Pharmacological and Parenteral Therapies

A client is taking phenelzine 15 mg PO three times a day. The nurse is about to administer the next dose when the client tells the nurse about having a throbbing headache. Which action should the nurse do first? Obtain the client's vital signs. Call the health care provider (HCP) to report the symptom. Administer the client's next dose of phenelzine. Give the client an analgesic prescribed PRN.

Obtain the client's vital signs. The nurse should first take the client's vital signs because the client could be experiencing a hypertensive crisis, which requires prompt intervention. Signs and symptoms of a hypertensive crisis include occipital headache, a stiff or sore neck, nausea, vomiting, sweating, dilated pupils and photophobia, nosebleed, tachycardia, bradycardia, and constricting chest pain. Giving this client an analgesic without taking his vital signs first is inappropriate. After the client's vital signs have been obtained, then the nurse would call the HCP to report the client's problems and vital signs. Administering the client's next dose of phenelzine before taking his vital signs could result in a dangerous situation if the client is experiencing a hypertensive crisis.

The plan of care for a client with hypertension taking propranolol hydrochloride should include: measuring partial thromboplastin time weekly to evaluate blood clotting status. instructing the client to notify the health care provider of irregular or slowed pulse rate. monitoring blood pressure every week and adjusting the medication dose accordingly. instructing the client to discontinue the drug if nausea occurs.

instructing the client to notify the health care provider of irregular or slowed pulse rate. Propranolol hydrochloride is a beta-adrenergic blocking agent used to treat hypertension. In addition to lowering blood pressure by blocking sympathetic nervous system stimulation, the drug lowers the heart rate. Therefore, the client should be assessed for bradycardia and other arrhythmias.The client needs to be instructed not to discontinue medication because sudden withdrawal of propranolol hydrochloride may cause rebound hypertension.Propranolol dosage is not adjusted based on weekly blood pressure readings.Measurement of partial thromboplastin time values is not a factor in treatment of hypertension.

A nurse is caring for a client in addisonian crisis. Which medication order should the nurse question? hydrocortisone potassium chloride fludrocortisone normal saline solution

potassium chloride Since addisonian crisis results in hyperkalemia, administering potassium chloride is contraindicated. Therefore, the nurse should question the order for potassium chloride, making this the correct choice for this question. Because the client is hyponatremic, an order for normal saline solution is appropriate. Hydrocortisone and fludrocortisone are used to replace deficient adrenal cortex hormones.

The healthcare provider orders nitroglycerin transdermal patch for a client having angina pain. What priority teaching would the nurse include? Select all that apply. "Remove the nitroglycerin patch before bathing or swimming." "Remove the nitroglycerin patch before going to bed." "Add an extra nitroglycerin patch if you are experiencing chest pain." "Apply a new nitroglycerin patch every morning." "Apply nitroglycerin patches at or around the same time every day."

Apply a new nitroglycerin patch every morning." "Apply nitroglycerin patches at or around the same time every day." Nitroglycerin is a coronary vasodilator. Priority teaching includes: applying a patch in the morning and removing the patch before bed, and removing the patch when defibrillation is needed. There is no need to remove the patch before bathing/swimming, and adding an extra dose of nitroglycerin may cause adverse effects.

The nurse learns that a client who is scheduled for a tonsillectomy has been taking 40 mg of oral prednisone daily for the last week for poison ivy on the leg. What should the nurse do first? Document the prednisone with current medications. Notify the surgeon of the poison ivy. Notify the anesthesiologist of the prednisone administration. Send the client to surgery.

Notify the anesthesiologist of the prednisone administration. The nurse should notify the anesthesiologist because supplemental prednisone suppresses the adrenal cortex's natural ability to produce increased corticosteroids in times of stress such as surgery. The anesthesiologist may need to prescribe supplemental steroid coverage during the perioperative period. The nurse should document the prednisone with current medications, but it is a priority to inform the anesthesiologist. Because the poison ivy is not in the surgical field, the surgeon does not need to be called regarding the skin disruption.

A nurse is reviewing the medication list of a client who presents with slow, involuntary muscle spasms of the arms and legs and twisting of the neck. The nurse reviews the client's prescriptions for which medication that could correlate with these symptoms? diazepam clonazepam haloperidol amitriptyline hydrochloride

haloperidol Haloperidol is a phenothiazine and is capable of causing dystonic reactions. Dystonia involves slow, involuntary contractions of an isolated muscle or groups of muscles in the limbs, trunk, and neck. It may involve spasmodic torticollis (involuntary turning of the neck). Diazepam and clonazepam are benzodiazepines. Benzodiazepines don't cause dystonic reactions; however, they can cause drowsiness, lethargy, and hypotension. Tricyclic antidepressants, like amitriptyline, rarely cause severe dystonic reactions; however, they can cause a decreased level of consciousness, tachycardia, dry mouth, and dilated pupils.

