NCLEX Saunders Pharmacology

The nurse is assisting in administering immunizations as well as providing education to the clients who receive them at a health care clinic. Which statement by a client indicates that teaching was successful? "Immunizations protect against all diseases." "Immunizations can provide natural immunity." "Immunizations can provide innate immunity." "Immunizations are a way to acquire immunity to a specific disease."

"Immunizations are a way to acquire immunity to a specific disease." Acquired immunity is immunity that can occur by receiving an immunization that causes antibodies to a specific pathogen to form. No immunization protects the client from all diseases. Natural (innate) immunity is present at birth.

Calcium carbonate is prescribed for a client with hypocalcemia. How should the nurse instruct the client to take the medication? With meals Every 4 hours Just before meals 1 hour after meals

1 hour after meals Calcium carbonate tablets should be taken with a full glass of water 30 to 60 minutes after meals; therefore, the remaining options are incorrect.

A client with myasthenia gravis has difficulty chewing and has received a prescription for pyridostigmine. The nurse should check to see that the client takes the medication at what time? With meals Between meals Just after meals 30 minutes before meals

30 minutes before meals Pyridostigmine is a cholinergic medication used to increase muscle strength in the client with myasthenia gravis. For the client who has difficulty chewing, the medication should be administered 30 minutes before meals to enhance the client's ability to eat. The times noted in the remaining options will not be helpful to the client.

A client reports frequent use of acetaminophen for relief of headaches and other discomforts. The nurse should evaluate which diagnostic data to determine if the client is at risk for toxicity? Chest x-ray Electrocardiogram Liver function studies Upper gastrointestinal x-ray results

Liver function studies In adults, overdose of acetaminophen causes liver damage. In addition, clients with liver disorders are at a higher risk of experiencing hepatotoxicity with chronic acetaminophen use. Options 1, 2, and 4 are not associated with acetaminophen overdose.

A client is taking trihexyphenidyl hydrochloride. The nurse should assess for which side or adverse effect of this medication? Diarrhea Urinary retention Urinary incontinence Excessive perspiration

Urinary retention Trihexyphenidyl is an anticholinergic medication used for the treatment of Parkinson's disease. Therefore, it can cause urinary hesitancy and retention, constipation, dry mouth, and decreased sweating.

A female client with carcinoma of the breast is admitted to the hospital for treatment with intravenously administered doxorubicin. The client tells the nurse that she has been told by her friends that she is going to lose all her hair. What is the most appropriate nursing response? "Your friends are correct." "You will not lose your hair." "Hair loss may occur, but it will grow back just as it is now." "Hair loss may occur, and it will grow back, but it may have a different color or texture."

"Hair loss may occur, and it will grow back, but it may have a different color or texture." Alopecia (hair loss) can occur after the administration of many antineoplastic medications. Alopecia is reversible, but the new hair growth may have a different color and texture. Therefore, options 1, 2, and 3 are incorrect.

On admission the client tells the nurse that sumatriptan is prescribed. Based on this information, which question should the nurse ask the client? "Do you have frequent earaches?" "Do you experience sinus headaches?" "Have you had migraine headaches?" "Are you allergic to pollen or molds?"

"Have you had migraine headaches?" Sumatriptan is used to treat migraine headaches. This medication constricts blood vessels around the brain and reduces substances in the body that can trigger headache pain. Sinus earaches, headaches, and allergies to pollen or mold are not treated with this medication.

The nurse teaches a client newly diagnosed with type 1 diabetes about storing Humulin N insulin. Which statement indicates to the nurse that the client understood the discharge teaching? ."I should keep the insulin in the cabinet during the day only." "I know I have to keep my insulin in the refrigerator at all times." "I can store the open insulin bottle in the kitchen cabinet for 1 month." "The best place for my insulin is on the window sill, but in the cupboard is just as good."

"I can store the open insulin bottle in the kitchen cabinet for 1 month." An insulin vial in current use can be kept at room temperature for 1 month without significant loss of activity. Direct sunlight and heat must be avoided. Therefore, options 1, 2, and 4 are incorrect.

The nurse has completed giving medication instructions to a client receiving benazepril. Which client statement indicates to the nurse that the client needs further instruction? "I need to change positions slowly." "I will monitor my blood pressure every week." "I will report signs and symptoms of infection immediately." "I can use salt substitutes freely and eat foods high in potassium."

"I can use salt substitutes freely and eat foods high in potassium." The client taking an angiotensin-converting enzyme (ACE) inhibitor is instructed to take the medication exactly as prescribed, to monitor blood pressure weekly, and to continue with other lifestyle changes to control hypertension. The client should change positions slowly to avoid orthostatic hypotension and report fever, mouth sores, or sore throat (neutropenia) to the health care provider. In addition, salt substitutes and high-potassium foods should be avoided because they contain potassium and increase the risk for hyperkalemia.

The nurse has a routine prescription to administer an injection of phytonadione (vitamin K) to the newborn. Which statement made by the new mother indicates that teaching on this medication was effective? "I know that this medication is used to stimulate the liver to produce vitamin K." "I know that this medication is used to prevent clotting abnormalities in the newborn." "I know that this medication is used to prevent vitamin deficiency of fat-soluble vitamins." "I know that this medication is used to supplement my baby because breast milk and formula are low in vitamin K."

"I know that this medication is used to prevent clotting abnormalities in the newborn." Vitamin K is given to the newborn to prevent clotting abnormalities. Vitamin K is usually produced by bacteria in the gastrointestinal tract, which is sterile in the newborn. The other options are incorrect reasons for administering this medication to a newborn.

The nurse asks a nursing student to describe the procedure for administering erythromycin ointment to the eyes of a newborn. Which student statement indicates that further teaching is needed about administration of the eye medication? "I will flush the eyes after instilling the ointment." "I will clean the newborn's eyes before instilling ointment." "I need to administer the eye ointment within 1 hour after delivery." "I will instill the eye ointment into each of the newborn's conjunctival sacs."

"I will flush the eyes after instilling the ointment." Eye prophylaxis protects the newborn against Neisseria gonorrhoeae and Chlamydia trachomatis. The eyes are not flushed after instillation of the medication because the flush would wash away the administered medication. Options 2, 3, and 4 are correct statements regarding the procedure for administering eye medication to the newborn.

A client with a prescription to take theophylline daily has been given medication instructions by the nurse. What statement by the client indicates the need for further education regarding the prescription? "I will take the daily dose at bedtime." "I need to drink at least 2 liters of fluid per day." "I know to avoid changing brands of the medication without my primary health care provider's approval." "I'll avoid over-the-counter cough and cold medications unless approved by my health care provider."

"I will take the daily dose at bedtime." The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. In addition, this medication causes insomnia. The client should take in at least 2 L of fluid per day to decrease viscosity of secretions. The client should check with the primary health care provider (PHCP) before changing brands of the medication because levels of bioavailability may vary for different preparations. The client also should check with the PHCP before taking over-the-counter cough, cold, or other respiratory preparations because they could have interactive effects, increasing the side and adverse effects of theophylline and causing dysrhythmias.

The nurse teaches a client about the effects of diphenhydramine, which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction if the client makes which statement? "I will take the medication on an empty stomach." "I won't drink alcohol while taking this medication." "I won't do activities that require mental alertness while taking this medication." "I will use sugarless gum, candy, or oral rinses to decrease dryness in my mouth."

