse effects should the nurse anticipate that the patient may experience with continuous use of the therapy? Select all that apply

Personality changes "Moon Face" Loss of bone density Rationale: Weight gain and personality changes are associated with glucocorticoid therapy. "Moon face" is related to glucocorticoid therapy. The patient is at high risk for osteoporosis as a result of glucocorticoid therapy, because glucocorticoids are associated with bone demineralization. Glucocorticoid therapy using prednisone causes hyperglycemia and insomnia, not hypoglycemia or increased sleep.

A child with cystic fibrosis is receiving ticarcillin disodium for Pseudomonas pneumonia. For which adverse effect should the nurse assess and report promptly to the health care provider?

Petechiae Rationale: Adverse effects of ticarcillin disodium include hypothrombinemia and decreased platelet adhesion, which can result in the presence of petechiae

A client who has chronic back pain is on long-term pain medication management and asks the nurse why his pain relief therapy is not as effective as it was 2 months ago. How should the nurse respond?

Pharmacodynamic tolerance requires increased drug levels to achieve the same effect. Rationale: Pharmacodynamic tolerance explains the client's need for an increased drug level to produce effects that formerly occurred at lower drug levels. Tolerance can occur with opioids during shorter periods of use. Although a withdrawal syndrome can occur if the client develops a dependency, this does not address the client's immediate concern of drug effectiveness. Although a stable serum drug level provides effective pain management, the client's complaint is consistent with a tolerance to his current pain management regimen

What is the study of the physiochemical properties of drugs and how they influence the body called?

Pharmacodynamics Rationale: In simpler terms, pharmacodynamics is the study of what drugs do to the body.

Which physiologic mechanism explains a drug's increased metabolism that is triggered by a disease process?

Pharmacokinetics

A pharmaceutical company is voluntarily conducting a postmarketing study to obtain further proof of the therapeutic effects of a new drug. What phase of drug study is this considered?

Phase IV Rationale: Phase IV studies are conducted by pharmaceutical companies after the drug is on the market to obtain further data and information on the drug.

The nurse recognizes that which medication is classified as an alpha-adrenergic agonist?

Phenylephrine Rationale: Phenylephrine works almost exclusively on the alpha-adrenergic receptors. It is used primarily for short-term treatment to raise blood pressure in patients in shock, to control some dysrhythmias (supraventricular tachycardias), and to produce vasoconstriction in regional anesthesia.

A nurse is caring for a patient with malaria who has been prescribed quinine. The nurse monitors the patient for the presence of which side effect? Select all that apply.

Photosensitivity Visual disturbances Rationale: While caring for a patient with malaria, the nurse should monitor the patient to prevent adverse effects of the drug. If the patient develops any adverse effects, the nurse should immediately document them and report them to the primary health care provider. Photosensitivity and visual distress are the two adverse effects of quinine. Throat pain is caused by pyrimethamine. Muscle pain (myalgia) is an adverse effect of mefloquine. Abdominal distress is an adverse effect of primaquine

When teaching a patient regarding proper application of a Testoderm transdermal patch, the nurse will instruct the patient to perform which action?

Place the patch on clean, dry, shaved scrotal skin. Rationale: Testoderm transdermal patches should be placed on clean, dry scrotal skin that has been shaved for optimal skin contact. A patch should be replaced every 24 hours.

In administering the antiinfective agent chloramphenicol IV to a client with bacterial meningitis, the nurse observes the client closely for signs of bone marrow depression. Which laboratory data would be most important for the nurse to monitor?

Platelet count Rationale: Chloramphenicol can cause irreversible, fatal bone marrow depression, so the nurse should monitor the client's platelet count.

Which are therapeutic effects of digoxin?

Positive inotropic, negative chronotropic, and negative dromotropic Rationale: Digoxin increases cardiac contractility (positive inotropic effect), decreases heart rate (negative chronotropic effect), and decreases conductivity (negative dromotropic effect).

A client was started on drug therapy with bumetanide 1 month ago. At a follow-up health visit, the nurse should be most concerned with which most recent laboratory test result?

Potassium 3.1 mEq/L Rationale: The nurse should be most concerned with the low serum potassium result (normal 3.5-5.1 mEq/L) because bumetanide is a potassium wasting diuretic. The blood urea nitrogen is within normal limits (8-22 mg/dL) and is not of concern. The blood glucose level is only slightly elevated (normal 70-110 mg/dL) so it is not the priority and is not related to therapy with bumetanide. The calcium level is within normal limits (8.5-11 mg/dL).

. Which is a National Patient Safety Goal associated with anticoagulation therapy?

Preventing adverse events associated with anticoagulant drugs Rationale: The Joint Commission has made safe use of these drugs a national patient safety goal. This goal requires hospitals to take steps to prevent adverse events associated with the drugs. It is sometimes necessary for patients to take oral and parenteral anticoagulants, whether synthetic or natural. The goal is to prevent adverse events associated with the anticoagulant therapy; not to decrease the usage. Anticoagulant use is imperative for some patients to prevent very serious illnesses such as stroke.

While completing preoperative patient teaching, which information should the nurse explain about general anesthesia?

Produces deep muscle relaxation and loss of consciousness Rationale: General anesthesia produces deep muscle relaxation (both visceral and skeletal) as well as loss of consciousness. Balanced anesthesia is the practice of using combinations of different drug classes rather than a single drug to produce anesthesia. Local anesthesia provides anesthesia to a specific region of the body and generalized sedation. Conscious sedation (also called moderate sedation) results in moderate sedation in which the patient can follow commands but will not remember anything after the procedure.

A client receiving a continuous infusion of heparin IV starts to hemorrhage from an arterial access site. Which medication should the nurse anticipate administering to prevent further heparin-induced hemorrhaging?

Protamine sulfate Rationale: Protamine sulfate is the antagonist for heparin and is given for episodes of acute hemorrhage

The nurse is assessing a patient who has been prescribed cholestyramine. The nurse finds that the patient has bloating and decreased peristalsis. Which intervention should the nurse perform to relieve the symptoms? Select all that apply.

Provide a diet rich in fiber. Increase the intake of fluid. Provide a diet rich in fiber. Rationale: A fiber-rich diet and increased fluid intake help aid easy peristalsis, minimizing constipation and bloating. Cholestyramine does not cause weight gain or loss. It is not mandatory to assess the weight of the patient. Milk helps reduce peristalsis; it should not be included in the patient's diet. The administration of this drug does not produce any cardiovascular effects; blood pressure does not need to be monitored.

Which response best supports the observations that the nurse identifies in a client who is experiencing a placebo effect?

Psychological response to inert medication Rationale: he placebo effect is a response in the client that is caused by the psychological impact of taking an inert drug that has no biochemical properties. A placebo effect can be therapeutic, negative, or ineffective but provides no cure or benefit to the client's progress. The placebo effect may evoke behavioral changes but does not affect neurochemical psychotropic changes. Malingering and drug seeking are behaviors that a client exhibits to obtain treatment for nonexistent disorders or obtain prescription medications.

Which medication may be administered to a patient who has myasthenia gravis?

Pyridostigmine Rationale: Pyridostigmine is an indirect-acting anticholinesterase drug used to treat myasthenia gravis. Donepezil and memantine are used to treat Alzheimer's dementia. Bethanechol is used to treat postoperative and postpartum functional urinary retention.

Which drug is contraindicated in patients with chronic obstructive pulmonary disease (COPD)?

