Elsevier Pharmacology EAQ
A primary healthcare provider prescribes atenolol 20 mg by mouth four times a day for a client who has had double coronary artery bypass surgery. What information is most important for the nurse to include in the discharge teaching plan for this client? A. Drink alcoholic beverages in moderation. B. Avoid abruptly discontinuing the medication. C. Increase the medication if chest pain develops. D. Report a pulse rate less than 70 beats per minute.
B. Avoid abruptly discontinuing the medication. An abrupt discontinuation of atenolol may cause an acute myocardial infarction. Alcohol is contraindicated for clients taking atenolol because it can cause additive hypotension. Clients should never increase medications without a healthcare provider's direction. The pulse rate can go much lower as long as the client feels well and is not dizzy.
Which prostaglandin agonist is used in the treatment of clients with glaucoma? A. Carteolol B. Bimatoprost C. Brinzolamide D. Apraclonidine
B. Bimatoprost Bimatoprost is the prostaglandin agonist used in the treatment of glaucoma. Carteolol is the beta-adrenergic blocker used for treatment of glaucoma. Brinzolamide is the carbonic anhydrate inhibitor used for the treatment of glaucoma. Apraclonidine is the adrenergic agonist used in the treatment of glaucoma.
A client is scheduled to receive an intravenous (IV) solution of lactated Ringer to run at 150 mL/hr. To deliver the solution, the nurse plans to use an administration set that delivers 15 gtt/mL. At how many drops per minute should the nurse set the IV to administer the prescribed amount of fluid? Record your answer using a whole number. ___ gtt/min.
The ordered rate is 150 mL/h. The drop factor of the administration set is 15 gtt/mL. Use the Flow Rate Equation to determine the appropriate flow rate.
A hospitalized client is receiving pyridostigmine for control of myasthenia gravis. In the middle of the night, the nurse finds the client weak and barely able to move. Which additional clinical findings support the conclusion that these responses are related to pyridostigmine? Select all that apply. A. Respiratory depression B. Distention of the bladder C. Decreased blood pressure D. Fine tremor of the fingers E. High-pitched gurgling bowel sounds
A, C, E Anticholinergic effects of pyridostigmine can cause life-threatening respiratory depression, bronchospasm, laryngospasm, and respiratory arrest. Anticholinergic effects of pyridostigmine can cause hypotension, tachycardia, bradycardia, dysrhythmias, and cardiac arrest. Pyridostigmine is an anticholinergic that increases the peristaltic activity of the intestines. The result is hyperactive bowel sounds. Bladder distention is not associated with pyridostigmine. Although pyridostigmine can cause uncoordination, it does not cause fine tremors of the hands.
The practitioner prescribes a regular diet, gait training, elastic stockings, and benztropine mesylate for a client. The client experiences orthostatic hypotension, a side effect of benztropine mesylate. What should the nurse anticipate as the priority nursing action? A. Postpone gait training B. Apply elastic stockings C. Withhold the next dose D. Increase the fluid intake
B. Apply elastic stockings Elastic stockings help decrease venous pooling of blood and help maintain systemic blood pressure when the client stands up. Orthostatic hypotension occurs on rising to an upright position. Gait training should not be postponed; safety measures, such as permitting adequate time for the blood pressure to adjust to the client moving to the sitting or standing position, should be implemented. An alteration in dosage may be prescribed, but sudden withdrawal is dangerous and unwarranted. Increasing fluid intake may increase the intravascular fluid volume temporarily but will not affect reflexes involved in orthostatic hypotension.
A client with hypertension has received a prescription for metoprolol. Which information should the nurse include when teaching this client about metoprolol? A. Do not abruptly discontinue the medication. B. Consume alcoholic beverages in moderation. C. Report a heart rate of less than 70 beats per minute. D. Increase the medication dosage if chest pain occurs.
