Pharmacology Quiz 1

A 10-year-old child is prescribed tetracycline. Which possible drug-related reactions are associated with this drug? 1 Kernicterus 2 Gray syndrome 3 Reye syndrome Correct4 Staining of teeth

Tetracycline causes staining or discoloration of developing teeth in children. Sulfonamides may cause kernicterus in neonates. Chloramphenicol may cause Gray syndrome in infants. Aspirin may cause Reye syndrome in pediatric clients with a history of chickenpox or influenza.

Which adverse effect of heparin may be seen during pregnancy? 1 Osteoporosis 2 Severe bleeding 3 Abnormal uterine contractions 4 Suppression of uterine contractions

Heparin is safe to a fetus but may cause osteoporosis in a pregnant woman. Severe bleeding and abnormal or suppressed uterine contractions are not associated with heparin.

The nurse is caring for a client admitted for a severe kidney infection and hyponatremia. The healthcare provider prescribes ceftriaxone 1 gram to be administered intravenously over 30 minutes. The intravenous (IV) piggyback contains 50 mL. The IV tubing drop factor is 15 drops/mL. At what rate will the nurse infuse the medication? 1 15 drops/min 2 20 drops/min 3 25 drops/min 4 30 drops/min

50ml/30min * 15gtt/mL = 25 gtt/min

A client reports nausea, vomiting, and seeing a yellow light around objects. A diagnosis of hypokalemia is made. Upon a review of the client's prescribed medication list, the nurse determines that what is the likely cause of the clinical findings? 1 Digoxin (Lanoxin) 2 Furosemide (Lasix) 3 Propranolol (Inderal) 4 Spironolactone (Aldactone)

These are signs of digitalis toxicity, which is more likely to occur in the presence of hypokalemia. Although furosemide most likely contributed to the hypokalemia, the client's symptoms are consistent with digitalis toxicity. Although propranolol can cause nausea, vomiting, and blurred vision, the presence of hypokalemia and yellow vision are more suggestive of digitalis toxicity. A side effect of spironolactone is hyperkalemia, not hypokalemia.

The healthcare provider prescribes finasteride for a client with benign prostatic hyperplasia. What information does the nurse provide to the client? 1 Male pattern baldness can occur. 2 Results can be expected in 4 to 6 weeks. 3 The medication relaxes the muscles in the bladder neck, making it easier to urinate. 4 Protection should be worn during intercourse with a pregnant female.

Contact with the semen of a client taking finasteride can adversely affect a developing male fetus in a pregnant woman. Finasteride helps prevent male pattern baldness. Results may take 6 to 12 months. Finasteride is used to shrink an enlarged prostate. Other medications, such as tamsulosin, relax the muscles in the prostate and bladder neck, making it easier to urinate.

A client is scheduled to receive phenytoin 100 mg orally at 6 PM but is having difficulty swallowing capsules. What method should the nurse use to help the client take the medication? 1 Sprinkle the powder from the capsule into a cup of water. 2 Insert a rectal suppository containing 100 mg of phenytoin. 3 Administer 4 mL of phenytoin suspension containing 125 mg/5 mL. 4 Obtain a change in the administration route to allow an intramuscular injection.

When an oral medication is available in a suspension form, the nurse can use it for clients who cannot swallow capsules. Use the "Desire over Have" formula to solve the problem. Desire 100 mg = x mL Have 125 mg 5 mL 125x = 500 X = 500 ÷ 125 X = 4 mL. Because a palatable suspension is available, it is a better alternative than opening the capsule. The route of administration cannot be altered without the healthcare provider's approval. Intramuscular injections should be avoided because of risks for tissue injury and infection.

A child being treated with cardiac drugs developed vomiting, bradycardia, anorexia, and dysrhythmias. Which drug toxicity is responsible for these symptoms? 1. Digoxin 2. Nesiritide 3. Dobutamine 4. Spironolactone

Digoxin helps improve pumping efficacy of the heart, but overdose can cause toxicity leading to nausea, vomiting, bradycardia, anorexia, and dysrhythmias. The side effects of nesiritide may include effects like headache, insomnia, and hypotension. Dobutamine does not cause nausea or vomiting but may cause hypertension and hypotension. Spironolactone may cause edema.

An infant with cardiopulmonary disease who displays signs and symptoms of bronchiolitis and pneumonia was admitted to the hospital. What condition is the infant likely to have? 1 Poliomyelitis 2 Pneumococcal infection 3 Meningococcal infection 4 Respiratory syncytial virus infection

Respiratory syncytial virus infections are the most common cause for hospitalization of infants younger than 1 year of age; this disease especially affects premature infants and infants with cardiopulmonary disease. Poliomyelitis is caused by the poliovirus. Streptococcus pneumonia infections cause meningitis, sepsis, pneumonia, and otitis media. Neisseria meningitidis causes meningitis.

Which nursing interventions would help to ensure the safe administration of antiepileptics to children? Select all that apply. 1 Avoid carbonated beverages while taking valproic acid 2 Use a graduated device to deliver an oral dose 3 Administer oral forms of valproic acid with milk 4 Encourage the wearing of a medical alert bracelet 5 Maintain a record of symptoms of seizures before, during, and after treatment with anti-epileptics

The nurse should advise a child who is taking valproic acid to avoid carbonated beverages because they cause gastric irritation. A graduated device should be used for the accurate measurement of liquids. The nurse should encourage the child to wear a medical alert bracelet all the time that contains information about the child's allergies, diagnosis, and drug therapy. The nurse should maintain a record of any symptoms of seizures before, during, and after treatment to prevent the progression of disease. Oral forms of valproic acid should not be taken with milk because they may cause mucosal irritation.

A nurse teaches a client about Coumadin and concludes that the teaching is effective when the client agrees not to drink which juice? 1 Apple juice Incorrect2 Grape juice 3 Orange juice Correct4 Cranberry juice

Antioxidants in cranberry juice may inhibit the mechanism that metabolizes warfarin, causing elevations in the international normalized ratio, resulting in hemorrhage. Apple juice, grape juice, and orange juice are fine to drink.

The nurse is assessing the vaccination profile for a diphtheria, tetanus, and pertussis (DTaP) vaccine and a Haemophilus influenzae type b (Hib) conjugate vaccine in a 5-year-old child. Which dose was incorrectly given to the child?

