PrepU: Pharmacology
A nurse is teaching a client about the side effects of ibuprofen. The client's learning is determined to be effective based on which statement by the patient describing the drug's effect on the immune system? "Ibuprofen can cause neutropenia, which can increase my risk of infection." "Ibuprofen can cause hemolytic anemia, which will make me feel tired and short of breath." "Ibuprofen can cause thrombocytopenia; I will need to watch for bruising and bleeding." "Ibuprofen can cause pancytopenia, which is a decrease in all of my blood cells."
"Ibuprofen can cause neutropenia, which can increase my risk of infection." Explanation: Ibuprofen causes leukopenia and neutropenia.
A client with obesity is prescribed lorcaserin for weight loss. The client reports dry mouth. What is the nurse's best response? "How much water are drinking?" "This is an expected finding with this medication." "Your dose may need to be adjusted." "Taking this medication with meals decreases this symptom."
"This is an expected finding with this medication." Explanation: Lorcaserin (Belviq), a selective serotonergic 5-HT2C receptor agonist, causes dry mouth. This is an expected and normal finding. Increasing fluid intake does not make this symptom go away. The other answer choices are incorrect.
A client asks the nurse how long to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse? 5 minutes 60 minutes 30 minutes 15 minutes
5 minutes Explanation: Nitroglycerin may be given by several routes: sublingual tablet or spray, oral capsule, topical agent, and intravenous (IV) administration. Sublingual nitroglycerin is generally placed under the tongue or in the cheek (buccal pouch). The nurse should instruct the client to take a second dose five minutes after the first if pain persists. The nurse should instruct the client to take a third dose five minutes after the second if pain still persists. The nurse should advise the client to call 911 if pressure or pain is not releived in 15 minutes by taking 3 tablets at 5-minute intervals.
Thyroid storm is a severe form of hyperthyroidism that can be fatal if not treated. Medical management includes pharmacotherapy. Which of the following drugs have proved helpful? Select all that apply. Hydrocortisone Methimazole Iodine Acetaminophen Salicylates
Hydrocortisone Methimazole Iodine Acetaminophen Explanation: Salicylates (i.e., aspirin) are contradicted because they displace thyroid hormone from binding to proteins and make hypermetabolism worse.
Monitored anesthesia care differs from moderate sedation in that monitored anesthesia care: is used as an adjunct to spinal anesthesia. requires the introduction of an anesthetic agent into the epidural space. is a type of regional anesthesia. may result in the administration of general anesthesia.
may result in the administration of general anesthesia. Explanation: Monitored anesthesia care may require the anesthesiologist to convert to general anesthesia.
The nurse is completing the preoperative checklist for a client scheduled for a phalloplasty. Which client statement alerts the nurse to contact the surgeon immediately? "I took my testosterone hormone replacement this morning." "I shaved the operative area at home last evening." "I completed the bowel preparation last evening." "I stopped smoking 1 week ago."
"I took my testosterone hormone replacement this morning." Explanation: Clients should stop their hormone therapy 2 to 3 weeks prior to the phalloplasty. The nurse will alert the surgeon that the client is still taking testosterone therapy. Gender reassignment surgeries, such as phalloplasty, require bowel preparation. Most surgeons require the client's to be free of tobacco products including nicotine and marijuana. Shaving the operative area is not a contraindication to proceeding with surgery.
A transgender male client asks the nurse about voice masculinization. Which therapy will the nurse recommend as an initial treatment? vocal cord surgery testosterone hormone therapy behavior therapy chondrolaryngoplasty surgery
testosterone hormone therapy Explanation: Testosterone hormone therapy often results in a lower voice for transgender male clients. If further voice alteration is desired, behavioral therapy and vocal cord surgery may also be suggested. Chondrolaryngoplasty surgery is the shaving of the thyroid cartilage to reduce the size of an Adam's apple, it is associated with male-to-female gender reassignment surgery.
A client with an H. pylori infection asks why bismuth subsalicylate is prescribed. Which response will the nurse make? "It enhances the function of the pyloric sphincter." "It helps propel food from the stomach into the duodenum." "It aids in the healing of the stomach lining." "It improves digestion in the stomach."
"It aids in the healing of the stomach lining." Explanation: Bismuth subsalicylate suppresses H. pylori bacteria in the gastric mucosa and assists with healing of mucosal ulcers. It does not affect digestion, enhance the function of the pyloric sphincter, or propel food from the stomach into the duodenum.
A client with gastric ulcers caused by H. pylori is prescribed metronidazole. Which client statement indicates to the nurse that teaching about this medication was effective? "I can have an alcoholic drink in the evenings." "My appetite may increase while taking this medication." "It might cause a metallic taste in my mouth." "I can take this medication with my blood thinner."