A. Do not abruptly discontinue the medication. Abrupt discontinuation of metoprolol may cause rebound hypertension and an acute myocardial infarction. Alcohol is contraindicated for clients taking beta-adrenergic blockers such as metoprolol. Clients should never increase medications without medical direction. The pulse rate can go lower than 70 beats per minute as long as the client feels well and is not dizzy.
A client with a history of type 1 diabetes is diagnosed with heart failure. Digoxin is prescribed. What is an important nursing action associated with this drug? A. Administer the digoxin 1 hour after the client's morning insulin B. Monitor the client for atrial fibrillation and first-degree heart block C. Administer the medication with 8 ounces (240 mL) of orange juice D. Withhold the medication if the apical pulse rate is greater than 60 beats/min
B. Monitor the client for atrial fibrillation and first-degree heart block The speed of conduction is decreased when digoxin is given, and this can result in premature beats, atrial fibrillation, and first-degree heart block. Digoxin does not deplete potassium and therefore orange juice does not need to be given; orange juice is high in calories and needs to be calculated in the diet. Insulin and digoxin can be given at the same time. The purpose of the drug is to reduce a rapid heart rate and therefore should be administered; it should be withheld when the client's heart rate decreases below a parameter set by the healthcare provider (e.g., 60 beats/min).
A client is receiving intravenous mannitol after sustaining a critical head injury. What assessment will the nurse perform that is specific to the safe administration of the medication? A. Body weight daily B. Urine output hourly C. Vital signs every 2 hours D. Level of consciousness every 8 hours
B. Urine output hourly Mannitol, an osmotic diuretic, increases the intravascular volume that must be excreted by the kidneys. The client's urine output should be monitored hourly to determine the client's response to therapy. Although with mannitol there is an increase in urinary excretion that is reflected in a decrease in body weight (1 L of fluid is equal to 2.2 pounds [1 kg]), a daily assessment of the client's weight is too infrequent to assess the client's response to therapy. Urine output can be monitored hourly and is a more frequent, accurate, and efficient assessment than is a daily weight. Vital signs should be monitored every hour considering the severity of the client's injury and the administration of mannitol. Although the level of consciousness should be monitored with a head injury, assessments every 8 hours are too infrequent to monitor the client's response to therapy.
Valsartan, an angiotensin II receptor antagonist, is prescribed for a client. For which possible side effects should the nurse monitor the client? Select all that apply. A. Constipation B. Hypokalemia C. Irregular pulse rate D. Change in visual acuity E. Orthostatic hypotension
C & E Dysrhythmias, including second-degree heart block, are cardiovascular side effects of valsartan. It also may precipitate angina pectoris, myocardial infarction, and brain attack (cerebrovascular accident, CVA). Angiotensin II receptor antagonists, such as valsartan, block vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites, including vascular smooth muscle, thus reducing the blood pressure; dizziness, orthostatic hypotension, and excessive hypotension may occur. Diarrhea, not constipation, may occur with valsartan. Hyperkalemia, not hypokalemia, may occur with valsartan. Valsartan does not cause altered visual acuity.
A client with tuberculosis asks the nurse how long drug therapy will be continued. What is the nurse's most accurate reply? A. 1 to 2 weeks B. 4 to 5 months C. 6 to 12 months D. 3 years or longer
C. 6 to 12 months The tubercle bacillus is a drug-resistant organism and takes a long time to be eradicated; usually a combination of three medications is used for a minimum of 6 months, and at least 6 months beyond culture conversion. One to 2 weeks or 4 to 5 months are too short a time for eradication of this organism. Usually, the organism can be eradicated in a shorter period of time than 3 years, unless a resistant strain of the bacillus has developed.
Which drug would be effective for the treatment of pituitary Cushing's syndrome? A. Mitotane B. Cabergoline C. Cyproheptadine D. Bromocriptine mesylate
C. Cyproheptadine Cyproheptadine is effective for the treatment of pituitary Cushing's syndrome. Mitotane is prescribed for the treatment of adrenal Cushing's syndrome. Cabergoline and bromocriptine mesylate are effective for the treatment of hyperpituitarism.
