Module 8-Pharmacology and IV Therapies

PRBCs have been prescribed for a client with low hgb and hct values. The nurse takes the client's temp orally before hanging the blood transfusion and notes that it is 100.0 F (37.7 C). what should the nurse do next

call the HCP

A client has a rx for a unit of PRBCs. Which IV solution should the nurse obtain to hang with the blood product at the client's bedside

0.9% NS

A nurse has just received a rx to transfuse a unit of PRBCs for an assigned client. For how long doe the nurse plan to stay with the client after the unit of blood is hung

15 min

At 1600 the nurse checks a client's TPN infusion bag and notes that the solution is running at a rate of 100mL/hr. The bag was hung the previous day at 1800. The nurse plans to change the infusion bag and tubing this evening at what time

1800

A nurse is making initial rounds on a group of assigned clients. Which client should the nurse see first

A client whose TPN solution was decreased to a rate of 25mL/hr who is now complaining of weakness, headache and swelling

A client has been given a rx to begin using nitroglycerin transdermal patches for the mgmt of angina pectoris. What should the nurse tell the client about the med

Apply the patch at the same time each day and leave it in place for 12-16 hours as directed

A nurse is monitoring a client who is receiving TPN. which s/s causes the nurse to suspect that the client is experiencing hyperglycemia as a complication

Nausea, thirst and increased UOP

A HHC nurse has been assigned a client who has been discharged home with a rx for TPN. which parameters does the nurse plan to check at each visit as a means of identifying complications of the TPN therapy SATA a) Glucose test b) Temp c) Weight d) Peripheral pulses e) Hgb and hct

a-c

A nurse is preparing a plan of care for a client who will be receiving meperidine hydrochloride. Which s/e does the nurse make a note of needing to be alert to in the plan of care SATA a) Urine retention b) Hypotension c) Constipation d) Resp depression e) Bradycardia

a-d

A client with HIV infection has been started on therapy with zidovudine. The nurse tells the client to report to the lab in 3months for testing to detect adverse effects of the therapy. Which lab test is the most important to monitor for this client

CBC

A client with HF is being furosemide and digoxin. The client calls the nurse and c/o anorexia and nausea. Which action should the nurse take first

Check the result of lab testing for potassium on the sample drawn 3 hours ago

The ED staff prepares for the arrival of a child who has ingested a bottle of acetaminophen. Which med does the nurse ensure is available

acetylcysteine

A client with schizophrenia has been taking an antipsychotic med for 2 months. For which adverse effect should the nurse monitor the client closely

akathisia

At 1300, the nurse is documenting the receipt of a unit of packed blood cells at the hospital blood bank. The nurse calculates that the transfusion must be started by thich time

at 1330

A client who needs to receive a blood transfusion has experienced a pruritic rash during previous transfusion. The client asks the nurse whether it is safe to receive the transfusion. Which med does the nurse anticipate will most likely be prescribed before the transfusion

Diphenhydramine

The serum theophylline level of a client who is taking the med is 16mcg/mL. On the basis of this result, the nurse should take which action initially

Document the normal value on the chart

A nurse is teaching a client how to mix regular and NPH insulin in the same syringe. The nurse should provide the client with which information about the insulin

Draw the regular insulin into the syringe first

A nurse is caring for a client with a dx of CKD who is receiving dialysis. Epoeitin alfa to be administered SQ, has been prescribed, and the nurse is drawing the med from a single-use vial. What should the nurse do to prepare the med

Draw up the med and discarded the unused portion

A HHC nurse provides instructions to a client who is taking allopurinol for the tax of gout. Which instruction should the nurse provide to the client

Drink at least 8 glasses of fluid everyday

Betaxolol eye drops have been prescribed for the tax of a client's glaucoma. The nurse tells the client to return to the clinic for f/up for which purpose

For measurement of BP and apical pulse

A nurse answers a call light and finds that the TPN solution bag of an assigned client is empty. The new rx was written for a new bag at the beginning of the shift, but it has not yet arrived from the pharmacy. Which action should the nurse take first

Hang a solution of 10% dextrose in water

A nurse instructs a client with hypothyroidism about the dosage, method of administration, n s/e of levothyroxine sodium. Which statement by the client indicates an understanding of the nurse's instructions

I need to report any episodes of palpitations, CP or dyspnea

A nurse provides instructions to a client who will be taking furosemide. Which statement by the client indicates to the nurse that the client needs additional instruction

