Pharmacology and Medication Management
2/10180019-year-old client with mild concussion after slipping in school parking lot three hours prior. No loss of consciousness. No appreciable neurological deficits. CT scan normal. Client was preparing for discharge. Now reports a 5/10 headache. Acetaminophen PO prescribed.When offered acetaminophen, the client's parents tell the nurse that they would like their child to have something stronger. What is the nurse's best response? "Acetaminophen is strong enough for your child's mild concussion." "We avoid giving aspirin to children and young adults because of the danger of Reye syndrome." "Opioids are avoided following a head injury because they may hide a deteriorating condition." "Stronger medications may lead to vomiting, which increases the intracranial pressure (ICP)."
"Opioids are avoided following a head injury because they may hide a deteriorating condition." Explanation: Opioids may mask changes in the level of consciousness (LOC) that indicate increased ICP, and should not be given as a first-line drug. Stating that acetaminophen is strong enough ignores the parents' question and is not appropriate. Aspirin is contraindicated in conditions that include bleeding, and for children or young adults with viral illnesses due to the danger of Reye syndrome. Stronger medications may not necessarily lead to vomiting, but will sedate the client, thereby masking changes in the client's LOC.
The supervisor is performing a chart review. The nurse can be held legally liable for which documentation? 0800 administered 2 mg hydromorphone IVP per PRN orders of 1 to 2 mg every 4 hours -BSmith, RN 0900 Withheld digoxin dose. Client's apical pulse is 56 beats/min -BSmith, RN 0900 Withheld mononitrate dose. Client's blood pressure is 80/40 mmHg -BSmith, RN 1200 Administered cephalosporin. The client has an allergy to penicillin -BSmith, RN
1200 Administered cephalosporin. The client has an allergy to penicillin -BSmith, RN Explanation: There is a cross-sensitivity between cephalosporin and penicillin, and the drug should not have been given. When a dosage range is ordered, any dose in that range is acceptable. Digoxin is a cardiac glycoside that acts to improve the efficiency of the heart and may slow the heart rate and the drug should not ordinarily be given if the apical pulse is less the 60. Mononitrate is a nitrate that can cause vasodilation and should not be given when hypotension is present.
What drug is the antidote for Magnesium Sulfate?
Calcium gluconate
What does IV insulin do to potassium?
IV insulin forces potassium into cells, meaning that serum potassium decreases (hypokalemia).
A client, diagnosed with asthma, is experiencing an anaphylactic reaction to a medication. After administering initial emergency care, the nurse would administer beta-adrenergic blockers. administer bronchodilators. obtain serum electrolyte levels. have the client lie flat in the bed.
administer bronchodilators. Explanation: Bronchodilators will open the client's airway and improve oxygenation status. Beta-adrenergic blockers aren't indicated in the management of asthma because they may cause bronchospasm. Obtaining laboratory values wouldn't be done during an emergency, and having the client lie flat in bed could impede their ability to breathe.
The nurse is preparing to administer the initial dose of digoxin PO to a client. What is the nurse's priority assessment before administering this medication? apical heart rate blood pressure radial heart rate respiratory rate
apical heart rate Explanation: Assessing the client's apical heart rate is essential before administering digoxin. The apex of the heart is the most accurate pulse point in the body. Blood pressure is only affected if the heart rate is too low, in which case the nurse would withhold digoxin. The radial heart rate can be affected by cardiac and vascular disease and; therefore, will not accurately depict the heart rate. Digoxin has no effect on respiratory function.
A client, recovering from a spinal cord injury, has a great deal of spasticity. Which medication would the nurse anticipate to relieve spasticity? hydralazine baclofen lidocaine methylprednisolone
baclofen Explanation: Baclofen is a skeletal muscle relaxant used to decrease spasms. It may be given orally or intrathecally. Hydralazine is an antihypertensive and afterload-reducing agent. Lidocaine is an antiarrhythmic and a local anesthetic agent. Methylprednisolone is an anti-inflammatory drug used to decrease spinal cord edema in the acute phase.
What is epoetin alfa used for?
increase in red blood cells Explanation: Epoetin alfa is a man-made form of the protein human erythropoietin used to lessen the need for red blood cell transfusions. It stimulates the bone marrow to produce more red blood cells. The drug is used to treat anemia caused by chronic kidney disease, chemotherapy, and zidovudine, which is a drug used to treat HIV infection. The drug does not affect white blood cells or coagulation, nor does it cause blood glucose to decrease.
Which antiparkinsonian drug can cause drug tolerance or toxicity if taken for too long? amantadine levodopa-carbidopa pergolide selegiline
levodopa-carbidopa Explanation: Long-term therapy with levodopa-carbidopa can result in drug tolerance or toxicity manifested by confusion, hallucinations, or decreased drug effectiveness. The other drugs listed don't require the client to take a drug holiday.
What adverse reaction might the nurse observe after administering enteric-coated erythromycin to a client? weight gain constipation increased appetite nausea and vomiting
nausea and vomiting Explanation: Erythromycin is an antibiotic. Common adverse effects include nausea, vomiting, diarrhea, abdominal pain, and anorexia. It should be given with a full glass of water and after meals, or with food, to lessen gastrointestinal symptoms.
A nurse is preparing to instill ear drops in a 28-year-old client with otitis externa. What is the correct procedure for instillation?
pull the pinna up and back
The nurse receives an order to administer morphine to a client with an acute myocardial infarction. What is the purpose of this medication? to decrease cardiac output to increase preload and afterload to increase myocardial oxygen demand to decrease myocardial oxygen demand
to decrease myocardial oxygen demand Explanation: Morphine will calm and relax the client and decrease respiratory rate, anxiety, and stress, thus decreasing myocardial oxygen demand. It doesn't have any effect on cardiac output or preload or afterload.
What is the therapeutic effect of atropine ?
Increases heart rate and cardiac output.
