test 3 pharm

The nurse is administering 0800 medications. Which medication would the nurse question? 1. Misoprostol (Cytotec), a prostaglandin analog, to a 29-year-old female with an NSAID-produced ulcer. 2. Omeprazole (Prilosec), a proton-pump inhibitor, to a 68-year-old male with a duodenal ulcer. 3. Furosemide (Lasix), a loop diuretic, to a 56-year-old male with a potassium level of 4.2 mEq/L. 4. Acetaminophen (Tylenol), a nonnarcotic analgesic, to an 84-year-old female with a frontal headache.

1 A 29-year-old female is of childbear- ing age. The nurse should determine that the client is not pregnant before administering this medication. Miso- prostol can be used in a combination with mifepristone to produce an abortion. Prilosec is prescribed to treat duodenal and gastric ulcers; the nurse would not question this medication. The potassium level is within normal range (3.5-5.5 mEq/L); the nurse would not question this medication. Tylenol is frequently administered for headaches; the nurse would not question this medication.

The client newly diagnosed with epilepsy is prescribed an anticonvulsant medication. Which information should the nurse tell the client? 1. The medication dosage will start low and gradually increase over a few weeks. 2. The dosage prescribed initially will be the dosage prescribed for the rest of your life. 3. The health-care provider will prescribe a loading dose and decrease dosage gradually. 4. The dose of medication will be adjusted monthly until a serum drug level is obtained.

1 Anticonvulsant dosages usually start low and gradually increase over a period of weeks until the serum drug level is within therapeutic range or the seizures stop. It is incorrect to state that the dosage prescribed will be the dosage for the rest of the client's life, but it is correct to state that the client will most likely be on the medication for the rest of his or her life. This is incorrect information. The medication is started in low dosages and gradually increased. The dose of medication will be adjusted until a serum drug level is reached but it will be more frequently than monthly.

The client diagnosed with severe ulcerative colitis is prescribed azathioprine (Imuran), an immunosuppressant. Which assessment data concerning the medication would warrant immediate intervention by the nurse? 1. Complaints of a sore throat, fever, and chills. 2. Reports of 10-20 loose stools a day. 3. Complaints of abdominal pain and tenderness. 4. Reports of dry mouth and oral mucosa.

1 Azathioprine can cause a decrease in the number of blood cells in the bone marrow (agranulocytosis). Signs or symptoms that would warrant inter- vention by the nurse include sore throat, fever, chills, unusual bleeding or bruising, pale skin, headache, confu- sion, tachycardia, insomnia, and short- ness of breath. Ten to 20 loose watery stools a day are characteristic of an acute exacerbation of ulcerative colitis and would not warrant intervention by the nurse secondary to the medication. Abdominal pain and tenderness are char- acteristic of an acute exacerbation of ulcerative colitis and would not warrant intervention by the nurse secondary to the medication. Dehydration may occur with ulcerative colitis, but it does not warrant interven- tion by the nurse secondary to the medication.

The client with a seizure disorder who is taking carbamazepine (Tegretol) tells the clinic nurse, "I am taking evening primrose oil for my premenstrual cramps and it is really working." Which statement would be the nurse's best response? 1. "You should inform your health-care provider about taking this herb." 2. "It is very dangerous to take both the herb and Tegretol." 3. "Herbs are natural substances and I am glad it is helping your PMS." 4. "Are you sure you should be taking herbs along with Tegretol?"

1 Evening primrose oil may lower the seizure threshold, and the Tegretol dose may need to be modified. Therefore, the client should notify the health-care provider. Evening primrose oil is not dangerous, and the nurse should not scare the client. Although the evening primrose oil may help the client's PMS, the nurse should inform the client that because she is also taking Tegretol, she should inform her HCP because the dose of Tegretol may need to be adjusted. The nurse needs to give factual informa- tion to the client— not ask the client a question.

The client with inflammatory bowel disease is prescribed sulfasalazine (Azulfidine), a sulfonamide antibiotic. Which intervention should the nurse implement when administering this medication? 1. Ensure the client drinks at least 2000 mL of water daily. 2. Administer the medication once a day with breakfast. 3. Explain that the medication may cause slight bruising. 4. Assess the client's stool for steatorrhea and mucus.

