Pharmacology Unit 3

CH. 14 George Orland is a 59-year-old salesman working at a local insurance company in the community. Due to the economy, his income has dropped significantly because it is partially based on commission and he is worried that he is not able to provide for his family. He begins to experience insomnia, difficulty concentrating, and other symptoms related to his anxiety. His healthcare provider prescribes a short-term course of lorazepam (Ativan) to help him through this difficult period. 1. What adverse effects are associated with this drug therapy? 2. What information should George receive about this medication? 3. What nonpharmacologic measures can the nurse recommend to George to assist him in feeling better about his current situation?

1. Adverse effects associated with lorazepam (Ativan) includedizziness, ataxia, drowsiness, blurred vision, vertigo, sedation, and confusion. These effects are dose related and tolerance to them may develop as therapy progresses. 2. The patient should be instructed to avoid performing potentially hazardous activities (e.g., driving) that require alert mental status until the effects of the drug are known. The drug should not be stopped abruptly and other CNS depressants such as alcohol and antihistamines must be avoided while the drug is used. 3. The nurse can make several suggestions to George: Encourage complementary non-pharmacologic strategies for stress reduction such as daily walking or other moderate exercise; refer George to the appropriate the social service agency (e.g., local workforce development) for possible employment opportunities; encourage group or individual behavioral therapy if desired.

CH. 31 Caroline Roberts is a 59-year-old woman who has just flown home from visiting her children and grandchildren on the opposite coast from where she currently lives. She noticed soreness in her left calf muscle, and when she noticed increased pain and swelling in her leg, she made an appointment with her healthcare provider. A diagnosis of DVT is made and the treatment plan is to admit her into the hospital for anticoagulant therapy. 1. Mrs. Roberts asks, "How soon will the heparin dissolve my blood clot?" How would you respond to this question? 2. What patient education should you provide Mrs. Roberts about anticoagulation therapy? 3. What factors predisposed this patient to DVT?

1. Anticoagulants do not dissolve blood clots that have already formed. The human body has a natural mechanism called fibrinolysis. This mechanism will slowly and naturally dissolve any blood clots. However, in the meantime, the heparin will prevent the existing clot from increasing in size. 2. The major emphasis for patients receiving anticoagulation therapy is to prevent injury that may result in internal or external bleeding. A few of the patient education tips that you will want to share with Mrs. Roberts include: Avoid activities that may cause traumatic injury. Use soft cloths and mild soap when bathing. Avoid wearing clothing that is tight or rubs. Avoid blowing or picking the nose. Avoid rectal suppositories or enemas. Watch for bleeding and examine all body fluids for the presence of blood. Avoid drugs that contain aspirin, NSAIDs, and other anticoagulants. 3. Long airplane flights can be problematic, especially for patients who have varicose veins (varicosities). People who travel on flights that last 8 hours or more are 4 times more likely to develop DVT. Air travel may increase the risk of DVT through prolonged sitting and pressure on the calves by the passenger's seat, dehydration as a result of low humidity in the cabin and the consumption of alcohol and caffeine, and decreased air pressure in the plane's cabin.

CH. 38 Ramon de la Cruz is a 27-year-old financial analyst who has recently begun chemotherapy for treatment of Hodgkin's lymphoma. He has tolerated the chemotherapy fairly well but has experienced mild, daily nausea with occasional vomiting, usually controlled by granisetron (Kytril). His main concern is the fatigue he experiences and the impact it has on his work. He also admits that he has been experiencing anorexia and "just doesn't feel like eating much," something which may be contributing to his fatigue. He has lost 2 kg (more than 4 lb) since his last clinic visit 2 weeks ago. 1. As Ramon's nurse, how might you manage his chemotherapy-related nausea and anorexia? 2. What suggestions might assist Ramon in managing his fatigue?

1. As the nurse, you should assess whether Ramon is taking the antinausea drug granisetron (Kytril) regularly or on a prn basis. If he consistently experiences nausea, taking the drug regularly rather than prn may provide better results. Additional antiemetic therapy, perhaps supplementing or switching to another drug group, may be needed. Small sips of ginger ale, without carbonation if desired, may also help relieve nausea. Supplementing his diet with high-protein drinks and eating smaller, more frequent meals may increase oral and caloric intake. Ramon may benefit from a dietary consult, and you could explore this option with him. Improved fluid and caloric intake will keep him in optimal health during the time of his chemotherapy and may help to reduce some of the drug-related fatigue. 2. If Ramon's job allows him to work at home, this might be a viable option during periods of extreme fatigue. Frequent rest breaks while at work, especially if a break room is available in which to lie down, may allow Ramon to continue to work during this time. His employer may be able to offer a shortened workweek, and he could explore medical leave options with the Human Resources department. If there are financial concerns, a social services referral may be advisable.

CH. 20 Isabel Turken is a 76-year-old retired school nurse. She has been married to Richard for 53 years, and they have three grown children who live within 25 miles of them. Isabel's physical health has been good. She has mild hypertension and had colon cancer successfully treated 20 years ago with no recurrence. Richard makes an appointment with Isabel's healthcare provider because he has noticed signs of decreasing mental acuity and increasing confusion over the past year. Isabel's physical exam is negative, but the healthcare provider suspects that she is experiencing the early stages of AD. Isabel is started on donepezil (Aricept), 5 mg at bedtime. 1. What information should be included in the initial assessment in order to determine a diagnosis for Isabel? 2. What recommendations will the healthcare provider most likely make to Isabel and her husband? 3. What should Richard be alert for with regard to the donepezil?

1. A complete physical exam and laboratory studies are necessary to determine any electrolyte imbalances, diabetes, or other conditions that may be present. A complete personal history, as well as a family history, is necessary to determine if any other close family members may have or had AD. The assessment should also include cognitive rating scale measurements and assessment of individual and family coping skills. A referral to social services agencies or respite care may be needed. 2. The healthcare provider will probably recommend that Isabel begin taking one of the medications used to treat early AD, such as donepezil. Measures to ensure her safety and the safety of others should be taken. This includes making sure that she does not drive or leave home alone; leave pots cooking on the stove; or leave water running in the sink or tub. A bedside commode nearby may assist Isabel with toileting if she has confusion or difficulty with walking. Furniture, clothing and other belongings, and routines at home must be kept the same as much as possible, including where items are stored and which people come into the home. 3. Donepezil may cause some common adverse effects: headache, fatigue, insomnia, nausea, vomiting, diarrhea, anorexia, and abdominal pain. Other adverse effects include vertigo, depression, irritability, syncope, bradycardia, dehydration, incontinence, and blurred vision. Richard will have to be alert for anorexia and encourage Isabel to eat if she loses weight. If she is unable to sleep, she may begin to wander, so he may have to install different locks on the doors.

CH. 32 Dave Sweeney is a 59-year-old patient with chronic kidney disease who has been on dialysis for 1 year while awaiting a kidney transplant. He has begun to receive injections of epoetin alfa (Epogen, Procrit) and asks the nurse why he must receive the injections. 1. As the nurse, how would you answer Mr. Sweeney's question? 2. What teaching points would you include about this drug when providing education for Mr. Sweeney?

1. Patients with CKD often have decreased secretion of erythropoietin from the kidneys and therefore require a medication such as epoetin alfa (Epogen) to stimulate RBC production and reduce the potential of becoming anemic, or to decrease the effects of anemia. 2. Teaching points should include the importance of monitoring the blood pressure for HTN and monitoring for adverse effects such as nausea, vomiting, constipation, or redness or pain at the injection site. Any confusion, numbness, chest pain, or difficulty breathing should be immediately reported to the healthcare provider. The patient should also be instructed to maintain a healthy diet and follow any dietary restrictions necessary because of CKD.

CH. 21 Check your understanding What is a major drawback to all of the centrally acting muscle relaxant drugs used to treat muscle spasms or spasticity?

All of the centrally acting drugs used to treat muscle spasms or spasticity may cause significant drowsiness, dizziness, or weakness. This creates safety concerns for the patient taking these drugs.

CH. 32 The nursing plan of care for a patient receiving oprelvekin (Neumega) should include careful monitoring for symptoms of which adverse effect? 1. Fluid retention 2. Severe hypotension 3. Impaired liver function 4. Severe diarrhea

Answer: 1 Rationale: Oprelvekin (Neumega) may cause significant fluid retention, which may be particularly detrimental to a patient with cardiac or kidney disease.

CH. 32 When planning to teach the patient about the use of epoetin alfa (Epogen, Procrit), which instructions would the nurse give? 1. Eating raw fruits and vegetables must be avoided. 2. Frequent rest periods should be taken to avoid excessive fatigue. 3. Skin and mucous membranes should be protected from traumatic injury. 4. Exposure to direct sunlight must be minimized and sunscreen used when outdoors.

Answer: 2 Rationale: Epoetin alfa (Epogen, Procrit) is ordered to treat anemia, and the patient with anemia may experience periods of excessive fatigue and weakness related to the diminished oxygen-carrying capacity from low RBC counts. Adequate rest periods should be planned and patients taught to avoid overexertion until the epoetin alfa has had therapeutic effects and the RBC counts improve.

CH. 32 To best monitor for therapeutic effects from filgrastim (Granix, Neupogen), the nurse will assess which laboratory finding? 1. Hemoglobin and hematocrit 2. White blood cell or absolute neutrophil counts 3. Serum electrolytes 4. Red blood cell count

Answer: 2 Rationale: Filgrastim stimulates granulocytes (WBCs).

CH. 32 A patient diagnosed with pernicious anemia is to start cyanocobalamin (Nascobal) injections. Which patient statements demonstrates an understanding of the nurse's teaching? (Select all that apply.) 1. "I need to be careful to avoid infections." 2. "I will need to take this drug for the rest of my life." 3. "I should increase my intake of foods that contain vitamin B12." 4. "I need to take the liquid preparation through a straw." 5. "I may be able to switch over to nasal sprays once my vitamin B12 levels are normal."

Answer: 2, 5 Rationale: The patient with pernicious anemia is unable to absorb vitamin B12from the stomach and must take lifelong supplements of the vitamin. Once vitamin levels reach normal, a weekly nasal spray may be ordered.

