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question the nurse is caring for a client with asthma exacerbation. blood pressure is 146/86, pulse is 110, and respiration are 32. the respiratory therapist administers nebulized albuterol as prescribed. one hour after the treatment, the nurse assess which finding that indicates the drug is producing the therapeutic effect? a. constricted pupils b. heart rate of 120 c. respiratory of 24 d. tremor

correct answer rational 1. albuterol (Proventil) is a short acting inhaled beta 2 agonist used to control airway obstruction caused by chronic obstructive pulmonary disease, asthma, or bronchitis. 1) it also is used to prevent exercise-induced asthma. the therapeutic effect is relaxation of the smooth muscles of the airway, which results in immediate bronchodilation. 2) bronchodilation decrease airway resistance, facilitates mucus drainage (expectorates mucus plugs), decrease the work of breathing, and increase oxygenation. 3) because of these actions, the respiratory rate will decrease, and peak flow will be increased 2. however short acting beta-agonists are associated with the following side effects (not therapeutic effects): tremors (most frequent), tachycardia and palpitations, restlessness, and hypokalemia ---these side effects are due to the oral deposition of medication (subsequent systemic absorption) and can be reduced with the use of a spacer or chamber device 3. about a: the presence of constricted pupils is neither a side effect nor therapeutic of the drug, constricted pupils are often seen with opioid medications (eg, morphine, oxycodone) educational objective: 1. albuterol (Proventil) is a short-acting beta-2 agonist that produces immediate bronchodilation by relaxing smooth muscles. 2. bronchodilation decrease airway resistance, facilitates mucus drainage, decrease the work of breathing and increase oxygenation. 3. peak flow will improve 4. the most frequent side effect are tremor, tachycardia, restlessness, and hypokalemia

question a child with cystic fibrosis is receive a dose of pancrelipase at 12pm. the client states that he is not hungry and will eat his lunch in an hour. which action is appropriate for the nurse to take? a. administer the prescribed pancrelipase b. hold the pancrelipase until the client eats c. notify the hcp d. skip this dose of the pancrelipase

correct answer rational 1. cystic fibrosis 囊性纤维化affects the pancreatic excretion of digestive enzymes. without these enzymes, the client is unable to absorb fats, starches, and some proteins from the diet. 2. pancrelipase provides these enzymes to the client and must be given with every snack and meal so that the client can digest and absorb the nutrients eaten. 3. if clients are not eating when the medication is scheduled, there is no nutrients to digest. therefore, the dose should be held until the client eats educational objective: 1. pancrelipase is a medication containing lipase, protease, and amylase. 2. in systolic fibrosis, the client's pancreas does not excrete these necessary enzymes. to prevent absorption syndrome, the enzymes must be take with every snack and every meal

question the nurse is reinforcing education to a client with a venous thromboembolism who is prescribed rivaroxaban. which statement by the client indicate the medication teaching has been effective? a. I need to continue to avoid eating spinach and kale b. I probably will have some weakness in my legs when I take this medication c. I should avoid taking aspirin while receiving this medication d. I will have to get blood routinely to check my clotting level

correct answer rational 1. factor Xa inhibitor (eg, rivaroxaban, edoxaban, apixaban) are anticoagulants used to prevent and treat venous thromboembolism. --factor Xa inhibitors are being prescribed more frequently than other oral anticoagulants (eg, warfarin), as they have a lower risk of bleeding and require less ongoing monitoring (eg PT/INR) 2. clients prescribed rivaroxaban should be educated to avoid taking oct medications or supplements that increase bleeding risk, such as NSAIDs (eg, aspirin), garlic, and ginger. -----the combined effects of rivaroxaban and other anticoagulants may greatly increase the risk of uncontrolled bleeding (eg, epidural, intracranial, gastrointestinal) and hemorrhage 1. 1) about a: unlike warfarin, factor Xa inhibitors are not affected by vitamin K, which is in many greens, leafy vegetables (eg, spinach, kale) 2) about b: anticoagulants, particularly factor Xa inhibitors, increase the risk for spontaneous intracranial bleeding or formation of epidural hematomas. clients taking factor Xa inhibitors should be instructed to immediately contact their hcp for symptoms of neurological impairment. 3) about d: routine monitoring of clotting times (eg, PT/INR/PTT) is unnecessary for clients prescribed factors Xa inhibitors educational objective: 1. the nurse should contact the client receiving Xa inhibitor (eg, rivaroxaban, edoxaban, apixaban) which ae anticoagulants, to avoid taking additional medication or supplements with anticoagulants effects (eg, NSAIDs, garlic, ginger) 2. the combined anticoagulant effects increase the risk for uncontrolled bleeding and hemorrhage

question the er nurse prepares a male client for surgery. the client was admitted with a traumatic open fracture of the femur, hematocrit of 36%, and hemoglobin of 12. which prescription should the nurse validate with hcp? a. cefazolin b. enoxaparin c. morphine d. tetanus toxoid

correct answer rational 1. the joint commission surgical improvement project CORE measures set shown that preventives (eg, enoxaparin, aspirin) in select surgical procedure, given 24 hours before and after surgery, reduce the risk of venous thromboembolism. however, the estimated blood loss in a client with a fracture can be significant depending on the site (ed, 250-1200). although this client's admission hematocrit 36% and hemoglobin are only slightly low for an adult male (normal 39-50%; 13.2-17.3), the blood loss may not yet be evident, therefore, the nurse would validate the prescription of enoxaparin (Lovenox) with he hcp before administration 2. medications commonly prescribed for a client with an open fracture: 1) cefazolin (Ancef), a bone-penetrating cephalosporin antibiotic that is active against skin flora (staphylococcus aureus); it is given prophylactically before and after surgery to prevent infection 2) cyclobenzaprine (Flexeril), a central and peripheral muscle relaxant given to treat pain associated with muscle spasm; carisoprodol (soma) or methocarbamol (Robaxin) can also be prescribed 3) tetanus and diphtheria toxoid, an immunization given prophylactically to prevent infection (Clostridium tetani) if immunization are not up to date (>10 years), unavailable, or unknown 4) ketorolac (Toradol), a nonsteroidal anti-inflammatory drug given to decrease inflammation and pain 5) opioids (eg, morphine, hydrocodone, given for analgesia) educational objective: medications commonly prescribed for a client with an open fracture to prevent infection and treat pain and muscle spasm include cefazolin (Ancef), tetanus toxoid, ketorolac (Toradol), opioid, and cyclobenzaprine (Flexeril)

question the nurse reviews the medication administration and lab results for assigned clients. which medication requires that the hcp be notified before administration? a. calcium acetate for a client with a phosphate level of 8.5 b. clopidogrel for a client with a platelet count of 70000 c. magnesium sulfate for a client with a magnesium level d. metformin for client with glycosylated hemoglobin level o 11%

correct answer 1. clopidogrel (Plavix) is a platelet aggregation inhibitor used to prevent blood clot formation in clients with recent myocardial infraction, acute coronary syndrome, cardiac stents, stoke, or peripheral vascular disease. -----because it can cause thrombocytopenia and increase the risk of bleeding, the nurse should notify the hcp of low platelet count (normal 150000-400000) before administering clopidogrel 2. 1) about a: calcium acetate (phoslo) is used to control hyperphosphatemia in clients with end-stage kidney disease by binding to phosphate in the intestine and excreting it in the stool. because the phosphate level is high (normal adult: 2.4-4.4), it is not necessary to notify the hcp. 2) about c: magnesium sulfate is used to correct hypomagnesium and treat torsade de points and seizure associated with eclampsia. because the magnesium level is low, it is not necessary to notify the hcp 3) about d: metformin (glucophage) is a first drug for the control of blood sugar in clients with type 2 diabetes mellites. glycosylated hemoglobin (A1c) measures the total hemoglobin that has glucose attached to it, expressed as a percentage. glucose remains attached to the red blood cell for the life of the cell (about 120 days) and reflects glycemic control over an extended period. the recommended A1c level for a client with diabetes is <7%. although the A1c level is elevated, the medication would be administered regardless of the result (unless the client is hypoglycemia), so it is not necessary to notify hcp education objective: clopidogrel (Plavix) can cause thrombocytopenia (platelet count <1500000) and increase a client's risk for bleeding

question the community health nurse prepares a teaching plan for a client with latent tuberculosis who is prescribed oral isoniazid (INH). which instructions should the nurse include? a. avoid drinking alcohol b. expect body fluids to change color to red c. report yellowing of skin or sclera d. report numbness and tingling of extremities e. take with aluminum hydroxide to prevent gastric irritation

correct answer 1. isoniazid (INH) is a first line antitubercular drug prescribed as monotherapy to treat latent tuberculosis infection. 1) combined with other drugs, INH is also used with active tuberculosis treatment. 2) two serious adverse effects of INH use are hepatotoxicity and peripheral neuropathy 2. a teaching plan for a client prescribed INH: 1) avoid intake of alcohol and limit use of other hepatotoxic agents (eg, acetaminophen) to reduce risk of hepatotoxicity 2) take pyridoxine (vitamin B6) if prescribed to prevent neuropathy 3) avoid aluminum-containing antacid (eg, aluminum hydroxide) within 1 hour of taking INH 4) report changes in vision (eg, blurred vision, vison loss) 5) report signs/symptoms of severe adverse effects such as: a. hepatoxicity (eg, scleral and skin jaundice, vomiting, dark urine, fatigue) b. peripheral neuropathy (eg, numbness, tingling of extremities) 3. 1) about a: rifampin, another antitubercular drug, often causes a red-orange discoloration of body fluids (ie, urine, sweat, saliva, tears). however, this effect is not associated with INH use 2) about e: concurrent use of antacids containing aluminum decrease INH absorption. the medication may be taken with food if gastric irritation is a concern educational objective: 1. common potential side effects of INH include hepatotoxicity (eg, jaundice, vomiting, dark urine, fatigue) and peripheral neuropathy (eg, numbness, tingling of extremities) 2. clients should avoid alcohol use and aluminum-containing antacids, and report any experienced side effect to the hcp