A client is taking furosemide. At each clinic visit, the nurse should assess for what adverse effect? A. Rapid weight loss B. Xanthopsia C. Hyporeflexia D. Bronchospasm
C. Hyporeflexia Furosemide enhances the excretion of potassium, producing signs and symptoms of hypokalemia, such as hyporeflexia. Rapid weight loss, xanthopsia, and bronchospasm are not side effects of furosemide.
When obtaining a health history, the nurse is informed that a client has been taking digoxin. What therapeutic effect of digoxin does the nurse expect? A. Decreased cardiac output B. Decreased stroke volume of the heart C. Increased contractile force of the myocardium D. Increased electrical conduction through the atrioventricular (AV) node
C. Increased contractile force of the myocardium Digoxin produces a positive inotropic effect that increases the strength of myocardial contractions and thus cardiac output. The positive inotropic effect of digoxin increases, not decreases, cardiac output. Digoxin increases the strength of myocardial contractions (positive inotropic effect) and slows the heart rate (negative chronotropic effect); these effects increase the stroke volume of the heart. Digoxin decreases the refractory period of the AV node and decreases conduction through the sinoatrial (SA) and AV nodes.
A client has increased intracranial pressure resulting from a traumatic brain injury. Assessment findings indicate that the client is unconscious with vital signs of pulse 60 beats/min, respirations 16 breaths/min, and blood pressure 142/64 mm Hg. The nurse reviews the treatment plan and questions which prescription? A. Mannitol B. Dexamethasone C. Chlorpromazine D. Morphine
D. Morphine Morphine injection is contraindicated for an unconscious, neurologically impaired client because it depresses respirations. Mannitol, an osmotic diuretic, is used to reduce increased intracranial pressure. Dexamethasone, a corticosteroid antiinflammatory agent, is used to help reduce increased intracranial pressure. Chlorpromazine, an antipsychotic/neuroleptic/antiemetic, can be given safely to a neurologically impaired client for restlessness.
The nurse is caring for a client hospitalized with a myocardial infarction. Which analgesic is the drug of choice for this client? A. Diazepam B. Meperidine C. Flurazepam D. Morphine sulfate
D. Morphine sulfate For myocardial infarction, morphine sulfate is the drug of choice because it relieves pain quickly and reduces anxiety while decreasing cardiac workload. Diazepam is a muscle relaxant that may be used for its sedative effect; it is not effective for the pain of a myocardial infarction. Although meperidine is effective, it is not the drug of choice. Flurazepam is a hypnotic that may be used to reduce fear and restlessness; it is not effective for the pain of a myocardial infarction.
A hospice client who has severe pain asks for another dose of oxycodone. What is the nurse's primary consideration when responding to the client's request? A. Prevent addiction B. Determine why the drug is needed C. Provide alternative comfort measures D. Reduce the client's pain
D. Reduce the client's pain Hospice clients with severe pain need increasing levels of analgesics and should be maintained at a pain-free level, even if addiction occurs. Pain management, not the prevention of addiction, is the priority. The client has severe pain, and the priority is to relieve the pain. Comfort measures should augment, not be substitutes for, pharmacologic interventions when clients are experiencing severe pain.
A client with a history of hypertension comes to the emergency department with double vision and a blood pressure of 260/120 mm Hg. The healthcare provider prescribes a sodium nitroprusside infusion. The nurse recalls that sodium nitroprusside decreases blood pressure by what mechanism? A. Decreasing the heart rate B. Increasing cardiac output C. Increasing peripheral resistance D. Relaxing arterial smooth muscles
D. Relaxing arterial smooth muscles This drug decreases blood pressure by relaxing venous and arteriolar smooth muscles and is used for immediate reduction of blood pressure. This drug may increase the heart rate as a response to vasodilation. It decreases cardiac workload by decreasing preload and afterload. It decreases peripheral resistance by dilating peripheral blood vessels.