Ramelteon Rationale: Ramelteon is recommended for the treatment of insomnia. This drug is contraindicated for patients with COPD or sleep apnea. Zaleplon is a nonbenzodiazepine drug used for the treatment of insomnia. It is contraindicated in patients with drug allergy, glaucoma, or pregnancy. Diazepam is a benzodiazepine drug used for the treatment of sleep disorders. It is contraindicated in patients with drug allergy, glaucoma, or pregnancy. Pentobarbital is a barbiturate class of drug used as hypnotic, sedative, and anticonvulsant. It is contraindicated in patients with drug allergy, pregnancy, or severe kidney or liver disease.

The nurse knows that the medication reconciliation process involves which three steps? (Select all that apply.)

Reconciliation Verification Clarification Rationale: The three steps of the medication reconciliation process are verification, clarification, and reconciliation

Nursing care for a patient receiving alteplase (Activase) would include which action? (Select all that apply.)

Record vital signs and report changes. Observe for signs and symptoms of bleeding. Assess for cardiac dysrhythmias Rationale: Alteplase can cause bleeding as well as cardiac dysrhythmias. Vital sign changes can alert the nurse to these complications. Alteplase does not directly affect liver enzymes. Injections should not be administered intramuscularly because of the increased risk of bleeding

When teaching a patient about carvedilol (Coreg), the nurse explains that this medication reduces blood pressure by which actions? (Select all that apply.)

Reducing heart rate Vasodilation Rationale: Carvedilol (Coreg) has the dual antihypertensive effects of reducing heart rate (beta1 receptor blockade) and also vasodilation (alpha1 receptor blockade).

A client with acute lymphocytic leukemia is to begin chemotherapy today. The health care provider's prescription specifies that ondansetron is to be administered IV 30 minutes prior to the infusion of cisplatin. What is the rationale for administering Zofran prior to the chemotherapy induction?

Reduction or elimination of nausea and vomiting Rationale: Ondansetron is a type 3 receptor (5-HT3) antagonist that is recognized for improved control of acute nausea and vomiting associated with chemotherapy. 5-HT3 antagonists are most effective when administered IV prior to the induction of the chemotherapeutic agent(s)

A patient diagnosed with cholecystitis reports pain in the back and scapular areas. What does the nurse infer about the type of pain from the assessment?

Referred pain Rationale: Patients with cholecystitis may report back pain and scapular pain. The signal for pain that is sent from the gallbladder to the spinal cord can get mixed up with signals from the back and scapular areas. Therefore, the brain receives a signal about back pain and scapular pain because of misinterpretation of signals by the nervous system. This type of pain is called referred pain. Referred pain occurs when visceral nerve fibers synapse at a level in the spinal cord close to fibers that supply specific subcutaneous tissues in the body. Vascular pain originates from the vascular or perivascular tissues. Phantom pain is associated with the area of a body part that has been removed surgically or traumatically. Neuropathic pain results from damage to peripheral or central nervous system nerve fibers by disease or injury.

When reviewing the health history of a patient, the nurse will note that a potential contraindication to potassium supplements exists if the patient has which problem?

Renal disease Rationale: Potassium supplements are contraindicated in the presence of renal disease; the other conditions listed may be treated with potassium supplements.

Which are contraindications for administration of cholinergic-blocking medications? Select all that apply.

Renal failure Down syndrome Recent heart surgery Rationale: Cholinergic-blocking medications are contraindicated in patients with renal failure, Down syndrome, or recent heart surgery. They may increase urinary retention and may further worsen renal failure. Cholinergic-blocking drugs act on the muscarinic receptors and cause delusions and decreased muscle rigidity. This may further worsen the symptoms of Down syndrome. In patients with a recent heart surgery, anticholinergics alter the heart rate, which in turn increases the workload on the heart. Anticholinergics are beneficial for patients with peptic ulcers and bronchial asthma, because they decrease the gastric secretions and dilate the bronchioles.

A client receives pancuronium, a long-acting, nondepolarizing neuromuscular blocker, during surgical anesthesia. Which client situation should alert the nurse to evaluate the client for a prolonged muscle relaxation response to this medication?

Renal insufficiency Rationale: Pancuronium is eliminated via the kidneys, so a client with renal failure is at risk for prolonged muscle relaxation. Although hepatitis can interfere with this drug's metabolism, it does not place a client at increased risk for prolonged muscle relaxation.

A client who is experiencing an acute attack of gouty arthritis is prescribed colchicine USP, 1 mg PO daily. Which information is most important for the nurse to provide the client?

Report any vomiting to the clinic. Rationale: The client should be instructed to report signs of colchicine toxicity, such as nausea, diarrhea, vomiting, and/or abdominal pain, to the health care provider. Food inhibits the absorption of colchicine when ingested concurrently. Limited fluid intake decreases the excretion of the uric acid crystals, which contributes to painful attacks. Typically, a client should remain on a daily dose of colchicine to decrease the number and severity of acute attacks, so stopping the medication after the pain resolves is not indicated

Minocycline, 50 mg PO every 8 hours, is prescribed for an adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.)

Report vaginal itching or discharge. Protect skin from natural and artificial ultraviolet light. Avoid driving until response to medication is known. Use a nonhormonal method of contraception if sexually active. Rationale: Adverse effects of tetracyclines include superinfections, photosensitivity, and decreased efficacy of oral contraceptives. Therefore, the client should report vaginal itching or discharge, protect the skin from ultraviolet light , and use a nonhormonal method of contraception while on the medication. Minocycline is known to cause dizziness and ataxia, so until the client's response to the medication is known, driving should be avoided. Tetracyclines should be taken around the clock

An older client who had a colon resection yesterday is receiving a constant dose of hydromorphone via a patient-controlled analgesia (PCA) pump. Which assessment finding is most significant and requires that the nurse intervene?

Respirations decrease to 14 breaths/min. Rationale: Hydromorphone is an opioid agonist-analgesic of opiate receptors that inhibits ascending pathways and can cause respiratory depression. Older adults are more sensitive to opioids so the "start low and go slow" approach should be taken.

When assessing for the most serious adverse reaction to a narcotic analgesic, what does the nurse monitor for in the patient?

Respiratory Rate Rationale: The most serious side effect of narcotic analgesics is respiratory depression.

A patient who presents with cough and difficulty breathing is prescribed decongestants and antitussives. Which assessment findings in the follow-up visit will the nurse immediately report to the primary health care provider? Select all that apply.

Respiratory rate of 30 breaths/minute Temperature of 100.8 degrees F Change in color of the sputum Rationale: After the treatment of cough and difficulty breathing, the nurse should look for signs of worsening during the follow-up visit. Temperature of 100.8° F indicates fever and is a sign of infection. A change in color of the sputum indicates infection and should be immediately reported. The normal respiratory rate is 12 to 20 breaths/min. The respiratory rate of 30 breaths/min indicates dyspnea and difficulty breathing. Increased expectoration of mucus indicates treatment effectiveness. Clear breath sounds indicate that lungs are clear of secretions.

During administration of theophylline, the nurse should monitor for signs of toxicity. Which symptom would cause the nurse to suspect theophylline toxicity?

Restlessness Rationale: Restlessness is a sign of theophylline intoxication. Other signs of toxicity are anorexia, nausea, vomiting, insomnia, tachycardia, arrhythmias, and seizures.

