401 Progression Exam

theophylline (theo-dur) nursing considerations for theophylline

-vital signs (RR, pulse, cardiac rhythm, lung sounds, effort, skin color, o2 sat prior to admin) -history of CAD, angina pectoris, severe renal or liver disorders, peptic ulcer, BPH, diabetes mellitus

prednisone Interactions

ASA, NSAID's, antacid, grapefruit juice

prednisone Adverse Reactions

Peptic ulcers, thromboembolism, depression, 4 H's (HTN, hyperglycemia, hypokalemia, hursutism)

prednisone Contraindications

Pregnancy/lactation, not suitable for long-term use in young children (may stunt growth)

Before administering Oxytocin/Pitocin

assess VS and I&O. Electric Pump is recommended.

A client is prescribed theophylline to relax the smooth muscles of the bronchi. The nurse monitors the client's theophylline serum levels to maintain which therapeutic range? a. 1 to 10 mcg/mL b. 10 to 20 mcg/mL c. 20 to 30 mcg/mL d. 30 to 40 mcg/mL

b. 10 to 20 mcg/mL

Which statement indicates to the nurse that the client understands sublingual nitroglycerin medication instructions? a. "I will take up to five doses every 3 minutes for chest pain." b. "I can chew the tablet for the quickest effect." c. "I will keep the tablets locked in a safe place until I need them." d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."

d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."

The nurse is monitoring a client during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action? a. Blood pressure 110/90 mm Hg b. Flushing c. Headache d. Chest pain

d. Chest pain

A nurse is monitoring a client with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective? a. Blood pressure 120/80 mm Hg b. Heart rate 70 beats per minute c. ECG without evidence of ST changes d. Client stating that pain is 0 out of 10

d. Client stating that pain is 0 out of 10

Adverse reactions to Oxytocin/Pitocin in the mother include

hypertension, fluid overload, and uterine tetany Overdosing of Oxytocin/Pitocin may cause severe uterine contractions resulting in possible abruptio placentae, impaired fetal blood flow, and fetal trauma

prednisone

intermediate-acting corticosteroids

Fentanyl Potential Nursing Diagnoses

● Acute pain (Indications). ● Disturbed sensory perception (auditory, visual) (Side Effects). ● Risk for injury (Side Effects). ● Deficient knowledge, related to disease process and medication regimen (Patient/Family Teaching).

The nurse is aware of which fact regarding lorazepam (Ativan)? a. It may cause confusion and blurred vision. b. It has a maximum adult dose of 25 mg/day. c. When combined with cimetidine, it causes plasma levels to be decreased. d. It interferes with the binding of dopamine receptors

a. It may cause confusion and blurred vision

The nurse will monitor the client taking albuterol (Proventil) for which condition? a. Palpitations b. Hypoglycemia c. Bronchospasm d. Uterine contractions

a. Palpitations

Heparin

MEDICATION CLASSIFICATION: ANTICOAGULANTS/PARENTERAL

If Fetal distress occurs with Oxytocin/Pitocin

reduce Pitocin infusion, turn mother to Left Side, Administer Oxygen, and Call provider immediately

A client has begun therapy with theophylline (Theo-24). A nurse plans to teach the client to limit the intake of which of the following while taking this medication? 1. Coffee, cola, and chocolate 2. Oysters, lobster, and shrimp 3. Melons, oranges, and pineapple 4. Cottage cheese, cream cheese, and dairy creamers

1. Coffee, cola, and chocolate Rationale: The methylxanthines comprise a group of bronchodilators chemically related to caffeine. Because of the drugs' chemical similarities, patients should avoid foods and beverages containing caffeine when taking these drugs.

The nurse administers theophylline (Theo-Dur) to a client. To evaluate the effectiveness of this medication, which of the following drug actions should the nurse anticipate? 1. Suppression of the client's respiratory infection. 2. Decrease in bronchial secretions. 3. Relaxation of bronchial smooth muscle. 4. Thinning of tenacious, purulent sputum.

3. Theophylline (Theo-Dur) is a bronchodilator that is administered to relax airways and decrease dyspnea. Theophylline is not used to treat infections and does not decrease or thin secretions.

A nurse should advise a client who is receiving lorazepam (Ativan) about the adverse effects of this medication which include 1. Tachypnea 2. Astigmatism 3. Ataxia 4. Euphoria

3. Ataxia Rationale: Ataxia, weakness, restlessness, dizziness, or other motor problems can occur with lorazepam. Options 1, 2, and 4 are incorrect. These are not adverse effects associated with lorazepam.

What would be the highest priority nursing diagnosis for a client taking phenytoin (Dilantin)? A. Anxiety B. Risk for falls C. Risk for constipation D. Deficient fluid volume

Answer: B- "risk for falls" has the highest priority for a client taking phenytoin because it may lead to side effects of dizziness, decreased coordination, and ataxia. Anxiety, constipation, and efficient fluid volume are not side effects of phenytoin.