A nurse is caring for a client who has been taking several antibiotic medications for a prolonged time. Because long-term use of antibiotics interferes with the absorption of fat, what prescription does the nurse anticipate? A. High-fat diet B. Supplemental cod liver oil C. Total parenteral nutrition (TPN) D. Water-soluble forms of vitamins A and E
D. Water-soluble forms of vitamins A and E Vitamins A, D, E, and K are known as fat-soluble vitaminsbecause bile salts and other fat-related compounds aid their absorption. A high-fat diet will not achieve the uptake of fat-soluble vitamins in this client. Supplemental cod liver oil will not achieve the uptake of fat-soluble vitamins in this client. TPN is unnecessary; a well-balanced diet is preferred. Water-miscible forms of vitamins A and E can be absorbed with water-soluble nutrients.
A nurse is caring for a client who is receiving total parenteral nutrition (TPN). The nurse would monitor the client for which complications? Select all that apply. A. Hyperglycemia B. Infection C. Hepatitis D. Anorexia E. Dysrhythmias
A & B Hyperglycemia related to the high concentration of dextrose in TPN is a common complication of this therapy and must be monitored for by the nurse. Another common complication is related to the central venous access that is needed for infusion of TPN. Catheter-related infection is frequently seen and must be monitored for by the nurse. Hepatitis is usually not associated with total parenteral nutrition. Anorexia often is present before the medical decision is made to begin total parenteral nutrition. Dysrhythmias are not related to total parenteral nutrition, but may be a sign of hyperkalemia or hypokalemia.
A client with diabetic ketoacidosis who is receiving intravenous fluids and insulin complains of tingling and numbness of the fingers and toes and shortness of breath. The cardiac monitor shows the appearance of a U wave. What complication does the nurse suspect? A. Hypokalemia B. Hypoglycemia C. Hypernatremia D. Hypercalcemia
A. Hypokalemia These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose. Symptoms of hypoglycemia are weakness, nervousness, tachycardia, diaphoresis, irritability, and pallor. Symptoms of hypernatremia are thirst, orthostatic hypotension, dry mouth and mucous membranes, concentrated urine, tachycardia, irregular heartbeat, irritability, fatigue, lethargy, labored breathing, and muscle twitching or seizures. Symptoms of hypercalcemia are lethargy, nausea, vomiting, paresthesias, and personality changes.
A health care provider prescribes cholestyramine, an anion exchange resin, to treat a client's persistent diarrhea. What vitamin does the nurse anticipate may become deficient because cholestyramine reduces the absorption of fat? A. Retinol (Vitamin A) B. Riboflavin (Vitamin B2) C. Thiamine (Vitamin B12) D. Pyridoxine (Vitamin B6)
A. Retinol (Vitamin A) Cholestyramine is a fat-binding agent; it binds with and interferes with all the fat-soluble vitamins (A, D, E, and K). Thiamine is not a fat-soluble vitamin and is unaffected. Riboflavin is not a fat-soluble vitamin and is unaffected. Vitamin B6 is not a fat-soluble vitamin and is unaffected.
A client with tuberculosis asks the nurse why vitamin B6 (pyridoxine) is given with isoniazid. What explanation should the nurse provide? A. "It will improve your immunologic defenses." B. "The tuberculostatic effect of isoniazid is enhanced." C. "Isoniazid interferes with the synthesis of this vitamin." D. "Destruction of the tuberculosis organisms is accelerated."
C. "Isoniazid interferes with the synthesis of this vitamin." Isoniazid often leads to vitamin B6 (pyridoxine) deficiency because it competes with the vitamin for the same enzyme; this deficiency most often is manifested by peripheral neuritis, which can be controlled by regular administration of vitamin B6. Vitamin B6 does not improve immune status. Pyridoxine does not enhance isoniazid effects. Pyridoxine does not destroy organisms.