"I will take the medication on an empty stomach." Diphenhydramine has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Instructions for use include taking with food or milk to decrease gastrointestinal upset and using oral rinses, sugarless gum, or hard candy to minimize dry mouth. Because the medication causes drowsiness, the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities requiring mental awareness during use.

The home health care nurse is visiting a client with coronary artery disease with elevated triglyceride levels and a serum cholesterol level of 398 mmol/L). The client is taking cholestyramine, and the nurse teaches the client about the medication. Which statement by the client indicates the need for further teaching? "Constipation and bloating might be a problem." "I'll continue to watch my diet and reduce my fats." "Walking a mile each day will help the whole process." "I'll continue my nicotinic acid from the health food store."

"I'll continue my nicotinic acid from the health food store." Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin needs to be avoided. Constipation and bloating are the 2 most common adverse effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

A client is prescribed imipramine once daily. The nurse determines that additional teaching is needed on the basis of which statement by the client? "I need to avoid alcohol while taking this medication." "I'll take the medication in the morning before breakfast." "I won't notice any medication effects for at least 2 weeks." "I'll be sure to take a missed medication dose as soon as possible unless it is almost time for the next dose."

"I'll take the medication in the morning before breakfast." Imipramine is a tricyclic antidepressant. The client should be instructed to take a single daily dose of the medication at bedtime, not in the morning, because of its side effect of sedation. The client should avoid alcohol or other central nervous system depressants during therapy. The medication effects may not be noticed for at least 2 weeks. The client should take the medication exactly as directed, but if a dose is missed the client should take it as soon as possible unless it is almost time for another dose.

The nurse provides instructions to the client about nicotinic acid prescribed for hyperlipidemia. Which statement by the client indicates understanding of the instructions? "The medication should be taken with meals to decrease flushing." "It is not necessary to avoid the use of alcohol when taking nicotinic acid." "Clay-colored stools are a common side effect and should not be of concern." "Ibuprofen taken 30 minutes before the nicotinic acid may decrease the flushing."

"Ibuprofen taken 30 minutes before the nicotinic acid may decrease the flushing." Flushing is an adverse effect of this medication. Aspirin or a nonsteroidal antiinflammatory drug, as prescribed, can be taken 30 minutes prior to taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this effect. The medication should be taken with meals to decrease gastrointestinal upset; however, taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be reported to the primary health care provider (PHCP) immediately.

Minoxidil is prescribed for a client to treat hair loss. The client asks the nurse if the hair will continue to grow when the medication is stopped. What is the appropriate nursing response? "The hair will continue to grow." "Newly gained hair is lost in 3 to 4 months." "It depends on how long you have been taking the medication." "I'm not sure-you need to ask your primary health care provider."

"Newly gained hair is lost in 3 to 4 months." Hair regrowth with the use of minoxidil is most likely to occur when baldness has developed recently and has been limited to a small area. Benefits of the medication take several months. On discontinuation of the medication, newly gained hair is lost in 3 to 4 months, and the natural progression of hair loss resumes. Options 1 and 3 are incorrect. Option 3 places the client's question on hold and is inappropriate.

A client with glaucoma is receiving acetazolamide. The nurse educator provides education to a group of nurses about the indications for and effect of this medication. Which statement by one of the nurses indicates that the teaching has been effective? "This works to prevent hypertension." "This works to prevent hyperthermia." "This works to decrease intraocular pressure." "This works to maintain an adequate blood pressure for cerebral perfusion."

"This works to decrease intraocular pressure." Acetazolamide is a carbonic-anhydrase inhibitor used to treat glaucoma. The medication decreases the formation of aqueous humor. The statements in the remaining options are not indicative of the purpose of this medication.

A client has begun taking a stimulant laxative. In monitoring the client for medication side and adverse effects, the nurse is likely to note which finding? Abdominal cramps Peptic ulcer disease Gastrointestinal bleeding Partial bowel obstruction

Abdominal cramps A stimulant laxative causes nausea and abdominal cramps as the most frequent side effects. The incorrect options represent health problems that are not caused by this medication.

The nurse is caring for a client in the emergency department who has been diagnosed with Bell's palsy. The client has been taking acetaminophen, and acetaminophen overdose is suspected. Which antidote should the nurse prepare for administration if prescribed? Pentostatin Auranofin Fludarabine Acetylcysteine

Acetylcysteine The antidote for acetaminophen is acetylcysteine. The normal therapeutic serum level of acetaminophen is 10 to 20 mcg/mL. A toxic level is higher than 50 mcg/mL, and levels higher than 200 mcg/mL 4 hours after ingestion indicates that there is risk for liver damage. Auranofin is a gold preparation that may be used to treat rheumatoid arthritis. Pentostatin and fludarabine are antineoplastic agents.

A client was just admitted to the hospital to rule out a gastrointestinal (GI) bleed. The client has brought several bottles of medications prescribed by different specialists. During the admission assessment, the client states, "Lately, I have been hearing some roaring sounds in my ears, especially when I am alone." Which medication would the nurse identify as the cause of the client's complaint? Doxycycline Atropine sulfate Acetylsalicylic acid Diltiazem hydrochloride

Acetylsalicylic acid Aspirin (acetylsalicylic acid) is contraindicated for GI bleeding and is potentially ototoxic. The client should be advised to notify the prescribing primary health care provider so the medication can be discontinued and/or a substitute that is less toxic to the ear can be taken instead. Options 1, 2, and 4 do not have effects that are potentially associated with hearing difficulties.

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Following diagnostic studies, hypothyroidism is diagnosed and levothyroxine is prescribed. The nurse informs the client that which is the expected outcome of the medication? Alleviate depression. Increase energy levels. Increase blood glucose levels. Achieve normal thyroid hormone levels.

Achieve normal thyroid hormone levels. Laboratory determinations of the serum thyroid-stimulating hormone (TSH) level are an important means of evaluation. Successful therapy will cause elevated TSH levels to fall. These levels will begin their decline within hours of the onset of therapy and will continue to drop as plasma levels of thyroid hormone build up. If an adequate dosage is administered, TSH levels will remain suppressed for the duration of therapy. Although energy levels may increase, this occurs as a result of achievement of the normal thyroid hormone levels. Alleviation of depression and increased blood glucose levels are not expected outcomes.

Dantrolene sodium is prescribed for the client experiencing flexor spasms. The client asks the nurse how the medication is going to help. The nurse replies that this medication acts in which way? Depresses the spinal reflexes causing the spasms Acts on the central nervous system to suppress spasms Acts directly on the skeletal muscle to relieve the spasms Acts within the spinal cord to suppress excess reflex activity

Acts directly on the skeletal muscle to relieve the spasms Dantrolene sodium acts directly on skeletal muscle to relieve muscle spasticity. The primary action is the suppression of calcium release from the sarcoplasmic reticulum. This in turn decreases the ability of the skeletal muscle to contract. The other options are incorrect actions.

The client has a prescription to receive pirbuterol 2 puffs and beclomethasone dipropionate 2 puffs by metered-dose inhaler. The nurse plans to give these medications in which way to ensure effectiveness? Administering the pirbuterol before the beclomethasone Alternating a single puff of each hourly, beginning with the beclomethasone Alternating a single puff of beclomethasone with pirbuterol, repeating the steps Administering the pirbuterol, waiting 30 minutes, and administering the beclomethasone

Administering the pirbuterol before the beclomethasone Pirbuterol is a bronchodilator. Beclomethasone is a glucocorticoid. Bronchodilators are administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

Which clients can safely receive lindane? Select all that apply. An 89-year-old client with dementia A 32-year-old client with renal stones A 6-year-old child with a fractured arm A 42-year-old woman with osteoporosis A 52-year-old man with hypertension and high cholesterol

An 89-year-old client with dementia A 32-year-old client with renal stones A 42-year-old woman with osteoporosis A 52-year-old man with hypertension and high cholesterol Lindane can penetrate intact skin and cause seizures if absorbed in sufficient quantities. Clients at highest risk for seizures are premature infants, children, and those with preexisting seizure disorders. Lindane should not be used on pediatric clients unless safer medications have failed to control the infestation.

