Pharm Exam 1

A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client. What is the sequence of events the nurse should follow? (Move the steps of mixing insulin on the left into the box on the right, placing them in the selected order of performance. All steps must be used.)

1- Inspect vials for contaminants. 2- Roll NPH vial between palms of hands. 3- Inject air into NPH insulin vial. 4- Inject air into regular insulin vial. 5- Withdraw short-acting insulin into syringe. 6- Add intermediate insulin to syringe.

therapeutic use: mild allergies, motion sickness, insomnia ADR: drowsiness, dizziness, anticholinergic effects Interventions: monitor ambulation, advise against driving or operating machinery, recommend switching to non sedating antihistamine if sedation is excessive, monitor for urinary retention Administration: don't crush or chew EC, don't take w/ alcohol or other CNS depressants, take 30m-2h b/f motion sickness Contraindications: newborns and children under 2, breastfeeding women, narrow angle glaucoma, prostatic hypertrophy, acute asthma exacerbation Precautions: urinary retention, open angle glaucoma

1st generation/Sedating antihistamines: diphenhydramine (Benadryl)

therapeutic use: allergic rhinitis ADR: drowsiness and fatigue, anticholinergic effects Interventions: monitor ambulation Administration: expect lower dose for clients with compromised renal or liver function Teaching: avoid driving and activities, take frequent sips of water, suck hard candy Contraindications: infants under 6mo, breast feeding, allergy to h1 receptor antihistamines or hydroxyzine Interactions: theophylline can reduce clearance and l/t toxicity

2nd degree/Nonsedating Antihistamines: cetirizine (Zyrtec)

A nurse is preparing to administer hydrocodone/acetaminophen (Lortab) 5 mg. It is available in 7.5 mg/500 mg/15 mL elixir. How many mL should the nurse administer? (Round the answer to the nearest whole number.)

7.5ml

therapeutic use: relief of bronchoconstriction ADR: dry mouth, urinary retention, increased IOP Interventions: provide water and hard candy, routine glaucoma testing, monitor urinary elimination patterns Administration: delay use of other inhalants for 5 minutes, do not use as emergency medication Client instructions: suck on hard candy, sip water frequently, regular eye exams, report changes of urinary elimination Contraindications: hypersensitivity precautions: glaucoma, prostatic hypertrophy, bladder neck obstruction, Interactions: B2AA enhance bronchodilation

Anticholinergics: Ipratropium (Atrovent, Atrovent HFA)

therapeutic use: suppress chronic nonproductive cough ADR: CNS depression dizziness and lightheadedness commonly with opioid but occurs with nonopioid at in large doses, GI distress, constipation and respiratory depression with opioids Interventions: monitor clients changing positions or ambulating, increase fluids and fiber, administer stool softeners, administer naloxone to restore RR Teaching: change positions gradually or lie/sit if lightheaded, don't take this drug before driving or activities , remove cough triggers Contraindications: MAOIs, SSRIs, prostatic hypertrophy, reduced respiratory reserve (chronic asthma, emphysema) Interactions: alcohol and other CNS depressants increase CNS depression, st john's wart

Antitussives Opioid: codeine Nonopioid: dextromethorpan (Delsym)

therapeutic use: long term mgmt of asthma ADR: chest pain, palpitations, nervousness, restlessness, tremors Administration: use SABA for acute exacerbations and LABA for LT control; inhale this drug before inhaling glucocorticoids, keep a log of exacerbation frequency and intensity Teaching: report chest pain and heart palpitations, avoid caffeine Precautions: CV disease as this drug also stimulates the heart Interactions: beta adrenergic blockers reduce the effectiveness of this drug class, MAOIs and tricyclic antidepressants can increase the r/f HTN, tachycardia, and angina if used with this drug, hypoglycemic drugs require increased dosing because of the hyperglycemic effects of this drug

Beta 2 Adrenergic Agonists: Albuterol (proventil, Ventolin)

A nurse is preparing to administer heparin subcutaneously to a client? Which of the following techniques should the nurse use?

Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, and observe for bleeding.

A nurse is caring for a client who is taking lisinopril (Zestril). Which of the following outcomes should the nurse anticipate?

Decreased blood pressure

therapeutic use: cough r/t viral URTI ADR: dizziness, drowsiness, GI distress Interventions: monitor clients when changing positions or ambulating, give drug with food administration: don't take with combination products for colds that also contain this medication TeachingL don't take before driving or activities, change positions gradually contraindications: phenylketonuria d/t aspartame content, disulfram d/t alcohol content

Expectorants: guaifenesin (mucinex)

A nurse is caring for a client who is at 6 weeks of gestation and has pneumonia. While the nurse is obtaining the client's history, she tells the nurse that she takes the herb feverfew for migraine headaches. Which of the following actions should the nurse take?

