Medications RN must know (Pharmacological/Parenteral Therapies)

A client in a detoxification unit has an alcohol withdrawal seizure. Diazepam 7.5 mg intramuscularly stat is prescribed. Diazepam is available as 5 mg/mL. How many milliliters will the nurse administer? Record your answer using one decimal place. ___ mL Solve for x with the "Desire over Have" formula of ratio and proportion.

1.5

A client is diagnosed with Parkinson disease and receives a prescription for levodopa therapy. What does the nurse identify as the drug's mechanism of action? 1. Blocks the effects of acetylcholine 2. Increases the production of dopamine 3. Restores the dopamine levels in the brain 4. Promotes the production of acetylcholine

Levodopa is a precursor of dopamine, a catecholamine neurotransmitter; it increases dopamine levels in the brain that are depleted in Parkinson disease. Blocking the effects of acetylcholine is accomplished by anticholinergic drugs. Increasing the production of dopamine is ineffective because it is believed that the cells that produce dopamine have degenerated in Parkinson disease. Levodopa does not affect acetylcholine production.

A 3-year-old child is to receive a liquid iron preparation. What will the nurse teach the mother regarding this medication? 1. Monitor the stools for diarrhea. 2. Administer with meals to improve absorption. 3. Avoid giving the child orange juice with the iron preparation. 4. Have the child drink the diluted iron preparation through a straw.

> A liquid iron preparation may stain tooth enamel; therefore it should be diluted and administered through a straw. > Constipation, rather than loose stools, often results from the administration of iron. > Iron absorption is improved when taken on an empty stomach. The exception is acidic foods, such as citrus juices, which improve absorption.

What would be the drug of choice in an adolescent who is diagnosed with syphilis during the first trimester of pregnancy? 1. Penicillin G 2. Doxycycline 3. Tetracycline 4. Erythromycin

> Penicillin G is safe to use during all stages of pregnancy. > Doxycycline and tetracycline are contraindicated during pregnancy due to their teratogenic effects. > Erythromycin is unlikely to be prescribed for syphilis.

A 67-year-old client has tested positive for influenza A. The client also has asthma. Which drug would the nurse recommend be avoided in this client? 1. Ribavirin 2. Zanamivir 3. Oseltamivir 4. Amantadine

> Zanamivir is used with caution in clients who have asthma or chronic obstructive pulmonary disease (COPD) and in older adults. > Ribavirin is used for the treatment of severe influenza B. > Oseltamivir may be used in treating both influenza A and B. > Amantadine may be used for the treatment of influenza A.

A healthcare provider prescribes disulfiram for a client who abuses alcohol. The nurse teaches the client that disulfiram will have which action? 1. Affect short-term memory 2. Permit a healthier lifestyle 3. Allow the client to tolerate small amounts of alcohol 4. Cause a severe adverse reaction if alcohol is consumed

Disulfiram is an aversion therapy; a person who consumes alcohol while taking disulfiram will experience a severe reaction consisting of nausea, vomiting, hypotension, headache, tachycardia, tachypnea, and flushing. The drug does not affect short-term memory. Use of disulfiram may or may not foster a healthier lifestyle, and if it does occur, this is the result of multiple factors, not just disulfiram therapy. When taking disulfiram the client cannot tolerate any alcohol.

A client is to take an antipsychotic drug twice a day. Two-thirds of the daily dose is given in the evening and one-third in the morning. What will the nurse tell the client is the rationale for this schedule? 1. To facilitate dreaming 2. To maintain the daily sleep rhythm 3. To reduce sedation during the daytime 4. To decrease assaultiveness in the evening

> Antipsychotic drugs tend to make the client listless or drowsy and can interfere with the ability to participate in the therapeutic regimen. > Antipsychotic drugs do not induce rapid eye movement sleep, which is when most dreams occur. > Antipsychotic drugs do not appreciably affect diurnal rhythms. > Assaultiveness is associated with increased anxiety and is unrelated to the time of day.

