Saunders Pharm Review for HESI

The *optimal therapeutic range for digoxin* is

0.5 to 0.8 ng/mL.

The normal blood urea nitrogen level is

10 to 20 mg/dL (3.6 to 7.1 mmol/L)*.

The normal blood urea nitrogen level is

10 to 20 mg/dL (3.6 to 7.1 mmol/L).

The normal platelet count is

150,000 to 400,000 mm3 (150 to 400 × 109/L).

The normal Male: hematocrit level is

42% to 52% (0.42 to 0.52);

*Bethanechol* is a *cholinergic medication*. Administration of bethanechol could result in *cholinergic overdose*. WHAT IS THE *ANTIDOTE*

ATROPINE (an anticholinergic), which should be readily available for use if overdose occurs.

A client is prescribed *DUTastERide* Which outcome indicates that the medication is effective?

Decreased obstruction to outflow of urine through the urethra

The nurse is providing discharge instructions to a client receiving *trimethoprim-sulfamethoxazole*. Which instruction should be included in the list?

Drink 8 to 10 glasses of water per day. Each dose of trimethoprim-sulfamethoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake to *avoid crystalluria*. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Clients should be advised to use sunscreen since the skin becomes sensitive to the sun. Some forms of trimethoprim-sulfamethoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the HCP.

*Alendronate* is a bisphosphonate used in *hyperparathyroidism* to inhibit bone loss and normalize serum calcium levels.

Esophagitis For this reason the client is instructed to take alendronate *first thing in the morning* with a *full glass of water* on an *empty stomach*, DO NOT eat or drink anything else for at least 30 minutes REMAIN SITTING UPRIGHT 30 minutes after taking it. A daily dosing schedule and a once-weekly dosing schedule is available for clients taking alendronate.

The *normal FEMALE creatinine* level for a

FEMALE = 0.5 to 1.1 mg/dL (44 to 97 mcmol/L)

*Propantheline bromide* is prescribed for a client with *bladder spasms*. Which disorder, if noted in the client's record, should alert the nurse to question the prescription for this medication?

Glaucoma Propantheline bromide is *contraindicated* in clients with - narrow-angle glaucoma - obstructive uropathy - gastrointestinal disease, or ulcerative colitis. *The medication decreases bladder muscle spasm*

A client with a *urinary tract infection* is receiving *ciprofloxacin* by the intravenous *(IV) route*. The nurse appropriately administers the medication by performing which action?

Infusing slowly over 60 minutes

A client with chronic kidney disease (CKD) who is receiving an antihypertensive medication is experiencing frequent hypotensive episodes. The nurse reviews the client's medication record, knowing that which medication would have the greatest tendency to cause hypotension?

Methyldopa Methyldopa is metabolized by the kidneys and requires careful dosage adjustment according to the client's renal function to prevent hypotension.

*Trimethoprim-sulfamethoxazole* is prescribed to be administered by intravenous infusion to a client with a *recurrent urinary tract infection*. How should the nurse administer this medication?

Over 60 to 90 minutes Trimethoprim-sulfamethoxazole may be administered by intravenous infusion but *should not be mixed with any other medications or solutions*. Trimethoprim-sulfamethoxazole is infused over 60 to 90 minutes, and bolus infusions or rapid infusions must be avoided.

A client who has had a *prostatectomy* is complaining of *pain from bladder spasms*. The nurse checks the health care provider's prescription sheet and expects to see which medication prescribed to treat the problem?

Oxybutynin Bladder spasms after prostatectomy are treated with ANTISPASMOTIC medications, such as oxybutynin. Opioid analgesics such as morphine sulfate, hydromorphone, and meperidine hydrochloride usually are not effective in treating pain caused by spasms.

*Ondansetron* is an *antiemetic* used to treat

POST-OP nausea and vomiting, as well as nausea and vomiting associated with *chemotherapy*.

*Oxybutynin chloride* is prescribed for a client with *urge incontinence*. Which sign would indicate a possible toxic effect related to this medication?

Restlessness *Toxicity (overdosage) of oxybutynin produces central nervous system excitation*, such as - nervousness - restlessness - hallucinations - irritability. Other signs of toxicity include - hypotension - hypertension - confusion - tachycardia - flushed - red face - respiratory depression. - Drowsiness is a frequent side effect of the medication but does not indicate overdosage.

