Ati pharmocology Detailed Answer Key (SIMPLE VERSION)

took 3 nitroglycerin tablets sublingually for chest pain. The client reports relief from the chest pain but now he is experiencing a headache.

"A headache is an expected adverse effect of the medication." Rationale: The vasodilation nitroglycerin induces increases blood flow to the head and typically results in a headache

the contraindications of warfarin therapy

"Clients who are pregnant should not take warfarin." Rationale: Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta and places the fetus at risk for bleeding

disulfiram

"Do not drink alcohol while taking this medication." Rationale: Disulfiram is a type of aversion therapy that helps maintain abstinence from alcohol. Drinking alcohol while taking disulfiram can produce a life-threatening response that can include palpitations, headache, and hypotension. Therapy must not begin until the client has abstained from alcohol for at least 12 hr. The client should avoid all forms of alcohol including cough syrups and after-shave lotions.

multiple sclerosis about a new prescription for baclofen.

"Do not take antihistamines with this medication." Rationale:The nurse should instruct the client not to take antihistamines while taking baclofen. Antihistamines will intensity the depressant effects of baclofen

type2 DM - glipizide

"Glipizide stimulates your pancreas to release insulin." Rationale: Glipizide is an oral antidiabetic medication in the pharmacological classification of sulfonylurea agents. These medications help to lower blood glucose levels in clients who have type 2 diabetes mellitus using several methods, including reducing glucose output by the liver, increasing peripheral sensitivity to insulin, and stimulating the release of insulin from the functioning beta cells of the pancreas

rheumatoid arthritis and a new prescription for prednisone.

"I should eat more bananas while taking this medication." Rationale: The nurse should instruct the client to eat more potassium-rich foods such as bananas and citrus fruits while taking this medication. Prednisone can cause a loss of potassium, and the nurse should instruct the about the manifestations of hypokalemia such as muscle weakness and cramping and to notify the provider should these occur.

oral candidiasis - nystatin suspension

"I will store the medication at room temperature." Rationale: Nystatin oral suspension should be stored at room temperature.

fluoxetine to treat depression

"I'll take this medicine first thing in the morning." Rationale: The client should take fluoxetine in the morning to reduce the risk for insomnia

teaching: colchicine to tx gout

"Monitor for muscle pain." Rationale: This medication can cause rhabdomyolysis. The client should monitor and report muscle pain

docusate

"Take the medication with a full glass of water." Rationale: The nurse should instruct the client to take this medication with a full glass of water, unless contraindicated, to reduce the risk for constipation

iron-deficiency anemia - ferrous sulfate tablets why the provider instructed that she take the ferrous sulfate between meals?

"Taking the medication between meals will help you absorb the medication more efficiently." Rationale: Ferrous sulfate provides the iron needed by the body to produce red blood cells. Taking iron supplements between meals helps to increase the bioavailability of the iron

pt with nause - metoclopramide intermittent IV bolus q4hrs prn

"The medication relieves nausea by promoting gastric emptying." Rationale: Reglan is a gastrointestinal stimulant used to relieve nausea, vomiting, heartburn, stomach pain, bloating, and a persistent feeling of fullness after meals. Reglan works by promoting gastric emptying.

biploar disorder -lithium ; manifestatinos of toxicity

"Vomiting is an indication of toxicity." Rationale: Since vomiting and diarrhea are early signs of lithium toxicity, the client should omit the next dose of lithium and call the provider.

a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary.

"Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." Rationale: Heparin and warfarin are both anticoagulants that decrease the clotting ability of the blood and help prevent thrombosis formation in the blood vessels. However, these medications work in different ways to achieve therapeutic coagulation and must be given together until therapeutic levels of anticoagulation can be achieved by warfarin alone, which is usually within 1 to 5 days. When the client's PT and INR are within therapeutic range, the heparin can be discontinued

UTI-ciprofloxacin

"You should report any tendon discomfort you experience while taking this medication." Rationale: The nurse should instruct the client to report any tendon discomfort as well as swelling or inflammation of the tendons due to the risk of tendon rupture

a duodenal ulcer about his new prescription for cimetidine

"Your doctor might need to reduce your theophylline dose while taking this medication." Rationale: The nurse should instruct the client that the provider might need to reduce his theophylline dose due to the possibility of increased medication levels

pt. difficulty to swallow for enteric-coated aspirin PO. ask if the med. can be curshed?

"crushing the med might cause you to have a stomache or indigestion"

thrombophlebitis - heparin by continuous IV infusion.