Explain that she should not take this herb while she is pregnant.

therapeutic use: reduce local inflammation; ST mgmt of post exacerbation symptoms (oral) ADR: inhaled l/t oral candidiasis, suppression of adrenal function (oral), bone demineralization, muscle wasting, hyperglycemia, PUD, infection, f&e imbalances Interventions: spacer, observe for adrenal suppression, monitor blood glucose, adjust insulin/hypoglycemics, observe for GI bleeding, give drugs with food or meals, recommend analgesic substitute if using NSAIDs, observe for signs of infection, monitor weigh gain, edema, or generalized weakness, administer nonNSAID s/a acetaminophen Administration: use on regular schedule, use B2AA first to dilate airways before using this drug, use metered dose spray device and nasal decongestant first if using nasal form Teaching: use spacer, rinse mouth/gargle, NEVER stop abruptly—taper instead, weight bearing exercises, adequate vD and calcium, avoid NSAIDs, take drug with food, nonNSAID analgesics, report alarming conditions immediately Contraindications: live virus immunization, systemic fungal infection Precautions: PUD, DM, HTN, Renal dysfunction, use of NSAIDs Interactions: furosemide increases r/f hypokalemia, NSAID increase r/f GI bleed, decreased effects of insulin and hypoglycemics

Glucocorticoids

beclomethasone dipropionate (QVAR), fluticasone (Flovent)

Inhaled Glucocorticoids

therapeutic use: adjunctive therapy of allergic rhinitis asthma and EIB ADR: liver damage in two forms of this drug, neuropsychiatric effects such as suicidal ideations Interventions: monitor liver function w periodic testing, observe behavioral changes Administration: take once daily in evening, take 2hr before exercise to prevent EIB but do not repeat dose w/I 24hr Teaching: report abdominal tenderness, nausea, anorexia, behavioral changes s/a agitation, insomnia, anxiety, irritability Interactions: concurrent use with phenobarbital may require higher dosage

Leukotriene modifiers: Montelukast (Singulair) [leukotriene receptor antagonists] zafirlukast and zileuton damage liver, montelukast does not

therapeutic use: prophylaxis treatment of EIB and seasonal allergy symptoms, mgmt of allergic rhinitis ADR: allergic reactions in clients allergic to drug Interventions: administer epinephrine or antihistamine to reverse anaphylaxis Administration: nebulizer or mdi, use for several weeks for full effects, administer 4x daily on fixed schedule, use 15m before exercising, not for cute asthma exacerbation

Mast cell stabilizers: cromolyn

therapeutic use: LT mgmt of chronic asthma ADR: restlessness and insomnia experienced when therapeutic levels are exceeded, toxic levels cause seizures, dysrhythmias interventions: monitor plasma drug levels, activated charcoal decreases absorption, prepare to initiate anticonvulsant therapy and institute seizure precautions, antidysrhythmics given to restore heart rate and rhythm administration: don't double dose, don't crush or chew SR or EC Teaching: eliminate caffeine stop taking drugs if experiencing seizures or dysrhythmias

Methylxanthines: Theophylline (Theolair, Theo 24)

therapeutic use: decrease viscosity of mucous secretions, reverses acetaminophen OD ADR: bronchospasm, rotten-egg smell of drug Administration: give via nebulizer that does not contain metal or rubber parts or direct instillation into trach tube, expect sulfur-like (rotten egg) odor Contraindications:r/f or actual GI bleeding Precautions: asthma, hx of bronchospasm, or severe respiratory insufficiency

Mucolytic: acetylcysteine

prednisone-oral fluticasone-flonase

Oral and Nasal Glucocorticoids

A nurse observes a parent of an infant administer a prescribed oral medication. Which of the following actions by the parent indicates a need for further instruction? a. Wraps infant in a blanket b. Administers medication with an oral syringe c. Positions infant in a supine position d. ​Inserts medication in the buccal cavity

Positions infant in a supine position

A nurse is talking with a client who has type 2 diabetes mellitus that has responded well to oral hypoglycemic medication. The client reports morning fasting blood glucose levels above 180 mg/dL for the past week. In reviewing the client's medication history, the nurse should identify which of the following medications as a possible contributing factor to the recent change in glycemic control?

Prednisone. (Deltasone)

The nurse is preparing a medication and observes the date of expiration on the vial occurred two months ago. Which action should the nurse perform?