A client taking *metronidazole* telephones the home health nurse to report *dark discoloration to the urine*. The nurse interprets that the client's complaint warrants which nursing action at this time?

Tell the client that this is a harmless medication side effect.

*Phenazopyridine* is prescribed for a client with a urinary tract infection. The nurse evaluates that the medication is effective based on which observation?

URINATION IS NOT PAINFUL Phenazopyridine is a *urinary analgesic*. It is effective when it eliminates pain and burning with urination. It does not eliminate the bacteria causing the infection, so it would not make the urine clear amber. It does not treat urge incontinence. It will cause the client to have reddish-orange discoloration of urine but this is a side effect of the medication, not the desired effect

antidote for warfarin.

Vitamin K

Mucomyst or ACETYLCYSTEINE is the antidote for

acetaminophen overdose.

Corticosteroids (glucocorticoids) should be administered

before 9 a.m. Administration at this time helps to minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning.

Calcium carbonate is used in the treatment of

calcium deficiency it does not cause hypotension when administered via the oral route. *Parenteral administration of calcium may cause hypotension*.

Ciprofloxacin

can be taken with or without food can cause photosensitivity can increase the risk for oral Candida infections.

A compound present in *grapefruit juice* inhibits metabolism of *cyclosporine* through the *cytochrome P450* system. As a result, consumption of grapefruit juice can raise

cyclosporine levels by 50% to 100%, thereby greatly increasing the risk of toxicity.

If the client taking digoxin is experiencing symptoms such as *anorexia* and is experiencing *hypokalemia* as evidenced by a low potassium level,

digoxin toxicity is a concern.

Protamine sulfate is the antidote for

heparin.

Administration of bethanechol chloride with food can cause nausea and vomiting. To avoid this problem,

oral doses should be administered 1 hour before meals or 2 hours after meals.

The principal manifestations of *Crohn's disease* are *diarrhea and abdominal pain* (usually in the RLQ) *Infliximab* is an *immunomodulator* that

reduces the degree of inflammation in the colon, thereby reducing the diarrhea.

Nitrofurantoin is contraindicated in clients with

renal impairment.

The *normal MALE creatinine* level for a

MALE = 0.6 to 1.2 mg/dL (53 to 106 mcmol/L)

The nurse is providing teaching for a client prescribed ciprofloxacin for a urinary tract infection. Which statement made by the client indicates that there is a need for further teaching?

"If I develop any tendon pain while taking ciprofloxacin, exercise should help to decrease the pain." he health care provider should be contacted immediately if the client develops any tendon pain, swelling, or inflammation because of the risk of tendon rupture. Exercise is contraindicated until tendon rupture is ruled out. Fluorquinolones such as ciprofloxacin need to be discontinued at the first sign of any tendon pain, swelling, or inflammation. \

The nurse provides instructions regarding the administration of *liquid oral cyclosporine* solution to a client. Which statement, if made by the client, would indicate the need for further teaching?

"I will purchase a dropper from the pharmacy to calibrate the amount of medication that I need." The client needs to be instructed to dispense the oral liquid into a glass container using a specially calibrated pipette. The client should not use any other type of dropper to calibrate the amount of prescribed medication. The remaining options identify correct procedure for administering this medication.

A client is being treated with procainamide for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take first?

*Auscultate the client's apical pulse and obtain a blood pressure.* Signs of *toxicity from procainamide* include - confusion - dizziness - drowsiness - decreased urination - nausea - vomiting - tachydysrhythmias. If the client complains of dizziness, the nurse should assess the vital signs first. Although measuring the heart rate on the rhythm strip and obtaining a 12-lead electrocardiogram may be interventions, these would be done after the vital signs are taken.

*Trimethoprim-sulfamethoxazole* is prescribed for a client. The nurse should instruct the client to report which symptom if it develops during the course of this medication therapy

*SORE THROAT* Clients taking trimethoprim-sulfamethoxazole should be informed about *early signs and symptoms of blood disorders that can occur from this medication*. These include sore throat Fever pallor and the client should be instructed to notify the health care provider (HCP) if these occur. The other options do not require HCP notification.

*Nitrofurantoin* is an

*antibacterial* used to treat *urinary tract infections*. Although rare, the medication can cause an *asthmatic exacerbation* in those with a history of asthma. Therefore, the priority baseline assessment should include questioning the client about a history of asthma and checking lung sounds.

