205 MED-SURG DRUGS EAQS

A client who has been diagnosed with acute lymphocytic leukemia will be receiving doxorubicin infusions as part of a chemotherapy regimen. The nurse monitors the client for signs and symptoms of doxorubicin toxicity. What clinical finding indicates that toxicity has occurred? 1 Alopecia 2 Dyspnea 3 Metallic taste to food 4 Cardiac rhythm abnormalities

Doxorubicin is cardiotoxic, which is manifested by transient ECG abnormalities. Alopecia is an expected side effect of doxorubicin, not a toxic effect. Dyspnea and a metallic taste to food are not effects of doxorubicin.

A client has been given a prescription for furosemide 40 mg every day in conjunction with digoxin. What would prompt the nurse to ask the provider about potassium supplements? 1 Digoxin causes significant potassium depletion. 2 The liver destroys potassium as digoxin is detoxified. 3 Lasix requires adequate serum potassium to promote diuresis. 4 Digoxin toxicity occurs rapidly in the presence of hypokalemia.

Furosemide promotes potassium excretion, and low potassium (hypokalemia) increases cardiac excitability. Digoxin is more likely to cause dysrhythmias when potassium is low. Digoxin does not affect potassium excretion. Furosemide causes potassium excretion. Potassium is excreted by the kidneys, not destroyed by the liver. Furosemide causes diuresis and consequent potassium loss regardless of the serum potassium level.

The client is prescribed potassium iodide solution prior to surgery for a subtotal thyroidectomy. What explanation should the nurse give as to why this medication should be taken? 1 The metabolic rate of the body will increase. 2 It will reduce the risk of hemorrhage during surgery. 3 It will maintain the functioning of the parathyroid glands. 4 The amount of thyroid hormones being secreted will decrease.

2 It will reduce the risk of hemorrhage during surgery Potassium iodide, which aids in decreasing vascularity of the thyroid gland, decreases the risk for hemorrhage. Thyroid hormone antagonists help decrease the body's metabolism. Potassium iodide does not regulate parathyroid function. Thyroid hormone antagonists help decrease the amount of thyroid hormones being secreted.

A nurse is taking the health history of a client who is to have surgery in one week. The nurse identifies that the client is taking ibuprofen for discomfort associated with osteoarthritis and notifies the healthcare provider. Which drug does the nurse expect will most likely be prescribed instead of the ibuprofen? 1 Naproxen 2 Aspirin 3 Ketorolac 4 Acetaminophen

4 Acetaminophen Acetaminophen is a nonopioid analgesic that inhibits prostaglandins, which serve as mediators for pain; it does not affect platelet function. Naproxen, aspirin, and ketorolac are nonselective nonsteroidal antiinflammatory drugs (NSAIDs) that are contraindicated for clients undergoing surgery; nonselective NSAIDs have an inhibitory effect on thromboxane, a strong aggregating agent, and can result in bleeding.

A client with chronic liver disease reports, "My gums have been bleeding spontaneously." The nurse identifies small hemorrhagic lesions on the client's face. The nurse concludes that the client needs which additional supplement? 1 Bile salts 2 Folic acid 3 Vitamin A 4 Vitamin K

Fat-soluble vitamin K is essential for synthesis of prothrombin by the liver; a lack results in hypoprothrombinemia, inadequate coagulation, and hemorrhage. Although cirrhosis may interfere with production of bile, which contains the bilirubin needed for optimum absorption of vitamin K, the best and quickest manner to counteract the bleeding is to provide vitamin K intramuscularly. Folic acid is a coenzyme with vitamins B12 and C in the formation of nucleic acids and heme; thus, a deficiency may lead to anemia, not bleeding. Vitamin A deficiency contributes to the development of polyneuritis and beriberi, not hemorrhage.

What should the nurse include when teaching a client with severe Parkinson's Disease about carbidopa-levodopa? 1 Multivitamins should be taken daily. 2 Alcohol consumption should be moderate. 3 The medication can be taken with meals. 4 A high-protein diet should be followed.

3 The medication can be taken with meals Carbidopa-levodopa is often taken with meals to reduce the nausea and vomiting commonly associated with this drug. Although the best practice is to take carbidopa-levodopa on an empty stomach, this is often not feasible for many clients who suffer from gastrointestinal disturbances related to this medication. Multivitamins are contraindicated as they often contain pyridoxine (vitamin B6), which diminishes the effects of levodopa. Moderate alcohol consumption can also antagonize the drug effect. A high-protein diet is contraindicated because levodopa is an amino acid that may increase blood urea nitrogen (BUN) levels. Additionally, some proteins contain pyridoxine, which diminishes the desired therapeutic effect by increasing peripheral levodopa metabolism and reducing the amount of bioavailable levodopa crossing the blood-brain barrier.