1 Increasing fluid intake dilutes the drug, which helps to prevent crystalluria (crystals in the urine) from occurring. The medication is administered every 6-8 hours, not once a day. Instruct the client to report any bruising or bleeding because it could be a sign of a drug-induced blood disorder (agranulocy- tosis). This medication will not cause fat, frothy stools; therefore, the nurse does not need to assess the stool.

The male client diagnosed with peptic ulcer disease (PUD) has been taking magne- sium hydroxide (Milk of Magnesia) for indigestion. The client complains that he has been having diarrhea. Which action would be the nurse's best response? 1. Suggest that the client use magnesium hydroxide with aluminum hydroxide (Mylanta). 2. Encourage the client to discuss the problem with the health-care provider. 3. Tell the client to take loperamide (Imodium), over the counter. 4. Discuss why the client is concerned about experiencing diarrhea.

1 Milk of Magnesia is the most potent antacid, but it is usually used as a laxa- tive because of the actions of magne- sium hydroxide on the bowel. A combination antacid—magnesium hydroxide (produces diarrhea) and aluminum hydroxide (produces consti- pation)—is preferred to balance the side effects. The nurse can answer the client's ques- tion. It is only necessary to discuss this with the health-care provider if antacids are not resolving the client's complaints of indigestion. The Milk of Magnesia is causing the problem, and changing antacids should resolve the situation. Most clients are concerned about diarrhea, and the nurse should be concerned about fluid and electrolyte imbalances resulting from diarrhea.

The client newly diagnosed with a seizure disorder also has Type 2 diabetes. The health-care provider prescribes phenytoin (Dilantin) for the client. Which interven- tion should the nurse implement? 1. Instruct the client to monitor his or her blood glucose more closely. 2. Explain that the Dilantin will not affect the client's antidiabetic medication. 3. Discuss the need to discontinue oral hypoglycemic medication and take insulin. 4. Call the health-care provider to discuss prescribing the Dilantin.

1 Serum glucose must be monitored more closely because phenytoin may inhibit insulin release, thus causing an increase in glucose level. This is not a true statement. Dilantin may affect the client's antidiabetic medication. This is not a true statement. The client can still take oral hypoglycemic medi- cations. The nurse should call and discuss any questionable medication with the HCP, but there is no reason to discuss Dilantin being prescribed for a client with Type 2 diabetes.

The client with inflammatory bowel disease has been on hyperalimentation, total parenteral nutrition (TPN), for 2 weeks. The health-care provider has written orders to discontinue TPN. Which action should the nurse implement? 1. Notify the health-care provider and question the order. 2. Discontinue the TPN and flush the subclavian port. 3. Do not implement the order and talk to the HCP on rounds. 4. Discuss the order with the pharmacist before discontinuing.

1 TPN must be tapered off because of its high glucose content; if TPN is not tapered, the client may experience hypoglycemia. Therefore, the nurse should call the HCP to request an order to taper the TPN. TPN must be tapered; therefore, the nurse should not discontinue the TPN abruptly. 3. If the nurse is not going to implement the order as written, the nurse should notify the HCP immediately and not wait for the HCP to make rounds. TPN is a medica- tion and the client should not be taking it any longer than necessary. 4. The pharmacist cannot change a health- care provider's order; therefore, there is no reason for the nurse to talk to the pharmacist.

The client with a seizure disorder is prescribed the anticonvulsant fosphenytoin (Cerebyx). Which interventions should the nurse discuss with the client? Select all that apply. 1. Instruct the client to wear a MedicAlert bracelet and carry identification. 2. Tell the client to not self-medicate with over-the-counter medications. 3. Encourage the client to decrease drinking of any type of alcohol. 4. Discuss the importance of maintaining good oral hygiene. 5. Explain the importance of maintaining adequate nutritional intake.

1, 2, 5 The client should wear a MedicAlert bracelet and carry identification so that a health-care provider and others possibly providing care know that the client has a seizure disorder. The client should not take any over- the-counter medications without first consulting with the HCP or pharmacist because many medications interact with Cerebyx. Alcohol and other central nerve depres- sants can cause an added depressive effect on the body and should be avoided, not just decreased. Gingival hyperplasia (overgrowth of gums) is a side effect of Dilantin, not of Cerebyx. Dilantin may cause anorexia, nausea, and vomiting; therefore, the client should maintain an adequate nutri- tional intake.