"It might cause a metallic taste in my mouth." Explanation: Metronidazole is a synthetic antibacterial and antiprotozoal agent that assists with eradicating H. pylori bacteria in the gastric mucosa when given with other antibiotics and proton pump inhibitors. This medication may cause a metallic taste in the mouth. It should not be taken with anticoagulants as it will increase the blood thinning effects of warfarin. Alcohol should be avoided while taking this medication. This medication may cause anorexia and not an increased appetite.
A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole, omeprazole, and clarithromycin. Which statement by the client indicates the best understanding of the medication regimen? "These medications will coat the ulcer and decrease the acid production in my stomach." "My ulcer will heal because these medications will kill the bacteria." "I should take these medications only when I have pain from my ulcer." "The medications will kill the bacteria and stop the acid production."
"The medications will kill the bacteria and stop the acid production." Explanation: Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton-pump inhibitors, and bismuth salts that suppress or eradicate H. pylori. Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (e.g., lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton-pump inhibitor and bismuth salts (Pepto-Bismol). Research is being conducted to develop a vaccine against H. pylori.
A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor? "You must have the second one in 6 months and the third in 1 year." "You must have the second one in 1 year and the third the following year." "You must have the second one in 2 weeks and the third in 1 month." "You must have the second one in 1 month and the third in 6 months."
"You must have the second one in 1 month and the third in 6 months." Explanation: Both forms of the hepatitis B vaccine are administered intramuscularly in three doses; the second and third doses are given 1 and 6 months, respectively, after the first dose.
The nurse is providing medication administration teaching for a client with obesity who is prescribed liraglutide for weight loss. What will the nurse include in the teaching? "You will be taking the medication for a short-term only." "You will be taking the medication with meals." "You will be injecting the medication on a daily basis." "You will be taking the medication with another medication."
"You will be injecting the medication on a daily basis." Explanation: Liraglutide (Belviq) is administered via subcutaneous injection. The other answer choices are incorrect.
Which solution is hypotonic? 0.45% NaCl 0.9% NaCl Lactated Ringer solution
0.45% NaCl Explanation: Half-strength saline is hypotonic. Lactated Ringer solution and normal saline (0.9% NaCl) are isotonic. A 5% NaCl solution is hypertonic.
Which is considered an isotonic solution? Dextran in normal saline 3% NaCl 0.9% normal saline 0.45% normal saline
0.9% normal saline Explanation: An isotonic solution is 0.9% normal saline (NaCl). Dextran in normal saline is a colloid solution, 0.45% normal saline is a hypotonic solution, and 3% NaCl is a hypertonic solution.
When administering heparin anticoagulant therapy, the nurse needs to make certain that the activated partial thromboplastin time (aPTT) is within the therapeutic range of: 2.5 to 3.0 times the baseline control. 3.5 times the baseline control. 1.5 to 2.5 times the baseline control. 4.5 times the baseline control.
1.5 to 2.5 times the baseline control. Explanation: A normal PTT level is 21 to 35 seconds. A reading of more than 100 seconds indicates a significant risk of hemorrhage.
A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? 100 units of regular insulin in normal saline solution 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution 100 units of regular insulin in dextrose 5% in water 100 units of NPH insulin in dextrose 5% in water
100 units of regular insulin in normal saline solution Explanation: Continuous insulin infusions use only short-acting regular insulin. Insulin is added to normal saline solution and administered until the client's blood glucose level falls. Further along in the therapy, a dextrose solution is administered to prevent hypoglycemia.
A client with end-stage dementia is admitted to the orthopedic unit after undergoing internal fixation of the right hip. How should the nurse manage the client's postoperative pain? Administer analgesics around the clock. Administer pain medication through a transdermal patch. Administer oral opioids as needed. Provide patient-controlled analgesia.
Administer analgesics around the clock. Explanation: Because assessing pain medication needs in a client with end-stage dementia is difficult, analgesics should be administered around the clock. Clients at this stage of dementia typically can't request oral pain medications when needed. They're also unable to use patient-controlled analgesia devices. Transdermal patches are used to manage chronic pain; not postoperative pain.
A client with a pulmonary embolus has the following arterial blood gas (ABG) values: pH, 7.49; partial pressure of arterial oxygen (PaO2), 60 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 30 mm Hg; bicarbonate (HCO3-) 25 mEq/L. What should the nurse do first? Administer oxygen by nasal cannula as ordered. Auscultate breath sounds bilaterally every 4 hours. Instruct the client to breathe into a paper bag. Encourage the client to deep-breathe and cough every 2 hours.
Administer oxygen by nasal cannula as ordered. Explanation: When a pulmonary embolus places a client at risk for oxygen deprivation, the body compensates by hyperventilating. This causes respiratory alkalosis, as reflected in the client's ABG values. However, the most significant ABG value is the PaO2 value of 60 mm Hg, which indicates hypoxemia. To manage hypoxemia, the nurse should increase oxygenation by administering oxygen via nasal cannula as ordered. Instructing the client to breathe into a paper bag would cause depressed oxygenation when the client re-inhaled carbon dioxide. Auscultating breath sounds or encouraging deep breathing and coughing wouldn't improve oxygenation.