question the nurse in an ambulatory care center is teaching a client with a diagnosis of persistent depressive disorder (dysthymia) about the appropriate use of bupropion hydrochloride SR. which statement made by the client indicates a need for further teaching? a. if I have a sudden change in my mood, I should call my physician immediately b. if I have trouble swallowing the tablet, I can cut it in half c. if I miss a dose, I should not double the next dose to catch up d. it may take several weeks before I get better

correct answer rational 1. Bupropion hydrochloride (Wellbutrin) is an atypical antidepressant used to treat depressive disorders, including major depressive disorders, seasonal affective disorder, and persistent depressive disorder (dysthymia). preparations of bupropion hydrochloride include immediate-release, sustained release (SR), and extended-release (XL) tablets 2. any medication marked SR or XL should not be chewed, cut, or crushed due to the risk of adverse effects from too rapid absorption of the drug. no form of bupropion hydrochloride should be altered, tablet should be swallowed whole, with or without food. seizures are of particular concern if a client takes a high or toxic dose of bupropion hydrochloride 3. clients on any kind of antidepressant need to be monitor closely for worsening depression, sudden or unusual behavior or mood changes, and the emergence of suicidal thoughts and behaviors. clients with a diagnosis of depression and/or their family members need education and information on the increased risk of suicide 4. additional instructions to a client about the use of bupropion hydrochloride include the following: 1) limit alcohol: inform the hcp if you are used consuming large amounts of alcohol 2) do not double up on the medication if a scheduled dose is missed 3) take the medication at the same time each day 4) it may take several weeks to feel the effects of bupropion hydrochloride 5) weight loss may occur when taking this medication educational objective: 1. no form of bupropion hydrochloride should be crushed, chewed, or cut due to the risk of seizure and other adverse effect caused by the more rapid absorption and resulting serum levels of the drug. 2. no additions labeled SR or XL should be altered before they administrated. this type of medication should be swallowed whole

question the hcp prescribed paroxetine to a client with depression. what statement by the client indicates proper understanding of the medication? a. I can discontinue the medication if my symptoms improve b. I need a healthy diet and regular exercise to combat weight gain c. if I do not feel better in 1-2 weeks, then the medication is not working d. this medication might increase my sexual performance

correct answer rational 1. Paroxetine (Paxil) is a selective serotonin reuptake inhibitor (SSRI) often prescribed for major depression and anxiety disorder. 2. other SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), and sertraline (Zoloft). 3. weight gain is a common side effect of long-term SSRI use. the nurse should teach the client to eat a healthy diet and engage in regular exercise to combat the weight gain. 4. other major side effect of SSRIs includes increased suicide risk (at the beginning of therapy), sexual dysfunction, and serotonin syndrome when taken in excess doses 5. 1) about a: SSRIs should not be stopped abruptly without discussion with the hcp. dosage should be gradually tapered before discontinuation to avoid withdrawal symptoms 2) about c: most clients will start to see symptoms improvement in 1-2 weeks. however, some may take several weeks and require dose adjustments. clients should take the medication and discuss it with the hcp. 3) about d: SSRIs can cause sexual dysfunction. clients should notify the hcp for a change of medication or to add medication to increase sexual performance educational objective: 1. the major side effect of SSRIs include increased suicide risk (at the beginning of therapy), sexual dysfunction, weight gain, and serotonin syndrome (excess doses) 2. it may take several weeks for the therapeutic effects of SSRIs to begin; they should never be discontinued abruptly

question the clinic nurse reviews the medical record of a client who was prescribed etanercept, a tumor necrosis factors (TNF) inhibitor, which test results is most important for the nurse to check before initiating this treatment? a. c-reactive protein (CRP) b. prothrombin time (PT) c. serum LDL cholesterol d. tuberculin skin test

correct answer rational 1. TNF inhibitor drugs (eg, etanercept, infliximab, adalimumab) blocks the action of TNF, a mediator that triggers a cell-mediated inflammatory response in the body. 1) these drugs reduce the manifestation of rheumatoid arthritis (RA) and slow the progression of joint damage by inhibiting the inflammatory response 2) the medication cause immunosuppression and increased susceptibility for infection and malignancies 2. clients should have a baseline TST before initiating therapy and yearly skin test thereafter. those with latent tuberculosis must be treated with antitubercular agents before initiating treatment with these drugs. otherwise, TB reactivation would occur 3. 1) about a: CRP is non-specific test used to detect acute or chronic inflammation in the body. a. CRP can be used to evaluate the effectiveness of medications that decrease inflammation. b. an elevation would be expected in clients with RA, especially during a flare, but it is not the most important rest result to check before initiating therapy 2) LDL cholesterol and PT are unrelated to the administration of these medications educational objective: 1. major adverse effects of biologic disease-modifying TNF inhibitor drugs (eg, etanercept, infliximab, adalimumab) include severe infections and bone marrow suppression 2. TB reactivation is a major concern. therefore, all clients must receive a TST to rule out latent TB

question a nurse conducing rounds on a client receiving continuous total parenteral nutrition (TPN). the infusion pump is found to be powered down, and TPN is no longer infusion. which action should the nurse take first? a. notify the hcp that the infusion has stopped b. obtain a blood specimen for serum electrolyte testing c. obtain a STAT finger capillary blood glucose level d. remove the infusion pump and tag the device as malfunctioning

correct answer rational 1. TPN (total parental nutrition) is an IV nutrition solution containing carbohydrates, amino acids, vitamins, minerals, electrolytes, and lipids that is administered to clients who are unable to receive enteral nutrition. 2. TPN is rich in glucose, which supplies caloric energy and stimulates the pancreases to secrete insulin 3. if TPN is stopped abruptly, the pancreas may continue to secrete increased amounts of insulin in anticipation of glucose metabolism, placing the client at risk for rapid-onset hypoglycemia. ---therefore, clients whose TPN infusion has stopped or abruptly slowed should be assessed for signs of hypoglycemia and have blood glucose measured immediately, because hypoglycemia is associated with potentially life-threatening neurologic complications 4. 1) about a: the nurse must notify the hcp to obtain appropriate prescriptions for intervention and monitoring. however, the nurse should fist ensure the client's safety by assessing for hypoglycemia. 2) about b: obtaining a serum electrolyte panel may be necessary to identify electrolyte abnormalities. however, the nurse must first assess for hypoglycemia because this will occur more rapidly than changes in electrolyte status. 3) about d: removal, identification, and storage of defective equipment are important to prevent future adverse events. however, the nurse should assess the stabilize the client before handing malfunctioning equipment educational objective: 1. total parenteral nutrition (TPN) is a nutritional IV solution that is rich in glucose. 2. clients whose TPN delivery has stopped abruptly are at risk for severe hypoglycemia due to increased insulin production; therefore, the nurse should promptly assess the client for hypoglycemia.

question an elderly client with depression is given trazodone. which statement by the client indicates that additional teaching is needed? a. I will call the hcp if I develop a prolonged erection b. I will get up slowly, in stages, from supine to standing c. I will take this medication at night to avoid daytime drowsiness d. it's okay to drink 2 glasses of wine at night

correct answer rational 1. Trazodone (Oleptro), a serotonin modulator, is used to treat major depressive disorders. in addition to affecting serotonin levels, the drug blocks alpha and histamine (H1) receptors. 1) blockade of alpha receptors can cause orthostatic hypotension like that from other alpha blockers (eg, terazosin, tamsulosin) used to treat benign prostatic hyperplasia. 2) blockade of H1 receptors leads to sedation. therefore, this drug is particularly effective in treating insomnia associated with depression. 3) however, concurrent intake of other medication or substances that cause sedation can be detrimental; these include benzodiazepine (eg, alprazolam, lorazepam, diazepam), sedating antihistamines (eg, chlorpheniramine, hydroxyzine), and alcohol 2. 1) about a: priapism is a known serious side effect of trazodone. a client with an erection lasting several hours should go to the hospital 2) about b: clients should be advised to risk from supine to standing slowly, due to the risk of orthostatic hypotension. 3) about c: the drug should be taken at bedtime to avoid daytime sedation educational objective: 1. trazodone modulates serotonin levels in the brain 2. in addition, it blocks alpha and H1 receptors, leading to orthostatic hypotension and sedation, respectively 3. priapism is another serious side effect, thought rate

question a client with a history of degenerative arthritis is being discharged home following an exacerbation of chronic obstructive pulmonary disease. after reviewing the discharge medications, the nurse should educate the client about which topic? discharge medication: albuterol: 2 puffs every 4-6as needed prednisone: 40 mg po daily naproxen: 220 twice daily tiotropium: 1 capsule inhaled daily a. dryness of the mouth and throat may occur b. ringing in the ears is an expected, transient side effect c. the albuterol canister should not be shaken before use d. the hcp should be notified if stools are black and tarry e. tiotropium capsules should not swallow

correct answer rational 1. a common side effect of tiotropium (Spiriva) and other anticholinergics (eg, ipratropium, benztropine) is xerostomia (dry mouth) the to the blockade of muscarinic receptors of the salivary glands, which inhibits salivation. sugar-free candies or gum maybe used to alleviate dry mouth and throat 2. tiotropium capsules should not be swallowed. these capsules are placed inside the inhaler device, and the capsules is pierced, allowing the client to inhale its content 3. glucocorticoids (eg, prednisone), when taken in combination with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDS) such as naproxen, can increase the risk of gastrointestinal ulceration and bleeding. the client should report black, tarry stools (ie, melena) to the hcp as they could indicate gastrointestinal bleeding 4. 1) about b: tinnitus (ie, ringing in the ears) is uncommon side effect of NSAID (eg, naproxen) use. tinnitus is commonly associated with toxicity related to salicylate containing NSAIDS (eg, aspirin) or aminoglycoside (eg, gentamicin, neomycin, tobramycin); its onset should be reported by client taking this medication. the medication may need to be discontinued to prevent permanent hearing loss. 2) about c: the albuterol consider should be shaken prior to inhalation to ensure appropriate medication delivery educational objective: 1. the nurse should teach the client taking glucocorticoids with aspirin or nonsteroidal anti-inflammatory drugs about the risk for anterointernal bleeding or ulceration 2. xerostomia is a common side effect of anticholinergic drugs that can be alleviated with sugar-free or gum. 3. tiotropium capsules should not be swallowed