The nurse notes a persistent, dry cough in an adult client being seen in the ambulatory clinic. When questioned, the client states that the cough began approximately 2 months ago. On further assessment, the nurse learns that the client began taking quinapril shortly before the time that the cough began. How should the nurse interpret the development of the cough? An early indication of heart failure Caused by neutropenia as a result of therapy Caused by a concurrent upper respiratory infection An expected although bothersome side effect of therapy

An expected although bothersome side effect of therapy A frequent side effect of therapy with any angiotensin-converting enzyme (ACE) inhibitor, including quinapril, is a persistent, dry cough. In general, the cough does not resolve during the course of medication therapy, so clients should be advised to notify the primary health care provider if the cough becomes very troublesome. The other options are incorrect.

A client with diabetes mellitus taking daily NPH insulin has been started on therapy with dexamethasone. The nurse anticipates that which adjustments in medication dosage will be made? An increased dose of NPH insulin A change to oral diabetic medications A lower dose of dexamethasone than usual An increase in the amount of daily dietary calories

An increased dose of NPH insulin Dexamethasone is a glucocorticoid (corticosteroid) and therefore can elevate the blood glucose level. Diabetic clients may need their dosage of insulin or oral hypoglycemic medications increased during glucocorticoid therapy. This is most often a temporary change, needed to compensate for the actions of the medication. The client would not change to an oral diabetic medication if taking daily insulin. Additional calories would not be required. The client would not take a lower dose of dexamethasone than usual to compensate.

A hospitalized client with coronary artery disease complains of substernal chest pain. After assessing the client's heart rate and blood pressure, the nurse administers nitroglycerin, 0.4 mg sublingually. After 5 minutes the client states, "My chest still hurts." Which actions should the nurse take? Select all that apply. Call a Code Blue. Contact the client's family. Assess the client's pain level. Check the client's blood pressure. Contact the primary health care provider (PHCP). Administer a second nitroglycerin, 0.4 mg sublingually.

Assess the client's pain level. Check the client's blood pressure. Administer a second nitroglycerin, 0.4 mg sublingually. The usual guidelines for administering nitroglycerin tablets for chest pain to a hospitalized client include administering 1 tablet every 5 minutes PRN (as needed) for chest pain, for a total dose of 3 tablets. If the client does not obtain relief after taking a third dose of nitroglycerin, the PHCP is notified. Because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would assess the client's pain level and check the client's blood pressure before administering each nitroglycerin dose. There are no data in the question that indicate the need to call a Code Blue. In addition, it is not necessary to contact the client's family unless he or she has requested this.

A client in the postpartum care unit who is recovering from disseminated intravascular coagulopathy is to be discharged on low dosages of an anticoagulant medication. In developing home care instructions for this client, the nurse should include which priority safety instruction regarding this medication? Avoid brushing the teeth. Avoid taking acetylsalicylic acid (aspirin). Avoid walking long distances and climbing stairs. Avoid all activities because bruising injuries can occur.

Avoid taking acetylsalicylic acid (aspirin). Aspirin can interact with the anticoagulant medication to increase clotting time beyond therapeutic ranges. Avoiding aspirin is a priority. The client does not need to avoid brushing the teeth; however, the client should be instructed to use a soft toothbrush. Walking and climbing stairs are acceptable activities. Not all activities need to be avoided.

The nurse is preparing discharge instructions for a client who sustained a skeletal muscle injury and is receiving baclofen. Which instruction should be included in the teaching plan? Restrict fluid intake. Avoid the use of alcohol. Stop the medication if diarrhea occurs. Notify the primary health care provider (PHCP) if fatigue occurs.

Avoid the use of alcohol. Baclofen is a skeletal muscle relaxant. The client should be cautioned against the use of alcohol and other central nervous system depressants, because baclofen potentiates the depressant activity of these agents. Constipation, rather than diarrhea, is a side effect. Restriction of fluids is not necessary, but the client should be warned that urinary retention can occur. Fatigue is related to a central nervous system effect that is most intense during the early phase of therapy and diminishes with continued medication use. The client does not need to notify the PHCP about fatigue.

The nurse is applying a topical corticosteroid to a client with eczema. The nurse understands that it is safe to apply the medication to which body areas? Select all that apply. Back Axilla Eyelids Soles of the feet Palms of the hands

Back Soles of the feet Palms of the hands Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions where permeability is poor (back, palms, soles). The nurse should avoid areas of higher absorption to prevent systemic absorption.

The nurse is preparing to administer pentamidine to an assigned client by the intravenous route. The nurse plans to monitor which item mostclosely after administering this medication? Capillary refill Peripheral pulses Blood pressure (BP) Level of consciousness

Blood pressure (BP) Pentamidine is an anti-infective medication. Life-threatening and fatal hypotension can occur after the administration of pentamidine. The client must be in a supine position with frequent BP checks after administration. The remaining options are not associated with the administration of this medication.

Blood work has been drawn on a client who has been taking cyclosporine following allogenic liver transplantation. The nurse should check the results of which test to determine the presence of an adverse effect related to this medication? Hematocrit level Cholesterol level Hemoglobin level Blood urea nitrogen (BUN) level

Blood urea nitrogen (BUN) level Cyclosporine is an immunosuppressant. Nephrotoxicity is one of the most common adverse effects of cyclosporine. Nephrotoxicity is evaluated by monitoring the BUN and creatinine levels. The laboratory tests in the remaining options are unrelated to the adverse effects associated with the administration of this medication.

The primary health care provider (PHCP) writes a prescription for carbamazepine for a client who was admitted to the hospital. The nurse contacts the PHCP to verify the prescription if which condition is noted in the assessment data? Hypertension Tonic-clonic seizures Trigeminal neuralgia Bone marrow depression

Bone marrow depression Carbamazepine is classified as an iminostilbene derivative and is used as an anticonvulsant, antineuralgic, antimanic, and antipsychotic. It is used to treat seizure disorders, trigeminal neuralgia, and diabetic neuropathy. The medication can cause blood dyscrasias as an adverse effect and is contraindicated if the client has a history of bone marrow depression, hypersensitivity to tricyclic antidepressants, or concurrent use of monoamine oxidase inhibitors.

A client has developed paroxysmal nocturnal dyspnea. Which medication should the nurse anticipate will be prescribed by the primary health care provider? Bumetanide Amiodarone Propranolol Streptokinase

Bumetanide Bumetanide is a diuretic. The paroxysmal nocturnal dyspnea may be caused by increased venous return when the client is lying in bed, and the client needs diuresis. Amiodarone is an antidysrhythmic, Propranolol is a beta blocker, and streptokinase is a thrombolytic.

A client has been started on long-term therapy with rifampin. The nurse should provide which information to the client about the medication? Should always be taken with food or antacids Should be double-dosed if 1 dose is forgotten Causes orange discoloration of sweat, tears, urine, and feces May be discontinued independently if symptoms are gone in 3 months

Causes orange discoloration of sweat, tears, urine, and feces Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses permanently. Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a primary health care provider. It is best to administer the medication on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication.