Routine vaccination of DTaP consists of five injections: the first dose at 2 months, second dose at 4 months, third dose at 6 months, fourth dose between 15 and 18 months, and fifth dose between 4 and 6 years. The Hib vaccination consists of four doses: the first dose at 2 months, second dose at 4 months, third dose at 6 months, and fourth dose between 12 and 15 months. Therefore the fourth doses of both the DTaP and Hib vaccines were administered too early. The first, second, and third doses were administered at the appropriate ages.

A pregnant client with a history of hypertension is treated with an angiotensin-converting enzyme inhibitor. Which teratogenic effect of angiotensin-converting enzyme (ACE) inhibitors is the neonate at risk for? 1 Growth delay 2 Skull hypoplasia 3 Neural tube defects 4 Skeletal and central nervous system defects

The use of angiotensin-converting enzyme (ACE) inhibitors in the second and third trimesters of pregnancy may cause skull hypoplasia in the newborn. Antiseizure drugs may cause neural tube defects and growth delays in the newborn. Warfarin may cause skeletal and central nervous system defects in the newborn.

A child with pulmonary edema is treated with opioids and furosemide. Which nursing interventions should be performed to promote safe drug administration? Select all that apply. Correct 1 Following the principle of atraumatic care Correct 2 Administering oral drugs with food or snacks Correct 3 Documenting the client's age, weight, and height 4 Exposing the child to sunlight for healthy growth 5 Administering medications if the client reports dizziness or drowsiness

A local anesthetic should be applied at the injection site to promote atraumatic care. Administering drugs with food reduces gastric discomfort. The client's age, weight, and height should be documented to help ensure correct calculation of the drug dose. A child who is undergoing treatment with diuretics should not be exposed to sunlight because this can cause fluid volume loss and exhaustion. If the client reports dizziness or drowsiness, medications should not be administered until an order is prescribed by the primary healthcare provider.

A client is receiving an antihypertensive drug intravenously for control of severe hypertension. The client's blood pressure is 160/94 mm Hg before the infusion. Fifteen minutes after the infusion is started, the blood pressure increases to 180/100 mm Hg. Which type of response is the client demonstrating? 1 Allergic 2 Synergistic 3 Paradoxical 4 Hypersusceptibility

A paradoxical response to a drug is directly opposite to the desired therapeutic response. An allergic response is an antigen-antibody reaction. A synergistic response involves drug combinations that enhance each other. Hypersusceptibility is a response to a drug that is more pronounced than the common response.

Trimethoprim-sulfamethoxazole is prescribed for a client with cystitis. When teaching about the medication, what does the nurse instruct the client to do? Correct1 Drink 8 to 10 glasses of water daily. 2 Drink two glasses of orange juice daily. Incorrect3 Take the medication with meals. 4 Take the medication until symptoms subside.

A urinary output of at least 1500 mL daily should be maintained to prevent crystalluria (crystals in the urine). Orange juice produces an alkaline ash, which results in an alkaline urine that supports the growth of bacteria. Trimethoprim-sulfamethoxazole should be taken 1 hour before meals for maximum absorption. A prescribed course of antibiotics must be completed to eliminate the infection, which can exist on a subclinical level after symptoms subside.

A client with metastatic breast cancer is started on a multiple drug regimen that includes docetaxel. The nurse assesses the client for which nontherapeutic effects of docetaxel? Select all that apply. 1 Alopecia 2 Constipation 3 Febrile neutropenia 4 Increased blood pressure 5 Hypersensitivity reaction

Alopecia is a nontherapeutic response to docetaxel. Docetaxel affects interphase and mitosis of the cell cycle. Febrile neutropenia is a common nontherapeutic effect. Clients should concurrently receive a growth factor support agent such as pegfilgrastim when given a regimen of docetaxel. Hypersensitivity reactions (e.g., flushing, rash, local eruption) are common nontherapeutic reactions, particularly within the first few minutes of the infusion. Minor reactions do not require discontinuation of the therapy. Nausea, vomiting, and diarrhea, not constipation, are nontherapeutic effects of docetaxel. Hypotension, not hypertension, is a nontherapeutic effect of docetaxel.

A client is admitted to the hospital with a diagnosis of an exacerbation of asthma. What should the nurse plan to do to best help this client? 1 Determine the client's emotional state. 2 Give prescribed drugs to promote bronchiolar dilation. 3 Provide education about the impact of a family history. 4 Encourage the client to use an incentive spirometer routinely.

Asthma involves spasms of the bronchi and bronchioles as well as increased production of mucus; this decreases the size of the lumina, interfering with inhalation and exhalation. Bronchiolar dilation will reduce airway resistance and improve the client's breathing. Although identifying and addressing a client's emotional state is important, maintaining airway and breathing are the priority. In addition, emotional stress is only one of many precipitating factors, such as allergens, temperature changes, odors, and chemicals. Although recent studies indicate a genetic correlation along with other factors that may predispose a person to develop asthma, exploring this issue is not the priority. Use of an incentive spirometer is not helpful because of mucosal edema, bronchoconstriction, and secretions, all of which cause airway obstruction.

Which antihypertensive drug is contraindicated in lactating women? Correct1 Atenolol 2 Labetalol 3 Metoprolol 4 Propranolol

Atenolol is contraindicated in lactating woman because it enters the breast milk and may cause adverse effects to the neonate. Labetalol and propranolol are safe to administer during lactation. Metoprolol is a safe drug to be taken during pregnancy.

The nurse is preparing to administer ear drops to a client who has impacted cerumen. Before administering the drops, the nurse will assess the client for which contraindications? Select all that apply. 1 Allergy to the medication 2 Itching in the ear canal 3 Drainage from the ear canal 4 Tympanic membrane rupture 5 Partial hearing loss in the affected ear

Contraindications to ear drops include allergy to the medication, drainage from the ear canal, and tympanic membrane rupture. Itching may occur with some ear conditions and is not a contraindication to the use of ear drops. Partial hearing loss may occur with impacted cerumen and is not a contraindication to the use of ear drops.