Which are accurate nursing interventions when administering heparin subcutaneously? (Select all that apply.) A. Assessment of recent aPTT levels B. Massaging the site after injection of medication C. Aspirating after needle insertion D. Documentation of ecchymotic areas E. Monitoring of vital signs

ANS: D, E Feedback Correct Ecchymosis, or bruising, indicates bleeding below the dermis and should be assessed closely. Patients on heparin therapy are prone to bleeding, which would lead to hemorrhagic shock. Vital sign alterations would alert the nurse to internal bleeding. Incorrect aPTT levels are required to be monitored for the intravenous route, but not for subcutaneous injections. The injection site should not be massaged to reduce local bleeding. Aspiration may cause bruising when administering heparin subcutaneously.

Atropine

Atropine is an anticholinergic agent that blocks the effects of the parasympathetic nervous system, producing sympathetic nervous system effects. Adverse reactions include nasal congestion, tachycardia, hypotension, pupillary dilation, abdominal distention, and palpitations. This blood pressure is low enough that action is required. Atropine is the antidote for treating a cholinergic crisis.

Which of the following statements should the nurse include when teaching a client about phenytoin (Dilantin) therapy? A) "Use of phenytoin (Dilantin) therapy will cause an increase in your appetite." B) "Increased alertness frequently occurs after taking phenytoin (Dilantin)." C) "Phenytoin (Dilantin) should always be taken with food or milk." D) "Inform your healthcare provider immediately if your urine is pinkish red or reddish brown."

C) always take with food or milk

theophylline (theo-dur) contraindication

CAD angina pectoris

Fentanyl Adverse Reactions/Side Effects

CNS: confusion, paradoxical excitation/delirium, postoperative depression, postoperative drowsiness. EENT: blurred/double vision. Resp: APNEA, LARYNGOSPASM,allergic bronchospasm, respiratory depression. CV: arrhythmias, bradycardia, circulatory depression, hypotension. GI: biliary spasm, nausea/ vomiting. Derm: facial itching. MS: skeletal and thoracic muscle rigidity (with rapid IV infusion).

prednisone nursing Implications

Check BP, BS, K+ levels, monitor I/O, weight, avoid others with infections, monitor stools, NEVER stop abruptly

Before giving a heparin injection we should inspect the area for? And avoid areas that are?

Inspect for bruising, bleeding or lesions. Avoid areas that have scaring, stretch marks, tattoos, burns or pockets with no tissue.

Fentanyl Patient/Family Teaching

Patient/Family Teaching ● Discuss the use of anesthetic agents and the sensations to expect with the patient before surgery. ● Explain pain assessment scale to patient. ● Caution patient to change positions slowly to minimize orthostatic hypotension. Geri: Geriatric patients may be a greater risk for orthostatic hypotension and, consequently, falls. Teach patient to take precautions until drug effects have completely resolved ● Medication causes dizziness and drowsiness. Advise patient to call for assistance during ambulation and transfer and to avoid driving or other activities requiring alertness for 24 hr after administration during outpatient surgery. ● Instruct patient to avoid alcohol or other CNS depressants for 24 hr

Terbutaline (Brethine)

Terbutaline is used to treat premature labor. Terbutaline is a beta-adrenergic receptor stimulant, which acts primarily on the beta-2 receptors. Stimulation of beta-1 receptors produces uterine relaxation and relaxation of the bronchial and vascular smooth muscle. In higher doses, terbutaline will stimulate the beta-1 receptors, which raises heart rate. Action Produce relaxation of uterine bronchial and vascular smooth muscles, increase HR Uses Stop premature labor when no other indications to DC pregnancy Serious Side Effects tachycardia, palpitations, HTN, Tremors, nervousness, anxiety, restlessness, HA, Dizziness, nausea, vomiting, hyperglycemia, electrolyte imbalance

Magnesium Sulfate

Uterine Relaxant Action Range 1.5-3.5 Produce anticonvulsant effects and smooth muscle relaxation, inhibit uterine muscle contractions Uses Inhibit preterm labor, control seizure activity associated with preeclampsia and eclampsia Serious Side Effects Absence of deep tendon reflexes, confusion, reduced urine output, and decreased CNS. Ca Gluconate is used as an antidote for magnesium toxicity Early signs of Toxicity is maternal c/o feeling "hot all over" and "being thirsty all the time" Hypotension, flushed, diaphoresis, and decreased muscle reflexes.

The client asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response? a. "You can protect it from heat by placing the bottle in an ice chest." b. "It's best to keep it in its original container away from heat and light." c. "You can put a few tablets in a resealable bag and carry it in your pocket." d. "It's best to lock them in the glove compartment to keep them away from heat and light.

b. "It's best to keep it in its original container away from heat and light."