The parent of a child who is taking an antibiotic for bilateral otitis media tells the nurse that he has stopped the medicine since the child is better and is saving the rest of the medication to use the next time the child gets sick. What should the nurse tell the parent? "Your child needs all of the medicine so that the infection clears." "How do you know your child's ears are cured?" "Stopping the medicine will make the next ear infection harder to treat." "It's important to give the medicine as prescribed."

"Your child needs all of the medicine so that the infection clears." Commonly, when a child appears better, the parents stop the medication. Unfortunately, the infection remains. Therefore, the nurse needs to explain that all of the medication must be administered to clear up the infection. Explaining why the medicine should be continued is more helpful to parents than saying it needs to be given. Telling the parent that stopping the medication will make the next ear infection harder to treat does not focus on the present issue.

A short time after administering pain medication to a client, the nurse returns to the client's room and finds the client difficult to arouse. The nurse realizes that 25 ml of the liquid medication was administered instead of the ordered 25 mg, which is contained in 5 ml. How could the nurse have prevented this error? Carefully review the order and medication label, then calculate the ordered dose. Highlight dosage instructions on the medication bottles. Have another nurse double check the medications before administration. Attempt non-pharmacological pain control methods, and administer PRN pain medications as a last resort.

Carefully review the order and medication label, then calculate the ordered dose. The nurse should always take the time to identify the client, carefully review the medication order, read the medication label, and calculate the ordered dose. Consistently following these steps helps prevent medication administration errors. The nurse should double check calculations with another nurse, not ask another nurse to double check all medications. The nurse can use non-pharmacological pain therapies, but as an adjunct to pain medications and not a last resort. Using non-pharmacological therapies only delays treatment and places the client at risk for intensified pain. Highlighting dosage instructions can lead to errors if done inconsistently. It is best to carefully review each order.

The nurse instructs a client with coronary artery disease in the proper use of nitroglycerin. The client has had 2 previous episodes of coronary artery disease. At the onset of chest pain, what should the client do? Go to the emergency department if two nitroglycerin tablets taken 5 minutes apart are not effective. Call 911 when five nitroglycerin tablets taken every 5 minutes are not effective. Take one tablet and then immediately call 911. Call 911 when three nitroglycerin tablets taken every 5 minutes are not effective.

Call 911 when three nitroglycerin tablets taken every 5 minutes are not effective. Nitroglycerin tablets should be taken 5 minutes apart for three doses; if this is ineffective, 911 should be called to obtain an ambulance to take the client to the emergency department. The client should not drive or have a family member drive the client to the hospital.

A client with a history of Addison's disease is experiencing weakness and headache. The vital signs are blood pressure of 100/60 and heart rate of 80. Laboratory values are Na 130, potassium 4.8, and blood glucose 70. Which solution would the nurse expect to administer? I.V. normal saline and glucocorticoids I.V. total parenteral nutrition and insulin coverage I.V. 5% dextrose and dopamine I.V. lactated Ringer's solution and packed cells

I.V. normal saline and glucocorticoids The client with Addison's is expected to have hypotension and inadequate corticosteroids. There is no evidence that the client would be anemic. Although the blood pressure may be a little below normal, there is no indication for an inotropic drug such as dopamine to increase perfusion. There is no indication that the client would be weak and hypoglycemic.

An IV infusion is to be administered through a scalp vein on an infant's head. What should the nurse tell the parents to prepare them for the procedure? Holding the infant will be contraindicated while the infusion is being administered. It may be necessary to remove a small amount of hair from the infant's scalp. A sedative will be given to the infant to help keep the child quiet. Visiting the infant will be delayed until the infusion has been completed.

It may be necessary to remove a small amount of hair from the infant's scalp. Parents are typically quick to notice changes in their infant's physical appearance. The removal of the infant's hair may be upsetting to them if they have not been told why it is being done. Hair may be removed on the scalp at the site of needle insertion for IV therapy to provide better visualization and a smooth surface on which to attach tape to secure the needle. Sedatives are not ordinarily prescribed before IV fluid administration. In most instances, it is acceptable for parents to visit their infant while the IV solution is infusing. Holding the infant is encouraged to provide comfort.

A primigravid client at 32 weeks' gestation with ruptured membranes is prescribed to receive betamethasone 12 mg intramuscularly for two doses 24 hours apart. When teaching the client about the medication, what should the nurse include as the purpose of this drug? to reduce contraction frequency to accelerate fetal lung maturity to prevent potential infection to improve the fetal heart rate pattern

to accelerate fetal lung maturity Corticosteroids, such as betamethasone, are prescribed for clients who are preterm to accelerate fetal lung maturity and reduce the incidence and severity of respiratory distress syndrome.Infection would be treated with antibiotics. Tocolytic therapy is used to reduce contractions.The nurse should monitor the fetal heart rate pattern, but betamethasone will not improve the fetal heart rate.

A nurse should assess the maturity of enzyme systems (kidney and liver) in which pediatric population before administering medications? toddlers adolescents neonates premature infants

premature infants Factors related to growth and maturation significantly alter an individual's capacity to metabolize and excrete drugs. Thus, the premature infant is at risk for problems because of immaturity. Deficiencies associated with immaturity become more important with decreasing age. Enzyme systems develop quickly, with most increasing to adult levels within 1 to 8 weeks after birth. Within the first year of life, all are probably as active as they will ever be.