The client with a severe acute exacerbation of Crohn's disease is prescribed total parenteral nutrition (TPN). Which interventions should the nurse implement when administering TPN? Select all that apply. 1. Monitor the client's glucose level every 6 hours. 2. Administer the TPN on an intravenous pump. 3. Assess the peripheral intravenous site every 4 hours. 4. Check the TPN according to the five rights prior to administering. 5. Encourage the client to eat all of the food offered at meals.

1, 2,4 TPN is 50% dextrose; therefore, the client's blood glucose level should bechecked every 6 hours; sliding-scale regular insulin coverage is usually ordered. TPN should always be administered using an intravenous pump and not via gravity; fluid volume resulting from an overload of TPN could cause a life- threatening hyperglycemic crisis. TPN must be administered via a subcla- vian line because a peripheral line will collapse as a result of the hyperosmolarity of the TPN and phlebitis may occur. TPN is considered a medication and should be administered as any other medication. The client with severe acute exacerbation of Crohn's is NPO to rest the bowel. When on TPN, the client is usually NPO because the TPN provides all necessary nutrients; therefore, the nurse would not encourage the client to eat food.

Amobarbital (Amytal)

1-5

Phenytonin (Dilantin)

10-20 SE: Visual problems, hirsutism, gingival hyperplasia, dysrhythmias, dysarthria, nystagmus Toxic: Severe skin reaction, peripheral neuropathy, ataxia, drowsiness, blood dyscrasias Treatment of tonic-clonic seizures, prevention of status epilepticus, and treatment of seizures after neurosurgery

Phenobarbital (Luminal)

15-40 SE: Sedation, irritability, diplopia, ataxia Toxic: Skin rash, anemia Long-term treatment of tonic-clonic seizures localized in the cortex; treatment of cortical focal seizures, simple partial seizures, febrile seizures; used as a sedative/hypnotic; emergency control of status epilepticus and acute seizures associated with eclampsia, tetanus, and other conditions

The client diagnosed with inflammatory bowel disease is prescribed mesalamine (Asacol), an aspirin product, suppositories. Which statement indicates the client understands the medication teaching? 1. "I should retain the suppository for at least 15 minutes." 2. "The suppository may stain my underwear or clothing." 3. "I should store my medication in the refrigerator." 4. "I should have a full rectum when applying the suppository."

2 The suppository should be retained for 1-3 hours if possible to get the maximum benefit of the medication. The client should use caution when using the suppository because it may stain clothing, flooring, painted surfaces, vinyl, enamel, marble, granite, and other surfaces. This statement indicates the client understands the teaching. The medication should be stored at room temperature away from moisture and heat. The client should empty the bowel just before inserting the rectal suppository.

The female client diagnosed with epilepsy tells the nurse, "I am very scared to get pregnant since I am taking medication for my epilepsy." Which statement is the nurse's best response? 1. "You are scared because you take medication for your epilepsy." 2. "Many women with epilepsy give birth to normal infants." 3. "You should not get pregnant when you are taking anticonvulsants." 4. "Have you discussed your concerns with your health-care provider?"

2 This is a therapeutic response that is used to encourage the client to ventilate feel- ings, but the nurse should provide factual information to this client. Many anticonvulsant medications have teratogenic properties that increase the risk for fetal malformations, but many women with epilepsy give birth to normal infants. The nurse should provide the client with facts. A female client with epilepsy can give birth to a normal infant. The client should discuss a potential preg- nancy with the significant other, but this is not addressing the client's concerns.

The female client diagnosed with low back pain has been self-medicating with ibuprofen (Motrin), a nonsteroidal anti-inflammatory drug (NSAID), around the clock. The client calls the clinic and tells the nurse that she has been getting dizzy and lightheaded. Which action would be the nurse's best response? 1. Tell the client to get up from a sitting or lying position slowly. 2. Have the client come to the clinic for lab work immediately. 3. Suggest the client take the ibuprofen with food or an antacid. 4. Discuss changing to a different nonsteroidal anti-inflammatory medication.