A physician orders triamcinolone and salmeterol for a client with a history of asthma. What action should the nurse take when administering these drugs? Administer the triamcinolone and then administer the salmeterol. Monitor the client's theophylline level before administering the medications. Administer the salmeterol and then administer the triamcinolone. Allow the client to choose the order in which the drugs are administered.
Administer the salmeterol and then administer the triamcinolone. Explanation: A client with asthma typically takes bronchodilators and uses corticosteroid inhalers to prevent acute episodes. Triamcinolone (Azmacort) is a corticosteroid; Salmeterol (Serevent) is an adrenergic stimulant (bronchodilator). If the client is ordered a bronchodilator and another inhaled medication, the bronchodilator should be administered first to dilate the airways and to enhance the effectiveness of the second medication. The client may not choose the order in which these drugs are administered because they must be administered in a particular order. Monitoring the client's theophylline level isn't necessary before administering these drugs because neither drug contains theophylline.
A client has been diagnosed with shingles. Which of the following medication classifications will reduce the severity and prevent development of new lesions? Corticosteroids Antiviral Antipyretics Analgesics
Antiviral Explanation: Oral acyclovir (Zovirax), when taken within 48 hours of the appearance of symptoms, reduces their severity, and prevents the development of additional lesions. Corticosteroids, analgesics,, and antipyretics are not used for this purpose.
Prior to starting a peripheral intravenous line on a patient, what intervention can the nurse provide to decrease the pain from the needle puncture? Inject lidocaine 2% with epinephrine locally around the potential procedure site. Apply eutectic mixture of local anesthetic cream 30 minutes prior to the procedure. Apply diclofenac gel over the site 1 hour before the procedure. Give an oral opioid analgesic 30 minutes before the procedure.
Apply eutectic mixture of local anesthetic cream 30 minutes prior to the procedure. Explanation: The topical route of administration is used for both acute and chronic pain. For example, the nonopioid diclofenac is available in patch and gel formulations for application directly over painful areas. Local anesthetic creams, such as EMLA (eutectic mixture or emulsion of local anesthetics) and L.M.X.4 (lidocaine cream 4%), can be applied directly over the injection site prior to painful needle stick procedures, and the lidocaine patch 5% is often used for well-localized types of neuropathic pain, such as postherpetic neuralgia.
A nurse is caring for a client receiving warfarin therapy following a mechanical valve replacement. The client had a prothrombin time and International Normalized Ratio (INR) drawn before breakfast. The laboratory report shows the client's INR reading was 4. What is the nurse's first priority ? Assess the client for bleeding and notify the health care provider of the results. Notify the health care provider to request an increase in the warfarin dose. Notify the next nurse on afternoon shift to hold the evening dose of warfarin. Be prepared to administer an I.M. vitamin K injection and notify the healthcare provider of the results.
Assess the client for bleeding and notify the health care provider of the results. Explanation: For a client taking warfarin following a valve replacement, the INR should be between 2 and 3.5. The nurse should notify the health care provider of an elevated INR level and communicate assessment data regarding possible bleeding. The nurse shouldn't administer medication such as warfarin or vitamin K without a health care provider's order. The nurse should notify the health care provider before holding a medication scheduled to be administered during another shift.
A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client? Bank autologous blood. Ask people to donate blood. Use volume expanders in case blood is needed. Sign a refusal of blood transfusion form so the client will not receive the transfusion.
Bank autologous blood. Explanation: Banking autologous blood that is self-donated is the safest option for the client. Signing the refusal form does not give the client any information about the options that are available and places the client at risk. Directed donor blood may be no safer than blood collected from public donors. Those who support this belief say that directed donors may not reveal their high-risk behaviors that put the potential recipient at risk for blood-borne pathogens such as HIV.
A preventative approach to pain relief with non-steroidal anti-inflammatory drugs (NSAIDs) means that the medication is given: Before pain becomes severe. When pain is at its peak. Before pain is experienced. When the level of pain tolerance has been exceeded.
Before pain is experienced. Explanation: NSAIDs are most effective for preventive pain management when administered on a fixed-schedule (i.e., every 3-4 hours) to prevent the pain experience. When combined with an opioid, the medication regimen is highly effective in managing moderate to severe pain.
A client with a history of sickle cell anemia has developed iron overload from repeated blood transfusions. What treatment does the nurse anticipate will be prescribed? Hepatitis B immunization White blood cell filter Red blood cell phenotyping Chelation therapy
Chelation therapy Explanation: Chelation therapy is prescribed to treat iron overload. Hepatitis B immunization helps immunize against hepatitis B. Red blood cell phenotyping helps decreased sensitization. A white blood cell filter protects against cytomegalovirus and some sensitization and febrile reactions.