hematological/oncological question a client is receiving chemotherapy for acute myeloid leukemia. the hcp provider prescribed allopurinol to prevent tumor lysis syndrome (TLS) which lab values indicate the therapeutic to the medication? a. serum calcium 9.5 b. serum phosphate 4 c. serum potassium 4.5 d. serum uric acid level 6

correct answer rational 1. a potential complication of chemotherapy is acute tumor lysis syndrome (TLS) a rapid release of intracellular into the blood stream. 1) massive cell lysis releases intracellular ions (potassium and phosphorus) and nucleic acid into the bloodstream. 2) catabolism of the nucleic acid produces uric acid, resulting in severe hyperuricemia. release phosphorus binds calcium, producing calcium phosphate mixture but lowering serum calcium level 3) both calcium phosphate and uric acid are deposited into the kidney, causing renal injury 2. allopurinol (Zyl prim) blocks the nucleic acid catabolism and prevent hyperuricemia but would not affect potassium, phosphate, and calcium levels. 1) chronic gout and uric acid calculi also require the administration of allopurinol to decrease uric acid accumulation 2) a normal blood uric acid level for an adult male is 4.4-7.6 and female 2.3-6.6 3. 1) about a: the normal calcium level for adult is 8.6-10.2. the client with this complication would experience hypocalcemia 2) about b: the normal phosphate level for adults is 2.4-4.4. in this condition, the phosphate level would show hyperphosphamia. 3) about c: the normal potassium level for adult is 3.5-5. hyperkalemia is usually present in clients with this chemotherapy-induced complication educational objective: 1) the therapeutic effect of allopurinol (Zyloprim) is to decrease hyperuricemia caused by TLS 2) laboratory values of significance in TLS including rising blood uric, potassium, and phosphate levels, with decreasing calcium levels

question the nurse is preparing medication for 4 clients on a respiratory medical surg unit. which situation would promote the nurse to clarify the prescribed treatment with the hcp? a. clients with bronchospasm who is due to receive nebulized acetylcysteine b. clients with chronic obstructive pulmonary disease due to receive po prednisone c. clients with cystic fibrosis who is due to receive po pancrelipase with breakfast d. client with suspected bacterial pneumonia due to receive iv levofloxacin

correct answer rational 1. acetylcysteine (Mucomyst) may be given via nebulizer to help loosen and liquefy respiratory secretions to clear them form the airway more easily 1) inhaled acetylcysteine may be used for clients with cystic fibrosis or other respiratory conditions with thick bronchial mucus. 2) acetylcysteine has no therapeutic effect on airway smooth muscle as it works primarily on secretions and has been shown to cause and/or worsen bronchospasm. 3) nursing caring for clients with reactive diseases (eg, asthma) prescribed acetylcysteine should clarify the prescription with the hcp 2. 1) about b: chronic obstructive pulmonary disease (COPD) is a respiratory illness in which excess mucus, inflamed bronchioles, and easily collapsible airways trap air within the alveoli. oral corticosteroids (eg, prednisone) may be used to reduce airway inflammation and improve ventilation in clients with acute COPD exacerbation 2) about c: cystic fibrosis 囊性纤维化 is a genetic condition that cause dehydration and thickening of mucus in the respiratory, gestroinstinal, and genitourinary system. the mucus within the pancreas impairs the release of digestive enzyme (eg, lipase), requiring supplementation to improve digestion and prevent malnutrition in clients with CF 3) about d: levofloxacin (Levaquin) is a broad-spectrum antibiotic that maybe used to treat respiratory tract infections, such as bacterial pneumonia educational objective 1. acetylcysteine is a medication that can be inhaled to help loosen thick respiratory secretions. 2. nurse caring for clients with reactive airway disease (eg, asthma) who are prescribed acetylcysteine should clarify the prescription with the hcp as it may cause and/or worsen bronchospasm

question a parent rushes a 4year old child to the er after finding the child sitting on the kitchen floor holding an empty bottle of aspirin. the parent has no idea how many tablets in the container. the child is sniffling and quietly crying. the nurse anticipates initially implanting which treatment? a. activated charcoal b. gastric lavage c. sodium bicarbonate d. syrup of ipecac

correct answer rational 1. activated charcoal: an important treatment in early acetylsalicylic acid (ASA) toxicity. it is recommended for gastrointestinal decontamination in clients with clinical signs of ASA poisoning (disorientation, vomiting, hyperpnea, diaphoresis, restlessness) as well as in those who are asymptotic. activated charcoal binds to available salicylates, thus limiting further absorption in the small intestine and enhancing elimination 2. 1) about b: like syrup of ipecac, gastric lavage is associated with risk of aspiration. in addition, there is not convicting evidence that it decreases mobility. 1. it is not routinely recommended but may performed for the ingestion of a massive or life-threatening amount of drug. 2. if necessary, it should be administration within 1 hour of ingestion and require a protected airway and possible sedation 2) about c: IV sodium bicarbonate is appropriate treatment for aspirin toxicity after the administration of activated charcoal. it is given to make the blood and urine more alkaline, therefore promoting urinary excretion of salicylate. 3) about d: syrup of ipecac has been shown to have minimal benefit in treating aspirin overdose; in addition, it is not recommended due to the risk of aspiration pneumonia secondary to induced vomiting educational objective: 1. activated charcoal is used as the initial treatment for aspirin overdose in clients with clinical signs of salicylate toxicity as well as in those who are sympathetic 2. activated charcoal binds with salicylate and therefore inhibits absorption by the small intestine. IV sodium bicarbonate is also used for treating aspirin overdose after treatment with activated charcoal has been initiated.

question a client with an asthma exacerbation has been using her albuterol rescue inhaler 10-12 times a day because she cannot take a full breath. what possible side effect of albuterol does the nurse anticipate the client will report? a. constipation b. difficulty sleeping c. hives with pruritus d. palpitations e. tremor

correct answer rational 1. albuterol is a short-term beta-adrenergic agonist used as a rescue inhaler to treat reversible airway obstruction associated with asthma 1) dosing in an acute asthma exacerbation should not exceed 2-4 puffs every 20 minutes X3; if albuterol is not effective, an inhaled corticosteroid is indicated to treat the inflammatory component of the disease. 2) albuterol is a sympathomimetic drug. 3) expected side effect mimic manifestations related to stimulation of sympathetic nervous system, and commonly include insomnia, nausea and vomiting, palpitations (from tachycardia) and mild tremor 2. 1) about a: constipation is not a common side effect of inhaled beta-agonist drugs 2) about c: hives can occur as a sign of an allergic reaction and are not a common anticipated side effect of an inhaled beta-agonist drug educational objective: 1. albuterol is a short-term beta agonist rescue drug used to control symptoms of airway obstruction and promote bronchodilation. 2. it is a sympathomimetic drug, common expected side effect includes insomnia, nausea and vomiting, palpitation (tachycardia), and mild tremor

question the parent of a child diagnosed with attention-deficit hyperactivity disorder (ADHD), predominantly inattentive type, says to the nurse. "I hate the idea of my child taking a drug that's a stimulant" how will I know that the methylphenidate is even working? which is the best response by the nurse? a. methylphenidate is generally a safe and effective drug for children with ADHD b. methylphenidate will increase the levels of neurotransmitters in your child's brain c. you should see your child's school grades improve d. your child should be able to be more easily complete school assignments and other tasks

correct answer rational 1. although methylphenidate (eg, Ritalin, Concerta) is classified as a stimulant, in children with ADHD it improves attention, decreases distractibility, helps maintain focus on an activity, and improves listening skills. 1) for many years, the effects of methylphenidate in children were labeled as paradoxical. 2) no research has shown that methylphenidate significantly increases level of dopamine in the central nervous system (CNS) that lead to stimulation of the inhibitory system of the CNS. methylphenidate works quickly, symptoms relief is often seen after the first dose 2. 1) about a: this is the true statement, methylphenidate is generally safe for most children, adolescent, and adults. methylphenidate can cause adverse reactions, but these affect a very small percentage of users. however, this response does not address the patient's question about how the drug works 2) about b: this is a true statement but does not give the parent information about the benefits of methylphenidate. in addition, it contains language that most clients would not understand 3) about c: a child's school grades may improve due to the benefits of methylphenidate. this would be seen over times as a secondary benefit; the immediate therapeutic effects are often observed with the first dose educational objective: 1. the therapeutic effects of methylphenidate can be observed very quickly in children with ADHD 2. methylphenidate improves attention, decrease distractibility, helps maintain focus on activity, and improve listening skills

question the nurse is providing instruction on the proper use of prescribed short-acting beta agonist and inhaled corticosteroid metered-dose inhaled to a client with newly diagnosed asthma. which instruction should the nurse include? a. omit the beclomethasone if the albuterol is effective b. rinse your mouth well after using the beclomethasone inhaler and do not swallow the water c. take the albuterol inhaler apart and wash it after every use d. use the albuterol inhaler first if needed, then the beclomethasone inhaler e. use the beclomethasone inhaler first, then the albuterol, if needed