CH. 32 Darbepoetin (Aranesp) is ordered for each of the following patients. The nurse would question the order for which condition? 1. A patient with chronic renal failure 2. A patient with AIDS who is receiving anti-AIDS drug therapy 3. A patient with hypertension 4. A patient on chemotherapy for cancer

Answer: 3 Rationale: Darbepoetin (Aranesp) and other similar drugs should not be used or are used cautiously in the patient with HTN because they may increase blood pressure.

CH. 37 Check your understanding Viral infections are very often more difficult to treat than bacterial infections. What are several reasons for this?

Because of the rapid mutation rate of viruses, drugs that are used may rapidly become ineffective. Viruses exist inside the host's own cells, making it difficult to eliminate the pathogen without giving excessively high doses of drugs that injure normal cells. Antiviral drugs also have narrow spectrums of activity usually limited to one specific virus.

CH. 15 Check your understanding If an antiseizure drug must be discontinued, how will this be accomplished, and why is this method necessary?

Because seizures are likely to occur when antiseizure drugs are abruptly withdrawn, the medication is usually discontinued over a period of 6 to 12 weeks.

CH. 41 Check your understanding Drug therapy for PUD and GERD may be started after other measures have not succeeded. What additional nonpharmacologic measures should be tried before drug therapy is considered?

Before initiating pharmacotherapy, patients are usually advised to change lifestyle factors contributing to the severity of PUD or GERD. Losing weight, eliminating tobacco and alcohol use, and reducing stress may eliminate the symptoms. Other strategies such as elevating the head of the bed, avoiding fatty or acidic foods, and eating smaller meals at least 3 hours before sleep may also improve the condition. If these methods are not successful, drug therapy may be prescribed; however, these measures are also important adjuncts to drug therapy that may significantly improve the condition.

CH. 14 Check your understanding Benzodiazepines are among the first-line drugs for treating insomnia and anxiety disorders. Why would these drugs pose a safety risk in the older adult? What are the nursing considerations for these drugs when used in the older adult population?

Benzodiazepines have possible adverse effects of excessive sedation, confusion, or impaired mobility, which may occur even at normal doses. This is especially true for the older patient, who may be at greater risk for falls. The nurse should evaluate the safety of the home environment, evaluate other risk factors contributing to insomnia (e.g., diuretic use), and explore nondrug options that may be useful in treating the patient's underlying insomnia or anxiety. Whenever possible, the lowest dose of a benzodiazepine for the shortest amount of time should be used.

CH. 35 Check your understanding Superinfections are common adverse effects of antibiotic use. Which type of antibiotic is more likely to cause a superinfection, broad-spectrum or narrow-spectrum, and why?

Broad-spectrum antibiotics are more likely to cause a superinfection than narrow-spectrum antibiotics. Broad-spectrum antibiotics kill many different species of micro-organisms, including normal host flora. Some of these host organisms serve a useful purpose by producing antibacterial substances and by competing with pathogenic organisms for space and nutrients. Removal of host flora by an antibiotic gives the remaining microorganisms an opportunity to grow, allowing for overgrowth of pathogenic microbes.

CH. 36 A patient has been diagnosed with an active TB infection and has been prescribed isoniazid (INH), ethambutol (Myambutol), rifampin (Rifadin), and pyrazinamide (PZA) for 6 moths. She is also instructed to take pyridoxine (vitamin B6). Why is she receiving 4 different drugs for her tuberculosis, and why has pyridoxine been ordered?

Combining drug therapies is essential because the tuberculosis bacteria grow slowly and commonly develop resistance to the treatment. One of the most common adverse effects associated with isoniazid therapy is peripheral neuropathy. Isoniazid frequently affects the nervous system and produces tingling and numbness of the hands and feet. Pyridoxine (vitamin B6) is routinely prescribed by healthcare providers to prevent the development of these symptoms.

CH. 20 A 47-year-old patient with MS has had increasing motor difficulty and has been increasingly dependent on her walker to move about her house and work setting. Her provider gives her a new prescription for dalfampridine (Ampyra). What is the purpose of this drug and what will you, as the nurse, first assess?

Dalfampridine (Ampyra) tablets are approved as a treatment to improve walking in patients with MS. It has been shown to increase nerve conduction and improve walking speed. Dalfampridine is the first FDA-approved oral drug addressing walking impairment in patients diagnosed with MS. The most bothersome adverse effect of dalfampridine is seizure activity. Because of this concern, you would first assess for a prior history of seizures. Ampyra is contraindicated in patients with a known seizure disorder.

CH. 20 Check your understanding What is the main goal of pharmacotherapy for neurodegenerative disorders such as PD, AD, and MS?

Drugs used to treat chronic neurodegenerative disorders such as PD, AD, and MS seek to slow the progression and to treat the symptoms of the underlying disorder. Currently there is no pharmacotherapy available that prevents, stops the progression of, or reverses these conditions. This may change in the years ahead as more is learned about the underlying pathogenesis of these disorders and newer treatments are investigated.

CH. 32 Check your understanding While the patient is receiving CSF drugs such as filgrastim (Granix, Neupogen) and pegfilgrastim (Neumega), neutropenia continues to present a risk to the patient until blood counts increase. What infection control measures will the nurse follow and teach the patient to avoid risks associated with neutropenia?

Instruct the patient in hygiene and infection control measures, such as washing hands frequently; avoiding crowded indoor places; avoiding people with known infections or young children who have a higher risk of having an infection; cooking food thoroughly; allowing the family or care-giver to prepare raw foods prior to cooking and to clean up afterwards. The patient should not consume raw fruits or vegetables. The patient should also be taught to report any fever and symptoms of infection, such as wounds with redness or drainage, increasing cough, increasing fatigue, white patches on oral mucous membranes, white and itchy vaginal discharge, or itchy blister-like vesicles on the skin.

CH. 36 Check your understanding Why would a patient with neutropenia be more susceptible to fungal infections?

Neutropenic patients lack the normal defense mechanisms provided by the WBCs, which help to fight off infections. Fungi, molds, and spores are common in the environment and on humans. When WBC counts are low, as in neutropenia, these pathogens may produce infections rapidly. They are considered opportunistic because the normal surveillance of the immune system is lowered and the pathogens take full advantage of the opportunity.

CH. 31 Check your understanding Will an anticoagulant drug prevent emboli?

No, anticoagulant drugs will not prevent emboli. Anticoagulants lengthen clotting time and prevent thrombi from forming or growing larger. An existing clot may still dislodge and become an emboli.

CH. 42 Check your understanding What drug(s) may cause constipation or diarrhea?

Opioids, anticholinergics, antihistamines, certain antacids, and iron supplements may cause constipation. Laxatives and antibiotics, which reduce the number of intestinal flora, may cause diarrhea.

CH. 32 A patient is receiving filgrastim (Granix, Neupogen). What nursing interventions are appropriate to safely administer this drug and provide patient safety throughout therapy?

Patients who are receiving filgrastim (Granix, Neupogen) should have their vital signs assessed every 4 hours (especially pulse and temperature) to monitor for signs of infection related to a low WBC count. Other nursing interventions include monitoring for bone pain, palpitations, dizziness, angina, or dyspnea, and encouraging fluid intake. Patients who will receive filgrastim at home should be taught how to give the injection and all monitoring needs.

CH. 32 A patient is receiving ferrous sulfate (Feosol, others). What teaching should the nurse provide to this patient?

Patients who are taking this iron supplement need education about the GI distress that may occur while on iron supplements. This medication may be taken with food to reduce the potential for GI upset if administration on an empty stomach is not possible due to nausea. Constipation is a common complaint of patients on this medication, so preventive measures such as increased fluids and fiber or the use of a stool softener may be needed. The patient needs to ensure that this medication has a child-resistant cap and is safely secured, because overdose of iron supplements is a common overdose in children.

CH. 38 Check your understanding For most cancers, a combination of anticancer drugs are used. What is the rationale for using drugs from different classifications?

The use of multiple drugs affects different stages of the cancer cell's lifecycle and attacks the various clones within the tumor via several mechanisms of action, thus increasing the percentage of cell kill. Combination chemotherapy also allows lower dosages of each individual drug, thus reducing toxicity and slowing the development of resistance.

CH. 35 Lou Viega is a 66-year-old patient with cellulitis of the lower extremity, colonized with MRSA. He has been admitted to the medical unit and has been started on gentamicin IV. He expresses concern about the need for hospitalization and especially about the need for IV antibiotics. He asks you, his nurse, to explain things to him. 1. Why was gentamicin required for Mr. Viega's infection? 2. To what class of antibiotics does gentamicin belong? 3. What adverse effects are possible with this drug class? What monitoring will be required?

1. Because of MRSA's resistance, other antibiotics that are not penicillins or similar (e.g., cephalosporins) must be used. Gentamicin is typically reserved for more serious infections such as MRSA because of its higher potential for toxicity. 2. Gentamicin belongs to the aminoglycoside classification of antibiotics. 3. Gentamicin can cause nephrotoxicity, and assessment of kidney function is a priority for this patient. The nurse should monitor daily weight, urine output, urine protein, and serum creatinine frequently. A secondary priority is assessment of both hearing and balance. Ototoxicity is a potential adverse effect of gentamicin and may affect either one or both branches of cranial nerve VII.

CH. 15 Joelle Birdwell, 16 years old, presents to the clinic with fatigue and pallor. She has a history of a generalized tonic—clonic seizure disorder that has been managed well on carbamazepine (Tegretol). In addition to her pallor and fatigue, Joelle has multiple small petechiae and bruises on her arms and legs. Her hematocrit is 26%. 1. In which drug classification does carbamazepine (Tegretol) belong? 2. What are adverse effects associated with carbamazepine? 3. Can Joelle's symptoms be related to her use of carbamazepine?

1. Carbamazepine (Tegretol) belongs to the classification of phenytoin-like drugs that have a similar mechanism of action to phenytoin (Dilantin). 2. Carbamazepine (Tegretol) adverse effects are drowsiness, dizziness, nausea, ataxia, and blurred vision. Serious and sometimes fatal blood dyscrasias secondary to bone marrow suppression have occurred with carbamazepine. 3. The patient's hematocrit suggests anemia, and the petechiae and bruising suggest thrombocytopenia. The nurse should evaluate for complaints of fever and sore throat that would suggest leukopenia and report the findings to the patient's healthcare provider.

