M/S, GU, M/W Health, Supplements
A client is prescribed alendronate. Which instruction should the nurse emphasize when teaching about this medication? "Take the medication with a full glass of milk two hours after meals." "It is recommended that you take this medication with calcium and a glass of juice." "Be sure to take this medication on an empty stomach." "You may take this medication after any meal, at the same time every day."
"Be sure to take this medication on an empty stomach." Alendronate (Fosamax) is used to treat and prevent osteoporosis. It should be taken first thing in the morning with 6 to 8 ounces of plain water at least 30 minutes before other medication or food. Food and fluids (other than water) greatly decrease the absorption of this medication. The client must also be instructed to remain in the upright position for 30 minutes following the dose to facilitate passage into the stomach and minimize irritation of the esophagus.
The nurse is caring for a female client who is requesting hormonal contraceptives. Which of the following questions should the nurse ask to assess for contraindications? "Have you ever had a blood clot?" "How many children do you have?" "Do you drink alcohol?" "Did you experience acne in adolescence?"
"Have you ever had a blood clot?" A history of thromboembolic disorders is a contraindication to hormonal contraceptives; therefore, any history of thrombus should be assessed. The number of children/pregnancies and use of alcohol are probable history questions but are not contraindications to this method. Acne is a side effect of oral contraceptives but not a contraindication.
A client has been prescribed alendronate for osteoporosis. Which statements indicate that the client understands how to safely take this medication? Select all that apply. "I will notify my doctor if I experience worsening heartburn." "I will take the pill with an antacid to prevent stomach upset." "I will swallow the pill with a full glass of water." "I will stand or sit quietly for 30 minutes after taking the pill." "I will always eat breakfast before taking the pill."
"I will notify my doctor if I experience worsening heartburn." "I will swallow the pill with a full glass of water." "I will stand or sit quietly for 30 minutes after taking the pill." Alendronate is a bisphosphonate used to treat osteoporosis. It can cause esophagitis or esophageal ulcers unless precautions are followed. The client must sit upright or stand for at least 30 minutes after taking the medication. The client should take the medication with a full glass of water, at least 30 minutes before eating or drinking anything or taking any other medication. Antacids will interfere with absorption and should not be taken at the same time.
The nurse is reviewing discharge instructions with the parent of a 3-year-old client who was admitted for poisoning after ingesting cherry-flavored acetaminophen. Which statement by the parent would require follow up by the nurse? Question 7 Answer Choices A "I should use non-flavored medications." B "I will reach out to the poison control center if this happens again." C "I will use ipecac syrup to induce vomiting." D "I will have all medications in a locked cabinet."
"I will use ipecac syrup to induce vomiting." Accidental ingestions (poisoning) are the most frequent accident in toddlers. Therefore, it is imperative to focus on keeping all poisonous substances, drugs, and small objects securely out of the reach of children and medications in a locked cabinet. Parents should be instructed to call the poison control center in case of accidental ingestion and to have the number listed on their cell phone. Since 2003, the American Academy of Pediatrics has discouraged the use of syrup of ipecac to induce vomiting after accidental ingestion. Instead, families should call the poison control center immediately. Using non-flavored medications will decrease the likelihood the child will consume a large amount; it does not prevent the ingestion of the medication or determine what should be done after accidental ingestion.
Which statement by a client who had a laminectomy and is receiving a skeletal muscle relaxant that will be continued after discharge indicates that teaching was effective? "I'm going to take the medication between meals." "If the medication makes me sleepy, I'll stop taking it." "If the medication upsets my stomach, I'll take it with milk." "I'll take an extra dose of the medication before I do anything active."
"If the medication upsets my stomach, I'll take it with milk." These medications tend to irritate the gastric mucosa and should be taken with milk or food to limit gastrointestinal irritation. Drowsiness is an expected side effect; safety precautions are indicated, but the medication should not be discontinued. Taking an extra dose of the medication before activity can result in toxicity if the extra dose, in addition to the prescribed dose, exceeds the therapeutic range; the dosage prescribed by the health care provider should be followed.
The nurse is reinforcing teaching for a client with chronic kidney disease about the prescribed aluminum hydroxide. Which is the best statement by the nurse about this medication? "It decreases phosphate levels." "It increases urine output." "It reduces potassium levels." "It controls stomach acid secretions."
"It decreases phosphate levels." Phosphates tend to accumulate in the client with chronic kidney disease due to decreased filtration capacity of the kidneys. Antacids that contain aluminum such as aluminum hydroxide (Amphojel) are commonly used to lower phosphate levels. Aluminum binds phosphates in the gastrointestinal tract and prevents their absorption. Aluminum hydroxide neutralizes stomach acid already present, but does not control gastric acid production or secretion. It does not affect potassium absorption or levels.
The nurse is teaching a client with chronic renal failure about their medications. The client questions the purpose of taking aluminum hydroxide. How should the nurse respond? "It increases your urine output." "It decreases your blood's phosphate levels." "It is taken to control gastric acid secretions." "It will reduce your blood's calcium levels."
"It decreases your blood's phosphate levels." Aluminum binds to phosphates that tend to accumulate in the client with chronic renal failure due to decreased filtration capacity of the kidneys. Antacids such as aluminum hydroxide are commonly used in clients with chronic renal failure to decrease serum phosphate levels. Aluminum hydroxide will not increase urine production, control gastric acid secretions or lower serum calcium levels.
Which rationale will the nurse provide to a client with Crohn's disease who asks why the prescribed vitamins have to be given intravenously (IV) rather than by mouth? Select all that apply. One, some, or all responses may be correct. "They provide more rapid action results." "They decrease colon irritability." "Oral vitamins are less effective." "Intestinal absorption may be inadequate." "Allergic responses are less likely to occur."
"They provide more rapid action results." "Oral vitamins are less effective." "Intestinal absorption may be inadequate." Absorption through the gastrointestinal (GI) tract is impaired, and parenteral administration goes directly into the intravascular compartment. Disease of the GI tract hampers absorption. Because the mucosa of the intestinal tract is damaged, its ability to absorb vitamins taken orally is greatly impaired. IV vitamins do not decrease colonic irritability. Route of administration does not affect allergic response.
A client with benign prostatic hypertrophy has been prescribed tamsulosin. Which statement by the nurse correctly describes how this medication works? "This medication will shrink your enlarged prostate gland." "This medication will eliminate your nocturia." "Your sexual desire will increase with this medication." "This medication will improve the flow of urine."
"This medication will improve the flow of urine." Tamsulosin is an alpha-adrenergic blocker that is prescribed to promote bladder and prostate gland relaxation for clients with benign prostatic hypertrophy or hyperplasia (BPH). Tamsulosin will relax the smooth muscle of the bladder neck and prostate, allowing urine to flow more easily. Tamsulosin does not shrink the prostate, nor does it increase sexual desire. Although tamsulosin may reduce episodes of having to void during the night (nocturia), it might not eliminate them.
The nurse provides client teaching on the use of oral contraceptives. Which statement made by the client indicates to the nurse that teaching was effective? 'I will take my pill at the same time every day.' 'I can stop the pill and try to get pregnant right away.' 'I may miss two periods and not worry about being pregnant.' 'I am so glad we won't have to use condoms even if I miss just one pill during the month.'
'I will take my pill at the same time every day.' Taking the pill at the same time every day makes it more effective, and the client should be instructed to do so. A woman should wait 2 to 3 months after stopping the oral contraceptive pill before attempting to become pregnant. If two consecutive menstrual cycles are missed, the client should stop the contraceptive pill and perform a pregnancy test. The client should use a barrier method of contraception for the first month of pill use and when a pill is missed to help prevent conception.
The nurse teaches a client about side effects that necessitate discontinuation of oral contraceptives. Which statement made by the client indicates that the teaching was effective? 'I'll stop taking the pills if I have chest pain.' 'I'll stop taking the pills if I start to retain fluid.' 'I'll stop taking the pills if I have white discharge from the vagina.' 'I'll stop taking the pills if I have pain during the middle of my cycle.'
