Exam 1 practice Pharmocology
Mrs. Higgins looks relieved by your answer, but Mr. Higgins still looks worried. He states that he has read that health care providers just prescribe antibiotics because they think parents want them, when in fact they are not necessary. Which statements do you make to educate the family regarding the use of antibiotics to treat Matthew's condition? Select all that apply. "There is nothing wrong with giving medicine the client may not need." "The pediatric health care provider believes that Matthew has an infection that requires treatment." "Untreated strep throat can cause rheumatic fever, a serious condition." "If left untreated, strep throat is contagious." "If Matthew doesn't take the penicillin, he could become penicillin resistant."
"The pediatric health care provider believes that Matthew has an infection that requires treatment." "Untreated strep throat can cause rheumatic fever, a serious condition." "If left untreated, strep throat is contagious." The parents should understand that untreated strep throat can lead to rheumatic fever and other serious conditions. It is also contagious and must be treated. In Matthew's case, the pediatric health care provider suspects strep throat, and that is the reason the medication has been prescribed. It is not being prescribed to placate the parents. The statement, "There is nothing wrong with giving medicine the client may not need" is untrue, as penicillin resistance may develop and the client may experience side effects for no reason. People do not become penicillin resistant, strains of bacteria do.
The attending health care provider orders the following medication for Mr. Young: cloxacillin (Cloxapen) 500 mg in 100 ml IV Saline every 6 hours to infuse over 1 hour. Using a drop factor of 15 drops/ml, how many drops per minute need to be delivered? Please limit your answer to a numeral. Record your answer rounding to the nearest whole number.
25 drops/min 100ml x 15 (1500)/ 60 = 25 gtts/minute
Mr Young reports severe pain in his head and the left side of his face. He has a low grade fever or 99degreesF. Considering his presenting symptoms, what phase of the infections process would your report this as to the primary health care provider? Acute phase Incubation phase Prodromal phase Infectious phase
Acute phase Based on the presenting symptoms, Mr. Young is in the acute phase of the disease. The infectious process follows distinct stages of development. Maximal impact of the infectious process is felt during the acute phase when the pathogen proliferates and disseminates rapidly. Toxic by-products of microorganism metabolism and cell lysis, along with the immune response, produce tissue damage and inflammation. During this stage, the patient is often tachycardic and tachypneic because of increased metabolic demands. His presenting symptoms indicate that he is well past the incubation, prodromal, and infection phases.
Based on your assessment, you feel it is likely that Matthew has strep throat. You prepare to perform a rapid strep test. What is the best method for obtaining the sample? Ask Matthew to sit, put his hands under his bottom and pant like a dog while you swab the back of his throat with a long, sterile cotton swab. Ask Matthew's parents to hold him down on his back while you swab his throat with a long, sterile cotton swab. Ask Matthew to open his mouth and say, "aaah" as you scrape the back of his throat with a tongue depressor. Ask Matthew to gently cough and then spit into a sterile cup.
Ask Matthew to sit, put his hands under his bottom and pant like a dog while you swab the back of his throat with a long, sterile cotton swab. Children are often cooperative with basic medical procedures by the age of seven. You should attempt to obtain the specimen by asking Matthew to sit with his hands under him and pant while you swab the back of his throat. It is not appropriate to have the parents hold him down.Asking Matthew to cough and spit is not the correct way to obtain a throat specimen. The specimen should be obtained with a long, sterile swab, not by scraping with a tongue depressor.
A nurse is preparing to administer an intravenous medication to a client. Which of the following assessments should the nurse conduct prior to administering the medication? Select all that apply. Spike the bag of intravenous medication. Assess the client's understanding of the medication. Check the chart for the client's past medications. Inspect and palpate IV insertion site. Check the client's most recent vital signs.
Assess the client's understanding of the medication. Check the chart for the client's past medications. Inspect and palpate IV insertion site. Check the client's most recent vital signs. Rationale In the assessment phase of the nursing process, the nurse should assess psychosocial and biophysical parameters related to the client's medication needs and response to drug therapy. This would include the client's: bullet General health history, allergies, current and past medications, and diet bullet Perception of health and drug reactions bullet Understanding of medication action, use, adverse effects, and implications related to administration bullet Most recent vital signs The nurse should always inspect and palpate IV insertion site for infection, infiltration, or a dislocated catheter.Spiking the bag of the intravenous medication is part of the implementation phase of the medication administration.
The nurse identifies several problems in a client admitted with a diagnosis of pneumonia. Which problem should have top priority? Dysuria Nutritional deficiencies Insomnia Dyspnea
Dyspnea The client's ability to breathe is the first priority. The nurse uses airway, breathing, and circulation in determining priority status. Painful urination, poor nutritional status, and trouble sleeping are all needs that should be addressed, but respiratory difficulty is the top priority.
A nurse is preparing to administer a medication for a client. Which of the following actions should the nurse take prior to administering the medication? Administer the medication with applesauce. Administer the medication provided by the family. Administer a buccal medication on the chest area. Check the client's chart for any allergies.
