prep u 26, 18,16,9
A client with acute joint inflammation tells the nurse , "I've been taking acetaminophen as it's ordered on the bottle, but my swelling and inflammation doesn't seem to be getting better." What should the nurse teach the client?
"Acetaminophen has no effect on inflammation." Acetaminophen has antipyretic and analgesic properties, but no anti-inflammatory properties. Acetaminophen does not increase a person's risk for bleeding. Relief of pain and fever occur quickly.
After teaching a local community group about the use of OTC anti-inflammatory agents, the nurse determines that the group needs additional teaching when they state:
"These drugs are relatively safe since they don't have adverse effects." All anti-inflammatory drugs available OTC have adverse effects that can be dangerous if toxic levels of the drug circulate in the body. Since these drugs are available OTC, there is a potential for abuse and overdosing. In addition, these drugs block the signs and symptoms of a present illness. OTC agents, if combined with other drugs, can induce toxicity.
The nurse is working with the parents of an infant and has initiated a dialogue about immunizations. The infant's parent states, "We're not comfortable with immunizations because of the safety issue." What is the nurse's best response?
"What are some of the safety risks that most concern you?" The nurse should attempt the therapeutically engage with the clients' concerns in an attempt to have a productive dialogue. The nurse should avoid being condescending or confrontational. Categorical statements about the safety of immunizations may be true, but are likely to be met with resistance from parents who are reluctant.
The nurse should be prepared to administer an infant's first dose of polio vaccine at what age?
2 months The first recommended dose of polio vaccine is at age 2 months
A nursing instructor is teaching a class illustrating the various reactions to antivenins. The instructor determines the class is successful when the students correctly point out clients may react within which time period if they are sensitive to an antivenin?
30 minutes The immediate reactions usually occur within 30 minutes of administration of the antivenin. The antivenins may cause various reactions, with hypersensitivity being the most severe. Symptoms include apprehension; flushing; itching; urticaria; edema of the face, tongue, and throat; cough; dyspnea; vomiting; cyanosis; and collapse.
The college health nurse is providing health education for freshmen. Which piece of information about immunizations is applicable to individuals of this age group?
A second dose of chickenpox vaccine is required for those who only received a single dose
Which is an example of artificially acquired active immunity? (Select all that apply.)
Administration of the varicella vaccine to an individual who has no immunity to the disease. Administration of the influenza vaccine to an individual who has no immunity to the disease. Administration of the rubella vaccine to an individual who has no immunity to the disease.
A home care nurse is seeing a 66-year-old female who has just been released from the hospital after being treated for rotator cuff repair. The nurse knows that it is important to assess the client's knowledge of which area?
Adverse effects of NSAIDs The nurse should review adverse drug effects with client. The other factors are also important but the priority is to esnure the client is aware of and understands which adverse effects need to be reported immediately if detected.
A client receiving penicillin therapy reports mouth irritation and a sore throat to the nurse. Inspection reveals a red, swollen tongue with ulcerations. The nurse suspects a fungal superinfection and prioritizes which nursing diagnosis as most appropriate for this client?
Altered Oral Mucous Membranes The assessment suggests a fungal superinfection, which would lead to the nursing diagnosis of Altered Oral Mucous Membranes. Although Altered Comfort may be appropriate, Altered Oral Mucous Membranes is more specific. There is no evidence of lack of knowledge or problems with nutrition. However, if the superinfection is not addressed, the client may experience difficulty eating due to the irritation and discomfort.
When describing the use of vaccines to a local community group, what would the nurse include?
Antivenins are used for passive, transient protection from the toxic effects of bites by black widows, rattlesnakes, copperheads, cottonmouth, and coral snakes.
The client is having surgery this week. What information should the nurse give the client concerning the use of pain medication after surgery?
Ask for pain medication before the pain gets severe. The nurse should emphasize the importance of pain control, stressing to the client that pain relief is greater if the medication is taken when pain is not very severe. If the client waits too long for pain medication, it will be much harder to control the pain. Also, the client should not take pain medication whenever it is available, but only when it is needed. It is rare for a client to become addicted to pain medication when it is taken for the relief of pain. The need for the pain medication goes away when the pain subsides.