'I'll stop taking the pills if I have chest pain.' Oral contraceptives should be discontinued with any symptom that may be related to a pulmonary embolus. Fluid retention is a common side effect of increased estrogen and progestin; discontinuation of the contraceptive is unnecessary. Leukorrhea may be a sign of infection, not a side effect of oral contraceptives. Abdominal pain in the middle of the menstrual cycle is not expected while an oral contraceptive is being taken. Abdominal pain in the area of an ovary that occurs midway during the menstrual cycle (mittelschmerz) usually indicates ovulation.
The nurse explains to a group of nursing students how magnesium sulfate treats severe preeclampsia. Which response by a student indicates effective teaching? 'It blocks neuromuscular transmissions.' 'It provides analgesia for the client in labor.' 'It increases the quantity of acetylcholine.' 'It improves the quality of uterine contractions.'
'It blocks neuromuscular transmissions.' Eclamptic seizures may be prevented with the administration of intravenous magnesium sulfate, which is a central nervous system depressant that blocks neuromuscular transmissions. Although magnesium sulfate is a neuromuscular sedative that relaxes smooth muscle and decreases blood pressure, it is not considered an analgesic and is not given for that purpose. Magnesium sulfate decreases, not increases, the quantity of acetylcholine. Improved quality of uterine contractions is not associated with magnesium sulfate administration.
The nurse is caring for a 6-year-old child who has undergone craniotomy. The parents ask what effect mannitol has. Which response by the nurse is most appropriate? 'It relieves cerebral pressure.' 'It increases the bladder's filtration rate.' 'It reduces glucose excretion in the urine.' 'It decreases the peripheral retention of fluid.'
'It relieves cerebral pressure.' Mannitol is an osmotic diuretic used to relieve cerebral edema. The bladder is a storage basin and is not involved with filtration; mannitol acts in the kidneys. Mannitol is an osmotic diuretic that affects neither the body's excretion of glucose nor peripheral edema.
A 28-year-old woman who is a smoker seeks advice about oral contraceptives. Which response by the nurse is appropriate? 'Oral contraceptives can cause thrombophlebitis.' 'Oral contraceptives must be used with other methods.' 'Some oral contraceptives can be used without concern.' 'Some oral contraceptives are safe, but others are not safe.'
'Oral contraceptives can cause thrombophlebitis.' Studies have shown that women who smoke at least a pack of cigarettes a day are more prone to cardiovascular problems such as thrombophlebitis. Using oral contraceptives with other methods of contraception is not necessary if there are no contraindications; oral contraceptives are effective used alone. There is no 'safe' oral contraceptive for all women or one that may be used without concern; any client at risk should be informed of the potential consequences of taking an oral contraceptive.
A biphasic antiovulatory medication of combined progestin and estrogen is prescribed for a client. Which instruction would the nurse include when teaching about this oral contraceptive? 'Report irregular vaginal bleeding.' 'Restrict sexual activity temporarily.' 'Have regular bimonthly Pap smears.' 'Increase dietary intake of calcium.'
'Report irregular vaginal bleeding.' Antiovulatory medications suppress menstruation. Breakthrough bleeding is not expected with biphasic medications. The medication is given for 21 days, and menstrual flow does not occur during this time. Sexual activity is not restricted when one is taking oral contraceptives. There is no indication for increased frequency of Pap smears; one a year is sufficient. Increased calcium intake is not relevant to the administration of oral contraceptives.
The health care provider prescribes finasteride for a client with benign prostatic hyperplasia (BPH). The client would like to take saw palmetto instead of the finasteride. Which information would the nurse provide to the client about this herbal supplement? 'Research has shown that saw palmetto is no better than a placebo.' 'You can take both; saw palmetto doesn't require a prescription.' 'The herbal supplement will relieve symptoms by altering the size of the prostate.' 'Substituting saw palmetto is a good option to avoid all the bad side effects of finasteride.'
'Research has shown that saw palmetto is no better than a placebo.' Rigorous research has demonstrated no significant difference between saw palmetto and a placebo. The health care provider must be consulted regarding the client's desire to change the prescribed therapy. Saw palmetto should be taken with food to limit gastrointestinal side effects. Saw palmetto does not alter the size of the prostate gland. Substituting something that is ineffective is not a good solution regardless of issues surrounding side effects.
A client comes in for a pregnancy test. She tells the nurse that pregnancy may have occurred because she missed her contraceptive pills for 1 week when she had the flu. Which response by the nurse is appropriate? 'That's the trouble with using contraceptive pills. People frequently forget to take them.' 'You may be correct. The effect of contraceptive pills depends on them being taken on a regular schedule.' 'Let's find out whether you really are pregnant. If you are, you may want to consider having an abortion.' 'Contraceptive pills are unpredictable. You could have become pregnant even if you had taken them regularly.'
*'You may be correct. The effect of contraceptive pills depends on them being taken on a regular schedule.' An oral contraceptive program requires the client to take one tablet daily from the fifth day of the cycle and continue taking tablets for 20 or 21 days. Interrupting the monthly dosage program may permit release of luteinizing hormone, resulting in ovulation and possibly pregnancy. Stating that people often forget to take oral contraceptive pills is judgmental; contraceptive practice is the client's choice. It is premature to discuss abortion. Oral contraceptives that are taken on an exact schedule have a very high rate of success.
Which finding in a menopausal client's health history would prevent the health care provider from prescribing hormone replacement therapy? Select all that apply. One, some, or all responses may be correct. Smoking Cirrhosis Cholecystitis Breast cancer Deep vein thrombosis
*Smoking *Cirrhosis *Cholecystitis *Breast cancer *Deep vein thrombosis Use of estrogens can have major side effects, especially if the client smokes. The nurse would provide information to the client about smoking cessation. Clients with cirrhosis have a decreased ability to break down medications, especially estrogen. Cholecystitis can worsen in clients taking estrogen. Clients at risk for breast and endometrial cancer should not take estrogen because it can further increase the risk. Estrogens can lead to deep vein thrombosis.
Which information would the nurse give to a client interested in kava and valerian supplements for the treatment of anxiety and insomnia? Select all that apply. One, some, or all responses may be correct. Valerian can cause restlessness and insomnia. Both kava and valerian are contraindicated with liver disease. Kava is contraindicated with Parkinson disease or depression. Kava can cause temporary yellow discoloration of the skin, hair, and nails. Both kava and valerian can have adverse effects on the central nervous system.
*Valerian can cause restlessness and insomnia. *Both kava and valerian are contraindicated with liver disease. *Kava is contraindicated with Parkinson disease or depression. *Kava can cause temporary yellow discoloration of the skin, hair, and nails. It is true that valerian can cause restlessness and insomnia. Both kava and valerian can cause liver toxicity and liver injury; both are contraindicated with liver disease. Kava is also contraindicated with Parkinson disease or depression and can worsen symptoms of both. Kava can cause temporary yellow discoloration of the skin, hair, and nails. It is not true that both kava and valerian have adverse effects on the central nervous system; only valerian does, including depression, nausea, and vomiting.
Which medication would the nurse anticipate may be prescribed to produce diuresis and inhibit formation of aqueous humor for a client with glaucoma? Chlorothiazide Acetazolamide Methazolamide Aclidinium bromide
Acetazolamide Acetazolamide is a carbonic anhydrase inhibitor that decreases inflow of aqueous humor and controls intraocular pressure in acute angle-closure glaucoma attack. Chlorothiazide has no effect on the eye. Methazolamide lowers ocular pressure but does not decrease the inflow of aqueous humor. Aclidinium bromide is a bronchodilator.
