Final Review

A nurse in an emergency department is caring for a client who is experiencing acute respiratory failure. Which of the following laboratory findings should the nurse expect?

Pao2 58 mmHg

A patient who is taking glipizide (Glucotrol) to treat type 2 diabetes mellitus contacts the health care professional to report feeling shaky, hungry, and fatigued. the health care professional should tell the patient to do which of the following?

Perform a finger stick blood glucose check

A nurse is planning teaching for a client who has been prescribed loperamide to treat diarrhea. Which of the following statements should the nurse plan to include?

"Avoid driving or activities requiring alertness" Loperamide can cause drowsiness and dizziness.

A nurse is teaching a client how to prepare for a colonoscopy. Which of the following instructions should the nurse include in the teaching?

"Drink clear liquids for 24 hr prior to the procedure, and then take nothing by mouth for 6 hr before the procedure."

A nurse is providing discharge teaching to a client who has pulmonary tuberculosis and a new prescription for rifampin. Which of the following instructions should the nurse include?

"Expect your urine and other secretions to be orange while taking this medication."

A nurse is providing teaching to a client who is 2 days postoperative following a heart transplant. Which of the following statements should the nurse include in the teaching?

"You might no longer be able to feel chest pain."

A health care professional is caring for a patient who is about to begin taking pioglitazone (Actos) to treat type 1 diabetes mellitus. The health care professional should explain to the patient the need to monitor which of the following laboratory tests? (Select all that apply)

-ALT -LDL

A patient with lung cancer has an order for fentanly transdermal patch which is to be replaced every 72 hours. The patch delivers 25 mcg/hour. How many mcg of this medication will the patient be receiving over a 24 hour period?

600 mcg

The nurse has administered aspart insulin S/C yo a patient at 8 am. At which of the following times will it be most important to monitor the patient for signs of hypoglycemia?

9:00 am. Look at Lewis textbook pg 1114

A nurse is providing health teaching to a group of clients. Which of the following clients is at risk for developing peripheral arterial disease?

A client who has diabetes mellitus

A nurse receives prescription from the provider for performing nasopharyngeal suctioning on four clients. For which of the following clients should the nurse clarify the provider's prescription?

A client who has epistaxis

A nurse is caring for four clients. Which of the following clients is at greatest risk for pulmonary embolism?

A client who is 48 hr postoperative following a total hip arthroplasty.

A nurse should recognize that misoprostol is contraindicated for a client who has which of the following conditions?

A positive pregnancy test Misoprostol, a prostaglandin E1 analog, is a teratogenic drug. It can cause uterine contractions and induce spontaneous abortion

A nurse is assessing a client who has a history of deep-vein thrombosis and is receiving warfarin. Which of the following findings should indicate to the nurse that the medication is effective?

INR 2.0

A nurse is admitting a client who has acute pancreatitis. Which of the following actions should the nurse take first?

Identify the client's current level of pain.

A nurse is caring for a client who has a new prescription for alosetron to treat irritable bowel syndrome. The nurse should instruct the client to report which of the following adverse effects of the drug?

Abdominal pain it can cause ischemic colitis. The nurse should tell the client to report abdominal pain, bloody diarrhea, or rectal bleeding and to stop taking the drug if these manifestations occur.

A nurse is assessing a client who has pulmonary edema to heart failure. Which of the following findings indicates effective treatment of the client's condition?

Absence of adventitious breath sounds

A patient who is taking metformin (Glucophage) to treat type 2 diabetes mellitus plans to undergo angiography using iodine-containing contrast. The healthcare should recognize that an interaction between metformin and the IV contrast dye can increase the patients risk for which of the following?

Acute Renal Failure

A nurse is caring for a client who has a pulmonary embolism. Which of the following interventions is the nurse's priority?

Administer heparin via continuous IV infusion.

A nurse is developing a plan of care for a client who has active tuberculosis. Which of the following isolation precautions should the nurse include in the plan?

Airborne

A nurse is planning care for a client who has asthma. Which of the following medications should the nurse plan to administer during an acute asthma attack?

Albuterol

A nurse is caring for a client who is taking allopurinol to treat gout and has a new prescription for azathioprine to treat ulcerative colitis. For which of the following reasons should the nurse clarify these prescriptions with the provider?

Allopurinol delays the conversion of azathioprine and can lead to toxicity.

A nurse is assessing a client who had a right hemispheric stroke. Which of the following neurologic deficits should the nurse expect?

Impulsive behavior

Which of the following drugs has protocols that require clients to meet specific risk-management criteria and sign a treatment agreement before the nurse can administer the drug?

Alosetron Clients who take alosetron, a serotonin 5-HT3 receptor antagonist, can develop severe constipation that can lead to impaction, bowel obstruction, perforation, and potentially fatal ischemic colitis.

A nurse is caring for a client who has peptic ulcer disease. The nurse should monitor the client's phosphorus levels when administering which of the following drugs?

Aluminum hydroxide Antacids that contain aluminum, such as aluminum hydroxide, can cause hypophosphatemia because of aluminum's ability to bind with phosphate and decrease its absorption.

A nurse is reviewing the laboratory results of a client who has hepatic cirrhosis. Which of the following laboratory findings should the nurse report to the provider?

Ammonia 180 mcg/dL Normal range of ammonia is 10-80 mcg/dL

A nurse is caring for a client who has a new prescription for ranitidine to treat GERD. The nurse should instruct the client to wait at least 1 hr between taking ranitidine and which of the following over-the-counter drugs?

Antacids Antacids can decrease the absorption of ranitidine, a histamine2 receptor antagonist. The nurse should instruct the client to wait at least 1 hr between taking ranitidine and taking an antacid.

A nurse in an emergency department is caring for a client who is experiencing a pulmonary embolism. Which of the following actions should the nurse take first?

Apply supplemental oxygen.

A nurse should recognizes that sulfasalazine is contraindicated for clients who has which of the following conditions?

Aspirin sensitivity Any sensitivity to salicylates, sulfonamides, or trimethoprim is contraindication for the use of sulfasalazine, a 5- aminosalicylate.

A nurse in an emergency department is caring for a client who had an anterior myocardial infarction. The clients history reveals they are 1 week postoperative following an open cholecystectomy. The nurse should identify that which of the following interventions is contraindicated?

Assisting with thrombolytic therapy.

A nurse is caring for a client who has GERD and a new prescription for metoclopramide. The nurse should plan to monitor for which of the following adverse effects?

Ataxia

A nurse is providing teaching to a client who has a new prescription for loperamide. Which of the following instructions should the nurse include?

Avoid activities that require alertness. Loperamide, an opioid agonist, can cause sedation and dizziness.

When talking to a patient who is about to begin glipizide (Glucotrol) therapy to treat type 2 diabetes mellitus, the health care professional should include which of the following instructions?

Avoid drinking alcohol.

A health care professional is caring for a patient who is about to begin insulin glargine (Lantus) therapy. The health care professional should recognize the need for additional precautions because the patient also takes which of the following types of drugs?

Beta blockers Patients who take insulin and also take beta blockers are at risk for failing to promptly recognize the symptoms of hypoglycemia because they mask symptoms such as tachycardia and tremors. They also increase hypoglycemic effects.

A nurse is caring for a client who is 8 hr postoperative following a coronary artery bypass graft (CABG). Which of the following findings should the nurse report?

Blood pressure 160/80 mm Hg

A nurse is assessing a client who has lung cancer. Which of the following manifestations should the nurse expect?

Blood-tinged sputum

A nurse is caring for a client who has viral meningitis. Which of the following actions should the nurse take?

Check capillary refill at least every 4 hr.

A nurse is caring for a client who is in balance suspension skeletal traction and reports intermittent muscle spasms. Which of the following actions should the nurse take first?

Check the position of the weights and ropes

A nurse is providing discharge teaching for a client following an ileostomy. The nurse should instruct the client to report which of the following findings to the provider?

Dark purple stoma. Indication of bowel ischemia.

A nurse is assessing a client who is 4 hr postoperative following a total laryngectomy. Which of the following findings is the priority for the nurse to report to the provider?

Decreased oxygen saturation ABC's

A nurse is assessing a client immediately following a paracentesis for the treatment of ascites. Which of the following findings indicates the procedure was effective?

Decreased shortness of breath. Increased abdominal fluid can limit the expansion of the diaphragm and prevent the client from taking a deep breath.

A nurse is assessing a client who was administered ondansetron IV 1 hr ago. Which of the following findings should the nurse recognize as an adverse effect of this drug?

Dizziness.

When talking with a patient who is about to begin repaglinide (Prandin) therapy to treat type 2 diabetes mellitus, the health care professional should include which of the following instructions?

Do not drink more than 1 L of grapefruit per day.

A nurse is assessing a client who has dilated cardiomyopathy. Which of the following findings should the nurse expect?

Dyspnea on exertion.

A health care professional is caring for a patient who is about to begin acarbose (Precose) therapy to treat type 2 diabetes mellitus. Which of the following instructions should the health care professional include when talking with the patient about the drug?

Eat more iron-rich foods. Acarbose, an alpha-glucosidase inhibitor, can cause iron deficiency anemia.

A nurse should recognize that diphenoxylate/atropine should be used with caution for a client who has which of the following conditions?

Inflammatory bowel disease Diphenoxylate is an opioid, which can cause the severe complication of toxic megacolon in clients who have inflammatory bowel disease.

A nurse is planning care for a client who is receiving chemotherapy and has a new prescription for ondansetron. Which of the following actions should the nurse plan to take? (Select all that apply.)

Infuse the drug 30 min prior to chemotherapy Infuse the drug slowly over 15 min. Repeat the dose 4 hr after chemotherapy.

A health care professional is caring for a patient who is about to begin pramlintide (Symlin) therapy to treat type 1 diabetes mellitus. Which of the following instructions should the health care professional include when talking with the patient about using this drug?

Inject pramlintide before meals.

A nurse in an emergency department is caring for a client who has sustained a fracture of the femur following a motor-vehicle crash. Which of the following images should the nurse recognize as a comminuted fracture?

Injury causes the bone fragment into several pieces.

A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse expect?

Intention tremors

A nurse is caring for an older adult client who has renal impairment and a new prescription for cimetidine. The nurse should instruct the client to report which of the following manifestations?