A client with a positive sputum culture for TB has been started on streptomycin antitubercular therapy. Upon review of the laboratory results, the nurse notes that the client may be experiencing toxicity if which of the following results is abnormal?
BUN and creatinine Streptomycin can cause nephrotoxicity. The nurse would be monitoring the BUN and creatinine levels. Amylase and lipase are related to liver function. Streptomycin does not affect the electrolytes or blood cell counts.
A patient with arthritis is on nonsteroidal anti-inflammatory drug (NSAID) therapy. What should be evaluated by the nurse to determine the effectiveness of NSAID therapy?
Better mobility
A client is receiving anakinra as treatment for arthritis. The nurse understands that this drug acts in which manner?
Blocks interleukin-1 Anakinra blocks the increased interleukin-1 responsible for the degradation of cartilage in rheumatoid arthritis. Etanercept reacts with free-floating tumor necrosis factor released by active leukocytes in autoimmune inflammatory disease to prevent damage caused by tumor necrosis factor. Leflunomide directly inhibits an enzyme, dihydroorotate dehydrogenase (DHODH), that is active in the autoimmune process. Penicillamine lowers immunoglobulin M rheumatoid factor levels.
A nurse is required to administer an anti-infective drug to a patient. The nurse knows that which of the following tests need to be conducted before administering the first dose of an anti-infective drug to the patient?
Culture tests The nurse should check whether culture tests are conducted before the first dose of drug is administered to the client. Ulcer tests and stool tests are not required to be conducted before administering the first dose of an anti-infective drug to the client. The nurse has to ensure that urinalysis is conducted before the administration of the drug but not specifically before the first dose of the anti-infective drug.
A nurse administrates an opioid medication to a client. For what side effect should the nurse assess?
Drowsiness Drowsiness and sedation are results of central nervous system depression. The client will not develop lower extremity paresthesia, occipital headache, or polyuria. If these effects develop, they are not related to the opioid medication.
A nurse is caring for a patient who has been administered ibuprofen for fever reduction. Which should the nurse monitor the patient for?
Dyspepsia The nurse should check for dyspepsia when caring for a patient administered with ibuprofen. Administration of ketoprofen may cause diarrhea. Administration of etodolac may cause rash or tinnitus.
An 80-year-old male client presents to the health care provider's office with reports of fatigue and a change in the color of stools. He self-administers ibuprofen 400 mg each night for general discomfort. The provider orders a stool test for guaiac, which yields positive results. The provider discontinues the ibuprofen. The nurse is responsible for a client education plan. The client should be educated regarding what as a risk with chronic use of NSAIDs?
GI bleed Older clients on long-term NSAID therapy should be evaluated for GI blood loss, renal dysfunction, edema, hypertension, and drug-drug or drug-disease interactions (level A). Use of gastroprotective agents is recommended for people at risk of upper GI bleeding events (level B). COX-2 inhibitors may be preferred in older adults, because they are less likely to cause gastric ulceration and bleeding; however, this benefit must be weighed against the increased risk of cardiovascular events.
A client with rheumatoid arthritis is relieved to have less pain and inflammation since a change in medications. The nurse is aware that the new medication inhibits phagocytosis and prevents the release of lysosomal enzymes. What medication classification is this client receiving?
Gold salts
An infant is being administered an immunization. Which statement provides an accurate description of an immunization?
It is the administration of an antigen for an antibody response. Immunization involves administration of an antigen to induce antibody formation. This protects the child against the actions of infectious agents; it does not prevent exposure to them. Immunization must be administered to the child following birth. There are limited adverse effects associated with immunization; autism is not among them.
Prior to administering morphine, the nurse checks the client's medication history. The nurse will contact the health care provider and hold the morphine if the nurse notes the client is currently taking which medication?
Monoamine oxidase inhibitor (MAO)
A 40-year-old male client with arthritis of the knee joint has been prescribed an analgesic to relieve the pain. Which medication is a narcotic analgesic?