The nurse is caring for a client who is taking leuprolide for endometriosis. The nurse should monitor the client for which side effects? Select all that apply. Amenorrhea Hot flashes Vaginal dryness Emotional lability Increased fertility Anorexia
Amenorrhea Hot flashes Vaginal dryness Endometriosis is a benign gynecologic condition in which endometrial tissue grows outside of the uterus. It can be controlled, but not cured, by drug therapy. Drugs commonly used include oral contraceptives and GnRH agonists such leuprolide and nafarelin. GnRH drugs result in amenorrhea (absence of menstruation) and other symptoms that mimic menopause such as hot flashes, vaginal dryness and emotional lability. Anorexia (lack of appetite) is not a side effect usually seen with leuprolide. Leuprolide does not increase fertility.
A health care provider prescribes tolterodine for a client with an overactive bladder. Which action is important to include in client teaching? Maintain a strict record of fluid intake and urinary output. Chew the extended-release capsule thoroughly before swallowing. Report episodes of diarrhea or any increase in respiratory secretions. Avoid activities requiring alertness until the response to medication is known.
Avoid activities requiring alertness until the response to medication is known. Tolterodine, a urinary tract antispasmodic, may cause dizziness and blurred vision, placing the client at risk for injury. Although it is important to know if the client is experiencing anuria or overflow incontinence, which may indicate urinary retention, a detailed intake and output record is unnecessary. An extended-release capsule should be swallowed whole and should not be opened or chewed. If chewed or opened, the client will receive a surge of action and the long-term action of the medication is gone. Tolterodine is classified as an anticholinergic, and adverse reactions include constipation and dry mouth; diarrhea and an increase in respiratory secretions are associated with medications classified as cholinergics.
Which B vitamin deficiency will result in Wernicke encephalopathy? B 3 (niacin) B 1 (thiamine) B 2 (riboflavin) B 6 (pyridoxine)
B 1 (thiamine)
Which medications would the nurse identify as being used as preanesthetic agents? Select all that apply. One, some, or all responses may be correct. Barbiturates Benzodiazepines Antiepileptic agents Atypical antipsychotics Mood stabilizing agents
Barbiturates Benzodiazepines Barbiturates and benzodiazepines are sedative-hypnotics that may also be used to decrease effects of anxiety in presurgical clients. Antiepileptic agents are used to treat seizure activity and manage bipolar disorder. Atypical antipsychotics are mainly used to treat bipolar disorder and psychosis. Mood stabilizing agents are used to treat bipolar disorder.
Which mechanism of action explains how aluminum hydroxide decreases serum phosphorus? Binding with phosphorus in the intestine Promoting excretion of phosphorus Promoting excretion of excessive urinary phosphates Dissolving stones as they pass through the urinary tract
Binding with phosphorus in the intestine Aluminum hydroxide binds phosphorus in the intestine, preventing its absorption; this decreases serum phosphorus. Promoting excretion of phosphorus, promoting excretion of excessive urinary phosphates, and dissolving stones as they pass through the urinary tract are not actions of this medication.
A 31-year-old client is seeking contraceptive information. While obtaining the client's history, which factor indicates to the nurse that oral contraceptives are contraindicated? Older than 30 years Current hypothyroidism Two multiple pregnancies Blood pressure 162/110
Blood pressure 162/110 Oral contraceptives may cause or exacerbate hypertension; even borderline hypertension places the client at risk for a brain attack. Oral contraceptives are not contraindicated for women older than 30 years of age if there are no known risk factors. There is no relationship between oral contraceptives and multiple births. Contraceptives are not contraindicated in clients who have hypothyroidism.
A client is prescribed an oral contraceptive. As part of teaching, the nurse plans to inform the client of the possibility of which adverse effect? Cervicitis Ovarian cysts Fibrocystic breasts Breakthrough bleeding
Breakthrough bleeding Breakthrough bleeding, or midcycle bleeding, commonly occurs when women start using oral contraceptives. If it persists, the dosage should be changed. There is no evidence that cervicitis, ovarian cysts, or fibrocystic breasts are related to the use of oral contraceptives.
The nurse recognizes that hormonal therapy (HT) increases the risk of which condition in postmenopausal women? Breast cancer Rapid weight loss Accelerated bone loss Vaginal tissue atrophy
Breast cancer There is a relationship between HT that combines estrogen and progesterone compounds and an increased incidence of invasive breast cancer. One side effect of HT is weight gain with ankle and foot edema. Bone loss is slowed with HT. Vaginal tissue maintains turgor and lubrication with HT.
Which vitamin would the nurse anticipate may become deficient in a client prescribed cholestyramine for the treatment of type II hyperlipoproteinemia? Niacin (vitamin B 3) Calciferol (vitamin D) Ascorbic acid (vitamin C) Cyanocobalamin (vitamin B 12)
Calciferol (vitamin D) Bile acid sequestrants (also known as bile acid-binding resins) bind with bile acids to form an insoluble compound that is then excreted in the feces. These medications decrease the absorption of fat-soluble vitamins (A, D, E, K). Vitamins B 3, C, and B 12 are water-soluble vitamins and are not affected by the administration of this medication.
Which medication is derived from a natural source and may be prescribed for the treatment of osteoporosis? Calcitonin Raloxifene Clomiphene Bisphosphonates
Calcitonin Calcitonin is derived from natural sources such as fish; this medication may be prescribed to prevent osteoporosis. Raloxifene is prescribed to prevent postmenopausal osteoporosis. Clomiphene is prescribed to induce ovulation. Bisphosphonates are prescribed to treat osteoporosis; this medication is not derived from natural sources.
A pregnant client with severe preeclampsia is receiving intravenous magnesium sulfate. Which item would the nurse keep at the bedside in case of magnesium sulfate toxicity? Oxygen Naloxone Calcium gluconate Suction equipment
Calcium gluconate The antagonist of magnesium sulfate is calcium gluconate. Oxygen is ineffective if the action of magnesium is not reversed. Naloxone is unnecessary; it is an opioid antagonist. Suction equipment may be necessary if the client has excessive secretions after a seizure. The priority intervention is to try to prevent a seizure.
A child is treated with succimer for lead poisoning. Which of these assessments is the priority? Check the client's serum potassium level. Check the client's blood calcium level. Test the client's deep tendon reflexes. Check the client's complete blood count with differential.
Check the client's complete blood count with differential. Succimer is used in the management of lead or other heavy metal poisoning. Although it is generally well-tolerated and has a relatively low toxicity, it may cause neutropenia. Succimer therapy should be withheld or discontinued if the absolute neutrophil count (ANC) is below 1,200/mm3. The normal range for an ANC is 1.5 to 8.0 (1,500 to 8,000/mm3). Therefore, the assessment priority in this scenario is checking the complete blood count (CBC) with differential which includes an ANC value.
The nurse is completing a health history of a client diagnosed with Alzheimer's disease. The nurse reviews a list of the client's medications and supplements routinely taken at home. Which treatment should be a cause for concern by the nurse? Donepezil Ginkgo biloba Omega-3 fatty acids Coconut oil
Coconut oil Donepezil, rivastigmine, and galantamine are most commonly used in the treatment of Alzheimer's disease (AD). Complementary and integrative therapies used to treat AD include Gingko biloba (a plant extract) and omega-3 fatty acids. While there isn't sufficient research to support using these treatments, continued use won't necessarily be harmful. However, coconut oil, which is a source of caprylic acid, is a concern. While there has been limited research on Katasyn (an experimental drug containing caprylic acid), there is no scientific evidence that coconut oil is safe and effective or prevents cognitive decline.
A client is diagnosed with acute gouty arthritis. Which medication would the health care provider prescribe to treat the acute attack of gout and prevent future attacks? Ibuprofen Colchicine Probenecid Allopurinol
Colchicine High-dose colchicine decreases the inflammatory response to alleviate an acute gout attack; low-dose colchicine is used prophylactically to prevent future attacks. Ibuprofen is a nonsteroidal anti-inflammatory agent that may be used to treat an acute gout attack, but it does not possess activity to prevent future attacks. Probenecid increases uric acid excretion by the kidneys, making it useful for prophylaxis, but it does not possess the anti-inflammatory property needed to treat an acute gout attack. Allopurinol decreases uric acid formation, making it useful for prophylaxis, but it does not possess the anti-inflammatory properties needed to treat an acute gout attack.