Lethargy Cimetidine, a histamine2 receptor antagonist, can cause CNS effects such as lethargy, depression, confusion and seizures especially in older adults.

A nurse is caring for a client who is being treated for heart failure and has a prescription for furosemide. the nurse should plan for which of the following adverse effects of the medication?

Lightheadedness

The nurse is providing care for a patient diagnosed with Cushing Syndrome. Which of the following should be part of the plan of care for this patient?

Limiting the intake of high sodium foods.

A nurse is caring for a client who has a prescription for alosetron. The nurse should recognize that alosetron therapy is effective when the client reports which of the following?

One formed stool per day Alosetron, a serotonin 5-HT3 receptor antagonist, treats diarrhea and pain of severe irritable syndrome. One formed stool per day indicates effective therapy.

A nurse is assessing a client who has appendicitis. Which of the following findings should the nurse expect? (Select all that apply.)

Oral temperature 38.4 C (101.1 F) Nausea and vomiting Right lower quadrant pain

A nurse in an emergency department is assessing a client who reports sudden, severe eye pain with blurry vision. The provider determines that the client has primary angle-closure glaucoma. Which of the following medications should the nurse expect to administer?

Osmotic diuretics via IV bolus such as mannitol, to reduce intraocular pressure and prevent damage to the eye.

A nurse is caring for a client who is recovering from a stroke and has right-sided homonymous hemianopsia. To help the client adapt to the hemianopsia, the nurse should take which of the following actions?

Remind the client to look consciously at both sides of their tray.

A primary care provider should prescribe a lower dose of sitagliptin (Januvia) for a patient who has type 2 diabetes mellitus and who also has which of the following?

Renal impairment

A nurse is caring for a client who is 72 hr postoperative following an above- the-knee amputation and reports phantom limb pain. Which of the following actions should the nurse take?

Request a prescription for gabapentin for the client.

A nurse is providing teaching to a client who has a new prescription for omeprazole to treat a duodenal ulcer. Which of the following instructions should the nurse include?

Swallow the capsules whole. Omeprazole, a proton pump inhibitor, is unstable in stomach acid.

Mast Cell Stabilizers: Cromolyn

THERAPEUTIC USE - Long term treatment of allergy-related asthma - Prophylaxis for exercise-induced bronchospasm - Prophylaxis for seasonal allergy symptoms - Management of allergic rhinitis (intranasally) ADVERSE DRUG REACTIONS - Allergic reaction in clients with known allergic to cromolyn INTERVENTIONS - Administer epinephrine and/or antihistamines to reverse anaphylaxis ADMINISTRATIONS - Use with a nebulizer or metered-dose inhaler - Expect several weeks of use for full effects to become apparent - Administer four times daily on a fixed schedule - Use the inhaler 15 min before exercising to prevent exercise-induced bronchospasm - Do not use to relieve an acute asthma exacerbation CLIENT INSTRUCTIONS - Seek medical care immediately for sudden rash, swelling of the mouth or throat, or wheezing after use. CONTRAINDICATIONS/ PRECAUTIONS - Allergy to cromolyn INTERACTIONS - None known

Ranitidine Hydrochloride (Zantac) Histamine H2 antagonists

THERAPEUTIC USE - Gastric and duodenal ulcers - Heartburn, dyspepsia - Erosive esophagitis - Gastrointestinal reflux disease (GERD) - Aspiration pneumonitis - Hypersecretory disorders such as Zollinger-Ellison syndrome (gastrin), systemic mastocytosis (histamine) ADVERSE DRUG REACTIONS - Impotence, reduced libido with cimetidine (Tagamet), not ranitidine - Confusion, aplastic anemia, agranulocytosis, and arrhythmia - Increased susceptibility to pneumonia INTERVENTIONS - For clients who develop impotence or reduced libido, recommend switching to ranitidine - Monitor older clients for confusion. ADMINISTRATION - Give orally, IM or IV - Give with or without food (given with meals, immediately afterwards, or at bedtime does prolong effect). - Administer IV preparation slowly to avoid bradycardia. - Do not give antacids within 1 hr of administration. - Make sure clients dissolve effervescent tablets in water and do not chew them, swallow them whole, or allow them to dissolve on the tongue. CLIENT INSTRUCTIONS - Take all medication as prescribed - Avoid smoking - Avoid foods or medications that irritate GI tract - Tell clients to report any signs of obvious or occult gastrointestinal bleeding, such as coffee-ground emesis. CONTRAINDICATIONS - Known sensitivity - Some products may contain aspartame so avoid in clients with PKU PRECAUTIONS - Hepatic or renal dysfunction - Acute porphyria - Older adults INTERACTIONS - Ranitidine can decrease absorption of ketoconazole; itraconazole, atazanavir, glipizide; and delavirdine. - Antacids can reduce absorption of histamine H2 receptors bu has little effect on ranitidine. - Cimetidine increases levels of warfarin, also called Coumadin; phenytoin, also called Dilantin; lidocaine, also called Xylocaine; and theophylline, also called Theolair. - Ranitidine can increase procainamide levels and increases the effects of warfarin.

Insulin

THERAPEUTIC USE - Diabetes mellitus (type 1, type 2 and gestational) ADVERSE DRUG REACTIONS - Hypoglycemia - Injection site reactions- lipodystrophy or Lipohypertrophy - Hypersensitivity to inulin - Allergic response INTERVENTIONS - Monitor for signs of hypoglycemia (with abrupt onset: tachycardia, palpitations, diaphoresis, shakiness; with gradual onset: headache, tremors, weakness) - Check blood glucose level to confirm, then give glass of orange juice or 2-3 tsp of sugar, honey, or corn syrup dissolved in water or an appropriate number of glucose tablets as needed for hypoglycemia - For unconscious clients, administer glucagon parenterally - Monitor skin for subcutaneous fat accumulation - Monitor potassium levels - Monitor ECG - Monitor for indications of hypokalemia ADMINISTRATION Injection considerations -- Give subcutaneously (using an insulin syringe) or IV (Humulin R) -- Select an appropriate needle length for injecting insulin into subcutaneous tissue versus intradermal (too short) or intramuscular (too long) -- For insulin suspensions (cloudy insulins), gently rotate the vial between your palms to disperse the particles. -- When mixing short acting insulin with longer-acting insulin, draw the short acting insulin into the syringe first, then the longer acting insulin -- Do not mix insulin glargine or insulin determir with any other insulin -- Do not administer short-acting insulins if they appear cloudy or discolored -- Instruct clients to self administer insulin subcutaneous in one general area for consistent absorption rates Storage Of Insulin -- Keep vials in use at room temperature for 1 month -- Refrigerate unopened vials of a single type of insulin until their expiration date -- Keep insulins premixed in syringes for 1 to 2 weeks under refrigeration and vertical, with the needles pointing upward. Prior to administration, resuspend the insulin via gentle motion. - Expect dosage adjustments in response to caloric intake, infection, exercise, stress, growth spurts and pregnancy. - Make sure adequate glucose is available at onset and peak insulin times. CLIENT INSTRUCTIONS - Wear a medical alert bracelet - Watch for symptom of hypoglycemia. test blood glucose to confirm, then consume a snack of carbohydrates, and retest in 15 to 20 minutes and repeat treatment if still low - Carry a carbohydrate snack at all times - Report recurring episodes of hypoglycemia to provider - Rotate injection sites systemically and space them 1 inch apart - Do not inject cold insulin - Report weakness, nausea, palpitations or paresthesia CONTRAINDICATIONS - Hypersensitivity to insulin PRECAUTIONS - Older adults - Fever - Stress -Altered nutrition INTERACTIONS - Sulfonylureas, meglitidines, beta blockers, salicylates, and alcohol increase hypoglycemic effects - Thiazide and loop diuretics, sympathomimetics, thyroid hormones and glucocorticoids increase blood glucose levels, thus counteracting hypoglycemic effects - Beta blockers mask manifestations of hypoglycemia (tachycardia, tremors)

To determine the effectiveness of desmopressin (DDAVP), a health care professional should monitor a patient's

Urine output.

A nurse is caring for a client who has asthma and is receiving albuterol. For which of the following adverse effects should the nurse monitor the client?

Tachycardia

A nurse is planning to teach a client who has epilepsy and a new prescription for phenytoin. Which of the following instructions should the nurse plan to include?

Take medications at a consistent time each day to maintain therapeutic blood levels.

A nurse is providing teaching to a client who has a new prescription for dimenhydrinate to prevent motion sickness. Which of the following instructions should the nurse include? (Select all that apply.)

Take the drug 30 to 60 min before activities that trigger nausea. Avoid activities that require alertness. Increase fluid and fiber intake.

A nurse is teaching a client who has a new prescription for sulfasalazine. Which of the following statements should the nurse make?

Use sunscreen and protective clothing while taking sulfasalazine to prevent sunburn. Photosensitivity is a possible adverse effect of sulfasalazine that makes skin sensitive to light.

A nurse is providing teaching to a client who is about to start taking psyllium to treat constipation. Which of the following instructions should the nurse include? (Select all that apply.)

Take the drug with at least 8 oz (237 mL) of fluid. Increase fluid and fiber intake.

A nurse is assessing a client who has bacterial pneumonia. Which of the following manifestations should the nurse expect?

Temperature 38.8 C (101.8 F)

A nurse is assessing a client who has a duodenal ulcer. Which of the following findings should the nurse expect?

The client reports that pain occurs during the night. Pain associated with a duodenal ulcer occurs when the stomach is empty, which is typically 1.5 to 3 hr after meals and during the night.

A nurse is caring for a male client who asks the nurse about taking alosetron for irritable bowel syndrome with diarrhea (IBS-D) lasting 3 months. Which of the following information should the nurse provide the client about alosetron?

The drug is prescribed to female clients who have IBD-S lasting more than 6 months.

A nurse is teaching who is postoperative following a right hip arthroplasty. Which of the following images indicates the position the nurse should teach the client to take when sitting in a chair?

The nurse should instruct the client to sit with the hips at a 90 angle with the knees slightly lower than the hips to avoid hip dislocation.

A health care professional is caring for a patient who is taking pioglitazone (Actos) to treat type 2 diabetes mellitus. The health care professional should monitor for which of the following findings that indicates an adverse effect?