*Cromolyn sodium* is an *inhaled nonsteroidal antiallergy agent* and a *mast cell stabilizer*. Undesirable effects associated with inhalation therapy of cromolyn sodium are

*bronchospasm*, cough, nasal congestion, throat irritation, and wheezing. Clients receiving this medication orally may experience pruritus, nausea, diarrhea, and myalgia.

Audible expiratory wheezes may indicate a serious adverse reaction to propanolol,

*bronchospasm*. Beta blockers may induce this reaction, particularly in clients with *chronic obstructive pulmonary disease or asthma*. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.

*Bethanechol chloride* is a *direct-acting muscarinic agonist (cholinergic medication)*. It can cause

*hypotension secondary to vasodilation* bradycardia. *excessive salivation* *increased secretion of gastric acid* *abdominal cramps* *diarrhea*. Higher doses can cause *involuntary defecation*

*DUTastERide* promotes

*regression of prostate epithelial tissue* and thereby DECREASES MECHANICAL OBSTRUCTION of the UREthra. Because *the percentage of epithelial tissue is highest in very large prostates*, it is most *effective* in MEN whose PROTASTES are very ENLARGED

*Bethanechol* can elicit all of the responses typical of muscarinic receptor activation. The principal structures affected by muscarinic activation are the heart, exocrine glands, smooth muscles, and eyes. Muscarinic agonists act on the heart to cause

- bradycardia (decreased heart rate) - exocrine glands: increase sweating - increase salivation - increase bronchial secretions - increase secretion of gastric acid. *In smooth muscles of the lungs and GI tract, muscarinic agonists promote contraction*. ***constriction of the bronchi ***increased tone and motility of GI smooth muscle. bladder, muscarinic activation causes *contraction of the detrusor muscle and relaxation of the trigone and sphincter*; the result is BLADDER EMPTYING. In vascular smooth muscle, these drugs cause relaxation; the resultant *vasodilation can produce hypotension*. Activation of muscarinic receptors in the eyes has two effects: (1) miosis (pupillary constriction); and (2) contraction of the ciliary muscle, resulting in accommodation for near vision. (The ciliary muscle, which is attached to the lens, focuses the eyes for near vision by altering lens curvature.)

*Sucralfate* is a *gastric protectant*. The medication should be scheduled for administration

1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation.

*Digoxin* is a *cardiac glycoside*. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include

1. gastrointestinal manifestations such as a. anorexia b. nausea c. vomiting d. diarrhea. Subsequent manifestations inclue - headache; - visual disturbances such as diplopia, - blurred vision, - yellow-green halos, and - photophobia; - drowsiness; - fatigue; and - weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. The optimal therapeutic range for digoxin is 0.5 to 0.8 ng/mL.

*Metoclopramide* is a *gastrointestinal stimulant* and *antiemetic*. Because it is a gastrointestinal stimulant, it is contraindicated with

1. gastrointestinal obstruction 2. hemorrhage 3. perforation. It is used in the treatment of vomiting after surgery, chemotherapy, or radiation.

When taking Digoxin, An increased risk of toxicity exists in clients with

1. hypercalcemia 2. hypokalemia 3. hypomagnesemia 4. hypothyroidism 5. impaired renal function.

The normal range for magnesium is

1.3 to 2.1 mEq/L (0.65 to 1.05 mmol/L)

The normal white blood cell count is

5000 to 10,000 mm3 (5 to 10 × 109/L).

Ciprofloxacin is prescribed for treatment of mild, moderate, severe, and *complicated infections of the urinary tract*, lower respiratory tract skin and skin structure.

A single dose is administered slowly over 60 minutes to minimize discomfort and vein irritation.

*Omalizumab* is an *antiinflammatory* used for *long-term control of asthma*.

Anaphylactic reactions can occur with the administration of omalizumab. The nurse administering the medication should monitor for adverse reactions of the medication. swelling of the lips and tongue are an indication of an anaphylaxis.

A client with hyperthyroidism has been given *methimazole*. Which nursing considerations are associated with this medication? Select all that apply.