"heparin does not dissolve clots. it STOPS new clots from forming"

pre-op. - hydroxyzine

-controlling emesis -diminishing anxiety -reducing the amount of narcotics needed for pain relief -Drying secretions Rationale: Controlling emesis is correct. Hydroxyzine is an effective antiemetic that may be used to control nausea and vomiting in preoperative and postoperative clients.Diminishing anxiety is correct. Hydroxyzine is an effective antianxiety agent that may be used to diminish anxiety in surgical clients, as well as in clients who have moderate anxiety.Reducing the amount of narcotics needed for pain relief is correct. Hydroxyzine potentiates the actions of narcotic pain medications; therefore, narcotic requirements may be significantly reduced.Preventing thrombus formation is incorrect. Hydroxyzine, an antihistamine, has no role in the prevention of thrombi.Drying secretions is correct. Hydroxyzine, an antihistamine, commonly causes drying of the oral mucous membranes

diabetes insipidus - vasopressin

A decrease in urine output Rationale: The major manifestations of diabetes insipidus are excessive urination and extreme thirst. Vasopressin is used to control frequent urination, increased thirst, and loss of water associated with diabetes insipidus. A decreased urine output is the desired response

rheumatoid arthritis - naproxen requires further discussion by the nurse? ANSWER: B. "I've been taking an antacid to help with indigestion." Rationale: NSAIDs, like naproxen, can cause serious adverse gastrointestinal reactions such as ulceration, bleeding, and perforation. Warning manifestations such as nausea or vomiting, gastrointestinal burning, and blood in the stool reported by the client require further investigation by the nurse. The client might be taking an antacid because he is experiencing one or more of these manifestations.

A. "I signed up for a swimming class." Rationale: Daily exercise can relieve soreness caused by stiff, unused muscles and helps to maintain joint range of motion. C. "I've lost 2 pounds since my appointment 2 weeks ago." Rationale: This rate of weight loss is acceptable and indicates that the client is aware that decreased weight will decrease joint stress. D. "The naproxen is easier to take when I crush it and put it in applesauce." Rationale: Naproxen can be crushed or swallowed whole

Seizures - phenytoin need for futher teaching? ANSWER: "I'll be glad when I can stop taking this medicine." Rationale: Phenytoin is an anticonvulsant used to treat various types of seizures. Clients on anticonvulsant medications commonly require them for lifetime administration, and phenytoin should not be stopped without the advice of the client's provider

A. "I will notify my doctor before taking any other medications." Rationale: Many medication interactions can occur with phenytoin; therefore, the client's provider should be notified that the client is taking phenytoin. B. "I have made an appointment to see my dentist next week." Rationale: The client understands that phenytoin causes an overgrowth of the gums that makes dental monitoring important. C. "I know that I cannot switch brands of this medication." Rationale: The client understands that bioavailability varies with different brands, so no substitutions should be made.

A nurse is caring for four clients. After administering morning medications, she realizes that the nifedipine prescribed for one client was inadvertently administered to another client. Which of the following actions should the nurse take first? B. Check the client's vital signs. Rationale: The first action the nurse should take using the nursing process is to assess the client. The nurse should know that the action of nifedipine is to lower blood pressure. Immediately upon realizing the error, the nurse should check the client's vital signs (especially the client's blood pressure) to ensure that the client is not hypotensive as a result. Only after ensuring that the client is safe and has stable vital signs should the nurse take other action

A. Notify the client's provider. Rationale: The nurse should notify the client's provider to inform her of the event; however, there is another action the nurse should take first C. Fill out an occurrence form. Rationale: The nurse should fill out an occurrence form to report the event to hospital personnel; however, there is another action the nurse should take first. D. Administer the medication to the correct client. Rationale: The nurse should administer the medication to the correct client to fulfill the provider's prescription; however, there is another action the nurse should take first.

a detached retina and is preoperative for a surgical repair

A. Phenylephrine Rationale: Mydriatic medications, such as phenylephrine, are used preoperatively to dilate pupils to facilitate intraocular surgery

streptococcal pneumonia - penicillin G/ intermittent IV bolus . 10 minutes into the infusion of the third dose, the client reports that the IV site itches and that he feels dizzy and short of breath. Which actions should the nurse take first?

A. Stop the infusion. Rationale: When using the airway, breathing, circulation approach to client care, the nurse should place the priority on stopping the infusion. The client is exhibiting signs of penicillin anaphylaxis and the first action that should be taken is to withdraw the medication.

A charge nurse is supervising a newly licensed nurse care for a client who is receiving a transfusion of packed RBC. The nurse suspects a possible hemolytic reaction. After stopping the blood transfusion, which of the following actions by the new nurse requires intervention by the charge nurse? The nurse starts the transfusion of another unit of blood product. Rationale: When suspecting a hemolytic reaction, the nurse should immediately stop the transfusion of all blood products. The transfusion of additional products can increase the client's risk for further complication

A. The nurse initiates an infusion of 0.9% sodium chloride. Rationale: When suspecting a hemolytic reaction, the nurse should maintain IV access and blood volume with an infusion of 0.9% sodium chloride. B. The nurse collects a urine specimen. Rationale: When suspecting a hemolytic reaction, the nurse should obtain a urine specimen to assess for the presence of hemoglobin in the urine. C. The nurse sends a blood specimen to the laboratory. Rationale: When suspecting a hemolytic reaction, the nurse should obtain a blood specimen from the client for laboratory analysis.