CH. 21 Nathan Ebbens, a 32-year-old farmer, injured his lower back while unloading a truck at a farm cooperative. His healthcare provider started him on cyclobenzaprine (Amrix) 10 mg tid for 7 days and referred him to outpatient physical therapy. After 4 days, the patient reports back to the office nurse that he is constipated and having trouble emptying his bladder. 1. What might be the cause of these effects? 2. As the nurse, what orders do you anticipate from the healthcare provider? 3. Nathan is switched to baclofen (Lioresal) orally. What additional teaching will he need?

1. Cyclobenzaprine (Amrix) has been demonstrated to produce significant anticholinergic activity. Anticholinergics block the action of the neurotransmitter acetylcholine at the muscarinic receptors in the parasympathetic nervous system. This allows the activities of the sympathetic nervous system to dominate. In this case, the result has been a relaxation of the smooth muscles of the GI tract, decreasing peristalsis and motility, and resulting in constipation. The anticholinergic effect is also responsible for urine retention because of increased constriction of the internal sphincter. 2. Because Nathan is experiencing urinary retention, secondary to the cyclobenzaprine, you would anticipate that the drug will be discontinued and a different drug substituted. 3. Baclofen (Lioresal) has a good safety profile but may cause drowsiness, dizziness, weakness, and fatigue. Because of the type of work he does, Nathan should be reminded that drowsiness and dizziness are possible adverse effects. He should be careful working around farm machinery until the effects of the drug are known. Nonpharmacologic measures, such as localized heat, may also help.

CH. 42 Jerry Nobal is a 59-year-old manager at a local golf center. He has been prescribed diphenoxylate with atropine (Lomotil) for continual diarrhea for the past 3 days. He has taken the drug consistently, but he returns to his provider stating that he has had diarrhea 5 times today. 1. What is a possible rationale for Jerry's continuing diarrhea? 2. What is the key priority for nursing care? What are additional needs that Jerry may have?

1. Diphenoxylate with atropine is a combination drug that includes an opiate (diphenoxylate) and anticholinergic (atropine) that slows intestinal motility. If Jerry's diarrhea has continued despite drug therapy, he may have an infectious process that is causing the diarrhea, and additional treatment is needed to treat his infection. 2. A key priority is to assess the potential for dehydration. Signs and symptoms include hypotension, tachycardia, increased temperature, dry mucous membranes, and poor skin turgor. Because Jerry's diarrhea has continued over multiple days, the skin around the anus and perineal area may be excoriated and require treatment. As the nurse, you would also want to obtain a diet history and note any correlation between improvement or worsening of his symptoms. A dietary consultation may be needed.

CH. 37 Nathan Whitcomb is a 23-year-old college student seeking treatment in the student health clinic for recurrent cold sores (herpes simplex virus [HSV]). Like many college students, he eats on the run and seldom sleeps more than 4 to 5 hours per night. His weekends are even more hectic with his job, school, and social activities. Nathan requests something to help rid him of his existing cold sore immediately. Topical acyclovir (Zovirax) is prescribed. 1. As the nurse, how would you explain the mode of transmission and onset of symptoms for HSV to Nathan? 2. How would you respond when Nathan asks, "Is there any medication that I can take to prevent the cold sores from returning?" 3. Topical acyclovir is prescribed for this patient. What patient education would you provide?

1. Herpesviruses are usually acquired through direct physical contact with an infected person. HSV may remain in a latent, asymptomatic, nonreplicating state in sensory or autonomic nerve root ganglia for many years. Infection is lifelong. Immunosuppression, physical challenge, or emotional stress can promote active replication of the virus and reappearance of the characteristic lesions. 2. Antiviral agents are not routinely prescribed for prophylaxis due to the cost and potential adverse effects. Patients who experience particularly severe or recurrent episodes may receive low-dose antiviral agents. 3. Nathan should apply the acyclovir as soon as symptoms of a herpes infection appear. The medication should be applied to all sores every 3 hours (6 times a day) for 7 days, or as directed. Sometimes, this medication may cause burning, stinging, and redness. Cold sores are contagious at all stages and can spread to other people through kissing or sharing things that touch the lips, such as towels or utensils. Nathan should use disposable gloves when applying the medication to avoid spreading the infection. Lastly, a healthy lifestyle may reduce the recurrence of cold sores. This would include a balanced diet, exercise, restful sleep, and managing emotional stress. Nathan's university may have stress management and other support courses and services available that may be helpful.

CH. 41 Reginald Foxe, 68 years old, has had chronic hyperacidity of the stomach and takes calcium carbonate (Tums) multiple times daily. He comes to the clinic with complaints of fatigue, increasing weakness, and headaches. When taking his medication history, Mr. Foxe tells the nurse that he takes two Tums tablets (1000 mg calcium carbonate) every 4 hours, and sometimes as frequently as every 2 hours. 1. What may be the cause of Mr. Foxe's symptoms of fatigue, weakness, and headaches? 2. As the nurse, what will you recommend to Mr. Foxe? 3. What additional teaching is necessary?

1. Regular use of calcium-containing antacids, especially along with milk products, may cause milk-alkali syndrome. Early symptoms are similar to those of hypercalcemia and include headache, urinary frequency, anorexia, nausea, and fatigue. 2. As the nurse, you should instruct Mr. Foxe to stop taking the antacid and to discuss more appropriate therapy for the hyperacidity with the healthcare provider. 3. If Mr. Foxe's symptoms continue, he may need to be evaluated for H. pylori infection. General lifestyle changes such as quitting smoking, avoiding alcohol or caffeine, elevating the head of the bed, losing weight, and managing stress may also help to eliminate his symptoms.

CH. 36 Jessica Treadway is a 23-year-old patient recently diagnosed with type-1 diabetes, for which she has been prescribed insulin. She developed a vaginal discharge and made an appointment with her provider. She was diagnosed with a vaginal yeast infection with Candida albicans and prescribed fluconazole (Diflucan) topically for the infection. 1. Why do you think that Jessica is at risk for this type of infection? 2. What patient teaching will she need regarding this treatment?

1. Vaginal candidiasis is a common infection associated with diabetes due to increased blood glucose levels. The perineal area is also warm, moist, and dark, all environmental factors that favor the development of yeast. 2. General measures that will help to reduce the incidence of yeast infections include allowing adequate time to air dry after showering or bathing, increasing intake of yogurt or foods with natural probiotic cultures, and wearing cotton underclothes that allow air circulation. The nurse may also need to assess Jessica's blood glucose levels and control. If readings are consistently high, better control of the diabetes may help to reduce the recurrence of yeast infections.

CH. 41 The nurse is caring for a patient with gastroesophageal reflux disease and would question an order for which of the following? 1. Amoxicillin (Amoxil) 2. Ranitidine (Zantac) 3. Pantoprazole (Protonix) 4. Calcium carbonate (Tums)

Answer: 1 Rationale: Antibiotics such as amoxicillin (Amoxil) are used in the treatment of PUD caused by H. pylori. They are not indicated for the treatment of GERD.

CH. 21 A patient has purchased capsaicin over-the-counter cream to use for muscle aches and pains. What education is most important to give this patient? 1. Apply with a gloved hand only to the site of pain. 2. Apply the medication liberally above and below the site of pain. 3. Apply to areas of redness and irritation only. 4. Apply liberally with a bare hand to the affected limb.

Answer: 1 Rationale: Capsaicin should be applied to the site of pain with a gloved hand to avoid introducing the capsaicin to the eyes or other parts of the body not under treatment.

CH. 21 A patient who has been prescribed baclofen (Lioresal) returns to the healthcare provider after a week of drug therapy, complaining of continued muscle spasms of the lower back. What further assessment data will the nurse gather? 1. Whether the patient has been taking the medication consistently or only when the pain is severe 2. Whether the patient has been consuming alcohol during this time 3. Whether the patient has increased the dosage without consulting the healthcare provider 4. Whether the patient's log of symptoms indicates that the patient is telling the truth

Answer: 1 Rationale: Muscle relaxers such as baclofen (Lioresal) work best when taken consistently and not prn. Noting consistency of dosing helps to determine the appropriateness of dose, frequency, and drug effects.

CH. 41 The nurse is assisting the older adult diagnosed with a gastric ulcer to schedule her medication administration. What would be the most appropriate time for this patient to take her lansoprazole (Prevacid)? 1. About 30 minutes before her morning meal 2. At night before bed 3. After fasting at least 2 hours 4. 30 minutes after each meal

Answer: 1 Rationale: PPIs such as lansoprazole (Prevacid) should be taken before the first meal of the day. The proton pump is activated by food intake. The administration of a PPI 20 to 30 minutes before the first major meal of the day will allow peak serum levels to coincide with the occurrence of maximum acidity from the proton pump activity.

CH. 41 Simethicone (Gas-X, Mylicon) may be added to some medications or given plain for what therapeutic effect? 1. Decrease the amount of gas associated with GI disorders. 2. Increase the acid-fighting ability of some medications. 3. Prevent constipation associated with gastrointestinal drugs. 4. Prevent diarrhea associated with gastrointestinal drugs.

Answer: 1 Rationale: Simethicone is used along with other GI drugs or alone to decrease the amount of gas bubbles that accumulate with GI disorders or indigestion.

CH. 15 The nurse is providing education for a 12-year-old patient with partial seizures currently prescribed valproic acid (Depakene). The nurse will teach the patient and the parents to immediately report which symptom? 1. Increasing or severe abdominal pain 2. Decreased or foul taste in the mouth 3. Pruritus and dry skin 4. Bone and joint pain

Answer: 1 Rationale: Valproic acid may cause life-threatening pancreatitis, and any severe or increasing abdominal pain should be reported immediately.

CH. 32 An older adult patient diagnosed with iron-deficiency anemia will be taking ferrous sulfate (Feosol). The nurse will teach which of the required administration guidelines to the patient? (Select all that apply.) 1. Take the tablets on an empty stomach if possible. 2. Increase fluid intake and increase dietary fiber while taking this medication. 3. If liquid preparations are used, dilute with water or juice and sip through a straw placed in the back of the mouth. 4. Crush or dissolve sustained-release tablets in water if they are too big to swallow. 5. Take the drug at bedtime for best results.