I should expect to have ringing in my ears

A client with schizophrenia who has been taking an antipsychotic med calls the clinic nurse and says, "I need to cancel my appt with the psychiatrist again, b/c I still have this awful sore throat. It's so bad that my mouth has a sore." how does the nurse respond to the client

I think you need to come in for blood work today, b/c this may be an adverse effect of your med

Warfarin sodium has been prescribed and the nurse teaches the client about the med. Which statement by the client indicates that further teaching is necessary

I won't be taking any OTC meds expect aspirin

A client with HF being discharged home will be taking furosemide. Which statement by the client indicates to the nurse that the teaching has been effective

I'll weigh myself everyday

A client with a T-spine injury is receiving dantrolene sodium. Which statement by the client indicates to the nurse that the client is experiencing an adverse effect of the med

I'm feeling really drowsy

A nurse is preparing a client for the insertion of a central IV line into the subclavian vein by the HCP. The nurse gathers the equipment, places it at the bedside and prepares to assist the HCP with the procedure. As further prep for the procedure, the nurse places the client in which position

In a slight trendelenburg position

A nurse has taught a client who is taking lithium carbonate about the med. The nurse determines that the client needs additional teaching if the client makes which comment to the nurse

It is important to decrease fluid intake while taking the med to avoid nausea

A nurse is caring for a client with myasthenia gravis who is exhibiting signs of cholinergic crisis. Which med does the nurse ensure is available to treat this crisis

atropine sulfate

Metoprolol has been prescribed for a client with HTN. for which common s/e of the med does the nurse monitor the client SATA a) Dry eyes b) Impotence c) Weakness d) Nightmares e) Fatigue

b, c, e

A nurse suspects that a client receiving TPN through a central line has an air embolism. The nurse immediately places the client in which position

Left side with the head lower than the feet

A nurse is preparing a plan of care for a client with a dx of cancer who is receiving morphine sulfate for pain. Which action does the nurse identify as apriority in the plan of care for this client

Monitoring the client's resp rate

A client with a peripheral IV line in place has a new rx for infusion of TPN, a solution containing 25% glucose. Which action should be taken by the nurse

Questioning the HCP about the rx

A nurse is monitoring a client who is receiving a continuous IV infusion of morphine sulfate. Which finding should cause the nurse to contact the HCP

RR of 10/min

A client receiving TPN requires fat emulsion (lipids), which will be piggybacked to the TPN solution. On obtaining a bottle of fat emulsion, the nurse notes that fat globules are floating at the top of the solution. Which action should the nurse take

Request a new bottle from pharmacy

A client is receiving TPN with fat emulsion (lipids) piggybacked to the TPN solution. For which signs of an adverse reaction to the fat emulsion should the nurse monitor the client SATA a) Subnormal temp b) Chest and back pain c) Pallor d) Headache e) Chills f) N&V

b, d-f

A client is taking a folic acid supplement. Which lab parameter does the nurse use to evaluate the effectiveness of this therapy SATA a) Alkaline phosphatase b) Hgb c) Mag d) Blood glucose e) Hct

b, e

A nurse is to administer a dose of digoxin to a client with a-fib and notes that the client has a K+level of 4.6. The nurse determines which about the administration of the dose

Should be administered as prescribed

The nurse is preparing to change the solution bag and IV tubing of a client receiving TPN through a left subclavian central venous line. Which essential action does the nurse ask the client to perform just before switching the tubing

Take a deep breath and hold it

A client taking metronidazole for the tx of trichomonas vaginalis calls the clinic nurse to express concern b/c her urine has turned dark in color. The nurse should provide which information to the client

That darkening of the urine is harmless s/e

A client has been taking metoprolol. Which finding indicates to nurse that the media is effective

The client's BP has decreased

A client who has been taking lisinopril complains to the nurse of a persistent dry cough. What should the nurse tell the client

This is a s/e of therapy

A client with newly diagnosed angina pectoris has taken 2 sublingual nitroglycerin tabs for chest pain. The CP is relieved, but the client ℅ a headache. What should the nurse tell the client

This is an expected s/e of the nitroglycerin, and the client can relieve it by taking acetaminophen

Disulfiram is prescribed for a client. Which questions does the nurse make a priority of asking the client before administering this med SATA a) Do you have a hx of cancer in your family b) Do you have a hx of thyroid problems c) Do you have a hx of DI d) When did you have your last full meal e) When was your last drink of alcohol

b, e

A nurse is changing the central line dressing of a client receiving TPN. the nurse notes moisture under the dressing covering the catheter insertion site. What should the nurse assess next