A client has severe coronary artery disease (CAD) and hypertension. Which medication order should the nurse consult with the health care provider about that is contraindicated for a client with severe CAD? Amiloride Clonidine Bumetanide Methyldopa
Clonidine Explanation: Clonidine (Catapres) is contraindicated for clients with severe coronary artery disease.
Which assessment finding puts a client at increased risk for epistaxis? Use of a humidifier at night Hypotension Cocaine use History of nasal surgery
Cocaine use Explanation: Using nasally inhaled illicit drugs, such as cocaine, increases the risk of epistaxis (nosebleed) because of the increased vascularity of the nasal passages. A dry environment (not a humidified one) increases the risk of epistaxis. Hypertension, not hypotension, increases the risk of epistaxis. A history of nasal surgery doesn't increase the risk of epistaxis.
The nurse is caring for a client prescribed oral griseofulvin for treatment of a fungal toenail infection. Which instruction by the nurse is essential in understanding the treatment plan? Administer medications daily. Take the medication with meals. Continue medication regimen for several weeks. Administer a stool softener to offset constipation.
Continue medication regimen for several weeks. Explanation: Fungal infections are difficult to treat and often take many weeks of medication to eradicate. Taking medication with meals, administering daily, and stool softeners are good teaching components but not essential in understanding the treatment plan.
The nurse is caring for a victim of a chemical disaster. Medications given in the treatment of this client include amyl nitrate, sodium nitrate, and sodium thiosulfate. What chemical agent does the nurse know this client has been exposed to? Sarin Mustard gas Cyanide Anthrax
Cyanide Explanation: They administer one or all of the following antidotes: amyl nitrate, sodium nitrate, and sodium thiosulfate. Amyl nitrate promotes the formation of methemoglobin, which combines with cyanide to form nontoxic cyanmethemoglobin. Therefore, options A, B, and D are incorrect.
What is a negative effect of IV nitroglycerin for shock management that the nurse should assess for in a client? Decreased blood pressure. Reduced afterload. Increased cardiac output. Reduced preload.
Decreased blood pressure. Explanation: A potentially serious side effect of IV nitroglycerin (Tridil) is hypotension. Blood pressure needs to be monitored frequently according to the manufacturer's recommendation and institutional policy.
A client arrives at the emergency department complaining of extreme muscle weakness after minimal effort. The physician suspects myasthenia gravis. Which drug will be used to test for this disease? Pyridostigmine (Mestinon) Edrophonium (Tensilon) Ambenonium (Mytelase) Carbachol (Carboptic)
Edrophonium (Tensilon) Explanation: Edrophonium temporarily blocks the breakdown of acetylcholine, thus increasing acetylcholine level in the blood, and relieves weakness. Because of its short duration of action, edrophonium is the drug of choice for diagnosing myasthenia gravis. It's also used to differentiate myasthenia gravis from cholinergic toxicity. Ambenonium is used as an antimyasthenic. Pyridostigmine serves primarily as an adjunct in treating severe anticholinergic toxicity; it's also an antiglaucoma agent and a miotic. Carbachol reduces intraocular pressure during ophthalmologic procedures; topical carbachol is used to treat open-angle and closed-angle glaucoma.
A client is receiving vasopressin for the urgent management of active bleeding due to esophageal varices. What most serious complication should the nurse assess the client for after the administration? Urinary output changes Liver enzyme changes Electrocardiogram changes Electrolytes level changes
Electrocardiogram changes Explanation: Vasopressin (Pitressin) is administered during the management of an urgent situation with an acute esophageal bleed because of its vasoconstrictive properties in the splanchnic, portal, and intrahepatic vessels. This medication also causes coronary artery constriction that may dispose clients with coronary artery disease to cardiac ischemia; therefore, the nurse observes the client for evidence of chest pain, ECG changes, and vital sign changes. Vasopressin will does not infer with urinary output, electrolytes, or liver enzymes.
What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen? Encourage fluid intake to dilute the urine. Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. Take measures to acidify the urine and prevent uric acid crystallization. Limit fluids to 1,000 mL daily to prevent accumulation of the drug's end products after cell lysis.
Encourage fluid intake to dilute the urine. Explanation: The nurse should ensure adequate fluid hydration before, during, and after drug administration and assess intake and output. Adequate fluid volume dilutes drug levels, which can help prevent renal damage.
A patient is having an angiography to detect the presence of an aneurysm. After the contrast is administered by the interventionist, the patient begins to complain of nausea and difficulty breathing. What medication is a priority to administer at this time? Cimetidine (Tagamet) Hydrocortisone (Solu-Cortef) Epinephrine Metoprolol (Lopressor)
Epinephrine Explanation: Infrequently, a patient may have an immediate or delayed allergic reaction to the iodine contained in the contrast agent used in angiography. Manifestations include dyspnea, nausea and vomiting, sweating, tachycardia, and numbness of the extremities. Any such reaction must be reported to the interventionalist at once; treatment may include the administration of epinephrine, antihistamines, or corticosteroids.