A client receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's priority action? a. Assess the client's lung sounds. b. Decrease the intravenous nitroglycerin by 10 mcg/min. c. Stop the nitroglycerin infusion for 1 hour, and then restart. d. Recheck the client's vital signs in 15 minutes but continue the infusion

b. Decrease the intravenous nitroglycerin by 10 mcg/min.

The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action will the nurse perform to administer the drug? a. Give the dose as a fast intravenous (IV) bolus. b. Mix the drug with normal saline and give it as an IV piggyback. c. Mix the drug with dextrose (D5W) and give it as an IV piggyback. d. Mix the drug with any available solution as long as the drip rate is correct.

b.Mix the drug with normal saline and give it as an IV piggyback.

What will the nurse instruct the client to do to prevent the development of tolerance to nitroglycerin? a. Apply the nitroglycerin patch every other day. b. Switch to sublingual nitroglycerin when the client's systolic blood pressure elevates to more than 140 mm Hg. c. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night. d. Use the nitroglycerin patch for acute episodes of angina only.

c. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night.

Heparin Administration:

cannot be absorbed by the intestinal tract and must be given by subcutaneous injection or IV infusion:

What statement is the most important for the nurse to include in the teaching plan for a client who has started on a transdermal nitroglycerin patch? a. "This medication works faster than sublingual nitroglycerin works." b. "This medication is the strongest of any nitroglycerin preparation available." c. "This medication should be used only when you are experiencing chest pain." d. "This medication will work for 24 hours and you will need to change the patch daily."

d. "This medication will work for 24 hours and you will need to change the patch daily."

The nurse instructs the client to avoid which over-the-counter products when taking theophylline (Theo-Dur)? a. acetaminophen (Tylenol) b. echinacea c. diphenhydramine (Benadryl) d. St. John's wort

d. St. John's wort

theophylline (theo-dur)

nervousness, tremors, dizziness, headache, nausea, vomiting, anorexia,tachycardia, dysrhythmias, hypotension, seizures, circulatory failure, respiratory arrest

An adult patient is admitted for an asthma attack. Which assessment obtained by the nurse would support that albuterol (Proventil) was effective? A. Decrease in wheezing present on auscultation B. Less dyspnea while positioned in a high Fowler's position C. Sputum production is clear and watery D. Respiratory rate decreased to 38 breaths/min

ANS: A Feedback A A bronchodilator would open the airways and result in a reduction of wheezing. B Less dyspnea while positioned in a high Fowler's position would not indicate that the medication was effective. C Clear and watery sputum would not indicate that the medication was effective. D The respiratory rate decreased to 38 breaths/min would not indicate that the medication was effective.

Which response will the nurse provide when a patient complains of a headache when using sublingual nitroglycerin? A. "This is a common adverse effect that can be managed with acetaminophen." B. "Discontinue taking this medication." C. "Try taking this medication at night to minimize the possibility of headaches." D. "Lie down after using nitroglycerin to avoid a headache."

ANS: A Feedback A The most common adverse effect of nitrate therapy is headache. Analgesics, such as acetaminophen, may be used if needed. B The medication should not be discontinued. C When administered sublingually, this medication is taken as needed for chest pain. D Lying down will not prevent the occurrence of a headache.

What is albuterol (Proventil) used to treat? A. Acute bronchospasm B. Acute allergies C. Nasal congestion D. Dyspnea on exertion

ANS: A Feedback A The short-acting beta agonists have a rapid onset (few minutes) and are used to treat acute bronchospasm. B Beta agonists are not used to treat allergies. C Decongestants are used for nasal congestion. D Long-acting beta agonists are used for exertional dyspnea.

Which drug is administered after delivery to reduce the risk of postpartum hemorrhage after the placenta has been delivered? A. Oxytocin (Pitocin) B. Magnesium sulfate C. Vitamin K D. Dopamine

ANS: A Feedback A Uterine stimulants, primarily oxytocin, given in low-dose infusions after delivery of the fetus and placenta, help stimulate firm uterine contractions to reduce the risk of postpartum hemorrhage from an atonic uterus. B Magnesium sulfate is given to treat eclampsia and preeclampsia. C Vitamin K is given to prevent hemorrhage. D Dopamine is given to treat hypotension.

Anticoagulant therapy may be used for which situations? (Select all that apply.) A. To prevent stroke in patients at high risk B. Following a myocardial infarction C. Following total hip or knee joint replacement surgery D. With deep vein thrombosis E. To prevent thrombosis in immobilized patients F. Peptic ulcer disease

ANS: A, B, C, D, E Feedback Correct Anticoagulant therapy is used to treat patients at high risk for stroke. Anticoagulant therapy is used to treat patients with thromboembolic diseases, such as myocardial infarction. Anticoagulant therapy is used to treat patients at risk of developing thrombus secondary to underlying medical conditions. Anticoagulant therapy is used to treat patients with thromboembolic diseases, such as deep vein thrombosis. Anticoagulant therapy is used to treat patients at risk of developing thrombus secondary to underlying medical disease. Incorrect Anticoagulant therapy is not used to treat patients with peptic ulcer disease.