The nurse administers fat emulsion solution during TPN to a malnourished client. What should the nurse tell the client about the purpose of this solution? Fat emulsion solution: provides essential fatty acids. promotes effective metabolism of glucose. maintains a normal body weight. adds extra carbohydrates.

provides essential fatty acids. The administration of fat emulsion solution provides additional calories and essential fatty acids to meet the body's energy needs. Fatty acids are lipids, not carbohydrates. Fatty acids do not aid in the metabolism of glucose. Although they are necessary for meeting the complete nutritional needs of the client, fatty acids do not necessarily help a client maintain normal body weight.

A nurse is caring for a school-age client who is in the second percentile of height and weight for age as a result of an endocrine disorder. Which pharmacological intervention should the nurse anticipate? treatment with desmopressin acetate (DDAVP) replacement with biosynthetic growth hormone replacement with antidiuretic hormone (ADH) treatment with testosterone or estrogen

replacement with biosynthetic growth hormone The definitive treatment of growth hormone deficiency is the replacement of growth hormone (somatotropin) with biosynthetic somatotropin. This treatment is successful in 80% of affected children. Desmopressin acetate is used to treat diabetes insipidus. A deficiency of antidiuretic hormone causes diabetes insipidus, and isn't related to hypopituitarism. Testosterone or estrogen may be given during adolescence for normal sexual maturation, but neither is the definitive treatment for hypopituitarism.

A nurse has inserted a peripheral intravenous catheter. Which type of dressing is most appropriate to use to cover the insertion site? adhesive hydrocolloid transparent gauze

transparent A transparent dressing is optimal since it allows assessment of the insertion site. A sterile gauze dressing must be changed every 48 hours or more often if needed according to agency protocol. Adhesive bandages are not occlusive, cover a small surface area, and often irritate the skin. Hydrocolloid and foam dressings are used on pressure ulcers and not peripheral intravenous sites.

The nurse is discussing medications with a client with hypertension who has a prescription for furosemide daily. Which comment by the client indicates the client needs further education? "I should take the furosemide in the morning instead of before bed." "I should be careful not to stand up too quickly when taking furosemide." "I need to be sure to also take the potassium supplement that the health care provider prescribed along with my furosemide." "I know I shouldn't drive after taking my furosemide."

"I know I shouldn't drive after taking my furosemide." Furosemide is a diuretic often prescribed for clients with hypertension or heart failure; the drug should not affect a client's ability to drive safely. Furosemide may cause orthostatic hypotension, and clients should be instructed to be careful when changing from supine to sitting to standing position. Diuretics should be taken in the morning if possible to prevent sleep disturbance due to the need to get up to void. Furosemide is a loop diuretic that is not potassium sparing; clients should take potassium supplements as prescribed and have their serum potassium levels checked at prescribed intervals.

After a period of unsuccessful treatment with amitriptyline, a woman diagnosed with depression is switched to tranylcypromine. Which statement by the client indicates the client understands the side effects of tranylcypromine? "I must refrain from eating aged cheese or yeast products." "I should decrease my intake of foods containing sugar." "I must refrain from strenuous exercise." "I need to increase my intake of sodium."

"I must refrain from eating aged cheese or yeast products." Cheese and yeast products contain tyramine, which the client should avoid to prevent a negative interaction with tranylcypromine, a monoamine oxidase (MAO) inhibitor. Sodium will not interact with tranylcypromine, and neither exercise nor sugar needs to be limited.

The nurse instructs the client in mixing and administering regular and NPH insulin. Which statement indicates that the client needs additional instruction? "I draw up the regular insulin first." "I insert the needle at a 90-degree angle." "I store the insulin in a cool place." "I shake the bottle of NPH insulin before drawing it up."

"I shake the bottle of NPH insulin before drawing it up." NPH insulin should be rolled between the palms to mix it before drawing it up; shaking it will introduce air bubbles into the solution, which can cause inaccurate dosing. The client should draw up the regular insulin first, store the insulin in a cool place, and inject the insulin at a 90-degree angle.

The nurse is teaching the client with cirrhosis about taking lactulose. The nurse should tell the client that which type of bowel movement is an expected outcome of taking this drug? four to five loose stools per day two to three soft stools per day one regular bowel movement a day five to six loose stools per day

two to three soft stools per day The expected effect of lactulose is for the client to have two to three soft stools a day to help reduce the pH and serum ammonia levels, which will prevent hepatic encephalopathy. Diarrhea, or frequent loose stools, is a potential adverse effect of the medication.

The nurse is preparing a teaching plan about increased exercise for a female client who is receiving long-term corticosteroid therapy. What type of exercise is most appropriate for this client? walking running stretching floor exercises

walking The best exercise for females who are on long-term corticosteroid therapy is a low-impact, weightbearing exercise such as walking or weight lifting. Floor exercises do not provide for the weightbearing. Stretching is appropriate but does not offer sufficient weightbearing. Running provides for weightbearing but is hard on the joints and may cause bleeding.