The nurse is evaluating a client who received intravenous morphine. Which life-threatening response indicates the need to notify the healthcare provider? 1. Nausea 2. Headache 3. Drowsiness 4. Bradycardia

> Because morphine is a central nervous system depressant, it may cause bradycardia, shock, and cardiac arrest. > Although headache, drowsiness, and nausea may be a response to morphine, they are not life threatening.

An adolescent who has been prescribed prednisone and vincristine for leukemia tells the nurse that he is very constipated. What should the nurse cite as the probable cause of the constipation? 1. It is a side effect of the vincristine. 2. The spleen is compressing the bowel. 3. It is a toxic effect from the prednisone. 4. The leukemic mass is obstructing the bowel.

> Constipation is a side effect of vincristine because it slows gastrointestinal motility. > An enlarged spleen will put pressure on the stomach and diaphragm, not on the large bowel. > Constipation is not a toxic effect of prednisone. > It is unlikely that leukemia is causing an obstruction.

A client is undergoing diagnostic testing to determine if the client has myasthenia gravis. The nurse understands that the test that is most specific for determining the presence of this disease is what? 1. Electromyography 2. Pyridostigmine test 3. History of physical deterioration 4. Edrophonium chloride test

> Edrophonium chloride test uses a drug that is a cholinergic and an anticholinesterase; it blocks the action of cholinesterase at the myoneural junction and inhibits the destruction of acetylcholine. Its action of increasing muscle strength is immediate for a short time. > The results of an electromyography will be added to the database, but they are nonspecific. > Pyridostigmine is a slower-acting anticholinesterase drug that is prescribed commonly to treat myasthenia gravis; > edrophonium chloride is used instead of pyridostigmine to diagnose myasthenia gravis because, when injected intravenously, it immediately increases muscle strength for a short time. > The results of a history and physical are added to the database, but the data collected are not as definitive as another specific test for the diagnosis of myasthenia gravis.

A nurse is teaching a 10-year-old child with type 1 diabetes about insulin requirements. When does the nurse explain that insulin needs will decrease? 1. When puberty is reached 2. When infection is present 3. When emotional stress occurs 4. When active exercise is performed

> Exercise reduces the body's need for insulin. Increased muscle activity accelerates transport of glucose into muscle cells, thus producing an insulinlike effect. > With increased growth and associated dietary intake, the need for insulin increases during puberty. > An infectious process may require increased insulin. > Emotional stress increases the need for insulin.

A 55-year-old client who has a long history of drug and alcohol abuse mentions taking ginkgo biloba. The nurse knows that ginkgo biloba is taken to treat what condition? 1. Insomnia 2. Depression 3. Memory impairment 4. Anxiety and nervousness

> Ginkgo biloba is an herb used to treat age-related memory impairment and dementia. > It has not been shown to be effective in treating insomnia, depression, or anxiety.

A 30-year-old who began lithium carbonate therapy 3 weeks ago is having blood drawn for a lithium drug level. Which range will the nurse recognize as therapeutic? 1). 0.1 to 0.3 mEq/L (0.1 to 0.3 mmol/L) 2). 0.4 to 1.3 mEq/L (0.4 to 1.3 mmol/L) 3). 1.5 to 1.9 mEq/L (1.5 to 1.9 mmol/L) 4). 2.0 to 2.3 mEq/L (2.0 to 2.3 mmol/L)

> Lithium levels of 0.4 to 1.3 mEq/L (0.4 to 1.3 mmol/L) are therapeutic and effective in treating symptoms of mania. > A level below 0.3 mEq/L (0.3 mmol/L) is too low to be therapeutic. > At levels above 1.5 mEq/L (1.5 mmol/L), early signs of toxicity may occur; > at levels of 2.0 mEq/L (2.0 mmol/L) and higher, severe lithium toxicity may occur, constituting a life-threatening emergency.