HF - digoxin

AE: "I feel nauseated and have no appetite." Rationale: Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity

HIV-1 infection - zidovudine

AE: Aplastic anemia Rationale: Severe myelosuppression that results in anemia (decreased red blood cells), agranulocytosis (decreased white blood cells), and thrombocytopenia (decreased platelets) is a life-threatening adverse reaction to zidovudine therapy. Consequently, zidovudine must be used cautiously in clients already experiencing myelosuppression, and the client must be monitored with a CBC performed every few weeks for early detection of marrow failure, which may lead to aplastic anemia.

rheumatoid arthritis. - aspirin

AE: Bleeding Rationale: Aspirin can cause bleeding, tinnitus, gastric ulceration, nausea, and heartburn. The client should monitor and report manifestations of bleeding, such as black tarry stools

aluminum hydroxide to treat heartburn

AE: Constipation Rationale: Aluminum hydroxide can cause constipation. The nurse should tell the client to increase fluid and fiber intake to reduce the risk for constipation

metronidazole: sense alterations

AE: Metallic taste Rationale: Metronidazole is an antiprotozoal medication that treats giardiasis and trichomoniasis. It most common adverse effects are headaches, nausea, dry mouth, and an unpleasant metallic taste in their mouth.

nalbuphine to a postoperative client who is experiencing pain

AE: Miosis Rationale: Adverse effects of nalbuphine include visual disturbances such as miosis, blurred vision, and diplopia

bacterial infection- gentamicin

AE: Monitor the serum medication levels. Rationale: A disadvantage of gentamicin, an aminoglycoside, is the association with nephrotoxicity and ototoxicity, both of which are a result of elevated trough levels. Monitoring the serum medication levels is an important action to minimize the risk of an adverse effect of gentamicin

teaching: renal failure - elevated phosphorous level px) aluminum hydroxide 300 mg PO

AE: constipation Rationale: Constipation is a common side effect of aluminum-based antacids. The nurse should instruct the client to increase fiber intake and that stool softeners or laxatives may be needed.

seizure disorder - penytoin IV

Administer a saline solution after injection. Rationale: The nurse should flush the injection site with a saline solution after the injection of phenytoin to reduce and prevent venous irritation.

asthma child - montelukast granules

Administer the medication 2 hr before exercise. Rationale: Montelukast should be given daily during the evening, except when being used for exercise-induced bronchospasm. It should then be given 2 hr before exercise, and not given again for 24 hr.

gout

Allopurinol Rationale: Allopurinol is a xanthene oxidase inhibitor that reduces uric acid synthesis. The medication is prescribed to treat gout.

cirrhosis - lactulose The client states, "I don't need this medication. I am not constipated." The nurse should explain that in clients who have cirrhosis, lactulose is used to decrease levels of which of the following components in the bloodstream?

Ammonia Rationale: Lactulose, a disaccharide, is a sugar that works as an osmotic diuretic. It prevents absorption of ammonia in the colon. Accumulation of ammonia in the bloodstream, which occurs in pathologic conditions of the liver, such as cirrhosis, may affect the central nervous system, causing hepatic encephalopathy or coma

breast cancer - doxorubicin

An excess amount of doxorubicin can lead to cardiomyopathy. Rationale: Doxorubicin is an antineoplastic antibiotic used in the treatment of various cancers. Irreversible cardiomyopathy with congestive heart failure can result from repeated doses of doxorubicin, and prolonged use can also cause severe heart damage, even years after the client has stopped taking it. The maximum cumulative dose a client should receive is 550 mg/m2 or 450 mg/m2 with a history of radiation to the mediastinum.

postoperative following a transurethral resection of the prostate (TURP). The nurse should plan to administer the client's PRN bethanechol when

An inability to void Rationale: Bethanechol is a cholinergic medication that stimulates the parasympathetic nervous system, thus improving the tone and motility of the smooth muscles of the urinary tract enough to initiate urination

digoxin tocixity

Anorexia Rationale: Anorexia, vomiting, confusion, headache, and vision changes are manifestations of digoxin toxicity.

transdermal nitroglycerin to treat angina pectoris.

Apply the transdermal patch in the morning. Rationale: The client should apply the patch every morning and leave it in place for a 12 to 14 hr, then remove it in the evening

methylphenidate.

Avoid activities that require alertness such as driving. Rationale: The client should avoid driving and other activities that require alertness until the effects of this medication are known.