correct answer rational 1. asthma is a disorder of the lung characteristized by reversible airway hyper-reactivity and chronic inflammation of the airway. 1) albuterol (Proventil) is a short acting beta agonist (SABA) administered as a quick-relief, rescue drug to relieve symptoms (eg, wheezing, breathlessness, chest tightness) associated with intermittent or persistent asthma. 2) beclomethasone (Beconase) is an inhaled corticosteroid (ICS) normally used as a long-term, first-line drug to control chronic airway inflammation 2. when using an ICS metered-dose inhaler (MDI), small particles of the medication are deposited and can impact the tongue and mouth. 1) rinsing the mouth and throat well after using the MDI and not swallowing the water are recommended to help prevent a candida infection (white spots on tongue, buccal mucosa, and throat), a common side effect of ICSs. 2) the use of a spacer with the inhaler can also decrease the risk of developing thrush. 3. 1) about a: inhaled corticosteroid (eg, fluticasone, beclomethasone) are not rescue drugs, they are prescribed to be taken on a regular schedule (eg, morning, bedtime) on a long-term basis to prevent exacerbations and should not be omitted even if the SABA is effective 2) about c: taking the albuterol (Proventil) inhaler apart, washing the mouthpiece (not canister) under warm running water, and letting it air dry at least 1-2 times is recommended. medications particles can deposit in the mouthpiece and prevent a full dose of medication from being dispensed. taking the ICS inhaler apart and cleaning it every day is recommended educational objective: 1. proper use of the short-acting beta agonist (SABA) inhaler includes talking it apart and rinsing the mouthpiece with warm water 1-2 times a week 2. proper use of the inhaled corticosteroid inhaler including taking it apart and rinsing the mouthpiece with arm water daily and rinsing the mouth and throat after each use to prevent a candida infection. 3. when these medication are administered together, the sequence is SABA first to open the airways and ICS second

question a pediatric client is diagnosed with an acute attack, which immediate-acting medications should the nurse prepare to administer to this client? a. albuterol b. ibuprofen c. ipratropium d. montelukast e. tobramycin

correct answer rational 1. asthma is an inflammatory condition in which the smaller airway and become filled with mucus. breathing, especially on expiration, becomes more difficult. 1) oxygen to maintain saturation >90% 2) high dose inhaled short-acting beta agonist (albuterol or levalbuterol) and anticholinergic agent (ipratropium) nebulizer treatment every 20 minutes 3) systemic corticosteroids (Solu-medrol) to control the underlying inflammation. these will take some time to show an effect 2. 1) about b: nonsteroidal anti-inflammatory agents (eg, ibuprofen, naproxen, indomethacin) and aspirin can worsen asthma symptoms in some clients and are not indicated unless necessary 2) about d: Montelukast (singular) is a leukotriene (chemical mediator of inflammation) inhibitor and is not used to treat acute episodes. it is given orally in combination with beta agonists and corticosteroid inhalers (eg, fluticasone, budesonide) to provide long-term control 3) about e: tobramycin is an aminoglycoside antibiotic, it is used in aerosolized form to treat cystic fibrosis exacerbation when pseudomonas is the predominant organism causing lung infection educational objective: 1) inhaled corticosteroids and leukotrienes inhibitors are typically used to achieve and maintain control of inflammation for long tern management of asthma 2) quick-relief medications (eg, albuterol, ipratropium) are used to treat acute symptoms and exacerbations

question the nurse has provided education for a client newly prescribed alprazolam for generalized anxiety disorder. which client statement indicates that teaching has been effective? a. eliminating aged cheeses and processed meals from my diet is essential b. I can skip doses on days that I am not feeling anxious c. I will take my daily at bedtime d. using sunscreen is important as this drug will make the sensitive to sunlight

correct answer rational 1. benzodiazepines (eg, alprazolam, lorazepam, clonazepam, diazepam) are commonly used antianxiety drugs. they work by potentiating endogenous GABA, a neurotransmitter that decreases excitability of nerve cells, particularly in the limbic system of the brain, which controls emotions. 2. benzodiazepines may cause sedation, which can interfere with daytime activities. giving the dose at bedtime will help the client sleep 3. 1) about a: eliminating aged cheese and processed meats, which contain tyramine, is necessary with monoamine oxidase inhibitors (eg, tranylcypromine, phenelzine), which are used for depressive disorders. it is not necessary with benzodiazepines 2) about b: a benzodiazepine should never be stopped abruptly. instead, it should be tapered gradually to prevent rebound anxiety and a withdrawal reaction characterized by increased anxiety, confusion and more. 3) about d: photosensitivity is a problem with most antipsychotics and many antidepressants, but not with benzodiazepines. educational objective: 1. benzodiazepines have a sedative effect and should be administered at bedtime possible 2. benzodiazepines should never be stopped abruptly in long-term users as this can precipitate withdrawals symptoms

psychiatric medication question the nurse reviews a client's medical record and notes the following prn medication prescription: acetaminophen, haloperidol, and benztropine. a. muscle rigidity and shuffling gait b. nihilistic delusion c. tangentiality d. waxy flexibility

correct answer rational 1. benztropine (Cogentin) is an anticholinergic medication used to treat some extrapyramidal syndrome, which are side effects of some antipsychotic medications. these side effects include: 1) pseudoparkinsonism: symptoms that resemble parkinsonism (eg, masklike face, rigidity, resting tremor, psychomotor retardation (bradykinesia)) 2) dystonia: abnormal muscle movements of the face, neck, and trunk caused by sustained muscular contractions (eg, torticollis, oculogyric crisis, opisthotonos) 2. about acd: delusions are a symptom of schizophrenia. tangentiality 正切(deviating from the original topic of discussion) is abnormal though process seen in schizophrenia. waxy flexibility (tendency to remain in an immobile posture) is a motor disturbance seen in schizophrenia. all are treated with antipsychotic medication 3. haloperidol typical antipsychotic medication educational objective: benztropine (Cogentin) is an anticholinergic drug used to treat extrapyramidal symptoms, which are side effect of some antipsychotic medication

question the nurse is preparing to administer a client with endometrial cancer to the oncology unit for brachytherapy via a sealed cervical implant. which of the following interventions are appropriate to include in the plan of care for his client? select all a. assign the client to lead-lined room and ensure availability of lead shields b. cluster care to limit the amount of time in the client's room c. ensure all staff caring for the client are wearing their own dosimeter badge d. instruct the client to be careful not to dislodge the implant when repositioning e. teach visitors to stay at least 6 ft away from the client

correct answer rational 1. brachytherapy is an internal radiation treatment that is ingested, injected into the blood stream or implanted (eg, seeds, wires) directly into or near the tumor. clients with permanent radiotherapy implants emit low dose of over an extended time and typically do not pose a risk of radiation expose to others. 2. the plan of care for a client with temporary brachytherapy implants should include the following: 1) use appropriate shielding (eg, place client in a lead room, use lead shields and apron) to limit exposure 2) limit each person's time of exposure to the client (eg, cluster care, 30 minutes per shift) 3) assign all staff members involved in the client's care for their own dosimeter badge to measure radiation exposure, and instruct them to wear it during every shift 4) instruct the client to remain on bed rest, and use caution when repositing to avoid device dislodgement 5) maximize distance from the client educational objective: 1. to avoid radiation exposure from temporary brachytherapy implants, caregivers and visitors should limit time in the client's room maximum distance from the client, and use appropriate shielding. 2. the client should remain on bed rest and use caution when repositioning, and all staff numbers should wear their own dosimeter badge

question the nurse reinforces teaching for a client newly buspirone for generalized anxiety disorder. which client statesmen indicates that teaching has been effective? a. driving is not recommended until I stop taking this medication b. if I experience a panic attack I should take an extra dose of medication c. it will be 2-4 weeks before I feel the full effect of this medication d. withdrawal symptoms will occur if I abruptly stop taking this medication

correct answer rational 1. buspirone (Buspar) is an anxiolytic medication that differs from other medications used to manage anxiety disorders (eg, benzodiazepines) because it typically lacks central nervous system depressant effects and has a low abuse potential. 2. therefore, Buspirone has a favorable side -effect profile because it usually does not produce withdrawal symptom, dependence, or psychomotor slowing (eg, slowing of thought, impaired movement) 3. however, unlike other anxiolytic medication, buspirone does not work immediately. onset of symptoms relief occurs after 1 week of therapy, with full effects occurring between 2 to 4 weeks 4. 1) about a: as with any medication, the nurse should adverse clients to avoid until individual effects are known. however, it is unlikely that buspirone will cause psychomotor impairment and require cessation of driving or operating machinery for the duration of treatment 2) about b: buspirone should be taken as prescribed and is not indicated for relief of acute anxiety or panic attacks, the hcp provider may prescribe an additional medication with a fast-acting effect for panic attacks 3) about d: buspirone does not cause physical dependence or tolerance, and withdrawal symptoms do not occur with discontinuation of use educational objective: 1. buspirone is an anxiolytic medication that does not have central nervous system depressant effects; therefore, it does. not cause dependence, tolerance, psychomotor slowing, or withdrawal symptoms 2. full therapeutic effects occur between 3 and 4 weeks of therapy

question which medication prescription should the nurse question? select all that apply a. cephalexin for a client with severe allergy to penicillin b. fexofenadine for a client with hives c. ibuprofen for a client with asthma and nasal polyps d. lisinopril for a client with diabetes mellitus e. propranolol for a client with asthma

correct answer rational 1. cephalexin is a cephalosporin, which is chemically like penicillin. if a client has had a severe allergic reaction to penicillin, there is a 1%-4% chance of an allergic reaction (cross-sensitive) to a cephalosporin 2. clients with nasal polys often have sensitivity to nonsteroidal anti-inflammatory drugs (NSAIDS), including aspirin. NSAID can exacerbate asthma symptoms. therefore, acetaminophen may be a better choice for these client 3. the selective beta blockers (eg, metoprolol, atenolol, bisoprolol) are generally given for heart failure and hypertension control due to their beta-blocking effect. the nonselective beta blockers (eg, propranolol, nadolol), in addition, have beta-blocking effect that results in bronchial smooth muscle constriction. therefore, nonselective beta blockers are generally contradicted in client with asthma 4. 1) about b: H1 receptor antagonists (eg, fexofenadine, cetirizine, levocetirizine, loratadine) decrease the inflammatory response by blocking histamine receptors. histamine is released from mast cells during a type (immediate) hypersensitivity reaction (ie, allergic rhinitis, allergic conjunctivitis, and hives) 2) about d: angiotensin-converting (ACE) inhibitors are the drug of choice in diabetic clients with hypertension or proteinuria. this would be an appropriate administration educational objective: 1. clients with asthma and nasal polys can have sensitivity of NSAIDS; those with an allergy to penicillin can have a cross-sensitivity to cephalosporins 2. nonselective beta blockers are contraindicated in clients with asthma 3. H1 receptor antagonists block histamine in an allergic reaction. 4. ACE inhibitors are protective for diabetic nephropathy