A client taking rifampin reports, "My urine has blood in it." When the nurse assesses the urine, it is brown. Which is the nurse's best action? Notify the primary health care provider (PHCP). Chart the finding as a normal response to the rifampin. Immediately start prescribed intravenous (IV) fluids to prevent shock. Get the client into bed, and put the bed in modified Trendelenburg's position.

Chart the finding as a normal response to the rifampin. Brown-tinged urine is a normal finding associated with rifampin; thus, there is no need to notify the PHCP. There is no indication that the client is in shock, so eliminate the options that indicate to start prescribed IV fluids and to place the client in modified Trendelenburg's position. The nurse should also inform the client that his is a harmless side effect.

Atenolol hydrochloride is prescribed for a hospitalized client. The nurse should perform which action as a priority before administering this medication? Listen to the client's lung sounds. Check the client's blood pressure. Assess the client for muscle weakness. Check the client's most recent electrolyte levels.

Check the client's blood pressure. Atenolol hydrochloride is a beta blocker that is used to treat hypertension. Therefore, the priority nursing action before administration of the medication is to check the client's blood pressure. The nurse also checks the client's apical heart rate. If the systolic blood pressure is lower than 90 mm Hg or the apical pulse is 60 beats/min or slower, the medication is withheld and the primary health care provider is notified. The nurse checks baseline renal and liver function tests. The medication can cause weakness, and the nurse would assist the client if weakness with activities occurs.

The nurse is giving the client directions for proper use of aluminum hydroxide tablets. What should the nurse tell the client? Swallow the tablets whole with a full glass of water. Take the tablets at the same time as other medications. Take each dose with a laxative to prevent constipation. Chew the tablets thoroughly and follow with 4 oz of water.

Chew the tablets thoroughly and follow with 4 oz of water. Aluminum hydroxide tablets should be chewed thoroughly before swallowing. This prevents them from entering the small intestine undissolved. They should not be swallowed whole. Antacids should be taken at least 1 hour apart from other medications to prevent interactive effects. Constipation is a side effect of the use of aluminum products, but it is not correct for the client to take a laxative with each dose. This promotes laxative abuse. The client should first try other means to prevent constipation.

A client has begun therapy with a xanthine bronchodilator. The nurse determines that the client understands dietary alterations if the client states to limit which items while taking this medication? Select all that apply Milk Coffee Oysters Oranges Pineapple Chocolate

Coffee Chocolate The nurse teaches the client to limit the intake of xanthine-containing foods while taking a xanthine bronchodilator. These include coffee and chocolate. The other food items are acceptable to consume.

Capecitabine has been prescribed for a client with breast cancer. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication? Liver function tests Bilirubin level assay Complete blood count (CBC) Triglyceride level determination

Complete blood count (CBC) Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Bone marrow depression can occur from the use of this medication, and a CBC and blood chemistry studies should be done periodically. Liver function tests, bilirubin level assay, and triglyceride levels are unnecessary.

A client with chronic kidney disease is receiving ferrous sulfate. The nurse instructs the client that which finding is a common side/adverse effect associated with this medication? Fatigue Headache Weakness Constipation

Constipation Ferrous sulfate is an iron supplement used to treat anemia. Constipation is a frequent and uncomfortable side effect associated with the administration of oral iron supplements. Stool softeners often are prescribed to prevent constipation. Options 1, 2, and 3 are not side or adverse effects associated with this medication.

A client who is receiving nitrofurantoin calls the clinic complaining of troublesome effects related to the medication. Which side or adverse effect(s) indicates the need to stop treatment with this medication? Nausea Anorexia Diarrhea Cough and chest pain

Cough and chest pain Nitrofurantoin is an antimicrobial medication. Gastrointestinal (GI) effects are the most frequent side effects to this medication and can be minimized by administering the medication with milk or meals. However, they are not an indication for discontinuing the medication. Pulmonary reactions, manifested as dyspnea, chest pain, chills, fever, cough, and the presence of alveolar infiltrates on radiography, indicate the need to stop the treatment. These abnormalities typically resolve in 2 to 4 days after discontinuation of this medication.

The nurse is assigned to care for a client with multiple sclerosis who is receiving an intravenous dose of methocarbamol. The nurse monitors the client knowing that which is an expected side effect? Insomnia Excitability Hypertension Dark green-colored urine

Dark green-colored urine Methocarbamol is a skeletal muscle relaxant. It may cause the urine to turn a brown, black, or dark green color, and the client needs to be told that this is a harmless effect. This medication can cause hypotension. Drowsiness and dizziness can also occur. Therefore, the remaining options are incorrect.

A sulfonamide is prescribed for a client with a urinary tract infection. The client has diabetes mellitus and is receiving tolbutamide. Because the client will be taking these 2 medications, which prescription should the nurse anticipate for this client? Increased dosage of tolbutamide Decreased dosage of tolbutamide Increased dosage of sulfonamide Decreased dosage of sulfonamide

Decreased dosage of tolbutamide Sulfonamides can intensify the effects of warfarin sodium phenytoin and orally administered hypoglycemics such as tolbutamide. When combined with sulfonamides, these medications may require a reduction in dosage.

A client with multiple sclerosis is receiving baclofen. The nurse assessing the client monitors for which finding as an indication of a primarytherapeutic response to the medication? Decreased nausea Decreased muscle spasms Increased muscle tone and strength Increased range of motion of all extremities

Decreased muscle spasms Baclofen is a skeletal muscle relaxant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases or with multiple sclerosis. Increased muscle tone and strength and increased range of motion of all extremities are not directly related to the effects of this medication. Decreased nausea is an incorrect option.

Lactulose is prescribed for a client with a diagnosis of hepatic encephalopathy. The nurse should determine that this medication is effective if serum diagnostics reveal which finding? Increased protein level Increased red blood cell count Decreased serum ammonia level Decreased white blood cell count

Decreased serum ammonia level Lactulose is prescribed for the client with hepatic encephalopathy to reduce bacterial breakdown of protein in the bowel. The medication creates an acidic environment in the bowel and causes the ammonia to leave the bloodstream and enter the colon. Ammonia then becomes trapped in the bowel. Lactulose also has a laxative effect that allows for the elimination of the ammonia.

Capecitabine has been prescribed for a client with breast cancer, and the client asks the nurse about the side effects of the medication. The nurse responds that a frequent side effect of this medication is which finding? Diarrhea Weakness Irritability Increased appetite

Diarrhea Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Frequent side effects include diarrhea, nausea, vomiting, stomatitis, hand and foot syndrome (painful palmar-plantar erythema and swelling with paresthesias, tingling, and blistering), fatigue, anorexia, and dermatitis. Weakness, irritability, and increased appetite are not side effects of this medication.

The nurse is working with a client who shows signs of benzodiazepine withdrawal. The nurse should suspect that the client has suddenly discontinued taking which prescribed medication? Sertraline Diazepam Fluoxetine Haloperidol

Diazepam The only benzodiazepine presented in the options is diazepam. Benzodiazepines are effective only when used for short-term therapy. Short-acting benzodiazepines can produce withdrawal symptoms within 1 to 2 days, whereas long-acting benzodiazepines take 5 to 10 days for withdrawal symptoms to occur following discontinuation. Manifestations include insomnia, agitation, anxiety, irritability, nausea, and diaphoresis. The other options list an antipsychotic (sertraline), and antidepressants (fluoxetine and haloperidol).