Answer: 1, 2, 3 Rationale: Iron preparations should be taken on an empty stomach, diluted, and taken through a straw if liquid preparations are used, and extra fluid and fiber will help prevent constipation.

CH. 36 A patient has been diagnosed with tuberculosis and is prescribed Rifater (pyrazinamide with isoniazid and rifampin). While the patient is on this medication, what teaching is essential? (Select all that apply.) 1. "It is critical to continue therapy for at least 6 to 12 months." 2. "Two or more drugs are used to prevent tuberculosis bacterial resistance." 3. "These drugs may also be used to prevent tuberculosis." 4. "No special precautions are required." 5. "After 1 month of treatment, the medication will be discontinued."

Answer: 1, 2, 3 Rationale: It is critical that the medicine be taken for 6 to 12 months, and possibly as long as 24 months in order for it to effectively treat the tuberculosis bacterium. Antitubercular drugs such as pyrazinamide, isoniazid (INH), and rifampin are also used for prevention and treatment of clients who convert from a negative TB test to a positive, although single drug use is most often prescribed in that situation. Multiple drug therapy is necessary because the mycobacteria grow slowly, and resistance is common. Using multiple drugs in different combinations during the long treatment period lowers the potential for resistance and increases the chances for successful therapy.

CH. 31 What patient education should be included for a patient receiving enoxaparin (Lovenox)? (Select all that apply.) 1. Teach the patient or caregiver to give subcutaneous injections at home. 2. Teach the patient or caregiver not to take any over-the-counter drugs without first consulting with the healthcare provider. 3. Teach the patient to observe for unexplained bleeding, such as pink, red, or dark brown urine or bloody gums. 4. Teach the patient to monitor for the development of deep vein thrombosis. 5. Teach the patient about the importance of drinking grapefruit juice daily.

Answer: 1, 2, 3, 4 Rationale: Enoxaparin is an LMWH. Patients and family can be taught to give subcutaneous injections at home. Teaching should include instructions to not take any other medications without first consulting the healthcare provider and recognizing the signs and symptoms of bleeding. Enoxaparin is given to prevent development of DVT. Patients should be taught signs and symptoms of DVT and should contact their healthcare provider immediately if these develop or worsen while on enoxaparin therapy.

CH. 42 Pancrelipase (Pancreaze) granules are ordered for a patient. Which action will the nurse complete before administering the drug? (Select all that apply.) 1. Sprinkle the granules on a nonacidic food. 2. Give the granules with or just before a meal. 3. Mix the granules with orange or grapefruit juice. 4. Ask the patient about an allergy to pork or pork products. 5. Administer the granules followed by an antacid.

Answer: 1, 2, 4 Rationale: Before administering pancrelipase (Pancreaze) the nurse should assess for an allergy to pork or pork products. The granules may be sprinkled on nonacidic foods and should be given 30 minutes before a meal or with meals.

CH. 15 Which of the following medications may be used to treat partial seizures? (Select all that apply.) 1. Phenytoin (Dilantin) 2. Valproic acid (Depakene) 3. Diazepam (Valium) 4. Carbamazepine (Tegretol) 5. Ethosuximide (Zarontin)

Answer: 1, 2, 4 Rationale: The phenytoin-like drugs, including phenytoin (Dilantin), valproic acid (Depakene), and carbamazepine (Tegretol), are used to treat partial seizures.

CH. 36 Metronidazole (Flagyl) is being used to treat a patient's Giardia lamblia infection, a protozoan infection of the intestines. Which of the following are appropriate to teach this patient? (Select all that apply.) 1. Metronidazole may leave a metallic taste in the mouth. 2. The urine may turn dark amber-brown while on the medication. 3. The metronidazole may be discontinued once the diarrhea subsides to minimize adverse effects. 4. Taking the metronidazole with food reduces GI upset. 5. Current sexual partners do not require treatment for this infection.

Answer: 1, 2, 4, 5 Rationale: Metronidazole may cause a metallic drug taste during therapy and may cause urine to darken. Taking the drug with food or milk may help reduce GI effects. Current sexual partners do not usually require treatment for Giardia infections because Giardia is not an STI; it affects the GI tract.

CH. 37 A patient has been diagnosed with genital herpes and has been started on oral acyclovir (Zovirax). What should be included in the teaching instructions for this patient? (Select all that apply.) 1. Increase fluid intake up to 2 L per day. 2. Report any dizziness, tremors, or confusion. 3. Decrease the amount of fluids taken so that the drug can be more concentrated. 4. Take the drug only when having the most itching or pain from the outbreak. 5. Use barrier methods such as condoms for sexual activity.

Answer: 1, 2, 5 Rationale: Acyclovir can be nephrotoxic and fluids should be increased throughout therapy. Neurotoxicity may occur, and increasing dizziness, tremors, or any confusion should be reported immediately. Acyclovir does not prevent transmission of the disease and transmission may occur even if the host is asymptomatic. Barrier methods for sexual activity should be used.

CH. 21 Cyclobenzaprine (Amrix) is prescribed for a patient with muscle spasms of the lower back. Which appropriate nursing interventions would be included? (Select all that apply.) 1. Assessing the heart rate for tachycardia 2. Assessing the home environment for patient safety concerns 3. Encouraging frequent ambulation 4. Providing oral suction for excessive oral secretions 5. Providing assistance with activities of daily living, such as reading

Answer: 1, 2, 5 Rationale: Adverse reactions to cyclobenzaprine include drowsiness, dizziness, dry mouth, rash, blurred vision, and tachycardia. Because the medication can cause drowsiness and dizziness, ensuring patient safety must be a priority. The patient may need assistance with reading or other activities requiring visual acuity if blurred vision occurs.

CH. 38 A 2-year-old patient is receiving vincristine (Oncovin) for Wilms' tumor. Which of the following findings will the nurse monitor to prevent or limit the main adverse effect for this patient? (Select all that apply.) 1. Numbness of the hands or feet 2. Angina or dysrhythmias 3. Constipation 4. Diminished reflexes 5. Dyspnea and pleuritis

Answer: 1, 3, 4 Rationale: The most serious adverse effect of vincristine is nervous system toxicity. Numbness of the feet or hands, constipation related to decreased peristalsis, and diminished reflexes are all signs of neurotoxicity.

CH. 31 A patient with a congenital coagulation disorder is given aminocaproic acid (Amicar) to stop bleeding following surgery. The nurse will carefully monitor this patient for development of which adverse effects? (Select all that apply.) 1. Anaphylaxis 2. Hypertension 3. Hemorrhage 4. Headache 5. Hypotension

Answer: 1, 4, 5 Rationale: Adverse effects of aminocaproic acid (Amicar) include headache, anaphylaxis, and hypotension.

CH. 31 The patient receiving heparin therapy asks how the "blood thinner" works. What is the best response by the nurse? 1. "Heparin makes the blood less thick." 2. "Heparin does not thin the blood but prevents clots from forming as easily in the blood vessels." 3. "Heparin decreases the number of platelets so that blood clots more slowly." 4. "Heparin dissolves the clot."

Answer: 2 Rationale: Anticoagulants do not change the viscosity (thickness) of the blood. Instead, anticoagulants modify the mechanisms by which clotting occurs.

CH. 31 A patient has started clopidogrel (Plavix) after experiencing a transient ischemic attack. What is the desired therapeutic effect of this drug? 1. Anti-inflammatory and antipyretic effects 2. To reduce the risk of a stroke from a blood clot 3. Analgesic as well as clot-dissolving effects 4. To stop clots from becoming emboli

Answer: 2 Rationale: Antiplatelet drugs such as clopidogrel are given to inhibit platelet aggregation and, thus, reduce the risk of thrombus formation.

CH. 15 An 8-year-old boy is evaluated and diagnosed with absence seizures. He is started on ethosuximide (Zarontin). Which information should the nurse provide the parents? 1. Terminate after-school sports activities because they will increase the risk of seizures. 2. Monitor height and weight to assess that growth is progressing normally. 3. Fractures may occur, so increase the amount of vitamin D and calcium-rich foods in the diet. 4. Avoid dehydration with activities, and increase fluid intake.

Answer: 2 Rationale: Because adverse drug effects, such as nausea, anorexia, or abdominal pain may occur with ethosuximide (Zarontin), the parents should monitor the child's height and weight to assess whether nutritional intake is sufficient for normal growth and development.

CH. 20 The patient is receiving levodopa-carbidopa for parkinsonism. Which drug would the nurse expect to be added to the patient's drug regimen to help control tremors? 1. Amantadine (Symmetrel) 2. Benztropine (Cogentin) 3. Haloperidol (Haldol) 4. Donepezil (Aricept)

Answer: 2 Rationale: Benztropine, a cholinergic antagonist, is frequently used as combination therapy with other antiparkinson drugs to decrease tremors.

CH. 37 A patient is started on efavirenz (Sustiva) for HIV. What should the nurse teach the patient about this drug? 1. Efavirenz (Sustiva) will cure the disease over time. 2. Efavirenz (Sustiva) will not cure the disease but may significantly extend the life expectancy. 3. Efavirenz (Sustiva) will be used prior to vaccines. 4. Efavirenz (Sustiva) will prevent the transmission of the disease.

Answer: 2 Rationale: Drug therapy with efavirenz (Sustiva) and other ART drugs has not produced a cure but has resulted in a significant number of therapeutic successes with increased lifespan.

CH. 21 The patient is scheduled to receive rimabotulinumtoxinB (Myobloc) for treatment of muscle spasticity. Which symptoms will the nurse teach the patient to report immediately? 1. Fever, aches, or chills 2. Difficulty swallowing, ptosis, blurred vision 3. Continuous spasms and pain on the affected side 4. Moderate levels of muscle weakness on the affected side

Answer: 2 Rationale: Dysphagia, ptosis, and blurred vision are all symptoms of possible botulinum toxin B toxicity and must be reported immediately.