A client is informed that he has benign prostatic hyperplasia (BPH), and the healthcare provider prescribes finasteride. The client would like to take saw palmetto instead of the finasteride. What does the nurse inform the client about this herbal supplement? 1 It may be taken after consultation with the healthcare provider. 2 Saw palmetto should be taken on an empty stomach for best results. 3 The herbal supplement will relieve symptoms by altering the size of the prostate. 4 Saw palmetto can cause a regrowth of hair lost to male pattern baldness.

Finasteride and saw palmetto both have antiandrogenic and antiproliferative properties in prostate tissue. Saw palmetto has comparable efficacy to finasteride. The healthcare provider must be consulted regarding the client's desire to change the prescribed therapy. Saw palmetto should be taken with food to limit gastrointestinal side effects. Saw palmetto does not alter the size of the prostate gland. Finasteride, an androgen inhibitor, not saw palmetto, promotes the regrowth of hair that is lost.

A client with advanced cancer of the bladder is scheduled for a cystectomy and ileal conduit. What intervention does the nurse anticipate the healthcare provider will prescribe to prepare the client for surgery? 1 Intravesicular chemotherapy 2 Instillation of a urinary antiseptic Correct3 Administration of an antibiotic 4 Placement of an indwelling catheter

Intestinal antibiotics and a complete cleansing of the bowel with enemas until returns are clear are necessary to reduce the possibility of fecal contamination when the bowel is resected to construct the ileal conduit. Intravesicular chemotherapy is unnecessary because the urinary bladder is removed with this surgery. Instillation of a urinary antiseptic is not necessary. There is no evidence of a urinary tract infection. The urinary bladder will be removed, so there is no need for an indwelling urinary catheter. No data indicate that the client is experiencing urinary retention before surgery.

Which is the drug of choice for treating Reye syndrome in pediatric clients? Aspirin Mannitol Ibuprofen Furosemide

Mannitol is a diuretic that helps in reducing cerebral edema and intracranial pressure. Reye syndrome is caused by the administration of aspirin in pediatric clients with viral infections like chicken pox, so aspirin and drugs that contain aspirin must not be given to reduce fever during the viral infections. Ibuprofen helps reduce fever associated with viral disease but is not useful in the treatment of Reye syndrome. Furosemide is a loop-diuretic which relieves pulmonary edema, but it has no effect on cerebral edema.

A child who reports shortness of breath, wheezing, and coughing is found to have pulmonary edema and is prescribed furosemide. Which nursing interventions would be beneficial to the client? Select all that apply. 1 Administering the drug on an empty stomach Correct 2 Checking the child's weight every day Correct 3 Calculating the dose of drug as carefully as possible 4 Exposing the child to sunlight for increasing periods Correct 5 Assessing the child regularly to help prevent electrolyte loss

The child's weight should be checked and recorded daily to aid in the assessment of therapeutic and adverse effects. Pediatric doses should be calculated carefully to prevent an accidental overdose. Pediatric clients are at greater risk of electrolyte loss; therefore, they require closer and more cautious assessment to help prevent hypertension and stroke. Furosemide may cause stomach upset if it is taken on an empty stomach; the child should be given the drug with food to help prevent gastric upset. A child taking diuretics should not be exposed to sunlight for long periods because this action may precipitate fluid volume loss and heatstroke. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options.

A registered nurse teaches a nursing student about considerations for administering medication in infants. Which statement of the nursing student indicates a need for additional learning? 1 "I should administer nasal drops 20-30 minutes before a feeding." 2 "I should pull the ear pinna up and back while administering ear drops." 3 "I should wait until the infant stops crying for administering oral medication." 4 "I should restrain the head and place an eye drop at the corner near the nose if the infant is uncooperative."

The ear pinna should be pulled down and back while administering eardrops in infants. Pulling the pinna up and back is recommended for an adult or a child older than 3 years of age. Nasal drops should be administered 20 to 30 minutes before a feeding because potential congestion caused by nasal medications may make it difficult for the infants to suck. If the infant is crying, wait until he or she calms to prevent medication aspiration. Infants often squeeze their eyes tightly shut to avoid eye drops. Therefore to administer drops in an uncooperative infant, the infant's head should be gently restrained and the drops should be placed at the corner nearest the nose.

Despite receiving 2900 mL intake for 2 days, the client's urine output has progressively diminished. The nurse identifies that the urinary output is less than 40 mL/hr over the past 3 hours. What action will the nurse take? 1 Assess breath sounds and obtain vital signs. 2 Decrease the intravenous flow rate and increase oral fluids. 3 Insert an indwelling catheter to facilitate emptying of the bladder. 4 Check for dependent edema by assessing the lower extremities

The imbalance in intake and output, with a decreasing urinary output, may indicate kidney failure. The retention of excess body fluid can precipitate the development of heart failure. Assessing breath sounds and obtaining the vital signs are necessary when monitoring for these complications. In the presence of hypervolemia, oral and intravenous fluid intake should be decreased. There are no data to support a problem with excretion of urine; the problem is with insufficient production. The insertion of a urinary retention catheter requires a healthcare provider's prescription. Checking for dependent edema by assessing the lower extremities is an appropriate assessment after respirations and vital signs are assessed.

To begin the administration of total parenteral nutrition (TPN), a client has a right subclavian central venous access device inserted. Immediately after insertion of the catheter, what is the priority nursing action? 1 Obtain a chest x-ray to determine placement. 2 Auscultate the lungs to evaluate breath sounds. 3 Draw a blood sample to assess blood glucose level. 4 Assess the right upper extremity for neurologic deficits

The most significant and life-threatening complication of insertion of a subclavian catheter is a pneumothorax because of the proximity of the subclavian vein and the apex of the upper lobe of the lung; a client's respiratory status always is the priority. Although a chest x-ray may be done before TPN is begun, it is not the priority immediately after insertion of the catheter. A baseline blood glucose level should be obtained before insertion of the catheter. After TPN is started, routine monitoring of blood glucose levels is important. Although assessing for a neurologic deficit should be done eventually, it is not the priority at this time.

A child is admitted to the hospital with diarrhea and is prescribed antidiarrheal medications. Which nursing actions indicate that the nurse is skilled in safe drug administration to pediatric clients? Select all that apply. 1 The nurse calculates the drug dose according to the weight. 2 The nurse recommends long-term use of the medication. 3 The nurse promotes fluid and electrolyte balance. 4 The nurse assesses the child for the presence of any eating disorders. 5 The nurse assesses the severity of diarrhea by counting the number of stools every 48 hours.

