MED-SURG/Pharmacology

ALT expected range

4-36 international units/L

Creatinine clearance expected range

87-139 mL/min

Check lab values of Valproic Acid (Depakote)

Anticonvulsant - PTT - AST/ALT Explanation: - Can alter coagulation; therefore PT and PTT should be monitored. It also can cause life-threatening hepatotoxicity. Liver function tests (LFT's) should be started before starting medication.

Celiac disease

Autoimmune disorder characterized by a permanent intolerance to wheat, barley, and rye.

Chlordiazepoxide

Benzodiazepine - Most effective for alcohol withdrawal - Can stabilize vital signs, reduce the intensity of symptoms, and decrease the risk of seizures and delirium tremens

Levothyroxine adverse effects

Chest pain tachycardia insomnia tremors hyperthermia heat intolerance diaphroesis

A nurse is assessing a client who has acute kidney injury (AKI). According to the RIFLE classification system, which of the following findings indicates that the client has end-stage kidney disease? A. <0.5 mL/kg of urine output of 12 hr B. No urine output for 12 hr C. No urine output without renal replacement therapy for 4-12 weeks D. No urine output without renal replacement therapy for more than 3 months

Correct answer is D. In the RIFLE classification, the R stands for risk, I stands for injury, F stands for failure, L stands for loss, and E stands for end-stage kidney disease.

Disulfiram

Detoxification medication used to treat clients after alcohol withdrawal. Causes extreme nausea, vomiting, palpitations, headaches, sweating, and chest pain when taken with alcohol.

A nurse is assessing a client who is in early stages of hepatitis A. Which of the following manifestations should the nurse expect? A. Jaundice B. Anorexia C. Dark Urine D. Pale Feces

Explanation: Anorexia is an early manifestation of hepatitis A and is often severe. It is thought to result from the release of a toxin by the damaged liver or by the failure of the damaged liver cells to detoxify an abnormal product

A nurse is preparing a client for a bronchoscopy. Which of the following actions should the nurse take (select all that apply)? A. Explain that the client will receive sedation and will not remember the procedure B. Verify that the client understands the purpose and nature of the procedure C. Offer the client sips of clear liquids until 1 hr before the test D. Obtain a pre-procedural sputum specimen E. Instruct the client to keep his neck in a neutral position

Explanation: Correct answer are A and B. C. The client should remain NPO for 4-8 hours prior to the procedure to minimize aspiration risk D. The provider can obtain any necessary sputum specimens during the procedure E. The client's neck will be hyperextended to bring the pharynx into alignment with the trachea and to allow insertion of the scope without trauma

A nurse is teaching a client medications that prevent osteoporosis. The nurse should instruct the client that which of the following medications is prescribed to prevent osteoporosis? A. Levothyroxine B. Calcitonin C. Raloxifene D. Allopurinol

Explanation: Answer is C. A. Levothyroxine is prescribed to treat hypothyroidism B. Calcitonin is prescribed to delay bone resorption in women who already have osteoporosis. It does not prevent osteoporosis.

A nurse is completing a history and physical assessment for a client who has chronic pancreatitis. Which of the following findings should the nurse identify as a likely cause of the client's condition? A. High-calorie diet B. Prior gastrointestinal C. Tobacco use D. Alcohol use

Explanation: Answer is D. Alcohol is a major cause of chronic pancreatitis in the US. Long-term alcohol alcohol use disorder produces hyper secretion of protein in pancreatic secretions, which results in protein plugs and calculi within the pancreatic ducts.