Teaching) emphysema (comprised COPD) - theophylline

Avoid caffeine while taking this medication. Rationale: The nurse should instruct the client that caffeine should be avoided while taking theophylline, as it can increase central nervous system stimulation

warfarin. need for further teaching? A. "I have started taking ginger root to treat my joint stiffness." Rationale: Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. This statement indicates the client needs further teaching

B. "I take this medication at the same time each day." Rationale: The client should take warfarin at the same time each day to maintain a stable blood level. C. "I eat a green salad every night with dinner." Rationale: Green leafy vegetables are a good source of vitamin K, which can interfere with the clotting effects of warfarin. Clients who are taking warfarin do not need to restrict dietary vitamin K intake but rather should maintain a consistent intake of vitamin K in order to control the therapeutic effect of the medication. D. "I had my INR checked three weeks ago." Rationale: Clients who have been taking warfarin for more than 3 months should have their INR level checked every 2 to 4 week

bipolar - antipsychotic meds/ suspect not adhering to the med theraphy. encourage client's adherence

B. Provide for once-daily dosing. C. Use sustained-release forms D. Engage the client in conversation following medication administration ationale: Perform mouth checks following the administration of medication is incorrect. Mouth checks may not find pills that the client has hidden in his mouth.Provide for once-daily dosing is correct. Once-daily dosing of medications simplifies the therapy, making it easier for the client to comply.Use sustained-release forms is correct. Sustained-release forms remain in the client's system longer, requiring less frequent dosing.Engage the client in conversation following medication administration is correct. If the client is speaking, he will be less likely able to hide the medication in his mouth.Rotate staff that administers the medications is incorrect. Rotating treatment providers is an obstacle that increases the risk of a client's nonadherence to therapy.

warfarin

B. Use an electric razor while on this medication. Rationale: Warfarin, an anticoagulant, increases the client's risk for bleeding. The nurse should teach the client safety measures, such as using an electric razor, to decrease the risk for injury and bleeding

dietary teaching for furosemide/ best source of potassiuim

Bananas Rationale: The nurse should determine that bananas are the best food source to recommend because 1 cup of bananas contains 806 mg of potassium. In addition to the potassium supplements the provider might prescribe, the client should increase his daily intake of foods that have high potassium content, such as bananas, orange juice, and spinach

systemic lupus erythematosus and is taking hydroxychloroquine report which of the following adverse effects to the provider immediately?

Blurred vision Rationale: When using the urgent vs non-urgent approach to client care, the nurse should determine that the priority finding to report to the provider is blurred vision, as this is a manifestation of hydroxychloroquine toxicity and can be an indication of retinal damage.

initiate a transfusion of packed RBC

C. Check the client's vital signs every hour during the transfusion. Rationale: The nurse should check the client's vital signs every 15 min at the start of the transfusion, then every 1 hr to monitor for a transfusion reaction

cancer - methotrexaste PO/ Bleeding gum

Check the value of the client's current platelet count. Rationale: The nurse should recognize that the bleeding is likely due to the adverse effect of the chemotherapy and needs to be evaluated further. Bleeding gums is a sign of thrombocytopenia (decreased platelet count) secondary to bone marrow suppression, which can be life-threatening in a client who is receiving chemotherapy

assessing a client who is receiving a unit of packed red blood cells.

Client report of low back pain Rationale: Manifestations of an acute hemolytic reaction include apprehension, tachypnea, hypotension, chest pain, and lower back pain

A nurse is preparing to administer clindamycin 300 mg by intermittent IV bolus over 30 min to a client who has a staphylococci infection. Available is clindamycin premixed in 50 mL 0.90% sodium chloride (NaCl). The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero. 100 mL/hr

Correct Rationale: STEP 1: What is the unit of measurement the nurse should calculate? mL/hr STEP 2: What is the volume the nurse should infuse? 50 mL STEP 3: What is the total infusion time? 30 min STEP 4: Should the nurse convert the units of measurement? Yes (min does not equal hr) 60 min/30 min = 1 hr/X hr X = 0.5 hr STEP 5: Set up an equation and solve for X. Volume (mL)/Time (hr) = X mL/hr 50 mL/0.5 hr = X mL/hr X = 100 STEP 6: Round if necessary. STEP 7: Reassess to determine whether the amount to administer makes sense. If the prescription reads clindamycin 300 mg in 50 mL 90% NaCl by IV intermittent bolus to infuse over 30 min, it makes sense to administer it at 100 mL/hr. The nurse should set the IV pump to deliver clindamycin 300 mg in 50 mL 0.90% NaCl IV at 100 mL/h

sucralfate to treat a gastric ulcer

D. "I will take this medication 1 hour before meals and at bedtime." Rationale: The client should take sucralfate on an empty stomach, 1 hr before each meal and at bedtime to create a protective coating over the ulcer.

pt. with levothyroxine for several month

Decrease in level of thyroid stimulating hormone (TSH). Rationale: In hypothyroidism, the nonfunctioning thyroid gland is unable to respond to the TSH, and no endogenous thyroid hormones are released. This results in an elevation of the TSH level as the anterior pituitary continues to release the TSH to stimulate the thyroid gland. Administration of exogenous thyroid hormones, such as levothyroxine, turns off this feedback loop, which results in a decreased level of TSH.