Antithyroid medications are not generally recommended for elderly patients because of which side effect? Mental confusion Granulocytopenia Fatigue Weight loss
Granulocytopenia Explanation: Antithyroid medications are not generally recommended for elderly clients because of the increased incidence of side effects such as granulocytopenia and the need for frequent monitoring.
The nurse is administering oral metoprolol. Where are the receptor sites mainly located? Bronchi Heart Blood vessels Uterus
Heart Explanation: Metoprolol works at beta 1 -receptor sites. Most beta1-receptor sites are located in the heart. Beta2-receptor sites are located in the uterus, blood vessels, and bronchi.
A healthcare provider orders several drugs for a client with hemorrhagic stroke. Which drug order should the nurse question? Heparin sodium Dexamethasone Phenytoin Methyldopa
Heparin sodium Explanation: Administering heparin, an anticoagulant, could increase the bleeding associated with hemorrhagic stroke. Therefore, the nurse should question this order to prevent additional hemorrhage in the brain. In a client with hemorrhagic stroke, the healthcare provider may use dexamethasone (Decadron) to decrease cerebral edema and pressure, methyldopa (Aldomet) to reduce blood pressure, and phenytoin (Dilantin) to prevent seizures.
The nurse is obtaining a medication history from a client who is reporting erectile dysfunction. Which medication would the nurse identify as being least likely to contribute to the client's condition? Ibuprofen Methyldopa Cimetidine Spironolactone
Ibuprofen Explanation: Certain medications, such as antihypertensive agents (e.g. methyldopa and spironolactone), antidepressants, narcotics, and cimetidine cause sexual dysfunction in men. Ibuprofen is not associated with causing erectile dysfunction.
A client is receiving an IV infusion of mannitol (Osmitrol) after undergoing intracranial surgery to remove a brain tumor. To confirm that this drug is producing its therapeutic effect, the nurse should consider which finding most significant? Decreased level of consciousness (LOC) Decreased heart rate Increased urine output Elevated blood pressure
Increased urine output Explanation: The therapeutic effect of mannitol is diuresis, which is confirmed by an increased urine output. A decreased LOC and elevated blood pressure may indicate lack of therapeutic effectiveness. A decreased heart rate doesn't indicate that mannitol is effective.
The nurse is caring for a patient with severe pain related to ureteral colic. What medication can the nurse administer with a physician's order that will inhibit the synthesis of prostaglandin E, thereby reducing swelling and facilitating passage of the stone? Meperidine (Demerol) Morphine sulfate Aspirin Ketoralac (Toradol)
Ketoralac (Toradol) Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac (Toradol) are effective in treating renal stone pain because they provide specific pain relief. They also inhibit the synthesis of prostaglandin E, reducing swelling and facilitating passage of the stone.
A client is exhibiting signs of increasing intracranial pressure (ICP). Which intravenous solution (IV) would the nurse anticipate hanging? One-third normal saline (0.33% NSS) Half-normal saline (0.45% NSS) Dextrose 5% in water (D5W) Lactated Ringer's
Lactated Ringer's Explanation: With increasing ICP, isotonic normal saline, lactated Ringer's, or hypertonic (3%) saline solutions are used to decrease swelling in the brain cells. D5W, 0.45% NSS, and 0.33% NSS are all hypotonic solutions that will move more fluid into the cells, worsening the ICP.
A health care provider prescribed a luteinizing hormone-releasing hormone (LHRH) agonist to suppress testicular androgen and treat prostate cancer. Which medication is the primary drug of choice? Nilandron Lupron Casodex Eulexin
Lupron Explanation: Lupon is an LHRH agonist. The other three choices are antiandrogen receptor antagonists.
A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer? Glyburide Glipizide Metformin Repaglinide
Metformin Explanation: Metformin is a biguanide and along with the thiazolidinediones (rosiglitazone and pioglitazone) are categorized as insulin sensitizers; they help tissues use available insulin more efficiently. Glyburide and glipizide which are sulfonylureas, and repaglinide, a meglitinide, are described as being insulin releasers because they stimulate the pancreas to secrete more insulin.
The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about? Methotrexate Celecoxib Methylprednisolone Mercaptopurine azathioprine
Methotrexate Explanation: Methotrexate is a DMARD that reduces the amount of joint damage and slows the damage to other tissues as well. Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). Methylprednisolone is a steroid to reduce pain and inflammation and slow joint destruction. Mercaptopurine azathioprine is a cytotoxic drug.