A client is taking cetirizine. The nurse should inform the client of which side effect of this medication? Diarrhea Excitability Drowsiness Excess salivation

Drowsiness Cetirizine is an antihistamine; frequent side effects are drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating. Therefore, the other options are incorrect.

Etanercept is prescribed for a client with rheumatoid arthritis. The nurse should monitor the client for which side/adverse effect of the medication following administration? Dyspnea Headache Dizziness Abdominal discomfort

Dyspnea Etanercept is an antiarthritic medication that is administered via the subcutaneous route. Side/adverse effects include heart failure (noted by manifestations of dyspnea and congested lung sounds on auscultation), hypertension or hypotension, pancreatitis, or gastrointestinal hemorrhage. Headache, dizziness, and abdominal discomfort are not side/adverse effects of the medication.

The nurse is monitoring a client in preterm labor who is receiving intravenous magnesium sulfate. The nurse should monitor for which adverse effects of this medication? Select all that apply Flushing Hypertension Increased urine output Depressed respirations Extreme muscle weakness Hyperactive deep tendon reflexes

Flushing Depressed respirations Extreme muscle weakness Magnesium sulfate is a central nervous system depressant and relaxes smooth muscle, including the uterus. It is used to halt preterm labor contractions and is used for preeclamptic clients to prevent seizures. Adverse effects include flushing, depressed respirations, depressed deep tendon reflexes, hypotension, extreme muscle weakness, decreased urine output, pulmonary edema, and elevated serum magnesium levels.

Amikacin is prescribed for a client with a bacterial infection. The nurse instructs the client to contact the primary health care provider (PHCP) immediately if which occurs? Nausea Lethargy Hearing loss Muscle aches

Hearing loss Amikacin is an aminoglycoside. Side and adverse effects of aminoglycosides include ototoxicity (hearing problems), confusion, disorientation, gastrointestinal irritation, palpitations, blood pressure changes, nephrotoxicity, and hypersensitivity. The nurse instructs the client to report hearing loss to the PHCP immediately. Lethargy and muscle aches are not associated with the use of this medication. It is not necessary to contact the PHCP immediately if nausea occurs. If nausea persists or results in vomiting, the PHCP should be notified.

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? Hematocrit of 33% (0.33) Platelet count of 400,000 mm3 (400 × 109/L) White blood cell count of 6000 mm3 (6.0 × 109/L) Blood urea nitrogen level of 15 mg/dL (5.25 mmol/L)

Hematocrit of 33% (0.33) Epoetin alfa is synthetic erythropoietin, which the kidneys produce to stimulate red blood cell production in the bone marrow. It is used to treat anemia associated with chronic kidney disease. The normal hematocrit level is Male:42% to 52% (0.42 to 0.52); Female: 37% to 47% (0.37 to 0.47). Therapeutic effect is seen when the hematocrit reaches between 30% and 33% (0.30 and 0.33). The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). The normal blood urea nitrogen level is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). The normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L). Platelet production, white blood cell production, and blood urea nitrogen do not respond to erythropoietin.

The nurse is caring for a client who is receiving growth hormone replacement therapy. The nurse monitors the client for which option as an adverse effect of this therapy? Hypocalciuria Hypoglycemia Hyperglycemia Hyperthyroidism

Hyperglycemia Hyperglycemia can occur as a result of the administration of growth hormone, particularly in a client with diabetes mellitus. Hypercalciuria can occur, particularly during the first 2 to 3 months of therapy. Growth hormone therapy is associated with a decline in thyroid function.

An older client takes a stimulant laxative for ongoing management of chronic constipation. Which findings should the nurse expect to note when reviewing the client's laboratory results? Hypokalemia Hyperkalemia Hyponatremia Hypernatremia

Hypokalemia Hypokalemia can result from long-term use of a stimulant laxative. The medication stimulates peristalsis and alters fluid and electrolyte transport, thus helping fluid to accumulate in the colon. The remaining options are not specifically associated with the use of this medication.

The nurse is planning to administer hydrochlorothiazide to a client diagnosed with hypertension. The nurse should monitor for which adverse effects related to the administration of this medication? Hypouricemia, hyperkalemia Increased risk of osteoporosis Hypokalemia, hyperglycemia, sulfa allergy Hyperkalemia, hypoglycemia, penicillin allergy

Hypokalemia, hyperglycemia, sulfa allergy Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

The nurse gave an intramuscular dose of methylergonovine to a client following delivery of an infant. The nurse determines that this medication had the intended effect if which finding is noted? Decreased pulse rate Increased urine output Improved uterine tone Increased blood pressure

Improved uterine tone Methylergonovine is an ergot alkaloid that is given following delivery to treat postpartum hemorrhage. It acts by vasoconstricting arterioles and directly stimulating uterine muscle contractions. Blood pressure may increase, but this is not the intended therapeutic effect. Decreased pulse rate and increased urine output are unrelated to the effects of this medication.

The nurse is instructing a client who is taking levothyroxine and tells the client that full therapeutic benefits will be seen when? Immediately In 1 to 3 weeks Within 24 hours Within 3 to 5 days

In 1 to 3 weeks It takes up to 1 month for plateau levels of levothyroxine to be achieved, so clients must be told that full benefits will not be seen for 1 to 3 weeks. Therefore, the remaining options are incorrect.

The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action? Take the medication with food. Increase fluid intake to 2000 to 3000 mL daily. Decrease sodium intake while taking the medication. Increase potassium intake while taking the medication.

Increase fluid intake to 2000 to 3000 mL daily. Hemorrhagic cystitis is an adverse effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake.

A postpartum nurse is caring for a client with an epidural catheter in place for opioid analgesic administration following cesarean birth. The client develops respiratory depression and requires naloxone administration. Which finding should the nurse anticipate as a result of the naloxone administration? Bradycardia Decrease in sensation Increase in pain level Sudden onset of itching

Increase in pain level Opioids are used for epidural analgesia. Naloxone is an opioid antagonist, which reverses the effects of opioids. If it is given, the client may complain of an increase in her pain level. One of the side effects of naloxone is rapid pulse or tachycardia, not bradycardia. Sudden onset of itching would not be a typical reaction. Naloxone would not affect sensation.

The nurse is preparing to administer exogenous surfactant to a premature infant who has respiratory distress syndrome. The nurse prepares to administer the medication by which route? Intradermal Intratracheal Subcutaneous Intramuscular

Intratracheal Respiratory distress syndrome is a serious lung disorder caused by immaturity and the inability to produce surfactant, resulting in hypoxia and acidosis. It is common in premature infants and may be due to lung immaturity as a result of surfactant deficiency. The mainstay of treatment is the administration of exogenous surfactant, which is administered by the intratracheal route. Options 1, 3, and 4 are not routes of administration for this medication.

A client is taking clorazepate. The client asks the nurse if there is a risk of addiction with this medication. Which information should the nurse provide? It is not habit forming either physically or psychologically. It leads to physical tolerance, but only after 10 or more years of therapy. It leads to physical and psychological dependence with prolonged high-dose therapy. It can result in psychological dependence only because of the nature of the medication.

It leads to physical and psychological dependence with prolonged high-dose therapy. Clorazepate is classified as an anticonvulsant, an anxiolytic (antianxiety agent), and a sedative-hypnotic (benzodiazepine). One of the nursing implications of clorazepate therapy is that the medication can lead to physical or psychological dependence with prolonged therapy at high doses. For this reason, the amount of medication that is readily available to the client at any one time is restricted.