CH. 38 A patient who is undergoing cancer chemotherapy asks the nurse why she is taking three different chemotherapy drugs. What is the nurse's best response? 1. "Your cancer was very advanced and therefore requires more medications." 2. "Each drug attacks the cancer cells in a different way, increasing the effectiveness of the therapy." 3. "Several drugs are prescribed to find the right drug for your cancer." 4. "One drug will cancel out the side effects of the other."

Answer: 2 Rationale: Effectiveness of chemotherapy is increased by use of multiple drugs from different classes that attack cancer cells at different points in the cell cycle. Thus, lower doses of each individual medication can be used to reduce side effects. A third benefit of combination chemotherapy is reduced incidence of drug resistance.

CH. 14 A 17-year-old patient has been prescribed escitalopram (Lexapro) for increasing anxiety uncontrolled by other treatment measures. Because of this patient's age, the nurse will ensure that the patient and parents are taught what important information? 1. Cigarette smoking will counteract the effects of the drug. 2. Signs of increasing depression or thoughts of suicide should be reported immediately. 3. The drug causes dizziness and alternative schooling arrangements may be needed for the first two months of use. 4. Anxiety and excitability may increase during the first 2 weeks of use but then will have significant improvement.

Answer: 2 Rationale: Escitalopram (Lexapro) is an antidepressant in the SSRI class. The drug carries a black box warning of increased risk of suicidal thinking and behavior in children, adolescents, and young adults. Signs of increasing depression or suicidal thoughts should be reported immediately.

CH. 36 A patient with type 2 diabetes treated with oral antidiabetic medication is receiving oral fluconazole (Diflucan) for treatment of chronic tinea cruris (jock itch). The nurse instructs the patient to monitor blood glucose levels more frequently because of what potential drug effect? 1. Fluconazole (Diflucan) antagonizes the effects of many antidiabetic medications, causing hyperglycemia. 2. Fluconazole (Diflucan) interacts with certain anti-diabetic drugs, causing hypoglycemia. 3. Fluconazole (Diflucan) causes hyperglycemia. 4. Fluconazole (Diflucan) causes hypoglycemia.

Answer: 2 Rationale: Fluconazole (Diflucan) inhibits the hepatic CYP450 enzymes and interacts with many drugs. Hypoglycemia may result if fluconazole is administered concurrently with certain oral antidiabetic medications, including glyburide.

CH. 20 The nurse discusses the disease process of multiple sclerosis with the patient and caregiver. The patient will begin taking glatiramer (Copaxone), and the nurse is teaching the patient about the drug. Which points should be included? 1. Drink extra fluids while this drug is given. 2. Local injection site irritation is a common effect. 3. Take the drug with plenty of water and remain in an upright position for at least 30 minutes. 4. The drug causes a loss of vitamin C so include extra citrus and foods containing vitamin C in the diet.

Answer: 2 Rationale: Glatiramer (Copaxone) is given by injection and often causes injection site irritation.

CH. 36 A patient with a severe systemic fungal infection is to be given amphotericin B (Fungizone). Before starting the amphotericin infusion, the nurse premedicates the patient with acetaminophen (Tylenol), diphenhydramine (Benadryl), and prednisone (Deltasone). What is the purpose of premedicating the patient prior to the amphotericin? 1. It delays the development of resistant fungal infections. 2. It decreases the risk of hypersensitivity reactions to the amphotericin. 3. It prevents hyperthermia reactions from the amphotericin. 4. It works synergistically with the amphotericin so a lower dose may be given.

Answer: 2 Rationale: Many patients develop fever and chills, vomiting, and headache at the beginning of therapy with amphotericin that subside as treatment continues. Cardiac arrest, hypotension, and dysrhythmias are possible with severe hypersensitivity reactions. A combination of antipyretics (e.g., acetaminophen), antihistamines (e.g., diphenhydramine), and corticosteroids (e.g., prednisone) may be given preinfusion to prevent or reduce these adverse reactions.

CH. 35 A patient will be discharged after surgery with a prescription for penicillin. When planning at-home instructions, what will the nurse include? 1. Penicillins can be taken while breastfeeding. 2. The entire prescription must be finished. 3. All penicillins can be taken without regard to eating. 4. Some possible side effects include abdominal pain and constipation.

Answer: 2 Rationale: Many people will discontinue medication after improvement is noted. All antibiotic regimens must be completed to prevent recurrence of infection unless allergy or significant adverse effects occur that warrant discontinuing or changing the drug used.

CH. 42 A patient with terminal cancer is receiving naloxegol (Movantik) for control of opioid-induced constipation. Because this drug is an opioid-antagonist, what effects on the patient's pain should the nurse anticipate? 1. The pain may worsen and additional adjunctive drugs may be required 2. There should be no effects on the patient's level of pain 3. The pain may decrease, requiring less of the opioid drug 4. The patient's pain level may decrease, but respiratory depression may occur

Answer: 2 Rationale: Naloxegol (Movantik) is an opioid-antagonist that works on opioid receptors in the large intestine, thus decreasing chronic constipation. It is not absorbed through the blood-brain barrier.

CH. 42 A 24-year-old patient has been taking sulfasalazine (Azulfidine) for irritable bowel syndrome and complains to the nurse that he wants to stop taking the drug because of the nausea, headaches, and abdominal pain it causes. What would the nurse's best recommendation be for this patient? 1. The drug is absolutely necessary, even with the adverse effects. 2. Talk to the healthcare provider about dividing the doses throughout the day. 3. Stop taking the drug and see if the symptoms of the irritable bowel syndrome have resolved. 4. Take an antidiarrheal drug such as loperamide (Imodium) along with the sulfasalazine.

Answer: 2 Rationale: Nausea, vomiting, diarrhea, dyspepsia, abdominal pain, and headache are common adverse effects of sulfasalazine (Azulfidine). Dividing the total daily dose evenly throughout the day and using the enteric-coated tablets may improve adherence.

CH. 15 A patient has been taking phenytoin (Dilantin) for control of generalized seizures, tonic-clonic type. The patient is admitted to the medical unit with symptoms of nystagmus, confusion, and ataxia. What change in the phenytoin dosage does the nurse anticipate will be made based on these symptoms? 1. The dosage will be increased. 2. The dosage will be decreased. 3. The dosage will remain unchanged; these are symptoms unrelated to the phenytoin. 4. The dosage will remain unchanged but an additional antiseizure medication may be added.

Answer: 2 Rationale: Nystagmus, confusion, and ataxia may occur with phenytoin, particularly with higher dosages. The dosage is likely to be decreased.

CH. 35 A 32-year-old female has been started on amoxicillin (Amoxil, Trimox) for a severe UTI. Before sending her home with this prescription, the nurse will do what? 1. Teach her to wear sunscreen. 2. Ask her about oral contraceptive use and recommend an alternative method for the duration of the amoxicillin course. 3. Assess for hearing loss. 4. Recommend taking the pill with some antacid to prevent gastrointestinal upset.

Answer: 2 Rationale: Penicillin antibiotics such as amoxicillin (Amoxil, Trimox) may significantly decrease the effectiveness of oral contraceptives and another method of birth control should be suggested during the time the drug is taken.

CH. 20 The patient asks what can be expected from the levodopa-carbidopa (Sinemet) he is taking for treatment of Parkinson's disease. What is the best response by the nurse? 1. "A cure can be expected within 6 months." 2. "Symptoms can be reduced and the ability to perform ADLs can be improved." 3. "Disease progression will be stopped." 4. "Extrapyramidal symptoms will be prevented."

Answer: 2 Rationale: Pharmacotherapy does not cure or stop the disease process but does improve the patient's ability to perform ADLs, such as eating, bathing, and walking.

CH. 37 The nurse is teaching a community health class about preventing hepatitis B to a group of young adults who have recently immigrated to the United States. What is the most effective method of preventing a hepatitis B infection? 1. Peginterferon alfa-2a (Pegasys) 2. HEPLISAV-B (hepatitis B vaccine) 3. Adefovir dipivoxil (Hepsera) 4. Entecavir (Baraclude)

Answer: 2 Rationale: The best method of preventing hepatitis B (HBV) infections is to complete a series of the HBV vaccination. Two doses of HEPLISAV-B provides up to 95% protection following exposure to the virus.

CH. 38 The nurse notes that the patient has reached his nadir. What does this finding signify? 1. The patient is receiving the highest dose possible of the chemotherapy. 2. The patient is experiencing bone marrow suppression and his blood counts are at their lowest point. 3. The patient has peaked on his chemotherapy level and should be going home in a few days. 4. The patient is experiencing extreme depression and will be having a psychiatric consult.

Answer: 2 Rationale: The nadir is the point of greatest bone marrow suppression, as measured by the lowest neutrophil count.

CH. 42 The nurse is preparing to administer chemotherapy to an oncology patient who also has an order for ondansetron (Zofran). When should the nurse administer the ondansetron? 1. Every time the patient complains of nausea 2. Just prior to starting the chemotherapy 3. Only if the patient complains of nausea 4. When the patient begins to experience vomiting during the chemotherapy

Answer: 2 Rationale: To be most effective, ondansetron (Zofran) or other antiemetics should be administered just prior to initiating the chemotherapy drugs.

CH. 21 A female patient is prescribed dantrolene (Dantrium, Revonto) for painful muscle spasms associated with multiple sclerosis. The nurse is writing the discharge plan for the patient and will include which teaching points? (Select all that apply.) 1.If muscle spasms are severe, supplement the medication with hot baths or showers 3 times per day. 2. Inform the healthcare provider if she is taking estrogen products. 3. Sip water, ice, or hard candy to relieve dry mouth. 4. Return periodically for required laboratory work. 5. Obtain at least 20 minutes of sun exposure per day to boost vitamin D levels.

Answer: 2, 3, 4 Rationale: Dantrolene (Dantrium, Revonto) may cause hepatotoxicity with the greatest risk occurring for women over age 35, and periodic laboratory tests will be required for monitoring. Estrogen taken concurrently with dantrolene may increase this risk. The drug may cause dry mouth and sucking on hard candy, sucking ice chips, or sipping water may help relieve the dryness.

CH. 20 The nurse knows that which of the following are major disadvantages for the use of donepezil (Aricept) to treat the symptoms of early Alzheimer's disease? (Select all that apply.) 1. It must be administered four times per day. 2. It may causes significant weight loss. 3. It may cause potentially fatal cardiac dysrhythmias. 4. It may cause serious liver damage. 5. It results in only modest cognitive improvement and results do not last.