Weight gain

A nurse is providing discharge teaching to a client who has heart failure. The nurse should instruct the client to report which of the following findings immediately to the provider?

Weight gain of 0.9 kg (2 lb) in 24 hours. When using the urgent vs nonurgent approach to client care, the nurse should determine that the priority findings is weight gain of 0.5 to 0.9 kg (1.1 to 2 lb) in 1 day. This weight gain is an indication of fluid retention resulting from worsening heart failure. The client should report this finding immediately.

A nurse is providing discharge teaching for a client who has a new colostomy and is concerned about flatus and odor. Which of the following foods should the nurse recommend to the client?

Yogurt The nurse should recommend yogurt. crackers, and toast which can prevent flatus and stool odor.

Where is the point of maximal impulse located?

it is located at the left intercostal space in the midclavicular line.

A nurse is caring for a client who is postoperative and has a respiratory rate of 9/min secondary to general anesthesia effects and incisional pain. Which of the following ABG values indicates the client is experiencing respiratory acidosis?

pH 7.30 PO2 80 mm Hg PaCO2 55 mm Hg HCO3 22 mEg/L

A nurse is caring for a client who is taking lubiprostone. The nurse should tell the client that lubiprostone can cause which of the following adverse drug reactions?

Nausea Lubiprostone, a chloride channel activator, can cause nausea.

A nurse is caring for a client following insertion of a permanent pacemaker. Which of the following client statements indicates a potential complication of the insertion procedure?

"I cant get rid of these hiccups."

A nurse is reviewing postoperative instructions with a client following cataract surgery. Which of the following client statements indicates an understanding of the instructions?

"I should call my doctor if my vision gets worse."

A nurse is providing discharge teaching for a client who has mild diverticulitis. Which of the following statements by the client indicates an understanding of the teaching?

"I should eat foods that are low in fiber." The nurse should instruct a client who has diverticulitis to follow a low-fiber diet When the inflammation subsides, the client should consume foods that are high in fiber.

A nurse is providing discharge teaching to a client who has a temporary tracheostomy. Which of the following statements by the client indicates an understanding of the teaching?

"I should remove the old twill ties after the new ties are in place."

A nurse is providing discharge teaching for a client who has peptic ulcer disease and a new prescription for famotidine. Which of the following statements by the client indicates an understanding of the teaching?

"I should take this medication at bedtime."

A nurse is caring for a client who is scheduled for a coronary artery bypass graft (CABG) in 2 hr. Which of the following client statements indicates a need for further clarification by the nurse?

"I took my warfarin last night according to my usual schedule."

A health care professional administers pramlintide (Symlin) at 0800 to a patient who has type 1 diabetes mellitus. At which of the following times should the patient expect the drug to exert its peaks action?

0820 Pramlintide peaks 20 min after administration.

A nurse is providing dietary teaching for a client who has chronic pancreatitis. Which of the following food selections by the client indicates an understanding of the teaching?

1 cup (0.24 L) sliced banana. Foods that are high in fat can cause diarrhea for clients who have pancreatitis.

A nurse is caring for a client who is in acute respiratory failure and is receiving mechanical ventilation. Which of the following assessments is the best method for the nurse to use to determine the effectiveness of the current treatment regimen?

Arterial blood gases

A nurse is caring for a client who is receiving mechanical ventilation when the low-pressure alarm sounds. Which of the following situations should the nurse recognize as a possible cause of the alarm?

Artificial airway cuff leak.

A nurse is assessing a client who has cirrhosis. Which of the following findings is the priority for the nurse to report to the provider?

Bloody stools the greatest risk to the client who has cirrhosis of the liver is hemorrhagic shock due to bleeding in the esophageal varices.

A nurse is assessing a client who has peritonitis. Which of the following findings should the nurse expect?

Board-like abdomen a board-like abdomen, accompanied by extreme pain and tenderness is an expected finding for a client who has peritonitis.

A nurse is reviewing the laboratory results of several male clients who have peripheral arterial disease. The nurse should plan to provide dietary teaching for the client who has which of the following laboratory values?

Cholesterol 190 mg/dL HDL 25 mg/dL LDl 160 mg/dL

A nurse is caring for a client who has basilar skull fracture following a fall from a ladder. Which of the following assessment findings should the nurse report to the provider?

Clear drainage from nose Clear drainage from the nose indicates that cerebrospinal fluid is leaking from the skull fracture.

A nurse is performing pain assessment for a client who is postoperative. Which of the following findings should the nurse use to determine the severity of the client' pain?

Client's report of pain on a pain scale.

A nurse is providing dietary teaching for a client who is postoperative following a gastrectomy. Which of the following foods should the nurse encourage the client to include in their diet to reduce the risk for dumping syndrome?

Eggs

A nurse is assessing a client who has emphysema. Which of the following findings should the nurse report to the provider?

Elevated temperature

A nurse is admitting a client who has a leg ulcer and a history of diabetes mellitus. Which of the following focused assessments should the nurse use to help differentiate between an arterial ulcer and a venous stasis ulcer?

Inquire about the presence of absence of claudication. Clients who have arterial ulcers experience claudication. Those with venous stasis ulcer do not.

A nurse is assessing a client who has acute respiratory distress syndrome (ARDS). Which of the following findings should the nurse report to the provider?

Intercostal retraction

A nurse is assessing a client who has acute hepatitis B. Which of the following findings should the nurse expect.

Joint pain

A nurse is reviewing the medical record of a client who has a new prescription for ranitidine. The nurse should recognize that which of the following drugs interacts with ranitidine.

Ketoconazole Ranitidine reduces the absorption of ketoconazole.

A patient who is taking metformin (Glucophage) to treat type 2 diabetes mellitus contacts the health care professional to report muscle pain. The health care professional should suspect which of the following adverse reactions?

Lactic acidosis Metformin can cause lactic acidosis, which is a life threatening complication, manifesting as muscle aches, sleepiness, malaise and hyperventilation. The patient should stop taking the drug and seek medical care immediately.

A health care professional is talking to a patient about self-injecting Regular insulin (Humulin). The healthcare professional should tell the patient to rotate injection sites to prevent which of the following?

Lipohypertrophy also called lipodystrophy.

A nurse is teaching a client who recently had a myocardial infarction and has a new prescription for docusate sodium. The nurse should inform the client that docusate sodium has which of the following therapeutic effects?

Prevents straining Docusate sodium, a stool softener, prevents straining during defecation and prevents the elevation in blood pressure that can result from straining. It also helps relieve constipation and reduces the painful elimination of hard stools.

A nurse is preparing a client for coronary angiography. Which of the following findings should the nurse report to the provider prior to the procedure?

Previous allergic reaction to shellfish.

A nurse in a providers office is assessing a client who has COPD. Which of the following findings is the priority for the nurse to report to the provider?

Productive cough with green sputum

Which of the following would place the patient at risk for orthostatic hypotension?

Prolonged Bed Rest

A nurse is creating a plan of care for a client who has COPD. Which of the following interventions should the nurse include?

Provide a diet that is high in calories and protein

A nurse is assessing a client who has a head injury following a motor-vehicle crash. The nurse should identify that which of the following findings indicates increasing intracranial pressure?

Restlessness Behavioral changes, such as restlessness and irritability, are early manifestations of increased intracranial pressure.

The nurse notices the following complex on the patient EKG. This would be consistent with which of the following interpretations?

ST Elevated Myocardial Infarction

A nurse is caring for a client who is taking phenytoin for a seizure disorder and has a new prescription for sucralfate to treat a duodenal ulcer. The nurse should instruct the client to take the drugs at least 2 hr apart for which of the following reasons?

Sucralfate interferes with the absorption of phenytoin.

A health care professional should question the use of levothyroxine (Synthroid) for a patient who has

a myocardial infarction levothyroxine can cause tachycardia, palpitations and hypertension.

The nurse is caring for a patient with Polycythemia Vera the nurse recognizes that this patient is at risk for:

Thrombus Formation

A nurse in an emergency department is caring for a client who suddenly lost consciousness and fell while at home. The provider determines that the client had an embolic shock. Which of the following medications should the nurse expect to administer?

Tissue plasminogen activator

A nurse working in an emergency department is caring for a client following an acute chest trauma. Which of the following findings should indicate to the nurse that the client is possibly experiencing a tension pneumothorax?

Tracheal deviation to the unaffected side. The nurse should recognize that deviation to the unaffected side is a possible indicator that the client is experiencing a tension pneumothorax. A tension pneumothorax results from free air filling the chest cavity, causing the lungs to collapse and forcing the trachea to deviate to the unaffected side.

A nurse is providing discharge teaching for a client who has GERD. Which of the following statements by the client indicates an understanding of the teaching.

"I will decrease the amount of carbonated beverages i drink." The nurse should instruct the client to limit or eliminate fatty foods, coffee, tea, carbonated beverages, and chocolate from the diet because they irritate the lining of the stomach.

A nurse is providing dietary teaching for a client who has a diagnosis of celiac disease. Which of the following statements by the client indicates an understanding of the teaching?

"I will eat beans to ensure i get enough fiber in my diet." Clients who have celiac disease must maintain a gluten free diet, which eliminates fiber-rich whole wheat products.

A charge nurse is reviewing the care of a client who has a chest tube connected to a water seal drainage system in place following thoracic surgery with a newly licensed nurse. Which of he following statements by the newly licensed nurse indicates an understanding of when to notify the provider?

"I will notify the provider if there is continuous bubbling in the water seal chamber."

A nurse is providing teaching to a client who has chronic asthma and a new prescription for montelukast. Which of the following clients statements indicates an understanding of the teaching?

"I will take this medication every night even if i don't have symptoms." Montelukast is used for the prophylactic treatment of asthma and is taken on a daily basis in the evening

A charge nurse is providing an in-service to a group of staff nurses about endotracheal suctioning. Which of the following statements by a staff nurse indicates an understanding of the teaching?

"I will use a rotating motion when removing the suction catheter."

A nurse is teaching a client who has osteoporosis and has a new prescription for alendronate. Which of the following information should the nurse include in the teaching?

"Remain upright for 30 minutes after taking this medication." To prevent esophagitis or esophageal ulcers

A nurse is caring for a client who has colorectal cancer and is receiving chemotherapy. The client asks the nurse why blood is being drawn for a carcinoembryonic antigen (CEA) level. Which of the following responses should the nurse make?