The nurse should calculate the dose according to the weight of the child to ensure accurate dosing. Diarrhea causes rapid loss of fluid volume and electrolytes through the stools; therefore, the nurse should promote fluid and electrolyte balance by ensuring the appropriate intake of fluids. The nurse should assess the child for the presence of eating disorders such as bulimia and anorexia to check for the abuse of laxatives. The nurse should not recommend the long-term use of antidiarrheal medications because they cause toxic effects. The nurse should measure the amount of diarrhea by the number of stools every 24 hours and not for 48 hours.

In what ways can a nurse prevent medication errors? Select all that apply. Correct 1 Avoid using abbreviations and acronyms Correct 2 Minimize the use of verbal and telephone orders 3 Try to guess what the client is saying if the language is not understood 4 Document each dose of the drug using trailing zeros when recording the dose Correct 5 Check three times before giving a drug by comparing the drug order and medication profile

The use of abbreviations is avoided because this action may cause confusion and increase the risk of error. The use of verbal and telephone orders should be minimized to avoid confusion over drugs that have similar names. Before a drug is administered, the dosage order should be checked three times to verify the five rights: right drug, right dose, right time, right route, and right client. The use of trailing zeros should be avoided because it increases the risk of overdose. If the client's language is not understood, a translator's help should be enlisted.

Which immunosuppressant drug interacts with allopurinol and may cause bone marrow suppression in children? 1 Tacrolimus 2 Azathioprine 3 Cyclosporine 4 Muromonab-DC3

When used with allopurinol, azathioprine may cause bone marrow suppression in children. Tacrolimus should be administered only after a careful assessment of a child's kidney functioning, history of past anaphylactic reactions, and availability of resuscitative equipment. The functioning level of various systems must be assessed before administering cyclosporine because this drug has a toxic effect on numerous organs. Baseline vital signs including weight should be assessed before administering muromonab-DC3 because of the potential risk for fluid retention.

A nurse is administering gold salts to a client with the diagnosis of rheumatoid arthritis. For which adverse effect of this drug should the client be monitored? 1 Kidney damage 2 Persistent nausea 3 Pulmonary emboli 4 Cardiac decompensation

Gold salts, bound to plasma proteins, are distributed irregularly throughout the body, but the highest concentration occurs in the kidneys. When the slow excretion of gold salts cannot keep up with their intake, they can accumulate in the kidneys, causing damage. Persistent nausea, pulmonary emboli, and cardiac decompensation are not side effects associated with gold salts.

A client's medication history includes a cholinergic medication. The client states, "I take that for some kind of urinary problem." The nurse recalls that cholinergic medications are prescribed primarily for what type of urinary condition? 1 Kidney stones Correct2 Urine retention 3 Spastic bladder 4 Urinary tract infections

Cholinergics intensify and prolong the action of acetylcholine, which increases the tone in the genitourinary tract, preventing urinary retention. Cholinergics will not prevent renal calculi. Anticholinergics are prescribed for the frequency and urgency associated with a spastic bladder. Preventing urinary tract infections is a secondary gain because cholinergics help prevent urinary retention that can lead to a urinary tract infection, but this is not the primary purpose for administering these drugs.

A client is receiving dexamethasone to treat acute exacerbation of asthma. For what side effect should the nurse monitor the client? 1 Hyperkalemia 2 Liver dysfunction 3 Orthostatic hypotension 4 Increased blood glucose

Dexamethasone increases gluconeogenesis, which may cause hyperglycemia. Hypokalemia, not hyperkalemia, is a side effect. Liver dysfunction is not a side effect. Hypertension, not hypotension, is a side effect.

A client with phosphate-based urinary calculi asks why aluminum hydroxide gel has been prescribed. The nurse explains that the medication decreases serum phosphorus by which action? 1 Binding with phosphorus in the intestine 2 Preventing absorption of phosphorus in the stomach 3 Promoting excretion of excessive urinary phosphorus 4 Dissolving stones as they pass through the urinary tract

Aluminum hydroxide binds phosphorus in the intestine, preventing its absorption; this decreases serum phosphorus. Preventing absorption of phosphorus in the stomach, promoting excretion of excessive urinary phosphorus, and dissolving stones as they pass through the urinary tract are not actions of this drug.

A 25-weeks pregnant client who is being treated with tenormin reports labor pain. What medication would the primary healthcare provider prescribe? 1 Sucralfate Correct2 Nifedipine 3 Indomethacin 4 Dexamethasone

Nifedipine inhibits myometrial activity by blocking calcium reflux. This action helps to reduce preterm labor. Indomethacin is commonly used to treat preterm labor. However, concomitant use of tenormin and indomethacin may increase maternal and fetal risk. Dexamethasone is administered if indomethacin and nifedipine is ineffective. Sucralfate is used to protect the stomach from gastrointestinal issues associated with indomethacin.

A breastfeeding mother requires treatment for depression. Which drug would be safe to use if the mother wishes to continue breastfeeding the newborn? 1 Fluoxetine Correct2 Paroxetine Incorrect3 Valproic acid 4 Methotrexate

Paroxetine can be safely given during breastfeeding. Fluoxetine can easily enter breast milk; therefore this drug would only be used when other selective serotonin reuptake inhibitors are ineffective. Valproic acid is an antiepileptic drug that can be given safely to breastfeeding women. Methotrexate is an anticancer drug that cannot be given during breastfeeding because it enters the breast milk and can cause adverse effects in the baby.

A 5-year-old child is given fluoroquinolones. Which potential adverse effect unique to pediatric clients should the nurse anticipate? 1. Tendon rupture 2. Cartilage erosion 3. Staining of developing teeth 4. Central nervous system toxicity

Fluoroquinolones may cause tendon rupture in children. Nalidixic acid can cause cartilage erosion, and tetracycline can cause staining of developing teeth. Hexachlorophene may cause central nervous system toxicity in infants.

After receiving streptomycin sulfate for 2 weeks as part of the medical regimen for tuberculosis, the client states, "I feel dizzy and I can't hear as well as usual." The nurse withholds the drug and promptly reports the problem to the healthcare provider. Which part of the body does the nurse determine is being affected as indicated by the symptom reported by the client? 1 Pyramidal tracts 2 Cerebellar tissue 3 Peripheral motor end-plates 4 Eighth cranial nerve's vestibular branch

Streptomycin sulfate is ototoxic and may cause damage to auditory and vestibular portions of the eighth cranial nerve. Pyramidal tracts, cerebellar tissue, and peripheral motor end-plates are not affected by streptomycin.