Answer: 2, 3, 4, 5 Rationale: Donepezil (Aricept) may cause serious liver damage and potentially fatal dysrhythmias, including severe bradycardia and heart block. It may also cause significant weight loss, and the patient's weight should be monitored. While cognitive improvement may be observed in as few as 1 to 4 weeks, patients should receive pharmacotherapy for at least 6 months prior to assessing maximum benefits of drug therapy. Unfortunately, cognitive improvement is only modest and short-term.

CH. 37 A patient with HIV has been taking lopinavir with ritonavir (Kaletra) for the past 8 years and has noticed a redistribution of body fat in the arms, legs, and abdomen (lipodystrophy). The nurse will evaluate this patient for what other additional adverse effects associated with this drug? (Select all that apply.) 1. Kidney failure 2. Hyperglycemia 3. Pancreatitis 4. Bone marrow suppression 5. Liver failure

Answer: 2, 3, 5 Rationale: Hyperglycemia, pancreatitis, and liver failure are adverse effects associated with lopinavir with ritonavir (Kaletra).

CH. 41 A 35-year-old man has been prescribed omeprazole (Prilosec) for treatment of gastroesophageal reflux disease. Which assessment findings would assist the nurse to determine whether drug therapy has been effective? (Select all that apply.) 1. Decreased "gnawing" upper abdominal pain on an empty stomach 2. Decreased belching 3. Decreased appetite 4. Decreased nausea 5. Decreased dysphagia

Answer: 2, 4, 5 Rationale: Symptoms of GERD include dysphagia, dyspepsia, nausea, belching, and chest pain. Therapeutic effects of omeprazole (Prilosec) would include relief of these symptoms.

CH. 42 A patient with severe diarrhea has an order for diphenoxylate with atropine (Lomotil). When assessing for therapeutic effects, what will the nurse expect to find? 1. Increased bowel sounds 2. Decreased belching and flatus 3. Decrease in loose, watery stools 4. Decreased abdominal cramping

Answer: 3 Rationale: A decrease in the number and consistency of stools is a therapeutic effect of diphenoxylate with atropine (Lomotil).

CH. 14 The nurse should assess a patient who is taking lorazepam (Ativan) for the development of which of these adverse effects? 1. Tachypnea 2. Astigmatism 3. Ataxia 4. Euphoria

Answer: 3 Rationale: Adverse CNS effects for lorazepam (Ativan) include ataxia, amnesia, weakness, disorientation, blurred vision, diplopia, nausea, and vomiting.

CH. 41 A woman reports using OTC aluminum hydroxide (AlternaGEL) for relief of gastric upset. She is on renal dialysis three times a week. What should the nurse teach this patient? 1. Continue using the antacids but if she needs to continue them beyond a few months, she should consult the healthcare provider about different therapies. 2. Take the antacid no longer than for 2 weeks; if it has not worked by then, it will not be effective. 3. Consult with the healthcare provider about the appropriate amount and type of antacid. 4. Continue to take the antacid; it is OTC and safe.

Answer: 3 Rationale: Antacids are generally combinations of aluminum hydroxide, calcium, and/or magnesium hydroxide. Hypermagnesemia, hypercalcemia, or hypophosphatemia can develop with use of OTC antacids. Because this patient is on renal dialysis, her kidneys are unable to adequately control the excretion of electrolytes. The nephrologist should be contacted about whether an antacid is appropriate for this patient.

Ch. 20 An early sign(s) of levodopa toxicity is (are) which of the following? 1. Orthostatic hypotension 2. Drooling 3. Spasmodic eye winking and muscle twitching 4. Nausea, vomiting, and diarrhea

Answer: 3 Rationale: Blepharospasm (spasmodic eye winking) and muscle twitching are early signs of potential overdose or toxicity.

CH. 21 A patient has been prescribed clonazepam (Klonopin) for muscle spasms and stiffness secondary to an injury from a car crash. While the patient is taking this drug, what is the nurse's primary concern? 1. Monitoring hepatic laboratory work 2. Encouraging fluid intake to prevent dehydration 3. Assessing for drowsiness and implementing safety measures 4. Providing social services referral for patient concerns about the cost of the drug

Answer: 3 Rationale: Clonazepam (Klonopin) is a benzodiazepine; because it works on the CNS, it may cause significant drowsiness and dizziness. Safety measures should be implemented to prevent falls and injury.

CH. 35 What important information should be included in the patient's education regarding taking ciprofloxacin (Cipro)? 1. The drug can cause discoloration of the teeth. 2. Fluid intake should be decreased to prevent urine retention. 3. Any heel or lower leg pain should be reported immediately. 4. The drug should be taken with an antacid to reduce gastric effects.

Answer: 3 Rationale: Fluoroquinolones such as ciprofloxacin (Cipro) have been associated with an increased risk of tendinitis and tendon rupture. Any heel or lower leg pain should be reported immediately for evaluation.

CH. 38 What is the most effective treatment method for the nausea and vomiting that accompany many forms of chemotherapy? 1. Administer an oral antiemetic when the patient complains of nausea and vomiting. 2. Administer an antiemetic by intramuscular injection when the patient complains of nausea and vomiting. 3. Administer an antiemetic prior to the antineoplastic medication. 4. Encourage additional fluids prior to administering the antineoplastic medication.

Answer: 3 Rationale: For maximum effect, patients should be given an antiemetic prior to the start of treatment.

CH. 38 How are monoclonal antibodies such as bevacizumab (Avastin) different from other antineoplastic drugs? 1. They treat many different types of cancer, both blood and solid tumors. 2. They only need to be administered for a short period of time. 3. They are highly specific to certain cell types and target specific cancers. 4. They have fewer adverse effects than traditional antineoplastic drugs.

Answer: 3 Rationale: Monoclonal antibodies used in cancer therapy are highly targeted to specific cell types. They target specific types of cancer with fewer effects on normal cells.

CH. 37 Which of the following findings would suggest that myelosuppression is occurring in a patient who is taking zidovudine (Retrovir)? 1. Increase in serum blood urea nitrogen (BUN) levels 2. Increase in white blood cell (WBC) count 3. Decrease in platelet count 4. Decrease in blood pressure

Answer: 3 Rationale: Myelosuppression is the declining ability of the bone marrow to produce blood cells. A decrease in platelet count may indicate myelosuppression is occurring.

CH. 35 A patient taking trimethoprim-sulfamethoxazole (Bactrim, Septra) develops a reddish-purplish papular rash surrounded by areas of erythema. The rash should be evaluated by the healthcare provider because it may indicate which skin condition? 1. A fungal superinfection 2. Viral skin eruptions 3. Dermatologic toxicity, including Stevens-Johnson syndrome 4. Nonadherence with drug therapy

Answer: 3 Rationale: TMP-SMZ causes dermatologic toxicities, including Stevens-Johnson syndrome. Unusual, blistering-type rashes with purplish-red discoloration should be immediately reported to the provider.

CH. 20 Levodopa-carbidopa/entacapone (Stalevo) is prescribed for a patient with Parkinson's disease. At discharge, which teaching points should the nurse include? 1. Monitor blood pressure every 2 hours for the first 2 weeks. 2. Report the development of diarrhea. 3. Take the pill on an empty stomach or 2 hours after a meal containing protein. 4. If tremors seem to worsen, take a double dose for two doses and call the provider.

Answer: 3 Rationale: Taking dopamine replacement drugs such as levodopa with meals containing protein significantly impairs absorption. The drug should be taken on an empty stomach or 2 or more hours after a meal containing protein.

CH. 14 A 32-year-old female patient has been taking lorazepam (Ativan) for her anxiety and is brought into the emergency department after taking 30 days' worth at one time. What antagonist for benzodiazepines may be used in this case? 1. Epinephrine 2. Atropine 3. Flumazenil 4. Naloxone

Answer: 3 Rationale: The competitive antagonist drug used in cases of benzodiazepine overdosage is flumazenil (Romazicon).

CH. 31 A patient with deep vein thrombosis is receiving an infusion of heparin and will be started on warfarin (Coumadin) soon. While the patient is receiving heparin, what laboratory test will provide the nurse with information about its therapeutic effects? 1. Antithrombin III 2. International normalized ratio (INR) 3. Activated partial thromboplastin time (aPTT) 4. Platelet count

Answer: 3 Rationale: Therapeutic effects of heparin are monitored by the aPTT. While the patient is receiving heparin, the aPTT should be 1.5 to 2 times the patient's baseline, or 60 to 80 seconds.

CH. 31 A patient is receiving a thrombolytic drug, alteplase (Activase), following an acute myocardial infarction. Which effect is most likely attributed to this drug? 1. Skin rash with urticaria 2. Wheezing with labored respirations 3. Bruising and epistaxis 4. Temperature elevation of 38.2 °C (100.8 °F)

Answer: 3 Rationale: Thrombolytics such as alteplase (Activase) dissolve existing clots rapidly and continue to have effects for 2 to 4 days. All forms of bleeding must be monitored and reported immediately.

CH. 14 Zolpidem (Ambien, Edluar, Intermezzo) has been ordered for a patient for the treatment of insomnia. What information will the nurse provide for this patient? (Select all that apply.) 1. Be cautious when performing morning activities because it may cause a significant "hangover" effect with drowsiness and dizziness. 2. Take the drug with food; this enhances the absorption for quicker effects. 3. Take the drug immediately before going to bed; it has a quick onset of action. 4. If the insomnia is long-lasting, this drug may safely be used for up to one year. 5. Alcohol and other drugs that cause CNS depression (e.g., antihistamines) should be avoided while taking this drug.

Answer: 3, 5 Rationale: Zolpidem (Ambien, Intermezzo) has a rapid onset, approximately 7 to 27 minutes, and should be taken immediately before going to bed. It should not be taken with alcohol or other drugs that cause CNS depression because of increased sedation and CNS depression.