Check the client's chart for any allergies. The nurse is the health care professional most legally responsible for the administration of medications to clients. One of the questions the nurse should consider prior to administering the medication is whether the client has allergies to the drug(s).There is not enough information in this question to determine the route of the medication and whether the client will need to take medications with applesauce.The health care provider will order the medication, the pharmacist will provide the medication, and the nurse will administer the medication.A buccal medication should be placed in the cheek, not on the chest.
The nurse is reviewing the medication order for a pregnant client. Which category of drugs, established by the U.S. Food and Drug Administration (FDA), is safest for the client to take? Category A Category C Category D Category B
Category A A category A drug is defined as one that shows no evidence of causing fetal abnormalities in studies on pregnant women; these drugs are the safest for the pregnant client. A drug is placed in category B because of one of two scenarios: either there is no evidence in animal studies that the drug causes abnormalities but the studies conducted on pregnant females are insufficient, or adverse effects have been demonstrated in animal studies but the studies conducted on pregnant women have not demonstrated risk to the fetus. Category C drugs should be avoided because not enough data supports safe or unsafe use in pregnant clients. Category D drugs should be avoided, except for a life-threatening or critical scenario, due to the evidence indicating a risk of causing fetal abnormalities and birth defects.
Mrs. Higgins asks you about measures they can take at home to help Matthew feel better. You explain that Matthew needs a lot of rest until he has recovered, and that he should remain out of school until he has taken the antibiotics for 24 hours and has been free of fever for 24 hours. You should also recommend which home care treatments? Select all that apply. Children's acetaminophen for fever and pain Massive doses of vitamin C for immunity Orange juice in small amounts Warm, salt-water gargle Room humidifier for Matthew's room
Children's acetaminophen for fever and pain Warm, salt-water gargle Room humidifier for Matthew's room Children's acetaminophen can be given as directed on the label to reduce fever and pain. A humidifier and gargling with warm salt-water can help relieve symptoms. Orange juice is acidic; while low-acid fluids are helpful, orange juice should not be suggested. Massive doses of vitamin C are not indicated.
Seven-year-old Matthew Higgins is brought to the pediatric health care provider's office by his parents. He is a regular client but has appeared without appointment. His worried parents have requested he be worked into the schedule. He is African American, slightly underweight, with no significant medical history other than a fractured arm two years ago. Matthew is crying, stating his throat hurts "really bad." Mrs. Higgins expresses concern about her daughter, explaining that she is allergic to penicillin. You reassure Mrs. Higgins by telling her that, should her daughter have strep throat, the pediatric health care provider can provide an appropriate treatment alternative to penicillin. Which alternative would the pediatric health care provider likely select for Matthew's sister? Ampicillin or amoxicillin Intravenous penicillin Home care measures such as salt water gargles Clarithromycin, azithromycin, or erythromycin
Clarithromycin, azithromycin, or erythromycin Due to her allergy to penicillin, Matthew's sister will likely be prescribed erythromycin, azithromycin, or clarithromycin if she has strep throat. Ampicillin, amoxicillin, and intravenous penicillin are contraindicated in clients with penicillin allergy. Home care measures, while effective at reducing symptoms, do not kill the causative organism and are not acceptable as sole treatment for strep throat.
The nurse is performing discharge teaching. The nurse notes the written prescription shown. Which action by the nurse is appropriate? Contact the health care provider to rewrite the prescription. Obtain clarification of the prescription order. Continue with the discharge teaching; the prescription is properly written. Correct the client instructions section of the prescription
Continue with the discharge teaching; the prescription is properly written. The prescription shown is properly written; no action is needed by the nurse. The nurse would not need to contact the health care provider about a prescription that is written properly. The prescription depicted does not require clarification; it contains a proper heading, body, and closing as required by all states; and displays a correct client instructions section. The nurse should not alter a prescription.
A nurse is preparing to administer medication to an 80-year-old male client with a diagnosis of congestive heart failure. Which lab test result raises concern about the potential for drug toxicity? Hemoglobin (Hgb) 13.6 g/dL (normal: 13.5dash18 g/dL) Brain natriuretic peptide (BNP) 120 pg/mL (normal: less than 100 pg/mL) White blood cells 6,000 mcL (normal: 4,500dash10,000 mcL) Creatinine clearance 75 mL/min (normal: 97dash137 mL/min)
Creatinine clearance 75 mL/min (normal: 97dash137 mL/min) A low creatinine level raises concern about potential drug toxicity because it indicates a lack of kidney function and a decrease in the client's ability to excrete drugs. The hemoglobin is within normal (13.5dash18 g/dL) limits and is not a factor in the buildup of drugs in the body system. The white blood cell count is also within the normal range of 4,500dash10,000, and has no effect on drug toxicity. The brain natriuretic peptide (BNP) level (normal less than 100 pg/mL) may be elevated with a congestive heart failure diagnosis, but does not affect the potential for drugs to become toxic.