"The CEA determines the efficacy of your chemotherapy." The clients CEA levels will decrease if the chemotherapy s effective.

A nurse is teaching a client and her family about the diagnosis and treatment of Alzheimer's disease. Which of the following statements should the nurse identify as an indication that the family understands the teachings?

"The medications that treat Alzheimer's disease can help delay cognitive changes."

When talking with a patient who is about to begin exenatide (Byetta) therapy to treat type 2 diabetes mellitus, the health care professional should include which of the following instruction? (Select all that apply)

-Inject the drug subcutaneously -Expect the peak effect in 2 hr. -Use the drug as a supplement to an oral hypoglycemic.

A health care professional is caring for a patient who is about to begin taking propylthiouracil (PTU) to treat hyperthyroidism. The health care professional should tell the patient to report which of the following adverse effects?

-Sore throat -Muscle pain -Bradycardia -Rash

A health care professional is caring for a patient who is about to begin taking somatropin (Genotropin). the health care professional should explain the need to monitor which pf the following laboratory tests? (Select all that apply).

-Urine calcium -Blood glucose

A nurse is caring for a client who has a history of angina and is scheduled for exercise electrocardiography at 1100. Which of the following statements by the client requires the nurse to contact the provider for possible rescheduling?

"I smoked a cigarette this morning to calm my nerves about having this procedure."

When the nurse is getting a history from a patient admitted for jaundice, which statement would indicate the need for patient teaching?

"I used acetaminophen every 4 hours for my joint pain last week."

A nurse is providing discharge teaching for a client who has chronic Hepatitis C. Which of the following statements by the client indicates an understanding of the teaching?

"I will avoid medications that contain acetaminophen." A client who has hepatitis C should avoid medications that contain acetaminophen, which can cause additional liver damage.

A nurse is developing a teaching plan for a client who has Meniere's disease. Which of the following instructions should the nurse include?

"Move your head slowly to decrease vertigo"

A nurse is assessing a client who has a new diagnosis of osteoarthritis. Which of the following findings should the nurse expect? (Select all that apply.)

-Crepitus with joint movement -Decreased range of motion of the affected joint -Joint pain that resolves with rest

A nurse is planning a presentation for a group of clients who have hypertension. Which of the following modifications should the nurse include? (Select all that apply)

-Limit alcohol intake -Regular exercise program -Tobacco cessation

A nurse in an emergency department is assessing a client who has bradydysrhythmia. Which of the following findings should the nurse monitor for?

Confusion

A nurse is assessing a client who is quadriplegic following a cervical fracture level C5. The client reports a throbbing headache and nausea. The nurse notes facial flushing and a blood pressure of 220/110 mm Hg. Which of the following actions should the nurse take first?

Elevate the head of the client's bed.

The nurse is performing an abdominal assessment, which of the following findings would be MOST important to report to the physician?

Liver is palpable 5 inches (12.5cm) below the costal margin.

The nurse is assessing a patient who has a right proximal Humerus fracture which has had a splint applied. The patient is complaining of pain which is "9" on a scale of 0-10, where 0 indicates no pain and 10 indicates severe pain. The nurses notes that the fingers are cyanotic and cold. The nurse recognized the immediate action needed is?

Loosen the splint.

A nurse is reviewing the prescriptions for a client who has Campylobacter enteritis. Which of the following prescriptions should the nurse clarify with the provider?

Magnesium hydroxide Nausea, vomiting and diarrhea are manifestations of enteritis. The nurse should clarify a prescriptions for magnesium hydroxide, also known as milk of magnesia, with the provider. This medication increases gastrointestinal motility, which can increase the clients risk for an electrolyte imbalance and contribute to dehydration.

A nurse is planning care for a client who has a closed traumatic brain injury from a fall and is receiving mechanical ventilation. Which of the following interventions is the nurse's priority?

Maintain a PaCO of approximately 35 mm Hg.

A nurse is developing a plan of care for a client who has cirrhosis and ascites. Which of the following interventions should the nurse include in the plan?

Measure the client's abdominal girth daily. The nurse should measure the client's abdominal girth and weigh the client daily to monitor the amount of fluid accumulated in the abdomen and the effectiveness of treatment measures.

A nurse is caring for a client who is in respiratory distress. Which of the following low-flow delivery devices should the nurse use to provide the client with the highest level of oxygen?

Nonrebreather mask

A nurse is teaching a client who has a new prescription for ACE inhibitor to treat hypertension. The nurse should instruct the client to notify their provider if they experience which of the following adverse effects of this medication?

Persistent cough

A nurse is caring for a client who is 1 hr postoperative following a thoracentesis. Which of the following is the priority assessment finding?

Persistent cough This can indicate a tension pneumothorax, which is a medical emergency.

A nurse is providing discharge teaching to a client who has a prescription for transdermal nitroglycerin patches. Which of the following instructions should the nurse include in the teaching?

Place the patch on an area of skin away from skin folds and joints.

Sucralfate (Carafate) Mucosal Protectants

THERAPEUTIC USE - Acute duodenal ulcers ADVERSE DRUG REACTIONS - Constipation INTERVENTIONS - Monitor bowel function - Administer stool softeners as needed. ADMINISTRATION - Administer orally on an empty stomach - Give four times a day, 1 hr before the usual three mealtimes and again at bedtime. - Do not give antacids within 30 min of administration. - Do not give within 2 hr of administering fluoroquinolone antibiotics, warfarin (Coumadin), phenytoin (Dilantin), theophylline (Theolair), digoxin (Lanoxin), tetracycline, or diazepam (Vallium). CLIENT INSTRUCTIONS - Increase fluid and fiber intake - Increase activity and exercise - Drink plenty of clear fluids - Tell clients to report any signs of obvious or occult gastrointestinal bleeding, such as coffee-ground emesis. CONTRAINDICATIONS - Hypersensitivity to the drug PRECAUTIONS - Chronic renal failure - Diabetes - Difficulty swallowing INTERACTIONS - Absorption of fluoroquinolone antibiotics, warfarin (Coumadin), phenytoin (Dilantin), theophylline (Theolair), digoxin (Lanoxin), tetracycline, and diazepam

Glucocorticoids: Inhalation- beclomethasone dipropionate (QVAR), fluticasone (Flovent); Oral- prednisone; Nasal- fluticasone (Flovent

THERAPEUTIC USE - Long term management of chronic asthma - Short term management of post- exacerbation symptoms (oral) ADVERSE DRUG REACTIONS - Inhaled: Oral candidiasis - Oral: Suppression of adrenal function - Bone demineralization, muscle wasting - Hyperglycemia - Peptic ulcer disease - Infection - Fluid and electrolyte imbalances -Nasal: Dry mucous membranes, epistaxis, sore throat - Headache INTERVENTIONS - Provide/prescribe a spacer - Initiate antifungal therapy as needed - Observe for suppression of adrenal function - Monitor plasma drug levels - Recommend alternate-day dosing - Monitor for signs of bone demineralization, muscle wasting - Recommend the lowest possible effect dose and alternate-day dosing - Monitor blood glucose levels, especially for clients who have diabetes mellitus - Recommend adjust of dosages of insulin/hypoglycemic drugs accordingly -Observe for gastrointestinal bleeding (bloody vomitus; black, tarry stools) - Implement gastric protective measures - Give drug with food or meals - Recommend analgesic substitute of NSAID is prescribed - Observe for signs of infections that may not include fever or inflammation (sore throat, fatigue, tachycardia, and discharge from a wound) - Recommend initiation of appropriate antimicrobial therapy - Monitor for weight gain or edema (hypernatremia) - Monitor for generalized weakness (hypokalemia) - Recommend initiation of appropriate fluid and electrolyte replacement therapy - Provide client with water and hard candy or throat lozenges to suck on - Provide humidified air for epistaxis and sore throat - Administer non-NSAID analgesic such as acetaminophen ADMINISTRATION Inhaled - Use on a regular schedule rater than PRN -- do not use these drugs for acute attacks -- when using concurrently with a beta 2 adrenergic agonist inhaler, use the beta2 agonist first to dilate the airway before using the glucocorticoid Oral - Use oral therapy twice daily for 5 to 10 days -- for long therapy use (10 days or more), take once daily using alternating-day dosing -- taper the dose slowly when symptoms are controlled to establish the lowest possible oral dose -- take supplemental doses as needed in times of stress (illness, surgery) Nasal - Use a nasal metered dose spray device -- use the full dose initially and taper to the lowest effective dose. Expect the full therapeutic effect to take 2 to 3 weeks - use a nasal decongestant first if the nares are completely blocked CLIENT INSTRUCTIONS - Use a spacer (on most glucocorticoids metered-dose inhalers) to deposit less drug in the oropharynx - Rinse the mouth and/or gargle after using the glucocorticoid inhaler to prevent candidiasis - Explain the schedule of alternate-day therapy - Taper the dose before discounting it. NEVER stop abruptly - Take the drug on alternate days - Perform weight bearing exercises daily - Consume adequate calcium and Vitamin D - Avoid taking NSAID's - Take the drug with food or meals - Use a humidifier during sleep - Increase fluid intake - Suck on hard candy or lozenges - Take over the counter, non-NSAID analgesics as needed - Report any of the following conditions immediately --polyphagia, polydypsia, polyuria -- indegestion or bloody vomitus as well as black tarry stools -- signs of infection, such as a sore throat, that may not be accompanied by fever or inflammation -- painful mucous membranes with white patches -- weight gain or edema -- weakness CONTRAINDICATIONS - Recent live virus immunization - Systemic fungal infection - Oral candidiasis PRECAUTIONS - Peptic ulcer disease - Diabetes mellitus - Hypertension - Renal dynsfunction - Use of NSAIDs INTERACTIONS - Potassium-depleting diuretics such as furosemide (Lasix) increase risk of hypokalemia - NSAIDs increase risk of gastrointestinal bleeding - Effects of insulin and oral hypoglycemics are decreased

Metoclopramide (Reglan) Prokinetic

THERAPEUTIC USE - Nausea and vomiting from chemotherapy, opioids, radiation therapy, toxins - Gastroesophageal reflux disease (GERD) - Diabetic gastroparesis ADVERSE DRUG REACTIONS - Sedation - Restlessness - Diarrhea - Extrapyramidal symptoms, especially tardive dyskinesia (long-term, high doses, irreversible) - Neuroleptic malignant syndrome INTERVENTIONS - Monitor clients when ambulating - Monitor for severe diarrhea and dehydration - Recommend the lowest possible dose for the shortest duration of time - Monitor for restlessness, anxiety, spasms of the face and neck, lip smacking, writhing motions, and involuntary movements. - Discontinue the drug for extrapyramidal symptoms - Monitor for muscle rigidity, hyperthermia, tachycardia, diaphoresis and altered consciousness.