CH. 15 The nurse is caring for a 72-year-old patient taking gabapentin (Gralise, Horizant, Neurontin) for a seizure disorder. Because of this patient's age, the nurse would establish what care priority related to the drug's common adverse effects? 1. Monitor for dehydration 2. Supply nonverbal methods of communication because verbal communication may be impaired 3. Increase fluid intake to reduce the risk of constipation 4. Place the patient on fall precautions and assist with ambulation

Answer: 4 Rationale: CNS depression including dizziness and drowsiness is a common adverse effect of gabapentin (Gralise, Horizant, Neurontin). Because of this patient's age, these effects may increase the risk of falls.

CH. 15 Teaching for a patient receiving carbamazepine (Tegretol) should include instructions that the patient should immediately report which symptom? 1. Leg cramping 2. Blurred vision 3. Lethargy 4. Blister-like rash

Answer: 4 Rationale: Carbamazepine (Tegretol) is associated with Stevens-Johnson syndrome and exfoliative dermatitis. A blister-like skin rash may indicate that these conditions are developing.

CH. 36 A 32-year-old female patient is started on metronidazole (Flagyl) for treatment of a trichomonas vaginal infection. What must the patient eliminate from her diet for the duration she is on this medication? 1. Caffeine 2. Acidic juices 3. Antacids 4. Alcohol

Answer: 4 Rationale: Concurrent use of alcohol during metronidazole treatment may cause a disulfiram-like reaction with excessive nausea, vomiting, and possible hypotension.

CH. 14 Education given to patients about the use of all drugs to treat insomnia should include an emphasis on what important issue? 1. They will be required long term to achieve lasting effects. 2. They require frequent blood counts to avoid adverse effects. 3. They are among the safest drugs available and have few adverse effects. 4. Long-term use may increase the risk of adverse effects, create a "sleep debt," and cause rebound insomnia when stopped.

Answer: 4 Rationale: Long-term use of drugs to treat insomnia is not recommended. They have significant adverse effects, may cause a "sleep debt" due to effects on the sleep cycle, and may cause rebound insomnia when discontinued.

CH. 36 A patient was prescribed chloroquine (Aralen) prior to a trip to an area where malaria is known to be endemic. The nurse will instruct the patient to remain on the drug for up to 6 weeks after returning, and the patient asks why this is necessary. What is the nurse's best response? 1. "You may be carrying microscopic malaria parasites back with you on clothes or other personal articles." 2. "It helps prevent transmission to any of your family members." 3. "It will prevent any mosquito that bites you from picking up the malaria infection." 4. "It continues to kill any remaining malarial parasites that may have been acquired during the trip that are in your red blood cells."

Answer: 4 Rationale: Malarial parasites (Plasmodium) concentrate in RBCs and prophylactic treatment with chloroquine (Aralen) for 2 weeks prior to and up to 6 weeks after a trip is necessary to prevent infection or to treat any Plasmodium that has entered the host's system.

CH. 41 In taking a new patient's history, the nurse notices that he has been taking omeprazole (Prilosec) consistently over the past 6 months for treatment of epigastric pain. Which recommendation would be the best for the nurse to give this patient? 1. Try switching to a different form of the drug. 2. Try a drug like cimetidine (Tagamet) or famotidine (Pepcid). 3. Try taking the drug after meals instead of before meals. 4. Check with his healthcare provider about his continued discomfort.

Answer: 4 Rationale: PPIs such as omeprazole (Prilosec) are recommended for short-term therapy, approximately 4 to 8 weeks in length. If symptoms of epigastric pain and discomfort continue, other therapies and screening for H. pylori may be indicated.

CH. 14. A patient is receiving temazepam (Restoril). Which of these responses should a nurse expect the patient to have if the medication is achieving the desired effect? 1. The patient sleeps in 3-hour intervals, awakens for a short time, and then falls back to sleep. 2. The patient reports feeling less anxiety during activities of daily living. 3. The patient reports having fewer episodes of panic attacks when stressed. 4. The patient reports sleeping 7 hours without awakening.

Answer: 4 Rationale: Temazepam (Restoril) is a benzodiazepine ordered for insomnia. Therefore, the patient should be experiencing relief from insomnia and reporting feeling rested when awakening.

CH. 35 A patient has been prescribed tetracycline. When providing information regarding this drug, the nurse should include what information about tetracycline? 1. It is classified as a narrow-spectrum antibiotic with minimal adverse effects. 2. It is used to treat a wide variety of disease processes. 3. It has been identified to be safe during pregnancy. 4. It is contraindicated in children younger than 8 years.

Answer: 4 Rationale: Tetracycline has the ability to cause permanent mottling and discoloration of teeth and therefore is not advised for children younger than 8 years of age.

CH. 42 A patient with constipation is prescribed psyllium (Metamucil) by his healthcare provider. What essential teaching will the nurse give to the patient? 1. Take the drug with meals and at bedtime. 2. Take the drug with minimal water so that it will not be diluted in the GI tract. 3. Avoid caffeine and chocolate while taking this drug. 4. Mix the product in a full glass of water and drink another glassful after taking the drug.

Answer: 4 Rationale: To avoid esophageal or gastric obstruction, psyllium (Metamucil) should be mixed with a full glass of water or juice and followed by another full glass of liquid.

CH. 35 Superinfections are an adverse effect common to all antibiotic therapy. Which of the following best describes a superinfection? 1. An initial infection so overwhelming that it requires multiple antimicrobial drugs to treat successfully 2. Bacterial resistance that creates infections that are difficult to treat and are often resistant to multiple drugs 3. Infections requiring high-dose antimicrobial therapy with increased chance of organ toxicity 4. The overgrowth of normal body flora or of opportunistic organisms, such as viruses and yeast, no longer held in check by normal, beneficial flora

Answer: 4 Rationale: When normal host flora are decreased or killed by antibacterial therapy, opportunistic organisms such as viral and fungal infections may occur.

CH. 37 A patient has received a prescription for zanamivir (Relenza) for flulike symptoms. The patient states, "I think I'll hold off on starting this. I don't feel that bad yet." What is the nurse's best response? 1. "The drug has a stable shelf life so you can save it for later infections." 2. "It can be saved for later but you will also require an antibiotic to treat your symptoms if you wait." 3. "It can be started within 2 weeks after the onset of symptoms." 4. "To be effective, it must be started within 48 hours after the onset of symptoms."

Answer: 4 Rationale: Zanamivir (Relenza) must be started within 48 hours after the onset of symptoms to be effective.

CH. 38 Which of the following statements by a patient who is undergoing antineoplastic therapy would be of concern to the nurse? (Select all that apply.) 1. "I have attended a meeting of a cancer support group." 2. "My husband and I are planning a short trip next week." 3. "I am eating six small meals plus two protein shakes a day." 4. "I am taking my 15-month-old granddaughter to the pediatrician next week for her baby shots." 5. "I am going to go shopping at the mall next week."

Answer: 4, 5 Rationale: Patients and family members should avoid receiving live virus vaccinations or exposure to chickenpox. The patient could have an exacerbation or a more pronounced episode of the disease. The patient should not care for the granddaughter if vaccination with live viruses is planned. The patient should also avoid crowds, especially in enclosed spaces when possible, to minimize exposure risk. The nurse should discuss measures to minimize the risk of infections if the patient desires to go shopping.

CH. 21 A 52-year-old executive has started treatment with onabotulinumtoxinA (Botox) and is preparing to return home after her first injections. What should the nurse teach her?

Botulinum toxin type A (Botox) is widely used for cosmetic procedures to reduce the appearance of wrinkles and creases. Although the drug is usually effective, it may take up to 6 weeks for full effects to be realized. These effects last 3 to 6 months, requiring further injections to maintain results. There is a risk of systemic effects from the drug that may occur immediately, within weeks, or even months after the injection. Dysphagia, dysphonia, diplopia, blurred vision, ptosis, urinary incontinence, generalized muscle weakness, and respiratory distress are all signs of systemic effects of botulinum toxins. If any of the symptoms occur, the patient should immediately report them to the healthcare provider.

CH. 42 A patient comes to the clinic complaining of no bowel movement for 4 days (other than small amounts of liquid stool). The patient has been taking psyllium (Metamucil) for his constipation and wants to know why it is not working. What is the nurse's response?

Bulk-forming laxatives promote bowel regularity but they take several days or longer for best effects. The liquid stool the patient is experiencing is a concern and may be a result of fecal impaction, in which only liquid seeps out around the impacted area. The nurse should assess the abdomen for bowel sounds and, if hypoactive or absent, or if abdominal pain is present, should report the findings immediately to the healthcare provider. If the bowel sounds are normal, the nurse should educate the patient about the need to drink plenty of fluids when taking bulk-forming laxatives.

CH. 37 A 62-year-old woman has recently been diagnosed with hepatitis C and has begun treatment with ledipasvir and sofosbuvir (Harvoni). She is still unsure about her diagnosis, how she could have contracted hepatitis C, and what the treatment is supposed to do. What information should be given to this patient?

Hepatitis C is a viral infection transmitted by infected blood or body fluids. Previous blood transfusions, past IV drug use, or sex with an infected partner may transmit the virus. Hepatitis C virus (HCV) is more common than HBV, but there is not currently a vaccination to prevent HCV. Because HCV may progress to more serious conditions, such as chronic hepatitis, antiviral drugs such as ledipasvir and sofosbuvir (Harvoni) are given. Her healthcare provider will follow up with her to ensure that further complications are not developing.

CH. 15 The nurse is admitting a 17-year-old female patient with a history of seizure disorder. The patient has broken her leg in a car crash in which she was the driver. The patient states that she stopped taking the prescribed phenytoin (Dilantin) drug because she was not allowed to drive. Explain the possible long-term effects of phenytoin therapy and their impact on patient adherence to the treatment plan. What additional information could the nurse provide for this patient?

Long-term phenytoin therapy can produce significant CNS effects, including headaches, nystagmus, and peripheral neuropathy. These changes, coupled with the risk for gingival hypertrophy, may be difficult for the adolescent to cope with. In addition, the adolescent with a seizure disorder may be prohibited from operating a motor vehicle at the very age when driving becomes key to achieving young-adult status. The nurse will consider the range of possible support groups for this patient once she is discharged and will encourage the patient to discuss her concerns about the drug regimen with her healthcare provider.