Return the medication to the pharmacy.

therapeutic use: allergic rhinitis and common cold ADR: CNS stimulation, increased BP, tachycardia/palpitations, OD or systemic absorption, rebound congestion Interventions: monitor for agitation, anxiety, insomnia, BP and HR Teaching: notify HCP of excessive symptoms of CNS stimulation, report prolonged tachycardia or heart palpitations, have BP checked while on medication if previously diagnosed with HTN Contraindications: narrow angle glaucoma

Sympathomimtics: phenylephrine (neo-synephrine)

relieve pain w/o causing loss of consciousness

Tylenol, ibuprofen

A provider is discharging a client who has pulmonary tuberculosis with a prescription for rifampin (Rifadin). The nurse should include which of the following information in the client's discharge teaching?

Urine and other secretions will turn orange.

A client provides a nurse with a list of home medications. Which of the following should the nurse recognize as incompatible?

Warfarin sodium (Coumadin) and multivitamins

A nurse prepares to administer a medication to a client who states, "That looks different from the pill I usually take." How should the nurse respond? a. "Describe what the pill looks like." b. ​"This is the medication prescribed by your provider." c. ​"This pill is probably from a different lot number than yours at home." d. "This hospital uses a different manufacturer, but the medication is the same."

a. "Describe what the pill looks like."

A nurse is caring for a child in status asthmaticus. Which of the following is the priority action for the nurse to take? a. Administer a short-acting β2 -agonist. b. Obtain a peak flow reading. c. Administer a corticosteroid. d. Start intervenous fluids.

a. Administer a short-acting ß2 -agonist. Therapy for status asthmaticus is improving ventilation and decreasing airway resistance. Therefore, administering a short-acting β2 -agonist is the priority action for the nurse to take.

A nurse is reinforcing the controlled substance guidelines with a newly licensed nurse. Which of the following should the nurse include in the teaching? (Select all that apply.) a. Count each dose of narcotics in inventory. b. ​Match number of available doses to record. c. ​Sign acceptance of narcotic count if correct. d. ​Check each client MAR to ensure matching records. e. Confirm that wasted narcotics are identified on the report form

a. Count each dose of narcotics in inventory. b. Match number of available doses to record. c.Sign acceptance of narcotic count if correct.

A nurse is instructing a hospitalized client who has asthma about how to use an albuterol inhaler. the nurse should recognize that the client understands how to use the inhaler when the client demonstrates by a. holding a breath for 10 seconds after inhaling the medication. b. taking a deep breath just prior to releasing the medication from the inhaler. c. exhaling as the medication is released from the inhaler. d. waiting 5 min between inhalations.

a. holding a breath for 10 seconds after inhaling the medication The medication should be retained in the lungs for a minimum of 10 seconds so the maximum amount of the dosage can be delivered properly to the airways. To use the inhaler, the client exhales deeply just prior to releasing the medication, inhales deeply as the medication is released, then holds the medication in the lungs for approximately 10 seconds prior to exhaling.

A nurse is talking with a client about taking diphenhydramine (Benadryl). The nurse should explain that the most common side effect of this medication is a. sedation b. anxiety c. insomnia d. bradycardia

a. sedation ​The most common adverse effect of diphenhydramine, a first-generation antihistamine, is sedation. In fact, this medication is sometimes used as a sleep aid.

A nurse is preparing to administer blood to a client. As the nurse begins to check the 1st unit with another nurse, she notices that the unit of blood is type B and the client's blood type is AB. Which of the following actions should the nurse take?

administer the blood as ordered

when does addiction/physical dependence begin?

after daily use for 30 days

-affects all body organs: CV system, bone health, respiratory system (depresses respirations), erodes stomach, causes cancer, destroys liver (cirrhosis), affects kidneys -Interactions: CNS depressant, DO NOT take Tylenol with this drug as it can increase liver damage -acute OD symptoms: vomiting, aspiration, HTN, poisoning (treated like all poisoning conditions -LT use produces physical dependence -abrupt withdrawal: sweating, shaking, tremors, confusion, hallucination, HR and BP go up, seizures -in extreme cases death results

alcohol

5 A model for treating tobacco use

ask if they smoke, advise to quit, assess willingness to quit, assist with quitting and offer medication, arrange follow up

A nurse is caring for a client who has poison ivy and dermatitis and is started on diphenhydramine (Benadryl). Which of the following nursing recommendations is appropriate for decreasing the dry mouth associated with the use of diphenhydramine? a. "Drink extra fluids while taking this medication." b. "Chew on sugarless gum or suck on hard, sour candies." c. "Place a humidifier at your bedside every evening." d. "I'll ask your doctor to prescribe Salagen."

b. "Chew on sugarless gum or suck on hard, sour candies." Clients who report dry mouth can get the most effective relief by sucking on hard candies (especially the sour varieties that stimulate salivation), chewing gum, or rinsing the mouth frequently. It is the local effect of these actions that provides comfort to the client.