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

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

A nurse administers an intravenous solution of 0.45% sodium chloride. In what category of fluids does this solution belong? 1 Isotonic 2 Isomeric 3 Hypotonic 4 Hypertonic

3- hypotonic Hypotonic solutions are less concentrated (contain less than 0.85 g of sodium chloride in each 100 mL) than body fluids. Isotonic solutions are those that cause no change in the cellular volume or pressure because their concentration is equivalent to that of body fluid. This relates to two compounds that possess the same molecular formula but that differ in their properties or in the position of atoms in the molecules (isomers). Hypertonic solutions contain more than 0.85 g of solute in each 100 mL.

A nurse is caring for a client who is receiving total parenteral nutrition (TPN). The nurse should assess for which complications? Select all that apply. 1 Infection 2 Hyperglycemia 3 ABO incompatibility 4 Electrolyte imbalance 5 Cardiac dysrhythmias

1, 2, 4 1- Infection 2- Hyperglycemia 4- Electrolyte Imbalance The concentration of glucose in the solution is an excellent culture medium that promotes the growth of microorganisms. Hyperglycemia is a common complication with TPN because of the high-glucose formulas used; blood glucose levels need to be monitored carefully during therapy. TPN formulas may need to be adjusted daily based on the client's daily electrolyte levels. ABO incompatibility is not associated with TPN. Cardiac dysrhythmias are not related to TPN.

A client reports frequently taking calcium carbonate. What effect should the nurse advise the client that this can have? 1 Diarrhea 2 Water retention 3 Rebound hyperacidity 4 Bone demineralization

3 Rebound hyperacidity The antacid action of calcium carbonate adds alkalinity, neutralizing gastric pH; this in turn stimulates renewed secretion of acid by the gastric mucosa. This medication causes constipation, not diarrhea. Calcium carbonate does not contain sodium, as do some antacids; thus it does not promote fluid retention. This antacid provides a source of calcium, which helps prevent bone demineralization.

A client who is immunosuppressed is receiving filgrastim. When monitoring effectiveness, the nurse will check for an increase in which blood component? 1 Platelets 2 Erythrocytes 3 Thrombocytes 4 White blood cells

4- wbcs Filgrastim, a granulocyte colony-stimulating factor, increases the production of neutrophils with little effect on the production of other blood components. The production of platelets is not stimulated by filgrastim. The production of erythrocytes is not stimulated by filgrastim. The production of thrombocytes is not stimulated by filgrastim.

A client is admitted to the hospital with pancytopenia as a result of chemotherapy. What should the nurse plan to teach this client in an effort to minimize the risk of complications as a result of pancytopenia? 1 Avoid traumatic injuries and exposure to infection. 2 Perform frequent mouth care with a firm toothbrush. 3 Increase oral fluid intake to a minimum of 3 L daily. 4 Report any unusual muscle cramps or tingling sensations in the extremities.

1 Avoid traumatic injuries and exposure to infection Reduced platelets increase the likelihood of uncontrolled bleeding; reduced lymphocytes increase susceptibility to infection. Aggressive oral hygiene can precipitate bleeding from the gums. Although fluids may be increased to flush out the toxic by-products of chemotherapy, this has no effect on pancytopenia. Muscle cramps or tingling sensations in the extremities are adaptations to hypocalcemia; hypocalcemia is unrelated to pancytopenia.

What is the maximum length of time a nurse should allow an intravenous bag of solution to infuse? 1 6 hours 2 12 hours 3 18 hours 4 24 hours

4---- 24 hours After 24 hours there is increased risk for contamination of the solution and the bag should be changed. It is unnecessary to change the bag any less often, such as 6 hours, 12 hours, or 18 hours

A client is receiving hydrochlorothiazide. What should the nurse monitor to best determine the effectiveness of the client's hydrochlorothiazide therapy? 1 Blood pressure 2 Decreasing edema 3 Serum sodium level 4 Urine specific gravity

1- BP Diuretics promote urinary excretion, which reduces the volume of fluid in the intravascular compartment, thus lowering blood pressure. Edema reflects multiple physiologic processes including venous competence, gravity, and disuse. The serum sodium level remains stable unless the dosage is excessive; an altered sodium level is not a therapeutic response. Although specific gravity decreases with increased urinary output, this does not reflect the desired reduction in intravascular pressure.