lisinopril

Decreased blood pressure Rationale: Lisinopril, an ACE inhibitor, may be used alone or in combination with other antihypertensives in the management of hypertension and congestive heart failure. A therapeutic effect of the medication is a decrease in blood pressure

liver failure with ascites and is receiving spironolactone

Decreased sodium level Rationale: The nurse should expect a decreased sodium level. Spironolactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in an increased excretion of sodium.

diazepam

Diazepam can cause drowsiness. Rationale: Diazepam has sedative properties, so the client should not engage in potentially hazardous activities after receiving diazepam.

how to draw up regular insulin and NPH insulin into the same syringe

Discard regular insulin that appears cloudy. Rationale: The nurse should teach the client to discard any regular insulin that appears cloudy, as egular insulin should be clear. NPH insulin has a cloudy appearance

infection and a prescription for gentamicin intermittent IV bolus every 8 hr. A peak and trough is required with the next dose. Which of the following actions should the nurse take to obtain an accurate gentamicin serum level?

Draw a trough level immediately prior to administering the medication and a peak level 30 min after the dose. Rationale: Timing of the peak and trough is based on the pharmacokinetics of absorption and the half-life of the medication. The trough level is the lowest serum level after pharmacokinetic effects have taken place. For divided doses, correct timing for the trough is just before administering the next dose. The peak is the highest serum level of the medication; if this level is too low, then the medication will not be effective. Correct timing for the peak is between 30 and 60 min after the dose has finished infusing

parental lipid infusion / manifestation of fat overload syndrome

Elevated temperature Rationale: An elevated temperature is an early manifestation of fat overload syndrome. The client is at risk for coagulopathy and multi-organ system failure due to fat overload syndrome.

diabetes mellitus and receives 25 units of NPH insulin every morning if her blood glucose level is above 200 mg/dL

Expect the NPH insulin to peak in 6 to 14 hr. Rationale: NPH insulin is an intermediate-acting insulin. Its onset of action is 1 to 2 hr, peaking at 6 to 14 hr. Its duration of action is 16 to 24 hr. The client is at risk for hypoglycemia during the peak time

older adult: medication safety

Grapefruit juice Rationale: There is a high rate of food-drug interactions between grapefruit juice and many medications frequently taken by older adults, especially lipid-lowering agents. It is thought that one or more of the chemicals (most likely flavonoids) in grapefruit juice alter the activity of specific enzymes (such as CYP3A4 and CYP1A2) in the intestinal tract. These enzymes decrease the rate at which medications enter the systemic circulation. This could allow a larger amount of these drugs to reach the bloodstream, resulting in increased drug levels and possibly toxicity

rheumatoid arthritis - aspirin contraindication?

History of gastric ulcers Rationale: Aspirin is contraindicated for clients who have a history of gastrointestinal bleeding and peptic ulcer disease because it impedes platelet aggregation. An adverse effect of aspirin is gastric bleeding

heart failure and is receiving IV furosemide

Hyperuricemia Rationale: The nurse should monitor the client who is receiving IV furosemide for hyperuricemia. The nurse should instruct the client to notify the provider for any tenderness or swelling of the joints

Heparin

Inject the medication into the abdomen above the level of the iliac crest. Rationale: The nurse should inject the medication into the abdomen above the level of the iliac crest, at least 2 inches from the umbilicus

erectile dysfunction - sildenafil contraindication with

Isosorbide Rationale: Clients who are on nitrates including isosorbide and nitroglycerin preparations cannot take sildenafil, because of the serious medication interaction. There is the possibility of sudden death due to hypotension

regular insulin and NPH insulin

Keep the open vial of insulin at room temperature. Rationale: The client should keep the vial in use at room temperature to minimize tissue injury and to reduce the risk for lipodystrophy

chemotherapy : n/v

Metabolic alkalosis Rationale: Metabolic alkalosis can occur in clients who have excessive vomiting because of the loss of hydrochloric acid.

type2 DM; medication can cause glucose intolerance?

Prednisone Rationale: Corticosteroids such as prednisone can cause glucose intolerance and hyperglycemia. The client might require increased dosage of a hypoglycemic medication

coronary care unit- CPR after a cardiac arrest- lidocaine IV 2mg/min

Prevents dysrhythmias Rationale: Lidocaine is an antidysrhythmic medication that delays the conduction in the heart and reduces the automaticity of heart tissue.

thrombophlebitis and is receiving a continuous heparin infusion reverse heparin's effects

Protamine sulfate Rationale: Protamine sulfate reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties

artificial heart valve - warfarin

Prothrombin time (PT) Rationale: This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation warfarin - pt, INR

older adult - risk for orthostatic hypotension A. Furosemide B. Telmisartan C. Duloxetine