A nurse is talking with a client who is about to start taking allopurinol (Zyloprim) to treat gout. Which of the following statements indicates that the client understands how to take this medication? a. "If I get a rash, I will take my usual antihistamine." b. "I need to drink at least 3 quarts of water a day." c. ​"I should take the medicine on an empty stomach." d. ​"If I get a fever, I will take some aspirin."

b. "I need to drink at least 3 quarts of water a day."​ Clients taking allopurinol must drink enough fluid to produce 2,000 mL of urine per day. The recommended amount to drink is 3,000 mL, which is equivalent to 3 quarts.

A nurse is caring for a client who has several environmental allergies and was admitted in status asthmaticus. the provider prescribes cromolyn sodium via a metered-dose inhaler. to be added to the client's home management along with an albuterol MDI. When performing discharge teaching the nurse should identify the need for additional teaching when the client states a. "if my breathing begins to feel tight, I will use proventil immediately" b. "I will be sure to take the Intal four times a day before using the proventil" c. "It may take 2 to 3 weeks before the Intal will make a difference in my manifestations." d. "If I miss a dose of Intal and it is not yet time for the next dose, I will take it as soon as I remember."

b. "I will be sure to take the Intal four times a day before using the proventil" The client should always use the bronchodilator MDI prior to any other MDI. This helps to ensure that the maximum dose of medication will get to the client's lungs. Albuterol is a beta-agonist bronchodilator, but cromolyn sodium is a mast cell inhibitor that prevents the release of histamine; therefore, the albuterol should be used prior to the cromolyn sodium.

A nurse is caring for a client who is taking naproxen (Naprosyn) following an exacerbation of rheumatoid arthritis. Which of the following comments by the client requires further discussion by the nurse? a. "I signed up for a swimming class." b. "I've been buying Tagamet to help with the indigestion I've had." c. "I've lost 2 pounds since my appointment 2 weeks ago." d. "The Naprosyn goes down easier when I crush it and put it in applesauce."

b. "I've been buying Tagamet to help with the indigestion I've had." NSAIDs, like Naprosyn, can cause serious adverse gastrointestinal reactions such as ulceration, bleeding, and perforation. Warning manifestations such as nausea or vomiting, gastrointestinal burning, and blood in the stool reported by the client require further investigation by the nurse. The client may be taking cimetidine (Tagamet) because he is experiencing one or more of these manifestations.

​A female client who has rheumatoid arthritis asks the nurse if it is safe for her to take aspirin. Which of the following is a contraindication to this medication? a. Report of recent migraine headaches. b. History of gastric ulcers. c. Current diagnosis of glaucoma. d. Prior reports of amenorrhea.

b. History of gastric ulcers.​ Aspirin impedes clotting by blocking prosta-glandin synthesis, which can lead to bleeding. A side effect of prednisone is gastric irritation, also leading to bleeding. Therefore, a history of gastric ulcers is a contraindication to the use of aspirin.

A client is taking ibuprofen (Advil, Motrin) to treat hip pain. The nurse should teach the client that, to minimize gastric mucosal irritation, she should take this medication at which of the following times? a. ​At bedtime b. immediately after a meal c. On arising d. ​On an empty stomach

b. Immediately after a meal ​To minimize gastric irritation, the client should take ibuprofen with a meal or immediately after a meal.

Which of the following are appropriate references for the nurse to use to ensure safe medication administration? (Select all that apply.) a. ​Internet b. Published journals c. Pharmacists d. Physicians' Desk Reference e. ​Pharmaceutical sales representatives

b. Published journals c. Pharmacists d. Physicians' Desk Reference

A nurse is discontinuing a course of prednisone (Deltasone) for a client with an exacerbation of asthma. The nurse should taper the dose so that the client does not experience a. hyperglycemia b. adrenocortical insufficiency c. severe dehydration d. rebound pulmonary congestion

b. adrenocortical insufficiency. Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids may depress the body's normal adrenocortical activity, and abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency.