A nurse is reviewing the medications of a postoperative client. What medication related to the recent surgery may be of concern to the nurse? Furosemide Digoxin Allopurinol Prednisone
Prednisone Explanation: Corticosteroids such as prednisone (Deltasone) may impair the normal inflammatory process and may mask infection. Furosemide (Lasix), digoxin (Lanoxin), and allopurinol (Zyloprim) should not be of concern postoperatively.
While receiving heparin to treat a pulmonary embolus, a client passes bright red urine. What should the nurse do first? Prepare to administer protamine sulfate. Start an I.V. infusion of dextrose 5% in water (D5W). Monitor the partial thromboplastin time (PTT). Decrease the heparin infusion rate.
Prepare to administer protamine sulfate. Explanation: Frank hematuria indicates excessive anticoagulation and bleeding — and heparin overdose. The nurse should discontinue the heparin infusion immediately and prepare to administer protamine sulfate, the antidote for heparin. Decreasing the heparin infusion rate wouldn't prevent further bleeding. Although the nurse should continue to monitor PTT, this action should occur later. An I.V. infusion of D5W may be administered, but only after protamine has been given.
A patient is receiving parenteral nutrition. The current solution is nearing completion, and a new solution is to be hung, but it has not arrived from the pharmacy. Which action by the nurse would be most appropriate? Have someone go to the pharmacy to obtain the new solution. Begin an infusion of normal saline in another site to maintain hydration. Slow the current infusion rate so that it will last until the new solution arrives. Hang a solution of dextrose 10% and water until the new solution is available.
Propylthiouracil Explanation: Antithyroid drugs, such as propylthiouracil and methimazole are given to block the production of thyroid hormone preoperatively or for long-term treatment for clients who are not candidates for surgery or radiation treatment. Levothyroxine would increase the level of thyroid and be contraindicated in this client. Spironolactone is a diuretic and does not have the action of blocking production of thyroid hormone and neither does propranolol, which is a beta-blocker.
Which of the following is considered an antidote to heparin? Vitamin K Protamine sulfate
Protamine sulfate Explanation: Protamine sulfate, in the appropriate dosage, acts quickly to reverse the effects of heparin. Vitamin K is the antidote to warfarin (Coumadin). Narcan is the drug used to reverse signs and symptoms of medication-induced narcosis. Ipecac is an emetic used to treat some poisonings.
The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? Ascites and orthopnea Purpura and petechiae Dyspnea and fatigue Gynecomastia and testicular atrophy
Purpura and petechiae Explanation: A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.
A patient with a UTI is having burning and pain when urinating. What urinary analgesic is prescribed for relief of these symptoms? Bactrim Pyridium Levaquin Septra
Pyridium Explanation: The urinary analgesic agent phenazopyridine (Pyridium) is used specifically for relief of burning, pain, and other symptoms associated with UTI.
The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know is the only one that can be used intravenously? NPH Regular Lispro Lantus
Regular Explanation: Short-acting insulins are called regular insulin (marked R on the bottle). Regular insulin is a clear solution and is usually administered 20 to 30 minutes before a meal, either alone or in combination with a longer-acting insulin. Regular insulin is the only insulin approved for IV use.
A client is diagnosed with pneumocystis pneumonia (PCP). What medication does the nurse anticipate educating the client about for treatment? Garamycin TMP-SMZ Azithromycin Cephalexin
TMP-SMZ Explanation: TMP-SMZ (Bactrim, Cotrim, Septra) is the treatment of choice for PCP; it is as effective as parenteral pentamidine isethionate (Pentacarinat) and more effective than other regimens.
A client with peptic ulcer disease has been prescribed sucralfate. What health education should the nurse provide to this client?
Take the medication 2 hours before or after other medications Explanation: Sucralfate should be taken at least 2 hours before or after other medications. It does not decrease potassium levels and laboratory follow up is unnecessary. Sucralfate does not cause sedation.
The nurse provides care for a client, with a history of atherosclerosis, who is hospitalized for the initiation of pharmacotherapy for the treatment of hypothyroidism. Complete the following sentence by choosing from the lists of options. The client is at highest risk for developing _______ as evidenced by ______.
The client is at highest risk for developing cardiac dysfunction as evidenced by angina. Prevention of cardiac dysfunction is a priority when providing care to a client who requires the initiation of pharmacotherapy in the clinical setting. When thyroid hormone is given to a client who is diagnosed with hypothyroidism, the oxygen demand increases, but oxygen delivery cannot be increased unless, or until, the preexisting atherosclerosis improves. The occurrence of angina and acute coronary syndrome is the signal that the oxygen needs of the myocardium exceed its blood supply and is the result of thyroid hormones enhancing the cardiovascular effects of catecholamines. Although skin changes due to the accumulation of mucopolysaccharides in the client's subcutaneous tissues do occur with hypothyroidism, this is not caused by the initiation of pharmacotherapy but by the disease process. Hypothermia is caused by myxedema coma but the client's risk for this decreases, not increases, with the initiation of pharmacotherapy for the treatment of hypothyroidism.