Which substance abuse involves injection of the drug to produce intense excitement, energy, boldness, and paranoia similar to that produced by cocaine? 1. Freons 2. Methamphetamine 3. Model airplane cement 4. Lysergic acid diethylamide

> Methamphetamine is an inexpensive, easily available drug commonly known as crank, meth, and crystal. Upon injection or swallowing, it causes intense excitement, energy, boldness, and paranoia when compared to cocaine. > Freon is a substance found in canned air dusters, which on inhalation could cause fatal cardiac dysrhythmias. > Model airplane cement is a volatile substance that upon inhalation causes altered sensation. > Lysergic acid diethylamide is a drug that can produce hallucinations and euphoria.

A client visits a primary healthcare provider because of painful urination. The primary healthcare provider confirms that the client has candidiasis. Which medications would be prescribed? Select all that apply. 1. Tinidazole 2. Miconazole 3. Clotrimazole 4. Azithromycin 5. Metronidazole

> Miconazole and clotrimazole are used to treat candidiasis (Yeast fungus). > Tinidazole is used to treat trichomoniasis. > Azithromycin is used to treat chlamydia. > Metronidazole is used to treat bacterial vaginosis.

Which hypothalamic hormone helps to treat postpartum uterine atony and hemorrhage? 1. Oxytocin 2. Indomethacin 3. Dinoprostone 4. Methylergonovine

> Oxytocin is a hypothalamic secretory hormone that helps to treat postpartum uterine atony and hemorrhage. > Indomethacin helps to maintain pregnancy in preterm labor. > Dinoprostone causes ripening of the cervix during labor. > Methylergonovine is an ergot alkaloid that helps to maintain postpartum uterine atony and hemorrhage.

(A 2-year-old toddler is to have intravenous (IV) antibiotic therapy. What will the nurse plan to do to prevent the child from pulling out the IV line?) 1. Keep the arms restrained. 2. Tell the child not to touch the IV site. 3. Cover the IV site with a protective device. 4. Have the parent hold the child continuously.

> Restraints are a last resort; they cause more anxiety and agitation as the child attempts to get free. > Verbal instructions are not sufficient for a 2-year-old child. > Securing the IV site and putting protection around it decreases the likelihood that the IV line will be pulled out. > Although the family should be involved in care, the staff, not the family, is responsible for preventing the child from pulling out the IV line.

A client who is going to be discharged has been receiving 3 mg of risperidone three times a day. What will the nurse teach the client about the medication? 1. May be reduced if the client feels better at home 2. May be discontinued after the client is discharged 3. May cause sedation if taken concurrently with alcohol 4. Should be taken early in the day to be sure that it is not forgotten

> Risperidone potentiates the action of alcohol and can cause oversedation if the drug and alcohol are taken together. > This medication should be taken consistently to prevent recurrence of symptoms and maintain a therapeutic blood drug level. > Medications should be taken as prescribed; taking them all at one time may interrupt the maintenance of a constant therapeutic blood level.

When preparing discharge teaching for a client who had a kidney transplant, in addition to a corticosteroid, the nurse expects what other medications to be prescribed to prevent kidney rejection? 1. Furosemide and sirolimus 2. Cefazolin and methotrexate 3. Methylprednisolone and phenytoin 4. Tacrolimus and mycophenolate mofetil

> Standard triple therapy includes a corticosteroid prednisone (methylprednisolone), an antimetabolite (mycophenolate), and a calcineurin inhibitor (tacrolimus and cyclosporine). > Although sirolimus is used for immunosuppression, furosemide is a diuretic. Neither of these medications are immunosupressives. > Cefazolin is an antibiotic, and methotrexate is a folic acid antagonist used in cancer chemotherapy. > Although methylprednisolone is used for immunosuppression, phenytoin is an antiseizure medication.

A client with a diagnosis of anemia is receiving packed red blood cells. What is the most important action by the nurse when administering the transfusion? 1. Warning the client about the possibility of fluid overload 2. Monitoring the client's response, particularly within the first 10 minutes 3. Adjusting the client's transfusion flow rate so that it infuses at a consistent rate during the procedure 4. Having the client tested for human immunodeficiency virus (HIV) before administering the blood transfusion

> Transfusion reactions usually occur early during the administration of a blood transfusion (first 30 mL of blood); early detection of a transfusion reaction will permit a quick termination of the infusion. > The risk of fluid overload is unlikely, and this information can be frightening. > The donor's, not the recipient's, blood is tested for HIV. > The flow rate should be slower during the first 10 to 15 minutes of the infusion to limit the amount of blood infused; this allows time to assess the client's response for signs and symptoms of a transfusion reaction before too much of the blood is infused.