Assess for bruisng or bleeding Administer methimazole with food. Instruct the client to report side and adverse effects such as sore throat, fever, or headaches. Common side effects of methimazole include *nausea, vomiting, and diarrhea*. To address these side effects, this medication should be *taken with food*. Because of the increase in metabolism that occurs in hyperthyroidism, the client should consume a *high-calorie diet*. Antithyroid medications can cause *agranulocytosis* with *leukopenia* and *thrombocytopenia*. *Sore throat, fever, headache, or bleeding may indicate agranulocytosis* and the health care provider should be notified immediately. Methimazole is not radioactive and should not be stopped abruptly, due to the risk of thyroid storm.

Bethanechol chloride is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this medication?

Bethanechol chloride is a muscarinic agonists (prototype). It selectively mimics the effects of acetylcholine at muscarinic receptors. The *muscarinic agonists* bind to *muscarinic receptors* and thereby cause *receptor activation*. Since nearly all muscarinic receptors are associated with the *parasympathetic nervous system*, responses to muscarinic agonists closely resemble those produced by stimulation of parasympathetic nerves. Accordingly, muscarinic agonists are also known as *parasympathomimetic agents* Muscarinic receptors are found Sweat glands Blood vessels All organs regulated by the parasympathetic nervous system. Affects of receptor activation include: Many, including: ↓ Heart rate ↑ Gland secretion Smooth muscle contraction (RELAX) ANSWER to QUESTION: URINARY STRICTURES Bethanechol chloride can be hazardous to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could damage or rupture the bladder in clients with these conditions.

The nurse is administering a dose of a prescribed diuretic to an assigned client. The nurse should monitor the client for hypokalemia as a side effect of therapy if the client has been receiving which medication?

Bumetan*ide* LOOP DIURETIC

An *older client* recently has been taking *cimetidine*. The nurse monitors the client for which most frequent central nervous system side effect of this medication?

CONFUSION Cimetidine is a histamine (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.

A client with a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium 7.5 mg at 5:00 p.m. daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. The nurse should take which action based on the client's laboratory results?

Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed When a client is receiving warfarin for clot prevention due to atrial fibrillation, an INR of 2 to 3 is appropriate for most clients. Until the INR has achieved a therapeutic range, the client should be maintained on a continuous heparin infusion with the aPTT ranging between 60 and 80 seconds. Therefore, the nurse should collaborate with the HCP to obtain a prescription to increase the heparin infusion and to administer the warfarin as prescribed.

*Ethambutol* causes *optic neuritis*, which

DECREASES *visual acuity* and the *ability to discriminate between the colors red and green*. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if gastrointestinal upset occurs.

A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of *benign prostatic hyperplasia*, the nurse determines that the client should be questioned about the use of which medication?

Decongestants In the client with benign prostatic hyperplasia, *episodes of urinary retention can be triggered by certain medications*, such as - - decongestants, - anticholinergics, - antidepressants. These medications lessen the voluntary ability to contract the bladder. The client should be questioned about the use of these medications if he has urinary retention.

Antidote for digoxin toxicity

Digoxin immune Fab (Digibind)

The nurse is reviewing the laboratory results for a client receiving tacrolimus. Which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medication?

Fasting blood glucose of 200 mg/dL (11.1 mmol/L) A fasting blood glucose level of 200 mg/dL (11.1 mmol/L) is significantly elevated above the normal range of 70 to 110 mg/dL (4 to 6 mmol/L) and suggests an adverse effect. Recall that fasting blood glucose levels are sometimes based on health care provider preference. Other adverse effects include neurotoxicity evidenced by headache, tremor, and insomnia; gastrointestinal effects such as diarrhea, nausea, and vomiting; hypertension; and hyperkalemia. The remaining options identify normal reference levels. The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). The normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L).

The normal FeMale: hematocrit level is

Female: 37% to 47% (0.37 to 0.47).

The nurse is teaching the client about his prescribed *prednisone*. Which statement, if made by the client, indicates that *further teaching* is necessary? I can take aspirin or my antihistamine if I need it." "I need to take the medication every day at the same time." "I need to avoid coffee, tea, cola, and chocolate in my diet." "If I gain more than 5 pounds (2.25 kg) a week, I will call my health care provider (HCP)."

I can take aspirin or my antihistamine if I need it." Aspirin and other over-the-counter medications should not be taken unless the client consults with the HCP. The client needs to take the medication at the same time every day and should be instructed not to stop the medication. A slight weight gain as a result of an improved appetite is expected; however, after the dosage is stabilized, a weight gain of 5 pounds (2.25 kg) or more weekly should be reported to the HCP. *Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development.*

*Epoetin alfa* is *synthetic erythropoietin*, which the kidneys produce to stimulate red blood cell production in the bone marrow.