The nurse is evaluating quality, safe care. Which nursing practice predisposes the client to the greatest chance of injury? Crushing of an extended-release medication Inadequate flushing of a nasogastric (NG) tube after medication administration Clients with dysphagia receiving medication sprinkled over food or put in liquid Administering drugs by the intranasal route
Crushing of an extended-release medication Extended-release tablets have long durations with minimal dosing. Crushing these tablets or opening an extended-release capsule could be toxic to the client, leading to severe consequences. Clients who have difficulty swallowing may have tablets crushed and sprinkled over food or mixed with juice. Inadequate flushing could result in clogging of an NG tube, but does not predispose the client to the greatest amount of injury. A problem associated with the intranasal delivery system is irritation of the nasal mucosa, which can cause discomfort, but does not pose a great threat to the client.
pon physical examination, the health care provider suspects an infection of unknown etiology. As the nurse, you anticipate which laboratory and diagnostic tests will be ordered for Mr. Young? Select all that apply. Cultures of blood and other infected body fluids Serum iron level Activated partial thromboplastin time (APTT) Hematocrit White blood cell count with differential (WBC differential
Cultures of blood and other infected body fluids White blood cell count with differential (WBC differential WBC differential provides clues about the infecting organism and the body's immune response to it. Cultures indicate the type of pathogen present which may be the cause of the infection. Serum iron levels are usually not affected by infection. A partial thromboplastin time indicates coagulation status, not infection status. Hematocrit is a blood test that measures the percentage of the volume of whole blood that is made up of red blood cells, but will not provide information regarding infection status.
The nurse is caring for a pregnant client who has asthma. Which possible change would the nurse expect the health care provider to make to this client's treatment regimen? Discontinue the inhalant. Decrease the inhalant dose. Change the inhalant to a drug administered intravenously. Increase in the inhalant dose.
Decrease the inhalant dose. Blood flow to the lungs is increased due to progesterone. This increased blood flow can cause greater amounts of inhaled agents to be absorbed. Thus, the nurse would expect the health care provider to decrease the inhalant dose. The nurse would not expect the health care provider to discontinue the asthma medication completely, because that would increase the risk of an asthma attack. A change in route to IV would not be practical for the client, and some inhalants are not available in alternate dosage forms. More absorption occurs in pregnant clients, so the nurse would not expect the health care provider to increase the dosage.
he nurse is reviewing the difference between therapeutic and pharmacologic drug classifications. Which does the nurse identify as an example of a therapeutic classification? Select all that apply. Diuretic medications work to increase urinary output. Local anesthetics interfere with nerve transmission. Antihypertensive medications work to decrease the blood pressure. Anesthetic medications work to decrease or prevent pain. Calcium channel blockers block the calcium channels of the heart.
Diuretic medications work to increase urinary output. Antihypertensive medications work to decrease the blood pressure. Anesthetic medications work to decrease or prevent pain Therapeutic classifications are based on why a drug is given and how effective it is in treating a particular condition; for example, antihypertensive medications are prescribed to decrease blood pressure, diuretics are prescribed to increase urinary output, and anesthetics are given to decrease or prevent pain. Pharmacologic classification of a medication is based on the drug's mechanism of action; for example, the mechanism of action of calcium channel blockers is to block the calcium channels of the heart, and the mechanism of action of a local anesthetic is to interfere with nerve transmission.
The nurse is reviewing the client's chart for information obtained during an initial nursing interview. Which is the most important information for the nurse to report to the health care provider prescribing medications? Click the three Exhibit links below for additional information about the client. EXHIBIT Health History/Nurses' Vital Signs . Drug History . Health history Nurses' notes Vital signs Drug history
Drug History . Current and past drug history is essential information for the nurse to report to the health care provider who is writing orders. These drugs must be continued during hospitalization, or could be the cause of a problem the client is exhibiting. The information on the health history is relevant, but not essential for providing pharmacotherapy. The vital signs listed are within normal limits and are important as a baseline, but are not essential to pharmacotherapy. The nurses' notes shown are general and not essential to pharmacotherapy.
Alfred Young, a 22-year-old black male, works as a construction site helper. He is unmarried and lives alone. He has not been feeling well lately, and is barely able to get through the day without feeling extreme fatigue and a loss of appetite. Mr. Young doesn't make much money, and his employer doesn't provide health insurance. He can't remember the last time he saw a physician or a dentist. Whenever he is sick, he usually endures his illness without seeking medical attention, because he feels he cannot afford to see a health care provider or buy any medications that might be prescribed. Whenever Mr. Young knows someone receiving antibiotics, he will ask that individual if he can buy any leftover pills at a reduced price. For the last few months, Mr. Young has been experiencing mouth pain secondary to multiple caries. He has been self-medicating with over-the-counter pain medication. At times his jaw and mouth swell, and he experiences high fevers. During those episodes, he takes the variety of antibiotics that he has stockpiled. For Mr. Young, making an appointment to see the dentist was out of the question. He was struggling to pay his rent and health care was not a priority. Today, he arrives at the neighborhood clinic with fever, chills, and general malaise. His vital signs are: T 102.6degreesF, P 109 beats/min, R 28/min, and BP 116/72 mmHg. The right side of his jaw appears swollen, causing his face to be asymmetrical. Mr. Young is hopeful that he will be prescribed an inexpensive medication, and that he will be able to return to work quickly. You are the nurse who will be caring for Mr. Young. Mr. Young asks you, "What are the causes of antibiotic resistance?" Which factors will you include in your response? Select all that apply. Failure to identify and treat with narrow spectrum antibiotics Inappropriate use of antibiotic therapy Bacteria-producing enzymes that inactivate drugs Living in high altitude locations Prolonged use of antibiotic therapy
Failure to identify and treat with narrow spectrum antibiotics Inappropriate use of antibiotic therapy Bacteria-producing enzymes that inactivate drugs Prolonged use of antibiotic therapy Antibiotic-resistant microorganisms are increasing at an alarming rate primarily due to prolonged or inappropriate use of antibiotic therapy. Although antibiotic therapy is expected to eradicate all targeted microorganisms, sometimes a few bacteria survive, leading to bacteria that reproduce with antibiotic resistance already encoded into their genetic makeup. Other bacteria produce enzymes that inactivate drugs, change drug binding sites, or alter their cell membrane to prevent drug absorption. It is important for infectious agents to be identified and treated with effective antibiotics through culture and sensitivity. Living in high altitudes does not impact bacterial proliferation.