A client who is HIV-positive is receiving combination therapy with the antiviral medication zidovudine. Which instruction should the nurse include in this client's teaching plan?

Return to the clinic every 2 weeks for blood counts Rationale: Bone marrow depression with granulocytopenia is a severe but common adverse effect of zidovudine. Careful monitoring of CBCs is indicated.

A client who arrives in the postanesthesia care unit (PACU) after surgery is not awake from general anesthesia. Which action should the nurse implement first?

Review the medication administration record (MAR). Rationale: Most general anesthetics produce cardiovascular and respiratory depression, so a review of the client's MAR identifies all the medications received during surgery and helps the nurse anticipate the client's response and emergence from anesthesia

To prevent oral candidiasis, it is most important for the nurse to teach a patient using a steroid inhaler to perform which action?

Rinse mouth after every use Rationale: It is most important to teach patients to rinse their mouth after each use of a steroid inhaler to prevent the occurrence of oral candidiasis, a fungal infection. Mycostatin is not routinely used to prevent this infection unless the patient is immunocompromised. Reporting irritation once it has occurred does not prevent the infection. Minimizing the use of the inhaler to every other day negates its therapeutic effect.

The priority nursing diagnosis for a patient taking metoprolol (Lopressor) would be

Risk for decreased cardiac tissue perfusion related to effects of medication. Rationale: Using the ABCs of prioritization, Risk for decreased cardiac tissue perfusion puts the patient at highest risk. Although the other nursing diagnoses are pertinent, they are not the priority.

The nurse is preparing a plan of care for a client receiving the glucocorticoid methylprednisolone. Which nursing diagnosis reflects a problem related to this medication that should be included in the care plan?

Risk for infection Rationale: Corticosteroids depress the immune system, placing the client at risk for infection

Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic drug?

Risk for injury Rationale: Sedative-hypnotics cause central nervous system (CNS) depression, putting the patient at risk for injury.

A patient who is receiving an oral anticoagulant is started on fluconazole to treat a fungal infection. What possible drug interaction could occur in this patient?

Risk of bleeding Rationale: Fluconazole increases the effects of anticoagulants, and thus the patient is at risk of bleeding. Fluconazole does not increase the risk of thrombosis. The interaction of fluconazole and anticoagulants does not cause fluconazole toxicity.

What atypical antipsychotic medication would the nurse anticipate a health care provider prescribing for treatment of refractory schizophrenia?

Rispiridone Rationale: Risperidone is effective for refractory schizophrenia, including negative symptoms. Trazodone, phenelzine, and amoxapine are antidepressants.

The nurse is teaching the patient taking an antithyroid medication to avoid foods high in iodine. Which food will the nurse advise the patient against?

Seafood

Because phenytoin was ordered stat for a client who was just admitted to the nursing unit from the emergency department, the nurse performs which of the following assessments?

Seizure activity, mental status, and respiratory status Rationale: Since the medication was ordered stat, one can presume the seizure disorder is unstable. The elements that would be of the greatest assistance to the nurse includes seizure activity, changes in mental status, and current respiratory status. To prevent toxicity, hydration needs to be attended to later along with the client's emotional needs. Although renal failure can be a side effect of the drug, impaired airway, changes in mental status, and the nature of seizure activity needs to be managed first. Although altered electrolyte status and leg edema may need attention if they occur, management of the seizure activity take priority first. The critical word in the question is stat. Recognize that phenytoin is an antiepileptic to choose the option that include seizure activity.

The nurse is preparing to administer amphotericin B IV to a client. What laboratory data is most important for the nurse to assess before initiating an IV infusion of this medication?

Serum potassium level Rationale: The nurse should obtain baseline potassium levels prior to beginning drug therapy because amphotericin B changes cellular permeability, allowing potassium to escape from the cell, which could lead to a decrease in the serum potassium level and severe hypokalemia.

Two hours after taking the first dose of penicillin, a client arrives at the emergency department complaining of feeling ill, exhibiting hives, having difficulty breathing, and experiencing hypotension. These findings are consistent with which client response that requires immediate action?

Severe acute anaphylactic response Rationale: Anaphylaxis related to penicillin can cause a life-threatening allergic response characterized by bronchospasm, laryngeal edema, and a precipitous drop in blood pressure. This client's ingestion of penicillin and presenting clinical picture indicate the client is having an acute reaction with respiratory difficulty.

Which assessment finding in a patient receiving nitrate therapy requires immediate nursing intervention?

Severe anemia Rationale: if a patient with severe anemia is administered nitrates, the vasodilatory effects of the nitrates can worsen the anemia. Headache is a side effect of nitrates therapy. Nitrates will minimize the frequency of angina episodes in a patient with ischemic heart disease.

What possible effect will the nurse anticipate in a patient who has received amphotericin B along with thiazide diuretics?

Severe hypokalemia Rationale: Administration of amphotericin B along with thiazide diuretics causes severe hypokalemia, because both drugs may cause loss of fluids and electrolytes. Administration of amphotericin B along with nephrotoxic drugs causes additive nephrotoxicity. Administration of amphotericin B along with thiazide diuretics causes a decreased adrenal cortex response to corticotrophin. Administration of voriconazole along with quinidine causes prolongation of the QT interval on an electrocardiogram

Which condition is a contraindication for the administration of acetaminophen?

Severe liver disease Rationale: A patient who has severe liver disease is unsuitable for the administration of acetaminophen. Hepatotoxicity is an adverse effect of acetaminophen. If it is administered in the patient who has liver disease, it increases the risk of liver failure. Acetaminophen is safe for a patient who has anemia, asthma, or joint pain.

A woman who lives in New York City is preparing to take a plane trip to China. She has been taking the SERM raloxifene (Evista) for 6 months. The nurse will provide which instructions to this patient?

She needs to stop taking the drug at least 72 hours before the trip. Rationale: A patient taking a SERM must be informed to discontinue the drug 72 hours before and during prolonged immobility so as to prevent the development of a thrombosis.

42-year-old client is admitted to the emergency department after taking an overdose of amitriptyline in a suicide attempt. Which drug should the nurse plan to administer to reverse the cardiac and central nervous system effects of amitriptyline?

Sodium Bicarbonate Rationale: Sodium bicarbonate is an effective treatment for an overdose of tricyclic antidepressants such as amitriptyline to reverse QRS prolongation

Which medication increases the duration of the action potential by prolonging repolarization in phase 3?

Sotalol Rationale: Sotalol increases the action potential duration by prolonging repolarization in phase 3. It also has beta-blocking properties. Verapamil acts by blocking the calcium channels. Flecainide blocks the sodium channel but does not have a pronounced effect on the duration of the action potential or repolarization. Adenosine acts by several mechanisms and does not fall under one particular category.

The nurse is providing care to a patient in the emergency department. The patient reports headache and weakness and is noted to have dysrhythmias on an ECG. The patient is talkative, restless, anxious, and asking to leave the emergency department. The nurse suspects that the patient might be taking which substance of abuse?

Stimulants Rationale: Stimulants of abuse include amphetamines and often are related to anxiety, talkativeness, headaches, and cardiac dysrhythmias.

During IV administration of dopamine, the nurse notes a bruise, "bluish in color," and edema at the intravenous (IV) insertion site on the patient's right arm. What is the nurse's priority action?

Stop the dopamine infusion. Rationale: Bruising and edema are signs of dopamine infiltration. The infusion should be stopped immediately to prevent further harm to the patient. After stopping the IV infusion, the health care provider can be notified. Another IV line will likely need to be started. However, the dopamine must be stopped first. After the dopamine is stopped, the arm will need to be elevated to reduce swelling.