2 his is information to teach when the client is taking antihypertensive medica- tions, not NSAIDs. A life-threatening complication of NSAID use is the development of gastric ulcers that can hemorrhage; dizziness and lightheadedness could indicate a bleeding problem. The client has been taking the medications "around the clock," indicating use during the night when it would be unusual for the client to consume food along with the medication. NSAID medications should be taken with food or something to coat the stomach lining, but this client is symptomatic and should be seen by an HCP. There is no reason to suggest a change in NSAID; the nurse should be concerned that the client has developed an NSAID- produced ulcer.

Clonazepam (Klonopin)

20-80 Side Effects: Drowsiness, behavior changes, headache, hirsutism, alopecia, palpitations Toxic: Hepatotoxicity, thrombocytopenia, bone marrow failure, ataxia Treatment of absence and myoclonic seizures; administered to patients who do not respond to succinimides; being studied for use in the treatment of panic attacks, restless leg movements during sleep, hyperkinetic dysarthria, acute manic episodes, multifocal tic disorders, and neuralgias and as an adjunct in the treatment of schizophrenia

The nurse is preparing to administer phenytoin (Dilantin) intravenous push. The client has an IV of D5W 0.45 NS at 50 mL/hr. Which action should the nurse implement? 1. Administer the Dilantin undiluted over 5 minutes via the port closest to the client. 2. Dilute the medication with normal saline and administer over 2 minutes. 3. Flush tubing with normal saline (NS), administer diluted Dilantin, and then flush with NS. 4. Insert a saline lock in the other arm and administer the medication undiluted.

3 Dilantin cannot be administered with dextrose because it will cause precipita- tion. Dextrose solutions should be avoided because of drug precipitation. Dilantin should be diluted in a saline solution and the IV tubing should be flushed before and after administration because a dextrose solution will cause drug precipitation. There is no reason for the nurse to cause more pain to the client by starting a saline lock because the IV tubing is already in place and can be flushed before and after the administration of Dilantin.

The client diagnosed with severe congestive heart failure is complaining of indiges- tion. Which antacid medication should the nurse administer? 1. Sodium bicarbonate. 2. Amphogel. 3. Riopan. 4. Mylanta DS.

3 Clients with congestive heart failure are limited in the amount of sodium they should consume. Sodium bicarbonate has sodium as an ingredient. 2. Amphogel is not a low-sodium prepara- tion. This client requires a low-sodium antacid. 3. Riopan is the antacid of choice for clients who need to limit their sodium intake. 4. Mylanta is not a low-sodium preparation. This client requires a low-sodium antacid.

Which data should the nurse assess for the client with a seizure disorder who is taking valproate (Depakote)? 1. Creatinine and BUN. 2. White blood cell count. 3. Liver enzymes. 4. Red blood cell count.

3 Depakote does not cause nephrotoxicity. Depakote does not cause blood dyscrasia. Hepatotoxicity is one of the possible adverse reactions to Depakote; there- fore, the liver enzymes should be monitored. Depakote does not affect the RBC count.

11. The client with a seizure disorder is prescribed the anticonvulsant phenytoin (Dilantin). Which statement indicates the client understands the medication teaching? 1. "If my urine turns a reddish-brown color, I should call my doctor." 2. "I should take my medication on an empty stomach." 3. "I will use a soft-bristled toothbrush to brush my teeth." 4. "I may get a sore throat when taking this medication."

3 Dilantin may cause the client's urine to turn a harmless pinkish-red or reddish- brown; therefore, the client does not need to call the health-care provider. The client should take Dilantin at the same time every day with food or milk to prevent gastric upset. The client should use a soft-bristled toothbrush to prevent gum irritation and bleeding. Gingival hyperplasia (overgrowth of gums) is a side effect of this medication. A sore throat, bruising, or nosebleeds should be reported to the health-care provider because this may indicate a blood dyscrasia.

The intensive care nurse is preparing to administer the H2 receptor blocker raniti- dine (Zantac) IVPB to a client with severe burns. Which statement is the scientific rationale for administering this medication? 1. Zantac will prevent an H. pylori infection. 2. The client has a history of ulcer disease. 3. It is for prophylaxis to prevent Curling's ulcer. 4. There is no rationale; the nurse should question the order.