question the nurse is caring for a client who started receiving chemotherapy 10 days ago. today, the hcp prescribes filgrastim. which of the following is an expected outcome of this medication? a. decrease in serum uric acid b. increase in hemoglobin level c. increase in neutrophil count d. increase in platelet count

correct answer rational 1. chemotherapy can cause suppression of rapidly reproducing cells, including bone marrow suppression. this can result in decreased red blood, white blood cell, and platelets, all manufactured in the bone marrow 1) it is most likely to be seen with chemotherapy (venous radiation), with the lowest counts (the nadir) usually at 7-10 days after therapy initiation. 2) leukopenia is a decrease in total circulating white blood cell count (<4000) and neutropenia is a decrease in circulating neutrophils (<1500) 2. filgrastim (neupogen) and peg filgrastim (neulasta) stimulate neutrophil production and are given prophylactically or if the client has an infection and more neutrophils are needed to fight it 3. 1) about a: cancer chemotherapy cause cell lysis, which result in tumor lysis syndrome due to massive release of nucleic acid and its metabolic products, uric acid. uric acid deposition leads to acute kidney injury. medications such as allopurinol or rasburicase and aggressive IV hydration are used to prevent this complication 2) about b: anemia is also common with chemotherapy. epoetin (procrit), a form of erythropoietin, stimulates the body to make additional red blood cells 3) about d: low platelet count is not considered an urgent need until it is at<5000, usually platelet transfusion is given educational objective: 1. bone marrow suppression form chemotherapy can cause decreased red blood cells, and platelet. 2. erythropoietin is used to increase red blood cell production, and filgrastim is administrated neutrophil production

question the nurse on the behavioral health unit reviewing medication prescription for 4 clients. which combination of medication does the nurse question? a. a client with anxiety prescribed escitalopram and alprazolam b. a client with bipolar disorder prescribed risperidone and lithium c. a client with depression prescribed escitalopram and selegiline d. a client with depression prescribed sertraline and zolpidem

correct answer rational 1. clients are often prescribed medications from more than one class to effectively treat anxiety and depression; 1) however, monoamine oxidase inhibitors (MAOIs) (eg, selegiline (Emsam)) interact with many medications, including many antidepressants. 2) concurrent use of MAOIs with selective serotonin reuptake inhibitors (SSRIs) (eg, escitalopram (Lexapro)) may prescriptive life-threatening adverse reactions (eg, serotonin syndrome, neuroleptic malignant syndrome, hypertensive crisis) 2. if a client's prescribed medication regimen will change to or from an MAOI, the existing medication should be tapered and discontinued, followed by a 2 week "washout" period without either medication. the client can then take the new medication 3. 1) about a&d: SSRIs (eg, citalopram (Celexa), escitalopram (Zoloft)) can be given safely with benzodiazepines (eg, alprazolam (Xanax), lorazepam (Ativan) or hypnotics (eg, zolpidem (Ambien) 2) about b: clients with bipolar disorder often need antipsychotic medication (eg, Risperidone (Riseperdal), Haloperidol (Haldol)) to control acute psychosis and lithium for long-term maintenance therapy educational objective: 1. monoamine oxidase (MAOIs) (eg, Selegiline (Emsam)) interacts with many medications, including many antidepressants. 2. MAOIs and selective serotonin should not be given with 2 weeks of each other to prevent adverse reactions (eg, serotonin syndrome, neurologic malignant syndrome, hypertensive crisis)

question a client is having a severe asthma attack lasting over 4 hours after exposure to animal dande. on arrival, the pulse is 128, respiration 36, pulse oximetry 86% on room air, and the client is using accessory muscle to breath. lung sounds are diminished and high pitched wheezes are present on expiration. based on this assessment, the nurse anticipates the administration of which of the following medication a. inhaled albuterol nebulizer every 20 minutes b. inhaled ipratropium nebulizer every 20 minutes c. intravenous methylprednisolone d. montelukast 10 mg by mouth stat e. salmeterol metered-dose inhaler every 20 minutes

correct answer rational 1. clinical manifestations characteristic of moderate to severe asthma exacerbations include: tachycardia (>120) tachypnea (>30) saturation<90% on room air, use of accessory muscle to breathe, and peak expiratory flow (PEF) < 40% of predicted or best (<150) 2. pharmacologic treatment modalities recommended by the global initiative for asthma to correct hypoxemia, improve ventilation, and promote bronchodilation include: 1) oxygen to maintain saturation >90% 2) high dose inhaled short-acting beta agonist (SABA) (albuterol) and anticholinergic agent (ipratropium) nebulizer treatments every 20 minutes 3) systemic corticosteroid (Solu-medrol) 3. 1) about d: montelukast (singular) is a leukotriene 白三烯receptor blocker with both bronchodilator and anti-inflammatory effects it is used to prevent asthma attacks but is not recommended as an emergency rescue drug in asthma 2) about e: a long-acting beta agonist (salmeterol) is administered with an inhaled corticosteroid for long-term control of moderate to severe asthma; it is not used as an emergency rescue in asthma educational objective: 1. clinical manifestation characteristic of moderate to severe asthma exacerbation include tachycardia, tachypnea, saturation<90% on room air, use of accessory muscle of respiration, and PEF <40% predicted. 2. management includes the administration of high-dose inhaled SABA and ipratropium nebulizer, systemic corticosteroids, and oxygen to maintain saturation >90%

question the nurse prepares to administer clozapine to a client with schizophrenia. which client statement would require priority investigation before administrating the medication? a. I have gained a few pounds since I started this medication b. I have had a sore throat for 3 days and feel feverish today c. I have noticed increased salivation and drooling d. I often feel sleepy when I take this medication

correct answer rational 1. clozapine (Clozaril) is an atypical antipsychotic medication used to manage schizophrenia in client who have not improved with other antipsychotic medications ---clozapine is highly effective at controlling schizophrenia; however, it has many severe, life-threatening adverse effects, including agranulocytosis, cardiac disease (myocarditis), and seizure. 2. agranulocytosis (decreased neutrophils) increases the risk for infection. clients require serial monitoring of white blood cell counts and frequent assessment for signs of infection (eg, sore throat, fever, flulike symptoms), which should be reported immediately to hcp 3. 1) about a: weight gain is a common side effect. clients should be educated about weight management 2) about c: hypersalivation and a drooling are common side effect. when excessive, they can occasionally pose risk for aspiration, especially while the client is sleeping. this is important but not an immediate priority. the side effect can be reduced by lowering the dose. the client should chew sugarless gum to promote swallowing and reduce drooling 3) about d: many clients experience significant sedation when the medication is started. most will develop tolerance to this and eventually improve educational objective: 1. clozapine, an atypical antipsychotic, is used to manage schizophrenia in clients who have not improved with other medication 2. clozapine may cause agranulocytosis粒细胞缺乏症, which increase the risk of life-threatening infection. 3. clients receiving clozapine should monitored for signs of infection (eg, fever, flulike symptoms)

respiratory question a nurse has received new medication prescription for a client admitted with hypertension and an exacerbation of chronic obstructive pulmonary disease. which prescription should the nurse question? a. amlodipine b. codeine c. ipratropium d. methylprednisolone

correct answer rational 1. codeine is a narcotic analgesic used for acute pain or as a cough suppressant. depressing the cough reflex can cause an accumulation of secretion in the presence of chronic obstructive pulmonary disease, leading to respiratory difficulty. 2. in general, sedatives (eg, narcotics, benzodiazepines) can also depress the respiratory center and efforts; therefore, they should not be given to clients with respiratory disease (eg, asthma, COPD) 3. 1) about a: calcium channel blockers (eg, amlodipine, nifedipine) are used to treat hypertension and do not worsen bronchoconstriction, unlike beta blockers (eg, metoprolol, atenolol) 2) about c: ipratropium (Atrovent) is a short-acting inhaled anticholinergic often used in combination with short acting beta agonist (eg, albuterol) to promote bronchodilation and reduce bronchospasm 3) about d: methypresdnisone (solumedrol) is a systemic glucocorticoid that improves respiratory and overall lung function in clients experiencing an exacerbation of COPD educational objective: 1. codeine is a narcotic medication with antitussive properties that can cause an accumulation of secretions in clients with chronic obstructive pulmonary disease and lead to respiratory distress. 2. cautions is adverse when sedative are prescribed for clients with respiratory disease

question: an elderly client is prescribed codeine for a severe cough, the home health nurse teaches the client how to prevent the common adverse effects associated with codeine. which client statement indicate an understanding of how to prevent them? select all a. I will be sure to apply sunscreen if I go outside b. I will drink 8 glasses after water a day c. I will drink decaffeinated coffee so I can sleep at night d. I will sit on the side of my bed for a few minutes before getting up e. I will take my medicine with food

correct answer rational 1. codeine is an opioid prescribed as an analgesic to treat mild to moderate pain and as an antitussive to suppress the cough reflex. 1) although the antitussive dose (10-20 every 4-6 hours) is lower than the analgesic dose. clients can still experience the common adverse effects (eg, constipation, nausea, vomiting, orthostatic hypotension, dizziness) associated with the drug 2) codeine decrease gastric motility, resulting in constipation, increasing fluid intake and fiber in the diet, and taking laxatives are effective measures to prevent constipation 3) changing position slowly is effective in preventing the orthostatic hypotension associated with codeine, especially in the elderly 4) taking the medication with food is effective in preventing the gastroinstinal irritation (eg, nausea, vomiting) associated with codeine 2. about a/c: these statements are inaccurate as photosensitivity, insomnia, palpitations, and anxiety are not adverse effects associated with codeine educational objective: 1. the common adverse effects of codeine, an opioid drug, include constipation, nausea, vomiting, orthostatic hypotension, and dizziness. 2. interventions to help prevent them include increasing fluid intake and bulk in the diet, taking the medication with food, and changing position slowly