Tightness of the tubing connections

Cyclophosphamide has been prescribed for a client with a dx of breast cancer, and the nurse is providing instructions to the client. The nurse should provide which information to the client

To increase fluid intake to 2,000-3,000mL/day

A nurse is providing instructions to a client regarding quinapril hydrochloride. The nurse should teach the client to implement which measure

To rise slowly from a lying to a sitting position

Zidovudine is prescribed for an adult client with HIV infection. The nurse should provide which instruction to the client about the med

To space the doses evenly around the clock

A nurse is reviewing the lab results of a client receiving IV chemo. Which lab finding prompts the nurse to initiate neutropenic precautions

WBC count of 2.0

A young female client with schizophrenia says to the nurse, "Since I started on Olanzapine last year, I'm doing well in school and all, but I've gained so much weight and it's really bothering me. What can I do about this?" which response by the nurse would be therapeutic

Weight gain can be a s/e of the med, so you need to watch your diet and exercise. How much weight have you gained

A nurse has just hung a transfusion of PRBCs and stayed with the client for the appropriate amount of time. Before leaving the room, the nurse tells the client that it is most important to immediately report which specific signs if it occurs SATA a) Backache b) Chills c) Fatigue d) Rash e) Tiredness

a, b, d

A nurse has taught a client taking a methylxanthine bronchodilator about beverages that must be avoided. Which beverage choices by the client indicate to the nurse that the client needs further education SATA a) Coffee b) Cocoa c) Lemonade d) Chocolate milk e) OJ

a, b, d

A nurse is providing dietary instructions to a client taking spironolactone. Which foods does the nurse instruct the client are acceptable to consume SATA a) Rice b) Cereal c) Citrus fruits d) Bananas e) Carrots

a, b, e

A nurse is caring for a group of adult clients in an acute care nursing unit. Which clients does the nurse recognize as the most likely candidates for TPN SATA a) A client with a severe exacerbation of ulcerative colitis b) A client who has undergone repair of a hiatal hernia c) A client with pancreatitis d) A client with severe sepsis e) A client with renal calculi

a, c, d

Carbamazepine is prescribed for a client with trigeminal neuralgia. Which s/e does the nurse instruct the client to report to the HCP SATA a) Mouth sores b) Nausea c) Fever d) Sore throat e) h/a

a, c, d

A nurse discontinues an infusion of a unit of PRBCs b/c the client is experiencing a transfusion reaction. After discontinuing the transfusion, which action should the nurse take next

contact the HCP

Resperidone is prescribed for a client with a dx of schizophrenia. Which lab study does the nurse expect to see among the HCP's prescriptions

creatinine level

A client is receiving heparin sodium by way of continuous IV infusion. For which adverse effects of the therapy does the nurse assess the client SATA a) Increased BP b) Slowed HR c) Tinnitus d) Tarry stools e) Bleeding from the gums

d, e

A nurse is assessing a client who is being hospitalized with a dx of pneumonia. The client's husband tells the nurse that the client is taking donepezil hydrochloride. The nurse should ask the husband about the client's hx of which disorder

dementia

The first bag of TPN solution has arrived on the clinical unit for a client beginning this nutritional therapy. The solution is to be infused by way of a central line. Which essential piece of equipment should the nurse obtain before hanging the solution

electronic infusion device

A client taking HCTZ reports to the clinic for f/up blood tests. For which s/e of the med does the nurse monitor the client's lab result

hypokalemia

Fluoxetine hydrochloride is prescribed for a client, and the nurse provides instruction regarding the use of the med. The nurse tells the client that it is best to take the med at what time

in the morning

A nurse is caring for a client who has been taking acetazolamide for glaucoma. Which, if documented in the assessment data, indicates to the nurse that the client may be experiencing an adverse effect of the med

jaundice

A client with TB is being started on isoniazid and the nurse stresses the importance of returning to the clinic for follow up blood testing. Which blood test will be performed

liver enzymes

A client is receiving IV bleomycin sulfate. During administration of the chemo, nursing assessment is the priority

lung sounds

A nurse is providing instructions to a client who is taking codeine sulfate for severe back pain. Which instruction should the nurse provide to the client

maintain a high fiber diet

A nurse is caring for a client with histoplasmosis who is receiving IV amphotericin B. what should the nurse do while the medication is being administered

monitor the client's UOP

A nurse is developing a plan of care for a client, hospitalized with HF, who has a hx of Parkinson disease and is taking benztropine mesylate daily. Which intervention does the nurse identify as a priority in the plan