Morphine Morphine is a narcotic analgesic. Aspirin, ibuprofen, and celecoxib are nonnarcotic analgesics. Aspirin is classified as a salicylate and ibuprofen as a nonsteroidal anti-inflammatory drug (NSAID). Celecoxib is a newer NSAID that acts by inhibiting the cyclo-oxygenase-2 (COX-2) enzyme.
The nurse notes a respiratory rate of 6 breaths/min in a client in the postanesthesia recovery unit. Which drug would the nurse anticipate being given immediately?
Naloxone Naloxone has long been the drug of choice to treat respiratory depression caused by an opioid. Therapeutic effects occur within minutes after IV, IM, or sub-Q injection and last 1 to 2 hours. Butorphanol would worsen respiratory depression. Acetaminophen and diphenhydramine are used to treat headache. Epinephrine may be prescribed for an allergic reaction but not for respiratory depression.
A client is prescribed zolmitriptan for migraine headaches. The nurse should instruct the client to administer this drug by which route?
Oral
The school nurse is participating in a program to immunize students against human papillomavirus (HPV). What benefit should the nurse describe to students and their families?
Reduced risk for cervical cancer The HPV vaccine directly reduces the risk of cervical cancer, but not the risk of other sexually transmitted infections, PID, or polycystic ovary syndrome.
What organ system is responsible for the excretion of cefotaxime sodium from the body?
Renal Cefotaxime sodium, like all cephalosporins, is excreted by the kidneys. Cefotaxime is not excreted by the lungs, liver, or GI tract.
The client has had a myocardial infarction. The nurse is administering morphine sulfate for the pain. What vital sign would the nurse monitor that directly relates to the use of this narcotic?
Respiratory rate The first sign of narcotic overdose is often respiratory depression. Therefore, monitoring the client's vital signs, particularly respirations, is extremely important when administering narcotics.
The nurse is caring for a 6-year-old child who has pyelonephritis. The use of what group of antibiotics would be contraindicated due to the client's age?
Tetracyclines Tetracyclines can potentially damage developing teeth and bones and thus should be used cautiously or avoided in children under the age of 8 years. Penicillins are safe to give to children and commonly used. Cephalosporins are safe to administer to pediatric clients. Aminoglycosides would not be administered to children lightly, but they can be administered when the benefits outweigh the risks, such as an infection that is resistant to other drugs.
The client has been taking her antibiotic for five days. She tells the nurse that she is now experiencing vaginal itching and discharge. The nurse suspects what has occurred?
The client has developed a superinfection.
Morphine, an opioid agonist, is administered for both acute and chronic pain. Along with the administered dosage, what determines the patient's response to morphine?
The route of administration Patient response to morphine depends on the route of administration and the dosage.
Tuberculosis typically affects the lungs but can also involve other parts of the body. Which of the following can be affected by the disease?
Tuberculosis typically affects the lungs but can also involve other parts of the body. Which of the following can be affected by the disease? All the above Tuberculosis is an infectious disease that usually affects the lungs but may involve most parts of the body, including lymph nodes, meninges, bones, joints, kidneys, and the gastrointestinal tract.
A nurse is conducting an in-service about antibacterial drugs such as penicillins and cephalosporins. During the question-and-answer period, the audience asks for examples of conditions that can be treated by cephalosporins. Which examples would the nurse include in the response?
Urinary tract infections Cephalosporins are used to treat respiratory infections, otitis media, urinary tract infections, and bone and joint infections, and prophylactically to treat infections that may result from a sexual assault. Cephalosporins are not used to treat hemolysis or jaundice. Nausea and diarrhea are some of the adverse reactions that can occur when a patient is on cephalosporin therapy.
When describing the use of vaccines to a local community group, what would the nurse include?
Vaccines are used to provide active immunity Immunization is the process of using vaccines to artificially stimulate active immunity. They promote the formation of antibodies against a specific disease. The person experiences an immune response without having to suffer the full course of the disease. Severe reactions are rare.