A client receiving intravenous vancomycin reports ringing in both ears. Which initial action should the nurse take? 1 Notify the primary healthcare provider. 2 Consult an audiologist. 3 Stop the infusion. 4 Document the finding and continue to monitor the client.

The first action the nurse should take is to stop the infusion immediately. Vancomycin can cause temporary or permanent hearing loss. The nurse should stop the medication infusion and then notify the healthcare provider at once if a client reports any hearing problems or ringing in the ears. An audiologist may need to be consulted at a later date, but this is not the best first action. The nurse should document the findings; however, it is not the initial action.

While receiving an adrenergic beta2 agonist drug for asthma, the client complains of palpitations, chest pain, and a throbbing headache. What is the most appropriate nursing action? 1 Withhold the drug and notify the healthcare provider. 2 Tell the client not to worry; these are expected side effects from the medicine. 3 Give instructions to breathe slowly and deeply for several minutes. 4 Explain that the effects are temporary and will subside as the body becomes accustomed to the drug.

These drugs cause increased heart contraction (positive inotropic effect) and increased heart rate (positive chronotropic effect). If toxic levels are reached, side effects occur, and the drug should be withheld until the healthcare provider is notified. Telling the client not to worry and that these are expected side effects from the medicine is false reassurance and a false statement. Controlled breathing may be helpful in allaying a client's anxiety; however, the drug may be producing adverse effects and should be withheld.

A women undergoing chemotherapy for cancer gave birth to a newborn with limb malformations. Which medication may cause limb malformations in the neonates? 1 Methotrexate 2 Nitrofurantoin 3 Carbamazepine 4 Cyclophosphamide

When taken during pregnancy, methotrexate may cause limb malformations. Nitrofurantoin is not an immunosuppressant; it may cause abnormally small eyes or absent eyes in fetuses. Carbamazepine is an antiepileptic drug that may cause neural tube defects. Cyclophosphamide may cause central nervous system malformations and secondary cancers.

What nursing interventions should be performed when medications are administered to a 10-year-old child? Select all that apply. 1 Allowing the child to bite Correct 2 Explaining the procedure Correct 3 Explaining the need to take the medication Correct 4 Providing activities to relieve the child's aggression 5 Providing a pacifier after medication administration

Explaining the procedure to the child helps promote the child's cooperation. A 10-year-old is mature enough to understand the importance of taking medication. Providing activities to relieve aggression will help to soothe the child. The child may be allowed to scream and cry but not to bite. Pacifiers are given to infants; pacifier use is not appropriate in a 10-year-old.

A client with a history of pulmonary emboli is taking warfarin daily. The nurse teaches the client about foods that are appropriate to consume when taking this medication. The nurse evaluates that the client needs further teaching when the client makes which statement? 1 "Eggs provide a good source of iron, which is needed to prevent anemia." 2 "Yellow vegetables are high in vitamin A and should be included in the diet." 3 "Milk and other high-calcium dairy products are necessary to counteract bone density loss." Correct4 "Dark green leafy vegetables are high in vitamin K so I should eat them more often."

Foods high in vitamin K should be limited to usual amounts eaten by the client when establishing the prothrombin time/international normalized ratio because vitamin K is part of the body's blood-clotting mechanism and will counter the effects of warfarin if eaten in excess. Foods containing protein and iron are permitted because they are unrelated to blood clotting. Foods containing vitamin A are permitted because vitamin A is unrelated to blood clotting. Foods containing calcium are permitted because calcium is unrelated to blood clotting.

A client is receiving furosemide to relieve edema. The nurse should monitor the client for which response to the medication? 1 Hypernatremia 2 Low blood urea nitrogen 3 Hypokalemia 4 Increase in the urine specific gravity

Furosemide is a potent diuretic used to provide rapid diuresis; it acts in the loop of Henle and causes depletion of electrolytes, such as potassium and sodium. Furosemide inhibits the reabsorption, not retention, of sodium. Furosemide does not affect protein metabolism. With edema, the specific gravity of the fluid more likely will be low.

A client with newly diagnosed hyperthyroidism is treated with propylthiouracil, an antithyroid drug, along with potassium iodide. What should the nurse take into consideration when caring for the client? 1 Iodide solutions must be diluted in water and taken on an empty stomach. 2 Monitoring for signs of infection or bleeding is necessary. 3 Postoperative hemorrhage is a common complication if these drugs are used before a thyroidectomy. 4 These drugs will be discontinued as soon as the temperature and pulse rate return to the expected range.

Propylthiouracil can cause depression of leukocytes and platelets. Propylthiouracil and potassium iodide should be given with milk, juice, or food to prevent gastric irritation. Drug therapy decreases the risk of postoperative hemorrhage because this drug regimen decreases the size and vascularity of the thyroid gland. Drug therapy is continued for at least 6 to 8 weeks, even if the client's temperature and pulse return to the expected range.

What is the priority goal for a client with asthma who is being discharged from the hospital with prescriptions for inhaled bronchodilators? 1 Is able to obtain pulse oximeter readings 2 Demonstrates use of a metered-dose inhaler 3 Knows the healthcare provider's office hours 4 Can identify the foods that may cause wheezing

Clients with asthma use metered-dose inhalers to administer medications prophylactically or during times of an asthma attack; this is an important skill to have before discharge. Pulse oximetry is rarely conducted in the home; home management usually includes self-monitoring of the peak expiratory flow rate. Although knowing the healthcare provider's office hours is important, it is not the priority; during a persistent asthma attack that does not respond to planned interventions, the client should go to the emergency department of the local hospital or call 911 for assistance. Not all asthma is associated with food allergies.

A client who is taking rifampin tells the nurse, "My urine looks orange." What action will the nurse take? 1 Explain this is expected. 2 Check the liver enzymes. 3 Strain the urine for stones. 4 Ask what foods were eaten.