A nurse administers leucovorin calcium to a client before the prescribed methotrexate. The client asks the reason for this. What effect of leucovorin calcium should the nurse consider when formulating a response? 1 Supplies levels of folic acid required by blood-forming organs 2 Potentiates metabolite required for destruction of cancer cells 3 Acts synergistically with antineoplastic drugs to destroy cancer cells 4 Increases production of phagocytes to help remove debris from destroyed cancer cells

1- Supplies levels of folic acid required by blood-forming organs Methotrexate is a folic acid antagonist that can depress the bone marrow; this serious toxic effect sometimes is prevented by administration of folic acid. Some healthcare providers advocate its administration after a course of methotrexate therapy to avoid interfering with methotrexate activity. Folic acid is a metabolite and does not destroy cancer cells. Leucovorin calcium does not increase the production of phagocytes.

A client is scheduled to receive conscious sedation during a colonoscopy. The client asks the nurse, "How will they 'knock me out' for this procedure?" Which answer by the nurse correctly describes the route of administration for conscious sedation? 1 "You will receive the anesthesia through a face mask." 2 "You will receive medication through an intravenous (IV) catheter." 3 "We will give you an oral medication about 1 hour before the procedure." 4 "The medicine will be injected into your spine."

2 "You will receive medication through an intravenous (IV) catheter." Conscious sedation is administered by direct IV injection (IV push) to dull or reduce the intensity of pain or awareness of pain during a procedure without loss of defensive reflexes. General anesthesia usually is administered via inhalation of the vapor of a volatile liquid or an anesthetic gas via a mask or endotracheal tube; as a result, the client is unconscious, unaware, and anesthetized. The oral route of drug administration is commonly used for pediatric clients, not adults. An epidural block, a type of regional anesthesia, involves the injection of a local anesthetic into the epidural (extradural) space; it works by binding to nerve roots as they enter and exit the spinal cord. Epidural blocks are not used for moderate sedation.

A client will be discharged with a peripherally inserted central venous catheter (PICC) for administration of peripheral parenteral nutrition (PPN). What would be appropriate for the nurse to include in the client's discharge teaching? 1 Learning how to change the percutaneous catheter 2 Determining which days to self-administer the PPN solution 3 Arranging for professional help to monitor the alternative nutrition 4 Scheduling administration of the PPN solution around mealtimes

3 Arranging for professional help to monitor the alternative nutrition Professional assistance will ensure correct administration, which may limit complications such as intravascular overload and sepsis; eventually, the client may self-administer the PPN with supervision. Learning how to change the percutaneous catheter usually is done by an appropriate health care provider. PPN usually is administered every day. The PPN solution usually is administered as an intermittent infusion while the client is sleeping at night, not at mealtimes; this allows for independent movement during the day.

A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone. What should the nurse monitor the client for? 1 Bruising 2 Tachycardia 3 Hyperkalemia 4 Hypoglycemia

3 Hyperkalemia Spironolactone is a potassium-sparing diuretic that is used to treat clients with ascites; therefore the nurse should monitor the client for signs and symptoms of hyperkalemia Bruising and purpura are associated with cirrhosis, not with the administration of spironolactone Spironolactone does not cause tachycardia. Spironolactone does not cause hypoglycemia.

A nurse is preparing a client for discharge from the emergency department. Which client statement provides evidence that the client understands the instructions for the prescribed high-dose ampicillin? 1 "I should take this medication with meals." 2 "I can stop taking this medication when I feel better." 3 "I will miss eating my yogurt while taking this medication." 4 "I must increase my intake of fluids while taking this medication."

4 "I must increase my intake of fluids while taking this medication." Because penicillin in high doses is nephrotoxic, keeping hydrated helps flush the kidneys as the drug is excreted. It should be taken on an empty stomach for best absorption. Stopping this medication when the client feels better is contraindicated; completing the medication treatment as prescribed prevents the development of resistant strains of bacteria. Dietary restrictions are not imposed while this medication is taken

The laboratory international normalized ratio (INR) results of a client receiving warfarin have been variable. The nurse interviews the client to determine factors contributing to the problem. Which is most important for the nurse to identify? 1 Use of analgesics 2 Serum glucose level 3 Serum potassium levels 4 Adherence to the prescribed drug regimen

4 Adherence to the prescribed drug regimen The dosage of warfarin is adjusted according to INR results; if the client fails to take the drug as prescribed, test results will not be reliable in monitoring the client's response to therapy. Although some medications can affect the absorption or metabolism of warfarin and should be investigated, this is less likely to be a cause of fluctuations in laboratory values. Serum glucose level and serum potassium levels do not affect the absorption of warfarin.

Parents of a child with sickle cell anemia ask about their child taking iron supplements to help treat the anemia. What would be the best response? 1 Taking supplements will not help with this condition. 2 It is advised that iron be taken with orange juice to aid in absorption. 3 An over-the-counter multivitamin with iron should meet the needs of the child. 4 It is advised that liquid iron supplements be given through a straw to prevent staining the teeth.