The nurse is reviewing therapeutic options for a client with a seizure disorder who just learned she is pregnant. Teratogenic drugs pose the greatest risk to the fetus during which phase of pregnancy? Second and third trimesters First and second trimesters First trimester Second trimester
First trimester The first trimester of pregnancy is a crucial time for embryonic development; structural malformations can occur if the fetus is exposed to teratogens during this period. Although teratogenic drugs are of concern for any time period during the pregnancy, the first trimester is the most dangerous period. The danger from teratogenic drug exposure is not quite as high during the second and third trimesters of pregnancy.
Mr. Young's family has come to visit him. His mother states that she wants to be certain not to contract any infection during the visit. As the nurse, which instructions should you provide the family members? Don't visit until Alfred's infection has completed been resolved. Follow the universal precautions that are posted in his room. Infection can only occur by drinking from the same container as the client. Family members are prescribed prophylactic antibiotics to avoid cross contamination.
Follow the universal precautions that are posted in his room. Use standard precautions to reduce the risk of transmission. Gloves, gowns, and masks are to be worn whenever there is a risk of skin or mucous membrane contamination by direct contact with infectious material, airborne spread of organisms, or droplet nuclei. Limiting visitors may deprive the client with a social support system in a time that is most needed. When visitors are taught proper precautions, it is unlikely that the infection will be transmitted to others. The risk of cross contamination is minimal and does not warrant prophylactic antibiotic therapy.
You continue your client education by explaining the normal course of strep throat and what should be expected during antibiotic use. What will you include as a part of client education? Encouraging Matthew's parents to continue the course of medication until Matthew has been symptom-free for 48 hours. Encouraging Mrs. Higgins to give Matthew his medication with a glass of milk. Giving full instructions regarding the medication and anticipated side effects and then asking both parents if they have any questions. Giving Mrs. Higgins a pamphlet on antibiotic administration and asking if she has any questions about giving the medication to Matthew.
Giving full instructions regarding the medication and anticipated side effects and then asking both parents if they have any questions. Client education is a critical nursing task. It must be accurate and delivered in a way the clients can understand, followed by an opportunity to ask questions. Medication education should include administration instructions, medication purpose, and anticipated side effects. Asking for questions without giving administration instructions directly to both parents can lead to improper drug administration. Penicillin should be given with a glass of water, not milk. Antibiotics should be given for their full prescribed course: for 10 days in Matthew's case. Stopping the medication early can cause the infection symptoms to return and be more difficult to treat.
The rapid strep test is negative, and you explain to Mr. and Mrs. Higgins that a longer test should be run to confirm whether or not Matthew has strep throat. You step outside the room to speak with the pediatric health care provider and tell her you strongly suspect that Matthew has a strep infection. She asks you to tell her which evidence gathered in your assessment leads you to suspect strep. You should describe which findings to explain your suspicions? Select all that apply. His temperature is 96.8degreesF. His cervical lymph nodes are non-palpable and non-tender. His throat has white patches. His throat hurts so badly he is crying. His tonsils are 3plus in size.
His throat has white patches. His throat hurts so badly he is crying. His tonsils are 3plus in size. White patches are often found on the throat during a strep infection. Swollen tonsils and severe pain can be caused by strep throat. Strep throat often leads to an elevation in temperature, not a decrease in temperature. Non-palpable and non-tender lymph nodes are normal findings and are not a sign of strep throat. Often cervical lymph nodes will be mildly swollen and tender when a client has strep throat.
A nurse is preparing to administer an oral medication for a client. Which of the following is the most appropriate nursing action when a client refuses to take a medication due to nausea? Crush the medication and mix it with applesauce for administration. Hold the medication and report the information to the health care provider. Give only half of the medication so that the client can better tolerate it. Complete an incident report since the medication cannot be administered.
Hold the medication and report the information to the health care provider. In the diagnostic phase of the nursing process, the nurse identifies any problems the client has in the administration of medications and reactions to the medication. The needs the client has will be based on the physiologic and psychosocial effects of nursing care.In this situation, the client has the right to refuse the medication. The nurse should hold the medication, attempt to relieve the nausea, and notify the health care provider to request a different medication order. The nurse should not adjust the dose of the medication without consulting with the health care provider and obtaining new orders. In addition, some medications should not be crushed.The nurse needs to document that the medication was not administered due to the client's condition (nausea). An incident report is not warranted in this case.