Rifampin causes a reddish-orange discoloration of secretions such as urine, sweat, and tears. Although liver enzymes should be monitored because of the risk of hepatitis, this action is not addressing the client's statement. Straining the urine for stones is indicated for renal calculi, which are not related to rifampin. The medication, not food, is responsible for the urine color.

Which vaccine may cause intussusception in children? Correct1 Rotavirus 2 Hepatitis 3 Measles, mumps, and rubella 4 Diphtheria, tetanus, and pertussis

Rotavirus vaccines very rarely cause intussusception, a form of bowel obstruction in which the bowel telescopes in on itself. Hepatitis vaccines can cause anaphylactic reactions. The measles, mumps, and rubella vaccine may cause thrombocytopenia. The diphtheria, tetanus, and pertussis vaccine carries a small risk of causing acute encephalopathy, convulsions, and a shock-like state.

After radioactive iodine therapy, a female client becomes hypothyroid and levothyroxine is prescribed. The client asks the nurse whether the hormone replacement therapy will interfere with the ability to become pregnant. What is the nurse's best response? 1 "Do you think you won't be able to get pregnant?" 2 "I recommend that you discuss this with your healthcare provider." 3 "While taking this medication, you should avoid becoming pregnant." 4 "If your thyroid function is controlled, the medicine should not interfere with your ability to become pregnant."

Hormone replacement should stabilize the metabolic rate and should not interfere with the client's becoming pregnant. The response "Do you think you won't be able to get pregnant?" may elicit feelings but does not answer the client's question. The response "I recommend that you discuss this with your healthcare provider" ignores the client's request for information and abdicates the nurse's teaching responsibility. If thyroid function remains controlled, there is no reason why the client should not become pregnant.

A healthcare provider prescribes furosemide for a client with hypervolemia. The nurse recalls that furosemide exerts its effects in what part of the renal system? 1 Distal tubule 2 Collecting duct 3 Glomerulus of the nephron 4 Loop of Henle

Furosemide acts in the ascending limb of the loop of Henle in the kidney. Thiazides act in the distal tubule in the kidney. Potassium-sparing diuretics act in the collecting duct in the kidney. Plasma expanders, not diuretics, act in the glomerulus of the nephron in the kidney.

A client who is postoperative hip replacement is receiving morphine by patient-controlled analgesia and has a respiratory rate of 6 breaths/min. What intervention should the nurse anticipate? 1 Nasotracheal suction 2 Mechanical ventilation 3 Naloxone administration 4 Cardiopulmonary resuscitatio

Naloxone is an opioid antagonist and will reverse respiratory depression caused by opioids. Nasotracheal suction, mechanical ventilation, and cardiopulmonary resuscitation are not needed; naloxone will correct the respiratory depression.

During which period of pregnancy would functional disabilities in a fetus's brain occur via fetal exposure to a teratogenic agent? 1 Fetal period 2 Presomite period 3 Embryonic period 4 Preimplantation period

Teratogenic exposure during the fetal period may cause functional disabilities of the brain in the fetus, such as learning deficits and behavioral abnormalities. Gross malformations due to teratogenic exposure are seen in the embryonic period. Teratogenic exposure during the presomite period or preimplantation period may result in the death of the fetus.

Which nursing interventions may promote safe drug administration in a child diagnosed with heart failure who is receiving digoxin? Select all that apply. Correct 1 Checking for compliance with the client's drug regimen Correct 2 Monitoring the client's serum potassium and magnesium levels regularly Incorrect 3 Administering digoxin only through the intramuscular route Correct 4 Calculating the correct dosage form, prescribed amounts, and the prescriber's order Correct 5 Monitoring and recording the client's intake and output, heart rate, blood pressure, daily weight, and respiration rate regularly

Digoxin may alter the serum potassium and serum magnesium levels, which affects heart function. Calculating the correct dose according to the healthcare provider's orders helps to prevent drug toxicity. Checking for compliance with the client's drug regimen is important so that the child does not have drug to drug interactions. Monitoring and recording drug intake and output, heart rate, blood pressure, daily weight, and respiration rate is a part of general nursing care. Administering digoxin through the intramuscular route is not advised because this method is very painful.

The nurse is preparing discharge instructions for a client who was prescribed enalapril for treatment of hypertension. Which instruction is appropriate for the nurse to include in the client's teaching? 1 Do not change to a standing position suddenly. 2 Lightheadedness is a common adverse effect that need not be reported. 3 The medication may cause a sore throat for the first few days. 4 Schedule blood tests weekly for the first 2 months.

Enalapril is classified as an angiotensin-converting enzyme (ACE) inhibitor. It is used to treat hypertension and congestive heart failure. It can also be used to treat a disorder of the ventricles. Angiotensin is a chemical that causes the arteries to become narrow. ACE inhibitors help the body produce less angiotensin, which helps the blood vessels relax and open up, which, in turn, lowers blood pressure. Clients should be advised to change positions slowly to minimize orthostatic hypotension. A healthcare provider should be notified immediately if the client is experiencing lightheadedness or feeling like he or she is about to faint, as this is a serious side effect. This medication does not cause a sore throat the first few days of treatment. Presently, there are no guidelines that suggest blood tests are required weekly for the first 2 months.

A nurse is caring for a client who is receiving serum albumin. What indicates that the albumin is effective? 1 Improved clotting of blood 2 Formation of red blood cells 3 Activation of white blood cells (WBCs) 4 Effective cardiac output

Serum albumin, a protein, establishes the plasma colloid osmotic (oncotic) pressure because of its high molecular weight and size. Indicators of adequate osmotic pressure include an effective cardiac output. Blood clotting involves blood protein fractions other than albumin; for example, prothrombin and fibrinogen are within the alpha- and beta-globulin fractions. Red blood cell formation (erythropoiesis) occurs in red marrow and can be related to albumin only indirectly; albumin is the blood transport protein for thyroxine, which stimulates metabolism in all cells, including those in red bone marrow. Albumin does not activate WBCs; WBCs are activated by antigens and substances released from damaged or diseased cells.

A client receiving steroid therapy states, "I have difficulty controlling my temper, which is so unlike me, and I don't know why this is happening." What is the nurse's best response? 1 Tell the client it is nothing to worry about. 2 Reassure that everyone does this at times. 3 Instruct the client to attempt to avoid situations that cause irritation. 4 Interview the client to determine whether other mood swings are being experienced.