It is used to treat *anemia* associated with *chronic kidney disease*.

*Zafirlukast* is prescribed for a client with *bronchial asthma*. Which laboratory test does the nurse expect to be prescribed before the administration of this medication?

Liver enzymes Zafirlukast is a *leukotriene receptor anTAGonist* used in the *prophylaxis and long-term treatment of bronchial asthma*. Zafirlukast is used with *caution in clients with impaired hepatic function*. Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication. It is not necessary to perform the other laboratory tests before administration of the medication.

*Nitrofurantoin is* a *urinary antiseptic* and should be taken with

MEALS to decrease the incidence of GI side effects. Food or milk decreases the GI upset. The medication could cause the urine to turn rust yellow or brown.

*Loperamide* is an *antidiarrheal agent*. It is used to

Manage acute and chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy.

*Ciprofloxacin* is prescribed for a client with a *Pseudomonas aeruginosa infection* of the *urinary tract*. The health care provider (HCP) should be questioned by the nurse about the prescription if which underlying condition is noted in the client's record?

Myasthenia gravis *Ciprofloxacin and other fluorquinolone*s can *exacerbate muscle weakness* in clients with *myasthenia gravis*. Accordingly, clients with a history of myasthenia gravis should not receive these medications. History of the remaining disease processes does not pose a problem.

*Cyclosporine* is an *immunosuppressant* (possibly given after a kindey trnasplan t

Nephrotoxicity can occur from the use of cyclosporine. Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels. The *normal blood urea nitrogen level is 10 to 20 mg/dL (3.6 to 7.1 mmol/L)*. The *normal creatinine* level for a MALE = 0.6 to 1.2 mg/dL (53 to 106 mcmol/L) FEMALE = 0.5 to 1.1 mg/dL (44 to 97 mcmol/L) Cyclosporine can lower complete blood cell count levels. A *normal hemoglobin* Male: 14 to 18 g/dL (140 to 180 mmol/L); Female: 12 to 16 g/dL (120 to 160 mmol/L). A normal hemoglobin is not an adverse effect. Cyclosporine does affect the glucose level. The *normal fasting glucose is 70 to 110 mg/dL* (4 to 6 mmol/L).

A client with *acute pyelonephritis* who was started on antibiotic therapy 24 hours earlier is still complaining of burning with urination. The nurse should anticipate that the health care provider will prescribe which medication?

Phenazopyridine The pain experienced with pyelonephritis usually resolves as antibiotic therapy becomes effective. However, clients may be treated for *urinary tract pain with phenazopyridine*, which is a *urinary analgesic*. Oxybutynin chloride and propantheline bromide are antispasmodics that are used to treat bladder spasm.

A client is prescribed sulfamethoxazole for treatment of urinary tract infection. Identification of which other medication noted on the client's medical record requires further collaboration with the health care provider (HCP)?

Phenytoin Sulfonamides can intensify the effects of warfarin, phenytoin, and sulfonylurea-type oral hypoglycemics (e.g., glipizide, glyburide). The principal mechanism is inhibition of hepatic metabolism. When combined with sulfonamides, these medications may require a reduction in dosage to prevent toxicity. Therefore, the nurse should collaborate with the HCP regarding dose adjustment of phenytoin.

The nurse is planning to administer furosemide 40 mg by intravenous push (IVP) through an existing intravenous (IV) line. To deliver this medication safely, the nurse should perform which action?

Pinch the IV tubing above the injection port, and inject slowly over 1 to 2 minutes.

A client is receiving levofloxacin for treatment of urinary tract infection. Which finding warrants an immediate call to the health care provider (HCP)?

Prolonged QT interval on electrocardiogram *Levofloxacin can prolong the client's QT interval*, which would be noted on electrocardiogram. This warrants a call to the HCP because a prolongation in the QT interval can lead to torsades de pointes, a lethal dysrhythmia. The client may complain of diarrhea, not constipation, as a side or adverse effect. The medication can be taken with or without food and is effective against Staphylococcus aureus.

A client has begun medication therapy with *pancrelipase*. The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed?