The nurse instructs a client on the use of transdermal nitroglycerin 0.2 mg/hour patch for angina pectoris. Which client statement indicates that teaching was effective? "I should apply the patch to the same area every day." "I should report any skin irritation to the healthcare provider." "I should store the supply of transdermal pads in the refrigerator." "I should touch the medication pad before applying to my skin."

"I should report any skin irritation to the healthcare provider." Because transdermal nitroglycerin can cause skin irritation, this should be reported to the healthcare provider. The site to apply the patch should be rotated every day to prevent sensitization and tolerance. The medication pad should not be touched, because this could cause the drug to be absorbed through the fingers. The medication should be stored away from temperature and humidity extremes because this may inactivate the drug.

A nurse is assigned to four clients. Which client should the nurse see first? A client who is being prepared for a major surgery receiving clopidogrel A client with acquired immunodeficiency syndrome receiving emtricitabine A client who had open reduction internal fixation (ORIF) receiving fondaparinux A client with a low white blood cell count receiving pegfilgrastim

A client who is being prepared for a major surgery receiving clopidogrel Clopidogrel is an anti-platelet drug that should be stopped seven days prior to surgery because it can increase the risk of bleeding. All the other options are correct. Fondaparinux can be given to a client who had ORIF to prevent blood clot formation. Pegfilgrastim is given to a client with low white blood cell (WBC). Emtricitabine is a nucleoside-nucleotide reverse transcriptase inhibitor (NNRTI) drug used for clients with HIV/AIDS.

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving A-positive blood to an A-negative client. B-positive blood to an AB-positive client. O-negative blood to an O-positive client. O-positive blood to an A-positive client.

A-positive blood to an A-negative client. An acute hemolytic reaction occurs when there is an ABO or Rh incompatibility. For example, giving A blood to a B client would cause a hemolytic reaction. Likewise, giving Rh-positive blood to an Rh-negative client would cause a hemolytic reaction. It's safe to give Rh-negative blood to an Rh-positive client if there is a blood type compatibility. O-negative blood is the universal donor and can be given to all other blood types. AB clients can receive either A or B blood as long as there isn't an Rh incompatibility.

If a client's central venous catheter accidentally becomes disconnected, what should a nurse do first? Call the physician. Apply a dry sterile dressing to the site. Clamp the catheter. Tell the client to take and hold a deep breath.

Clamp the catheter. If a central venous catheter becomes disconnected, the nurse should immediately apply a catheter clamp. If a clamp isn't available, the nurse may place a sterile syringe or catheter plug in the catheter hub. After cleaning the hub with alcohol or povidone-iodine solution, the nurse must replace the I.V. extension set and restart the infusion. Calling the physician, applying a dry sterile dressing to the site, and telling the client to take a deep breath aren't appropriate interventions at this time.

Atropine sulfate is contraindicated as a preoperative medication for which client? A client with: glaucoma. diabetes. pyelonephritis. chronic obstructive pulmonary disease (COPD).

glaucoma. Atropine is contraindicated in clients with glaucoma because it increases intraocular pressure. It is not contraindicated in clients with diabetes, pyelonephritis, or COPD.

The nurse administers the first dose of warfarin to an older adult client. Which important client teaching point(s) should the nurse emphasize regarding this new medication? Select all that apply. Limit intake of foods high in vitamin K. You can take an extra dose of this medication if you feel like you need it. Watch for signs and symptoms of bleeding. Eat a diet high in fiber. Take extra care to avoid injuries.

Limit intake of foods high in vitamin K. Watch for signs and symptoms of bleeding. Take extra care to avoid injuries. Warfarin is an anticoagulant medication that helps prevent the formation of blood clots. Important client teaching considerations for this medication include limiting the intake of foods high in vitamin K, as too much vitamin K can inhibit the action of warfarin. Clients must also be taught to watch for signs and symptoms of bleeding and to take precautions to avoid injury while taking an anticoagulant. There is no need to increase fiber intake while on this medication, as it does not cause constipation. The client should never take an extra dose of any medication without being instructed to by the provider, and doing so with this medication could cause dangerous bleeding.

A client has been taking dexamethasone for 2 weeks. The nurse evaluates a client's knowledge as deficient when the client makes which comment? "I need to watch for an allergic reaction when I first start taking this pill." "If I forget a dose, it's no big deal; I'll just take it when I remember it." "When I get a cold, I need to let my health care provider know." "I can't stop the medication all at one time."

"If I forget a dose, it's no big deal; I'll just take it when I remember it." The statement "If I forget a dose, it's no big deal, I'll just take it when I remember it" indicates a knowledge deficit. The nurse should reinforce that the client should take dexamethasone as prescribed and at the same time each day. The drug has to be tapered off and cannot be stopped abruptly. The health care provider (HCP) should be notified when the client is under additional stress (e.g., infection, surgery, illness). The client can have an allergic reaction to inactive ingredients contained in dexamethasone.