What is the main anatomic area of the brain that is affected in a patient with Parkinson disease?

Substantia nigra Rationale: The substantia nigra is a part of the extrapyramidal system, which is involved in motor function, including posture, muscle tone, and smooth muscle activity. Dopamine depletion in this area causes Parkinson disease. The thalamus is the relay station for brain impulses. The cerebellum is the area of the brain involved in the regulation of muscle coordination. The globus pallidus is a structure adjacent to the substantia nigra and is not affected in patients with Parkinson disease.

During the initial nursing assessment history, a client tells the nurse that he is taking tetracycline hydrochloride for urethritis. The nurse is most concerned if the client reports taking which medication concurrently?

Sucralfate Rationale: Sucralfate is used to treat duodenal ulcers and will bind with tetracycline hydrochloride, inhibiting this antibiotic's absorption.

The nurse advises a patient to use sunscreen and wear a hat to avoid the sun between 10:00 AM and 4.00 PM. Which group of antibiotics is the patient most likely using?

Sulfonamide Rationale: TMS Sulfonamides, including cotrimoxazole and tetracyclines (especially demeclocycline), are more likely than other antibiotics to cause photosensitivity during their use. Photosensitivity is induced by exposure to sunlight during sulfonamide drug therapy. So the nurse advises the patient to use sunscreen and wear a hat. Allergic reactions to penicillins occur in 0.7% to 4% of treatment courses. The most common reactions are urticaria, pruritus, and angioedema. The safety profiles, contraindications, and pregnancy ratings of cephalosporins are similar to those of penicillins. The most commonly reported adverse effects are mild diarrhea, abdominal cramps, rash, pruritus, redness, and edema. No photosensitivity is seen here.

The nurse is preparing to administer phentolamine to treat extravasation of a vasoconstricting drug and is collecting the proper equipment. What equipment will the nurse need?

Syringe for subcutaneous injection Rationale: Phentolamine is administered by subcutaneous injection when given to treat extravasation of a vasoconstricting drug.

A 67-year-old client is discharged from the hospital with a prescription for digoxin, 0.25 mg daily. Which instruction should the nurse include in this client's discharge teaching plan?

Take and record radial pulse rate daily. Rationale: Monitoring pulse rate is very important when taking digoxin. The client should be further instructed to report pulse rates <60 or >110 beats/min and to withhold the dosage until consulting with the health care provider in such a case.

A 3-year-old boy is admitted to the emergency department after ingesting an unknown amount of phenobarbital elixir prescribed for his brother's seizure disorder. Which nursing intervention should the nurse implement first?

Take childs vital signs Rationale: Phenobarbital causes respiratory depression, so the priority intervention is assessment of vital signs

The health care provider prescribes oral contraceptives for a client who wants to prevent pregnancy. Which information is the most important for the nurse to provide to this client?

Take one pill at the same time every day until all the pills are gone. Rationale: To maintain adequate hormonal levels for contraception and enhance compliance, oral contraceptives should be taken at the same time each day. There is no strong pharmacokinetic evidence that shows a relationship between the category of broad-spectrum antibiotic use and altered hormone levels in oral contraceptive users, so option B is not indicated at this time. Abstinence is the best method to prevent pregnancy during the first cycle. If a client misses two pills during the first week, the client should take two pills a day for 2 days and finish the package while using a backup method of birth control until her next menstrual cycle.

A client with angina pectoris is instructed to take sublingual nitroglycerin tablets PRN for chest pain. Which instruction should the nurse include in the client's teaching plan?

Take one tablet at the onset of angina and stop activity. Rationale: Nitroglycerin tablets should be taken at the onset of angina, and the client should stop activity and rest. One tablet can be taken every 5 minutes, up to three doses. Nitroglycerin should be replaced every 3 to 6 months, not every 12 months. Nitroglycerin should provide relief in 5 minutes, not 30 minutes.

When providing teaching to a patient diagnosed with myasthenia gravis, which instruction regarding the administration of physostigmine (Antilirium) is most appropriate?

Take the medication 30 minutes before meals. Rationale: Drugs used for myasthenia gravis should be given about 30 minutes before meals to allow for onset of action and therapeutic effects (e.g., decreased dysphagia). Constipation, tachycardia, and hypertension are not effects of cholinergic medications. A missed dose should never be doubled.

The nurse is teaching a patient who has been prescribed a daily oral dose of prednisone about the medication regimen. How will the nurse tell the patient to take this medication to ensure safe administration? Select all that apply.

Taper dose to discontinue "Take it in the early morning." "Take with milk or food." Rationale: Glucocorticoids can cause gastrointestinal (GI) distress and should be administered with milk or food to minimize GI upset. Prednisone, which is a synthetic glucocorticoid, should be administered in the early morning, because the adrenal glands secrete the maximum amount of hormones during the early morning. This helps to prevent adrenal suppression. This drug is ulcerogenic; hence, the administration of aspirin and other nonsteroidal antiinflammatory drugs should be avoided, to prevent gastric irritation and gastric bleeding. It should not be administered early in the evening, because the adrenocortical secretion levels are low during evenings. This medication should not be administered on an empty stomach, because it would enhance the effects of gastric irritation.

While investigating the cause of sudden death in a patient with asthma, the nurse finds that the patient's medications were changed from systemic corticosteroids to inhaled corticosteroids. Which intervention, if followed, might have saved the patient from dying?

Tapering the dose of systemic corticosteroid Rationale: When a patient's medications are suddenly switched from systemic corticosteroids to an inhaled corticosteroid, adrenal suppression takes place. This leads to adrenal failure, which can be fatal. Death can be prevented by gradually reducing the dose of systemic corticosteroids, because this prevents the withdrawal symptoms. An initial high loading dose of inhaled corticosteroids may cause localized irritation and other adverse effects. However, the initial loading dose is usually preferred for the systemic administration of medications. By continuing the administration of same dose of systemic corticosteroids, the patient would have severe adverse effects from the synergistic effects of systemic and inhaled corticosteroids. Gradual reduction of dosage frequency may not help, because an initially large amount of drug might have been accumulated in the body and would have caused an adverse reaction in the patient.

The nurse knows that certain antipsychotic drugs cause extrapyramidal symptoms. Which extrapyramidal symptom is a permanent and irreversible adverse effect of long-term phenothiazine administration?

Tardive dyskinesia is a permanent effect of long-term phenothiazine administration. Rationale: Tardive dyskinesia is a permanent effect of long-term phenothiazine administration.

Which intervention is a priority for a patient who is taking highly active antiretroviral therapy (HAART)?

Teach adherence to the medication regimen Rationale: Although all of these interventions should be carried out, teaching adherence to the regimen is the highest priority.

A client who is receiving chlorpromazine HCl to control his psychotic behavior also has a prescription for benztropine. When teaching the client and/or significant others about these medications, what should the nurse explain about the use of benztropine in the treatment plan for this client?

The benztropine is used to control extrapyramidal symptoms. Rationale: Benztropine, an anticholinergic drug, is used to control extrapyramidal symptoms associated with chlorpromazine HCl (Thorazine) use.

Methenamine mandelate is prescribed for a client with a urinary tract infection and renal calculi. Which finding indicates to the nurse that the medication is effective?