A client being evaluated for an infection informs the nurse that she is concerned about taking any medications because she is in the 18th week of pregnancy. Which physiologic changes must be considered when prescribing medications to this client? Decreased total body water Increased levels of hydrochloric acid in the stomach This is the correct answer. Accelerated gastric emptying Decreased blood flow to the kidneys
Increased levels of hydrochloric acid in the stomach Increased estrogen causes increased hydrochloric acid production and disrupts acid-labile drugs (such as penicillin). The inhibitory, not accelerated, effect of gastric emptying causes drugs to stay in the gastrointestinal tract longer. The body water of a pregnant client increases, not decreases, by 50%, resulting in greater amounts of drug in plasma and increased risk to the fetus. Increased, not decreased, blood flow to the kidneys leads to increased excretion of drugs.
The nurse, seeking the fastest and most consistent absorption, would administer drugs by which route to the infant client? Select all that apply. Intravenous (IV) Transdermal Subcutaneous Oral Intramuscular
Intravenous (IV) Transdermal Oral The oral and IV routes of drug administration offer fast, consistent absorption. Medication applied directly to the skin is absorbed quickly due to the infant's extremely thin skin. Due to minimal blood flow to skeletal muscles in infants, drugs administered subcutaneously or intramuscularly are absorbed slowly and inconsistently.
With rapid infusion intravenous fluids, Mr. Young becomes more alert, and his blood pressure returns to 120/82 mmHg. However, two days later he continues to spike a fever, and his white blood cell count remains elevated. The attending health care provider suspects that he has become resistant to the antibiotic therapy. Blood for culture and sensitivity, as well as mouth cultures, are sent to the laboratory. His health care provider discontinues the penicillin and prescribes cloxacillin (Cloxapen). You suspect the health care provider selected cloxacillin because: It is inexpensive and easier to administer via IV. It is helpful in treating recurrent infections. It produces fewer allergic and hypersensitivity reactions. It is effective against penicillinase-producing bacteria.
It is effective against penicillinase-producing bacteria. Cloxacillin (Cloxapen) is effective against penicillinase-producing bacteria, and is therefore a reasonable choice for a client exhibiting penicillin resistance. Although its ability to treat infections, its safety profile, and its cost and ease of administration are important considerations, the priority for Mr. Young at this time is to rid him of infection.
The nurse is reviewing the principles of learning drugs with a new colleague who is providing care on the medical-surgical unit. Which strategy is the best to use for learning medications? Learn each drug individually Learn only the generic names of each drug Learn only the brand names of each drug Learn the prototypical drugs
Learn the prototypical drugs Learning the prototype drug in a particular drug classification gives understanding of the indications for use and side/adverse effects of similar drugs in that classification. Thousands of drugs are prescribed, and it is nearly impossible to learn them all. A single drug may be marketed under both the generic drug name and several brand names.
The nurse is administering medications to older adult clients in a long-term care facility. Which does the nurse identify as a physiologic change affecting drug therapy? Select all that apply. Loss of skin tone and elasticity Less efficient blooddashbrain barrier Decreased gastric mobility Loss of muscle cells Increased amount of body fat
Less efficient blooddashbrain barrier Decreased gastric mobility Increased amount of body fat A decrease in gastric motility causes the drug to stay in the GI tract longer, increasing the risk for adverse effects. The increased amount of fat causes lipid-soluble drugs to remain in the tissues. The reduced efficiency of the blooddashbrain barrier allows more substances to affect the central nervous system. The loss of muscle cells, muscle atrophy, and loss of skin tone and elasticity all occur with age, but do not affect drug therapy or utilization.
While in the clinic, Mr. Young's condition deteriorates. He becomes somewhat lethargic, and his blood pressure abruptly drops to 90/50 mmHg. An ambulance is called, and he is admitted to a local hospital with a diagnosis of suspected dental sepsis. Upon admission, intravenous fluids are initiated, and Mr. Young is treated with IV penicillin. As the nurse caring for Mr. Young, you will be observing the patient for an allergic reaction to the penicillin. Which symptoms would indicate that such a reaction is occurring? Select all that apply. Local erythema Indigestion Shortness of breath Pruritus Urticaria
Local erythema Shortness of breath Pruritus Urticaria Cardinal signs of penicillin hypersensitivity include itching (pruritis), local erythema (redness), and urticaria (hives). Shortness of breath is indicative of severe allergic reaction leading to anaphylaxis. Indigestion is typically not a symptom associated with allergic reactions.
The nurse reviews the prescribed orders on a client admitted to the medical-surgical unit. Which order should the nurse question? D5LR intravenously (IV) 125 ml/hour Promethazine (Phenergan) 50 mg in 2 mL intramuscular (IM) every 6 hours as needed for nausea and vomiting Tuberculin skin test 0.1 ml by intradermal injection Meperidine (Demerol) 100 mg in 2 ml subcutaneously every 4 hours
Meperidine (Demerol) 100 mg in 2 ml subcutaneously every 4 hours Subcutaneous injections are reserved for small amounts of 0.5 to 1 mL. Therefore, the nurse should question the order for meperidine (Demerol) 100 mg in 2 mL subcutaneously every 4 hours. Intradermal amounts are also small: 0.2 mL or less. Up to 4 mL can be administered by the IM route, but it is highly recommended to limit the dose to 2dash3 mL. IV is the appropriate administration route for large-volume fluids.
