Medical-Surgical Drugs

A client who is receiving multiple meditations for a myocardial infarction complains of severe nausea, and the clients heartbeat is irregular and slow. The nurse determines that these signs and symptoms are toxic effects of what drug? 1. Digoxin 2. Captopril 3. Furosemide 4. Morphine Sulfate

1. Digoxin Rationale: Signs of digoxin toxicity include cardiac dysrhythmias, anorexia, nausea, vomiting, and visual disturbances. Although nausea and heart block may occur with captopril, these symptoms rarely are seen; drowsiness and central nervous system disturbances are more common. Toxic effects of morphine are slow, deep respirations, stupor, and constricted pupils; nausea is a side effect, not a toxic effect. Toxic effects of furosemide are renal failure, blood dyscrasias, and loss of hearing.

A client is admitted to the hospital for an adrenalectomy. The nurse is providing postoperative care before the client's replacement steroid therapy is regulated fully. The nurse should monitor the client for which complication? 1. Hypotension 2. Hypokalemia 3. Hypernatremia 4. Hyperglycemia

1. Hypotension Rationale: Because of instability of the vascular system and the lability of circulating adrenal hormones after an adrenalectomy, hypotension frequently occurs until the hormonal level is controlled by replacement therapy. Hyperglycemia is a sign of excessive adrenal hormones; after an adrenalectomy, adrenal hormones are not secreted. Sodium retention is a sign of hyperadrenalism; it does not occur after the adrenals are removed. Potassium excretion is a response to excessive adrenal hormones; after an adrenalectomy, adrenal hormones are decreased until replacement therapy is regulated.

What should the nurse teach a client who is taking warfarin? 1. Report episodes of spontaneous bleeding. 2. Increase the dose wit prolonged inactivity. 3. Take antibiotics, if injured, to prevent infection. 4. Eat a diet with increased quantity of green vegetables.

1. Report episodes of spontaneous bleeding. Rationale: Warfarin is an anticoagulant; therefore, excessive bleeding, especially that which occurs spontaneously and unrelated to injury, may require a dosage adjustment for safety reasons. Activity or inactivity is unrelated to the need to alter the dose of warfarin. The dose should not be altered without healthcare supervision. The problem of bleeding is more significant than infection when a client is taking warfarin. Green vegetables that contain vitamin K, which is necessary for the synthesis of clotting factors VII, IX, and X, should be kept consistent in the diet from week to week; increased consumption will decrease the action of warfarin, and a decreased consumption will increase the action of warfarin.

A healthcare provider prescribes an antibiotic intravenous piggyback twice a day for a client with an infection. The healthcare provider prescribes peak and trough levels 48 and 72 hours after initiation of the therapy. The client asks the nurse why there is a need for so many blood tests. What reason does the nurse provide? 1. They determine adequate dosage levels of the drug. 2. They detect if you are having an allergic reaction to the drug. 3. The tests permit blood culture specimens to be obtained when the drug is at its lowest level. 4. These allow comparison of your fever to when the blood level of the antibiotic is at its highest.

1. They determine adequate dosage levels of the drug. Rationale: Drug dose and frequency are adjusted according to peak and trough levels to enhance efficacy by maintaining therapeutic levels. Peak and trough levels reveal nothing about allergic reactions. Blood cultures are obtained when the client spikes a temperature; they are not related to peak and trough levels of an antibiotic. A sustained decrease in fever is the desired outcome, not reduction just at peak serum levels of the medication.

A client with a stage IV pressure ulcer is to receive 0.22 g of zinc sulfate by mouth. Each tablet contains 110 mg. How many tablets should the nurse administer? Record your answer using a whole number. _____ tablets

2 tablets Rationale: The prescribed dose is 0.22 g. The available medication is 110 mg/tablet. First, convert the prescribed dose in grams to the available medication in milligrams. Then, use the dimensional analysis and ratio and proportion methods to determine the appropriate number of tablets to be administered.

A client is rescued from a house fire and arrives at the emergency department 1 hour after the rescue. The client weighs 132 pounds (60 kilograms) and is burned over 35% of the body. The nurse expects that the amount of lactated Ringer solution that will be prescribed to be infused in the next 8 hours is what? 1. 2100 mL 2. 4200 mL 3. 6300 mL 4. 8400 mL

2. 4200 mL Rationale: In the first 8 hours 4200 mL should be infused. According to the Parkland (Baxter) formula, one half of the total daily amount of fluid should be administered in the first 8 hours. Because the client weighs 60 kg (132 pounds ÷ 2.2 kg = 60 kg), the calculation is 60 kg × 4 mL/kg × 35% burns = 8400 mL per day; half of this amount should be infused within the first 8 hours. 2100 mL, 6300 mL, and 8400 mL are incorrect calculations.

What should a nurse teach the client to do to avoid lipodystrophy when self-administering insulin therapy? 1. Exercise regularly. 2. Rotate injection sites. 3. Use the Z-track technique. 4. Avoid massaging the injection site.

2. Rotate injection sites Rationale: Fibrous scar tissue can result from the trauma of repeated injections at the same site. Exercise is unrelated to lipodystrophy, but it reduces blood glucose, which decreases insulin requirements. Insulin is given subcutaneously; the Z-track technique is used with some intramuscular injections. Gentle pressure over the injection site after insulin administration promotes absorption.

The healthcare provider prescribes 1 liter of intravenous (IV) fluid to infuse over 4 hours for a client admitted for a urinary tract infection and hyponatremia. The tubing drop factor is 10 drops/mL. At what rate will the nurse infuse the medications? 1. 20 drops/minute 2. 34 drops/minute 3. 42 drops/minute 4. 60 drops/minute

3. 42 drops/minute

An insulin pump is instituted for a client with type 1 diabetes. The nurse plans discharge instructions. Which short-term goal is the priority for this client? 1. "Adhere to the medical regimen." 2. "Remain normoglycemic for 3 weeks." 3. "Demonstrate correct use of the insulin pump." 4. "List three self-care activities that help control the diabetes."

3. Demonstrate correct use of the insulin pump Rationale: Demonstrating correct use of the insulin pump is the short-term, client-oriented goal necessary for the client to manage the pump and avoid hypo- and hyperglycemia; this outcome can be measured by observing a return demonstration by the client. Adhering to the medical regimen is not a short-term goal. Remaining normoglycemic for 3 weeks is measurable but requires the client to manage the insulin pump. Although listing three self-care activities that help control the diabetes is a measurable short-term goal, it is not the priority when the client must master use of the insulin pump.

A client with diabetes who is receiving long-term corticosteroid therapy is admitted to the hospital with leg ulcers. What increased risk does the nurse consider when assessing this client? 1. Weight loss 2. Hypoglycemia 3. Decreased blood pressure 4. Inadequate wound healing

4. Inadequate wound healing Rationale: Because the antiinflammatory response is depressed as a result of increased cortisol levels, the wounds of clients receiving long-term corticosteroid therapy tend to heal slowly. A common finding associated with long-term corticosteroid use is weight gain, caused not only by fluid retention but also by alterations in fat, carbohydrate, and protein metabolism. Persistent hyperglycemia (steroid diabetes) occurs because of altered glucose metabolism. Hypertension, not hypotension, occurs as a result of sodium and fluid retention.