3 H. pylori is a bacterial infection. Zantac is not an antibiotic and would not prevent an infection. In this situation, Zantac or a proton-pump inhibitor would be administered to all clients, not just those with a history of ulcer disease. Because of the fluid shifts that occur as a result of severe burn injuries, the blood supply to the gastrointestinal tract is diminished while the stress placed on the body increases the gastric acid secretion, leading to gastric ulcers, a condition called Curling's ulcer. Zantac would be administered to decrease the production of gastric acid. The nurse should request an H2 receptor blocker or a proton-pump inhibitor if one is not ordered; the nurse would not ques- tion the order.

The client with inflammatory bowel disease is prescribed the glucocorticoid pred- nisone. Which priority intervention should the nurse implement? 1. Monitor the client's blood glucose level. 2. Discuss the long-term side effects of prednisone. 3. Administer the medication with food. 4. Explain that the prednisone will be tapered when it is to be discontinued.

3 Prednisone may increase the glucose level, but no matter what the glucose level, the nurse must administer the medication; therefore, this is not the priority intervention. Long-term side effects occur, but teaching about them is not priority when adminis- tering the medication. Steroids are notorious for causing gastric irritation that may result in peptic ulcers; therefore, administering the prednisone with food is priority. Tapering the medication is important, but it is not priority when administering the medication.

The client diagnosed with inflammatory bowel disease taking mesalamine (Asacol), an aspirin product, has complaints of nausea, vomiting, and diarrhea. Which action should the clinic nurse take? 1. Instruct the client to quit taking the medication immediately. 2. Tell the client to take Prevacid, a proton-pump inhibitor, with the medication. 3. Advise the client to keep taking the medication, but notify the HCP. 4. Explain that these symptoms are expected and will resolve with time.

3 The client should not quit taking the medication abruptly because that would result in an acute exacerbation of the inflammatory bowel disease. A PPI will not help treat these symptoms. These are side effects of the medica- tion, and the HCP should be notified, but the client should not stop taking the medication. These symptoms will not resolve with time and should be reported to the HCP.

The client diagnosed with peptic ulcer disease is admitted to the medical unit with a hemoglobin level of 6.2 g/dL and a hematocrit level of 18%. Which intervention should the nurse prepare to implement first? 1. Obtain an order for an oral proton-pump inhibitor. 2. Instruct the client to save all stools for observation. 3. Initiate an IV with 0.9% NS with an 18-gauge catheter. 4. Place a bedside commode in the client's room.

3 The client would need an intravenous proton-pump inhibitor at first and then later could be changed to an oral PPI. The client may also need a nasogastric tube or to be NPO. This client has a very low hemoglobin and hematocrit level, indicating active bleeding and the need for a fast route for the delivery of fluids and medications. The nurse should observe the stool for color (black) and consistency (tarry) indi- cating blood, but this is not the first action. This client has very low blood counts; is at risk for shock; and should be assessed for hypotension, tachycardia, and cold clammy skin. The client will need fluid and blood cell replacement. The nurse should start the IV as soon as possible. 4. The client should have a bedside commode for safety, but it is not the first intervention. Prevention of or treating shock is the first intervention.

The nurse is preparing to administer the following anticonvulsant medications. Which medication would the nurse question administering? 1. Carbamazepine (Tegretol) to the client who has a Tegretol serum level of 8 g/mL. 2. Clonazepam (Klonopin) to the client who has a Klonopin serum level of 60 ng/mL. 3. Phenytoin (Dilantin) to the client who has a Dilantin serum level of 26 g/mL. 4. Ethosuximide (Zarontin) to the client who has a Zarontin serum level of 45 g/mL.

3 The therapeutic serum level of Tegretol is 5-12 g/mL. Because the client's level is within that range, the nurse has no reason to question administering the drug. The therapeutic serum level of Klonopin is 20-80 ng/m. Because the client's level is within that range, the nurse has no reason to question administering the drug. The therapeutic serum level of Dilantin is 10-20 g/mL. Because the client's level is above that range, the nurse should question administering this medication. The therapeutic serum level of Zarontin is 40-100 g/mL. Because the client's level is within that range, the nurse has no reason to question administering the drug.

Which laboratory data should the nurse monitor for the client with inflamma- tory bowel disease who is prescribed sulfasalazine (Azulfidine), a sulfonamide antibiotic? 1. The client's liver function tests. 2. The client's serum potassium level. 3. The client's serum creatinine level. 4. The client's International Normalized Ratio (INR).