Steroids increase the excitability of the central nervous system, which can cause labile emotions manifested as euphoria and excitability or depression. Telling the client it is nothing to worry about or that it is normal denies the value of the client's statement and offers false reassurance. The client has already stated the problem and does not know why this is happening. Instructing the client to attempt to avoid situations that cause irritation is difficult to do because the mood swings may occur without an overt cause.

The nurse is preparing to administer an intravenous piggyback antibiotic that has been newly prescribed. Shortly after initiation, the client becomes restless and flushed and begins to wheeze. The nurse determines the that appropriate priority action will be to stop the antibiotic infusion and then do what? 1 Notify the physician immediately about the client's condition. 2 Take the client's blood pressure. 3 Obtain the client's pulse oximetry. 4 Assess the client's respiratory status.

The client is experiencing an allergic reaction that may progress to anaphylaxis. Anaphylactic shock can lead to respiratory distress as a result of laryngeal edema or severe bronchospasm. Assessing and maintaining the client's airway is the priority. In most facilities, the rapid response team will be called to assist the client. Another staff member can notify the physician of the client's condition while the nurse assesses the client. Vital signs, including blood pressure and pulse oximetry, are obtained after airway patency is ensured and maintained.

A nurse administers sodium polystyrene sulfonate to a client with chronic renal failure. Which finding provides evidence that the intervention is effective? 1 Frequent loose stools 2 Improved mental status 3 Sodium increases to 137 mEq/L (137 mmol/L) 4 Potassium decreases to 4.2 mEq/L (4.2 mmol/L)

This resin exchanges sodium ions for potassium in the large intestine to lower the serum potassium level; 4.2 mEq/L (4.2 mmol/L) is in the expected range for potassium. Constipation is a more common side effect. Mental status improvement is not a therapeutic effect of the drug. Sodium retention is an adverse effect; 137 mEq/L (137 mmol/L) is in the expected range for sodium.

Which drug is used as an ovulation stimulant but may cause multiple pregnancies? 1 Oxytocin 2 Clomiphene 3 Dinoprostone 4 Methylergonovine

Clomiphene is used to stimulate ovulation; this drug may cause multiple pregnancies. Oxytocin stimulates uterine contractions to induce labor. Dinoprostone is used to terminate a pregnancy. Methylergonovine is used to reduce postpartum uterine hemorrhage.

What response will a nurse monitor for when assessing a client for side effects of long-term cortisone therapy? 1 Hypoglycemia 2 Severe anorexia 3 Anaphylactic shock 4 Behavioral changes

Development of mood swings and psychosis is possible during long-term therapy with glucocorticoids because of fluid and electrolyte alterations. Hypoglycemia, severe anorexia, and anaphylactic shock are not responses to long-term glucocorticoid therapy.

Which drug may cause gynecologic malignancies in females? 1 Tamoxifen 2 Raloxifene 3 Thalidomide 4 Diethylstilbestrol

Diethylstilbestrol may cause gynecologic malignancies such as endometrial, ovarian, and cervical cancers. Tamoxifen is used to treat breast cancer. Raloxifene is used to prevent postmenopausal osteoporosis. The use of thalidomide during pregnancy may cause birth defects in the newborn.

A client has an order for a sublingual nitroglycerin tablet. The nurse should teach the client to use what technique when self-administering this medication? 1 Place the pill inside the cheek and let it dissolve. 2 Place the pill under the tongue and let it dissolve. 3 Chew the pill thoroughly and then swallow it. 4 Swallow the pill with a full glass of water.

Sublingual medication is placed under the tongue and is quickly absorbed through the mucous membranes into blood. The buccal route requires placing medication between the cheek and gums. Chewing the pill and then swallowing it may be done for oral administration of some large size pills, but not with the sublingual route of administration. Taking the pill with water is required with the PO route of administration of medication, but not with sublingual. In addition, a full glass of water may be an excessive amount of fluid to swallow one pill.

Which drug increases the risk of Reye syndrome in children? Correct1 Aspirin 2 Naloxone 3 Ibuprofen 4 Acetaminophen

Aspirin increases the risk of Reye syndrome in children. Naloxone, ibuprofen, and acetaminophen can be used, but the child should be assessed for renal and liver functioning before prescribing.

Which nursing interventions would be beneficial for a child who is undergoing treatment with opioid analgesics? Select all that apply. Correct 1 Assessing the child's level of pain Correct 2 Administering oral medications with meals or snacks Correct 3 Assessing the child's verbal and nonverbal behaviors Correct 4 Documenting the child's age, weight, and height before treatment Incorrect 5 Monitoring and documenting the child's vital signs before the start of therapy

Assessing the child's level of pain is very important for a child undergoing treatment with opioid analgesics. This can be done with the use of the Ouch scale. Oral medications may be given with meals to prevent or ease gastric discomfort. A careful assessment of verbal and nonverbal behaviors help the nurse understand the child's feelings, including intensity of pain. The child's age, weight, and height are important data in the calculation of pediatric dosages. Vital signs should be checked before, during, and after the administration of opioid analgesics. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options are likely related to the situation, but only some of the options may be related directly to the situation.

Which factors should the nurse consider when administering medications to adolescents? Select all that apply. 1. Explanation of the medication administration procedure by the nurse to the client 2. Interactive communication regarding the procedure of medication administration 3. Implementation of comfort measures like holding 4. Acceptance of aggressive behavior with certain limitations 5. Encouragement of self-expression, individuality, and self-care

During administration of medication to the children of all age groups, the nurse should consider certain points. For adolescents, the nurse should provide a description regarding the procedure being conducted. The adolescent must be allowed to express fears and experiences regarding the administration, and self-expression, individuality, and self-care should be allowed and encouraged. Implementing comfort measures like holding are more appropriate for a younger age group, and accepting aggressive behavior with certain limitations is appropriate only for toddlers.

A 25-year-old woman on estrogen therapy has a history of smoking. Which complication does the nurse anticipate in the client? 1 Osteoporosis 2 Hypermenorrhea 3 Endometrial cancer 4 Pulmonary embolism

Estrogen therapy increases the risk of pulmonary embolisms in clients who have a history of smoking because the medication affects blood circulation and hemostasis. Osteoporosis may be caused by reduced bone density observed in postmenopausal woman. Hypermenorrhea (excessive menstrual bleeding) is treated with estrogen therapy. Endometrial cancer is a complication of estrogen therapy seen in postmenopausal woman.