A nurse is preparing to administer medications to a client. Which of the following medication orders would warrant a call from the nurse to the health care provider? Select all that apply. Morphine 4 mg IV for pain Guaifenesin syrup orally at bedtime Aspirin 81 mg once daily Heparin 5,000 units subcut bid Furosemide 40 mg orally now
Morphine 4 mg IV for pain Guaifenesin syrup orally at bedtime Aspirin 81 mg once daily Specific items included in the medication order are drug name, dose, route, and frequency of administration. The furosemide and heparin orders have all the components of a medication order. The aspirin order does not have a route. The morphine order does not have a frequency of administration. The guaifenesin syrup does not have a dose.
When the laboratory test results return, the health care provider says that Mr. Young's blood work reveals a "shift to the left." What does this reveal about Mr. Young's infection status? Mr. Young has an acute infection. The inflammation is localized on the left side of Mr. Young's body. He has a chronic respiratory infection. His infection is not likely to last long.
Mr. Young has an acute infection. Neutrophilia, increased numbers of circulating neutrophils, is a common response with infection or inflammation as the bone marrow responds to an increased need for phagocytes. A shift to the left, which is most common in acute infection, means there are more immature neutrophils in circulation than normal, indicating an appropriate bone marrow response. It does not mean that Mr. Young has a chronic infection, as a "shift to the left" indicates an acute infection. The acute infection could be anywhere in his body. The "shift to the left" only indicates that it is currently acute, and does not predict how long the infection will last.
Mr. Young has made a remarkable recovery in 48 hours following the initiation of the new antibiotics and is being prepared for discharge. Which instructions will you include in your discharge teaching? Select all that apply. Save any antibiotics you don't use in case they are needed later. Never use anyone else's prescription. Take the prescription at intervals around the clock as directed. Report loose, watery, and foul-smelling diarrhea; itching; fuzzy growth in mouth. Stop taking the prescribed antibiotics once the fever subsides.
Never use anyone else's prescription. Take the prescription at intervals around the clock as directed. Report loose, watery, and foul-smelling diarrhea; itching; fuzzy growth in mouth. Mr. Young should be instructed to take all the prescribed antibiotics even after symptoms disappear. Furthermore, he should be instructed to take the prescription at intervals around the clock as directed. Mr. Young has a history of taking medication that has not been prescribed for him which could be the cause of the development of the antibiotic resistance. You should stress the importance of not taking other people's medication. Loose, watery, foul-smelling diarrhea, itching, and fuzzy mouth growth are all typical signs seen with a superinfection. Saving antibiotics should be strongly discouraged since he needs the full dose to completely eradicate the infection.
The nurse is preparing to perform discharge teaching to a client being discharged after an appendectomy. Which factor should be considered for the timing of the teaching session? Client age Language barriers Cognitive level Pain level
Pain level If a client is in pain, it is not an optimal time to perform teaching, as the client focus would be on the pain. The age level of the client is important when the nurse develops the teaching plan and method, but is not associated with the timing of the teaching session. The cognitive level should be considered when formulating the plan of what and how to teach, but is not associated with timing of the teaching. Any language barriers should be identified and addressed prior to teaching, but these do not affect the timing of the teaching.
The nurse is preparing a teaching plan to increase a client's compliance with his prescribed drug regimen. Which should be included in the plan? Perform an assessment on foods or herbal products that interfere with the prescribed medication. Instruct the client to take two doses of the medication if symptoms worsen. Allow the client to change the regimen to meet his needs. Instruct the client that his role does little to influence the effectiveness of the medication.
Perform an assessment on foods or herbal products that interfere with the prescribed medication. Any foods or herbal products that can interfere with the medication could possibly reduce or change the effects of the drugs given and decrease adherence to the regimen. The medication regimen is prescribed to produce the desired effect, and should not be altered from the original plan. The client should not be instructed to increase the dosage. This could cause toxic results and is not within the nursing role. The client shares responsibility in ensuring the effectiveness of his medication and his own safety.
The nurse is performing an admission assessment on a client with several newly prescribed medications. Which information is most important to communicate to the health care provider? Blood pressure reading of 128/70 mmHg Client's occupation as a furniture mover Breast biopsy 3 weeks prior to admission Presence of renal damage
Presence of renal damage Clients who have kidney disease are more at risk for complications of drug therapy. Drug dosages may have to be changed for a client with kidney damage or disease, so it is important to notify the health care provider of this issue. Neither lifting heavy furniture nor a breast biopsy procedure has any effect on medication prescription. A blood pressure reading of 128/70 mmHg is within normal limits and has no effect on medication orders.