3 There is no indication that sulfasalazine is hepatotoxic; therefore, liver function tests do not need to be monitored when admin- istering this medication. 2. The serum potassium level is not affected by sulfasalazine; therefore, the nurse does not need to monitor this laboratory data. 3. Sulfasalazine is insoluble in acid urine and can cause crystalluria and hema- turia, resulting in kidney damage. Therefore, the nurse should monitor the serum creatinine level, which is normally 0.5 to 1.5 mg/dL. 4. Sulfasalazine may cause abnormal bleeding and bruising, but the INR is monitored for clients taking the oral anticoagulant warfarin (Coumadin).

Carbamazepine (Tegretol)

3-14 Side Effects: Dizziness, drowsiness, unsteadiness, nausea and vomiting, diplopia, mild leukopenia Toxic: Severe skin rash, blood dyscrasias, hepatitis

The client has been on a therapeutic regimen for an H. pylori infection. Which data suggest the medication is not effective? 1. The client states that the midepigastric pain has been relieved. 2. The client's hemoglobin is 15 g/dL and the hematocrit is 44%. 3. The client has gained 3 pounds in 1 week. 4. The client's pulse is 124 and blood pressure is 92/48.

4 A lack of epigastric pain would indicate the medication is effective. The question asks for which data indicates the medica- tion is not effective. 2. A hemoglobin of 15 g/dL and hematocrit of 44% are within normal limits and would indicate that the client is not bleed- ing as a result of the ulcer. 3. Clients who experience a gastric ulcer lose weight because of the pain associated with eating. A weight gain would indicate less pain and the client being able to consume nutrients. The client has a rapid pulse and low blood pressure, which indicate shock. This could be caused by hemorrhage from the ulcer. This client's treatment has not been effective.

The nurse is administering 0900 medications to a client diagnosed with peptic ulcer disease (PUD). Which medication would the nurse question? 1. Metronidazole (Flagyl), an anti-infective. 2. Bismuth subsalicylate (Pepto Bismol), an antibiotic. 3. Lansoprazole (Prevacid), a proton-pump inhibitor. 4. Sucralfate (Carafate), a mucosal barrier agent.

4 Flagyl is administered in combination with Pepto Bismol, Prevacid, and one other antibiotic to treat PUD; the nurse would not question this medication. 2. Pepto Bismol is administered in combina- tion with Flagyl, Prevacid, and one other antibiotic to treat PUD; the nurse would not question this medication. 3. Prevacid is administered with a combina- tion of antibiotics to treat PUD; the nurse would not question this medication. 4. Sucralfate (Carafate) is a mucosal barrier agent and must be administered on an empty stomach for the medica- tion to coat the stomach lining. The nurse should question the time the medication is scheduled for and arrange for the medication to be administered at 0730.

The client is diagnosed with a Helicobacter pylori infection and peptic ulcer disease (PUD). Which discharge instructions should the nurse teach? 1. Discuss placing the head of the bed on blocks to prevent reflux. 2. Teach to never use nonsteroidal anti-inflammatory drugs again. 3. Encourage the client to limit smoking to half a pack per day. 4. Take the combination of medications for 14 days as directed.

4 The client has peptic ulcer disease (PUD), not gastroesophageal reflux disease (GERD), for which elevating the head of the bed would be recommended. The client's ulcer is caused by a bacterial infection, not NSAID use. The client should limit use of NSAIDs until the ulcer has healed to prevent complicating the healing process, but the client should be able to use NSAID medications once the H. pylori infection has been treated. Smoking decreases prostaglandin produc- tion and results in decreased protection of the mucosal lining. Smoking should be stopped, not decreased. H. pylori is a bacterial infection that is treated with a combination of medica- tions. At least two antibiotics and an antisecretory medication will be ordered. As with all antibiotic prescrip- tions, the client should be taught to take all the medications as ordered. Resistant strains of H. pylori are being documented in clients who have not been compliant with the treatment program.

