PrepU Pharm 1301 - Chap 57,58,59

The nurse has just finished client education with a client who is being discharged home on bulk-forming laxatives. The nurse knows the client understands discharge instructions regarding these medications when which statement is made?

"I will mix the medication with 4 to 8 ounces of liquid and follow it by an additional 4 to 8 ounces." Explanation: Bulk-forming laxatives need to be taken with at least 8 oz of water or other liquid. The other options are incorrect statements and would indicate further need for teaching.

A cancer client is in the outpatient clinic to receive chemotherapy. The nurse administers prochlorperazine prophylactically before the infusion. What will the nurse's teaching for this client include?

"Transfer or change positions slowly in case of dizziness."

The nurse is caring for a 7-month-old infant in the clinic whose parents report that the baby has not had a bowel movement in 4 days. What is the nurse's best action?

Administer a glycerin suppository as prescribed.

The nurse is caring for a client who is receiving antacids to relieve GI discomfort. What nursing action is most appropriate?

Administer the antacid 1 hour before or 2 hours after other oral medications.

A nurse is caring for a patient with intestinal stenosis who has been prescribed psyllium. During the course of the treatment, the patient shows the signs of colon obstruction. What intervention should the nurse perform to avoid the occurrence of colon obstruction?

Administer the drug with adequate fluid intake. Explanation: The nurse should administer the drug with adequate fluid intake to avoid obstruction of the esophagus, stomach, small intestine, and colon in a patient with intestinal stenosis. Mineral oil is given to the patient as a laxative on an empty stomach in the evening. The nurse should provide foods high in bulk or roughage to avoid constipation in a patient receiving laxatives. The nurse administers a laxative with an unpleasant or salty taste after chilling it to disguise its taste.

What priority teaching point should the nurse include when instructing clients about the use of antacids?

Be aware of risk of acid rebound with long-term use.

A nurse is caring for an elderly patient who has been administered cimetidine. Which intervention should the nurse perform?

Closely monitor the patient for confusion and dizziness. Explanation: The nurse should closely monitor the elderly patient who has been administered cimetidine for confusion and dizziness. When the patient is receiving an antiemetic, the nurse monitors the patient frequently for continued reports of pain, sour taste, spitting blood, or coffee-ground-colored emesis. When antacids are given to the patient, the nurse should observe the patient for concentrated urine and restlessness. When the patient is administered prolonged doses of metoclopramide, the nurse reports any sign of tardive dyskinesia or extrapyramidal symptoms to the PHCP.

The nurse administers loperamide to decrease the number and liquidity of stool by what mechanism?

Decreasing intestinal motility

A new mother required an episiotomy during the birth of her baby. Two days after the birth of the baby, the client is in need of a laxative. What will be the most effective drug for the nurse to administer?

Docusate

What recommendations should be included in client teaching as a means of avoiding constipation? (Select all that apply.)

Drink plenty of fluids. Be active and exercise daily. Eat foods high in bulk or roughage. Explanation: Measures to prevent constipation include: drink plenty of fluids, get exercise, and eat foods high in bulk or roughage. Opioid medications can cause constipation and are therefore not a means of prevention. Avoiding the need to defecate when the urge occurs can lead to constipation.

A male client is taking cimetidine. Which adverse effect is more likely to occur with cimetidine than with other histamine2 receptor antagonists?

Gynecomastia Explanation: Gynecomastia is an adverse effect that is more likely to occur with cimetidine than with other histamine2 antagonists. Hypoxia, hypertension, and seizures are not adverse effects of cimetidine.

Carter, age 2, is diagnosed with cystic fibrosis; the physician places him on pancrelipase. What would be the most appropriate diagnosis for Carter related to his medication regimen?

Imbalanced nutrition: less than body requirements, related to impaired digestion secondary to insufficient pancreatic enzymes Explanation: Pancrelipase is administered as enzymatic replacement therapy for patients with deficient exocrine pancreatic secretions; cystic fibrosis; chronic pancreatitis; ductal obstructions caused by cancer of the pancreas or common bile duct; pancreatic insufficiency; or steatorrhea from malabsorption syndrome and after pancreatectomy, gastrectomy, or post-GI surgery, such as Billroth II gastroenterostomy. Caution must be used with large doses because they may cause nausea, abdominal cramps, and diarrhea. Hyperuricosuria and hyperuricemia have occurred with extremely high doses. Less often, allergic reactions have occurred.

The nurse is providing care for a 51-year-old male client who has been taking cimetidine for several months. When monitoring for adverse effects, the nurse should perform what assessment?

Inspect the client for gynecomastia

Which part of the brain is responsible for autonomic functioning such as ventilation, cardiac conduction, and vomiting?

Medulla oblongata Explanation: The medulla oblongata is the vomiting center as well as the center for other autonomic functioning. It is located in the hindbrain. The pineal gland and the pituitary gland are glands located in the forebrain and are responsible for endocrine functioning. The hypothalamus is a part of the limbic system.

Vomiting occurs when signals from the chemoreceptor trigger zone reach the vomiting center. Where is the vomiting center located?

Medulla oblongata Explanation: The vomiting center is a nucleus of cells in the medulla oblongata.

A female client is self-administering cimetidine. What is the home care nurse's most important assessment of this client?