A client with rheumatoid arthritis has been given a prescription for acetylsalicylic acid. The client asks the nurse, "What kind of drug is acetylsalicylic acid?" The nurse recalls that this drug has which property? A. Sedative B. Hypnotic C. Analgesic D. Antibiotic
C. Analgesic Acetylsalicylic acid (aspirin) acts as an analgesic by inhibiting production of inflammatory mediators. Acetylsalicylic acid does not act as a sedative to calm individuals. Acetylsalicylic acid does not act as a hypnotic to induce sleep. Acetylsalicylic acid does not destroy or control microorganisms.
A nurse is planning to administer a prescribed intravenous solution that contains potassium chloride. What assessment should be brought to the healthcare provider's attention before administration of the intravenous line? A. Uncharacteristic irritability B. Poor tissue turgor with tenting C. Urinary output of 200 mL during the previous 8 hours D. Oral fluid intake of 300 mL during the previous 12 hours
C. Urinary output of 200 mL during the previous 8 hours Decreased urinary output will result in the retention of potassium, causing hyperkalemia. Reporting uncharacteristic irritability is unnecessary; this is a sign of dehydration, which can be corrected with appropriate hydration. Reporting poor tissue turgor with tenting is unnecessary; this may indicate dehydration, which is probably the rationale for the fluid prescribed. Reporting an oral fluid intake of 300 mL during the previous 12 hours is unnecessary; this can precipitate dehydration or can compound an existing dehydration, which can be treated with appropriate hydration.
A client is to receive 125 mL of intravenous (IV) fluid every hour. The drop factor of the IV tubing is 10 gtt/mL. How many drops per minute should the nurse administer? Record your answer using a whole number. ___ gtts/min
The ordered rate is 125 ml/hr. The drop factor of the tubing is 10 gtt/mL. Use the flow rate equation to determine the appropriate flow rate in drops/minute.
During administration of a whole blood transfusion, the client begins to complain of shortness of breath. The nurse notes the presence of jugular venous distension, bibasilar crackles, and tachycardia. Prioritize the following nursing actions. 1. Elevate the head of the bed to 45 degrees 2. Apply oxygen via nasal cannula 3. Reduce the flow rate of the transfusion 4. Administer furosemide (Lasix) per provider prescription 5.Document findings in the client record
1, 2, 3, 4, 5 These symptoms represent circulatory overload. First, the nurse's priority is to facilitate gas exchange by elevating the head of the bed, then applying oxygen. Next, the transfusion rate should be slowed to reduce further circulatory overload and client compromise, followed by the administration of a diuretic to reduce circulating volume. Lastly, the findings and interventions should be documented accordingly.
What is a nurse's responsibility when administering prescribed opioid analgesics? Select all that apply. A. Count the client's respirations. B. Document the intensity of the client's pain. C. Withhold the medication if the client reports pruritus. D. Verify the number of doses in the locked cabinet before administering the prescribed dose. E. Discard the medication in the client's toilet before leaving the room if the medication is refused.
A, B, D Opioid analgesics can cause respiratory depression; the nurse must monitor respirations. The intensity of pain must be documented before and after administering an analgesic to evaluate its effectiveness. Because of the potential for abuse, the nurse is legally required to verify an accurate count of doses before taking a dose from the locked source and at the change of the shift. Pruritus is a common side effect that can be managed with antihistamines. It is not an allergic response, so it does not preclude administration. The nurse should not discard an opioid in a client's room. Any waste of an opioid must be witnessed by another nurse.
A client with hyperthyroidism is being treated with propylthiouracil (PTU). What instruction should the nurse plan to include in the teaching plan regarding this drug? Select all that apply. A. "Avoid abrupt discontinuation of the medication." B. "Monitor your weight, pulse, and mood routinely." C. "You can expect an immediate response to this medication." D. "Also take an iodine replacement to aid metabolism of the drug." E. "Report side effects, such as sore throat, fever, joint pain, or oral lesions."