Which medication would the health care provider prescribe to treat the acute attack of gout and prevent future attacks? Ibuprofen Colchicine Probenecid Allopurinol
Colchicine High-dose colchicine decreases the inflammatory response to alleviate an acute gout attack; low-dose colchicine is used prophylactically to prevent future attacks. Ibuprofen is a nonsteroidal anti-inflammatory agent that may be used to treat an acute gout attack, but it does not possess activity to prevent future attacks. Probenecid increases uric acid excretion by the kidneys, making it useful for prophylaxis, but it does not possess the anti-inflammatory property needed to treat an acute gout attack. Allopurinol decreases uric acid formation, making it useful for prophylaxis, but it does not possess the anti-inflammatory properties needed to treat an acute gout attack.
A nurse is preparing to administer intravenous mannitol to a client with increased intracranial pressure. Which action will the nurse perform prior to administering the medication? Connect an in-line filter to the infusion tubing Dilute the medication with lactated ringers Prepare an infusion warmer Ensure the client has a patent central line
Connect an in-line filter to the infusion tubing The nurse should connect a filter to the infusion tubing prior to administering mannitol. Mannitol is an osmotic diuretic that may contain crystals within the solution. The in-line filter prevents the administration of particulates into the bloodstream. Mannitol should be administered undiluted. An infusion warmer is not required for the administration of mannitol. Mannitol can be administered through a peripheral line.
A client is prepared for a supratentorial craniotomy with burr holes, and an intravenous infusion of mannitol is instituted. The nurse concludes that this medication is primarily given for which purpose? Lower blood pressure Prevent hypoglycemia Increase cardiac output Decrease fluid in the brain
Decrease fluid in the brain Osmotic diuretics remove excessive cerebrospinal fluid (CSF), reducing intracranial pressure. Osmotic diuretics increase, not decrease, the blood pressure by increasing the fluid in the intravascular compartment. Osmotic diuretics do not directly influence blood glucose levels. Although there is an increase in cardiac output when the vascular bed expands as CSF is removed, it is not the primary purpose of administering the medication.
Which therapeutic effect would the nurse expect to identify when mannitol is administered to a client? Improved renal blood flow Decreased intracranial pressure Maintenance of circulatory volume Prevention of the development of thrombi
Decreased intracranial pressure As an osmotic diuretic, mannitol helps reduce cerebral edema. Although there may be a transient increase in blood volume as a result of an increased osmotic pressure, which increases renal perfusion, this is not the therapeutic effect. Prevention of the development of thrombi is not the reason for giving this medication.
Which outcome does allopurinol produce to prevent acute gouty attacks? Promotes uric acid excretion Decreases synovial swelling Decreases uric acid production Prevents crystallization of uric acid
Decreases uric acid production Allopurinol interferes with the final steps in uric acid formation by inhibiting the production of xanthine oxidase. This medication does not promote uric acid excretion. It does not affect bone density. Allopurinol has no effect on swelling of the synovial membranes. This medication prevents the synthesis of uric acid, not its crystallization.
Which condition is contraindicated for St. John's wort herbal therapy? Anxiety Seizures Dementia Cardiac disease
Dementia St. John's wort is contraindicated for dementia; this herbal therapy is used to treat anxiety. Bupropion therapy is contraindicated for seizures. Valerian (Valeriana officinalis) is contraindicated for cardiac disease.
A client reports to the nurse, 'I've been using St. John's wort to try and feel more like myself again. I'm not sure whether it's going to work.' Which symptom would the nurse further assess? Depression Sleep disturbances Diminished cognitive ability Sensory-perceptual disturbances
Depression St. John's wort is an herb marketed as a natural way to improve mood and ease feelings of depression. Because St. John's wort is considered a dietary supplement, it is not regulated by the Food and Drug Administration as medications are. It has not been shown to exert positive effects in people with sleep disturbances, diminished cognitive abilities, or sensory-perceptual disturbances.
Several minutes after a client receives an infusion of oxytocin for induction of labor, the uterine monitor indicates contractions lasting 100 seconds with a frequency of 130 seconds. Which action would the nurse take next? Discontinuing the infusion Checking the fetal heart rate Slowing the oxytocin flow rate Turning the client on her left side
Discontinuing the infusion Contractions lasting too long and occurring too frequently can lead to fetal hypoxia; stopping the oxytocin infusion should stop the contractions, thereby increasing oxygen flow to the fetus. The fetal heart rate should be monitored, but this is not the priority. Oxytocin will continue to promote uterine contractions; this is unsafe because the prolonged, frequent contractions decrease oxygen flow to the fetus. Turning the client on her left side will promote placental perfusion, but it is not the priority at this time.
A client is taking an estrogen-progestin oral contraceptive. Which adverse effects from the contraceptive would the nurse teach the client to report to the primary health care provider? Select all that apply. One, some, or all responses may be correct. Dizziness Chest pain Bloating Nausea Calf tenderness Breast tenderness
Dizziness Chest pain Calf tenderness Early side effects of oral contraceptives include bloating, nausea, and breast tenderness. Although they may be bothersome enough to lead to discontinuation of the contraceptive, these side effects usually subside in several months. Dizziness is not a common side effect and should be reported to the provider. Contraceptives have been associated with thrombophlebitis; clinical manifestations of thrombophlebitis include calf tenderness and redness and heat over the affected area. If the clot travels, it could present as a pulmonary embolism, so chest pain should be reported as well.
A health care provider prescribes mannitol for a client with a head injury. Which mechanism of action is responsible for therapeutic effects of this medication? Decreasing the production of cerebrospinal fluid Limiting the metabolic requirements of the brain Drawing fluid from brain cells into the bloodstream Preventing uncontrolled electrical discharges in the brain
Drawing fluid from brain cells into the bloodstream Mannitol, an osmotic diuretic, pulls fluid from the brain to relieve cerebral edema. Mannitol's diuretic action does not decrease the production of cerebrospinal fluid. Mannitol does not affect brain metabolism; rest and lowered body temperature reduce brain metabolism. Preventing uncontrolled electrical discharges in the brain is the action of phenytoin sodium, not mannitol.
Sildenafil is prescribed for a man with erectile dysfunction. Which side effects of this medication would the nurse mention in teaching? Select all that apply. One, some, or all responses may be correct. Flushing Headache Dyspepsia Constipation Hypertension
Flushing Headache Dyspepsia Flushing is a common central nervous system response to sildenafil. Headache is a common central nervous system response to sildenafil. Dyspepsia is a common gastrointestinal response to sildenafil. Diarrhea, not constipation, is a common gastrointestinal response to sildenafil. Hypotension, not hypertension, is a cardiovascular response to sildenafil. It should not be taken with antihypertensives and nitrates because medication interactions can precipitate cardiovascular collapse.
Which vaccine is used to prevent human papilloma virus infection? Varivax RotaTeq Gardasil Hepatitis A vaccine
Gardasil Gardasil is a quadrivalent vaccine used to prevent genital cancers and warts caused by human papilloma virus. Varivax is associated with protection from the varicella virus; this vaccine is sometimes given in combination with the MMR vaccine. The RotaTeq vaccine is used to vaccinate against a rotavirus infection. The hepatitis A vaccine is used to protect against the hepatitis A virus.
Which conditions would the nurse identify as decreasing the effectiveness of estrogen therapy? Select all that apply. One, some, or all responses may be correct. Habit of smoking Use of anticoagulants Use of tricyclic antidepressants Presence of endometrial cancer Presence of thromboembolic disorders
Habit of smoking Use of anticoagulants The effectiveness of estrogen therapy decreases with smoking and decreases with the use of anticoagulants. The use of tricyclic antidepressants along with estrogen may result in medication toxicity. Estrogen therapy is not recommended in clients with endometrial cancer and thromboembolic disorders because it may increase the risk of these complications.