At what time of day does the nurse recommend that a child prescribed methylphenidate be given the last dose of the day of the medication? At bedtime With a bedtime snack Just before the noontime meal In the morning, 2 hours before breakfast

Just before the noontime meal Methylphenidate is used to treat attention deficit hyperactivity disorder and has stimulant effects. Children with attention deficit hyperactivity disorder should take the morning dose after breakfast, and the last daily dose should be taken at least 6 hours before bedtime (14 hours for extended-release forms) to prevent insomnia. Usually the primary health care provider recommends that the last dose be given just before the noontime meal. The other options are incorrect.

A client reports frequent use of acetaminophen for relief of headaches and other discomforts. The nurse should evaluate which diagnostic data to determine if the client is at risk for toxicity? Chest x-ray Electrocardiogram Liver function studies Upper gastrointestinal x-ray results

Liver function studies In adults, overdose of acetaminophen causes liver damage. In addition, clients with liver disorders are at a higher risk of experiencing hepatotoxicity with chronic acetaminophen use. Options 1, 2, and 4 are not associated with acetaminophen overdose.

The nurse is analyzing the laboratory studies on a client receiving dantrolene to treat muscle spasms from an injury. Which laboratory test would identify an adverse effect associated with the administration of this medication? Platelet count Creatinine level Liver function tests Blood urea nitrogen level

Liver function tests Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests should be performed before treatment and throughout the treatment interval. Dantrolene is administered at the lowest effective dosage for the shortest time necessary.

The nurse is preparing to administer albuterol to a client. Which parameters should the nurse assess before and during therapy? Nausea and vomiting Headache and level of consciousness Lung sounds and presence of dyspnea Urine output and blood urea nitrogen level

Lung sounds and presence of dyspnea Albuterol is an adrenergic bronchodilator. The nurse assesses respiratory pattern, lung sounds, pulse, and blood pressure before and during therapy. The nurse also notes the color, character, and amount of sputum.

The nurse transcribes a medication prescription for ifosfamide for a client with a diagnosis of germ cell cancer of the testes. The nurse reviews the client's history and looks for another prescription for which medication, which usually is administered with the antineoplastic medication? Mesna Melphalan Prednisone Bleomycin sulfate

Mesna Ifosfamide is used to treat refractory germ cell cancer of the testes. Concurrent therapy with mesna and at least 2 L of oral or intravenous fluid daily will limit the toxicity of this medication, evidenced by bone marrow depression and hemorrhagic cystitis. Mesna is a detoxifying agent used to inhibit the hemorrhagic cystitis induced by ifosfamide. The medications in options 2, 3, and 4 are not routinely administered with ifosfamide.

A client seen in the health care clinic is diagnosed with syphilis, and the primary health care provider prescribes an intramuscular injection of penicillin G benzathine. After administering the intramuscular injection of medication, the nurse should perform which action? Monitor the client for 30 minutes. Encourage the client to ambulate. Administer subcutaneous epinephrine. Apply a topical anesthetic spray to the injection site.

Monitor the client for 30 minutes. Penicillin G benzathine is an antibiotic. Anaphylactic shock is a possible reaction to penicillin therapy, and the onset of anaphylaxis nearly always occurs within 10 minutes. The client should be observed for 30 minutes after intramuscular injection so that if anaphylaxis develops, treatment is immediately available. Encouraging ambulation is unnecessary. The remaining 2 options are inaccurate interventions.

A client with gastrointestinal hypermotility has a prescription to receive atropine sulfate. The nurse should withhold the medication and question the prescription if the client has a history of which disease process? Biliary colic Sinus bradycardia Peptic ulcer disease Narrow-angle glaucoma

Narrow-angle glaucoma Atropine sulfate can cause a blockade of muscarinic receptors on the iris sphincter, producing mydriasis (dilation of the pupils). It also produces cycloplegia (relaxation of the ciliary muscles). It is contraindicated in clients with narrow-angle glaucoma. The other options are therapeutic reasons for using the medication.

A client diagnosed with anxiety is starting therapy with lorazepam. Which factor in the client's history should prompt the nurse to consult with the primary health care provider before administering the medication? Hypothyroidism Diabetes mellitus Narrow-angle glaucoma Coronary artery disease

Narrow-angle glaucoma Lorazepam is a benzodiazepine and is contraindicated in hypersensitivity, cross-sensitivity with other benzodiazepines, comatose state, preexisting central nervous system depression, uncontrolled severe pain, and narrow-angle glaucoma because these medications can further increase the intraocular pressure. It also is contraindicated in pregnancy and in women who are breast-feeding. None of the other options are relevant to the administration of lorazepam.

The nurse is caring for a client who was prescribed furosemide. The nurse should monitor the client for damage of which kidney structure? Pelvis Calyx Nephron Renal artery

Nephron The nephron is the functional unit of the kidney that is responsible for clearance of excess fluid and waste products of metabolism. The renal pelvis and calices collect urine to send to the ureter. The renal artery brings blood to the kidney for filtering by the nephron.

The nurse provides instructions to a client who is taking levothyroxine. The nurse should tell the client to take the medication in which way? With food At lunchtime On an empty stomach At bedtime with a snack

On an empty stomach Oral doses of levothyroxine should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.

A client with a gastric ulcer has a prescription for sucralfate 1 gram by mouth 4 times daily. The nurse should schedule the medication for which times? With meals and at bedtime Every 6 hours around the clock One hour after meals and at bedtime One hour before meals and at bedtime

One hour before meals and at bedtime Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect.

A client is receiving oxybutynin. The nurse should suspect that this medication is prescribed to relieve which condition? Gastritis Renal calculi Ulcerative colitis Overactive bladder

Overactive bladder When medication therapy for overactive bladder is indicated, anticholinergic agents are the medications generally prescribed. These medications block muscarinic receptors on the bladder detrusor and thereby inhibit bladder contractions and decrease the urge to void. It is not used to treat gastritis. The medication would not be used to treat renal calculi or ulcerative colitis. In fact, it may make those conditions worse.

A client is prescribed sulfamethoxazole for treatment of urinary tract infection. Identification of which other medication noted on the client's medical record requires further collaboration with the primary health care provider (PHCP)? Insulin Phenytoin Metoprolol Propranolol

Phenytoin Sulfonamides can intensify the effects of warfarin, phenytoin, and sulfonylurea-type oral hypoglycemics (e.g., glipizide, glyburide). The principal mechanism is inhibition of hepatic metabolism. When combined with sulfonamides, these medications may require a reduction in dosage to prevent toxicity. Therefore, the nurse should collaborate with the PHCP regarding dose adjustment of phenytoin.

A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL (10 to 11.1 mmol/L). Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? Atenolol Prednisone Phenelzine Allopurinol

Prednisone Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 1, a beta blocker, and option 3, a monoamine oxidase inhibitor, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

Enoxaparin sodium is prescribed for a client after hip replacement surgery. Which medication should the nurse anticipate to administer in the event of enoxaparin sodium overdose? Epinephrine Phytonadione Protamine sulfate Diphenhydramine

Protamine sulfate Enoxaparin sodium is an anticoagulant. Accidental overdose of this medication may lead to bleeding complications. The antidote is protamine sulfate. Epinephrine is used to treat hypersensitivity reactions or acute bronchial asthma attacks and bronchospasms. Phytonadione is the antidote for warfarin sodium. Diphenhydramine is an antihistamine.