The nurse is preparing to administer medications to a group of adult clients. What must the nurse consider when planning to administer the medications? Select all that apply. Proper route of administration for each drug Expected client response to the taste of each drug Need to hold other drugs or foods before or after administration Time of day each drug should be administered Compatibility of each drug with others to be administered
Proper route of administration for each drug Need to hold other drugs or foods before or after administration Time of day each drug should be administered Compatibility of each drug with others to be administered The nurse must consider the time each drug is to be administered, which may be ordered by the health care provider or regulated by facility policy. The nurse must assess all drugs to be given to ensure that each drug is compatible; the nurse must also check to be certain that one drug does not decrease or increase the effect of another drug. Some drugs may have to be held for a certain time period before another medication is given. Drugs also may have to be given with or without food for the best effect. The nurse should administer drugs by the ordered route. Any need for changes must be discussed with the prescribing health care provider and/or pharmacy. It is not necessary for the nurse to consider how the drug tastes before administering the drug.
A health care provider has ordered a client to receive dexamethasone sodium phosphate (Decadron) 2 mg IV push stat for treatment of cerebral edema. The available vial label reads: 4 mg/mL. Using the formula method, the nurse would prepare nothing mL of the medication. Please limit your answer to a numeral. Record your answer to one decimal place.
Rationale Formula Method: H = 4 mg, V = 1 mL, D = 2 mg. (D / H) x V = X (2 mg/4 mg) x 1 mL = 0.5 mL
The health care provider orders aluminum/magnesium antacid liquid 150 mg to be administered by mouth. The medication from the client's supply is 100 mg per 10 mL. The nurse would administer nothing ounce(s). Please limit your answer to a numeral. Record your answer to one decimal place.
Rationale The first action should be to determine the dose to be given in mL: Formula method: H = 100 mg, V = 10 mL, D = 150 mg (D / H) x V = X (150 mg/100 mg) x 10 mL = 15 mL Convert 15 mL to ounces using the fractional method: 1 oz = 30 mL 1 oz = X mL 30 mL 15 mL (30 mL)(X mL) = 15 mL X = (15 mL) / (30 mL) X = 0.5
The nurse at a clinic has been asked to review complementary and alternative medicine (CAM) therapies to incorporate into client care. Which is considered CAM? Select all that apply. Aromatherapy Meditation practices Massage Aerobic exercise Yoga
Select all that apply. Aromatherapy Meditation practices Massage Yoga Yoga and meditation both reduce stress and are both considered complementary and alternative medicine (CAM). Massage is a therapeutic alternative to medication. Aromatherapy, which uses the sense of smell for treatment effects, is considered CAM. Aerobic exercise is part of a healthy lifestyle program, but is not considered CAM.
You introduce yourself to Matthew and his parents and begin to assess him. Which steps should you take as part of your assessment? Select all that apply. Take Matthew's temperature. Ask the parents to leave the room prior to the examination. Ask Matthew to cough strongly. View Matthew's throat. Palpate Matthew's cervical lymph nodes
Take Matthew's temperature. View Matthew's throat. Palpate Matthew's cervical lymph nodes You should take Matthew's temperature as it can aid diagnosis. You should view his throat to look for redness, swelling, and exudate. You should palpate his cervical lymph nodes to determine if they are swollen or tender. Matthew's throat is very sore; asking him to cough is unnecessary and may be painful. The parents should be allowed to remain in the room to provide support and comfort to Matthew.
A client has been taking phenytoin (Dilantin) for several days. The health care provider is concerned that the amount of the drug circulating in the blood may not be appropriate to achieve the desired response. Which term best correlates with what the health care provider is describing? Maintenance dose Plasma half-life Therapeutic range Minimum concentration
Therapeutic range The therapeutic range is the concentration of the drug needed to produce a therapeutic response. Plasma half-life is the term for how long it takes for the plasma concentration of a drug to decrease by half. Maintenance dose is a dosage administered to keep a preferred plasma drug concentration in the blood. Minimum effective concentration refers to the time it takes for an accumulated concentration of the drug to become minimally effective.
The nurse is reviewing the medical records for an older adult woman who has just been admitted to the long-term care facility. Which of the client's over-the-counter medications should be classified as herbal supplements? Select all that apply. Valerian root St. John's wort Ginkgo biloba Feverfew Glucosamine
Valerian root St. John's wort Ginkgo biloba Feverfew, ginkgo, St. John's wort, and valerian are all herbal drugs. Glucosamine is classified as a nonherbal dietary supplement.
The nurse is reviewing the drugs taken by clients at an extended care facility for combination risks between herbal drugs and prescription medications. Clients taking which drug should have their histories reviewed first? Diphenhydramine (Benadryl) Cephalexin (Keflex) Ibuprofen (Advil) Warfarin (Coumadin
Warfarin (Coumadin The possibility of potential adverse effects is increased when taking warfarin (Coumadin), antineoplastic drugs, antiepileptic drugs, insulin, or digoxin (Lanoxin) concurrently with herbal drugs. It is not as common for ibuprofen (Advil), antibiotics such as cephalexin (Keflex), or antihistamines such as diphenhydramine (Benadryl) to cause adverse effects when used in combination with herbal drugs.