The nurse would instruct a client to stop taking an oral contraceptive and notify the health care provider immediately for the presence of which clinical findings? Select all that apply. One, some, or all responses may be correct. One, some, or all responses may be correct. Nausea Headaches Weight loss Visual disturbances Increased menstrual flow
Headaches Visual disturbances Headaches, either sudden or persistent, may indicate hypertension or a cardiovascular event. Visual disorders, such as partial or complete loss of vision or double vision, may indicate neuro-ocular lesions, which are associated with the use of some oral contraceptives. Nausea is a side effect that is not life threatening; the dose may need to be adjusted or the product changed to an alternative. Weight gain, not loss, may occur because of fluid retention. Menorrhagia is less likely to occur.
The nurse is counseling a 34-year-old client who has requested a prescription for oral contraceptives. Which condition would warrant additional discussion? Anemia Depression Hypertension Dysmenorrhea
Hypertension One of the side effects of oral contraceptives is hypertension; therefore they are contraindicated for any woman who already has hypertension, particularly at the client's age or older. Anemia is not a contraindication for women who want to take oral contraceptives because oral contraceptives may help this condition by decreasing bleeding. Depression is not a contraindication for women who want to take oral contraceptives. Oral contraceptives may be prescribed for women with menstrual difficulties such as dysmenorrhea.
A client is experiencing both tingling of the extremities and tetany. The nurse will review the client's laboratory report to check for which electrolyte abnormality? Hypokalemia Hypocalcemia Hyponatremia Hypochloremia
Hypocalcemia Paresthesias (tingling of the extremities) and tetany are signs of hypocalcemia. These are not expected findings for hypokalemia, hyponatremia, or hypochloremia.
The nurse is caring for a client who has just received epidural anesthesia. The nurse would monitor for which adverse effects? Uterine atony Hypotension Decreased urine production Precipitous second stage of labor
Hypotension Regional anesthesia lowers the blood pressure, which puts both mother and fetus in jeopardy. The client may not have the sensation to void, but the amount of urine manufactured does not decrease because a regional block does not affect the kidneys. Epidural anesthesia does not shorten the second stage of labor and does not cause uterine atony.
A 6-year-old child is receiving an intravenous solution of 10% glucose and mannitol to reduce cerebral edema. Which complication would the nurse monitor the child for? Overhydration Seizure activity Acute heart failure Hypovolemic shock
Hypovolemic shock Both hypertonic glucose and mannitol cause diuresis; the child should be monitored for excessive fluid loss. Hypertonic glucose and mannitol will cause fluid loss, not gain. Seizure activity is not anticipated as a result of this infusion. An increased fluid volume can lead to heart failure; however, hypertonic glucose and mannitol cause fluid loss, not gain.
A registered nurse teaches a nursing student about caring for a client prescribed estradiol to treat low estrogen levels. Which statement by the student indicates to the nurse a need for additional learning? 'I should apply the emulsion once a day on the thighs.' 'I should avoid covering the medication with clothing after it is dried.' 'I should educate the client about the pharmacokinetic effects of estradiol.' 'I should advise the client to avoid applying sunscreen at the same time as the medication intake.'
I should avoid covering the medication with clothing after it is dried.' Covering the medication with clothing after it is dried helps prevent the transfer of the medication to other individuals. The nurse would instruct the client to apply the emulsion once a day on the thighs. The nurse would educate the client about the pharmacokinetic properties of the medication to ensure the medication's safe and effective administration. The nurse would advise the client to not apply sunscreen products at the same time because this action may reduce the absorption of estradiol.
A 20-year-old woman visiting the clinic says that she wishes to begin using depot medroxyprogesterone acetate as a form of birth control. Which important information would the nurse include when teaching the client about this medication? 'Medroxyprogesterone offers protection against the herpes simplex virus.' 'You will need a repeat injection every 6 months.' 'Increase your intake of iron-rich foods to prevent anemia from increased blood loss during menstruation.' 'Increase your calcium intake and exercise because loss of bone mineral density may occur.'
Increase your calcium intake and exercise because loss of bone mineral density may occur.' Loss of bone mineral density is a significant side effect of depot medroxyprogesterone acetate, and increased calcium intake and exercise should be encouraged. Medroxyprogesterone should be administered every 11 to 13 weeks; 6 months is too long before the next dose. Menstrual periods usually lighten or disappear over time. Medroxyprogesterone confers no protection against herpes simplex virus.
Which statements accurately describe the different medications available for the treatment of osteoporosis? Select all that apply. One, some, or all responses may be correct. Denosumab acts by stimulating bone formation. Individuals with an allergy to salmon can't take calcitonin. Bisphosphonates inhibit osteoclast-mediated bone resorption. Denosumab is a subcutaneous injection given once every 6 months. Teriparatide is used for the prevention of postmenopausal osteoporosis.
Individuals with an allergy to salmon can't take calcitonin. Bisphosphonates inhibit osteoclast-mediated bone resorption. Denosumab is a subcutaneous injection given once every 6 months. Individuals with an allergy to salmon cannot take calcitonin, which is salmon-based. Bisphosphonates work by inhibiting osteoclasts, which are responsible for breaking down and reabsorbing minerals such as calcium from the bone. Denosumab is a subcutaneous injection that is given once every 6 months; the client takes calcium and vitamin D daily. It is not true that denosumab acts by stimulating bone formation; it is a monoclonal antibody that blocks osteoclast activation and thus decreases the breakdown of bone. Teriparatide is not used for the prevention of postmenopausal osteoporosis; instead, it is generally reserved for the subset of clients at the highest risk—those who have suffered a previous fracture. It stimulates osteoblast function and increases gastrointestinal calcium absorption and renal tubular reabsorption of calcium.
Which topic will the nurse include in the discharge teaching of a client who has had a total gastrectomy? Daily use of a stool softener Injections of vitamin B 12 for life Monthly injections of iron dextran Replacement of pancreatic enzymes
Injections of vitamin B 12 for life Intrinsic factor is lost with removal of the stomach, and vitamin B 12 is needed to maintain the hemoglobin level and prevent pernicious anemia. Adequate diet, fluid intake, and exercise should prevent constipation. Iron-deficiency anemia is not expected. Secretion of pancreatic enzymes should not be affected because this surgery does not alter this function.
The nurse is to administer a muscle relaxant, succinylcholine, just before a client undergoes electroconvulsive therapy. Which muscles does this medication inhibit? Biceps and triceps Facial and thoracic Intercostal and diaphragmatic Sternocleidomastoid and abdominal
Intercostal and diaphragmatic Succinylcholine causes paralysis of muscles including the intercostals and diaphragm, so artificial support of respiration is required to sustain life during the procedure. Inhibition of the biceps, triceps, facial, thoracic, sternocleidomastoid, and abdominal muscles is the purpose of the medication, not a disadvantage of it.
The nurse is administering an osmotic diuretic to a client with a traumatic brain injury. Which finding best indicates that the medication was effective? 250 mL clear, yellow urine output over four hours Clear bilateral lung sounds to posterior auscultation Intracranial pressure reading of 14 mmHg Bilateral ovoid pupils that are slow to constrict
Intracranial pressure reading of 14 mmHg Osmotic diuretics, such as mannitol, are used to reduce intracranial or intraocular pressure. Intracranial pressure (ICP) for a client with a head injury should be less than 20 mmHg and the osmotic diuretic may be administered to reduce a high ICP. The osmotic diuretic will reduce the amount of water normally reabsorbed by the renal tubules and loop of Henle, so urinary output is increased, which is an expected occurrence, but does not indicate effectiveness of the medication. Ovoid pupils may indicate the presence of cerebral hypertension. An osmotic diuretic is not intended to reduce pulmonary edema, thus clear lung sounds are not an indicator for effectiveness of the diuretic for this particular client.