Which action by the nurse is most accurate when administering nitroglycerin ointment to a patient? A. Spread the ointment on the patient's legs in a thin, uniform layer. B. Cover the patch with a clear plastic wrap. C. Rub the ointment into the skin in a circular motion. D. Shave the skin prior to application.

ANS: B Feedback A The ointment is not applied to the lower extremities, including the legs. B Covering the area where the patch is placed with a clear plastic wrap and taping it in place is appropriate. C The ointment should not be rubbed into the skin. D Shaving is not recommended prior to application because of possible skin irritation.

A patient has been diagnosed with rheumatoid arthritis and will begin daily oral corticosteroid treatment. Which baseline assessments are important for a patient receiving corticosteroids? (Select all that apply.) A. Baseline weight B. Blood pressure C. Complete blood cell count D. Electrolyte studies E. Hydration status

ANS: A, B, D, E Feedback Correct Baseline assessments for patients receiving corticosteroid therapy include weight. Baseline assessments for patients receiving corticosteroid therapy include blood pressure. Baseline assessments for patients receiving corticosteroid therapy include electrolyte studies and intake and output. Baseline assessments for patients receiving corticosteroid therapy include diet and hydration status. Incorrect A baseline CBC is not needed for patients taking corticosteroids

The nurse is instructing a patient about adverse effects associated with corticosteroid therapy. Which information would be important to include? (Select all that apply.) A. Avoid crowds or people with an infection. B. Monitor and care for your skin daily; change positions frequently. C. Take medication on an empty stomach. D. During periods of physical or psychological stress, higher doses of corticosteroids are necessary. Contact your health care provider. E. Follow a diet low in sodium.

ANS: A, B, D, E Feedback Correct Corticosteroid therapy patients should avoid large crowds or people with an infection. Patients taking corticosteroid drugs should monitor for signs of edema, skin breakdown, and weight daily. During periods of physical or psychological stress, increased dosing may be necessary. Patients taking corticosteroid drugs should follow a low-sodium diet that is also high in potassium, if not contraindicated. Incorrect Corticosteroids should be taken with food to avoid GI upset.

An older adult who has septicemia is receiving IV aminoglycoside therapy. Which symptom is most important for the nurse to monitor? A. Bone marrow suppression B. Ototoxicity C. Gastrointestinal distress D. Photosensitivity

ANS: B Feedback A Aminoglycosides do not produce bone marrow depression; this is characteristic of treatment with chloramphenicol. B Eighth cranial nerve damage can result from aminoglycoside therapy. Patients should be monitored during and after therapy has been discontinued for signs and symptoms of ototoxicity, including dizziness, tinnitus, and progressive hearing loss. C Aminoglycosides do not typically produce GI distress. D Aminogylcosides do not produce photosensitivity; this is characteristic of treatment with glycylcyclines.

A patient has been prescribed lorazepam (Ativan), a benzodiazepine used to treat insomnia. Which action will the nurse take? A. Advise the patient to take the medication with food. B. Assess the patient's blood pressure in sitting and lying positions. C. Inform the patient to discontinue the medication once sleep improves. D. Instruct the patient to lie down before taking the medication.

ANS: B Feedback A Ativan does not have to be taken with food. B Measuring blood pressure in sitting in lying positions is important to assess for transient hypotension. C Rapid discontinuance of the medication after long-term use may result in symptoms similar to those of alcohol withdrawal. Gradual withdrawal of benzodiazepines is over 2 to 4 weeks. D Medications should be taken sitting up.

Which technique by the nurse is accurate when administering heparin to a thin, older adult patient? A. Aspirate before injecting the medication. B. Inject at a 45-degree angle. C. Inject at a 90-degree angle. D. Massage site following injection.

ANS: B Feedback A Heparin should never be aspirated. B The skin may need to be pinched and a 45-degree angle used for thin individuals to avoid administration into the muscle. C Subcutaneous injections are properly administered at a 45-degree angle. D The injection site of heparin should never be massaged.

A patient receiving IV heparin therapy for a deep vein thrombosis in his right calf asks why his calf remains painful, edematous, and warm to touch after 2 days of anticoagulant therapy. Which response by the nurse is most accurate? A. "It takes at least 3 days for the symptoms to resolve once the clot dissolves." B. "Heparin does not dissolve blood clots, but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body." C. "I will report this to your health care provider because there may be a need to look at alternative treatments." D. "You appear anxious. The health care provider will eventually put you on ticlopidine, which allows for an earlier discharge."