The nurse is giving discharge instructions to a woman who will be taking amoxicillin for treatment of acute otitis media. The nurse teaches the client that which symptom indicates the development of a superinfection and should be reported to the physician?
Vaginal itching and discharge
A nurse is assigned to care for a patient with arthritis in a health care facility. The patient has been prescribed celecoxib. Celecoxib is contraindicated in clients with:
allergy to sulfonamides. Celecoxib is contraindicated among patients with allergy to sulfonamides. Ethambutol is contraindicated in patients with diabetic retinopathy and patients with cataract. Pyrazinamide is contraindicated among patients with acute gout.
A nurse would provide an immunization, antitoxin, or vaccination for which biological weapons? Select all that apply.
anthrax, smallpox,botulism,ebola
After teaching a group of nursing students about the different classes of drugs, the instructor determines that the teaching was successful when the students identify drugs that slow or retard the multiplication of bacteria as which type of medication?
bacteriostatic
The nurse knows that acetaminophen should not be used in older adults with which condition?
cirrhosis. An adverse effect of acetaminophen is hepatotoxicity. Therefore, an older adult with cirrhosis should not be prescribed acetaminophen. Having diabetes, a history of MI, or COPD does not restrict use of acetaminophen in the older adult.
While studying pharmacology, the nursing student learns that a naturally occurring narcotic drug with analgesic and antitussive effects is:
codeine
A client is ordered to receive an nonsteroidal anti-inflammatory drug (NSAID) for pain. The client states that NSAIDs are taken only to decrease inflammation. The nurse instructs the client that these medications are also used for which?
decrease body temperature.
A client who was bitten by a pit viper is to receive antivenin. What is the nurse's best action?
establish IV access
After teaching a group of students about aminoglycosides, the instructor determines that the teaching was successful when the group identifies which drug as the prototype for this class?
gentamicin
What drugs used to treat rheumatoid arthritis are contraindicated in a client who has a history of toxic levels of heavy metals?
gold salts Gold salts can be quite toxic and are contraindicated in the presence of any known allergy to gold, severe diabetes, congestive heart failure, severe debilitation, renal or hepatic impairment, hypertension, blood dyscrasias, recent radiation treatment, history of toxic levels of heavy metals, and pregnancy or lactation.
The client has been prescribed a fluoroquinolone. The nurse knows that nursing interventions for clients taking fluoroquinolones include which?
increase fluid intake. Clients taking fluoroquinolones should increase their fluid intake. Sodium ingestion is not affected.
When discussing cephalosporins with the nursing class, the pharmacology instructor explains that this classification of drug is primarily excreted through which organ?
kidney
A client is undergoing inpatient addiction rehabilitation following many years or addiction to heroin. What medication would be the most useful adjunct to treatment?
methadone
A client is prescribed zolmitriptan for migraine headaches. The nurse should instruct the client to administer this drug by which route?
oral
A nurse is assigned to care for a client with tuberculosis who has been prescribed rifampin. What should the nurse confirm to be sure that rifampin is not contraindicated in the client?
renal impairment
An 11-year-old client is having a cavity filled in the left mandibular first molar. The health care provider has prescribed aspirin for pain relief after the procedure. The nurse discovers upon assessment that the child is suffering from a flulike illness. The nurse contacts the health care provider about the prescribed medication for pain. What is the risk if aspirin is administered to this client?
reye syndrome
The nurse has administered a client's first scheduled dose of amoxicillin. What subsequent client report should prompt the nurse to seek the discontinuation of this drug?
shortness of breath Shortness of breath is suggestive of a hypersensitivity reaction and would likely warrant discontinuation of the drug. Nausea, reflux, and headache should each be addressed, but none likely necessitates discontinuation of drug therapy.
After administering sulfonamides to a client, the nurse observes the client has developed a fever, cough, and muscular aches, as well as lesions in the form of red wheals on the neck and the mouth. The nurse interprets these findings as indicating which possible adverse reaction?
stevens johnson syndrome
A client has been treated several times for a recurring ear infection with ofloxacin. The nurse instructs the client to look for side effects from the prolonged use of the antibiotic and informs the client that this is known as:
superinfection.