Which medication therapy is indicated for management of Wernicke encephalopathy associated with Korsakoff syndrome? Traditional phenothiazines Judicious use of antipsychotics Intramuscular injections of thiamine Oral administration of chlorpromazine
Intramuscular injections of thiamine Thiamine is a coenzyme necessary for the production of energy from glucose. If thiamine is not present in adequate amounts, nerve activity is diminished and damage or degeneration of myelin sheaths occurs. A traditional phenothiazine is a neuroleptic antipsychotic that should not be prescribed because it is hepatotoxic. Antipsychotics must be avoided; their use has a higher risk of toxic side effects in older or debilitated persons. Chlorpromazine, a neuroleptic, cannot be used because it is severely toxic to the liver.
Which birth control agent requires administration once every 3 months? Progestin-only pills Intramuscular progestin Combination biphasic forms Combination monophasic forms
Intramuscular progestin Intramuscular progestin requires the administration of a single injection every 3 months. Progestin-only oral contraceptive pills should be taken on a daily basis because of a higher incidence of ovulatory cycles. Combination biphasic and monophasic forms are administered as either a 21- or 28-day course.
Which statements would the nurse include when teaching a client who is considering medroxyprogesterone injection as a form of hormonal birth control? Select all that apply. One, some, or all responses may be correct. It lasts for 3 months. It can cause nausea and vomiting. It contains both progestin and estrogen. It decreases the risk of age-related loss of bone density. Side effects include drowsiness or insomnia and depression. The most severe undesirable effects are liver dysfunction and thromboembolic disorders.
It lasts for 3 months. It can cause nausea and vomiting. Side effects include drowsiness or insomnia and depression. The most severe undesirable effects are liver dysfunction and thromboembolic disorders. Medroxyprogesterone does last for 3 months. It can cause nausea and vomiting, as well as lethargy or insomnia and depression, although the most undesirable severe effects are liver dysfunction and thromboembolic disorders, including thrombophlebitis, cerebrovascular disorder, pulmonary embolism, and retinal thrombosis. Medroxyprogesterone does not contain both progestin and estrogen; it is progestin-only. Medroxyprogesterone does not decrease the risk of age-related loss of bone density; in fact, it has a black-box warning because it can cause bone mineral density loss that puts women at higher risk for osteoporosis and bone fractures later in life.
A client who is a smoker expresses a desire to postpone her first pregnancy for at least 5 years and declines to use a barrier method. Which method would the nurse anticipate providing education for? A birth control patch A vaginal ring Medroxyprogesterone Combined oral contraceptive pills
Medroxyprogesterone Medroxyprogesterone is a long-acting progestin-only contraceptive that is less likely to cause cardiovascular problems in women who smoke than contraceptives containing estrogen might. Vaginal rings, combined oral contraceptive pills, and the birth control patch all contain estrogen and are not recommended for women who smoke.
A client who has a long history of medication and alcohol abuse mentions taking ginkgo biloba. Which condition is this client taking ginkgo biloba to treat? Insomnia Depression Memory impairment Anxiety and nervousness
Memory impairment 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.
Which body function maintained by thiamine (vitamin B 1) and niacin (vitamin B 3) will the nurse monitor when prescribed for a client with alcoholism? Neuronal activity Bowel elimination Efficient circulation Prothrombin development
Neuronal activity Thiamine and niacin help convert glucose for energy and influence nerve activity. These vitamins do not affect elimination. These vitamins are not related to circulatory activity. Vitamin K, not thiamine and niacin, is essential for the manufacturing of prothrombin.
A client taking oral contraceptives for 3 months tells the nurse she has breakthrough bleeding between menstrual cycles. For which causative factor would the nurse first assess in the client? Illness Anorexia nervosa Ectopic pregnancy Nonadherence to protocol
Nonadherence to protocol Nonadherence to the instructions for taking the oral contraceptive can alter hormone levels, and breakthrough bleeding may occur as a result. Illness and anorexia nervosa are more likely to cause amenorrhea, not breakthrough bleeding. If nonadherence is determined not to be a concern, then the nurse would assess for far less likely causes such as ectopic pregnancy.
The nurse is caring for a client with osteoporosis who has been prescribed alendronate. When providing care, which intervention would be a priority? Administer the alendronate 30 to 60 minutes before the client eats. Notify the health care provider if the client reports jaw pain Encourage the client to increase their intake of vitamin D. Monitor the client's serum calcium levels.
Notify the health care provider if the client reports jaw pain Alendronate is a bisphosphonate that helps slow down bone resorption, decreasing osteoporosis. Osteonecrosis of the jaw is a rare, adverse reaction to alendronate, and jaw pain can be a symptom of this. Therefore, notifying the health care provider of the jaw pain is the priority. The other interventions are also correct for a client with osteoporosis, but are not as important as reporting the potential adverse drug effect.
A client asks the nurse what she should do if she forgets to take her contraceptive pill 1 day. Which response by the nurse is appropriate? 'Take your pills as instructed.' 'Call your primary health care provider immediately.' 'Continue as usual, and there shouldn't be a problem.' 'On the next day take 1 pill in the morning and 1 pill before bedtime.'
On the next day take 1 pill in the morning and 1 pill before bedtime.' The client should make up for the missed pill by taking 2 pills the next day; taking 1 pill in the morning and 1 pill in the evening decreases the chance of the client becoming nauseated. Telling the client to take her pills as instructed does not explain what is to be done if a pill is missed; missing 1 pill can alter hormone levels and predispose the client to becoming pregnant. It is unnecessary to call the primary health care provider unless other problems are identified. Telling the client that there should be no problem if she continues as usual is incorrect advice; again, missing 1 pill can alter hormone levels and predispose a woman to pregnancy.
A client is concerned about taking hormones for birth control. Which contraceptives, explained to the client by the nurse, have a hormonal component? Select all that apply. One, some, or all responses may be correct. Oral contraceptives Diaphragm Cervical cap Female condom Foam spermicide Transdermal agents
Oral contraceptives Transdermal agents Oral contraceptives have a hormonal component. Transdermal agents have a hormonal component. The diaphragm, cervical cap, and female condom act as barriers. Foam spermicides kill the sperm; there is no hormonal effect.
A child is prescribed intravenous mannitol. The nurse understands mannitol belongs to which classification of diuretics? Loop Osmotic Potassium sparing Carbonic anhydrase inhibitor
Osmotic Osmotic diuretics, such as mannitol, increase the osmotic pressure of glomerular filtrate and thus decrease absorption of sodium; they are used to treat cerebral edema and increased intraocular pressure. Loop diuretics, such as furosemide, inhibit resorption of sodium and potassium in the loop of Henle; they are used for heart failure and pulmonary edema. Potassium-sparing diuretics, such as spironolactone, interfere with sodium resorption in the distal tubules, thus decreasing potassium excretion; they are used to treat cirrhotic ascites and pulmonary edema. Carbonic anhydrase inhibitors, such as acetazolamide, increase sodium excretion by decreasing sodium-hydrogen ion exchange. They are used to treat seizure disorders and open-angle glaucoma.
A health care provider prescribes teriparatide for a client with osteoporosis. Which statement about this medication would the nurse recognize as accurate? It requires increased intake of vitamin A. It prevents existing bone from being destroyed. Sunscreen should be used to prevent vitamin D absorption. Osteoblastic activity is stimulated more than osteoclastic activity.
Osteoblastic activity is stimulated more than osteoclastic activity. Teriparatide is a 34-amino acid polypeptide that represents the biologically active part of human parathyroid hormone; it enhances bone microarchitecture and increases bone mass and strength by stimulating activity by osteoblasts. Supplemental intake of vitamin A should not exceed recommended daily requirements; too much vitamin A has been associated with bone loss and an increased incidence of fractures. Alendronate sodium, a regulator of bone metabolism, not teriparatide, inhibits osteoclast-mediated bone resorption, minimizing bone destruction and loss of bone density. Sunscreen should be avoided to promote exposure to the sun so that vitamin D can be converted in the skin; vitamin D helps the body absorb calcium. Sunscreen should be used after 5 to 20 minutes of exposure to prevent the negative effects of prolonged exposure to ultraviolet rays.