The nurse provides education to a client about the side effects of furosemide. Which client statements indicate that the teaching is understood? Select all that apply. 1 "I must not eat citrus fruits." 2 "I should wear dark glasses." 3 "I should avoid lying flat in bed." 4 "I should change my position slowly." 5 "I must eat a food that contains potassium every day."

Furosemide may cause hypovolemia, which can result in orthostatic hypotension with sudden changes in position. With loop diuretics, such as furosemide, an increased sodium load is presented to the distal tubule; this prompts an increase in sodium secretion, as well as a corresponding increase in potassium secretion. Citrus fruits, particularly oranges, are high in potassium and should be encouraged when the client is taking furosemide because this medication can cause hypokalemia. Furosemide does not cause photophobia. Lying horizontally has no relationship to furosemide.

Which statements are related to teratogenicity? Select all that apply. 1 Negative animal studies indicate that the drug is safe to use in pregnant clients. 2 Counseling must be provided to a sexually active client while using a known teratogen. 3 Pregnant clients can continue to take anticancer drugs if they cannot be avoided. 4 Functional defects in the newborn are the result of exposure of the fetus to teratogens in the later stages of pregnancy. 5 To wean a neonate from drug dependency, he or she should be given smaller doses of the drug.

In sexually active clients, the use of a teratogen must be followed by counseling regarding the harmful effects of the teratogen on the newborn. The client should use contraception methods to prevent pregnancy until the drug regimen is completed. Functional defects in a newborn occur as a result of exposure to a teratogen during the second and third trimester of pregnancy. The use of dependence-producing drugs during pregnancy may lead to drug dependency in the newborn. This dependency can be overcome by giving smaller doses of the drug to which the newborn is dependent. Animal studies may not be applicable to humans; therefore, a negative study of a teratogen does not mean that the drug can be used in humans with no teratogenicity. If the use of anticancer drugs cannot be avoided in a pregnant woman, an abortion is recommended to avoid teratogenic effects in the newborn.

The nurse provides instructions about how to use a nebulizer to a client with chronic obstructive pulmonary disease. The nurse concludes that additional teaching is needed when the client demonstrates which technique? 1 Places the tip of the mouthpiece an inch (2.5 centimeters) past the lips 2 Holds the inspired breath for at least 3 seconds 3 Exhales slowly through the mouth with lips pursed slightly 4 Inhales with the lips tightly sealed around the mouthpiece of the nebulizer

Inhaling with the lips tightly sealed around the mouthpiece of the nebulizer results in nasal breathing, which negates the effects of aerosol medication. The mouthpiece should be gently held in the mouth just past the lips. The nebulizer tip should be past the lips to deliver the medication. Holding the inspired breath for at least 3 seconds promotes contact of the medication with the bronchial mucosa. Exhaling slowly through the mouth with lips pursed slightly prolongs and improves delivery of the medication to the respiratory mucosa.

Which drug class may cause kernicterus in neonates? Incorrect1 Salicylates 2 Tetracyclines Correct3 Sulfonamides 4 Glucocorticoids

Sulfonamides may cause kernicterus in neonates. Salicylates may cause Reye syndrome. Tetracyclines may cause the discoloration of developing teeth. Glucocorticoids may cause growth suppression

A healthcare provider prescribes digoxin for a client. The nurse teaches the client to be alert for which common early indication of digoxin toxicity? Correct1 Nausea 2 Urticaria 3 Photophobia Incorrect4 Yellow vision

Nausea and loss of appetite are the first indications of toxicity in approximately 50% of clients who take a cardiac glycoside, such as digoxin. Urticaria is a rare, not common, manifestation of digoxin toxicity. Photophobia is a later, not early, manifestation of digoxin toxicity. Yellow vision is a later, not early, manifestation of digoxin toxicity.

A terminally ill client in a hospice unit for several weeks is receiving a morphine drip. The dose is now above the typical recommended dosage. The client's spouse tells the nurse that the client is again uncomfortable and needs the morphine increased. The prescription states to titrate the morphine to comfort level. What should the nurse do? 1 Add a placebo to the morphine to appease the spouse. 2 Discuss with the spouse the risk for morphine addiction. 3 Assess the client's pain before increasing the dose of morphine. 4 Check the client's heart rate before increasing the morphine to the next level

Over time clients receiving morphine develop tolerance and require increasing doses to relieve pain, thus requiring continuing reassessments. Adding a placebo to the morphine to appease the spouse will not meet the client's need for relief from pain. The client is terminal, and the risk for addiction is of no concern. The respiratory, not heart, rate is the significant vital sign to be monitored; morphine depresses the central nervous system, specifically the respiratory center in the brain.

A client with tuberculosis is started on a chemotherapy protocol that includes rifampin. The nurse evaluates that the teaching about rifampin is effective when the client makes which statement? 1 "I need to drink a lot of fluid while I take this medication." 2 "I can expect my urine to turn orange from this medication." 3 "I should have my hearing tested while I take this medication." 4 "I might get a skin rash because it is an expected side effect of this medication."

Rifampin causes body fluids, such as sweat, tears, and urine, to turn orange. It is not necessary to drink large amounts of fluid with this drug; it is not nephrotoxic. Damage to the eighth cranial nerve is not a side effect of rifampin; it is a side effect of streptomycin sulfate, sometimes used to treat tuberculosis. A skin rash is not a side effect of rifampin.

A healthcare provider prescribes a medication to be administered via a metered-dose inhaler (MDI) for a young adult with asthma. List in order the steps the nurse teaches the client to follow when using the inhaler. 1. Hold the inhaler upright in the mouth. 2. Shake the inhaler for 30 seconds. 3. Start breathing in and press down on the inhaler once. 4. Exhale slowly and deeply to empty the air from the lungs.

When using an MDI, the medication should be shaken for 30 seconds to ensure that the medication is mixed. Exhaling completely maximizes emptying the lungs. The inhaler should be held upright in the mouth past the teeth with the lips closed around the mouthpiece (closed mouth method) or held upright 1 to 2 cm in front of the open mouth (open mouth method). Inhalation is begun at the same time that the device is compressed to ensure that maximum medication reaches the lungs.