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? "Test your blood glucose every 4 hours." "Follow your regular meal plan, even if you're nauseous." "It's okay for your blood glucose to go above 300 mg/dl while you're sick." "Don't take your insulin or oral antidiabetic agent if you don't eat."

"Test your blood glucose every 4 hours." The nurse should instruct a client with diabetes mellitus to check their blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when the client is sick. If the client's blood glucose level rises above 300 mg/dl, the client should call their physician immediately. If the client is unable to follow the regular meal plan because of nausea, the client should substitute soft foods, such as gelatin, soup, and custard.

The client reports concerns regarding use of patient-controlled analgesia (PCA). Which response(s) by the nurse would most likely decrease the client's anxiety regarding the PCA? Select all that apply. "The PCA decreases complications." "The PCA yields earlier discharge." "The PCA helps attain early ambulation." "The PCA provides better pain management than PRN medications." "The PCA has a greater client satisfaction with pain management."

"The PCA helps attain early ambulation." "The PCA provides better pain management than PRN medications." "The PCA has a greater client satisfaction with pain management." The nurse should relay to the client that PCA helps with early ambulation, provides better pain management, and contributes to greater client satisfaction. Use of PCA does lead to earlier discharge or decrease in complications so this should not be communicated to the client.

Blood administration is ordered for a client receiving chemotherapy. The nurse is obtaining all supplies needed for infusion. Which intravenous solution is obtained? Lactated Ringer 0.9% Sodium Chloride D5 1/2 NS Solution D5 1/4 NS Solution

0.9% Sodium Chloride Normal saline solution (0.9 NS) is the only fluid compatible with blood administration. Lactated Ringers and dextrose solutions are not infused with blood products due to compatibility.

A client has a heart rate of 170 beats/minute. The physician diagnoses ventricular tachycardia and orders lidocaine hydrochloride, an initial I.V. bolus of 50 mg followed in 5 minutes by a second 50-mg bolus, then continuous I.V. infusion at 2 mg/minute. The nurse can expect the client to begin experiencing an antiarrhythmic effect within 10 to 15 minutes after I.V. bolus administration. 10 to 15 minutes after continuous I.V. infusion. 1 to 2 minutes after I.V. bolus administration. 1 to 2 minutes after continuous I.V. infusion.

1 to 2 minutes after I.V. bolus administration. Lidocaine exerts its antiarrhythmic effect in 1 to 2 minutes after I.V. bolus administration. A continuous I.V. infusion will maintain lidocaine's antiarrhythmic effect for as long as the drip is used. Lidocaine provides antiarrhythmic effects for only 15 minutes after the I.V. infusion is stopped.

The client's order is for 5 units of regular insulin and 10 units of NPH (neutral protamine Hagedorn) insulin given as a basal dose. The client also is to receive an amount prescribed from the medium-dose sliding scale (shown image) based on morning blood glucose levels. The current bedside blood glucose measurement is 264 mg/dL (14.7 mmol/L). How many total units of insulin would the nurse administer to the client? Record your answer using a whole number.

21 The basal dose for this client is 5 units of regular insulin and 10 units of NPH insulin. The medium-dose sliding scale indicates that, based on the glucose reading of 264 mg/dL (264 mmol/L), the client should receive an additional 6 units of regular insulin, totaling 21 units (5 units + 10 units + 6 units = 21 units).

An adolescent client is using glargine and lispro to manage type 1 diabetes. The nurse reviews the prescription for sliding scale lispro (see exhibit). Lispro subcutaneous give units according to sliding scale: Blood glucose: 70 - 150 mg/dL (3.9 to 8.3 mmol/L) = 0 units 151-200 mg/dL (8.4 to 11.1 mmol/L) = 1 unit 201-250 mg/dL (11.2 to 13.9 mmol/L) = 2 units 251-300 mg/dL (14 to 16.7 mmol/L) = 3 units 301-350 mg/dL (16.8 to 19.4 mmol/L) = 4 units Call for blood glucose > 350 (19.4 mmol/L)In addition give 1 unit for every 15 grams of carbohydrate. The morning blood glucose is 202 mg/dL (11.2 mmol/L) and the client is going to eat 2 carbohydrate exchanges. The nurse has the client administer how many units of lispro? Record your answer using a whole number.

4 Each carbohydrate food exchange has 15 grams of carbohydrate. Two units are needed to cover the current blood glucose, and 2 units are needed to cover the anticipated carbohydrate intake.

A client is prescribed morphine sulfate intramuscularly (IM). Which is true regarding administration of this controlled substance? Another nurse must observe disposal of unused medication. Another nurse must validate administration of the medication. Morphine may only be administered by a registered nurse. A registered nurse must observe the licensed practical/vocational nurse administer the medication.

Another nurse must observe disposal of unused medication. Morphine sulfate and other narcotics are carefully controlled by state and federal guidelines, including observation and documentation of any unused ("wasted") medication. While administering morphine intravenously is not within the scope of practice of a licensed nurse, IM morphine may be given by a registered or licensed nurse without observation or validation by another nurse.