A nurse is assisting a provider who is performing a thoracentesis at the bedside of a client. Which of the following actions should the nurse take? (Select all that apply)

-Wear goggles ad a mask during the procedure -Cleanse the procedure area with an antiseptic solution -Apply pressure to the site after the procedure is correct

When talking with a patient about taking fludrocortisone to treat adrenocortical insufficiency, the health care professional should tell the patient to do which of the following to reduce the risk of adverse reactions? (Select all that apply)

-Weigh yourself daily -Report weakness or palpitations -Have your blood pressure checked regularly

A patient is admitted to the emergency department following a motorcycle accident. He has dyspnea, tachycardia and tachypnea, restlessness and absence of breath sounds on the right side of the chest. Lungs are unequal in expansion and the trachea is deviated to the left. The nurse anticipates the immediate need for which of the following?

Closed Chest Tube Drainage

A nurse is caring for a client who has a chest tube following a lobectomy. Which of the following items should the nurse keep easily accessible for the client?

Container of sterile water

A nurse is reviewing the laboratory results of a client who has acute pancreatitis. Which of the following should the nurse expect?

Increased amylase Serum amylase levels are increased in a client who has acute pancreatitis due to pancreatic cell injury.

A nurse is caring for a client who had an onset of chest pain 24 hr ago. The nurse should identify that an increase in which of the following values is diagnostic of a myocardial infarction (MI)?

Creatine kinase MB

A nurse in an emergency department is caring for a client who has a blood pressure of 254/139 mm Hg. the nurse recognizes that the client is in a hypertensive crisis. Which of the following actions should the nurse take first?

Elevate the head of the client's bed. the greatest risk to this client is organ injury due to severe hypertension. Therefore, the first action the nurse should take is to elevate the head of the client's bed to reduce blood pressure and promote oxygenation.

A nurse is planning care for a client following a lumbar puncture. Which of the following actions should the nurse plan to take?

Ensure that the client lies flat for up to 12 hr.

A nurse is caring for a client who has history of status epilepticus and requires seizure precautions. Which of the following actions should the nurse take?

Establish IV access

A health care professional is caring for a patient who is about to begin taking radioactive iodine-131 (lodotope) to treat Graves' disease. Which of the following instructions should the health care professional include when talking with the patient about the drug?

Expect full effects in 2 to 3 months.

A health care professional is caring for a patient who is about to begin levothyroxine (Synthroid) therapy to treat hypothyroidism. Which of the following instructions should the health care professional include when talking with the patient about taking the drug.

Expect life-long therapy with the drug.

A nurse is providing teaching for a client who has cirrhosis and a new prescription for lactulose. The nurse should include which of the following instructions in the teaching?

Expect to have two to three soft stools per day.

A nurse is providing discharge teaching for a client who has a new prescription for medications to treat peptic ulcer disease. The nurse should inform the client that which of the following medications inhibits gastric acid secretion?

Famotidine

A nurse is assessing a client who has Crohn's disease. Which of the following findings should the nurse expect?

Fatty Diarrheal stools. Steatorrhea, or fatty stool, is an expected finding in a client who has Crohn's disease.

A nurse is caring for a client who has retinal detachment. Which of the following findings should the nurse expect?

Flashes of bright light

Which of the following drugs should a health care professional have available for a patient who is experiencing an insulin overdose?

Glucagon (GlucaGen)

A nurse is teaching a client who has a new prescription for methotrexate. The nurse should instruct the client to monitor for manifestation of which of the following conditions?

Gout An adverse effect of methotrexate is hyperuricemia, which causes gout.

A nurse is reviewing the laboratory values of a client who has colorectal cancer. Which of the following findings should the nurse expect?

Hemoglobin 9.1 g/dL Decreased hemoglobin is an expected finding in a client who has colorectal cancer due to occult intestinal bleeding.

A nurse is assessing a client who is postoperative following a gastrectomy. The nurse should identify which of the following findings as an indication of abdominal distention?

Hiccups Following surgery, hiccups can be caused by irritation of the phrenic nerve due to abdominal distention.

A nurse is caring for a newly admitted client who has emphysema. The nurse should place the client in which of the following positions to promote effective breathing.

High Fowler's position with the arms supported on the over bed table.

When considering replacement therapy options for a patient who has chronic adrenocortical insufficiency, the primary care provider should choose which of the following drugs?

Hydrocortisone (Cortef)

A nurse is assessing a client who has upper gastrointestinal bleeding. Which of the following findings should the nurse expect?

Hypotension A client who has an upper gastrointestinal bleeding is at risk for hemorrhagic shock. Hypotension is a manifestation of hemorrhagic shock.

A patient who is taking propylthiouracil (PTU) contacts the health care professional to report weight gain, drowsiness and depression. The health care professional should suspect which of the following adverse reactions to the propylthiouracil?

Hypothyroidism

A nurse is preparing a client for discharge following a bronchoscopy with the use of moderate sedation. The nurse should identify that which of the following assessments is the priority?

Presence of gag reflex.

A nurse is caring for a client who was admitted for treatment of left-sided heart failure and is receiving intravenous loop diuretics and digitalis therapy. The client is experiencing weakness and an irregular heart rate. Which of the following actions should the nurse take first?

Review serum electrolyte values. Weakness and irregular heart rate indicate that the client is at the greatest risk for electrolyte imbalance, an adverse effect of loop diuretics.

A nurse is administering sulfasalazine to a client. Which of the following data should the nurse collect to help identify an adverse drug reaction? (Select all that apply.)

Skin integrity Temperature CBC

A health care professional is caring for a patient who is taking repaglinide (Prandin) 15 to 30 minutes before each meal to treat type 2 diabetes mellitus. The patient asks the health care professional what to do if he skips a meal. Which of the following is the appropriate response?

Skip the dose. to avoid a sudden and serious drop in blood glucose level, the patient should skip the dose of repaglinide, a meglitidine, whenever he skips a meal and try to avoid skipping meals.

A nurse is caring for a client who has heart failure and is experiencing atrial fibrillation. Which of the following findings should the nurse plan to monitor for and report to the provider immediately?

Slurred speech

A nurse is caring for a client who is receiving heparin therapy and develops hematuria. Which of the following actions should the nurse take if the client's aPTT is 96 seconds?

Stop the heparin infusion.

A nurse is caring for a client who has spastic bladder following a spinal cord injury. Which of the following actions should the nurse take to help stimulate micturition?

Stroke the client's inner thigh.

Leukotriene Modifiers: Montelukast (Singluair)

THERAPEUTIC USE - Adjunctive therapy in the treatment of allergic rhinitis, asthma, and exercise induced bronchospasm ADVERSE DRUG REACTIONS - Leukotriene modifiers zileuton and zafirlukast can cause liver damage. Does not occur with montelukast - Neuropsychiatric effects such as suicidal ideations INTERVENTIONS - Monitor liver function with period testing - Observe for behavioral changes ADMINSTRATION - Schedule montelukast once daily in the evening - Available as tablets, chewable tablets and oral granules - Mix oral granules with applesauce, carrots, rice or ice cream or place directly on the tongue - To prevent EIB, take at least 2 hr before exercising and do not repeat the dose for 24 hours. CLIENT INSTRUCTIONS - Report abdominal tenderness, nausea, and anorexia - Report behavioral changes such as agitation, insomnia, anxiety or irritability CONTRAINDICATIONS - Liver dysfunction (Zileuton and Zafirlukast), not montelukast - Acute asthma exacerbations Status asthmaticus PRECAUTIONS - Severe asthma INTERACTIONS -Concurrent use with phenobarbital (Luminal), rifampin (Rifadin) and phenytoin (Dilantin) may necessitate higher dosages.

Dimenhydrinate (Antihistamines)

THERAPEUTIC USE - Antiemesis, vertigo, motion sickness ADVERSE DRUG REACTIONS - Sedation - Anticholinergic effects (dry mouth, urinary retention, constipation) INTERVENTIONS - Monitor clients when ambulating - Monitor for anticholinergic effects - Monitor bowel elimination patterns - Monitor vital signs as well as signs of anaphylaxis ADMINISTRATION - Give dimenhydrinate orally, IM or IV - Give the initial dose 30 to 60 min before the activity that triggers nausea - Give subsequent doses before meals and at bedtime - Make sure clients do not swallow chewable tablets whole CLIENT INSTRUCTIONS - Do not take prior to driving or activities requiring mental alertness - Sit or lie down if feeling drowsy - Change positions gradually - Suck on hard candy or chew gum - Sip water - Increased fluid and fiber intake - Increase activity levels - Urinate every 4 hr and report any undesirable changes in urinary elimination CONTRAINDICATIONS - Known hypersensitivity - Angle-closure glaucoma - Premature or newborn infants PRECAUTIONS - Hyperthyroidism - CV disease - Hepatic disease - Pyloric obstruction - Prostatic hypertrophy - Older adults - Pregnancy and lactation INTERACTIONS - Other CNS depressants increase sedative effects - MAO inhibitor antidepressant increase anticholinergic effects.