A client is receiving ganciclovir. Which nursing action is appropriate during the time the client is receiving this medication? Monitoring blood glucose levels for elevation Administering the medication on an empty stomach only Applying pressure to venipuncture sites for at least 1 minute Providing the client with a soft toothbrush and an electric razor

Providing the client with a soft toothbrush and an electric razor Ganciclovir is an antiviral medication. Common adverse effects of ganciclovir are neutropenia and thrombocytopenia. For this reason, the nurse implements the same precautions that are used for a client receiving anticoagulant therapy. These include providing a soft toothbrush and an electric razor to minimize risk of trauma that could result in bleeding. The medication may cause hypoglycemia, but not hyperglycemia. The medication does not have to be taken on an empty stomach. Pressure on venipuncture sites should be held for approximately 10 minutes.

The nurse would anticipate that the primary health care provider (PHCP) would add which medication to the regimen of the client receiving isoniazid? Niacin Pyridoxine Gabapentin Cyanocobalamin

Pyridoxine Isoniazid is an antituberculosis medication. Clients receiving isoniazid can develop neuropathy, and the agent of choice to help prevent this adverse effect is pyridoxine, vitamin B6. Niacin is used to lower the cholesterol level. Gabapentin is used to prevent seizures and for peripheral neuropathy, and cyanocobalamin is used to treat anemia.

The emergency department nurse is caring for a client admitted with diabetic ketoacidosis. The primary health care provider prescribes intravenous (IV) insulin. The nurse plans to prepare which type of insulin for the client? Insulin glargine Regular insulin Insulin isophane 50% human insulin isophane/50% human insulin

Regular insulin Regular insulin can be administered by the IV route. Insulin glargine is a long-acting insulin. Insulin isophane and 50% human insulin isophane/50% human insulin are intermediate-acting insulins.

A client who uses nonsteroidal antiinflammatory drugs (NSAIDs) has been taking misoprostol. The nurse determines that the misoprostol is having the intended therapeutic effect if which finding is noted? Resolved diarrhea Relief of epigastric pain Decreased platelet count Decreased white blood cell count

Relief of epigastric pain The client who uses NSAIDs is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence in clients taking NSAIDs frequently. Diarrhea can be a side effect of the medication but is not an intended effect. Options 3 and 4 are unrelated to the purpose of misoprostol.

The nurse is providing dietary instructions to a client who is prescribed tranylcypromine sulfate. The nurse emphasizes that it is important to avoid eating which food? Salami Scallops Pineapple Mashed potatoes

Salami Tranylcypromine sulfate is a monoamine oxidase inhibitor (MAOI) that is used to treat depression. A tyramine-restricted diet is required during therapy to avoid hypertensive crisis, a life-threatening effect of the medication. Foods to be avoided are meats prepared with tenderizer, smoked or pickled fish, beef liver, chicken liver, and dry sausage (salami, pepperoni, and bologna). In addition, figs; bananas; aged cheese; yogurt and sour cream; beer, red wine, alcoholic beverages; soy sauce; yeast extract; chocolate; caffeine; and foods that are aged, pickled, fermented, or smoked need to be avoided. Many over-the-counter medications also include tyramine and must be avoided as well.

The nurse is assigned to care for a client with cytomegalovirus retinitis and acquired immunodeficiency syndrome (AIDS) who is receiving foscarnet. The nurse should monitor the results of which laboratory study while the client is taking this medication? CD4 cell count Lymphocyte count Serum albumin level Serum creatinine level

Serum creatinine level Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Cytomegalovirus retinitis is an opportunistic viral infection of the eye. Foscarnet is an antiviral medication that is toxic to the kidneys. The serum creatinine level is monitored before therapy, 2 or 3 times per week during induction therapy, and at least weekly during maintenance therapy. Foscarnet also may cause decreased levels of calcium, magnesium, phosphorus, and potassium. Thus, these levels also are measured with the same frequency.

The nurse is educating a client about medroxyprogesterone. The nurse should provide the client with which information about the medication? Should be taken once daily by mouth Should be administered intramuscularly every 3 months Should be taken immediately following sexual intercourse Provides some protection against sexually transmitted infections

Should be administered intramuscularly every 3 months Medroxyprogesterone is given intramuscularly in the deltoid or gluteus maximus muscle. Injections should be administered every 12 weeks. Advantages of medroxyprogesterone include contraceptive effectiveness comparable to combined oral contraceptives and long-lasting effects. Additionally, injections are required only 4 times a year. Disadvantages are prolonged amenorrhea or uterine bleeding, increased risk of venous thrombosis and thromboembolism, and no protection against sexually transmitted infections.

Acarbose is prescribed for a client diagnosed with type 2 diabetes mellitus. What should the nurse include in the client's instructions? Take the medication with the first bite of each meal. Do not take the medication if you have a urinary tract infection. Monitor for hypoglycemia and treat symptoms with 4 oz of fruit juice. Hold the medication at the time of iodine contrast dye study, and restart it 48 hours after.

Take the medication with the first bite of each meal. Acarbose is an alpha-glucosidase inhibitor that delays absorption of dietary carbohydrates by inhibiting the enzyme alpha-glucosidase, which breaks down complex carbohydrates. It therefore slows digestion of carbohydrates, which reduces the postprandial rise in blood glucose, and should be taken with the first bite of food with each meal (3 times a day). The alpha-glucosidase inhibitors are the only oral antidiabetic agents whose effects do not depend at all on the presence of insulin. All of the other oral agents act, at least in part, by increasing insulin secretion and/or decreasing insulin resistance. Option 2 is incorrect, as there is no contraindication to taking acarbose with a urinary tract infection. Urinary tract infections are an adverse effect of the dipeptidyl peptidase-4 (DPP-4) inhibitor, sitagliptin. Option 3 is incorrect, as hypoglycemia is not likely to occur with acarbose alone but may develop when acarbose is combined with insulin or a sulfonylurea. If hypoglycemia develops for a client taking acarbose, simple glucose must be used for treatment. Foods such as fruit juice that contain sucrose, a disaccharide that must be broken down, cannot be used for oral therapy to treat hypoglycemia because the acarbose will impede its hydrolysis and thereby delay absorption. Option 4 is incorrect, as it is metformin, a biguanide medication, that should be held at the time of an iodine contrast dye study and restarted 48 hours after because of the risk of renal injury.

A client with a history of gastroesophageal reflux disease (GERD) is diagnosed with peptic ulcer disease (PUD). The primary health care provider prescribes sucralfate in addition to the client's other medications. What teaching should the nurse include in this client's instructions? Take the sucralfate once a day at bedtime with food. Take the sucralfate daily with the proton pump inhibitor. Take the sucralfate before meals and at bedtime on an empty stomach. Take the sucralfate immediately after eating and within 30 minutes of an antacid.

Take the sucralfate before meals and at bedtime on an empty stomach. Sucralfate is an antiulcer medication that promotes ulcer healing by creating a protective barrier against acid and pepsin. It should be taken on an empty stomach. The usual recommended adult dosage is 1 gram 4 times a day, taken 1 hour before meals and at bedtime. Options 1, 2, and 4 are incorrect, as sucralfate should be taken on an empty stomach, at least twice a day, and at least 30 minutes apart from an antacid.

A client with a history of gastroesophageal reflux disease (GERD) is diagnosed with peptic ulcer disease (PUD). The primary health care provider prescribes sucralfate in addition to the client's other medications. What teaching should the nurse include in this client's instructions? Take the sucralfate once a day at bedtime with food. Take the sucralfate daily with the proton pump inhibitor. Take the sucralfate before meals and at bedtime on an empty stomach. Take the sucralfate immediately after eating and within 30 minutes of an antacid.