Rationale: Furosemide is correct. This medication is used to reduce edema and hypertension, and an adverse effect is orthostatic hypotension.Telmisartan is correct. This medication is used to control hypertension, and an adverse effect is orthostatic hypotension.Duloxetine is correct. This medication is used to treat depression and anxiety disorder, and an adverse effect is orthostatic hypotension.Clopidogrel is incorrect. This medication is used to reduce the risk of MI and stroke and does not cause orthostatic hypotension.Atorvastatin is incorrect. This Created on:08/29/2018 Page 31 Detailed Answer Key RN 46 C9 Pharmacology medication is used to decrease cholesterol and does not cause orthostatic hypotension.

long term omeprazole therapy

Reduced dyspepsia Rationale: Omeprazole, a proton pump inhibitor, reduces gastric acid secretion and treats duodenal and gastric ulcers, prolonged dyspepsia, gastrointestinal reflux disease, and erosive esophagitis.

(over the counter med) H2 receptor antagonist (H2RA)

Relief of heartburn Rationale: Histamine2 receptor antagonists are used to treat duodenal ulcers and prevent their return. In over-the-counter strengths, these medications, such as cimetidine and ranitidine, are used to relieve or prevent heartburn, acid indigestion, and sour stomach

a unit of packed red blood cells

Remain with the client for the first 15 minutes of the transfusion. Rationale: The nurse should remain with the client for the first 15 to 30 minutes of the transfusion to monitor for a transfusion reaction, which occurs often during the first 50 mL of the transfusion

assess priority to admininstraion of morphine

Respiratory rate Rationale: When using the airway, breathing, circulation approach to client care, the nurse should determine the priority assessment is respiratory rate. Morphine can cause respiratory depression. The nurse should withhold the medication and notify the prescriber if the client has a respiratory rate less than 12/min.

A nurse is preparing to administer dextrose 5% in water (D5W) 150 mL IV to infuse over 3 hr. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) 8 gtt/min

STEP 1: What is the unit of measurement the nurse should calculate? gtt/min STEP 2: What is the volume the nurse should infuse? 150 mL STEP 3: What is the total infusion time? 3 hr STEP 4: Should the nurse convert the units of measurement? Yes (min does not equal hr) 1 hr/60 min = 3 hr/X min X = 180 min STEP 5: Set up an equation and solve for X. Volume (mL)/Time (min) x drop factor (gtt/mL = X 150 mL/180 min x 10 gtt/mL = X gtt/min X = 8.3333 STEP 6: Round if necessary. 8.3333 = 8 STEP 7Reassess to determine whether the amount to administer makes sense. If the prescription reads D5W 150 mL IV to infuse over 3 hr, it makes sense to administer 8 gtt/min. The nurse should set the manual IV infusion to deliver D5W IV at 8 gtt/min.Dimensional AnalysisSTEP 1: What is the unit of measurement the nurse should calculate? gtt/min STEP 2: What is the quantity of the dose available? 10 gtt/min STEP 3: What is the total infusion time? 3 hr STEP 4: What is the volume the nurse should infuse? 150 mLSTEP 5: Should the nurse convert the units of measurement? Yes (min does not equal hr) 1 hr/60 minSTEP 6: Set up an equation and solve for X. X = Quantity/1 mL x Conversion (hr)/Conversion (min) x Volume (mL)/Time (min) X gtt/min = 10 gtt/1 mL x 1 hr/60 min x 150 mL/3 hrX = 8.3333 STEP 7: Round if necessary. 8.3333 = 8STEP 8: Reassess to determine whether the amount to administer makes sense. If the prescription reads D5W 150 mL IV to infuse over 3 hr, it makes sense to administer 8 gtt/min. The nurse should set the manual IV infusion to deliver D5W IV at 8 gtt/min

A nurse is caring for client who has sepsis and a prescription for vancomycin 1 g in 250 mL dextrose 5% (D5W) over 2 hr by IV intermittent bolus. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) 125 mL/hr

STEP 1: What is the unit of measurement the nurse should calculate? mL/hr STEP 2: What is the volume the nurse should infuse? 250 mL STEP 3: What is the total infusion time? 2 hr STEP 4: Should the nurse convert the units of measurement? Yes (min does not equal hr) 60 min/30 min = 1 hr/X hr X = 0.5 hr STEP 5: Set up an equation and solve for X. Volume (mL)/Time (hr) = X mL/hr 250 mL/2 hr = X mL/hr X = 125 STEP 6: Round if necessary. STEP 7: Reassess to determine whether the amount to administer makes sense. If the prescription reads vancomycin 1 g in 250 mL (D5W) over 2 hr by IV intermittent bolus, it makes sense to administer 125 mL/hr. The nurse should set the IV pump to deliver vancomycin 1 g in 250 mL D5W at 125 mL/hr

A nurse is preparing to administer total parental nutrition (TPN) 1800 mL to infuse over 24 hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) 75 mL/hr

STEP 1: What is the unit of measurement the nurse should calculate? mL/hr STEP 2: What is the volume the nurse should infuse? 1800 mL STEP 3: What is the total infusion time? 24 hr STEP 4: Should the nurse convert the units of measurement? NoSTEP 5: Set up an equation and solve for X. Volume (mL)/Time (hr) = X mL/hr 1800 mL/24 hr = X mL/hr X = 75 STEP 6: Round if necessary. STEP 7: Reassess to determine whether the amount to administer makes sense. If the prescription reads TPN 1800 mL to infuse over 24 hr, it makes sense to administer 75 mL/hr. The nurse should set the IV pump to deliver TPN IV at 75 mL/hr.

post-op: R. pneumonectomy. after extubation fro the ventilation, client's position?