​An older adult client's provider prescribes aspirin, 650 mg/q6h PO to treat rheumatoid arthritis. The nurse should teach the client that a possible adverse effect of aspirin therapy is a. constipation b. bleeding c. blurred vision d. insomnia

b. bleeding Aspirin in more likely to cause diarrhea than constipation.​Aspirin can cause bleeding, tinnitus, gastric ulceration, nausea, and heartburn.Aspirin is more likely to cause hearing loss than blurred vision.​Aspirin is more likely to cause drowsiness than insomnia.

A nurse is caring for a client admitted for acute inflammation of the ankle. The provider diagnoses an acute attack of gout and orders colchicine (Colsalide) 2 mg IV now, then 0.5 mg IV every 6 hr. The nurse should know that the purpose of colchicine is to a. reduce serum uric acid levels. b. decrease joint inflammation. c. prevent joint destruction. d. increase phagocytosis in the involved joint.

b. decrease joint inflammation. Clients who have gout have too much uric acid in their blood and joints. An attack of gout occurs when uric acid causes inflammation in a joint. Colchicine is used to relieve an acute attack of gout by decreasing joint inflammation and pain. It inhibits the formation of lactic acid in leukocytes, decreasing phagocytosis and joint inflammation.

A nurse is preparing to administer prednisone (Deltasone) to a client for treatment of rheumatoid arthritis. Which of the following indicates effective therapy? a. Elevated blood glucose b. Improved range of motion c. ​Increased blood pressure d. ​Improved long-term memory

b. improved range of motion Prednisone is a glucocorticoid that produces anti-inflammatory and immunosuppressive effects. When used for rheumatoid arthritis, the client should experience a reduction in pain and inflammation, and improved range of motion in joints. Local injections can be highly effective, and clients should be warned against overactivity in the affected joint to prevent overuse, which can lead to injury. Because of the risk for complications, long-term systemic use should be avoided.

A nurse is caring for a client who has acute respiratory distress syndrome (ARDS), requires mechanical ventilation, and is receiving pancuronium (Pavulon). The nurse should recognize that the purpose of this medication is to a. decrease chest wall compliance. b. suppress respiratory effort. c. induce sedation. d. decrease respiratory secretions.

b. suppress respiratory effort Neuromuscular blocking agents, such as pancuronium, induce paralysis and improve chest wall compliance.Neuromuscular blocking agents, such as pancuronium, induce paralysis and suppress the client's respiratory efforts to the point of apnea, allowing the mechanical ventilator to take over the work of breathing for the client. This therapy is especially helpful for a client who has ARDS and poor lung compliance.Neuromuscular blocking agents, such as pancuronium, induce paralysis. They have no sedative effect at all.Neuromuscular blocking agents, such as pancuronium, induce paralysis. A side effect of this medication is excessive production of respiratory secretions.

IV infusion of vitamins, fluids, folic acid, b vitamin supplements, nutrients, thiamine; commonly used for alcoholic patients

banana bags

Which drug reduces the urge to smoke?

bupropion

A nurse is talking with a client about how to use montelukast (Singulair) to treat asthma. Which of the following client statements should indicate that the client understood the nurse's instructions? a. "I'll rinse my mouth after taking this medication." b. ​"I'll take this medication when I get an asthma attack." c. ​"I'll take this medication once a day in the evening." d. "I'll take this medication with meals."

c. "I'll take this medication once a day in the evening."​ The purpose of montelukast, a leukotriene modifier, is to prevent asthma exacerbations. The client should take it on a daily basis once a day in the evening, whether or not he has symptoms.

A nurse is caring for a client who has a prescription for diphenhydramine (Benadryl) to relieve pruritus. The client asks the nurse how he can minimize the daytime sedation he is experiencing. Which of the following is an appropriate response by the nurse? a. ​"Gradually decrease the dose once tolerance to the effect is reached." b. ​"Distribute the doses evenly throughout the day." c. "Take most of the daily dose at bedtime." d. ​"Take the medication with meals."

c. "take most of the daily dose at bedtime" Taking most of the dose at bedtime will allow the client to obtain the benefit of maximum relief of symptoms and rest without itching.

A nurse is giving discharge instructions to a client who has asthma and is about to start using beclomethasone (QVAR). The nurse should tell the client to report which of the following adverse effects to the provider? a. nausea b. tremors c. white coating in the mouth d. dry oral mucous membranes

c. White coating in the mouth ​Beclomethasone, an inhaled glucocorticoid, may cause oropharyngeal candidiasis. Patients should gargle after each use, use a spacer to reduce the amount of drug in the mouth and throat, and report any white patches inside the mouth or on the tongue.