A, B, E Abrupt discontinuation of the medication may result in thyroid crisis. PTU blocks the synthesis of T3 (triiodothyronine) and T4 (thyroxine). The therapeutic effect of the drug should result in increased weight, decreased pulse, and stability of mood. Sore throat, joint pain, fever, or oral lesions may indicate infection caused by drug-induced blood dyscrasias, such as leukopenia and agranulocytosis. The response to this drug may take up to 3 weeks. Over-the-counter medications and seafood containing iodine should be avoided.
A client with human immunodeficiency virus (HIV) infection is diagnosed with tuberculosis. Before starting antitubercular pharmacotherapy, what essential test results should the nurse review? A. Liver function studies B. Pulmonary function studies C. Electrocardiogram and echocardiogram D. White blood cell counts and sedimentation rate
A. Liver function studies Antitubercular drugs, such as isoniazid (INH) and rifampin (RIF), are hepatotoxic; liver function should be assessed before initiation of pharmacologic therapy. Pulmonary function studies, electrocardiogram, and echocardiogram might be done; the results of these tests are not crucial for the nurse to review before administering antitubercular drugs. White blood cell counts and sedimentation will not provide information relative to starting antitubercular therapy or to its side effects.
A nurse is caring for a client who is admitted to the hospital with a diagnosis of unstable angina. Sublingual nitroglycerin has been prescribed. What client response indicates that nitroglycerin is effective? A. Pain subsides as a result of arteriole and venous dilation. B. Pulse rate increases because the cardiac output has been stimulated. C. Sublingual area tingles because sensory nerves are being triggered. D. Capacity for activity improves as a response to increased collateral circulation.
A. Pain subsides as a result of arteriole and venous dilation. Nitroglycerin causes vasodilation, increasing the flow of blood and oxygen to the myocardium and reducing anginal pain. An increased pulse rate does not indicate effectiveness; it is a side effect of nitroglycerin. The tingling indicates that the medication is fresh; relief of pain is the only indicator of effectiveness. Nitroglycerin does not promote the formation of new blood vessels.
A client who takes daily megadoses of vitamins is hospitalized with joint pain, loss of hair, yellow pigmentation of the skin, and an enlarged liver due to vitamin toxicity. What type of toxicity does the nurse suspect? A. Retinol (vitamin A) B. Thiamine (vitamin B1) C. Pyridoxine (vitamin B6) D. Ascorbic acid (vitamin C)
A. Retinol (vitamin A) Joint pain, hair loss, jaundice, anemia, irritability, pruritus, and enlarged liver and spleen are signs of vitamin A toxicity. Unlike retinol, which is lipid soluble and eliminated by the liver, thiamine, pyridoxine, and ascorbic acid are water soluble, so they are typically excreted in the urine before toxic blood levels can be achieved. However, excess thiamine may elicit an allergic reaction in some individuals, excess vitamin C (ascorbic acid) may cause diarrhea or renal calculi, and ultrahigh doses (about 800 times the normal dose) of pyridoxine (vitamin B6) can promote neuropathy. Remember that lipid-soluble vitamins normally take longer to eliminate and accumulate faster than water-soluble vitamins.
The person with which type of blood is known to be the universal recipient? A B O AB
AB People with type AB blood have both A and B antigens on their red blood cells (RBCs) and no antibodies against either antigen in their plasma. They can receive packed RBCs of any ABO blood type. A, B, and O are not the universal recipient.
A healthcare provider prescribes morphine for a client being treated for myocardial infarction. What physiologic response will occur if the client experiences the intended therapeutic effect of morphine? A. Increased respiratory rate B. Decreased workload of the heart C. Reduced size of the clot blocking the coronary artery D. Diminished metabolites within the ischemic heart muscle
B. Decreased workload of the heart Morphine reduces pain and anxiety. This limits the response of the sympathetic nervous system, ultimately decreasing cardiac preload and the workload of the heart. Reduced respiratory rate is a side effect of morphine; it is not the intended therapeutic effect for a client being treated for myocardial infarction. Decreasing the size of the clot blocking the coronary artery is the action of antithrombolytic therapy. Decreasing metabolites within the ischemic heart muscle is not the action of morphine.