CH. 14 A 42-year-old female patient with ovarian cancer suffered profound nausea and vomiting after her first round of chemotherapy. The oncologist has added lorazepam (Ativan) 2 mg per IV in addition to a previously ordered antinausea medication as part of the prechemotherapy regimen. What is the purpose for adding this benzodiazepine?

Lorazepam (Ativan) is an antianxiety drug. As a benzodiazepine, it will also cause some sedation and relaxation. It is given in this situation because it has an unlabeled use as a treatment for chemotherapy-induced nausea and vomiting.

CH. 35 A 32-year-old patient has a diagnosis of otitis externa, and the healthcare provider has ordered erythromycin PO. This patient has a history of hepatitis B, allergies to sulfa and penicillin, and mild hypertension. Should the nurse give the erythromycin?

No, the nurse should not give the erythromycin until confirming the order with the healthcare provider. This patient has a history of hepatitis B, and this medication is metabolized by the liver and has significant hepatic effects. If the patient's liver function laboratory work is normal, the healthcare provider may indicate that it is acceptable to give the drug; otherwise, an alternative type of antibiotic should be used.

CH. 14 A 58-year-old male patient underwent an emergency coronary artery bypass graft. He is still experiencing a high degree of pain and also states that he cannot fall asleep. The patient has been ordered estazolam at night for sleep and an opioid (narcotic) analgesic for pain. As the nurse, explain to the student nurse why both medications should be administered.

Pain often interferes with adequate sleep. Drugs used in the treatment of insomnia, such as estazolam, do not provide pain relief. Giving an opioid (narcotic) analgesic along with the estazolam will treat the patient's pain and help ensure adequate sleep. Because both drug groups cause CNS depression, the patient's respiratory and heart rates and blood pressure will be closely monitored.

CH. 31 A patient has had an acute MI and has received alteplase (Activase) to dissolve the clot. What nursing actions should have been taken prior to administering the medication to the patient?

Prior to administration of alteplase (Activase), laboratory work must be drawn, including CBC, coagulation studies (aPTT, INR), platelet count, kidney and liver studies, lipid profiles, troponin or other cardiac studies, and ABG measurement as ordered. An IV line should be started and any other invasive monitoring or procedures (e.g., indwelling catheter) completed before the infusion of alteplase is started. ECG monitoring should be initiated if it hasn't already been started. A complete health and drug history should be taken, and the nurse should note any potential drug interactions or past history items that would increase the risk of bleeding. The nurse should also explain the procedure to the patient, including all follow-up monitoring and care.

CH. 41 A 37-year-old man has been taking NSAIDs for a shoulder injury. He develops abdominal pain that is worse when his stomach is empty. After trying several OTC remedies, he schedules a visit with his healthcare provider. A breath test confirms the presence of H. pylori and a diagnosis of PUD is made. The patient is started on omeprazole (Prilosec), clarithromycin (Biaxin), and amoxicillin (Amoxil). He asks about the purpose of the drugs. How should the nurse respond?

The antibiotics clarithromycin (Biaxin) and amoxicillin (Amoxil) are used to treat the infection with H. pylori. Two or more antibiotics are given concurrently to increase the effectiveness of therapy and to lower the potential for bacterial resistance. Omeprazole (Prilosec) or other PPIs are used to control gastric acidity, decreasing the irritation to the ulcer site.

CH. 42 An older adult patient has been ordered prochlorperazine (Compazine) for treatment of nausea and vomiting associated with a bowel obstruction, pending planned surgery. The nurse is preparing the plan of care for this patient. What should be included in the plan?

The nurse should plan to assess for signs of dehydration and plan for IV fluid replacement. Prochlorperazine (Compazine) may cause anticholinergic side effects, such as dry mouth, sedation, constipation, orthostatic hypotension, and tachycardia. The nurse will assess the patient for adverse effects and be particularly careful when helping the patient out of bed or with ambulation. If the drug is used for a prolonged period, EPS resembling those of Parkinson's disease are a serious concern, especially in older patients, and the nurse would assess for any motor-related symptoms.

CH. 38 A nurse is taking chemotherapy IV medication to a patient's room and the IV bag suddenly leaks solution (approximately 50 mL) on the floor. What action should the nurse take?

The nurse should remain with the solution and call for someone to bring the chemo spill kit immediately. While waiting for the spill kit, the nurse may cover the contaminated fluid with paper towels (the nurse must not touch the solution without wearing protective equipment). The nurse should clean up the spill and dispose of the waste per hospital protocols. At no time should the chemotherapy spill be left unattended.

CH. 21 A 46-year-old male quadriplegic patient has been experiencing severe spasticity in the lower extremities, making it difficult for him to maintain his position in his electric wheelchair. Prior to the episodes of spasticity, the patient was able to maintain a sitting posture. The risks and benefits of therapy with dantrolene (Dantrium, Revonto) have been explained to him, and he has decided that the benefits outweigh the risks. What assessments should the nurse make to determine whether the treatment is beneficial?

The nurse would anticipate a decrease in the patient's spasticity after 1 week of therapy. If there has been no improvement in 45 days, the medication regimen is usually discontinued. To evaluate for a decrease in spasticity, the nurse should assess the patient's muscle firmness, pain experience, range of motion, and ability to maintain posture and alignment when in a wheel-chair. When spasticity is necessary to maintain posture, dantrolene should not be used. In this case, the patient's spasticity was of recent origin and was the causative factor in his inability to maintain posture, something he was able to do before it began.

CH. 38 Chemotherapy medications often cause neutropenia in patients with cancer. What would be a priority for the nurse to teach a patient who is receiving chemotherapy at home?

The patient and family should be taught about the potential for infection related to immunosuppression. The nurse should stress infection control measures, self-assessing temperature accurately at home, and knowing when to call the oncology provider. Patients should also be taught that infections that occur during chemotherapy will not have symptoms as pronounced as when the patient was not on the drugs. Low-grade fevers, a feeling of general malaise, and other subtle signs of infection may occur and should be reported to the oncology provider.

CH. 20 A 58-year-old patient with PD is placed on levodopa. While obtaining her health history, the nurse notes that the patient takes Mylanta on a regular basis for mild indigestion and also takes multivitamins daily (vitamins A, B6, D, and E). What should the nurse include in teaching for this patient?

The patient should consult the healthcare provider about the need for regular Mylanta doses. This antacid drug contains magnesium, which may cause increased absorption and toxicity of the levodopa. The patient also needs teaching about decreasing foods that contain vitamin B6 (for example, bananas, wheat germ, and green vegetables) because vitamin B6 may adversely interact with the medication.

CH. 37 A newly diagnosed HIV-positive patient has been started on antiretroviral therapy with efavirenz (Sustiva), tenofovir (Viread), and emtricitabine (Emtriva). What should the nurse teach this patient about taking the drugs? What other factors should the nurse consider when talking with this patient? Identify priorities of nursing care for this patient.

The patient will require antiretroviral drugs to treat HIV infection long term and must be consistent with the treatment regimen to keep the infection from increasing or being transmitted to others. There are many adverse effects of the drugs, and the nurse should provide specific verbal and written instructions of administration needs, adverse effects, and when to notify the provider. While going over each medication, the nurse should keep in mind that a new diagnosis of HIV infection may be difficult or devastating to the patient. At this point in time, teaching may need to be brief and repeated several times, with written materials and follow-up teaching provided on subsequent office visits to ensure that the patient understands the information and follows any instructions.

CH. 15 A 24-year-old woman is brought to the emergency department by her husband. He tells the triage nurse that his wife has been treated for seizure disorder secondary to a head injury she received in an automobile crash. She takes phenytoin (Dilantin) 100 mg every 8 hours. He relates a history of increasing drowsiness and lethargy in his wife over the past 24 hours. A phenytoin level is performed, and the nurse notes that the results are 24 mcg/dL. What does this result signify, and what changes does the nurse anticipate will be made to this patient's treatment? (A laboratory guide may need to be consulted.)

The therapeutic drug level of phenytoin (Dilantin) is 5 to 20 mcg/dL and this increased level may indicate drug toxicity. Patients may develop signs of CNS depression, such as drowsiness and lethargy, as the level increases. Exaggerated effects of Dilantin may also be seen if the drug has been combined with alcohol or other drugs that cause CNS depression. Depending on the existence of these other factors, the nurse would anticipate that the drug dosage will be reduced.

CH. 36 A patient is traveling to Africa for 3 months and is requesting a prescription for Malarone to prevent malaria. What premedication assessment must be done for this patient?

This drug can have profound adverse effects, and the patient must be carefully screened and educated about this drug prior to taking it. The patient should have a baseline physical assessment, including an ECG and blood pressure, liver and kidney function tests, and hearing and visual assessment screenings. Baseline information is crucial for assessing adverse drug effects that occur during or after the patient returns from the trip.

CH. 41 A patient who is on ranitidine (Zantac) for PUD smokes and drinks alcohol daily. What education will the nurse provide to this patient?

This patient has a history of PUD, and alcohol and smoking exacerbate the condition. Avoiding these substances as well as caffeinated beverages and foods known to trigger abdominal pain should be included as part of the antiulcer regimen. This patient is on ranitidine (Zantac), and smoking decreases the effectiveness of the medication.

CH. 35 An 18-year-old woman comes to a clinic for prenatal care. She is 8 weeks pregnant. She is healthy and takes no other medication other than low-dose tetracycline for acne. What is a priority of care for this patient?

This patient should not be on tetracycline while pregnant because tetracycline is a category D drug that has adverse effects on fetal development. The nurse should instruct the patient to stop taking the tetracycline and explore alternative sources of care for her acne with her healthcare provider.

CH. 31 A patient is receiving enoxaparin subcutaneously after being diagnosed with thrombophlebitis. What precautions should be taken when giving this medication?

Whether the nurse gives this drug or is teaching the patient to self-administer the medication, proper placement of the needle in the abdomen is vital. The injection must be given at least 1 to 2 inches away from the umbilicus using the syringe supplied by the manufacturer. The air bubble included in the syringe should not be expelled to ensure full drug injection. The skin is pinched (drawn up) and the needle inserted at a 90-degree angle. Aspiration is not used. After giving the injection, slight pressure is held at the site and the site is not massaged.