The frequency of urinary tract infections decreases. Rationale: Mandelamine is prescribed to acidify the urine, decreasing the incidence of calcium phosphate calculi and urinary tract infections.

A patient is admitted to the hospital in an unconscious state caused by an overdose of benzodiazepines. The nurse administers flumazenil, and the patient regains consciousness but becomes unconscious again after some time. What is the reason for the patient becoming unconscious again?

The half-life of flumazenil is short. Rationale: Flumazenil has a short half-life, and its duration of effect is 1 to 4 hours. Therefore, the dose of the reversal drug may wear off and the patient may become unconscious again. Administration of flumazenil in higher doses is required for recovery when the patient becomes unconscious again. Consuming alcohol along with benzodiazepines results in hypotension and respiratory depression. Administration of 0.2 mg (2 mL) of flumazenil IV over 15 seconds is required for reversal of moderate sedation or general anesthesia.

A patient with hypercholesterolemia is prescribed lovastatin. After reviewing the patient's medical history, the nurse discovers that the medication is not safe to prescribe for the patient and reports this finding to the health care provider. What did the nurse find in the patient's medical history?

The patient has hepatic disease. Rationale: Lovastatin can cause an increase in liver enzymes and should not be prescribed to patients with preexisting liver disease. Statins induce cell death in malignant cells. Cell death occurs via apoptosis, and lovastatin concentrations are used in the treatment of leukemia. Statins slow down the progress of chronic kidney disease by reducing kidney inflammation or improving the function of kidney tissues. Statins reduce chronic obstructive pulmonary disorder (COPD). Lovastatin can be prescribed to the patient with leukemia, renal disease, and COPD.

A patient has been receiving donepezil for several weeks. Which finding indicates the medication is having a therapeutic effect?

The patient has increased cognition. Rationale: Donepezil is used to treat Alzheimer's disease, a disorder of decreased acetylcholine levels in the brain. It can increase cognition. The other responses are not evidence of a therapeutic effect from donepezil.

The nurse notes that the patient has an increased blood glucose level, increased blood pressure (BP), and abnormal cholesterol levels. What does the nurse infer from these observations?

The patient has metabolic syndrome. Rationale: Increased blood glucose level, increased BP, and abnormal cholesterol levels are the symptoms of metabolic syndrome. Thus, the nurse concludes that the patient has metabolic syndrome. Mania, dystonia, and dyskinesia are not characterized by increased blood pressure and abnormal cholesterol levels. Mania is a condition that involves an expansive emotional state, including extreme excitement, elation, hyperactivity, agitation, and anorexia. Dystonia refers to the condition of abnormal muscle contraction that produces repetitive involuntary twisting movements and abnormal posturing of the neck, face, trunk, and extremities. Dyskinesia refers to the condition of abnormal and distressing involuntary movement.

The nurse has administered bethanechol to a patient with hypotonic bladder. What assessment finding indicates a therapeutic response?

The patient has micturition within an hour. Rationale: Patients with hypotonic bladder have urinary retention. Therefore to determine the efficacy of the drug, the nurse should reassess the patient after administering the medication. If the patient has micturition within 60 minutes of administering the medication, it indicates that the medication has had the desired therapeutic effect. Cholinergic medications prevent constipation by increasing gastric motility. These drugs may cause an increase in the bowel sounds. Bronchoconstriction is an adverse effect of the drug; when this occurs, the patient may have a change in respiratory rate; however, these changes are not the expected therapeutic effects of a patient who has hypotonic bladder. Hypotension is an adverse effect of cholinergic medications such as bethanechol.

A patient with hyperlipidemia is treated with atorvastatin. On the follow-up visit, the nurse discovers that the patient has had no improvement in cholesterol levels. What could be the reason for this?

The patient is taking the medication in the morning. Rationale: Patients who take statins such as atorvastatin should be taught to take the medication in the evening to get the best effects. The drug increases the risk of rhabdomyolysis, but having a history of this disorder does not cause the drug to be ineffective. The use of gemfibrozil and statins together is not recommended due to increased risk for rhabdomylosis, not increasing cholesterol levels. Grapefruit juice increases the risk of rhabdomyolysis, but only if more than 1 quart per day is taken.

A patient was administered succinylcholine for intubation during surgery. The patient complains of muscle pain 2 days after the surgery. What does the nurse interpret from this?

The patient may have hyperkalemia. Rationale: Succinylcholine is a neuromuscular blocking agent. The muscle paralysis induced by succinylcholine is sometimes preceded by muscle spasms and injury to muscle cells. Injury to muscle cells releases potassium ions in the bloodstream, thereby leading to hyperkalemia. Myasthenia gravis is a disease characterized by chronic muscular weakness. Muscle pain is not a symptom of an allergic reaction. Tachypnea, tachycardia, and muscular rigidity are symptoms of malignant hyperthermia, which occurs during administration of anesthesia. This is an adverse metabolic reaction to general anesthetic. Because the nurse did not find these symptoms in the patient, the patient does not have malignant hyperthermia.

The clinical report of a patient who is undergoing estrogen therapy indicates thrombosis. Which event may the nurse suspect as the cause of thrombosis?

The patient smokes cigarettes. Rationale: Smoking causes thrombosis in patients who undergo estrogen therapy. Thrombosis is not caused by a decrease in fluids. Herbal medicines such as St. John's wort decrease the estrogenic effect of drugs. The use of estrogen therapy with tricyclic antidepressants causes toxicity of the antidepressant.

The nurse interprets a patient's international normalized ratio (INR) value of 2.5. What is the meaning of this reported value?

The patient's warfarin dose is therapeutic. Rationale: INR determination is a routine test to evaluate coagulation while patients are taking warfarin, not heparin. A therapeutic INR is 2 to 3.

A patient is receiving carbamazepine to treat trigeminal neuralgia. What assessment indicates a therapeutic response to the medication?

The pt states there is no facial pain Rationale: Carbamazepine is indicated in the treatment of trigeminal neuralgia (a painful facial nerve condition). If the patient relates no facial pain, this is a therapeutic response to the medication. The medication is not used to assist a patient in walking or relieving foot pain or dizziness. It is also a first-line treatment for partial and generalized seizures.

What is the medication dose of atropine that is used for symptomatic bradycardia?

The recommended dose of atropine to treat symptomatic bradycardia is 0.5 to 1 mg.

The nurse is assessing a patient diagnosed with bipolar disorder who has been prescribed lithium carbonate. On reviewing the laboratory reports of the patient, the nurse suspects that the drug has a risk of causing cardiac dysrhythmia. What is the reason for reaching such a conclusion?

The sodium level of the patient was 160 mEq/L. Rationale: Lithium carbonate is a mood stabilizer and is used for the treatment of bipolar disorder. Because lithium and sodium are monovalent ions, the therapeutic levels of lithium can be maintained by having normal levels (135 to 145 mEq/L) of sodium. Increased sodium levels in the blood (160 mEq/L) lead to lithium intoxication and may cause cardiac dysrhythmia. The sodium levels of 142 mEq/L, 140 mEq/L, and 138 mEq/L are within the normal range. Therefore these levels are not associated with the adverse effects of lithium carbonate therapy and do not cause cardiac dysrhythmia

A 45-year-old female client is receiving alprazolam for anxiety. Which client behavior would indicate that the drug is effective?

The staff observes the client sitting in the day room reading a book. Rationale: The ability to sit and concentrate on reading indicates decreased anxiety

What is the ratio between a drug's therapeutic effects and toxic effects called?