A nurse is providing discharge teaching to a client who has heart failure and a prescription for digoxin 0.125 mg PO daily and furosemide 20 mg PO daily. Which of the following statements by the client indicates an understanding of the teaching? A. "I know that blurred vision is expected to happen while I'm taking digoxin" B. "I will measure my urine output each day and document it in my diary" C. "I will skip a dose of my digoxin if my resting heart rate is below 72 beats per minute" D. "I will eat fruits and veggies that have a high potassium content every day"

Explanation: Answer is D. Hypokalemia is an adverse effect of diuretic therapy. Because the client is taking digoxin, it is important to maintain a potassium level between 3.5-5.0 mg/dL to avoid digoxin toxicity

A nurse is caring for a client who has had repeated middle ear infections. The client reports that the provider said the infections are due to an obstruction of the structure that connects the middle ear to the throat. The nurse should identify that the provider was referring to which of the following? A. Oval window B. Auricle C. Tympanic membrane D. Eustachian tube

Explanation: Answer is D. The Eustachian tube connects the middle ear to the throat and allows equalization of pressure and drainage of fluids from the middle ear into the throat. A. The oval window is located b/n the middle and inner B. The auricle is the external ear C. The tympanic membrane, often referred to as the eardrum, separates the external ear from the middle ear

A nurse is caring for a client who was recently diagnosed with rheumatoid arthritis. The nurse should expect the provider to prescribe methotrexate at which of the following times. A. Within 3 months of the initial diagnosis B. When NSAIDs have not provided pain relief C. During an exacerbation of symptoms D. Once bone degeneration progresses

Explanation: Correct answer is A. - The nurse should identify that current guidelines recommend starting a disease-modifying anti rheumatic drug (DMARD) such as methotrexate within 3 months of a diagnosis of rheumatoid arthritis to prevent or delay joint degeneration B. NSAIDs can be used along with DMARDs to control pain until the DMARDs take effect to limit the disease process

While auscultating a client's heart sounds, the nurse hears turbulence between S1 and S2 heart sounds. The nurse should document this finding as which of the following? A. A systolic murmur B. A third heart sound (S3) C. An expected heart sound D. A fourth heart sound (S4)

Explanation: Correct answer is A. A. Diastolic murmurs occur between S2 and the next S1 B. An extra heart sound that is low pitched and occurs in early diastole C. Turbulence is not an expected finding and requires further assessment D. An extra heart sound that is low pitched and occurs in late diastole

A home health nurse is planning care an older adult client who has impaired vision. Which of the following interventions should the nurse include in the plan of care to prevent injury in the home? A. Mark the edges of stairs for contrast B. Cover exposed extension cords with throw rugs C. Use 40 watt bulbs in lighting fixtures D. Instruct the client to obtain vision testing once every other year

Explanation: Correct answer is A. A. Marking the edges of the stairs with pain t or colored tape for contrast can help older adult clients who have impaired vision prevent injury by decreasing the risk of falls C. Use at least 75 watt bulbs to optimize the client's visibility D. At least once a year not every other year

A nurse is providing teaching to a client who has ulcerative colitis and a new prescription for sulfasalazine. The nurse should instruct the client to monitor for which of the following adverse effects of this medication? A. Jaundice B. Constipation C. Oral candidiasis D. Sedation

Explanation: Correct answer is A. Sulfasalazine can cause a yellow discoloration of the skin and yellow/orange discoloration of the urine.

A nurse is administering an enteric-coated tablet to a client and explaining the pharmaceutical preparation. Which of the following statements should the nurse make? A. This coated tablet dissolves better in your stomach and intestine B. You are less likely to have an upset stomach with this pill because of the coating on the tablet C. The coating on the tablet improves the absorption of the medication D. The coating on the tablet allows a gradual release of the medication

Explanation: Correct answer is B. - The outside coating of a substance that dissolves in the intestines instead of in the stomach. This protects the medication from acids and enzymes in the stomach and protects the stomach from ingredients in the medication that can cause gastric upset.