Taking iron supplements will not help. Sickle cell anemia is not caused by too little iron in the blood; it's caused by not having enough red blood cells. Taking iron supplements could cause harm, because the extra iron builds up in the body and can damage organs. Although iron is better absorbed when taken with orange juice, in the case of sickle cell anemia supplements are not given. Using a straw when giving liquid iron supplements does prevent staining of the teeth; however, giving iron to this child may be detrimental. A multivitamin may be beneficial for this child; however, the addition of iron could build up in the body.

A client is waiting for a kidney transplant. What explanation should the nurse include when teaching the client about the transplant? 1 "Production of urine will be delayed after surgery." 2 "You will require immunosuppressive drugs daily for the rest of your life." 3 "Symptoms of rejection include a decrease in temperature and blood pressure." 4 "You will need to modify your program of work and recreation, including sports."

2 "You will require immunosuppressive drugs daily for the rest of your life." Immunosuppressive agents are administered to reduce the immune system's tendency to reject the transplanted organ. Urine production occurs almost immediately. Fever, not hypothermia, will occur. Hypotension will not occur. An increased blood pressure may occur because of fluid retention. Recreation and exercise are encouraged, although contact sports should be avoided.

A health care provider prescribes psyllium 3.5 g twice a day for constipation. What is most important for the nurse to teach this client? 1 Urine may be discolored. 2 Each dose should be taken with a full glass of water. 3 Use only when necessary because it can cause dependence. 4 Daily use may inhibit the absorption of some fat-soluble vitamins.

2 Because this drug has a strong affinity for fluids, it will swell in the intestine. The large bulk stimulates peristalsis. A full glass of fluid taken at the same time will help minimize the risk of esophageal obstruction or fecal impaction. Senna (Senokot), a stimulant laxative, may discolor urine, not psyllium. Psyllium, a bulk forming laxative, is among the safest laxatives on the market. It is useful with prolonged therapy because it is not systemically absorbed and is not potent in its action. Prolonged use of lubricant or saline/osmotic laxatives can inhibit the absorption of some fat-soluble vitamins.

Alprazolam is prescribed for a client who is anxious. For what therapeutic effect will the nurse monitor the client? 1 Reduced anger 2 Resting quietly 3 Sleeping soundly 4 Reduced blood pressure

2 Resting quietly Alprazolam, an anxiolytic, promotes muscle relaxation, reduces anxiety, and facilitates rest. Possible adverse reactions to alprazolam are anger and hostility. Although drowsiness is a side effect of alprazolam, caused by depression of central nervous system activity, it is not a hypnotic. Transient hypotension is a side effect of alprazolam, but this is not why it is given to an anxious client.

A nurse adds 20 mEq of potassium chloride to the intravenous (IV) solution of a client with diabetic ketoacidosis. What is the primary purpose for administering this drug? 1 Treat hyperpnea. 2 Prevent flaccid paralysis. 3 Replace excessive losses. Incorrect4 Treat cardiac dysrhythmias.

3 Once treatment with insulin for diabetic ketoacidosis is begun, potassium ions reenter the cell, causing hypokalemia; therefore, potassium, along with the replacement fluids, is needed. Potassium will not correct hyperpnea. Flaccid paralysis does not occur in diabetic ketoacidosis. Considering the relationship between insulin and potassium, treatment with KCl is prophylactic, preventing the development of dysrhythmias.

The healthcare provider prescribes enoxaparin to be administered subcutaneously daily to a client who had a total knee replacement. To ensure client safety, which measure would the nurse take when administering this medication? 1 Remove air pocket from prepackaged syringe before administration. 2 Rub the injection site after administration for 30 seconds. 3 Administer medication over 2 minutes. 4 Administer in the abdomen area only.

4 Administer in the abdomen area only The preferred site for enoxaparin administration is the abdomen. According to package directions, the air pocket in the prepackaged syringe should not be removed. Rubbing the injection site also is contraindicated. Subcutaneous injections should not be given over 2 minutes.

A client with small-cell lung cancer is receiving chemotherapy. A complete blood count is prescribed before each round of chemotherapy. Which component of the complete blood count is of greatest concern to the nurse? 1 Platelets 2 Hematocrit 3 Red blood cells (RBCs) 4 White blood cells (WBCs)

4- wbcs Antineoplastic drugs depress bone marrow, which causes leukopenia; the client must be protected from infection, which can be life threatening. RBCs diminish slowly and can be replaced with a transfusion of packed red blood cells. Platelets decrease as rapidly as WBCs, but complications can be limited with infusions of platelets