Therapeutic index Rationale: The ratio of a drug's therapeutic benefits to its toxic effects is referred to as the drug's therapeutic index.

Which supplements are given to a patient who has severe alcohol withdrawal syndrome? Select all that apply.

Thiamine Magnesium Rationale: High temperature and elevated blood pressure are the common signs of alcohol withdrawal. Therefore to maintain normal body temperature and stabilize blood pressure, patients are supplemented with the amino acids thiamine and magnesium based on the severity of the withdrawal symptoms. Iron supplements are given to patients with conditions such as anemia. Calcium supplements are given to treat bone disorders. Dextrose is given in patients as a part of fluid replacement.

A client being treated for an acute myocardial infarction is to receive the tissue plasminogen activator alteplase. The nurse would be correct in providing which explanation to the client regarding the purpose of this drug?

This drug is a clot buster that dissolves clots within a coronary artery. Rationale: t-PA, or tissue plasminogen activator, is a coronary-specific fibrinolytic agent that dissolves clots within the coronary arteries. This drug is not a calcium channel blocker or nitrate, which would promote vasodilation of the coronary arteries. This medication is not an anticoagulant, such as warfarin or heparin, which would prevent new clot formation. Volume expansion is not provided by an infusion of t-PA and would not necessarily improve myocardial perfusion caused by an increased cardiac output in a client with coronary artery disease.

What is the goal of pharmacologic therapy in treating Parkinson's disease?

To balance cholinergic and dopaminergic activity in the brain Rationale: Parkinson's disease results from a decrease in dopaminergic (inhibitory) activity, leaving an imbalance with too much cholinergic (excitatory) activity. By increasing dopamine, the neurotransmitter activity becomes more balanced and symptoms become controlled.

A patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The nurse knows that the purpose of the metformin, in this situation, is which of these?

To decrease insulin resistance Rationale: Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; and improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance.

What is the primary indication for the use of calcium channel blockers (CCBs)?

To decrease the workload of the heart Rationale: CCBs decrease afterload and reduce the workload of the heart by decreasing muscle contraction and promoting muscle relaxation. CCBs do not prolong the QT interval. CCBs are contraindicated in patients with acute MI. Some calcium channel blockers decrease elevations in heart rate; however, this is not the primary indication for the use of calcium channel blockers.

What are the uses of cholinesterase inhibitors? Select all that apply.

To diagnose and treat myasthenia gravis To be used as an antidote in biochemical warfare To be used as an antidote to tricyclic antidepressant toxicity Rationale: When used therapeutically, cholinesterase inhibitors, such as physostigmine, affect the muscarinic receptors and nicotinic receptors of the neuromuscular junction, thereby helping restore acetylcholine to the level needed for nerve impulse transmission. Because patients with myasthenia gravis lack sufficient release of acetylcholine at the neuromuscular junction, administration of physostigmine helps improve muscle strength by decreasing the destruction of acetylcholine. Due to its capacity to restore the acetylcholine level, this medication is useful as an antidote to biochemical warfare involving anticholinergic agents, as well as in tricyclic antidepressant toxicity. Physostigmine therapy is contraindicated in patients with insomnia or bronchoconstriction.

A primary health care provider instructs a nurse to administer vancomycin to a patient. The nurse administers intravenous vancomycin to the patient over 1 hour. Why will the nurse do this?

To prevent hypotension and redman syndrome Rationale: Rapid infusion of vancomycin may precipitate hypotension as well as cause red man syndrome. Therefore, intravenous vancomycin should be infused slowly. Vancomycin does not cause edema during administration. However, edema may be observed because of nephrotoxicity when the drug is given in excess. Hemolysis and abdominal flatulence are not major effects observed during infusion of vancomycin. Vancomycin does not affect the structural integrity of red blood cells. Abdominal flatulence is a common adverse effect associated with quinolones.

A client with metastatic cancer reports severe continuous pain. Which route of administration should the nurse use to provide the most effective continuous analgesia?

Transdermal Rationale: Continuous pain is best managed by maintaining a constant serum drug level. Transdermal drug administration of an analgesic provides around-the-clock, controlled release of the medication that is absorbed through intact skin into the bloodstream to provide continuous pain relief.

Which conditions are indications for the use of propranolol? Select all that apply.

Tremor Migraine Hypertension Rationale: In addition to its use after a myocardial infarction and for hypertension, propranolol has been used for the treatment of tachydysrhythmias associated with cardiac glycoside intoxication and for the treatment of hypertrophic subaortic stenosis, pheochromocytoma, thyrotoxicosis, migraine headache, essential tremor, and many other conditions. Contraindications to the use of beta blockers include known drug allergies and may include uncompensated heart failure, cardiogenic shock, heart block or bradycardia, pregnancy, severe pulmonary disease, and Raynaud's disease.

Which postoperative nursing action will help the patient recover from the effects of anesthesia?

Turning, coughing, and deep breathing every 2 hours Rationale: Turning, coughing, and deep breathing can help prevent postoperative atelectasis, a sequela of generalized anesthesia and mechanical ventilation.

Which are expected clinical manifestations of hypomagnesemia? Select all that apply.

Twitching Hyperactive reflexes Rationale: Hypomagnesemia is the medical term for low levels of serum magnesium. It causes involuntary muscle contraction and relaxation, resulting in twitching. Hypomagnesemia can also cause central nervous system excitability and result in hyperactive reflexes. Edema can be caused by many factors but is not a clinical manifestation of low magnesium levels. Anorexia is sometimes associated with low levels of potassium, but not low levels of magnesium. Insomnia is a side effect of nesiritide but is not caused by low magnesium.

The nurse would question an order for steroids in a patient with which condition?

Uncontrolled diabetes mellitus Rationale: A common side effect of steroid therapy is hyperglycemia; therefore uncontrolled diabetes mellitus is a contraindication to steroid therapy.

A client with chronic gouty arthritis is talking allopurinol, 100 mg PO daily. Which laboratory serum level should the nurse report to the health care provider to determine the therapeutic outcome?

Uric Acid level Rationale: The primary therapeutic outcome associated with allopurinol therapy is reduced serum uric acid levels with a lower frequency of acute gouty attacks, so option B should be reported to the health care provider.

A client has begun taking an anticholinergic medication. The nurse should make it a priority to assess for which of the following manifestations?

Urinary retention, hesitancy, and constipation Rationale: Anticholinergic medications block the action of acetylcholine, resulting in decreased stimulation in the GI and urinary tract systems. This leads to urinary and bowel problems such as urinary retention, hesitancy, and constipation. Anticholinergic drugs stimulate the parasympathetic system and tachycardia and hypertension indicate sympathetic system stimulation. Cholinergic agonists, not anticholinergics, cause biliary contractions. Renal colic is also more commonly associated with cholinergic aggonists rather than anticholinergics. Correlate the nature of the drug category with the signs and symptoms. Specific knowledge of this category is needed to answer this question.

A patient with Parkinson's disease is discussing a recent bout of insomnia with the nurse. The patient asks if he can take an old prescription he has to treat insomnia. What does the nurse know about the use of benzodiazepines in patients taking levodopa?

Use of benzodiazepines decrease the therapeutic effect of the levadopa and may result in an increase in the symptoms of Parkinson's disease Rationale: Benzodiazepines interact with levodopa to cause reduced levodopa effects and an increase in the symptoms of Parkinson's disease

The nurse prepares to collect the health history of a patient with narcolepsy. Which strategy should be used to complete this assessment?