Potential drug-drug interactions Explanation: The home care nurse can assist clients by providing information about taking the drugs correctly and monitoring responses. If cimetidine is being taken, the home care nurse needs to assess for potential drug-drug interactions.

A 1-year-old postoperative client has been experiencing repeated vomiting. What antiemetic drug has a black box warning against use in a client of this age?

Promethazine Explanation: A black box warning alerts nurses that promethazine is contraindicated in children younger than 2 years of age because of the risk of potentially fatal respiratory depression. Benzquinamide, buclizine, and cyclizine do not have such warnings.

A client with a history of peptic ulcer disease has responded well to treatment with a histamine-2 antagonist. This client is most likely experiencing which of the following?

Reduction in the quantity of hydrochloric acid secreted

The client has a magnesium-based antacid prescribed for administration before meals. The nurse knows to withhold the medication if the client exhibits what?

Renal dysfunction Explanation: Magnesium-based antacids are contraindicated in clients with renal failure. Magnesium-based antacids are not contraindicated with hypertension, regular heart rate, or stress ulcer.

Which intervention has priority when caring for an older adult client who has been prescribed a phenothiazine for reported nausea?

The client is identified as a possible falls risk Explanation: Older adults are more likely to develop adverse effects associated with the use of these drugs. Safety measures may be needed if these effects occur and interfere with the patient's mobility and balance increasing their risk for falls. While the other options present possible side effects, none have the priority of falls management.

Pancrelipase would most likely be used to treat a patient with cystic fibrosis.

True

A client, prescribed an antihistamine for nausea, should be monitored for which adverse effect of this classification of medication?

Urinary retention Explanation: Adverse anticholinergic effects of antihistamines are dizziness, confusion, dry mouth, and urinary retention. Urinary incontinence, prolonged QRS complex, and inverted T wave are not adverse effects of antihistamines.

The nurse is teaching a client about lansoprazole prescribed for treatment of gastric ulcer. By what mechanism of action does lansoprazole help treat the disease?

inhibiting acid secretion Explanation: Lansoprazole is a proton pump inhibitor. Drugs in this class (sometimes known as gastric acid pump inhibitors) suppress gastric acid secretion.

A 2-year-old child from Nigeria is reported to have excellent health, except for the diarrhea that started within days of the family's arrival in the United States 3 weeks ago. History reveals nothing remarkable, but the mother comments on her child's love of (and continual consumption of) ice cream, something not available in their native country. This history supports what possible cause of the child's diarrhea?

lactase deficiency Explanation: Deficiency of lactase, which breaks down lactose to simple sugars (i.e., glucose and galactose) that can be absorbed by the gastrointestinal (GI) mucosa, inhibits digestion of milk and milk products. Lactase deficiency commonly occurs among people of African and Asian descent.

A client develops Clostridium difficile after receiving antibiotic therapy. The client asks the nurse how this occurs. Which is the nurse's best response?

"By suppressing normal flora, antibiotics allow proliferation of the organism." Explanation: Antibiotic-associated colitis is a serious condition that results from oral or parenteral antibiotic therapy from any client. By suppressing normal flora in the colon, antibiotics allow proliferation of other bacteria, especially gram-positive anaerobic Clostridium difficile organisms. These organisms cause fever, abdominal pain, and severe diarrhea with stools containing mucus, pus, and sometimes blood. Symptoms may develop within a few days or several weeks after the causative antibiotic is discontinued. C-diff is not common in all antibiotic therapy and hospitalized clients. The antibiotic does not decrease the WBC but decreases the bacteria, allowing the WBC to attack the bacteria. The diarrhea is not a result of overgrowth of viruses.

A caregiver of a 1-year-old asks the nurse if the caregiver can give the diphenoxylate that was prescribed for an older sibling to the child. Which is the nurse's best response?

"Children younger than 1 year of age should not be given this medication." Explanation: Children younger than 2 years of age should not take the drugs, and those from age 2 to less than 13 years should take the liquid preparation to enhance accuracy of the dosage. Calling the prescriber is not necessary. The nurse-should not encourage over-the-counter medications for the child.

When reviewing a newly admitted client's previous medication record, the nurse notes that the client has previously been treated with aprepitant. The nurse is justified in suspecting that this client's medical history includes which therapy/treatment?

Chemotherapy Explanation: Prescribers often order aprepitant as part of combination therapy along with a 5-HT3 receptor antagonist and corticosteroids to treat both acute and delayed nausea and vomiting associated with chemotherapy. NG tube insertion, radiation therapy, and endoscopy are not typical indications for the use of aprepitant.

A client develops intractable hiccups after surgery. The nurse anticipates that the physician will order which medication?

Chlorpromazine

The nurse has administered a prescribed dose of ondansetron IV to a client. What assessment finding best indicates therapeutic effect?

Client denies nausea

In pharmacology class the students are learning about the mechanism of action of different laxatives. What would the students learn about the mechanism of action of psyllium hydrophilic mucilloid?

Increasing mass and water content of stool Explanation: When water is added, the laxative substance swells and becomes gel-like. The added bulk or size of the fecal mass stimulates peristalsis and defecation. The other options are not the mechanism of action of psyllium.