Reduction of steatorrhea Pancrelipase is a *pancreatic enzyme* used in clients with *pancreatitis as a digestive aid*. The medication should *reduce the amount of fatty stools (steatorrhea)*. Another intended effect could be *improved nutritional status*. Its use could result in weight gain but should not result in weight loss if it is aiding in digestion.

Tacrolimus is prescribed for a client who underwent a kidney transplant. Which instruction should the nurse include when teaching the client about this medication?

Take the oral medication every 12 hours at the same times every day.

The nurse is providing instructions to the client newly diagnosed with diabetes mellitus who has been prescribed *pramlintide*. Which instruction should the nurse include in the discharge teaching? "Inject the pramlintide at the same time you take your other medications." "Take your prescribed pills 1 hour before or 2 hours after the injection." "Be sure to take the pramlintide with food so you don't upset your stomach." "Make sure you take your pramlintide immediately after you eat so you don't experience a low blood sugar."

Take your prescribed pills 1 hour before or 2 hours after the injection." *Pramlintide* is used for clients with types 1 and 2 diabetes mellitus who use insulin. It is administered subcutaneously before meals to lower blood glucose level after meals, leading to less fluctuation during the day and better long-term glucose control. Because pramlintide delays gastric emptying, oral medications should be given 1 hour before or 2 hours after an injection of pramlintide; therefore, instructing the client to take his or her pills 1 hour before or 2 hours after the injection is correct. Pramlintide should not be taken at the same time as other medications. Pramlintide is given immediately before the meal in order to control postprandial rise in blood glucose, not necessarily to prevent stomach upset. It is incorrect to instruct the client to take the medication after eating, as it will not achieve its full therapeutic effect.

*Nitrofurantoin* is prescribed for a client with a *urinary tract infection*. The client contacts the nurse and reports a cough, chills, fever difficulty breathing. The nurse should make which interpretation about the client's complaints?

The client is experiencing a pulmonary reaction requiring cessation of the medication. *Nitrofurantoin* can induce *2 kinds* of pulmonary reactions: 1. acute 2. subacute. *Acute reactions*, which are *most common*, manifest with: dyspnea chest pain chills fever cough alveolar infiltrates. These symptoms resolve 2 to 4 days after discontinuing the medication. Acute pulmonary responses are thought to be hypersensitivity reactions. Subacute reactions are rare and occur during prolonged treatment. Symptoms (e.g., dyspnea, cough, malaise) usually regress over weeks to months following nitrofurantoin withdrawal. However, in some clients, permanent lung damage may occur. The remaining options are incorrect interpretations.

Counseling for a pt receiving GEMI*floxacin*

You may experience altered taste." "You may get dizzy, so move around slowly." Your urine may become dark and if it does, you should call your health care provider."

The client who uses NSAIDs is prone to gastric mucosal injury. *Misoprostol*

a gastric protectant and is given specifically to prevent this occurrence in clients taking NSAIDs frequently. Diarrhea can be a side effect of the medication but is not an intended effect.

*Cimetidine*, a *histamine (H2)-receptor antagonist*, helps to

alleviate the symptom of *heartburn* Because *cimetidine crosses the blood-brain barrier*, central nervous system side and adverse effects, such as - mental confusion - agitation - depression - anxiety, can occur. Food reduces the rate of absorption, so if cimetidine is taken with meals, absorption will be slowed. *Antacids decrease the absorption of cimetidine and should be taken at least 1 hour apart*. If cimetidine is concomitantly administered with warfarin therapy, *warfarin doses may need to be reduced*, so prothrombin and international normalized ratio results must be followed. *PT & INR*

*Bethanechol chloride is a cholinergic medication that is used for urinary retention*. This medication should not be used for clients with

asthma because it can precipitate *bronchoconstriction* by activating muscarinic receptors. Other conditions this medication should not be used with include hypotension bradycardia gastric ulcers intestinal obstruction urinary tract obstruction hyperthyroidism. Bethanechol chloride is a cholinergic agent used to treat neurogenic bladder or urinary retention.

Repaglinide, a *rapid-acting oral hypoglycemic* agent that *stimulates pancreatic insulin secretion*, should be taken

before meals (approximately 30 minutes before meals) and SHOULD BE *withheld* if the client does *not eat*. Hypoglycemia is a side effect of repaglinide and the client should always be prepared by carrying a simple sugar at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by *decreasing hepatic glucose production*. A common side effect of metformin is *diarrhea*. *Muscle pain* may occur as an adverse effect from metformin but it might signify a more serious condition that *warrants health care provider notification*, not the use of acetaminophen.