A client who is obtunded has a blood pressure of 80/35 mm Hg after a blood transfusion. In an effort to support renal perfusion, the nurse administers dopamine at 2 mcg/kg/min as prescribed. What is the most relevant outcome indicating effectiveness of the medication for this client? 1. A decrease in blood pressure 2. An increase in urinary output 3. A decrease in core temperature 4. An increase in level of consciousness

As renal perfusion increases, urinary output also should increase; doses greater than 10 mcg/kg/min can cause renal vasoconstriction and decreased urinary output. A change in blood pressure is not a direct predictor of the effectiveness of dopamine given at a level of 2 mcg/kg/min; at 10 mcg/kg/min a client will experience an increased cardiac output and an increased blood pressure. Body temperature does not indicate improved renal perfusion. In this situation, improvement of renal perfusion is not directly related to the client's level of consciousness.

The nurse is caring for a client whose labor is to be induced. What is the nurse's responsibility when a client's labor is being stimulated with an oxytocin infusion? 1. Flushing the intravenous (IV) tubing if the flow slows 2. Checking the fetal heart rate every 2 hours 3. Stopping the infusion if contractions become hypertonic 4. Decreasing the infusion rate if hypertonic contractions continue for 15 minutes

Hypertonic contractions of the uterus, if allowed to continue, can lead to nonreassuring fetal signs and uterine rupture; therefore the infusion should be discontinued to stop the hypertonic contractions. A delay of 15 minutes can lead to uterine rupture. The IV should be monitored with an automatic pump to ensure a regulated and continuous flow. The fetal heart rate should be assessed and documented more frequently (continuously or every 15 min) when oxytocin is infusing.

(A nurse is caring for a 3-month-old infant with severe diarrhea following antibiotic therapy. After the effects of dehydration are stabilized, the healthcare provider prescribes Lactobacillus granules. What explanation does the nurse give to the infant's parents about the reason for giving lactobacilli?) 1. They diminish the inflammatory mucosal edema. 2. The discomfort caused by gastric hyperacidity is lessened. 3. They relieve the pain caused by gas in the gastrointestinal tract. 4. The flora that inhabit a healthy gastrointestinal tract must be recolonized.

Lactobacilli are part of the flora in the healthy gastrointestinal tract. The purpose of administering lactobacilli granules is to help recolonize the normal gastrointestinal flora that were destroyed with antibiotic therapy. The other options are not the actions of lactobacilli granules.

An intravenous (IV) antibiotic is prescribed for a child with fever of unknown origin. Within 10 minutes of the antibiotic infusion, the child's face and neck are flushed but the remainder of the body is unchanged. The nurse checks the child's record. In light of this information, what will the nurse do? 1. Administer acetaminophen. 2. Place the child on protective isolation. 3. Increase the rate of the vancomycin infusion. 4. Notify the primary healthcare provider after stopping the infusion.

The child is exhibiting a common vancomycin reaction called red man syndrome or red neck syndrome. Flushing usually begins in the chest area and spreads upward to the neck and face, usually during the first 15 minutes of administration. This reaction is caused by a release of histamine, which results in vasodilation. If not treated, the syndrome can lead to circulatory collapse. The appropriate response is to stop the infusion and notify the primary healthcare provider. The provider will usually prescribe diphenhydramine hydrochloride (Benadryl) and then resume the vancomycin infusion. Diphenhydramine will be administered before each vancomycin dose, and the infusion will be set at a slower rate. Normal temperature is 98.6° F (37° C). It is not necessary to administer acetaminophen for a temperature below 100.4° F (38° C). The child's laboratory results indicate a bacterial infection. Protective (or reverse) isolation is not necessary. Increasing the vancomycin infusion rate will exacerbate the reaction and lead to circulatory collapse.