A client who is postoperative reports incisional pain. The surgeon has prescribed subcutaneous morphine. Before administering this medication, the nurse should complete which priority assessment? a. Blood pressure b. Apical heart rate c. ​Respiratory rate d. ​Temperature

c. respiratory rate ​The priority action the nurse should take when using the airway, breathing, and circulation (ABC) approach to client care is to evaluate the client's respirations. The respiratory rate is especially important because opioid analgesics like morphine can cause respiratory depression.

A nurse is teaching a client who has asthma the appropriate use of inhaled beclomethasone (Beclovent). To avoid complications related to the use of beclomethasone, the nurse should encourage the client to a. check the pulse after medication administration. b. take the medication with meals. c. rinse the mouth after administration. d. limit caffeine intake.

c. rinse the mouth after administration. Use of glucocorticoids by metered dose inhaler can allow a fungal overgrowth in the mouth. Rinsing the mouth after administration can lessen the likelihood of this complication.

A nurse is administering ipratropium bromide (Atrovent) via nebulizer to a client who has emphysema. Which of the following client findings should cause the nurse to consult the provider before administering the next dose? a. Nervousness b. Tachycardia c. Visual changes d. Dizziness

c. visual changes Anticholinergics, like ipratropium bromide, can increase intraocular pressure and should be used with caution in clients who have glaucoma. The visual changes that have been reported by this client may indicate the presence of glaucoma.

remains the greatest single cause of preventable illnesses and premature deaths; promotes vomiting, increased gastric acid secretions (GERD), stimulates respirations and produces arousal pattern, causes tremors and convulsions in high doses; may cause acute poisoning

cigarettes

A nurse is educating a group of clients about contraindications of warfarin therapy. which of the following statements is appropriate to include in the teaching?

clients who are pregnant should not take Coumadin

-vasoconstriction, pin point pupils, cardiac stimulation -mild OD: agitation, dizziness, tremors, blurry vision -severe OD: convulsions, stroke treatment: IV diazepam (Valium), lorazepam (Ativan) -chronic toxicity: atrophy of nasal mucosa, loss of sense of smell, necrosis of nasal septum, injury to lungs, don't use during pregnancy -vaccination exists

cocaine

A nurse is caring for a client who is receiving mydriatic eye drops. Which of the following clinical manifestations indicates to the nurse that the client has developed a systemic anticholinergic effect?

constipation

A nurse is caring for a client who reports daily use of acetaminophen (Tylenol) to manage mild knee pain. Which of the following statements by the client should be of most concern to the nurse? a. ​"I have a glass of wine before bedtime each evening." b. ​"I have my blood checked often due to the heparin I am taking." c. "I take two regular-strength tablets in the morning and two in the evening." d. "I take three or four Vicodin ES tablets a day for severe knee and joint pain."

d. "I take three or four Vicodin ES tablets a day for severe knee and joint pain." Vicodin ES is a combination analgesic that contains 650 mg of acetaminophen in each tablet. If the client took three of these tablets, that would be 1,950 mg of acetaminophen and four tablets would be 2,600 mg. If the client takes four in one day, it would take only four regular-strength acetaminophen (Tylenol) tablets (325 mg each) to reach the maximum recommended dose of 4,000 mg.This option creates the highest potential for acetaminophen overdose. In the event of an overdose, administer the antidote for acetaminophen, which is acetylcysteine (Mucomyst).

A nurse is giving discharge instructions to a client who has asthma and is about to start taking zileuton (Zyflo). The nurse should tell the client to report which of the following adverse effects to the provider? a. blurred vision b. headache c. diarrhea d. abdominal pain

d. abdominal pain ​Zileuton can cause liver damage and hepatitis. The client should report any signs of hepatic toxicity, such as abdominal pain or jaundice.

A nurse is preparing to use the Z-track technique to administer a medication to a client. Which of the following is an appropriate action during this procedure? a. ​Pull the skin 1.3 cm (1/2 inch) to the side. b. Insert the needle slowly and gently. c. ​Use a 45-degree angle of insertion. d. ​Aspirate for 5 to 10 seconds.

d. aspirate for 5-10 seconds

A hospice nurse makes weekly visits to a client who has terminal cancer. For several weeks, the client has been taking morphine sulfate for pain relief. At today's visit, the client reports to the nurse that the usual dose of morphine does not seem to be working. The nurse should understand that the most likely explanation is that the client has a. not been taking the medication properly b. experienced episodes of confusion c. become addicted to the medication d. developed a tolerance to the medication

d. developed a tolerance to the medication. Morphine sulfate is a narcotic analgesic used for the treatment of severe pain. Tolerance is an undesirable side effect of narcotic analgesics in which a larger dose is needed to produce the same response.