question which client finding would be a contraindication for the nurse to administer dicyclomine hydrochloride for irritable bowel syndrome? a. bladder scan showing 500 ml urine b. hemoglobin of 11 c. history of cataract d. reporting frequent diarrhea today

correct answer rational 1. dicyclomine [ˈdaɪsaɪkləmaɪn] hydrochloride (Bentyl) is an anticholinergic medication. 1) anticholinergics are used to relax smooth muscle and dry secretion 2) anticholinergic side effects include pupillary dilation, dry mouth, urinary retention, and constipation 3) therefore, the classic contraindication are closed-angle glaucoma, bowel ileus, and urinary retention 2. the urge to urinate is normally present at 300 mL; pain is usually felt around 500 mL. this client has urinary retention and should not have the bladder smooth muscle further relaxed 3. 1) about b: anticholinergic drugs do not affect the blood count. the normal reference range for hemoglobin is 11.7-15.5 female/13.2-17.3 male 2) about c: the common eye contraindication is narrow-angle glaucoma as it could worsen the condition. cataracts are a clouding of the lens and are not related to drainage flow 3) about d: diarrhea is an expected finding with irritable bowel syndrome or other increased peristalsis and is common reason for the drug to be prescribed. ----anticholinergic drugs are contraindicated in the presence of a bowel ileus or atony as constipation is a side effect and further relaxation of the intestine could worsen three condition. educational objective: 1. anticholinergic drugs are contraindicated when smooth muscle relaxation is already concern 2. commonly cited contraindications include narrow-angle glaucoma, urinary retention (including benign prostatic hyperplasia), and bowel ileus/obstruction

question the student nurse is caring for a client with iron deficiency anemia who is newly prescribed ferrous sulfate. which action by the student nurse requires the supervising nurse to intervene? a. encourage the client to drink extra fluids while taking ferrous sulfate b. offers the client orange juice for administration of ferrous sulfate c. plans to administer ferrous one hour before breakfast d. prepare to administer a prescribed calcium supplement with ferrous sulfate

correct answer rational 1. ferrous sulfate is an oral iron supplement prescribed to prevent or treat iron deficiency anemia, which occurs when the body lacks sufficient iron, an essential mineral in the formation of new RBC 1) low iron levels may result from malabsorption, insufficient intake increased requirements (eg, pregnancy) or blood loss. 2) the nurse should avoid administrating calcium supplement or antacid with/within 1 hour of ferrous sulfate because calcium decrease iron absorption 2. 1) about a: taking an iron supplement increase the client's risk for constipation. instructing the client to increase fluid intake during therapy may help prevent hard stools 2) about bc: taking an iron supplement with vitamin C (eg, orange juice) further enhance duodenal acidity and increases absorption. an acid-rich environment enhances iron absorption, so oral supplements should be taken 1 hour before or 2 after meals educational objective. 1. ferrous sulfate is an oral iron supplement to prevent or treat iron deficiency anemias 2. the nurse should administer the medication 1 hour before or 2 hours after meals because it is best absorbed in an acidic environment. 3. antacids or calcium supplements absorption of iron if administrated with or within 1 hour of ferrous sulfate.

question: a client with asthma was recently prescribed fluticasone/salmeterol. after the client has received instructions about this medication. which statement would require further teaching by the nurse? a. after taking this medication, I will rinse my mouth with water b. at the first sign of an asthma attack, I will take this medication c. I have been smoking for 12 years, but I just quit a month ago d. I received the pneumococcal vaccine about a month ago

correct answer rational 1. fluticasone/salmeterol (Advair) is a combination drug containing a corticosteroid (fluticasone) and a bronchodilator (salmeterol). 1) salmeterol is a long-acting inhaled b12-adrenergic agonist that promotes relaxation of the bronchial smooth muscle over 12 hours. 2) fluticasone decreases inflammation. this medication is used as part of the treatment plan for prevention and long-term control of asthma. 2. client's instruction include: 1) after inhalation, rinse the mouth with water without swallowing to reduce the risk of oral/esophageal candidiasis 2) avoid smoking and using tobacco produces. 3) receive the pneumococcal and influenza vaccines if there is a risk for infection 3. about b: fluticasone/salmeterol is not a rescue inhaler and does not treat acute exacerbation of asthma. The client should always have a rescue inhaler (eg, albuterol (short acting b2 adrenergic agonist) or ipratropium for sudden changes in breathing and call 911 if the rescue inhaler does not relieve the breathing problem) educational objective: 1. fluticasone/salmeterol (Advair) is a long-acting inhaled b2-adrenergic agonist combination drug containing a corticosteroid (fluticasone) and a bronchodilator (salmeterol) 2. it is used for long-term control of asthma but not for acute attacks

question the nurse care for a client following a percutaneous coronary via the right groin. the client received an iv infusion of abciximab during the procedure. which action should the nurse question? a. assess invasive procedure sites for bleeding b. check hemoglobin and platelet count c. initiate a second large-bore iv line d. place the client on continuous cardiac monitoring e. report black tarry stools to the hcp

correct answer rational 1. glycoprotein (GP) llb/lla receptor inhibitors (eg, abciximab, eptifibatide, tirofiban) are used as platelet inhibitors to prevent the occlusion of treated coronary arteries during percutaneous coronary intervention procedures and prevent acute ischemic complications 1) GP IIb/IIa receptor inhibitors can cause serious bleeding. 2) the nurse should closely monitor the client for any bleeding at the groin puncture site after the percutaneous coronary intervention 2. the nurse should check the client's baseline complete blood count (eg, hemoglobin, platelet count). 1) some clients may develop serious thrombocytopenia within a few hours, further increasing the bleeding risk 2) hypotension, tachycardia changes in heart rhythm, blood in the urine, abdominal/back pain, mental status changes, and black tarry stools may also indicate internal bleeding and should be monitored carefully when GP IIb/IIa receptor 3. about c: during and after the infusion of GP IIb/IIa receptor inhibitors, no traumatic procedures (initiation of IV sites, intramuscular injection) should be performed unless necessary due to the risk of bleeding educational objective: 1. glycoprotein IIB/IIA receptor inhibitors (eg, abciximab, eptifibatide, tirofiban) inhibitor platelet and increase bleeding risk. 2. serious thrombocytopenia can occur within few hours, further increasing bleeding risk 3. after administration, the nurse should monitor the client's blood counts, blood pressure, and heart rate and rhythm, as well as watch for signs of bleeding

question the nurse is caring for a client with cirrhosis who has hepatic encephalopathy. the client is prescribed lactulose. which assessment by the nurse will most likely indicate that the medication has achieved the desired therapeutic effect? a. higher potassium level b. improved mental status c. looser stool consistency d. reduced abdominal distension

correct answer rational 1. hepatic encephalopathy in cirrhosis results from higher serum ammonia levels that cause neurotoxic effect, including mental confusion. 1) oral lactulose is given to reduce the ammonia by trapping it in the gut and then expelling it with a laxative effect 2) improved mental status implies reduction of ammonia levels 2. 1) about a: clients with cirrhosis typically have hypokalemia due to hyperaldosteronism高醛甾酮症 (as aldosterone is not metabolized by the damaged liver). 2) about c: lactulose is a laxative. in cirrhosis, constipation (which allows more ammonia to be absorbed) and hard stool (which irritates hemorrhoids) are to be avoided. however, the main purpose of lactulose is expelling the ammonia, with resulting benefits. 3) about d: abdominal distension (ascites) in cirrhosis is treated with diuretics (eg, furosemide, spironolactone) and paracentesis. lactulose do not influence this pathology or symptom educational objective: 1. lactulose is a laxative used to trap and expel ammonia in clients with cirrhosis who have hepatic encephalopathy 2. elevated ammonia level cause mental confusion

question a client with a history of cirrhosis has a new prescription for lactulose 30 ML 4 times a day. what does the nurse explain to the client about this medication? a. it will decrease intestinal absorption of ammonia b. it will facilitate diuresis of excess fluid c. it will promote renal excretion of bilirubin d. it will reduce portal pressure contributing to esophageall varices

correct answer rational 1. lactulose is a syruplike liquid that decrease intestinal ammonia absorption in clients with liver disease and hepatic encephalopathy. 1) hepatic encephalopathy occurs when the failing liver does not adequately detoxify ammonia in the body, leading to changes in mental status and death if not adequately and promptly treated. 2) the lactulose dosing frequently should be adjusted to ensure 2-3 soft stools per day with no confusion or lethargy 2. 1) about b: spironolactone [spaɪˈrɑːnəˈlækˌtoʊn], an aldosterone inhibitor and potassium-sparing diuretic, is typically used in a client with liver failure, ascites, and edema to promote diuresis and to prevent fluid retention. if more diuresis is needed, then intravenous furosemide is used, often in combination with albumin infusion. 2) about c: lactulose does not promote renal excretion of bilirubin 3) about d: a TIPS (trans jugular intrahepatic portosystemic shunt) produce, and beta blockers (propranolol) are used to reduce portal pressure in the client with liver failure and esophageal varices educational objective: lactulose controls ammonia levels in hepatic encephalopathy by reducing intestinal absorption of ammonia with excretion in the stool

question the register nurse supervises a student nurse who is caring for a client newly prescribed lithium for the treatment of bipolar disorder. which action by the nurse indicate a need for further teaching? a. adverse the client to drink 2-3 liters of water each day b. instruct the client to limit intake of cola, tea, and alcohol c. shows the client how to carefully check food label to follow a low sodium diet d. teaches the client that it may take up to several weeks for the drug to be effective