Oral contraceptives are prescribed for a client who smokes heavily. Which side effect would the nurse warn the client might occur? Blood clots Cervical cancer Ovarian cancer Risk of coronary heart disease later in life
Ovarian cancer Heavy smoking is a major risk factor for an increased risk of thrombosis or blood clots. Cervical cancer is associated with human papillomavirus infection, not oral contraceptive use. Oral contraceptives have a protective effect against ovarian cancer. Although there is an increased risk of coronary heart disease while taking an oral contraceptive, this risk abates when it is no longer taken and does not carry over into later life.
Which condition contraindicates the use of ginseng herbal therapy? Pregnancy Schizophrenia Bipolar depression Alzheimer disease
Pregnancy Pregnancy is contraindicated for ginseng herbal therapy. Schizophrenia, bipolar depression, and Alzheimer disease are contraindicated for St. John's Wort herbal therapy.
A 25-year-old woman on estrogen therapy has a history of smoking. Which complication would the nurse anticipate in the client? Osteoporosis Hypermenorrhea Endometrial cancer Pulmonary embolism
Pulmonary embolism Estrogen therapy increases the risk of pulmonary embolism in clients who have a history of smoking because the medication affects blood circulation and hemostasis. Osteoporosis may be caused by reduced bone density observed in postmenopausal woman. Hypermenorrhea (excessive menstrual bleeding) is treated with estrogen therapy. Endometrial cancer is a complication of estrogen therapy seen in postmenopausal woman.
The nurse is caring for a client diagnosed with diabetic ketoacidosis who is receiving 50 mEq of sodium bicarbonate in 1 L of dextrose 5% in water via a central venous access device. The client has three new prescriptions for continuously infused medications. Which action is appropriate? Refer to an IV compatibility chart Request that an additional IV access be inserted Use a Y-site connector to infuse two medications in the same port Insert a peripheral intravenous access
Refer to an IV compatibility chart Sodium bicarbonate is incompatible with many other drugs and solutions. The nurse should consult a drug compatibility reference for more information on which drugs can be administered via connection at the most distal IV tubing port. Y tubing should not be added to an IV until compatibility is determined. Y tubing does not prevent the mixing of infusions. Adding an additional access may be unnecessary if compatibility is determined and may pose an unnecessary infection risk to the client. A central line is the preferred access for drugs that have a pH less than 5 and greater than 9. Certain drugs are venous irritants regardless of pH or concentration; therefore, a PIV would be inappropriate.
Which adverse effect will the nurse monitor for in a client who has been administered a neuromuscular blocking agent before electroconvulsive therapy? Seizures Vomiting Loss of memory Respiratory depression
Respiratory depression A neuromuscular blocker such as succinylcholine produces respiratory depression because it inhibits contractions of respiratory muscles. This medication does not cause seizures. Because the client is not permitted anything by mouth for 8 to 10 hours before the treatment, vomiting is not a major problem. The loss of memory results from the electroconvulsive therapy, not from the neuromuscular blocking agent.
Which physiological function is the last function lost during anesthesia induction? Gag reflex Eyelid reflexes Voluntary control Respiratory movement
Respiratory movement There is no respiratory movement in stage 4 of anesthesia; before this stage, respirations are depressed but present. The gag reflex is lost in stage 3 of anesthesia. Eyelid reflexes are lost in stage 2 of anesthesia. Voluntary control is lost in stage 2 of anesthesia.
A client who takes daily megadoses of vitamins is hospitalized with joint pain, loss of hair, yellow pigmentation of the skin, and an enlarged liver due to vitamin toxicity. Which type of toxicity would the nurse suspect? Retinol (vitamin A) Thiamine (vitamin B 1) Pyridoxine (vitamin B 6) Ascorbic acid (vitamin C)
Retinol (vitamin A) Retinol is lipid soluble and eliminated by the liver. Joint pain, hair loss, jaundice, anemia, irritability, pruritus, and enlarged liver and spleen are signs of vitamin A toxicity. Thiamine, pyridoxine, and ascorbic acid are water soluble, so they are typically excreted in the urine before toxic blood levels can be achieved. However, excess thiamine may elicit an allergic reaction in some individuals, excess vitamin C (ascorbic acid) may cause diarrhea or renal calculi, and ultrahigh doses (about 800 times the normal dose) of pyridoxine (vitamin B 6) can promote neuropathy. Remember that lipid-soluble vitamins normally take longer to eliminate and accumulate faster than water-soluble vitamins.
Which complication will occur as the result of administering sildenafil to a client who takes isosorbide dinitrate? Constipation Protracted vomiting Respiratory distress Severe hypotension
Severe hypotension Concurrent use of sildenafil and a nitrate, which causes vasodilation, may result in severe, potentially fatal hypotension. Protracted vomiting and respiratory distress are not medication interaction effects associated with concurrent use of sildenafil and a nitrate. Sildenafil may cause diarrhea; adding a nitrate will not cause constipation.
Which responses would the nurse offer a client who asks whether she should take soy supplements to decrease menopausal symptoms and improve bone density? Select all that apply. One, some, or all responses may be correct. These supplements can cause high cholesterol. Estrasorb is applied like a lotion but can't transfer to men. Soy supplements might interfere with thyroid hormone absorption. These products have fewer contraindications than other estrogen products. Some women have reported nausea, bloating, diarrhea, and abdominal pain.
Soy supplements might interfere with thyroid hormone absorption. Some women have reported nausea, bloating, diarrhea, and abdominal pain. It is true that soy supplements might affect thyroid function and that some women have reported mild stomach and gastrointestinal side effects such as constipation, bloating, nausea, diarrhea, and abdominal pain. It is not accurate to say that soy supplements can raise cholesterol levels; in fact, they are commonly used to reduce blood lipids. Estrasorb is applied like a lotion but can transfer to men and increase their estradiol levels. It is a common misconception that 'natural' products such as soy have fewer contraindications than other products; in fact, they have many of the same contraindications and are not necessarily a safer alternative to traditional medications.
A primary health care provider prescribes venlafaxine for a client with a diagnosis of major depressive disorder who has been taking herbal medications. Which herbal supplement is contraindicated when taking venlafaxine? Ginseng Valerian Kava-kava St. John's wort
St. John's wort A client who takes venlafaxine, a selective serotonin reuptake inhibitor, and St. John's wort concurrently is at risk for serotonin syndrome, a medication-induced excess of intrasynaptic serotonin. Ginseng can precipitate a hypertensive crisis in clients taking a monoamine oxidase inhibitor. Valerian (valerian root) can enhance sedation in clients taking a tricyclic antidepressant. Kava-kava can increase the risk of dystonic reactions in clients taking an antipsychotic medication.
A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has completed discharge teaching regarding medication administration. Which morning schedule would indicate to the nurse that the client teaching has been effective? A. Take medication, go for a 30 minute morning walk, then eat breakfast. B. Take medication, rest in bed for 30 minutes, eat breakfast, go for morning walk. C. Take medication with breakfast, then take a 30 minute morning walk. D. Go for a 30 minute morning walk, eat breakfast, then take medication.
Take medication, go for a 30 minute morning walk, then eat breakfast. Alendronate (Fosamax) is best absorbed when taken thirty minutes before eating in the morning. The client should also be advised to remain in an upright position for at least thirty minutes after taking the medication to reduce the risk of esophageal reflux and irritation.
Which action by a client taking alendronate requires correction? Select all that apply. One, some, or all responses may be correct. Taking medication twice a week Taking medication before rising Taking medication with breakfast Taking medication before bedtime Taking medication with apple juice
Taking medication twice a week Taking medication before rising Taking medication with breakfast Taking medication before bedtime Taking medication with apple juice Bisphosphonates such as alendronate have specific dosing instructions. The medication is given once a week. Clients must remain in an upright position for 30 minutes after taking the medication. Clients should refrain from eating right before they are given the medication and should take it with a full glass of water because of the risk for esophagitis. Alendronate must be administered in the morning. Clients should take the medication with water.