A nurse plans to administer ceftriaxone (Rocephin) 1 mL to an older adult client. Which of the following indicates the correct technique? a. ​Uses a 5/8-inch needle b. ​Injects at a 45° angle c. Administers medication in deltoid muscle d. Locates the vastus lateralis injection site

d. locates the vastus lateralis injection site The ventrogluteal or vastus lateralis are the safest injection sites for this medication. The nurse locates the vastus lateralis muscle by placing one hand below the greater trochanter of the femur and one hand's width above the knee

A client who is in labor receives butorphanol (Stadol) for pain management. Which of the following medications should the nurse have readily available? a. protamine b. diphenhydramine (Benadryl) c. Atropine d. Naloxone (Narcan)

d. naloxone (narcan) rationale: Butorphanol is an opioid analgesic. The nurse should have the opioid reversal agent naloxone and resuscitation equipment available in the event that the client develops respiratory depression.

A nurse is giving discharge instructions to a client who has asthma and is about to start taking theophylline (Theo-24). The nurse should tell the client that this medication might cause which of the following adverse effects? a. drowsiness b. constipation c. oliguria d. tachycardia

d. tachycardia ​Theophylline can increase cardiac stimulation and cause tachycardia

what other drug is a strong opiate agonist?

dilaudid

A nurse is instilling ear drops to a young child and must straighten the ear canal by pulling the auricle of the ear. The nurse will pull the auricle in which directions?

down and backwards

A nurse is monitoring a client who is receiving a parenteral lipid infusion. which of the following findings is the highest priority for the nurse to report to the provider?

elevated temperature

-major drugs of abuse

heroin, meperidine, fentanyl, oxycodone

A nurse is caring for a client who takes prednisone (Deltasone) and has developed an infection. The nurse should expect that the provider will a. increase the dosage of prednisone. b. discontinue prednisone therapy. c. decrease the dosage of prednisone. d. make no changes in the prednisone dosage.

increase the dosage of prednisone rationale: infection increases the body's need for glucocorticoids. During times of stress such as infection, the provider should increase the dosage to help prevent adrenal insufficiency in clients who take the medications on a long term basis.

A nurse is caring for a client who requests pain medication. The nurse should understand that acute pain can cause which of the following?

increased heart rate

the nurse cares for a patient who has used marijuana daily for the past 7 years. the nurse should assess the patient for which of the following for excessive use of marijuana?

lack of interest in achievement, poor grooming, dullness, disinterest

-very common in hospital for medicinal purposes -treats nausea and increases appetite for chemo patients, chronic pain, insomnia -thc chemical is activated in brain -LT use: poor grooming, dullness, reduced interest in achievement, disinterest -high doses: hallucination, delusions, paranoia -low-moderate doses: relax, increased sensitivity, enhanced sense of smell and touch, distortion of time, increased appetite and ability to appreciate flavor of food, slow reaction time, impairment of motor coordination

marijuana, marinol

What do doctors prescribe for patients trying to come off heroin? -initial use causes nausea and vomiting, overall sense of euphoria

methadone

-taken orally, smoked, IV -called "naked drug" or "ice" -s/s: arousal, euphoria, sense of increased physical strength and mental capacity, hallucinations

methamphetamine

-strong opiate agonist (exacerbates effects, produce response) -usually in vile or pill form -clamp iv, flush saline, push medication, flush saline, reclamp -pain relief, drowsiness, anxiety reducing, sense of well being, respiratory depression, constipation, urinary retention, OH, emesis, miosis (constriction of pupil), cough suppression, biliary colic, tolerance and physical dependence, euphoria/dysphoria, sedation, neurotoxicity -NO loss on consciousness, relieves pain w/o affecting other senses, primarily at mu receptors -respiratory depression in elderly, infants, impaired pulmonary function -commonly given with stool softeners

morphine

reverses OD of opiates -comatose: tracks on arms, unconscious

naloxone (Narcan)

actions in CNS mimics cocaine and highly addictive substances; constricts blood vessels, accelerates heart, increases force of ventricular contraction, and elevates BP; in breast milk, it can harm the nursing infant

nicotine

what are interventions for cigarette smoking patients?

offer nicotine replacement while admitted, nicotine patches, lozenges, gums, encourage smoking cessation

-most effective pain relievers available; any natural or synthetic that have actions similar to those of morphine -cns depressants -low HR, BP, RR -no antipyretic effects -include mu receptors, delta receptors, kappa receptors

opiates

for moderate to severe pain

oxycodone

a form of oxycodone but it is given around the clock because it is controlled release

oxycontin

Whenever a nurse is caring for clients who are receiving heparin, which of the following medications should the nurse have on hand in the event of an overdose?

protamine

A nurse is talking with a client about taking an expectorant to treat a cough. The nurse should explain that this type of medication treats coughs because of which of the following actions? a. ​Reduces inflammation b. ​Suppresses the urge to cough c. ​Dries mucous membranes d. Stimulates secretions

stimulates secretions ​Expectorants act by increasing secretions to improve a cough's productivity.