Biologic DMARDs - Etanercept (Enbrel)

THERAPEUTIC USE - DMARDs are drugs that treat and decrease joint inflammation, and subsequently prevent joint damage - Biologic DMARD drugs are tumor necrosis factor antagonists- drugs that bind naturally occurring tumor necrosis factor, preventing it from attaching to cells on the surface of synovial tissue in the joints. ADVERSE DRUG REACTIONS - Increased susceptibility to infections - Dizziness - Abdominal pain - Pharyngitis - Psoriasis - Upper Respiratory Infections - Rare occurrence of severe allergic reaction such as Stevens- Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and erythema multiforme - Local injection site reaction - Heart failure - Reactivation of latent tuberculosis INTERVENTIONS - Assess for infections prior to each injection - Monitor for signs and symptoms of infection during therapy - Monitor for skin reactions - Monitor for redness, warmth, and itching at the injection site - Monitor clients for signs and symptoms of heart failure (cough, shortness of breath, elevated blood pressure, heart rate and pink sputum) - Administer TB test prior to starting therapy ADMINISTRATION - Administer by subcutaneous injection -Give once weekly - Monitor site for redness, pain and swelling after administration CLIENT INSTRUCTION - Report signs and symptoms of infection immediately. - Avoid immunizations, especially those that contain live vaccines. - Advise clients to report reactions that do not subside within a few days - Report signs and symptoms of heart failure (cough, shortness of breath, elevated blood pressure, heart rate and pink sputum) immediately. - Report shortness of breath or new production of sputum CONTRAINDICATIONS - Active infection - Hematologic disease - Malignancy PRECAUTIONS - Autoimmune diseases - Live vaccines - Heart Failure INTERACTIONS Administration with chemotherapeutic drugs may cause bone marrow suppression - Should not be given with anakinra (Kineret) due to increased risk of infections

Nonbiologic (Traditional) DMARDs Methotrexate

THERAPEUTIC USE - Decrease joint inflammation and subsequently joint damage. ADVERSE DRUG REACTIONS - Bone marrow suppression (decreased platelets, red and white blood cells) - Increased risk of infection - Liver damage - Gastrointestinal ulceration - Pulmonary fibrosis - Dizziness and headache - Nausea and vomiting INTERVENTIONS - Monitor for decreased platelets, red and white blood cell counts. - Monitor for signs and symptoms of infection - Monitor for liver function tests and observe for jaundice - Monitor for gastrointestinal bleeding (with methotrexate) - Monitor for respiratory distress and decreased oxygenation - Monitor for abdominal pain, diarrhea, nausea and vomiting ADMINISTRATION - Give methotrexate once a week via route prescribed (Oral, subcutaneous or intramuscular) - Folic acid supplement may be prescribed to decrease risk of toxicity. CLIENT INSTRUCTIONS - Report abnormal bleeding, bruising or petechiae (pinpoint areas of blood under the skin) Report ulcerations of the mouth or tongue - Report signs and symptoms of infection immediately. - Avoid ingesting alcohol. - Report yellowing of skin and eye immediately - Report blood in vomitus or stools - Report difficulty breathing or shortness of breath - Drink adequate amounts (2L) of water daily to ensure excretion of drug - Follow advice of Healthcare provider regarding contraception for men and women pf child bearing age - Avoid breastfeeding while on this drug. CONTRAINDICATIONS - Teratogenic - Liver insufficiency or hepatitis - Renal insufficiency PRECAUTIONS - Peptic ulcer or ulcerative colitis - Active bacterial or viral infections INTERACTIONS - Concurrent use of warfarin may increase the risk for bleeding - Alcohol use may increase risk of hepatotoxicity

Omeprazole (Prilosec) Proton pump inhibitors (PPI)

THERAPEUTIC USE - Gastric and duodenal ulcers - Prolonged dyspepsia - Gastrointestinal reflux disease (GERD) - Erosive esophagitis - Hypersecretory disorders such as Zollinger-Ellison syndrome, systemic mastocytosis ADVERSE DRUG REACTIONS - Bone loss (long-term use) - Headache, abdominal pain, nausea, vomiting and diarrhea - Hypomagnesemia INTERVENTIONS - Limit drug therapy to the lowest dose and shortest duration possible. - For longer-term therapy, monitor for bone loss via bone density scanning at recommended intervals. - Monitor for severe vomiting or diarrhea. - Monitor magnesium levels ADMINISTRATION - Administer orally once daily before the first meal of the day. - Make sure clients do not crush, chew or break delayed-release capsules of omeprazole. CLIENT INSTRUCTIONS - Perform weight-bearing exercise daily. - Consume adequate calcium and vitamin D. - Report vomiting or diarrhea - Drink plenty of clear fluids. - Take magnesium supplements as needed. PRECAUTIONS - Liver dysfunction - Pregnancy and lactation INTERACTIONS - Absorption of atazanavir (Reyataz), ketoconazole (Nizoral), and itraconazole decreases - Food can reduce absorption - Levels of warfarin (Coumadin), phenytoin (Dilantin), and diazepam (Valium) increase. - St John's wort decreases drug levels.

Calcium supplements- calcium citrate/ carbonate (Citracal/Tums)

THERAPEUTIC USE - Hypocalcemia - Clients who have, or are at risk for, experiencing a calcium deficiency -- adolescents -- women who are pregnant, breast feeding or postmenopausal -- men and women at risk for osteoporosis due to age or lactose intolerance - Gastric hyperacidity ADVERSE DRUG REACTIONS - Hypercalcemia --more likely to occur when taking large amounts of vitamin D -- more likely to occur with long-term therapy -Nausea, vomiting and constipation - may occur as adverse effects or secondary to calcium toxicity - Kidney stones - in clients with hypercalcemia or a history of kidney stones INTERVENTIONS - Monitor serum calcium periodically - Monitor clients for signs of decreased gastric and intestinal mobility - Monitor clients for urine output in excess of intake - Monitor clients for signs of decreased gastric and intestinal motility. - Monitor clients for flank pain and blood in urine ADMINISTRATION - Can be given orally and intravenously - Give calcium supplements 1 hr before or 1 to 2 hours after glucose steroids, thyroid supplements, and tetracycline and quinolone antibiotics - Give calcium - based antacids 1 hr after meals and at bedtime - Chewable tablets should be chewed before swallowing - Give clients glass of water after swallowing CLIENT INSTTRUCTIONS - Teach clients signs of hypercalcemia (constipation, nausea and vomiting, increased urine output, depression) - Instruct clients to take calcium supplements as prescribed by provider, and not to take additional doses - Instruct clients to report nausea and vomiting to provider - Instruct clients to eat high fiber diet and take laxative as necessary for constipation - Instruct clients to report flank pain or blood in urine to provider - Instruct client to take calcium supplements 1-2 hrs before or after taking other medications such as: glucocorticoids, thyroid supplements, and tetracycline and quinolone antibiotics - Instruct client to take calcium based antacids 1 hr after meals and at bedtime -- chew tablet before swallowing -- drink glass of water after swallowing -- do not take more than 600 mg at one time -- Compare dose with bioavailable amount of calcium in product CONTRAINDICATIONS - Hypercalcemia - Kidney stones - Low phosphate levels - Cardiac dysrhythmias PRECAUTIONS - Low gastric motility INTERACTIONS - Thiazide diuretics cause decreased excretion of calcium, which may result in hypercalcemia - Calcium supplements decrease absorption of many other medications, such as thyroid hormones, tetracycline, and quinolone antibiotics and glucocorticoids - Avoid taking calcium with foods such as cereals, rhubarb and spinach

Methylxanthines: Theophylline (Theolair, Theochron, Theo-24)

THERAPEUTIC USE - Long-term management if chronic asthma ADVERSE DRUG REACTIONS - Rare at therapeutic levels - When therapeutic levels are exceeded: restlessness, insomnia - Nausea, vomiting, diarrhea - When reaches toxic levels: seizures - Dysrhythmias INTERVENTIONS -Monitor plasma drug levels - Discontinue drug therapy if toxic levels are indicated - Give activated charcoal to decrease absorption - Prepare to initiate anticonvulsant therapy and institute seizures precautions -Monitor heart rate and rhythm - Give antidysrhythmics to restore heart rate and rhythm ADMINISTRATION - If a dose is missed, do not double the dose - Have the client chew the chewable tablets thoroughly -Do not crush or chew sustained-released or enteric coated preparations -Maintain scheduled interval between doses CLIENT INSTRUCTIONS -Reduce or eliminate caffeine intake - Have periodic laboratory testing of drug levels. - Stop taking the drug and notify the provider if experiencing seizures - Stop taking the drug and notify provider of experiencing dysrhythmias CONTRAINDICATIONS - Clients with impaired metabolism - Tobacco or marijuana use - Caffeine PRECAUTIONS - Heart disease - Liver dysfunction - Acute pulmonary edema INTERACTIONS - Cimetidine (Tagamet), some fluoroquinolones, and caffeine increase the risk of toxicity - Phenobarbital, phenytoin (Dilantin), and nicotine increase metabolism of theophylline

Beta 2 Adrenergic Agonist: Albuterol (Proventil, Ventolin)

THERAPEUTIC USE - Long-term management of asthma - Prevention of exercise-induced bronchospasm - Treatment of ongoing asthma exacerbations ADVERSE DRUG REACTIONS - Chest pain, palpitations - Nervousness, restlessness, tremors INTERVENTIONS - Monitor and report dizziness, heart palpitations, chest pain and shortness of breath - Monitor and report tremors. ADMINISTRATION - Follow manufacture's instructions for using delivery devices. - Use short-acting preparations for cute exacerbations - Use long acting preparations for long term control - Inhale beta2 agrenergic agonists before inhaling glucocorticoids. - Follow dosage and schedules - Watch for signs and triggers of impending exacerbations of asthma - Keep a log of the frequency and intensity of exacerbations - Notify the provider of changes in patterns of exacerbations CLIENT INSTRUCTIONS - Take as prescribed - avoid overuse of rescue inhalers - Report chest pain and heart palpitations - Avoid caffeine - Notify providers if tremors interfere with activities of daily living CONTRAINDICATIONS - Allergy to albuterol or levalbuterol PRECAUTIONS - Diabetes mellitus -Hyperthyroidism - Cardiovascular disease - Hypertension - Angina pectoris - Tachydysrhythmias - Tachycardia due to digitalis toxicity INTERACTIONS - Beta adrenergic blockers reduce the effectiveness of beta2 adrenergic agonists. - Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants increase the risk of hypertension, tachycardia and angina Hypoglycemic (antidiabetic) drugs require increased dose because of hyperglycemic effects

Ondansetron (Zofran) Serotonin antagonists

THERAPEUTIC USE - Nausea, vomiting from chemotherapy, radiation therapy, postoperative therapy ADVERSE DRUG REACTIONS - Serotonin syndrome, torsade de pointes, and Stevens Johnson's syndrome - Headache - Dizziness - Diarrhea - Constipation INTERVENTIONS - Monitor for persistent headache - Administer analgesics for pain relief - Monitor for dizziness - Monitor for severe diarrhea and dehydration ADMINISTRATION - Give orally or IV - When treating chemotherapy-induced nausea and vomiting, give the drug IV slowly (over 15 min) starting 30 min before chemotherapy administration, and then 4 and 8 hr later. - When treating anesthesia-induced nausea and vomiting, give the drug 1 hr before anesthesia induction - When treating radiation-induced nausea and vomiting, give the drug 1 to 2 hr before therapy, and then every 8 hr as needed. CLIENT INSTRUCTIONS - Report headache - Take over the counter analgesics to relieve headache if taking the drug at home - Report dizziness. - Do not engage in dangerous activities if dizziness occurs or tends to recur - Lie down and change positions slowly when feeling dizzy - Report diarrhea - Drink plenty of clear fluids CONTRAINDICATIONS - Phenylketonuria (oral disintegrating tablets) - Congenital long QT syndrome - Concurrent use with apomorphine PRECAUTIONS - Liver dysfunction - Recent abdominal surgery - Pregnancy/lactation - Children under the age of 3 INTERACTIONS - Drugs that affect serotonergic neurotransmitter systems, including SSRIs, SNRIs, tricyclic antidepressants, MAOIs, fentanyl, lithium, buspirone, tramadol, methylene blue, and triptans increase risk of serotonin syndrome - Do not use with apomorphine - results in severe hypotension.