A client with breast cancer is scheduled to undergo chemotherapy with aromatase inhibitors. Which rationale does the nurse give for the use of this group of drugs? They stimulate the immune system to attack a protein common in many tumors. They block progesterone-dependent tumors from growing. They prevent prehormones from becoming estrogen, blocking the tumor's ability to use it. They attach to endogenous protein receptors to slow the growth of cancerous cells.
They prevent prehormones from becoming estrogen, blocking the tumor's ability to use it. Explanation: Aromatase inhibitors lower the level of estrogen in the body thereby interfering with the ability of hormone-sensitive tumors to use estrogen for growth. Antiprogestin drug, such as mifepristone, blocks progesterone-dependent breast cancers. The monoclonal antibody, trastuzumab attaches to protein receptors to slow the growth of cancer cells. A breast cancer vaccine is under investigation in Italy. This vaccine stimulates the immune system to attack a protein called mammaglobin-A, which is found in 80% of breast cancer tumors.
A client who is HIV positive has been prescribed antiretroviral drugs. The nurse explains the action of each antiretroviral drug and develops a schedule for the client's self-administration, including strong emphasis about rigidly adhering to the dosage, time and frequency of the administration of the drugs. Why is it important to adhere to the schedule of drug dosing developed for this client? To get the most benefit from the drugs To maintain appropriate blood levels of the drugs To avoid resistance to the drugs To avoid overdosing on the drugs
To avoid resistance to the drugs Explanation: For clients with an established HIV status, the nurse explains the action of each antiretroviral drug and develops a schedule for the client's self-administration. This includes strong precautions about rigidly adhering to the dosage, time, and frequency of drug administration to avoid resistance. Adhering rigidly to the developed schedule is not to preclude overdosing, or to maintain appropriate blood levels, or to get the most benefit from the drugs.
The nurse is assisting the health care provider with a colonoscopy for a client with rectal bleeding. The health care provider requests the nurse to administer glucagon during the procedure. Why is the nurse administering this medication during the procedure? To reduce air accumulation in the colon. The client is probably hypoglycemic and requires the glucagon. To relax colonic musculature and reduce spasm. To relieve anxiety during the procedure for moderate sedation.
To relax colonic musculature and reduce spasm. Explanation: Glucagon may be administered, if needed, to relax the colonic musculature and to reduce spasm during the colonoscopy.
The nurse is assisting the health care provider with a colonoscopy for a client with rectal bleeding. The health care provider requests the nurse to administer glucagon during the procedure. Why is the nurse administering this medication during the procedure? To reduce air accumulation in the colon. The client is probably hypoglycemic and requires the glucagon. To relieve anxiety during the procedure for moderate sedation. To relax colonic musculature and reduce spasm.
To relax colonic musculature and reduce spasm. Explanation: Glucagon may be administered, if needed, to relax the colonic musculature and to reduce spasm during the colonoscopy.
The nurse is reviewing a client's medication and health history. Which assessment finding would cause the nurse to question the client's new prescription for the phosphodiesterase inhibitor sildenafil? Use of nitrates History of hypertension Type 2 diabetes Use of diuretics
Use of nitrates Explanation: PDE5 inhibitors facilitate penile erection by producing smooth muscle relaxation in the corpora cavernosa via vasodilation of the blood vessels. If a client is using nitrates (which also exhibit vasodilation) hypotension is likely to occur. History of hypertension and diabetes does not interfere with the administration of PDE5 inhibitors. Use of diuretics is not significant.
A nurse is caring for a client with a history of severe migraines. The client has a medical history that includes asthma, gastroesophageal reflux disease, and three pregnancies. Which medication does the nurse anticipate the physician will order for the client's migraines? Amiodarone (Cordarone) Metoprolol (Lopressor) Carvedilol (Coreg) Verapamil (Calan)
Verapamil (Calan) Explanation: Calcium channel blockers, such as verapamil, and beta-adrenergic blockers, such as metoprolol, are commonly used to treat migraines because they help control cerebral blood vessel dilation. Calcium channel blockers, however, are ordered for clients who may not be able to tolerate beta-adrenergic blockers, such as those with asthma. Amiodarone and carvedilol aren't used to treat migraines.
The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose? Ringing in the ears Vomiting Watery diarrhea Asterixis
Watery diarrhea Explanation: The patient receiving lactulose is monitored closely for the development of watery diarrhea stools, because they indicate a medication overdose. Serum ammonia levels are closely monitored as well.
A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents? Break needles after the infusion is discontinued. Throw I.V. tubing in the trash after the infusion is stopped. Disconnect I.V. tubing with gloved hands. Wear disposable gloves and protective clothing.