ANS: B Feedback A It is inappropriate to tell a patient how long it will take to dissolve a clot. B Heparin is used to treat a thromboembolism and promote neutralization of activated clotting factors, preventing the extension of thrombi and the formation of emboli. Heparin will minimize tissue damage by preventing it from developing into an insoluble, stable thrombus. C The patient's question does not warrant notification of the health care provider. D Telling the patient that the health care provider will be starting the patient on ticlopidine is inappropriate and inaccurate.

A patient on a high dosage of corticosteroids over a period of time may develop which type of psychiatric complication? A. Lethargy B. Psychotic behaviors C. Manic phases D. Anxiety attacks

ANS: B Feedback A Lethargy is not a common complication of treatment with corticosteroids. B A patient receiving a higher dosage of corticosteroids is susceptible to psychotic behavioral changes. The most susceptible patient is one with previous histories of mental dysfunction. Perform a baseline assessment of the patient's ability to respond rationally to the environment and the diagnosis of the underlying disease. C Mania is not a common complication of treatment with corticosteroids. D Anxiety is not a common complication of treatment with corticosteroids.

Which emergency drug must be available when caring for a patient receiving magnesium sulfate? A. Naloxone B. Calcium gluconate C. Dextrose D. Dopamine

ANS: B Feedback A Naloxone is an antidote for opioid drugs. B Calcium gluconate is the antidote for magnesium sulfate and should always be available when magnesium sulfate is administered. C Dextrose is given to treat hypoglycemia. D Dopamine is given to treat hypotension

Which will the nurse include in discharge teaching for patients on nitrate therapy? (Select all that apply.) A. Increase caffeine in diet B. Relaxation techniques C. Proper storage of medications D. Pain assessment E. Isometric exercise program

ANS: B, C, D Feedback Correct Lifestyle modifications such as relaxation techniques, are essential for many individuals with angina. Nitrates should be stored in dark, airtight containers. Pain assessment and rating is an important part of nitrate therapy. Incorrect Increasing caffeine in the diet should be discouraged. Participation in a regular, moderate exercise program is essential, but exercise should not be strenuous or isometric in patients with angina.

What risk is minimized when the smallest dose of nitroglycerin is used to provide satisfactory results? A. Allergy B. Dependence C. Tolerance D. Nausea

ANS: C Feedback A Allergy to nitrates is highly unlikely. B Increasing dosages and frequency of nitrate use is more likely to reflect deterioration of cardiac function than dependence on the medication. C Tolerance to nitrates can develop rapidly, particularly if large doses are administered frequently. D Nausea is not a common adverse effect of nitrate treatment.

A 36-week primigravida patient has been admitted to the unit with a blood pressure of 200/120 mm Hg, severe headache, and edema. Which medication does the nurse anticipate that the health care provider will order? A. Nifedipine (Procardia) B. Furosemide (Lasix) C. Magnesium sulfate D. Terbutaline (Brethine)

ANS: C Feedback A Calcium channel blockers, such as nifedipine, are sometimes given as tocolytic agents. B Furosemide is given for diuresis; it may be used in the treatment of hypertension, but not eclampsia. C Magnesium sulfate depresses the central nervous system and blocks peripheral nerve transmission, which produces anticonvulsant effects and smooth muscle relaxation. In cases of preeclampsia or eclampsia, magnesium sulfate is used to control seizure activity. Hypertension, headache, and edema are signs of preeclampsia in a pregnant woman. D Terbutaline is given as a tocolytic agent.

A patient is seen in the emergency department. The patient had been maintained on theophylline (Theo-Dur), and a blood sample reveals the serum theophylline level is subtherapeutic. Which may cause a subtherapeutic serum level? A. Cimetidine use B. Drug tolerance C. Smoking D. Overuse of the inhaler

ANS: C Feedback A Cimetidine would enhance the effects of theophylline, not decrease the effects. B Smoking reduces the therapeutic effects of xanthine derivatives, including theophylline. C The patient is not tolerant to the drug if the serum theophylline levels are too low. D Overuse of the inhaler would cause a high level of serum theophylline.

The nurse is teaching a patient about nitroglycerin prior to discharge to home. Which instruction will the nurse provide the patient? A. "Report any headaches following self-administration to your health care provider." B. "Carry the medication in a pocket directly next to the body." C. "Carry the medication with you at all times." D. "Store nitroglycerin in a clear glass container with a tight lid."

ANS: C Feedback A Headache is an expected adverse effect. B Heat causes the medication to deteriorate, so being carried next to the body would cause it to become ineffective. C Nonhospitalized patients should carry nitroglycerin at all times. D Tablets are degraded by sunlight.

How frequently are nitroglycerin tablets discarded and prescriptions refilled? A. Monthly B. Every 3 months C. Every 6 months D. Yearly

ANS: C Feedback A Nitroglycerin has a longer shelf life than 1 month. B Nitroglycerin has a longer shelf life than 3 months. C Every 6 months, the nitroglycerin prescription should be refilled and the old tablets safely discarded. D Nitroglycerin does not have a shelf life this long.