correct answer rational 1. lithium carbonate is a mood stabilizer used for treatment bipolar disorder. 1) lithium levels take some time to reach therapeutic levels, often up to a few weeks. 2) clients will need to have their lithium levels carefully monitored when starting therapy, as the therapeutic range is narrow (0.6-1.2) 2. blood sodium levels affect the renal excretion of lithium, as lithium and sodium are excreted in a parallel mechanism by the kidney. 1) if sodium intake is limited or the body is depleted of its normal sodium (eg, excessive perspiration, vomiting, diarrhea), lithium is reabsorbed by the kidney, increasing the possibility of toxicity. 2) therefore, client on lithium must consume adequate sodium in the diet 3. care should be taken to avoid dehydration, so diuretic medications and substances with a diuretic effect (eg, coffee, cola, team alcoholic beverage) educational objective: 1. clients initiating lithium therapy should be instructed that therapeutic effects may take several weeks to achieve. 1) clients taking lithium should maintain a normal dietary sodium intake, consume 2-3 liters of fluid per day, and be advised to avoid diuretics or products with diuretic effect (eg, coffee, cola, tea)

question a client is receiving lithium carbonate 900 for a schizoaffective disorder. the lab notifies the nurse that the client's lithium is 1.0. based on this result, which prescription does the nurse anticipate receiving from the hcp? a. continue at the current dosage b. decrease the dosage c. discontinue the medication d. increase the dosage

correct answer rational 1. lithium carbonate is used as a mood stabilizer in clients with schizoaffective disorder (combination of schizophrenia and a mood disorder) and bipolar disorder. lithium has a very narrow therapeutic index (0.6-1.2; >1.5 toxicity) 2. lithium toxicity can be acute (eg, ingesting a bottle of lithium tables in a suicide attempt) or chronic (eg, slow accumulation due to decreased renal function or drug-drug interactions). 1) acute or acute-on-chronic toxicity presents predominantly with gastrointestinal symptoms (eg, nausea, vomiting, diarrhea); neurologic manifestation occur later. 2) however, neurologic manifestation occurs early in chronic toxicity. common neurologic manifestations include ataxia, confusion, or agitation, and neuromuscular excitability (eg, tremor, myoclonic jerks) 3) chronic toxicity also manifests as diabetes insipidus (eg, polyuria, polydipsia) 3. about acd: no dose adjustment is needed as this client's lithium level is therapeutic educational objective: 1. lithium levels should be checked frequently given the narrow therapeutic index (0.6-1.2). 2. chronic toxicity manifestos with neurologic symptoms (eg, confusion, tremor, ataxia) and/or diabetes insipidus (eg, polyuria, polydipsia)

question a client has been on lithium carbonate therapy for 7 days. which of the following findings would be most important to report to the hcp? a. diarrhea, vomiting, and mild tremor b. dry mouth and mild thirst c. hyperactivity and auditory hallucination d. lithium level of 1.3

correct answer rational 1. lithium carbonate is used for the initial and maintenance treatment of bipolar mania. 1) typical symptoms of mania include extreme hyperactivity, delusions and hallucinations, grandiosity, elation, poor judgement, aggressiveness, impulsivity, pressure of speech, insomnia, flight of ideas, and sometimes hostility 2) acute lithium toxicity presents primality with gastrointestinal side effects such as persistent nausea and vomiting and diarrhea. 3) neurologic symptoms typically manifest later and include tremor, confusion, ataxia, and sluggishness. severe toxicity results in seizures and encephalopathy. 4) serum lithium levels and clinical condition must be monitored before medication administration. serum levels > 1.5 and/or even the mildest symptoms of lithium toxicity must be reported to the hcp 2. 1) about b: dry mouth and thirst are common and expected side effects of lithium when treatment is initiated. they will resolve spontaneously, and lithium need not be discontinued 2) about c: hyperactivity and auditory hallucinations are clinical findings associated with bipolar mania. because lithium may take up to 3 weeks to become effective, it would not be unusual for a client to experience these symptoms after only 7 days of treatment. 3) about d: lithium has a very narrow range of therapeutic serum levels; the usual ranges are 1-1.5 for treatment of acute mania and 0.6-1.2 for maintenance therapy. educational objective: 1. acute lithium toxicity (>1.5) presents primarily with gastroinstinal side effect such as persistent nausea and vomiting and diarrhea 2. neurological symptoms typically manifest later and include tremor, confusion, ataxia, and sluggishness. the hcp provider must be notified at the earliest indication of lithium toxicity.

question a nurse has completed teaching a client who is being discharged on lithium for a bipolar disorder. which statement by the client indicates a need for further teaching? a. I need to drink 1-2 liters of fluid daily b. I need to have my blood levels checked periodically c. I should not limit my sodium intake d. I should use ibuprofen for pain relief

correct answer rational 1. lithium is a mood stabilizer most often used to bipolar affective disorder. it has a very narrow therapeutic serum range of 0.6-1.2. 2. level>1.5 are considered toxic. 3. lithium toxicity: 1) dehydration 2) decreased renal function (eg, elderly clients) 3) diet low in sodium 4) drug-drug interactions (nonsteroidal anti-inflammatory drugs (NSAID) and thiazide diuretics) 4. lithium is cleared renally. even a mild change in kidney function (as seen in elderly clients) can cause serious lithium toxicity. therefore, drugs that decrease renal blood flow (eg, NSAID) should be avoided. acetaminophen would be a better choice for pain relief 5. 1) about a&c: sodium, water and lithium are normally filtered by the kidneys. restriction of dietary sodium/water or dehydration signals renal sodium and water reabsorption which will also increase lithium absorption, resulting in toxicity. therefore, clients should never restrict their sodium or water intake while taking lithium; instead, they should maintain a consistent sodium intake 2) about b: blood should be drawn frequently to monitor for therapeutic lithium levels and toxicity educational objective: dehydration, decreased renal function, diet low in sodium and drug interactions (eg, NSAIDs and thiazide diuretics) can cause lithium toxicity

question the clinic nurse emulates a client who was prescribed lithium therapy a month ago for bipolar disorder. which client statement would cause the most concern? a. I have felt need for an afternoon nap most days this week b. I have gained 3 lb since I began this medication c. I have had the stomach flu for the past couple of days d. my mouth seems to be drier than usual lately

correct answer rational 1. lithium is often used in the treatment of bipolar disorder. it has expected, mild side effects as well as potentially serious ones related to drug toxicity. drowsiness, weight gain, dry mouth, and gastrointestinal upset, mild side effect 2. lithium toxicity occurs with dehydration, hyponatremia, decreased renal function, and drug-drug interactions (eg, nonsteroidal anti-inflammatory drugs, thiazide diuretics). lithium and sodium are closely related in the body, 1) acute viral gastroenteritis (stomach flu) presents with abrupt onset of diarrhea, nausea, vomiting, and abdominal pain 2) clients with vomiting and diarrhea are at risk of developing and/or low serum sodium, increasing the risk for lithium toxicity 3. 1) about a: drowsiness is an expected side effect; the nurse should advise the client to avoid hazardous activities and driving until the effects of lithium ae known or this side effect subsides 2) about b: weight gain is an expected side effect. the nurse should provide client education about healthy food choices and prompt exercise and/or provide for a dietary consult 3) about d: dry mouth is an expected side effect, the nurse should provide client teaching about measures to counterpace this side effect (eg, ice chips, sugarless gum or candy, drinking plenty of water). however, excessive urination and polydipsia indicate nephrogenic diabetes insipidus from lithium toxicity educational objective: dehydration and sodium loss from vomiting and diarrhea can lead to toxic lithium levels in clients receiving lithium therapy

GI/NUTRITION question: a client has been on long-term therapy with esomeprazole. what is essential for the nurse to ask the clients? a. are you drinking plenty of water with the medication? b. are you taking the medication after meals? c. have you had a bone density test recently? d. have you had your blood pressure taken regularly?

correct answer rational 1. long-term therapy with a proton pump inhibitor (PPI) (eg, omeprazole, pantoprazole, esomeprazole) may decrease the absorption of calcium and promote osteoporosis. 1) a bone density test can assess if the client already has osteoporosis. 2) hospitalized clients also have an increased risk of diarrhea caused by clostridium difficile. 3) PPIs cause suppression of acid that otherwise would have prevented pathogens from more easily colonizing the upper gastroinstinal tract. this leads to increased risk of pneumonias 2. 1) about a: drinking extra water and being upright for 30 minutes after taking bisphosphonates (eg, risedronate, alendronate) is necessary to prevent esophagitis. however, this is not necessary with PPI use 2) about b: the medication should be taken prior to meals 3) about d: PPIs do not affect blood pressure educational objective: 1. long-term use of PPIs (eg, omeprazole, pantoprazole, esomeprazole) is associated with osteoporosis, C difficile infection, and pneumonias. 2. clients should be encouraged to increase calcium and vitamin D intake to help prevent osteoporosis

question a client who has been on long-term omeprazole therapy for gastroesophageal reflux disease is admitted to the hospital for a urinary tract infection. the nurse recognizes that this client is at highest risk for which complication due to omeprazole use? a. clostridium difficile infection b. gait disturbance c. jaw necrosis d. tremor

correct answer rational 1. long-term use of proton pump inhibitors (PPIs) is common as these medications are available over the counter. 1) PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increase the possibility of fractures of the spine, hip, and waist. 2) PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. this led to increased risk of pneumonias. 3) PPI use may also increase the risk for C. diffile; currently the cause is unclear. a safety alert has been issued by the US food and drug administration adverting health care providers to consider CDAD foe unresolved diarrhea in PPI users. this client would be receiving antibiotics for a urinary tract infection, further increasing the risk for C. difficle infection 2. 1) about b: gait disturbance (ataxia) is commonly seen with phenytoin toxicity 2) about c: jaw necrosis is associated with long-term bisphosphonate (eg, alendronate, risedronate) therapy 3) about d: tremor is seen with lithium toxicity and albuterol (short-acting beta agonist) use educational objective: long-term use of PPIs (prazoles-omeprazole, lansoprazole, pantoprazole, rabeprazole) has been associated with decreased bone density (calcium malabsorption) and increased risk of C difficile