Wear disposable gloves and protective clothing. Explanation: A nurse must wear disposable gloves and protective clothing to prevent skin contact with chemotherapeutic agents. The nurse shouldn't recap or break needles. The nurse should use a sterile gauze pad when priming I.V. tubing, connecting and disconnecting tubing, inserting syringes into vials, breaking glass ampules, or other procedures in which chemotherapeutic agents are being handled. Contaminated needles, syringes, I.V. tubes, and other equipment must be disposed of in a leak-proof, puncture-resistant container.
A patient has been diagnosed with meningococcal meningitis at a community living home. When should prophylactic therapy begin for those who have had close contact with the patient? Within 72 hours after exposure Within 24 hours after exposure Within 48 hours after exposure Therapy is not necessary prophylactically and should only be used if the person develops symptoms.
Within 24 hours after exposure Explanation: People in close contact with patients with meningococcal meningitis should be treated with antimicrobial chemoprophylaxis using rifampin (Rifadin), ciprofloxacin hydrochloride (Cipro), or ceftriaxone sodium (Rocephin). Therapy should be started within 24 hours after exposure because a delay in the initiation of therapy limits the effectiveness of the prophylaxis.
A client is prescribed cyproterone acetate for feminizing hormone therapy. Which laboratory values should be regularly monitored to detect adverse effects directly related to the administration of cyproterone acetate? potassium, sodium, calcium hemoglobin, white blood cell (WBC), platelets aspartate transaminase (AST), alanine transaminase (ALT), bilirubin creatinine, blood urea nitrogen (BUN)
aspartate transaminase (AST), alanine transaminase (ALT), bilirubin Explanation: Cyproterone acetate can cause hepatotoxicity, therefore liver function tests (AST, ALT, bilirubin) should be completed prior to and during therapy. Renal failure is not a side effect of this medication, so creatinine and BUN monitoring is not indicated. This medication does not cause fluctuations in electrolyte levels (potassium, sodium, calcium). Thrombocytopenia, anemia, and neutropenia are not associated with this medication, so a complete blood count (hemoglobin, WBC, platelets) is not indicated.
A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will be prescribed long-term administration of which drug? pentoxifylline or acetaminophen. aspirin or clopidogrel. penicillin V or erythromycin. aspirin or acetaminophen.
aspirin or clopidogrel. Explanation: After PTCA, the client begins long-term aspirin or clopidogrel therapy to prevent thromboembolism. Health care providers order heparin for anticoagulation during this procedure; some health care providers discharge clients with a prescription for long-term warfarin or low-molecular-weight heparin therapy. Pentoxifylline, a vasodilator used to treat chronic arterial occlusion, isn't required after PTCA because the procedure itself opens the vessel. The health care provider may order short-term acetaminophen therapy to manage fever or discomfort, but prolonged therapy isn't warranted. The client may need an antibiotic, such as penicillin or erythromycin, for a brief period to prevent infection associated with an invasive procedure; long-term therapy isn't necessary.
Three hours after injuring the spinal cord at the C6 level, a client receives high doses of methylprednisolone sodium succinate (Solu-Medrol) to suppress breakdown of the neurologic tissue membrane at the injury site. To help prevent adverse effects of this drug, the nurse expects the physician to order: atracurium (Tracrium). naloxone (Narcan). nitroglycerin (Nitro-Bid). famotidine (Pepcid).
famotidine (Pepcid). Explanation: Adverse effects of methylprednisolone sodium succinate and other steroids include GI bleeding and wound infection. To help prevent GI bleeding, the physician is likely to order an antacid or a histamine2-receptor antagonist such as famotidine (Pepcid). Naloxone, nitroglycerin, and atracurium aren't used to prevent adverse effects of steroids. Naloxone, an endogenous opioid antagonist, has been studied in animals for its action in inhibiting release of endogenous opioids after spinal cord injury. (Endogenous opioids are thought to contribute to secondary damage to spinal cord tissue by reducing microcirculatory blood flow.) Nitroglycerin is used to dilate the coronary arteries. Atracurium is a nondepolarizing muscle relaxant.
The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for: hypokalemia. hypernatremia. hyponatremia. hyperkalemia.
hypokalemia. Explanation: The older client taking digoxin must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.
When a client receives vincristine, an antineoplastic agent that inhibits DNA and protein synthesis, the client needs to be informed to report which symptoms that would be expected side effects of motor neuropathy? Select all that apply. alopecia muscle weakness burning and tingling sensations in the extremities cramps and spasms in the legs loss of balance and coordination
muscle weakness cramps and spasms in the legs loss of balance and coordination Explanation: Muscle weakness, cramps and leg spasms, and loss of balance and coordination are expected side effects of motor nerve damage. Burning and tingling sensations are signs of sensory nerve damage. Alopecia is hair loss, not a motor nerve damage sign.