What is the rationale for monitoring vital signs of patients receiving corticosteroids? A. Orthostatic hypotension B. Malignant hyperthermia C. Infection D. Hyperglycemia

ANS: C Feedback A Orthostatic hypotension is not a common adverse effect of treatment with corticosteroids. B Malignant hyperthermia is an anesthetic-related complication. C Patients receiving corticosteroids are more susceptible to infection, and fever is often an early indicator of infection. Glucocorticoids, however, sometimes suppress a febrile response to infection. D Hyperglycemia is a common adverse effect of treatment with corticosteroids, but is not assessed by vital signs

Which instruction will the nurse include when teaching a patient about the administration of translingual nitroglycerin spray? A. Shake the container to disperse the medication evenly. B. Inhale the medication slowly over 1 to 2 minutes. C. Administer the medication under the tongue. D. Close the mouth and "swallow" the spray.

ANS: C Feedback A Shaking the container can cause bubbles that will slow the release of nitroglycerin. B The dose should not be inhaled. C Translingual nitroglycerin spray should be sprayed onto or under the tongue. The container should not be shaken because the bubbles formed may slow the release of the medication. The spray should not be inhaled or swallowed. D The dose should not be swallowed.

A patient is receiving IV heparin therapy. The aPTT is 90; the laboratory control is 30 seconds. Which nursing intervention is most accurate? A. Document in the nursing notes that these results are within therapeutic range. B. Note the RBC count and wait for the health care provider to make the next round to discuss all laboratory values. C. Stop the heparin drip. D. Assess the patient for signs and symptoms of decreased sensorium.

ANS: C Feedback A These results are not within the normal therapeutic range. B RBC count is not relevant in assessing therapeutic response to anticoagulation. C Heparin dosage is considered to be in the normal therapeutic range if the aPTT is 1.5 to 2.5 times the control value. The patient's aPTT value is above the therapeutic range, which puts her at risk for hemorrhage. The most appropriate nursing action would be to stop the heparin drip. D Mental status is not relevant in assessing therapeutic response to anticoagulation.

For which reason will betamethasone IM be administered to the mother in premature labor? A. To stop uterine contractions B. To prevent precipitous labor C. To stimulate lung maturity in the fetus D. To stimulate prolactin to enhance breast-feeding

ANS: C Feedback A Tocolytic drugs are given to stop uterine contractions. B Tocolytic drugs are given to stop uterine contractions. C Glucocorticoids may be administered IM to accelerate fetal lung maturation to minimize respiratory distress syndrome. D Prolactin production and release are triggered by pituitary hormone, estrogen, and progesterone.

A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin? A. Warfarin sodium (Coumadin) B. Enoxaparin (Lovenox) C. Protamine sulfate D. Vitamin K

ANS: C Feedback A Warfarin is an anticoagulant and would not counteract hemorrhage. B Lovenox is chemically related to heparin and would not counteract hemorrhage. C Protamine sulfate is the antidote to heparin. With the patient's risk of fluid volume deficit as a result of trauma, the primary intervention would be to counteract the effects of heparin to prevent hemorrhage. D Vitamin K is used to control the bleeding that results from use of warfarin (Coumadin), not heparin.

What will the nurse advise the patient to do to avoid the development of tolerance to nitroglycerin? A. Use the sublingual form only. B. Administer subsequent doses parenterally. C. Allow for a daily 8- to 12-hour nitrate-free period. D. Store the drug in a dark container, free from light and moisture.

ANS: C An 8- to 12-hour nitrate-free period will Feedback A Nitrates are taken at the indication of pain. B Sublingual nitrates are not swallowed. C The patient should seek medical attention if chest pain is not relieved by one tablet within 5 minutes. Tablets should continue to be taken every 5 minutes, for a total of three tablets in 15 minutes. D Tablets should be taken every 5 minutes, for a total of three tablets in 15 minutes if pain is not relieved.

A patient is receiving 1400 units of heparin/hour on an IV pump. The aPTT time is 54. The laboratory control is 25. Which action by the nurse is accurate? A. Bolus the patient with an additional 5000 units of heparin. B. Stop the heparin immediately and notify the health care provider that the patient's blood level is toxic. C. Administer protamine sulfate stat. D. Continue with the prescribed rate.

ANS: D Feedback A An increase of heparin is not indicated because the patient is in the therapeutic range. B The range is not toxic. C An antidote to the anticoagulant is not indicated because the patient is within the therapeutic range. D Therapeutic heparin values are 1.5 to 2.5 times the control value. The therapeutic range of heparin with a control of 25 is 37.5 to 62.5 units/hour. Fifty-four is within the therapeutic range.