*Oxybutynin is an anticholinergic* used for Overactive bladder. Anticholinergic side effects include

dry mouth constipation tachycardia urinary hesitancy urinary retention mydriasis blurred vision dry eyes.

*Terbutaline* is a *bronchodilator* and is contraindicated in clients with

hypersensitivity to *sympathomimetics*. CAUTION: impaired cardiac function, diabetes mellitus, hypertension, hyperthyroidism history of seizures. The medication *may increase blood glucose levels.*

Bumetan*ide* is a loop diuretic and expected outcomes include

increased urine output, decreased crackles, and decreased weight.

Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore,

liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years or abuses alcohol.

*Cholestyramine* is a *bile acid sequestrant* used to

lower the cholesterol level client compliance is a problem because of its taste and palatability. The use of flavored products or fruit juices can improve the taste. Some side effects of bile acid sequestrants include 1. constipation 2. decreased vitamin absorption.

TamSUL*osin* hydrochloride is used to relieve

mild to moderate manifestations that occur in *benign prostatic hypertrophy*. The medication also *improves urinary flow rates*. The medication should be administered *30 minutes after meals* because FOOD DECREASES PEAK PLAMSA CONCENTRATION and LENTGHENS THE TIME TO ACHEIVE PEAK PLASMA medication concentrations.

In *diabetes insipidus*, there is a *deficiency in antidiuretic hormone (ADH)*, resulting in *large urinary losses*. Desmopressin is an analog of ADH. Clients with diabetes insipidus drink high volumes of fluid (polydipsia) as a compensatory mechanism to counteract urinary losses and maintain fluid balance. Once desmopressin is started,

oral fluids should be decreased to prevent water intoxication. *Headache and drowsiness are signs of water intoxication* in the client taking desmopressin and should be reported to the health care provider. The *amount of urine should decrease*, not increase, when desmopressin is started.

*Levofloxacin* is a *fluoroquinolone antibiotic* and is used for a *variety of infections*, including UTI. Adverse effects include:

peripheral neuropathy *rhabdomyolysis*, tendonitis, tendon rupture, Clostridium difficile infection, muscle weakness in clients with myasthenia gravis, and photosensitivity. Levofloxacin can also prolong the client's QT interval, leading to dysrhythmias. Pain in the back of the leg could be indicative of tendonitis and therefore risk for tendon rupture.

Impaired hearing results from antitubercular therapy with

streptomycin.

Epoetin alfa is erythropoietin that has been manufactured through the use of recombinant DNA technology. It is used to treat anemia in the client with chronic kidney disease. The medication may be administered

subcutaneously or intravenously as prescribed.

*Thiazide diuretics* such as *hydrochlorothiazide* are

sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia hyperglycemia hypercalcemia hyperlipidemia hyperuricemia.

Diphenhydramine (benedryl) has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Instructions for use include

taking *with food or milk* to decrease gastrointestinal upset and using oral rinses, sugarless gum, or hard candy to minimize dry mouth. Because the medication causes drowsiness, the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities requiring mental awareness during use.

*Isoniazid* is *hepatotoxic*, and therefore

the client is taught to report signs and symptoms of hepatitis immediately, which include yellow skin and sclera. For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing *tyramine* because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can *avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6)* during the course of isoniazid therapy.

Therapeutic effect with Epoetin alfa* is *synthetic erythropoietin*,is seen when

the hematocrit reaches between 30% and 33% (0.30 and 0.33).

*Nitrofurantoin* imparts a *harmless brown color* to the urine and

the medication should not be discontinued until the prescribed dose is completed.

Nitroglycerin is a

vasodilator and will lower the blood pressure.

Sulfonamides can intensify the effects of

warfarin phenytoin sulfonylurea-type oral hypoglycemics (e.g., glipizide, glyburide). The principal mechanism is inhibition of hepatic metabolism. When combined with sulfonamides, these medications may require a reduction in dosage to prevent toxicity.

*Theophylline* is a *methylxanthine bronchodilator*. The nurse teaches the client to limit the intake of

xanthine-containing foods while taking this medication. These foods include coffee, cola, and chocolate.