Aluminum hydroxide (Amphojel) Antacids

THERAPEUTIC USE - Peptic Ulcer Disease - Gastrointestinal reflux disease (GERD) ADVERSE DRUG REACTIONS - Constipation (aluminum and calcium antacids) - Diarrhea (magnesium antacids) - Hypophosphatemia INTERVENTIONS - Monitor bowel function - Administer stool softeners. - Monitor for severe diarrhea. - Monitor phosphorus and magnesium levels ADMINISTRATION - Administer orally up to four times a day. - Make sure clients chew tablets thoroughly and follow with at least 8 ox of water - Do not give within 1 to 2 hr of administering drugs that interact with antacids. CLIENT INSTRUCTIONS - Increase fluid and fiber intake - Increase activity and exercise - Report abdominal pain - Report severe diarrhea - Educate client on monitoring phosphate and sodium intake - Tell clients to report any signs of obvious or occult gastrointestinal bleeding, such as coffee-ground emesis - Instruct clients to not take aluminum hydroxide with 1 to 2 hr of other medications CONTRAINDICATIONS - Severe abdominal pain of unknown origin PRECAUTIONS - Hypercalcemia and hypophosphatemia INTERACTIONS - Interferes with absorption of many drugs including: tetracyclines, digoxin, fluoroquinolones, iron salts, salicylates and chlorpromazine

Selective estrogen receptor modulators (SERMs) - Raloxifene (Evista)

THERAPEUTIC USE - Postmenopausal osteoporosis - prevention and treatment - Reduces risk of estrogen and receptor- positive breast cancer ADVERSE DRUG REACTIONS - Increased risk of deep vein thrombosis (DVT) and pulmonary emboli - Hot flashes - Stroke INTERVENTIONS - Observe for signs and symptoms of thromboemboli - Use lightweight covers over clients - Monitor bone density ADMINISTRATION - Give orally daily - May give with or without food CLIENT INSTRUCTIONS - Contact provider if client experiences pain in calf or difficulty breathing - Do not take estrogen replacement therapy during treatment - Warn clients that hot flashes may occur - Encourage clients to consume adequate amounts of calcium and vitamin D - Encourage clients to perform weight-bearing exercises (Brisk walking, stair climbing) daily - Do not take estrogen replacement therapy during treatment CONTRAINDICATIONS - Teratogenic - Lactation - Current and past history of deep vein thrombosis PRECAUTIONS - Estrogen - Hyperlipidemia INTERACTIONS - Concurrent administration with estrogen is no recommended

Misoprostol (Cytotec) Prostaglandin E analog

THERAPEUTIC USE - Prevention of gastric ulcers from long term NSAID use ADVERSE DRUG REACTIONS - Diarrhea, abdominal pain - Dysmenorrhea, uterine cramping, spotting (women), miscarriage INTERVENTIONS - Monitor for severe diarrhea and abdominal pain. - Monitor for excessive menstrual pain or mid-cycle bleeding. ADMINISTRATION - Administer orally four times a day, with meals and again at bedtime. - Confirm non pregnant state before initiating drug therapy, as this drug can cause spontaneous abortion. - Make sure women of childbearing age use effective contraception during drug therapy. CLIENT INSTRUCTIONS - Report worsening diarrhea or abdominal pain Expect diarrhea to resolve after the first week of drug therapy - Drink plenty of clear fluids - Take the drug with food to minimize gastrointestinal effects - Report menstrual changes - Do not ingest alcohol or any foods that may further irritate the GI tract. CONTRAINDICATIONS - Pregnancy / teratogenic effects - Hypersensitivity to the drug PRECAUTIONS - Children younger than 18 yr INTERACTIONS - Antacids that contain magnesium worsen diarrhea.

A nurse is caring for a client who is 1 hr postoperative following an aortic aneurysm repair. Which of the following findings can indicate shock and should be reported to the provider.

Urine output of 20 ml/hr Urine output less than 30 ml/hr is a manifestation of shock.

Inhaled anticholinergics: Ipratroprium (Atrovent, Atrovent HFA)

THERAPEUTIC USE - Relief of bronchoconstriction in clients who have COPD - Decreases secretions in clients with COPD ADVERSE DRUG REACTIONS - dry mouth, irritation of the pharynx - Increased intraocular pressure - Urinary retention INTERVENTIONS - Provide water and hard candy to client - Schedule routine blood testing for glaucoma - Monitor urinary elimination patterns, especially in older adults ADMINISTRATION - Follow manufacturer's instructions for using delivery devices - Follow dosage limits and schedules - Allow the prescribed time between puffs - Delay use of other inhalants for 5 minutes - Do not use as an emergency rescue medications - Rinse the mouth after use to reduce unpleasant taste CLIENT INSTRUCTIONS - Suck on hard candy - Sip water frequently - Have regular eye examinations to test for glaucoma - Report any changes in urinary elimination CONTRAINDICATIONS - Hypersensitivity to ipratropium, atropine, belladonna alkaloids or bromide - History of sensitivity to soy or peanuts - avoid Combivent (ipratropuim/albuterol combination) MDI form of the drug PRECAUTIONS - Glaucoma - Prostatic hypertrophy - Bladder neck obstruction INTERACTIONS - Beta2 adrenergic agonists enhance bronchodilation

Calcitonin - calcitonin- salmon (Miacalcin, Calcimar)

THERAPEUTIC USE - Treatment of postmenopausal osteoporosis - Hypercalcemia secondary to hyperparathyroidism - Paget's disease ADVERSE DRUG REACTIONS -Nasal dryness and irritation with intranasal calcitonin - Hypersensitivity reactions/ anaphylaxis - Hypocalcemia - Decreased in therapeutic effects over time - Nasal form of calcitonin may cause nasal dryness and irritation as well as head aches and epistaxis - Injectable form may cause injection site reaction, nausea and vomiting and polyuria. INTERVENTIONS - When administering intranasal calcitonin -- alternate nostril used daily -- assess prior to administration for irritation/ulceration - Prior to beginning therapy -- perform intradermal allergy test -- development of erythema within 15 minutes indicates sensitivity - Have epinephrine 1:1000, antihistamines and oxygen available during early therapy - Monitor for hypocalcemia (Serum calcium level, muscle spasms, tingling of fingers and toes). - Provide diet high in calcium and vitamin D ADMINISTRATION - Intranasal spray - Hold nasal pump upright - If using pump for the first time, prime pump according to manufactures instructions. - Spray once in nostril opposite or previous instillation -- Intramuscular/ Subcutaneous - Rotate injection sites - Subcutaneous is the preferred route - administer IM dose more than 2 ml - Protect from light - Keep calcitonin salmon refrigerated CLIENT INTRUCTIONS - For intranasal calcitonin, instruct clients to -- alternate nostrils used daily -- report nasal irritation or bleeding - Instruct clients to immediately notify provider if rash or itching occurs - Instruct clients to... -- notify provider of muscle spams, tingling of fingers and toes -- eat a diet high in calcium and vitamin D - Monitor for loss of effect after a year or more of use through regular bone density studies. CONTRAINDICATIONS -Allergy to salmon - Prior treatment with bisphosphonates - Pregnancy and lactation PRECAUTIONS - Safety not established in pediatrics clients INTERACTIONS - May decrease serum lithium levels - Previous treatment with bisphosphonates may decrease the response to calcitonin

Gliptins - Sitagliptin (Januvia)

THERAPEUTIC USE - Treats type 2 diabetes alone or in combination with other drugs for diabetes ADVERSE DRUG REACTIONS - Upper respiratory tract infection and inflamed nasal passages - Headache - Pancreatitis - Steven-Johnson syndrome - Anaphylaxis - Angioedema INTERVENTIONS - Monitor for respiratory symptoms - Monitor temperature if respiratory effects occur - Monitor for headaches - Administer over the counter analgesic for persistent headache if provider approves - Monitor for gastrointestinal effects that could be signs of pancreatitis - Monitor blood amylase level to help confirm pancreatitis , if needed - Assess skin for signs of Stevens- Johnsons syndrome - Monitor for acute renal failure ADMINISTRATION - Administer orally alone or in combination with metformin (Janumet) - Give with food or without food - Give a reduced dosage to clients with severe renal impairment and low creatine clearance CLIENT INSTRUCTIONS - Report persistent upper respiratory symptoms of fever - Report persistent or unrelieved headaches - Report severe upper abdominal pain or abdominal pain that radiates to the back and is associated with nausea or vomiting - Take medications as prescribed, taking any missed medications as soon as remembered - Instruct clients on proper technique for obtaining routine blood glucose levels CONTRAINDICATIONS -Hypersensitivity - Type 1 diabetes - Diabetic ketoacidosis PRECAUTIONS - Hemodialysis - Moderate to severe renal dysfunction - History of pancreatitis INTERACTIONS - Sitagliptin may increase digoxin levels - Concurrent use with other antidiabetics increases risk for hypoglycemia

Sulfonylureas - Glipizide (Glucotrol)