A client is prescribed ranitidine 150 mg daily to treat peptic ulcer disease (PUD). Which instruction would the nurse give to the client about when to take this medication? A. As needed B. With meals C. At bedtime D. When indigestion occurs
C. At bedtime Ranitidine is administered typically in a single dose at bedtime. This medication is used for 4 to 6 weeks in combination with other therapy; it is not used as needed, with meals, or when indigestion occurs.
A client reports frequently taking calcium carbonate. What effect should the nurse advise the client that this can have? A. Diarrhea B. Water retention C. Rebound hyperacidity D. Bone demineralization
C. Rebound hyperacidity The antacid action of calcium carbonate adds alkalinity, neutralizing gastric pH; this in turn stimulates renewed secretion of acid by the gastric mucosa. This medication causes constipation, not diarrhea. Calcium carbonate does not contain sodium, as do some antacids; thus it does not promote fluid retention. This antacid provides a source of calcium, which helps prevent bone demineralization.
A client says, "I take baking soda in water when I get heartburn." The nurse suggests an antacid containing aluminum and magnesium hydroxide instead of baking soda. What is the advantage these antacids have over baking soda? A. They contain little, if any, sodium. B. Absorption by the stomach mucosa is markedly enhanced. C. There is no direct effect on the systemic acid-base balance when taken as directed. D. Fewer side effects, such as diarrhea or constipation, are experienced when they are used properly.
C. There is no direct effect on the systemic acid-base balance when taken as directed. Nonsystemic antacids are not readily absorbed, so they do not alter the acid-base balance. Sodium bicarbonate is absorbed and can alter the acid-base balance. These preparations do contain sodium. Nonsystemic antacids are insoluble and not readily absorbed. Diarrhea and constipation are side effects of nonsystemic antacids.
A nurse providing care to a client who had major abdominal surgery monitors the client for postoperative complications. Which clinical findings are indicators of impending hypovolemic shock? A. Diuresis, irritability, and fever B. Lethargy, cold skin, and hypertension C. Thirst, cool skin, and orthostatic hypotension D. Bounding pulse, restlessness, and slurred speech
C. Thirst, cool skin, and orthostatic hypotension With hypovolemic shock, extravascular fluid depletion leads to thirst, peripheral vasoconstriction produces cool skin, and inadequate venous return leads to orthostatic hypotension. Although irritability may occur with hypovolemic shock, decreased blood flow to the kidney leads to oliguria; the temperature usually decreases with hypovolemic shock. Restlessness, not lethargy, occurs with hypovolemic shock; hypotension and cool skin are signs of hypovolemic shock. Although restlessness may occur with hypovolemic shock, the pulse is thready, not bounding; subtle changes in sensorium will not result in slurred speech.
The client who takes furosemide and digoxin reports that everything looks yellow. How will the nurse respond? A. "This is related to your heart problems, not to the medication." B. "It is a medication that is necessary, and that side effect is only temporary." C. "Take this dose, and when I see your healthcare provider I will ask about it." D. "I will hold the medication until I consult with your healthcare provider."
D. "I will hold the medication until I consult with your healthcare provider." The response "I will hold the medication until I consult with your healthcare provider" is a safe practice because yellow vision indicates digitalis toxicity. The response "This is related to your heart problems, not to the medication" is incorrect; yellow vision is not a symptom of heart disease. The response "It is a medication that is necessary, and that side effect is only temporary" is incorrect; yellow vision is not a temporary side effect. The response "Take this dose, and when I see your healthcare provider I will ask about it" is unsafe.