Which points would the nurse include when counseling a woman on hormone therapy? Select all that apply. One, some, or all responses may be correct. The client should use appropriate sun protection. The client should monitor any deviations in body weight. The client should take the medication on an empty stomach. The client should discontinue the medication if adverse effects occur. The client should alternate the time of day the medication is taken.
The client should use appropriate sun protection. The client should monitor any deviations in body weight. Appropriate sun protection should be used because hormones make people sensitive to sunlight. The client's body weight should be monitored during hormonal therapy because abnormal bleeding can lead to weight loss and serious complications. Hormonal medications should be taken with food to reduce gastrointestinal upset. The client should report any side effects to the primary health care provider and seek his or her advice. Hormonal therapy should never be discontinued without the knowledge of the primary health care provider. Oral medications should be administered at the same time every day to maintain the appropriate concentration of serum medication levels.
The nurse is educating a client with end-stage renal failure about newly prescribed aluminum hydroxide. Which statement should the nurse include in the teaching? "This medication binds with phosphates from food to decrease absorption" "This medication is used to decrease urea to prevent urticaria." "This medication will coat the lining of the stomach to decrease acid production." "This medication treats hyperkalemia by exchanging sodium for potassium in the intestines."
This medication binds with phosphates from food to decrease absorption Hyperphosphatemia occurs in end-stage renal failure when kidneys can no longer filter out phosphorus. Treatment of hyperphosphatemia may include the administration of aluminum hydroxide as a phosphate-binding agent. The aluminum binds with phosphates which are excreted in the feces. Sodium polystyrene is used to treat hyperkalemia by exchanging sodium for potassium in the intestines. Dialysis is used to remove urea from the blood, and diphenhydramine is used to treat urticaria. Sucralfate is a medication that coats the stomach lining to decrease acid production.
A client who has a habit of smoking is on estrogen therapy. Which condition is the client at most risk of developing? Thrombosis Gastrointestinal upset Risk of developing cancer Decreased effectiveness of estrogen
Thrombosis Smoking along with estrogen therapy may increase the risk of thrombosis. Estrogen taken on an empty stomach may cause gastrointestinal upset. Estrogen is not prescribed to clients with endometrial or breast cancer. The effectiveness of estrogen decreases with the use of anticoagulants, rifampicin, and St. John wort.
A client has primary open-angle glaucoma. Which ophthalmic preparation is indicated to manage this condition? Tetracaine Fluorescein Timolol maleate Atropine sulfate
Timolol maleate Timolol maleate is a beta-adrenergic antagonist that decreases aqueous humor production and increases outflow, thereby reducing intraocular pressure. Tetracaine is a topical anesthetic; it will not reduce the increased intraocular pressure associated with glaucoma. Fluorescein is a dye used to identify corneal abrasions and foreign bodies. Atropine sulfate, a mydriatic, is contraindicated because it dilates the pupil, obstructing drainage and increasing intraocular pressure
Which assessment would the nurse perform specific to the safe administration of intravenous mannitol? Body weight daily Urine output hourly Vital signs every 2 hours Level of consciousness every 8 hours
Urine output hourly Mannitol, an osmotic diuretic, increases the intravascular volume that must be excreted by the kidneys. The client's urine output should be monitored hourly to determine the client's response to therapy. Although mannitol results in an increase in urinary excretion that is reflected in a decrease in body weight (1 L of fluid is equal to 2.2 pounds [1 kg]), a daily assessment of the client's weight is too infrequent to assess the client's response to therapy. Urine output can be monitored hourly and is a more frequent, accurate, and efficient assessment than is a daily weight. Vital signs should be monitored every hour considering the severity of the client's injury and the administration of mannitol. Although the level of consciousness should be monitored with a head injury, conducting assessments every 8 hours is too infrequent to monitor the client's response to therapy.
A woman questions the nurse about the effectiveness of oral contraceptives. Which important factor about the effectiveness of oral contraceptives would the nurse include in the response? User motivation Simplicity of use Reliability record Identified risk factors
User motivation Conception will not be prevented unless the user is motivated to use the method correctly and consistently. No matter how simple, the method must be used consistently. Reliability record is not relevant if the method is not used correctly and consistently by the woman. Risk factors have little influence on the effectiveness of the contraceptive method.
Which medication is indicated for emergency treatment of bleeding esophageal varices? Vasopressin Neostigmine Lansoprazole Phytonadione
Vasopressin Vasopressin is a vasoconstrictor that can be used to control gastrointestinal bleeding. Neostigmine inhibits cholinesterase, permitting acetylcholine to function; it is used primarily for myasthenia gravis. Lansoprazole is a proton pump inhibitor that is used for the treatment of gastric and duodenal ulcers. Phytonadione is vitamin K; it promotes formation of prothrombin in the liver. Although this medication may be helpful, its effects take too long to be of value in an emergency situation.
Which supplement would the nurse instruct a client taking oral contraceptives to increase? Calcium Vitamin C Vitamin E Potassium
Vitamin C Oral contraceptives can affect the metabolism of certain vitamins, particularly vitamin C, and supplementation may be required. It is unnecessary to increase the intake of calcium when one is taking oral contraceptives. There is no clinical evidence linking oral contraceptives with a deficiency of vitamin E. There is no interrelationship between oral contraceptives and dietary intake of potassium.
A thin 24-year-old woman who runs 10 miles each week asks the nurse for advice about preventing osteoporosis. Which vitamin would the nurse recommend? Vitamin E Vitamin B Vitamin D Vitamin C
Vitamin D All women, except those who are pregnant or lactating, should ingest between 1000 and 1300 mg of calcium daily; if the client is unable to ingest enough calcium in food, supplements of calcium and vitamin D are recommended. Vitamin C helps maintain cartilage and connective tissue integrity but does not help prevent osteoporosis. Vitamins E and B do not help prevent osteoporosis.
Which prescription would the nurse anticipate for the client who takes a medication that interferes with fat absorption? High-fat diet Supplemental cod liver oil Total parenteral nutrition (TPN) Water-miscible forms of vitamins A and E
Water-miscible forms of vitamins A and E Vitamins A, D, E, and K are known as fat-soluble vitamins because bile salts and other fat-related compounds aid their absorption. A high-fat diet will not achieve the uptake of fat-soluble vitamins in this client. Supplemental cod liver oil will not achieve the uptake of fat-soluble vitamins in this client. TPN is unnecessary; a well-balanced diet is preferred. Water-miscible forms of vitamins A and E can be absorbed with water-soluble nutrients.
Which item will the nurse teach a client who has had an excision of a thrombosed external hemorrhoid to use when cleaning the anus after a bowel movement? Betadine pads Soft facial tissue Witch hazel-moistened pads Sterile 4 × 4-inch (10 × 10 cm) pads
Witch hazel-moistened pads Witch hazel-moistened pads are not irritating and are soothing to the anal mucosa. Betadine may cause excessive drying and irritation. The rectum always is contaminated; external cleansing with Betadine will not appreciably affect the bacteria present. Dry facial tissue is irritating and can cause trauma. Sterile gauze pads are unnecessary; the rectal area is considered contaminated.
A breast-feeding mother asks the nurse if the use of herbal medicines will increase breast milk supply. Which nursing response is most appropriate? 'It may be safe if taken with lots of water.' 'It does not effectively increase breast milk supply.' 'It may cause iron deficiency anemia in the infant.' 'You should speak to your health care provider about this.'
You should speak to your health care provider about this.' The use of herbs may increase breast milk supply, but research is limited, so the mother should consult with her health care provider. The herbs are safe for the mother with or without water. However, the priority in this case is to inform the parent of the adverse effects that can result in the infant. Early introduction of solids may increase the risk for iron deficiency anemia in the infant. The herbs increase breast milk supply.
