HESI Prep: Medical-Surgical Drugs

The nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which client complications may be caused by the TPN? Select all that apply. One, some, or all responses may be correct. 1. Hyperglycemia 2. Infection 3. Hepatitis 4. Anorexia 5. Dysrhythmias

1. Hyperglycemia 2. Infection Hyperglycemia related to the high concentration of dextrose in TPN is a common complication of this therapy and must be monitored for by the nurse. Another common complication is related to the central venous access that is needed for infusion of TPN. Catheter-related infection is frequently seen and must be monitored for by the nurse. Hepatitis is usually not associated with total parenteral nutrition. Anorexia often is present before the medical decision is made to begin total parenteral nutrition. Dysrhythmias are not related to total parenteral nutrition but may be a sign of hyperkalemia or hypokalemia.

A client who has type 1 diabetes and chronic bronchitis is prescribed atenolol for the management of angina pectoris. Which clinical manifestation will alert the nurse to the fact that the client may be developing a life-threatening response to the medication? 1. Paroxysmal nocturnal dyspnea 2. Supraventricular tachycardia 3. Malignant hypertension 4. Hyperglycemia

1. Paroxysmal nocturnal dyspnea Atenolol is associated with the adverse reactions of bradycardia, heart failure, and pulmonary edema; these are the most serious responses to atenolol and are often manifested by episodes of paroxysmal nocturnal dyspnea and orthopnea. A decreased, not increased, pulse rate is associated with atenolol so supraventricular tachycardia is not a response. Atenolol decreases, not increases, blood pressure so malignant hypertension is not a response. It also will not cause an increase in blood glucose. It may increase the hypoglycemic response to insulin, causing hypoglycemia. In addition, the medication may mask the clinical manifestations of hypoglycemia.

A client with type 1 diabetes is placed on an insulin pump. Which is the priority short-term goal when teaching this client to control the diabetes? 1. "The client will adhere to the medical regimen." 2. "The client will remain normoglycemic for 3 weeks." 3. "The client will demonstrate correct use of the insulin pump." 4. "The client will list three self-care activities that are necessary to control the diabetes."

3. "The client will demonstrate correct use of the insulin pump." Demonstrating the correct use of the administration equipment is a short-term, client-oriented goal that is necessary for the client to control the diabetes and is measurable when the client performs a return demonstration for the nurse. Adhering to the medical regimen is not a short-term goal. Remaining normoglycemic for 3 weeks is measurable, but it is a long-term goal. Although listing three self-care activities that are necessary to control the diabetes is measurable and a short-term goal, it is not the one with the greatest priority when a client has an insulin pump that must be mastered before discharge.

A client is diagnosed with pulmonary tuberculosis, and the health care provider prescribes a combination of rifampin and isoniazid. The nurse evaluates that the teaching regarding the medications is effective when the client reports which action as most important? 1. "Report any changes in vision." 2. "Take the medicine with my meals." 3. "Call my doctor if my urine or tears turn red-orange." 4. "Continue taking the medicine even after I feel better."

The medication should be taken for the full course of therapy; most regimens last from 6 to 9 months, depending on the state of the disease. Visual changes are not side effects of this medication. The medication should be taken 1 hour before meals or 2 hours after meals for better absorption. Urine or tears turning red-orange is a side effect of rifampin; although this should be reported, it is not an adverse side effect.

A client's intravenous (IV) infusion infiltrates. Which factor would the nurse recognize as the cause of the infiltration? 1. Excessive height of the IV bag 2. Failure to secure the catheter adequately 3. Contamination during the catheter insertion 4. Infusion of a chemically irritating medication

2. Failure to secure the catheter adequately Infiltration is caused by catheter displacement, which allows fluid to leak into the tissues. Excessive height of the IV bag will affect the flow rate, not cause infiltration. Contamination during the catheter insertion can lead to infection and phlebitis, not infiltration. Infusion of a chemically irritating medication can lead to phlebitis, not infiltration.

Which nursing care will be included for a client who is receiving doxorubicin for acute myelogenous leukemia? 1. Increasing citrus foods 2. Providing frequent oral hygiene 3. Encouraging activity 4. Administering medications parenterally 5. Increasing oral fluids

2. Providing frequent oral hygiene Stomatitis and hyperuricemia are possible complications of therapy; therefore oral care and hydration are important. A cidic foods such as citrus foods and fluids will cause pain for clients with stomatitis. Rest, not increased activity, is important for increased fatigability. Emphasizing that the disease will be cured with this treatment may provide false reassurance. Abnormal bleeding is a common problem; thus injections (administering medications parenterally) are contraindicated.

A client who had a myocardial infarction has runs of ventricular tachycardia. Which medication will the nurse prepare to administer? 1. Digoxin 2. Furosemide 3. Amiodarone 4. Norepinephrine

3. Amiodarone Amiodarone decreases the irritability of the ventricles by prolonging the duration of the action potential and refractory period. It is used in the treatment of ventricular dysrhythmias such as ventricular tachycardia. Digoxin slows and strengthens ventricular contractions; it will not rapidly correct ectopic beats. Furosemide, a diuretic, does not affect ectopic foci. Norepinephrine is a sympathomimetic and is not the medication of choice for ventricular irritability.

A health care provider prescribes losartan for a client. Which is an important nursing action? 1. Assess the client for hypokalemia. 2. Administer the medication with food. 3. Monitor the client's blood pressure. 4. Monitor serum glucose levels.

3. Monitor the client's blood pressure. Losartan is an aldosterone receptor blocking antihypertensive. A lowering of the client's blood pressure reflects a therapeutic response and should be monitored regularly. The client may be at risk for hyperkalemia, not hypokalemia. Losartan may be taken without regard to meals. Although it may be beneficial for clients with diabetes, it does not affect serum glucose levels.

Corticosteroid therapy is prescribed for a client with multiple sclerosis. In response to the therapy, which symptom would the nurse expect to decrease? 1. Emotional lability 2. Muscular contractions 3. Pain in the extremities 4. Visual impairment

4. Visual impairment Corticosteroids decrease the inflammatory process around the optic nerve, thus improving vision; visual impairment is the most common physiological manifestation of multiple sclerosis. Steroids are associated with increased emotional lability. Steroids are not effective in easing muscle contractions. Pain in the extremities is not common unless spasms are present; steroids do not relieve spasms.