Use short, focused interview sessions with active participation by the patient Rationale: A patient with narcolepsy will be drowsy or fall asleep easily. To obtain accurate information, the nurse should keep the dialogue short and focused. Narcolepsy is an incurable neurologic condition in which patients unexpectedly fall asleep in the middle of normal daily activities. For this reason, it is difficult for patients to complete a structured form. Seeking information from significant others may not always work. Using the patient's past medical information may be helpful, but few critical factors may be missed if the patient is not interviewed.

A psychiatric client is discharged from the hospital with a prescription for haloperidol. Which instruction should the nurse include in the discharge teaching plan for this client?

Use sunglasses and sunscreen when outdoors Rationale: Photosensitivity is a common adverse effect of haloperidol (Haldol); therefore, the use of sunglasses and sunscreen should be included in the discharge teaching for this client

The nurse received an order to start intravenous (IV) heparin on a client admitted with deep vein thrombosis. To implement this order appropriately, what action should the nurse take?

Utilize infusing pump to administer the drug. Rationale: Because of the risk to the client, heparin administration requires the use of an infusion pump in order to maintain a safe an accurate level of medication. Vitamin K is the antidote for warfarin overdose; protamine sulfate is the heparin antagonist and should be used when reversal is indicated. When administering in within the safe dosage range, there is little risk of GI bleeding. Hence, the client does not have to be NPO. If using weight-based therapy, it is important to weigh the client once a day at the same time with the same scale to verify accuracy.

Phosphodiesterase inhibitors have an added advantage in treating heart failure. The drugs cause a positive inotropic effect and what other effect?

Vasodilation Rationale: Phosphodiesterase inhibitors are also called inodilators because they have both positive inotropic and vasodilator effects.

A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization?

Vastus lateralis

A patient has been prescribed lidocaine (Xylocaine). What does the nurse understand as the reason for this medication order?

Ventricular arrhythmias Rationale: Lidocaine is a sodium channel-blocking drug used specifically to treat ventricular arrhythmias.

When administering a sublingual medication, which action will the nurse perform?

Wear gloves to place the tablet under the patient's tongue Rationale: Standard precautions require the wearing of gloves when placing a tablet under a patient's tongue. The patient should not chew a sublingual tablet and should not drink or swallow until the tablet is completely dissolved and absorbed.

The nurse should teach which of the following items of information to a client being discharged on long-term warfarin therapy following cardiac valve replacement surgery?

Wear shoes that completely enclose the feet. Rationale: Because of the high risk for bleeding, the client should protect the feet from injury. Lettuce and tomatoes do not contain enough vitamin K to interact negatively with warfarin and so they do not need to be limited. Yellow wax beans do not contain a significant amount of vitamin K so they can be eaten freely. Aspirin increases the risk of bleeding and therefore should not be used while taking an anticoagulant such as warfarin. Foods high in Vitamin K are kale, spinach, natto (fermented soybeans), brussels sprouts, broccoli, scallions, cabbage, dairy (fermented), prunes, cucumbers, and dried basil.

When teaching a patient regarding the administration of digoxin, the nurse instructs the patient not to take this medication with which food

Wheat Bran Rationale: Large amounts of bran taken with digoxin will decrease and negatively impact the drug's absorption.

When assessing for cardiovascular effects of an adrenergic (sympathomimetic) drug, the nurse understands that these drugs produce

a positive inotropic, positive chronotropic, and positive dromotropic effect Rationale: Adrenergic stimulation of the beta1-adrenergic receptors on the myocardium and in the conduction system of the heart results in an increased heart rate (positive chronotropic effect), increased contractility (positive inotropic effect), and increased conductivity (positive dromotropic effect).

When teaching a patient about beta blockers such as atenolol (Tenormin) and metoprolol (Lopressor), it is important to inform the patient that

abrupt medication withdrawal may lead to a rebound hypertensive crisis Rationale: Abrupt withdrawal of a beta-blocking drug can cause rebound hypertension. These drugs should be gradually decreased.

Drug half-life is defined as the amount of time required for 50% of a drug to?

be eliminated by the body. Rationale:

Drug half-life is defined as the amount of time required for 50% of a drug to

be eliminated by the body. Rationale: In pharmacokinetics, the time required for half of an administered dose of drug to be eliminated by the body, or the time it takes for the blood level of a drug to be reduced by 50%, is the drug's half-life (also called elimination half-life).

A patient has started on a fentanyl patch. After 3 hours, the patient continues to complain of pain of "8 on a scale of 0 to 10." What is the nurse's best action?

call HCP Rationale: The fentanyl patch takes 6 to 12 hours to reach steady-state pain control after the first patch is applied. The nurse should call the primary health care provider for a medication to control pain immediately until the full effect of the patch is realized. The nurse should not change the patch, because it would then take longer for the patient to achieve pain control. The nurse should not administer naloxone, because this is not symptomatic of an overdose. The addition of a second patch would constitute an overdose.

The nurse is providing care to a patient following a non-accidental traumatic brain injury. The patient has developed diabetes insipidus due to the injury. What medication is most often used in the management of diabetes insipidus?

desmopressin (DDAVP) Rationale: Vasopressin (Pitressin) and desmopressin (DDAVP) are used to prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with diabetes insipidus caused by a deficiency of endogenous antidiuretic hormone.

The nurse reviews a patient's laboratory values and finds a digoxin level of 10 ng/mL and a serum potassium level of 6.2 mEq/L. The nurse would notify the health care provider and anticipate administering

digoxin immune Fab. Rationale: Digoxin immune Fab is indicated for severe digoxin toxicity as evidenced in this question by a digoxin level of 10 ng/mL and hyperkalemia.

The physician has ordered dopamine to treat the patient's hypovolemic shock secondary to severe blood loss. For the medication to be effective, the physician must also order

fluid replacement Rationale: Dopamine increases blood pressure secondary to vasoconstriction, which has a limited effect if there is not enough volume within the circulatory system.

The nurse administering donepezil (Aricept) to a patient understands that the expected therapeutic action of this drug is to

increase levels of acetylcholine in the brain by blocking its breakdown. Rationale: Donepezil is used to treat Alzheimer's disease, a disorder of decreased acetylcholine levels in the brain. Donepezil is an indirect-acting anticholinesterase drug.

Highly protein-bound drugs

increase the risk of drug-drug interactions. Rationale: When administering two medications that are highly protein bound, the medications can compete for binding sites on plasma proteins. This competition results in either less of both or less of one of the drugs binding to the proteins, thus increasing the risk of toxicity.

Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours?

insulin glargine (Lantus) Rationale: Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas

A patient is being treated for secondary amenorrhea. The nurse expects which drug to be used to treat this problem?

medroxyprogesterone (Provera) Rationale: Medroxyprogesterone, a progestin, is one of the drugs most commonly used for secondary amenorrhea.

The nurse is caring for a patient scheduled to undergo a cardiac catheterization procedure utilizing iodine-based contrast material. The nurse would question an order for which medication to be given to this patient the day of the scheduled procedure?

metformin (Glucophage) Rationale: The concurrent use of metformin and iodinated (iodine-containing) radiologic contrast media has been associated with both acute renal failure and lactic acidosis. Therefore metformin should be discontinued at least 48 hours prior to any radiologic study requiring such contrast media and should be held for at least 48 hours after the procedure.