The pediatric nurse is studying pharmacokinetics of drugs in children. Which factors are recognized as increasing drug toxicity in children? Select all that apply. Weak acids in the gastrointestinal (GI) tract Highly developed blooddashbrain barrier in the newborn Low water relative to body weight in the newborn Prolonged half-life Immature kidney function in the child
Weak acids in the gastrointestinal (GI) tract Prolonged half-life Immature kidney function in the child The prolonged half-life is due to immature liver enzymes. Toxicity can result when the drug remains in the system longer. The child's immature kidney function may result in excessive accumulation of the drug in the child's system. The low acids may increase the absorption of acid-labile drugs and result in toxicity. The newborn's weight is mostly (80%) water, so some water-soluble drugs may be diluted, leading to decreased amounts of the drug and reduced therapeutic action. The neonate's blood
Matthew's test results come back two days after his visit, confirming a diagnosis of group A beta-hemolytic Streptococcus, or strep throat. You are asked to call Mrs. Higgins to inform her of the results and determine how Matthew is progressing. She reports that Matthew's throat is less sore and his temperature has returned to normal. He has just returned to school. Mrs. Higgins states that Matthew has complained of mild nausea and had an episode of mild diarrhea this morning. Which statement should you make to educate Mrs. Higgins? "Nausea and diarrhea are common side effects of penicillin." "Matthew must have a gastrointestinal virus in addition to strep throat." "You should withhold all food for 24 hours, giving him liquids only." "You should stop Matthew's penicillin immediately."
"Nausea and diarrhea are common side effects of penicillin." Nausea, vomiting, and diarrhea are common side effects of penicillin and, when mild, do not usually warrant an immediate cessation of treatment. The reported symptoms do not necessarily indicate a gastrointestinal virus. Food should not be withheld for 24 hours in a case of mild nausea along with one episode of diarrhea. You should instruct Mrs. Higgins to report any further changes in Matthew's condition to the pediatric health care provider
The pediatric health care provider examines Matthew and also strongly suspects strep throat. Matthew has no allergies, and the provider prescribes a 10-day supply of penicillin. When you give Matthew's mother the prescription, she says, "Penicillin! I thought doctors didn't give that anymore." Which is the best response for you to give? "She was trying to avoid giving Matthew a shot." "She wants to see if the penicillin will work. If Matthew doesn't get better in ten days, she will prescribe something else." "Penicillin is effective in killing the type of strep bacteria that commonly causes strep throat." "She prescribed penicillin because it is an inexpensive antibiotic."
"Penicillin is effective in killing the type of strep bacteria that commonly causes strep throat." Penicillin is commonly prescribed in suspected strep throat due to its effectiveness at killing the strep bacteria responsible for the infection. This is the main reason for prescribing it. While oral penicillin does help Matthew avoid a shot, and may be low in cost compared to some antibiotics, these are not the primary reasons for prescribing it. If penicillin doesn't reduce and eventually eliminate the symptoms, it will likely be discontinued before 10 days so that a more effective antibiotic can be given.
Mr. Young asks, "How will you be able to tell what type of infection I have?" Which is your best response? "Various antibiotics will be prescribed to see which ones best eliminates the symptoms." "A series of x-rays will reveal the source of infection." "The cultures we took will allow us to determine the kind of bacteria that is causing the infection." "Hourly vital signs will allow us to determine the severity and cause of the infection."
"The cultures we took will allow us to determine the kind of bacteria that is causing the infection." Cultures of the wound, blood, or other infected body fluids are used to identify probable microorganisms by their characteristics, such as shape, and growth patterns. X-rays typically do not indicate the type of bacteria causing an infection. Vital signs may reflect the severity of an infection, but they do not confirm the type of bacteria causing an infection. Because antibiotics can alter the ability to culture an organism, specimens should be obtained before instituting therapy.
The nurse is performing discharge teaching for an older adult client with arteriosclerotic heart disease (ASD), hyperlipidemia, and type 2 diabetes mellitus. The client asks the nurse, "Why do I have to take fish oil?" Which is the nurse's most appropriate response? "Fish oil has been shown to prevent the common cold." "The use of fish oil can control your blood sugar." "The fish oil is prescribed for arthritis." "The fish oil can be used to decrease your cholesterol level."
"The fish oil can be used to decrease your cholesterol level." Fish oil is used for cholesterol reduction and can be helpful in clients with arteriosclerotic heart disease (ASD). Fish oil also may improve brain function and enhance vision. Fish oil is not utilized for hyperglycemia (chromium is used for blood sugar control), arthritis (glucosamine is prescribed for arthritic conditions), or prevention of colds (vitamin C is taken to boost immunity and prevent common colds).
Before you hang up the phone, Mrs. Higgins tells you that Matthew's 4-year-old sister has developed a fever of 101.4degrees F and a headache. Knowing that strep throat is contagious, you make what recommendation to Mrs. Higgins? "She should get better when Matthew does." "You should give her a few doses of his penicillin." "You should bring her in for an examination." "Her symptoms are different, so it is unlikely she has strep throat."
"You should bring her in for an examination." Matthew's sister should be brought in for an examination, because it is likely she has also become infected with strep. She will not automatically get better when Matthew does; she may need antibiotic treatment. One client should not be given the medication of another client. Even though her symptoms are different, they are consistent with strep throat. An examination and testing can reveal if she has strep throat or another illness that requires treatment.