Take the sucralfate before meals and at bedtime on an empty stomach. Sucralfate is an antiulcer medication that promotes ulcer healing by creating a protective barrier against acid and pepsin. It should be taken on an empty stomach. The usual recommended adult dosage is 1 gram 4 times a day, taken 1 hour before meals and at bedtime. Options 1, 2, and 4 are incorrect, as sucralfate should be taken on an empty stomach, at least twice a day, and at least 30 minutes apart from an antacid.

A client has a prescription to take guaifenesin. The nurse should conclude that the client understands the most effective use of this medication if the client states that they need to take which action? Watch for irritability as a side effect. Take the tablet with a full glass of water. Take an extra dose if the cough is accompanied by fever. Crush the sustained-release tablet if immediate relief is needed.

Take the tablet with a full glass of water. Guaifenesin is an expectorant and should be taken with a full glass of water to decrease the viscosity of secretions. The medication occasionally may cause dizziness, headache, or drowsiness as side effects. The client should contact the primary health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Sustained-release preparations should not be broken open, crushed, or chewed.

A client is receiving somatropin. The nurse should monitor which most significant laboratory study during therapy with this medication? Lipase level Amylase level Blood urea nitrogen (BUN) level Thyroid-stimulating hormone level

Thyroid-stimulating hormone level Somatropin is used to stimulate linear growth in pediatric clients who lack adequate normal human growth hormone. An adverse effect of somatropin is hypothyroidism. Therefore, thyroid function is monitored throughout therapy. Lipase and amylase levels would evaluate pancreatic function, and BUN level evaluates renal function.

The client arrives at the emergency department complaining of back spasms. The client states, "I have been taking 2 to 3 aspirin every 4 hours for the last week, and it hasn't helped my back." Since acetylsalicylic acid intoxication is suspected, the nurse should assess the client for which manifestation? Tinnitus Diarrhea Constipation Photosensitivity

Tinnitus Mild intoxication with acetylsalicylic acid is called salicylism and is experienced commonly when the daily dosage is higher than 4 g. Tinnitus (ringing in the ears) is the most frequent effect noted with intoxication. Hyperventilation may occur, because salicylate stimulates the respiratory center. Fever may result, because salicylate interferes with the metabolic pathways coupling oxygen consumption and heat production. Options 2, 3, and 4 are not associated specifically with toxicity.

A client with a diagnosis of rheumatoid arthritis is taking sulindac. The primary health care provider prescribes misoprostol for the client. The nurse explains that this medication has been prescribed for which purpose? To enhance the effects of the sulindac To prepare the client for weaning off the sulindac To prevent further development of arthritic nodules To prevent gastric complications such as ulcer disease

To prevent gastric complications such as ulcer disease Sulindac is a nonsteroidal anti-inflammatory drug (NSAID). Misoprostol, a synthetic prostaglandin E1 analogue, may be prescribed to be taken concurrently with sulindac to prevent gastric complications such as ulcer disease. The remaining options are incorrect.

The nurse has a prescription to administer a dose of iron by the intramuscular route to the client. What are the most appropriate nursing actions? Select all that apply. Use a Z-track method. Administer the medication only in the deltoid. Aspirate for blood after the needle is inserted. Use an air lock when drawing up the medication. Change the needle after drawing up the dose and before injection. Massage the injection site well after injection to hasten absorption.

Use a Z-track method. Use an air lock when drawing up the medication. Change the needle after drawing up the dose and before injection. An air lock and a Z-track method should both be used when administering iron by the intramuscular route. Proper technique includes changing the needle after drawing up the medication but before giving it to prevent staining of skin. Only the dorsogluteal site should be used, and proper identification of appropriate landmarks is essential. The site should not be massaged after injection because massaging could cause staining of the skin.

A client is receiving tobramycin. The nurse evaluates that the medication therapy is effective if which laboratory test result is noted? WBC count of 8000 mm3 (8 × 109/L) and a creatinine level of 0.9 mg/dL (79.5 mcmol/L) Sodium level of 145 mEq/L (145 mmol/L) and chloride level of 106 mEq/L (106 mmol/L) Sodium level of 140 mEq/L (140 mmol/L) and potassium level of 3.9 mEq/L (3.9 mmol/L) White blood cell (WBC) count of 15,000 mm3 (15 × 109/L) and a blood urea nitrogen level of 38 mg/dL (13.7 mmol/L)

WBC count of 8000 mm3 (8 × 109/L) and a creatinine level of 0.9 mg/dL (79.5 mcmol/L) Tobramycin is an antibiotic (aminoglycoside) that causes nephrotoxicity and ototoxicity. The medication is working if the WBC count drops back into the normal range and kidney function remains normal. A WBC count of 15,000 mm3(15 × 109/L) is elevated, indicating that infection is still present. The sodium, chloride, and potassium levels are all normal values and are unrelated to the effectiveness of this medication.

The nurse is preparing a plan of care for a client who will be receiving intravenous mitomycin for the treatment of liver cancer. In developing the plan of care, the nurse includes monitoring which as the priority? Heart rate Lung sounds White blood cell count Level of consciousness

White blood cell count Mitomycin is an antineoplastic medication that can cause bone marrow suppression, which can progress to infection. The priority is to monitor nadirs for neutropenia and thrombocytopenia. Although options 1, 2, and 4 may be a component of the nurse's assessment, assessing the white blood cell count is the priority when administering this medication.

The nurse is reading the laboratory results for a client being treated with carbamazepine for prophylaxis of complex partial seizures. When evaluating the client's laboratory data, the nurse determines that which value is consistent with a side or adverse effect of this medication? Sodium level, 136 mEq/L (136 mmol/L) Platelet count, 350,000 mm3 (350 × 109/L) White blood cell count, 3200 mm3 (3.2 × 109/L) Blood urea nitrogen (BUN), 19 mg/dL (6.84 mmol/L)

White blood cell count, 3200 mm3 (3.2 × 109/L) Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, and leukopenia. Other adverse effects include cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects.

The nurse is about to administer the next intravenous dose of tobramycin when the client complains of vertigo and a ringing in the ears. What is the most appropriate nursing action? Hang the dose immediately. Check the client's pupillary responses. Give a dose of droperidol with the tobramycin. Withhold the dose and call the primary health care provider (PHCP).

Withhold the dose and call the primary health care provider (PHCP). Tobramycin is an aminoglycoside. Ringing in the ears and vertigo are symptoms that may indicate dysfunction of the eighth cranial nerve. Ototoxicity is a toxic effect of therapy with aminoglycosides and could result in permanent hearing loss. The nurse should withhold the dose and notify the PHCP. The remaining options are inappropriate nursing actions.

A primary health care provider (PHCP) writes a prescription for digoxin, 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is most important to be sure to implement which measure? Count the radial and carotid pulses every morning. Check the blood pressure every morning and evening. Stop taking the medication if the pulse is faster than 100 beats/min. Withhold the medication and call the PHCP if the pulse is slower than 60 beats/min.

Withhold the medication and call the PHCP if the pulse is slower than 60 beats/min. An important component of taking digoxin is monitoring the pulse rate; however, it is not necessary for the client to take both radial and carotid pulses. It is also unnecessary for the client to check the blood pressure every morning and evening because the medication does not directly affect blood pressure. It is most important for the client to know the guidelines related to withholding the medication and calling the PHCP. The client should not stop taking the medication.