A nurse is caring for a client who is hospitalized and is on day 1 of a 10-day course of IV penicillin G potassium. Ten minutes into the infusion of the third dose, the client reports that the IV site itches. The client also states that he is "feeling dizzy and short of breath." The nurse's priority action is to

stop the infusion

A nurse is monitoring a client's transfusion of packed red blood cells and suspects that a hemolytic reaction is occurring. Which of the following is the priority intervention?

stop the transfusion

Which of the following should be recognized by the nurse as part of the medication reconciliation process?

the documents list includes all medications taken by the client

The nurse is providing teaching about smoking cessation to patient with heart disease who smokes 1-2 ppd. which patient teaching should nurse include?

the reduction of nicotine use will decrease BP

polyphagia, polydipsia, polyuria, indigestion or bloody vomitus as well as black tarry stools, signs of infections (sore throat, may not be accompanied by fever or inflammation), painful mucus membranes with white patches, weight gain or edema, weakness

these conditions should be immediately reported iff a let is taking glucocorticoids.

A patient states that the dose of oxycodone that he recently received does not provide the same pain relief as it used to. The nurse understand that the patient has most likely develop what?

tolerance

A patient who drinks more than 10 alcoholic beverages a day is admitted to the hospital. 12 hours later, the nurse should assess for abstinence syndrome which manifests as what?

tremors, muscle cramps, tachycardia

A provider prescribes a transfusion of one unit of packed RBC for a client who has a low hemoglobin level. The provider also prescribes diphenhydramine (Benadryl) for administration before the transfusion to prevent

urticaria

A nurse is caring for a client. The client states, " I don't want to take my medication." Which of the following actions should the nurse take?

"Document that the client refuses the medication"

A nurse is assessing a client who has numerous bruises on his upper extremities. The client reports that he has taken warfarin (Coumadin) daily for the past 3 months. Which of the following statements by the client indicates the client needs further teaching?

"I have started taking ginger root to treat my joint stiffness." rationale: Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. This statement indicates the client needs further teaching.

A nurse is reinforcing medication instruction to a group of clients. Which of the following statements indicates a need for further clarification? a. "I will take ibuprofen for arthritis" b. "I will take morphine sulfate during sickle cell crisis" c. "I will take propranolol hydrochloride to manage high blood pressure" d. "I will take aspirin for headaches like I did when I had a stroke"

"I will take aspirin for headaches like I did when I had a stroke." rationale: This is an incorrect client response because aspirin may be contraindicated. Aspirin is classified as a nonnarcotic analgesic that powerfully inhibits platelet aggregation, which increases bleeding. A client who has experienced a hemorrhagic stroke should not take any medications that could cause further bleeding. The nurse should reinforce education regarding the effect of aspirin therapy.

A nurse is providing discharge teaching to a client who will be taking warfarin (Coumadin) at home. Which of the following statements indicates that the client understands the effects of this medication?

"I'll use my electric razor for shaving."

A nurse is caring for a client who has a prescription for oral erythromycin (E-Mycin). Which of the following statements is appropriate for the nurse to document regarding expected side effects of this medication?

"The client had a small amount of yellow emesis."

What drugs are used to treat alcohol withdrawal?

-Librium (Ativan, lorazepam) around the clock for a/l 1 day; keeps the patient calm and helps with withdrawals

A nurse is caring for a client who asks how albuterol helps his breathing. which of the following should the nurse include in the response?

-the med will prevent wheezing -will open airways -will decrease coughing episodes

A nurse is caring for a client who received morphine sulfate 30 min ago. Which of the following best determines therapeutic client response to this medication? a. ​Stable vital signs b.0 rating on pain scale c.No nausea with good appetite d.​Improved output with decreased peripheral edema

0 rating on pain scale Nurses should monitor the effectiveness of analgesic medications 30 to 60 min after administration. The best indicator that the analgesic medication is effective is the client's interpretation of pain relief and verbalization that pain is at an acceptable level.