Which drug is administered when a patient is experiencing premature labor? A. Magnesium sulfate B. Oxytocin (Pitocin) C. Levonorgestrel (Mirena) D. Terbutaline (Brethine)

ANS: D Feedback A Magnesium sulfate is given to treat eclampsia. B Oxytocin is given to produce uterine contractions. C Levonorgestrel is a progestin given for contraception. D Terbutaline is a beta-adrenergic receptor stimulant, which acts primarily on the beta-2 receptors. Stimulation of beta-1 receptors produces uterine relaxation and relaxation of the bronchial and vascular smooth muscle. In higher doses, terbutaline will stimulate the beta-1 receptors, which raises heart rate.

A 26-year-old patient with preeclampsia is receiving IV magnesium sulfate. The 1400 assessment includes blood pressure, 100/70 mm Hg, respiration, 10, fetal heart tone, 100/min, urine output 20 mL/hour, absent patellar reflex. Which is the priority nursing action? A. Decrease IV magnesium sulfate to half the dose and reassess the patient and fetus in 15 minutes. B. Stop the IV magnesium sulfate and contact the health care provider. C. Place the patient on her left side and administer oxygen. D. Stop the IV magnesium sulfate and administer calcium gluconate 5 mEq IV over 3 minutes.

ANS: D Feedback A The treatment for magnesium intoxication is to discontinue the infusion and administer the antidote, calcium gluconate. B The treatment for magnesium intoxication is to discontinue the infusion and administer the antidote, calcium gluconate. C The treatment for magnesium intoxication is to discontinue the infusion and administer the antidote, calcium gluconate. D The patient is exhibiting signs of magnesium sulfate toxicity, including respiratory depression. The infusion should be stopped at once. The antidote, calcium gluconate, should be administered.

Which gauge needles are used for subcutaneous injections? A. 14 to 16 gauge B. 18 to 21 gauge C. 22 to 24 gauge D. 25 to 29 gauge

ANS: D Feedback A This needle size is used for administration of blood or large volumes of fluid in a short period of time. B This needle size is used for routine parenteral fluid administration. C This needle size is used for administering fluids or medication via small veins. D Commonly used gauges for subcutaneous injection are 25 to 29 gauge.

When are sustained-release nitroglycerin tablets administered? A. Once a day B. At bedtime C. When symptoms of acute angina appear D. Every 8 to 12 hours

ANS: D Feedback A To be effective, sustained-release nitroglycerin must be taken more often. B To be effective, sustained-release nitroglycerin must be taken more often. C Sustained-release nitroglycerin is taken to prevent angina; waiting until symptoms occur decreases its effectiveness. D Sustained-release nitroglycerin tablets are usually taken on an empty stomach every 8 to 12 hours. If gastritis develops, it may be necessary to take these tablets with food.

What high-priority nursing action is important before administering daily phenytoin (Dilantin)? A. Maintain bed rest. B. Check phenytoin levels. C. Monitor intake and output. D. Monitor renal function tests.

Answer: B- Checking the phenytoin level is most important because of the narrow therapeutic range of 10 to 20 mcg/mL.

Fentanyl Assessment

Monitor respiratory rate and BP frequently throughout therapy. Report significant changes immediately. The respiratory depressant effects of fentanyl may last longer than the analgesic effects. Initial doses of other opioids should be reduced by 25-33% of the usually recommended dose. Monitor closely. ● Geri: Opioids have been associated with increased risk of falls in geriatric patients. Assess risk and implement fall prevention strategies. ● IV, IM: Assess type, location, and intensity of pain before and 30 min after IM administration or 3- 5 min after IV administration when fentanyl is used to treat pain. ● Lab Test Considerations: May causeqserum amylase and lipase concentrations. ● Toxicity and Overdose: Symptoms of toxicity include respiratory depression, hypotension, arrhythmias, bradycardia, and asystole. Atropine may be used to treat bradycardia. If respiratory depression persists after surgery, prolonged mechanical ventilation may be required. If an opioid antagonist is required to reverse respiratory depression or coma, naloxone (Narcan) is the antidote. Dilute the 0.4-mg ampule of naloxone in 10mL of 0.9% NaCl and administer 0.5 mL (0.02mg) by direct IV push every 2 min. Pedi: For children and patients weighing 40 kg, dilute 0.1 mg of naloxone in 10 mL of 0.9% NaCl for a concentration of 10 mcg/mL and administer 0.5 mcg/kg every 2 min. Titrate dose to avoid withdrawal, seizures, and severe pain. Administration of naloxone in these circumstances, especially in cardiac patients, has resulted in hypertension and tachycardia, occasionally causing left ventricular failure and pulmonary edema.