Which statement indicates to the nurse that the client with Crohn's disease under- stands the medication teaching concerning sulfasalazine (Azulfidine), a sulfonamide antibiotic? 1. "I will take an antacid 30 minutes before taking my medication." 2. "I may get a slight red rash when taking this medication." 3. "I need to keep a strict record of my urinary output." 4. "I should avoid direct sunlight and use sunblock when outside."

4 The client should not take an antacid with this medication because it will decrease the absorption rate of the medication. Any type of rash should be considered a possible allergic reaction and should be reported to the health-care provider immediately. The client should drink several quarts of water a day to prevent the formation of crystals in the urine, but a strict record of urinary output is not required or needed. The client should avoid direct sunlight, use sunblock, and wear protective clothing to decrease the risk of photo- sensitivity reactions to the medication.

The client diagnosed with ulcerative colitis is prescribed mesalamine (Asacol), an aspirin product. Which information should the nurse discuss with the client? 1. Explain to the client that undissolved tablets may be expelled in stool. 2. Discuss the importance of taking the medication on an empty stomach only. 3. Tell the client to avoid drinking any type of carbonated beverages. 4. Instruct the client not to crush, break, or chew the tablets or capsules.

4 The client should notify the health-care provider if undissolved tablets or capsules are found in the stool because this is not expected. This medication can be taken with or without food; food does not affect the effectiveness of the medication. There are no restrictions on foods, bever- ages, or activities when taking this medica- tion unless the health-care provider directs otherwise. The tablets must be swallowed whole because they are specially formulated to release the medication after it has passed through the stomach.

The client is having status epilepticus and is prescribed intravenous diazepam (Valium). The client has an IV of D5W 75 mL/hr in the right arm and a saline lock in the left arm. Which intervention should the nurse implement? 1. Dilute the Valium and administer over 5 minutes via the existing IV. 2. Do not dilute the medication and administer at the port closest to the client. 3. Question the order because Valium cannot be administered with D5W. 4. Inject 3 mL of normal saline in the saline lock and administer Valium undiluted.

4 Valium is oil based and should not be diluted. Valium is oil based and should not be administered in an existing intravenous line if another option is available. Valium should not be administered in an existing intravenous line, but the nurse does not need to question the order because there is an existing saline lock. The nurse should administer the Valium undiluted through the saline lock.

ethosuximide (Zarontin)

40-100 SE: Nausea and vomiting, headache, gastric distress Toxic: Skin rash, blood dyscrasias, hepatitis, systemic lupus erythematosus Drug of choice for treatment of absence seizures

Lorazepam (Ativan)

50-240

Vedolizumab (Entyvio, Takeda)

A monoclonal antibody & integrin receptor antagonist. Indicated in adults with moderately to severely active UC & Crohns with inadequate response to other therapies. 300 mg as IV infusion over 30 minutes Dose is repeated at 2 & 6 weeks, then Q 8 weeks Stop if no therapeutic benefit by week 14. Promotes relief from symptoms of GI inflammation Because affects immune function, increases the risk of infection. Client immunizations should be up to date before starting tx. Contraindicated in patients with active, serious infections until the infections are controlled. If patient develops a severe infection during tx, withholding therapy should be considered. Monitor patients for new onset or worsening of neurologic signs or symptoms, such as progressive paresis of the extremities, visual disturbances, confusion, memory deficit, and personality changes. May elevate transaminase and/or bilirubin concentrations. D/C if jaundice or other evidence of significant liver injury. Adverse reactions: nasopharyngitis, headache, arthralgia, nausea, pyrexia, upper respiratory tract infection, fatigue, cough

gabapentin (Neurontin)

SE: Dizziness, drowsiness, somnolence, fatigue, ataxia, weight gain, nausea Toxic Leukopenia, hepatotoxicity

valproate (Depakote, Depakene)

SE: Nausea and vomiting, weight gain, hair loss, tremor, menstrual irregularities Toxic: Hepatotoxicity, skin rash, blood dyscrasias, nephritis Drug of choice for myoclonic seizures; second-choice drug for treatment of absence seizures; also effective in mania, migraine headaches, and complex partial seizures

Valium

Treatment of severe convulsions, clonic-tonic seizures, status epilepticus; treatment of alcohol withdrawal and tetanus; relieves tension, preoperative anxiety; being studied for use in treatment of panic attacks; this drug is no longer used for long-term management of epilepsy