After 5 days of hospitalization, a client who is receiving morphine sulfate for pain control asks for pain medication with increasing frequency and exhibits increased anxiety and restlessness. The vital signs are within normal ranges. What is a possible cause of this behavior? Other coping mechanisms are exhausted. The client is addicted to the morphine. The client has developed tolerance to the dose of morphine. The morphine dosage is too high.

The client has developed tolerance to the dose of morphine. Tolerance to a regular opioid dose can develop with frequent use. The client experiences increased discomfort, asks for medication more frequently, and exhibits anxious and restless behavior. Such actions are often misinterpreted as indicative of dependence or addiction. Addiction is a psychological condition in which a client takes drugs for nontherapeutic reasons; this client is receiving morphine for pain control. The client's symptoms do not suggest that the dosage is too high. No data are given about the client's coping mechanisms.

The client was recently diagnosed with a hiatal hernia. The healthcare provider orders an antacid that has reduced adverse effects. What should the nurse include in the client's teaching about the side effects of antacids? "A side effect of an antacid is fast breathing." "A side effect of an antacid is a decreased urge to urinate." "The major side effect of an antacid is profuse sweating." "The major side effect of an antacid is diarrhea."

The major side effect of an antacid is diarrhea." Major side effects of antacids include diarrhea, constipation, dry mouth, gas, nausea, and stomach pain. These should be explained to the client. Side effects do not include profuse sweating, decreased urge to urinate, or fast breathing. Some antacids, depending on the type, can cause dry mouth, increased urge to urinate, and slow breathing.

A client is taking iron supplements. What information should the nurse give the client? The stools will become darker. Liquid iron supplements will not discolor teeth. Do not use a bulk laxative. Iron supplements should be taken on an empty stomach.

The stools will become darker. Iron supplements will darken the stools. Iron supplements should not be taken on an empty stomach because they can cause gastric irritation. Iron is constipating, and a daily bulk-forming laxative should be started prophylactically. A straw should be used when taking liquid iron to avoid discoloring the teeth.

The nurse should advise which client who is taking lithium to consult with the health care provider regarding a potential adjustment in lithium dosage? a client who continues work as a computer programmer a client who is beginning training for a tennis team a client who attends college classes a client who can now care for her children

a client who is beginning training for a tennis team A client who is beginning training for a tennis team would most likely require an adjustment in lithium dosage because excessive sweating can increase the serum lithium level, possibly leading to toxicity. Adjustments in lithium dosage would also be necessary when other medications have been added, when an illness with high fever occurs, and when a new diet begins.

client being treated for iron deficiency anemia with ferrous sulfate continues to be anemic despite treatment. The nurse should assess the client for use of which medication? carbamazepine aluminum hydroxide prednisone amoxicillin trihydrate

aluminum hydroxide The nurse should assess the client for possible use of antacids such as aluminum hydroxide. Clients should take ferrous sulfate and an antacid at least 2 hours apart because antacids bind with iron in the GI tract, decreasing the rate or extent of iron absorption.

The nurse is working in the mother-baby unit. To which client would the nurse anticipate giving Rho(D) immune globulin (human)? the Rh-negative baby with an Rh-positive mother the Rh-positive mother with an Rh-negative baby the Rh-negative mother with an Rh-positive baby the Rh-positive baby with an Rh-negative mother

the Rh-negative mother with an Rh-positive baby Rho (D) immune globulin (human) is given to an Rh-negative mother after the birth of an Rh-positive baby to prevent the woman from making antibodies that are sensitized to attack foreign Rh-positive blood cells in future pregnancies. Rho (D) is also given during pregnancy to Rh-negative mothers at 28 weeks, with invasive procedures, or after any trauma, such as an automobile accident. Rho (D) is not given to Rh-positive mothers and is never given to babies.

The nurse is administering an IV antibiotic to a client in the emergency department (ED). Within 15 minutes, the client reports itching, shortness of breath, and difficulty swallowing. Which interventions should the nurse implement? Select all that apply. Administer another antibiotic. Apply oxygen. Administer epinephrine per order. Discontinue the medication. Administer copious amounts of PO fluids.

Apply oxygen. Administer epinephrine per order. Discontinue the medication. Interventions the nurse should implement include stopping the medication as this is the agent causing discomfort, administering epinephrine, which initiates the fight-or-flight response by increasing blood flow to muscles and output of the heart, and applying oxygen in order to help the client breathe easier. If the client is having problems swallowing fluids and foods, then they should be held, and then trying another antibiotic will come later.

A nurse is preparing to administer a blood transfusion. Which action should the nurse take first? Compare the client's identification wristband with the tag on the unit of blood. Measure the client's vital signs. Start an I.V. infusion of normal saline solution. Arrange for typing and crossmatching of the client's blood.

Arrange for typing and crossmatching of the client's blood. The nurse should first arrange for typing and crossmatching of the client's blood to ensure compatibility with donor blood. Comparing the identification wristband with the tag on the blood, starting an I.V. infusion of normal saline solution, and measuring the client's vital signs, although appropriate when preparing to administer a blood transfusion, come later in the procedure.