monitoring I&Os

A nurse is reading the medical record of a client receiving haloperidol. The nurse notes that the HCP has documented that the client is experiencing signs of akathisia. On the basis of the HCP's note, which clinical manifestation would the nurse expect to find during assessment of the client

motor restlessness

Baclofen is prescribed for a client with a SCI who is experiencing muscle spasms. While providing instructions to the client, which s/e does the nurse tell the client is possible

nasal congestion

Erythromycin is prescribed for a client with a resp tract infection. The nurse provides instruction to the client regarding the administration of the oral medication and tells the client that is is best to take the med in which way

on an empty stomach

Phenelzine sulfate is being administered to a client with depression. The client suddenly complains of a severe frontally radiating occipital headache, neck stiffness and soreness, and vomiting. On further assessment, the client exhibits signs of hypertensive crisis. Which med should the nurse prepare to administer, anticipating that will be prescribed as the antidote to treat phenelzine-induced hypertensive crisis

phentolamine

A nurse notes that the site of a client's peripheral IV catheter is reddened, warm, painful and slightly edematous in the area of the insertion site. After taking appropriate steps to care for the client, the nurse documents in the medical record that the client has experienced which problem

phlebitis of the vein

A client has just undergone insertion of a central venous catheter by the HCP at the bedside. Which result would the nurse be sure to check before initiating infusion of the IV solution that the HCP has prescribed

portable CXR

Methylergonovine IM is prescribed for a postpartum client. Before administering the med, the nurse explains to the client that the med will promote which effect

prevent postpartum bleeding

A client has a rx for short-term therapy with enoxaparin. The nurse explains to the client that this med is being prescribed for which purpose

reduce the risk of DVT

A nurse is assessing a peripheral IV site and notes blanching, coolness, and edema at the insertion site. What should the nurse do first

remove the IV

A nurse notes that the site of a client's peripheral IV catheter is reddened, warm, painful and slightly edematous near the insertion point of the catheter. On the basis of this assessment, the nurse should take which action first

remove the IV catheter

A client with RA is taking high doses of acetylsalicylic acid. While assessing the client for aspirin toxicity, which question should the nurse ask the client

ringing in the ears

A client who is taking bupropion in an attempt to stop smoking tells a nurse that he has been doubling the daily dose to make it easier to resist smoking. The nurse warns the client that doubling to daily dosage is dangerous. Of which s/e of the med does the nurse warn the client

seizures

A nurse hangs a 500mL bag of IVF for an assigned client. One hour later the client complains of chest tightness, is dyspneic and apprehensive and has an irregular pulse. The IV bag has 100mL remaining. Which action should the nurse take first

shut off the IV infusion

A nurse has a written rx to remove an IV line. Which item should the nurse obtain from the unit supply area for use in applying pressure to the site after removing the IV catheter

sterile 2 x 2 gauze

A pregnant client is receiving mag sulfate for the mgmt of preeclampsia. Which assessment finding indicates to the nurse that the client is experiencing mag toxicity

sudden drop in FHR

A client who has undergone adrenalectomy is prescribed prednisone. Which finding indicates that the client is experiencing an adverse effect of the med

tarry stools

A nurse is preparing a plan of care for a pregnancy client who will be given oxytocin to induce labor. Which occurrence does the nurse include in the plan of care as a reason for immediate d/c of the oxytocin infusion

uterine hyperstimulation

IV tobramycin sulfate is prescribed for a client with a resp tract infection. For which of the following symptoms, indicative of an s/e, does the nurse monitor the client

vertigo

A nurse has obtained a unit of blood from the blood bank and properly checked the blood bag with another nurse. Which parameter should the nurse assess just before hanging the transfusion

vital signs

The client rings the call light and ℅ pain at the site of an IV infusion. The nurse assesses the site and determines that phlebitis has developed. Which actions should the nurse take SATA a) Removing the IV catheter at that site b) Starting a new IV line in a proximal portion of the same vein c) Applying warm, moist compresses to the IV site d) Encouraging the client to scrub the site while in the shower e) Notifying the HCP about the finding

a, c, e

A nurse discontinues an infusion of a unit of blood after the client experiences a transfusion reaction. Once the incident has been documented appropriately, where does the nurse send the blood transfusion bag

blood bank

The HCP prescribes the administration of TPN to be started at a rate of 50mL/hr by way of an infusion pump through an established subclavian central line. After the first 2 hours of the TPN infusion, the client suddenly ℅ difficulty breathing and CP. the nurse should take which immediate action

clamp the TPN infusion line