A nurse is planning care for a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH) with mild manifestation. The nurse should expect the provider to prescribe which of the following medications? A. Chlorpropamide B. Tolvaptan C. Vasopressin D. Desmopressin

Explanation: Correct answer is B. A. Chlorpropamide is an antidiabetic agent with antidiuretic effects that would worsen the manifestations of SIADH. It is used to treat diabetes insidious, not SIADH C. Vasopressin is an exogenous form of antidiuretic hormone that would worsen the manifestations of SIADH. It is used to treat diabetes insipidus D. Desmopressin is a synthetic form of ADH that would worsen the manifestations of SIADH. It is used to treat diabetes insipidus.

A nurse is caring for a client with Alzheimer's disease who has a new prescription for memantine. Which of the following laboratory results should the nurse identify as increasing the client's risk for decreased clearance of the medication? A. Alanine aminotransferase (ALT) B. Creatinine clearance 35mL/min C. HbA1c 5% D. BMI 31

Explanation: Correct answer is B. Creatinine clearance of 35 mL/min indicates moderate renal impairment. The kidneys excrete memantine, and decreased clearance occurs with moderate renal impairment.

A nurse is working in a mental health facility is admitting a client with opioid use disorder who is experiencing withdrawal. The nurse should anticipate a prescription for which of the following medications from the provider? A. Methylnaltrexone B. Methadone C. Naloxone D. Hydromorphone

Explanation: Correct answer is B. Methadone is used to treat opioid withdrawal and for pain management. A. methylnaltrexone is an opioid antagonist that is used to treat opioid-induced constipation for clients who have not responded to other laxatives C. Naloxone is an opioid antagonist that is used to treat opioid overdose. D. Hydromorphone is an opioid pain medication

A nurse is teaching a client with a new diagnosis peptic ulcer disease (PUD) who has a prescription for bismuth subsalicylate. The client asks the nurse, "how will this medication help my ulcer?" Which of the following statements should the nurse make? A. The medication will decrease prostaglandins B. The amount of bicarbonate in your body will be increased C. This medication can decrease bacteria in the GI tract D. The medication acts by increasing blood flow to the stomach

Explanation: Correct answer is C. A. a decrease in prostaglandins can contribute to the progression of PUD. Increase in prostaglandins stimulate the secretion of defensive factors such as mucous. B. a decrease in bicarbonate can contribute the progression of PUD. Bicarbonate help to remove hydrogen ions that might penetrate the mucous layer in the GI tract. C. Bismuth does not increase blood flow to the stomach. Some medications for PUD increases blood flow.

A nurse is caring for a client who has a prescription for cholorthiazide to treat hypertension. The nurse should plan to monitor the client which of the following adverse effects? A. Thrombophlebitis B. Hyperactive reflexes C. Muscle weakness D. Hypoglycemia

Explanation: Correct answer is C. Thiazide diuretic used to treat hypertension and congestive heart failure. It promotes the excretion of water, sodium, and potassium and can cause hypokalemia

A nurse is caring for a client who is receiving radiation therapy for mouth cancer and reports a dry mouth. Which of the following dietary recommendations should the nurse provide? A. Offer graham crackers as a snack B. Avoid foods containing citrus C. Rinse the mouth with an alcohol-based mouthwash before eating D. Use gravies or sauces to soften the food

Explanation: Correct answer is D. - A. Dry course foods such as graham crackers can make the client's mouth feel more dry and pleasant - B. The client should consume foods containing citrus to stimulate saliva - C. The client should rinse the mouth with an alcohol-free mouthwash before eating. Alcohol-based mouthwash can make the client's mouth drier

A nurse is caring for a client who is receiving total parenteral nutrition (TPN) therapy and has just returned to the room following physical therapy. The nurse notes that the infusion pump for the client's TPN is turned off. After restarting the infusion pump, the nurse should monitor the client for which of the following findings? A. Hypertension B. Excessive thirst C. Fever D. Diaphoresis

Explanation: Correct answer is D. The nurse should recognize that the client has the potential to develop hypoglycemia due to the sudden withdrawal of the TPN solution. In addtion to diaphoresis, other potential manifestations of hypoglycemia can include weakness, anxiety, confusion, and hunger