On admission a client reports taking disulfiram as part of their home medications. What would the nurse need to be aware of when coordinating the client's other medications? Assess the patient for liver injury. Increase the client's fall risk if taken with antidepressants. Avoid all products containing alcohol. Collaborate with the doctor for vitamin B therapy.

Avoid all products containing alcohol. To avoid severe adverse effects, the client taking disulfiram must strictly avoid alcohol and all products that contain alcohol. Vitamin B therapy isn't necessary during disulfiram therapy. Therapeutic blood levels of disulfiram can't be measured. Disulfiram does not increase the sedative effects of antidepressants.

The nurse is administering vancomycin I.V. to a client. The pharmacy sent the correct dose, but it was to be administered 1 hour ago. What should the nurse do? Select all that apply. Notify the pharmacy of the late medication so they can change the time of the next dose. Run the infusion as directed, and document the time it was started. Complete any variance reports. Tell the nurse in the "hand-off" report that the medication and any associated labs need to be staggered. Call the healthcare provider.

Notify the pharmacy of the late medication so they can change the time of the next dose. Run the infusion as directed, and document the time it was started. Complete any variance reports. The nurse should start the dose when available, noting the time the medication was started; also the pharmacy should be notified so they can schedule the next dose accordingly; pass on the information about the late medication in the hand-off report; and complete any variance reports. The nurse does not need to call the healthcare provider because the medication will still be given, only at a later time and the labs will have adjusted times so that the physician will still get the needed labs that reflect the medication was given.

Acetaminophen was given to an adolescent for headache. Which of the following parameters would indicate the effectiveness of the medication? change in behavior no change in behavior intermittent sleeping no change in vital signs

change in behavior Positive changes in behavior and vital signs are indicators of an effective response to pain medication. Sleeping isn't a reliable indicator of pain relief because the teen may use sleep as a coping mechanism. Vital signs may or may not change.

A physician orders lithium carbonate for a client who has just been diagnosed with bipolar disorder. The nurse is teaching the client about signs and symptoms of lithium toxicity, which include: dry mouth, blurred vision, and urine retention. lethargy, vomiting, and diarrhea. skeletal muscle contractions, cogwheel rigidity, and a thick tongue. edema, orthostatic hypotension, and rash.

lethargy, vomiting, and diarrhea. Lethargy is an early sign of lithium toxicity; if it goes undetected, vomiting and diarrhea soon develop. Lithium doesn't cause extrapyramidal effects, such as skeletal muscle contractions, cogwheel rigidity, and a thick tongue, or cholinergic effects, such as dry mouth, blurred vision, and urine retention. The drug also doesn't cause edema, orthostatic hypotension, or rash.

A 6-year-old child with autism has been prescribed risperidone to treat aggression and self-injury behaviors. When educating the family about risperidone, the nurse should include which information? Notify the child's health care provider if the child is exhibiting lip smacking behaviors. Notify the child's health care provider if a dose of risperidone is missed. The child may experience weight loss after beginning risperidone. The child will have improved behavior about one week after starting risperidone.

Notify the child's health care provider if the child is exhibiting lip smacking behaviors. Notify the health care provider if the child exhibits lip smacking behavior as it may be an indication that the child is developing tardive dyskinesia. If the child misses a dose of risperidone, give the missed dose as soon as possible. If it is near the next scheduled dose, skip the missed dose. Weight gain is a common side effect of risperidone. It takes about 3 to 4 weeks of treatment with risperidone to see major changes in behavior.

A client taking newly prescribed metoprolol asks the nurse what medication to take for a headache. What is the nurse's best response? ibuprofen aspirin indomethacin acetaminophen

acetaminophen Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) counteract the blood pressure reducing effects of beta blockers by reducing the effects of prostaglandins. Acetaminophen is the best medicine for this client to take for a headache.

A client will receive IV midazolam hydrochloride during surgery. Which finding indicates a therapeutic effect? amnesia mild agitation blurred vision nausea

amnesia Midazolam hydrochloride causes antegrade amnesia or decreased ability to remember events that occurred around the time of sedation. Nausea, mild agitation, and blurred vision are adverse effects of midazolam.

A client is prescribed metaproterenol via a metered-dose inhaler, two puffs every 4 hours. The nurse instructs the client to report which adverse effect? pedal edema decreased pulse rate irregular heartbeat constipation

irregular heartbeat Irregular heartbeats should be reported promptly to the care provider. Metaproterenol may cause irregular heartbeat, tachycardia, or anginal pain because of its adrenergic effect on beta-adrenergic receptors in the heart. It is not recommended for use in clients with known cardiac disorders. Metaproterenol does not cause constipation, pedal edema, or bradycardia.