THERAPEUTIC USE - Type 2 diabetes mellitus ADVERSE DRUG REACTIONS - Hypoglycemia - Nausea and diarrhea INTERVENTIONS - Monitor for signs of hypoglycemia (diaphoresis, tachycardia, fatigue, excessive hunger, tremors) - If the client is conscious, give glucose orally in either pill form, 2-3 tsp of sugar, glass of orange juice, honey, or corn syrup dissolved in water - If the client is not conscious, give intravenous glucose; give parenteral glucagon if Iv not available - Check the clients blood glucose every 15 to 20 minutes - Continue treatment until the blood glucose has returned to the expected reference range and the client is no longer symptomatic - Monitor for persistent nausea, vomiting and diarrhea - Monitor CBC levels ADMINISTRATIONS - Give orally 30 minutes before selected meal - Make sure clients swallow the sustained-released form whole and do not crush or chew it. CLIENT INSTRUCTIONS - Wear a medical alert bracelet -Watch for and report symptoms of hypoglycemia - Test blood glucose to confirm - Consume a snack of carbohydrates - Retest in 15 to 20 min and repeat if still low - Carry carbohydrate snack at all times CONTRAINDICATIONS - Pregnancy, lactation (Insulin is recommended during pregnancy) - Diabetic ketoacidosis PRECAUTIONS - Renal or hepatic dysfunction - Adrenal or pituitary insufficiency INTERACTIONS - Alcohol poses a risk for a disulfiram (Antabuse) like reaction (nausea, palpitation, flushing) and increases hypoglycemic effects - Sulfonamide antibiotics, NSAIDs, oral anticoagulants, salicylates, monoamine oxidase inhibitors and cimetidine (Tagamet) increase hypoglycemic effects - Thiazides counteract hypoglycemic effects - Beta blockers mask manifestations of hypoglycemia

A nurse is caring for a client who has ulcerative colitis. The client has had several exacerbations over the past 3 years. Which of the following instructions should the nurse include in the plan of care

Use progressive relaxation techniques Arrange activities to allow for daily rest periods Restrict intake of carbonated beverages.

A nurse is monitoring a client's ECG monitor and notes the client's rhythm has changed from normal sinus rhythm to supraventricular tachycardia. The nurse should prepare to assist with which of the following interventions?

Vagal stimulation

A nurse is caring for a client who has endocarditis. Which of the following findings should the nurse recognize as a potential complication?

Valvular disease

A nurse is assessing a client who has left-sided heart failure. Which of the following manifestations should the nurse expect to find?

Weak peripheral pulses. Weak peripheral pulses are related to decreased cardiac output resulting from left-sided hart failure.

Meglitinides - repaglinide (Prandin)

THERAPEUTIC USE - Type 2 diabetes mellitus ADVERSE DRUG REACTIONS - Hypoglycemia - Nausea and vomiting INTERVENTIONS - Monitor for signs of hypoglycemia (diaphoresis, tachycardia, fatigue, excessive hunger, tremors) - If the client is conscious, give glucose orally in either pill form, glass of orange juice, 2-3 tsp of sugar, honey or corn syrup dissolved in water. - If the client is not conscious, give intravenous glucose, give parenteral glucagon if IV not available - Check the clients glucose every 15 to 20 minutes - Continue treatment until the blood glucose has returned to the expected reference range and the client is no longer symptomatic - Monitor for persistent nausea, vomiting and diarrhea - Monitor CBC levels ADMINISTRATION - Give orally 30 min or less before meals, usually 3 times a day - Tell clients to skip a dose if they skip a meal and to add a dose if they add a meal. - Do not exceed 4 doses a day. CLIENT INSTRUCTIONS - Wear a medical alert bracelet - Watch for and report symptoms of hypoglycemia - Test blood glucose to confirm - If hypoglycemia occurs, advise patient to take a glass of orange juice or 2 to 3 tsp of sugar, honey, or corn syrup dissolved in water (glucose, not table sugar, if taking miglitol), and notify health care professional - Retest in 15 to 20 minutes and repeat treatment if still low - Carry a carbohydrate snack at all times - Lie down when feeling nauseated - Consume adequate carbohydrate CONTRAINDICATIONS - Diabetes ketoacidosis - Systemic infection - Older adults - Use of alcohol, NSAIDs, warfarin, loop diuretics and anabolic steroids INTERACTIONS - Gemfibrozil (Lopid), erythromycin and chloramphenicol increase hypoglycemic effects - Alcohol, corticosteroids and rifampin decrease hypoglycemic effects.

Biguanides - Metformin (Glucophage)

THERAPEUTIC USE - Type 2 diabetes mellitus ADVERSE DRUG REACTIONS - Lactic acidosis (rare, but potentially fatal) - Nausea, diarrhea, vomiting - Unpleasant metallic taste - Vitamin deficiencies (Vitamin B12 and folic acid) INTERVENTIONS - Monitor for indications of lactic acidosis - For signs of lactic acidosis, stop drug therapy immediately - Expect that severe lactic acidosis while require hemodialysis - Monitor for persistent nausea, vomiting and diarrhea - Monitor fluid intake and output - Monitor for indications of Vitamin B12 or folic acid deficiency -Recommend the appropriate supplements -Monitor renal function upon initial therapy and yearly afterward ADMINISTRATION -Give orally twice a day with the morning and evening meals (immediate-release) or once a day with the evening meal (extended release -Make sure clients swallow the extended release form whole and do not crush it or chew it. CLIENT INSTRUCTIONS -Avoid drinking alcohol -Report weakness, fatigue, lethargy, or hyperventilation -If these symptoms develop, stop taking the drug and seek medical care immediately -Expect these effects to diminish as drug therapies continues - Lie down when feelings nauseated. - Maintain adequate carbohydrate and fluid intake. - Report weakness, fatigue, pallor or reddened tongue CONTRAINDICATIONS - Diabetic ketoacidosis - Cardiopulmonary, hepatic, or renal insufficiency - Alcoholism - Heart Failure - Severe infections - Shock - Acute myocardial infarction - Hypoxemia - Lactic acidosis PRECAUTIONS - Diarrhea - Dehydration - Anemia - Pituitary insufficiency - Gastroparesis - Gastrointestinal obstruction - Hyperthyroidism - Older adults INTERACTIONS - Alcohol and cimetidine (Tagamet) increase the risk of lactic acidosis - Any contrast medium containing iodine increases the risk of acute renal failure, thus worsening lactic acidosis - Nifedipine (Procardia), furosemide (Lasix), morphine, ranitidine (Zantac), antifungals, and many other drugs increase hypoglycemic effects

Thiazolidinediones - Pioglitazone (Actos)

THERAPEUTIC USE - Type 2 diabetes mellitus, with or without drug therapy with insulin or metformin (Glucophage) ADVERSE DRUG REACTIONS - Fluid retention - Hepatotoxicity - Increased serum lipid levels - Upper respiratory tract infection - Headaches - Myalgia INTERVENTIONS - Monitor for edema, weight gain or indications of heart failure - Hepatotoxicity - Obtain serum alanine aminotranferase (ALT) levels: Baseline and every 3 to 60 months thereafter - Stop drug therapy for indications of liver injury - Monitor serum lipid levels - Watch for increases in triglycerides - Watch for increases in both high-density (favorable) and low-density (unfavorable) lipoproteins ADMINISTRATION - Give orally once per day, with or without food. CLIENT INSTRUCTIONS - Follow instructions provided in access program - Report swelling, weight gain, or shortness of breath immediately - Report jaundice, dark urine, abdominal pain, vomiting, or fatigue - Expect periodic cholesterol testing - Report chest pain or discomfort, diaphoresis, or atypical fatigue - Report swelling, rapid weight gain, dyspnea CONTRAINDICATIONS - Cardiovascular disease including hypertension - Severe heart failure - Active hepatic disease - Typer 1 diabetes - Diabetes Ketoacidosis PRECAUTIONS - Mild heart failure, risk for heart failure - Hepatic impairment - Pioglitazone - may increase risk of bladder cancer after 1 year of use - Caution should be used in clients with a history of bladder cancer INTERACTIONS - Insulin increases the risk of hearth failure and edema - Gemfibrozil (Lopid) and ketoconazole increase hypoglycemic effects - Reduce effectiveness of contraceptives - Glucosamine can have a negative impact on blood glucose control - Chromium as well as coenzyme Q10 can increase hypoglycemic effects

Alpha- glucosidase inhibitors - Acarbose (Precose)

THERAPEUTIC USE - Type 2 diabetes mellitus, with or without drug therapy with insulin, a sulfonylurea or metformin (GLucophage) ADVERSE DRUG REACTIONS - Gastrointestinal effects (distention, flatus, hyperactive bowel sounds, diarrhea) - Hypoglycemia (combination therapy with insulin or a sulfonylurea) - Liver dysfunction - Anemia INTERVENTIONS - Monitor hyperactive bowel sounds, distention, and diarrhea - report persistent gastric distress - Monitor for signs of hypoglycemia (diaphoresis, tachycardia, fatigue, excessive hunger, tremors) - Measure liver enzymes at baseline, every 3 months for the first year, and periodically thereafter - Stop drug therapy for indications of liver injury - Monitor CBC - Watch for indications of anemia (Pallor, fatigue, shortness of breath) - Recommend iron-rich foods and supplements accordingly ADMINISTRATIONS - Give with the first bite of food, 3 times a day. - Tell clients who skip a meal to also skip the dose usually taken with that meal and to take only one dose at the next meal. CIENT INSTRUCTIONS - Warn the client about the gastric side effects of alpha-glucosidase inhibitors - Follow the diet regimen recommended by the provider. - Wear a medical alert bracelet - Watch for and report symptoms of hypoglycemia - Test blood glucose to confirm - Consume oral (Glucotabs) if necessary - Retest in 15 min and repeat if still low - Carry dextrose tablets at all times - Report dark urine, abdominal pain, vomiting or fatigue - Report pallor, fatigue, or shortness or breath CONTRAINDICATIONS - Gastrointestinal disorders (such as inflammatory bowel disease) obstruction, ulceration PRECAUTIONS - Hepatic impairment - Gastrointestinal distress - Not typically used in the US INTERACTIONS - Insulin and sulfonylurea increase risk of hypoglycemia