Semi-Fowler's Rationale: Pneumonectomy is the surgical removal of the lung, which is most commonly performed to remove a tumor in a client who has lung cancer. Following extubation from the ventilator, the client should be placed in semi-Fowler's position to help to ensure adequate ventilation and decrease the risk of complications. This position also offers the client the most comfort

assessing a client who is receiving a unit of packed RBCs. pt. shows hemolysis & intervention?

Stop the transfusion. Rationale: The greatest risk to the client is injury due to further hemolysis; therefore, the priority action is to stop the transfusion. When a hemolytic reaction is suspected, the priority action by the nurse is to immediately stop the transfusion to prevent further hemolysis.

blood transfusion / hemolytic reaction

Stop the transfusion. Rationale: The greatest risk to the client is injury due to further hemolysis; therefore, the priority action is to stop the transfusion. When suspecting a hemolytic reaction, the priority action by the nurse is to immediately stop the transfusion to prevent further hemolysis.

dopamine IV to treat left ventricular failure

Systolic blood pressure is increased Rationale: When dopamine has a therapeutic effect, it causes vasoconstriction peripherally and increases systolic blood pressure

teaching: iron deficiency anemia - ferrous sulfat

Take the ferrous sulfate between meals. Rationale: The client should take the medication between meals for optimal absorption.

anemia - ferrous sulfate liquid

Take the medication with orange juice to enhance absorption. Rationale: Ascorbic acid (vitamin C), which is found in orange juice, will enhance the absorption of iron and increase its bioavailability. This will also help to decrease the gastrointestinal side effects of iron

colesevelam to lower his low-density lipoprotein leve

Take this medication 4 hr after other medications." Rationale: The client should take this medication 4 hours after other medications to increase absorption of the medication.

Asthma - albuterol inhaler ( how to use?)

The client holds his breath for 10 seconds after inhaling the medication. Rationale: The medication should be retained in the lungs for a minimum of 10 seconds so the maximum amount of the dosage can be delivered properly to the airways. To use the inhaler, the client exhales normally just prior to releasing the medication, inhales deeply as the medication is released, then holds the medication in the lungs for approximately 10 seconds prior to exhaling

high choleterol - warfarin

The client uses garlic to lower cholesterol levels. Rationale: The nurse should recognize that garlic can potentiate the action of the warfarin

seasonal influenza vaccine. pt. is given as a nasla spray contraindication for the client receiving the live attenuated influenza vaccine (LAIV)?

The client's age is 62. Rationale: Clients must be between the ages of 2 and 49 to receive the LIAV; therefore, it is contraindicated for this client. Pregnancy and immunocompromised status are also contraindications

CKD - epoetin alfa

The hematocrit (Hct) Rationale: Epoetin alfa is an antianemic medication that is indicated in the treatment of clients who have anemia due to reduced production of endogenous erythropoietin, which may occur in clients who have end-stage renal disease or myelosuppression from chemotherapy. The therapeutic effect of epoetin alfa is enhanced red blood cell production, which is reflected in an increased RBC, Hgb, and Hct

ophthalmology: teaching for pt with opne angel gaucoma-timolol eye drop

The medication should be applied on a regular schedule for the rest of the client's life. Rationale: Medications prescribed for open angle glaucoma are intended to enhance aqueous outflow, or decrease its production, or both. The client must continue the eye drops on an uninterrupted basis for life to maintain intraocular pressure at an acceptable level

AE: cisplatin

Tinnitus Rationale: Tinnitus and hearing loss are adverse effects of cisplatin

ransfuse one unit of packed RBC to a client who experienced a mild allergic reaction during a previous transfusion. The nurse should administer diphenhydramine prior to the transfusion for which of the following allergic responses?