A young woman comes to the mental health clinic for routine medication follow-up. She has been married for 2 years and reports that she and her husband are ready to start a family. The client has a diagnosis of bipolar disorder and has been well managed with divalproex for at least 3 years. What is the most essential counsel for the nurse to give? "Check with your health care provider as divalproex carries an increased risk for birth defects." "Learning to reduce stress now is important to reduce your chances of developing postpartum depression." "Schedule an appointment for a complete gynecological exam if you haven't had one in the past year." "Pay careful attention to eating healthy from this point on to maximize the health of both mother and baby."

"Check with your health care provider as divalproex carries an increased risk for birth defects." All of these options need to be addressed. However, it is vital that this young woman receive counseling about the serious birth defects that have an increased incidence with the taking of divalproex during the first trimester of pregnancy. These problems include craniofacial abnormalities (cleft palate), organ malformations (holes in the heart and urinary tract problems), limb deficiencies, and developmental delays. The chances of preeclampsia and premature labor are also increased.

When preparing to administer a drug dose to a client, the nurse examines the drug label. The nurse understands that the U.S. Food, Drug, and Cosmetic Act and Canada's Food and Drug Act and Cosmetic Regulations require that drug labels include which information? Select all that apply. general disease information chemical compound expiration date Quantities and proportions of active ingredients manufacturer's lot number

expiration date Quantities and proportions of active ingredients manufacturer's lot number A drug label must list the active ingredients and their quantities and proportions, as well as directions for use, lot number, and expiration date. The laws do not require that the chemical compound be listed and it is not necessary for the label to provide general disease information.

A medication nurse is preparing to administer 0900 medications to a client with liver cancer. Which consideration is the nurse's highest priority? necessity of the medication frequency of the medication purpose of the medication metabolism of the medication

metabolism of the medication The rate and ability of the liver to metabolize medications will be altered in a client with liver cancer. Therefore, it is essential to understand how each medication is metabolized. The other considerations are important but not as vital.

A nurse in the emergency department is caring for a client with acute heart failure. Which laboratory value is most important for the nurse to check before administering medications to treat heart failure? platelet count white blood cell (WBC) count calcium potassium

potassium Diuretics, such as furosemide, are commonly used to treat acute heart failure. Most diuretics increase the renal excretion of potassium. The nurse should check the client's potassium level before administering diuretics, and obtain an order to replace potassium if the level is low. Other medications commonly used to treat heart failure include angiotensin-converting enzyme inhibitors, digoxin, and beta-adrenergic blockers. Although checking the platelet count, calcium level, and WBC count are important, these values don't affect medication administration for acute heart failure.

A nurse is monitoring a client for adverse reactions to dantrolene. Which adverse reaction is most common? muscle weakness slurred speech excessive tearing urine retention

muscle weakness The most common adverse reaction to dantrolene is muscle weakness. The drug also may depress liver function or cause idiosyncratic hepatitis. Muscle weakness is rarely severe enough to cause slurring of speech, drooling, or enuresis. Although excessive tearing and urine retention are adverse reactions associated with dantrolene use, they aren't as common as muscle weakness.

The nurse is instructing the client with hypothyroidism who takes levothyroxine 100 mcg, digoxin, and simvastatin. The nurse judges that the teaching regarding the use of these medications is effective if the client will take: all medications together 1 hour after eating breakfast. all medications before going to bed. the levothyroxine before breakfast and the other medications 4 hours later. the levothyroxine with breakfast and the other medications after breakfast.

the levothyroxine before breakfast and the other medications 4 hours later. Levothyroxine) must be given at the same time each day on an empty stomach, preferably ½ to 1 hour before breakfast. Other medications may impair the action of levothyroxine absorption; the client should separate doses of other medications by 4 to 5 hours.

A client with diabetes has been diagnosed with hypertension, and the health care provider has prescribed atenolol, a beta-blocker. When teaching the client about the drug, what should the nurse tell the client about how it may interact with the client's diabetes? Atenolol may cause: a decrease in the hypoglycemic effects of insulin. an increase in the hypoglycemic effects of insulin. an increase in the incidence of ketoacidosis. a decrease in the incidence of ketoacidosis.

an increase in the hypoglycemic effects of insulin. There is a direct interaction between the effects of insulin and those of beta blockers. The nurse must be aware that there is a potential for increased hypoglycemic effects of insulin when a beta blocker is added to the client's medication regimen. The client's blood sugar should be monitored. Ketoacidosis occurs in hyperglycemia. Although a decrease in the incidence of ketoacidosis could occur when a beta blocker is added, the direct result is an increase in the hypoglycemic effect of insulin.

TPN is prescribed for a client with Crohn's disease. What indicates to the nurse that the TPN has been effective? The client: has met nutritional needs. is in a negative nitrogen balance. is hydrated. is not in metabolic acidosis.

has met nutritional needs. The goal of TPN is to meet the client's nutritional needs. TPN is not used to treat metabolic acidosis; ketoacidosis can actually develop as a result of administering TPN. TPN is a hypertonic solution containing carbohydrates, amino acids, electrolytes, trace elements, and vitamins. It is not used to meet the hydration needs of clients. TPN is administered to provide a positive nitrogen balance.