A nurse in an allergy clinic is caring for a client who has a hx of seasonal allergy symptoms. The client had a RAST completed on a previous visit. The nurse should recognize that an elevation in which of the following immunoglobulin indicates a positive result? A. Immunoglobin G b. Immunoglobin A C. Immunoglobin E D. Immunoglobin M

Explanation: Correct answer is E. A. Assumes a major role in blood borne and tissue infections B. Protects against respiratory, GI, and GU infections C. RAST measures immunoglobulin E D. First one produced in response to bacterial and viral infections

A nurse is teaching a client who has a new diagnosis of primary open-angle glaucoma (POAG). Which of the following pieces of information should the nurse include in the teaching (select all that apply) A. Lost vision can improve with eye drops B. Administer eye drops as needed for vision loss C. Glassess will be necessary to correct the accompanying presbyopia D. Driving can be dangerous due to the loss of peripheral vision E. Laser surgery can help reestablish the flow of aqueous humor

Explanation: Correct answers D and E. A. Eye drops will not improve vision; however, they can reduce intraocular pressure and prevent further loss B. The client should administer eye drops on a regular schedule to reduce intraocular pressure C. Presbyopia, which is a decrease in near vision that occurs after 40 years of age, is not related to POAG. Vision loss that occurs with POAG will not improve with glasses

A nurse is preparing a client for a bone scan. Which of the following statements indicates that the client understands the pre-procedure teaching? (select all that apply) A. "I will have to drink a radioactive solution before the test begins" B. "A special camera will scan the bones in my entire body C. "There will be better absorption of the radiation by healthy bone" D. "I'll have to drink a lot of water to help get the radiation out of my body" E. "I understand the radiation is harmless, and I don't have to worry about it"

Explanation: Correct answers are B, D, E. A bone scan is a procedure that allows viewing of the entire skeleton. It is less common than other diagnostic tests but is still useful for identifying hairline fracture and some malignancies. The client should drink plenty of fluids to promote urinary excretion of the radioactive material. Also, the nurse should reassure the client that the radioactive material is not dangerous because it deteriorates quickly in the body and exits via urine and stool.

A nurse is caring for a client who received naloxone for a suspected opioid overdose. Which of the following findings should the nurse identify as an adverse effect of this medication? A. Report of pain B. Respiratory rate 8/min C. Report of numbness D. Report of abdominal cramping and diarrhea

Explanation: Used to reverse the effects an opioid administered for pain, sedation euphoria, and respiratory depression. Excess doses of naloxone can cause the return of pain but can improve the client's respiratory rate.

Adverse effects of steroids

Hypertension Weight gain Increased appetite Nausea Hypokalemia Increases glucose levels

Chronic use of oral glucocorticoids in children

Most likely to slow linear growth in children

SIADH

SIADH is a disorder of water intoxication due to the inappropriate continuous recreation of antidiuretic hormone by the posterior pituitary gland, causing hypervolemia and hyponatremia. Treatment includes fluid restriction, sodium replacement with small amounts of 0.9% sodium chloride, and a vasopressin antagonist such as tolvaptan. Tolvaptan promotes the excretion of water, which helps correct the fluid imbalance in clients who have SIADH.

Misoprostol

Used for cervical ripening and induction of labor. It causes a higher incidence of uterine tachysystole. There it is contraindicated in clients who has a history of major uterine surgery or cesarean delivery with past pregnancies because of the risk of uterine rupture

Normal reference range of urine after surgery

at least 30 ml/hr

Silver Solfadiazine

- Does not cause an electrolyte imbalance - Leukopenia (adverse effect)

Precautions for a client receiving radiation

1. The client should avoid heat exposure to the radiated area, which might lead to skin breakdown 2. Massage can cause friction to the radiated skin 3. External radiation sites are marked to indicate the exact area targeted by radiation therapy. Washing off the markings is contraindicated. 4. The nurse should protect areas of skin from sunlight that receive radiation