Fentanyl

Opioid Analgesics General Use Management of moderate to severe pain. Fentanyl is also used as a general anesthetic adjunct. General Action and Information Opioids bind to opiate receptors in the CNS, where they act as agonists of endogenously occurring opioid peptides (eukephalins and endorphins). The result is alteration to the perception of and response to pain. Precautions Use cautiously in patients with undiagnosed abdominal pain, head trauma or pathology, liver disease, or history of addiction to opioids. Use smaller doses initially in the elderly and those with respiratory diseases. Prolonged use may result in tolerance and the need for larger doses to relieve pain. Psychological or physical dependence may occur. Interactions Increases the CNS depressant properties of other drugs, including alcohol, antihistamines, antidepressants, sedative/hypnotics, phenothiazines, and MAO inhibitors. Interactions Drug-Drug: Avoid use in patients who have received MAO inhibitors within the previous 14 days (may produce unpredictable, potentially fatal reactions). Concomitant use of CYP3A4 inhibitors including ritonavir, ketoconazole, itraconazole, clarithromycin, nelfinavir, nefazodone, diltiazem, aprepitant, fluconazole, fosamprenavir, verapamil, and erythromycin may result in increase plasma levels and increase risk of CNS and respiratory depression. Additive CNS and respiratory depression with other CNS depressants, including alcohol, antihistamines, antidepressants, other sedative/ hypnotics, and other opioid analgesics increase risk of hypotension with benzodiazepines. Nalbuphine, buprenorphine, or pentazocine may decrease analgesia. Drug-Food: Grapefruit juice is a moderate inhibitor of the CYP3A4 enzyme system; concurrent use may increase blood levels and the risk of respiratory and CNS depression. Careful monitoring and dose adjustment is recommended.

A client is to be discharged home with a transdermal nitroglycerin patch. Which instruction will the nurse include in the client's teaching plan? a. "Apply the patch to a nonhairy area of the upper torso or arm." b. "Apply the patch to the same site each day." c. "If you have a headache, remove the patch for 4 hours and then reapply." d. "If you have chest pain, apply a second patch next to the first patch."

a. "Apply the patch to a nonhairy area of the upper torso or arm."

prednisone Nursing Interventions

● Assess for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) before and periodically during therapy. ● Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify health care professional if these occur. ● Children should have periodic evaluations of growth. ● Cerebral Edema: Assess for changes in level of consciousness and headache during therapy. ● Rect: Assess symptoms of ulcerative colitis (diarrhea, bleeding, weight loss, anorexia, fever, leukocytosis periodically during therapy. ● Lab Test Considerations: Monitor serum electrolytes and glucose. May cause hyperglycemia, especially in persons with diabetes. May cause hypokalemia. Patients on prolonged therapy should routinely have CBC, serum electrolytes, and serum and urine glucose evaluated. May decrease WBCs. May decrease serum potassium and calcium and increase serum sodium concentrations. ● Guaiac-test stools. Promptly report presence of guaiac-positive stools. ● May increase serum cholesterol and lipid values. May decrease uptake of thyroid ● Suppress reactions to allergy skin tests. ● Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal axis suppression in systemic and chronic topical therapy. PO: Administer with meals to minimize GI irritation.

Fentanyl Implementation

● High Alert: Accidental overdosage of opioid analgesics has resulted in fatalities. Before administering, clarify all ambiguous orders; have second practitioner independently check original order, dose calculations, route of administration, and infusion pump programming. ● Do not confuse fentanyl with sufentanil. ● Benzodiazepines may be administered before or after administration of fentanyl to reduce the induction dose requirements, decrease the time to loss of consciousness, and produce amnesia. This combination may also increase the risk of hypotension.

prednisone Patient/Family Teaching

● Instruct patient on correct technique of medication administration. Advise patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose. Do not double doses. Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care professional immediately. This can be life threatening. ● Corticosteroids cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious illnesses and to report possible infections immediately. ● Caution patient to avoid vaccinations without first consulting health care professional. ● Review side effects with patient. Instruct patient to inform health care professional promptly if severe abdominal pain or tarry stools occur. Patient should also report unusual swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, visual disturbances, or behavior changes. ● Advise patient to notify health care professional of medication regimen before treatment or surgery. ● Advise patient to carry identification describing disease process and medication regimen in the event of emergency in which patient cannot relate medical history. ● Explain need for continued medical follow-up to assess effectiveness and possible side effects of medication. Periodic lab tests and eye exams may be needed. ● Long-term Therapy: Encourage patient to eat a diet high in protein, calcium, and potassium, and low in sodium and carbohydrates (see Appendix M). Alcohol should be avoided during therapy; may increase risk of GI irritation. ● review side effects with patients, don't abruptly stop

Fentanyl IV Administration

● pH: 4.0-7.5. ● Direct IV: Diluent: Administer undiluted. Concentration: 50 mcg/mL. Rate: Injections should be administered slowly over 1-3 min. Administer doses 5 mcg/kg over 5-10 min. Slow IV administration may reduce the incidence and severity of muscle rigidity, bradycardia, or hypotension. Neuromuscular blocking agents may be administered concurrently to decrease chest wall muscle rigidity. ● Intermittent Infusion: Diluent: May be diluted in D5W or 0.9% NaCl. Concentration: Up to 50 mcg/mL. Rate: see Direct IV.