Which medication is used to treat a patient suffering from severe adverse effects of a narcotic analgesic?

naloxone (Narcan) Rationale: Naloxone is the narcotic antagonist that will reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

The nurse would plan to administer which calcium channel blocker to a patient with cerebral artery spasms following a subarachnoid hemorrhage?

nimodipine (Nimotop) Rationale: Nimodipine crosses the blood-brain barrier and has a greater effect on the cerebral arteries than on other arteries in the body; thus, it is indicated for the treatment of cerebral artery spasm following subarachnoid hemorrhage.

Patients prescribed sildenafil (Viagra) should be instructed regarding the potential fatal drug interaction with which medication(s)?

nitroglycerin Rationale: When taken in conjunction with nitroglycerin, sildenafil can cause severe hypotension unresponsive to treatment.

The nurse admitting a patient with acromegaly anticipates administering which medication?

octreotide (Sandostatin) Rationale: Octreotide suppresses growth hormone, the culprit of acromegaly.

During a postpartum assessment, the nurse notes a boggy uterus and increased vaginal bleeding. Based upon this assessment and standing physician orders, the nurse prepares to administer which medication?

oxytocin (Pitocin) Rationale: Oxytocin is a uterine stimulant that causes uterine contractions, which would decrease the vaginal bleeding.

The nurse assesses the intravenous infusion site of a patient receiving dopamine and finds it is infiltrated. The nurse will prepare which medication to treat this infiltration?

phentolamine (Regitine) Rationale: Phentolamine is an alpha blocker that causes vasodilation, thus counteracting the vasoconstrictive effects of the infiltrated dopamine. The vasodilation will increase blood flow to the site and decrease the risk of tissue necrosis.

During assessment of a patient diagnosed with pheochromocytoma, the nurse auscultates a blood pressure of 210/110 mm Hg. The nurse would expect to administer which medication?

phentolamine (Regitine) Rationale: Phentolamine is a potent alpha-blocking drug specifically effective for treatment of hypertension associated with pheochromocytoma.

ACE inhibitors and angiotensin receptor blockers both work to decrease blood pressure by

preventing aldosterone secretion Rationale: ACE inhibitors block the formation of angiotensin II, whereas angiotensin receptor blockers allow the formation of angiotensin II but block its effect at the receptors. Without the receptors stimulated (because of either drug), aldosterone is not produced, diminishing the reabsorption of sodium and water.

What is another approved and indicated use for bupropion, a second-generation antidepressant?

smoking cessation Rationale: Zyban is a sustained-release form of bupropion that is useful in helping patients quit smoking.

A patient using Afrin nasal spray complains of worsening cold symptoms and tells the nurse, "I don't understand why this is not working. I am using it almost every 3 hours!" The nurse's response is based on knowledge that

the patient is suffering from rebound congestion related to excessive use of the Afrin nasal spray. Rationale: Afrin nasal spray is a sympathomimetic drug with both alpha- and beta-adrenergic effects. The alpha-adrenergic activity is responsible for causing vasoconstriction in the nasal mucosa. However, excessive use of nasal decongestants can lead to greater congestion because of a rebound phenomenon that occurs when use of the product is stopped.

What medications are used for overactive bladder because of their decreased incidence of side effects such as dry mouth? Select all that apply.

trospium solifenacin darifenacin fesoterodine Rationale: Newer drugs for treating overactive bladder include trospium, solifenacin, darifenacin, and fesoterodine. The newer drugs are associated with a much lower incidence of dry mouth, in part because of their pharmacologic specificity for the bladder as opposed to the salivary glands. Oxybutynin is an older drug with more side effects.

The health care provider prescribes cisplatin to be administered in 5% dextrose and 0.45% normal saline with mannitol added. Which assessment parameters would be most helpful to the nurse in evaluating the effectiveness of the therapy?

urine output Rationale: The effectiveness of the diuresis is best measured by urine output. Mannitol, an osmotic diuretic, is given during cisplatin therapy to promote diuresis and reduce the risk of nephrotoxicity and ototoxicity associated with this chemotherapeutic agent

Which is the characteristic feature of rapid eye movement (REM) rebound sleep?

vivid dreams Rationale: REM rebound is an abnormally large amount of REM sleep that often leads to frequent and vivid dreams. Bedwetting and sleepwalking may occur in stage 4 non-REM sleep. At this stage, it is very difficult to wake a person. Daytime fatigue occurs in cases of REM interference, which is a reduction in the cumulative amount of REM sleep as a result of prolonged sedative-hypnotic use.

A patient with a herpes simplex virus type 1 (HSV-1) infection must apply topical acyclovir to the lesions. What instructions should the nurse provide to the patient to help prevent the transmission of HSV-1? Select all that apply.

"Apply the ointment with a clean, gloved hand." "Avoid applying the ointment to multiple lesions." "Do not touch the ointment after touching the lesion." "Use a new part of the hand each time after touching the container." Rationale: To help prevent transmission of HSV-1, the nurse instructs the patient to wear fresh gloves to apply the medication and to touch the container of ointment with a different, fresh part of the glove's surface each time. This means that the patient should not touch the lesion and then touch the container, because this will contaminate the container with HSV-1. The nurse also instructs the patient to apply ointment to each lesion individually, meaning that the patient should use a fresh surface to move the ointment from the container to the lesion. The nurse instructs the patient to consider the gloved hand contaminated after touching a lesion with it and to use a new, fresh surface to move the ointment to the next lesion.

While screening an elementary school's faculty for hypertension, the nurse detects high blood pressure in a 32-year-old female client. What question is most appropriate for the nurse to ask the client at this time?

"Are you currently taking an oral contraceptive?" Rationale: Oral contraceptives are the most common cause of secondary hypertension in females of reproductive age. Although the actual cause of hypertension is unknown, psychological stress may be associated with it, but is not currently considered a primary cause. It is too early to tell if the client will need medication therapy, or whether lifestyle changes alone will be effective treatment. Hyperlipidemia tends to contribute to hypertension across populations but again is not the priority question of concern.

Which question should the nurse ask a client prior to the initiation of treatment with IV infusions of gentamicin sulfate?

"Are you having difficulty hearing?" Rationale: Complications of gentamicin sulfate therapy include ototoxicity, nephrotoxicity, and neurotoxicity. Determining if the client is hard of hearing prior to initiation of this aminoglycoside will be helpful as the treatment progresses and ototoxicity is identified as a possible complication.

Two months after beginning drug therapy with alprazolam 2 mg PO BID for generalized anxiety, an adult client states, "I feel much better, but I can't believe how dry my mouth gets and how dizzy and lightheaded I get." Which of the following would be the priority response by the nurse?

"Because the dizziness and lightheadedness are side effects of the drug, avoid dangerous activities." Rationale: Without proper instructions the client may perform activities such as driving or use of equipment that could lead to injury if the client was experiencing dizziness and lightheadedness. Dry mouth is an uncomfortable side effect, but if unresolved would not place the client at the greatest risk. Side effects may be dose-related during early high-dose therapy, but client has been taking the drug for 2 months and "high dosage" is 8 mg/day. The medication has no known GI effects so it does not need to be taken with food. Need to determine first that the issue of dizziness and lightheadedness is more serious than dry mouth. Then compare each of the options to find the statement that provides guidance to the client to maintain safety. Another way to approach this question would be to ask, "The client would be at greatest risk if which intervention was not initiated?"