A nurse prepares to administer intravenous (IV) albumin to a client with ascites. What effect does the nurse anticipate? A. Ascites and blood ammonia levels will decrease. B. Decreased capillary perfusion and blood pressure. C. Venous stasis and blood urea nitrogen level will increase. D. As extravascular fluid decreases, the hematocrit will decrease.
D. As extravascular fluid decreases, the hematocrit will decrease. Serum albumin is administered to maintain blood volume and normal oncotic (osmotic) pressure; it does this by pulling fluid from the interstitial spaces into the intravascular compartment. Serum albumin does affect blood ammonia levels; fluid accumulated in the abdominal cavity is removed via a paracentesis. The administration of albumin results in a shift of fluid from the interstitial to the intravascular compartment, which probably will increase the blood pressure. Albumin administration does not affect venous stasis or the blood urea nitrogen level.
A client had surgery for a ruptured appendix. Postoperatively, the health care provider prescribes an antibiotic to be administered intravenously twice a day. The nurse administers the prescribed antibiotic via a secondary line into the primary infusion of 0.9% sodium chloride. During the administration of the antibiotic, the client becomes restless and flushed, and begins to wheeze. What should the nurse do after stopping the antibiotic infusion? A. Check the client's temperature. B. Take the client's blood pressure. C. Obtain the client's pulse oximetry. D. Assess the client's respiratory status.
D. Assess the client's respiratory status. The client is experiencing an allergic reaction that may progress to anaphylaxis. Anaphylactic shock can lead to respiratory distress as a result of laryngeal edema or severe bronchospasm. Assessing and maintaining the client's airway is the priority. Checking the client's temperature and taking the client's blood pressure are not the priority; vital signs should be obtained after airway patency is ensured and maintained. Pulse oximetry is only one portion of the needed respiratory status assessment.
A, C, E Anticholinergic effects of pyridostigmine can cause life-threatening respiratory depression, bronchospasm, laryngospasm, and respiratory arrest. Anticholinergic effects of pyridostigmine can cause hypotension, tachycardia, bradycardia, dysrhythmias, and cardiac arrest. Pyridostigmine is an anticholinergic that increases the peristaltic activity of the intestines. The result is hyperactive bowel sounds. Bladder distention is not associated with pyridostigmine. Although pyridostigmine can cause uncoordination, it does not cause fine tremors of the hands.
The prescribed dose is 1200 mg. The available concentration of drug is 1 g/3 mL. The prescribed dose should first be converted to the available concentration. Then, use the dimensional analysis and/or ratio and proportion methods to determine the appropriate amount of medication to be added to 50 mL D5W. (Copy & paste image link on an extra tab for written solution: https://eaq.elsevier.com/Libraries/EAQ_NCLEX-RN_2-0/QB-k3dz/Q-2996-x4y1jski/9t8b/Drug+calculation+questions_gold_1_Q33.png)
A healthcare provider prescribes cefazolin sodium 375 mg intravenous piggyback (IVPB) every 8 hours. The vial of powder contains 500 mg of the medication. This must be reconstituted with 2 mL of 0.9% sodium chloride. In the resulting solution 1 mL contains 225 mg of cefazolin. How many mL of cefazolin solution should the nurse administer? Record your answer using one decimal place. ____mL
The prescribed medication is 375 mg. The available concentration is 225 mg/mL. Use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters the nurse should administer.
A nurse is caring for a client after a total knee replacement who is requesting hydrocodone/acetaminophen in addition to the patient-controlled analgesia (PCA). The client reports having taken two hydrocodone/acetaminophen tablets every 4 hours for several weeks before surgery. If each tablet contains 500 mg of acetaminophen, how much acetaminophen had the client been ingesting per day? Record your answer using a whole number with no punctuation. ___ mg
Two tablets every 4 hours over 24 hours equals a total of 12 tablets daily. Because each tablet has 500 mg, then 500 × 12 = 6000 mg. This is more than the recommended maximum dose of 4000 mg/24 hr for short-term use.