Urticaria Rationale: For clients who have previously had allergic reactions to blood transfusions, administering an antihistamine such as diphenhydramine prior to the transfusion might prevent future reactions. Allergic reactions typically include urticaria (hives).

cancer-ondansetron. tx) chemotherapy-induced nausea

adverse effect: A. Headache Rationale: Headache is a common adverse effect of ondansetron. Analgesic relief is often required

teaching: asthma- cromolyn & albuterol, both by nebulizer

albuterol ------> cromoly ALBUTEROL: a short acting bronchodilator, should be used for the treatment of acute bronchospasms Cromolyn, a leukotriene modifier, is used for prophylaxis treatment of asthma, not acute attacks.

fungal infection - amphotericin B

assess: BUN 55 mg/dL Rationale: This BUN level is above the expected reference range (10-20 mg/dL). Amphotericin B is nephrotoxic and is contraindicated if BUN is > 40mg/dL. The nurse should report this laboratory value to the provider before initiating the medication

substance abuse - disulfiram; discondinue d/t N/V

cause of the client's distress? The client consumed alcohol while taking the medication. Rationale: Disulfiram is given to clients who have a history of alcohol abuse. It produces a sensitivity to alcohol that results in a highly unpleasant reaction when the client ingests even small amounts of alcohol. When combined with alcohol, disulfiram produces nausea and vomiting

digoxin. pt. is complaining of nausea & weakness

check vital signs FIRST b/c digoxin tocixity

cancer-morhine (PO) for pain. get increased the dose of morphine

documentation: The client developed a tolerance to the medication. Rationale: The nurse should document that the client has developed a tolerance to the medication. Morphine is a narcotic analgesic used for the treatment of severe pain. Tolerance is an adverse effect of narcotic analgesics in which a larger dose is needed to produce the same response

calcium carbonate (over the counter)

drink a glass of water after taking the medication Rationale: Clients who take aluminum hydroxide, not calcium carbonate, antacids should be advised against excessive sodium intake in the diet

teaching: CKD - epoetin alfa

increase dietary intake of IRON Rationale: Epoetin alfa is a synthetic form of erythropoietin, a substance produced by the kidneys that stimulates the bone marrow to produce red blood cells. Increased iron is needed for the production of hemoglobin and red blood cells by the bone marrow

poison ivy - diphenhydramine AE: dry mouth

intervention: "Chew on sugarless gum or suck on hard, sour candies." Rationale: Clients who report dry mouth can get the most effective relief by sucking on hard candies (especially the sour varieties that stimulate salivation), chewing gum, or rinsing the mouth frequently. It is the local effect of these actions that provides comfort to the client.

assess IV vancomycin. nurse note: flushing of the neck and tachycardia

intervention: Decrease the infusion rate on the IV. Rationale: This client is experiencing Red man syndrome, which includes a flushing of the neck, face, upper body, arms and back along with tachycardia, hypotension and urticaria. This can lead to an anaphylactic reaction if the IV infusion rate is not slowed down to run greater than 1 hour.

cardiac dysrhythmia - verapamil by IV bolus

monitor: hyportension rationale: Verapamil, a calcium channel blocker, can be used to control supraventricular tachyarrhythmias. It also decreases blood pressure and acts as a coronary vasodilator and antianginal agent. A major adverse effect of verapamil is hypotension; therefore, blood pressure and pulse must be monitored before and during parenteral administration

alendronate Bone health It can treat or prevent osteoporosis. It can also treat Paget's disease of the bone.

must administer in the morning first on an empty stomach and wait at least 30 minutes before eating, drinking or taking other medication

acute respiratory distress syndrome (ARDS), and requires mechanical ventilation.

pancuronium to Suppress respiratory effort Rationale: Neuromuscular blocking agents, such as pancuronium, induce paralysis and suppress the client's respiratory efforts to the point of apnea, allowing the mechanical ventilator to take over the work of breathing for the client. This therapy is especially helpful for a client who has ARDS and poor lung compliance.

HTN-pt. asks if he can take propranolol

propranolol is contraindicated in pt with asthma Rationale: Propranolol, a beta-blocker, is contraindicated in clients who have asthma because it can cause bronchospasms. Propranolol blocks the sympathetic stimulation, which prevents smooth muscle relaxatio

asthma with prednisone and discountiune

reduce dose gradually b/c Adrenocortical insufficiency Rationale: Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids can suppress production of glucocorticoids, and an abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency

asthma - inhaled beclomethasone

rinse the mouth after administration C. Rinse the mouth after administration. Rationale: Use of glucocorticoids by metered dose inhaler can allow a fungal overgrowth in the mouth. Rinsing the mouth after administration can lessen the likelihood of this complication

assess: pt. with levothyroxine

s/s overdose Insomnia Rationale: Levothyroxine overdose will result in manifestations of hyperthyroidism, which include insomnia, tachycardia, and hyperthermia

TB-rifampin therapy

se: body secretions turning a red-orange color

angina pectoris - propranolol hydrochloride PO contraindication

the client has a history of bronchial asthma. Rationale: Beta-adrenergic blockers can cause bronchospasm in clients who have bronchial asthma; therefore, this is a contraindication to its use and should be reported to the provider.

fall risk

the client takes alprazolam. Rationale: Alprazolam is a CNS depressant that can cause dizziness and orthostatic hypotension, which can cause the client to lose his balance and fall

bipolor is taking litium for a year. nurse need to assess before administration lithium

thyroid hormone assess b/c lithium may lead to thyroid dysfunction