question a child with attention-deficit hyperactivity disorder (ADHD) has been taking methylphenidate for a year. what are the priority nursing assessment when the client for a well-child visit? a. attention span and activity level b. dental health and mouth dryness c. height/weight and blood pressure d. progress with schoolwork and in making friends

correct answer rational 1. methylphenidate (Ritalin, Concerta) is a central nervous system stimulant used to treat ADHD and narcolepsy. it affects neurotransmitters (dopamine and norepinephrine) in the brain that contribute to hyperactivity and lack of impulse control 2. a common side effect of methylphenidate is loss of appetite with resulting weight loss. parents and caregivers should be instructed to weigh the child with ADHD at least weekly due to the risk of temporary interruption of growth and development. 1) it is very important to compare weight/height measures from one well-child checkup to the next. 2) if weight loss becomes a serious problem, methylphenidate can be given after meals; however, before meals is preferable 3) another side effect of methylphenidate is increased blood pressure and tachycardia. these should be monitored before and after starting treatment with stimulants 3. 1) about a: therapeutic effects of methylphenidate include increased attention span and improvement in hyperactivity. these would be important components of a well child assessment, but not the priority 2) about b: evaluating dental health is part of any well child assessment, dry mouth is not a common side effect of methylphenidate 3) about d: expected outcomes of methylphenidate therapy include improvement in schoolwork and social relationships. these would be important component of a well child assessment but not the priority educational objective: 1. side effect of methylphenidate therapy that require on-going monitoring are delayed growth and development and increased blood pressure 2. children with ADHD should be weight regularly at home or school. weight loss trends should be reported and discussed with the hcp. 3. blood pressure and cardiac function also should be monitored on on-going basis.

question the nurse is preparing to administer a scheduled dose of metoclopramide IV to a client with diabetic gastroparesis, which clinical finding cause the nurse to question the prescription? a. diarrhea b. frequent burping c. headache d. sucking lip motions

correct answer rational 1. metoclopramide (Metozolv ODT): commonly used antiemetic medication that treats nausea, vomiting, and gastroparesis by increasing gastrointestinal modality and promoting stomach emptying. 1) with extended use and/or high doses, metoclopramide may lead to the development of tardive dyskinesia (TD), a movement disorder that is characterized by uncontrollable motions (eg, sucking/smacking lip motions) and is often irreversible. 2) the movement alterations of TD may impact a client's essential activities of daily living (eg, eating, dressing) and overall quality of life. the nurse should question the administration of the medication associated with TD in clients experiencing movements alterations 2. clinical manifestation of tardive dyskinesia: 1) face: lip movement (eg, smacking, sucking, puckering); tongue movement (eg, protrusion, curling); grimace; brow furrow or twitch; excess blinking; 2) extremities: foot tap; hand wringing 3) neck torso: rocking; torticollis (eg, persistent neck flexion or extension) educational objective: 1. clients receiving metoclopramide at Hight dose extended periods are at risk for developing tardive dyskinesia (TD), an often-irreversible movement disorder. 2. the nurse should question a prescription for metoclopramide if symptoms of TD (eg, uncontrollable, lip smacking, hand wringing, rocking) are present

question the nurse reinforces teaching a female client about taking misoprostol to prevent stomach ulcers. which statement by the client would prompt further instruction? a. I can take this medication with food if it hurts my stomach b. I must use a reliable form of birth control while taking this medication c. I should continue to take my ibuprofen as prescribed d. I will take this medicine with an antacid to decrease stomach upset

correct answer rational 1. misoprostol (Cytotec) is a synthetic prostaglandin that promotes against gastric ulcers by reducing stomach acid and promoting mucus production and cell regeneration. 1) it is often prescribed to prevent gastric ulcers in clients receiving long-term nonsteroidal anti-inflammatory drug (NSAID) therapy 2) antacids, especially those that contain magnesium (eg. Gaviscon) can increase the adverse effect of misoprostol (ef, diarrhea, dehydration). 3) if clients require therapy with antacids, they should choose one that does not contain magnesium (eg, calcium carbonate and contact the hcp provider if adverse effect occur) 2. 1) about a: taking misoprostol with food can help decrease gastrointestinal side effect (eg, abdominal pain, cramping, diarrhea) 2) about b: misoprostol is also used for labor induction and is classified as a pregnancy category x drug; women of childbearing age must be educated on using reliable birth control and possible sensation of uterine cramping while taking misoprostol. clients who suspect they are pregnant must stop taking the medication and contact their hcp 3) about c: the client can continue taking ibuprofen (an NSAID) with misoprostol because misoprostol is designed to reduce side effect of ibuprofen educational objective: 1. misoprostol prevent gastric ulcers in clients receiving long-term nonsteroidal anti-inflammatory drug therapy. 2. it should not be taken with antacids but can be taken with foods to reduce gastrointestinal upset. 3. women of childbearing age should be educated on using reliable birth control methods as misoprostol can induce labor

question a client with obesity has just started taking orlistat. which statement by the client indicates a need for further teaching? a. I have started taking a daily, multivitamin with my dinner time dose of medication b. I may have oily stools and fecal incontinence when taking this medication c. I will consume a low-fat diet in which no more than 30% of many calories are from fat d. I will take my medication with, or within 1 hour of, meals that contain fat

correct answer rational 1. orlistat is a lipase inhibitor prevents the breakdown and absorption of fats from the intestine. this medication is prescribed to clients with obesity who have difficulty losing weight or a comorbidity that makes weight loss therapeutically essential (eg, diabetes, heart disease). orlistat should always be used with diet modification and an exercise regimen 2. because orlistat blocks the absorption of fats, it also interferes with fat-soluble vitamin uptake. clients should offset this effect by taking a multivitamin that contains vitamins ADEK. to be most effective, multivitamins should be taken >2 hours after taking orlistat 3. 1) about b: clients may experience fecal incontinence, flatulence, oily stools, and oily spotting because unabsorbed fat is eliminated through defecation 2) about c: a low fat is an essential component of weight loss when a lipase inhibitor has been prescribed 3) about d: the nurse should teach the client to take orlistat with, or within 1 hour of, meals that contain fat. if the client selects foods that do not contain fat, the dose may be skipped educational objective: 1. orlistat, a lipase inhibitor, prevents the absorption of fat from the gastrointestinal tract and is used with diet and exercise to promote weight loss. 2. because orlistat blocks the absorption of fats, it also interferes with the uptake of fat-solute vitamins. clients should take a daily multivitamin with vitamin ADEK>2 hours after taking orlistat to prevent nutrient deficiencies

question the nurse reviews an elderly client's medication administration record and identifies which prescriptions as having the potential for injury in the elderly? a. amitriptyline b. chlorpheniramine c. docusate d. donepezil e. lorazepam

correct answer rational 1. polypharmacy and physiologic changes associated aging (eg, decreased renal and hepatic function, orthostatic hypotension, decreased visual acuity, balance and gait problems) place the elderly at increased risk of adverse drug effects 2. the beer criteria provide a list that classifies potentially harmful drugs to avoid or administer caution in the elderly due to the high incidence of drug-induced toxicity, cognitive dysfunction, and falls. 3. some commonly used medication in this list includes antipsychotics, anticholinergics, antihistamines, antihypertensives, benzodiazepines, diuretics, opioids, and sliding insulin scales. 4. amitriptyline (Elavil) is a tricyclic antidepressant used to treat depression and neuropathic pain; its anticholinergic property may cause dry mouth, constipation, blurred vision, and dysrhythmias. 5. chlorpheniramine (chloTrimeton) is a sedating histamine H1 antagonist used to treat allergy symptoms. increased central nervous system affects (eg, drowsiness, dizziness) may occur due to its reduced clearance in the elderly 6. lorazepam (Ativan) is a benzodiazepine with long half-time (10-17 hours). side effect includes drowsiness, dizziness, ataxia, and confusion 7. 1) about c: docusate is a stool softener and does not increase risk of injury in the elderly 2) about d: donepezil (aricept) is an acetylcholinesterase inhibitor 乙酰胆碱酯酶抑制剂used to treat Alzheimer dementia. it does not place the elderly at increased risk of adverse effects educational objective: 1. the beers criteria provide a list classifies potentially harmful drugs to avoid or administer with caution in the elderly due to the high incidence of adverse effects and potential for injury 2. the list include: antipsychotics, anticholinergics, antihistamines, antihypertensives, benzodiazepine, diuretics, opioids, and sliding insulin scales.

question the nurse is assessing a client diagnosed with tuberculosis who started taking rifapentine a week ago. which statement by the client warrants further assessment and intervention by the nurse? a. I do not want to get pregnant, so I restarted my oral contraceptive last month b. I have been taking my medication with breakfast every morning c. I should alter my hcp I notice yellowing of my skin d. since I started this medicine, my saliva has become a red orange color

correct answer rational 1. rifapentine (Priftin), a derivative of rifampin, is an antitubercular agent used with other drugs (eg, isonizaid) as a combination therapy in active and latent tuberculosis infections. both rifampin and rifapentine reduce the efficacy of oral contraceptives by increasing their medication; therefore, this client will need an alternate birth control plan (non-hromone) to prevent pregnancy during treatment 2. 1) about b: rifapentine should be taken with meals for best absorption and to prevent stomach upset 2) about c: hepatotoxicity may occur; therefore, liver function tests are required at least every mouth, signs, and symptom of hepatitis include jaundice of the eyes and skin, fatigue, weakness, nausea and anorexia 3) about d: rifapentine may cause red-orange-colored secretions, which is an expected finding, dentures and contact lenses may be permanently stained educational objective: 1. clients taking rifampin or rifapentine (Priftin) as part of antitubercular combination therapy should be taught to prevent pregnancy with non-hormonal contraceptives, 2. notify the hcp (jaundice, fatigue, weakness, nausea, anorexia) and expect red-orange colored body secretions

question which herbal supplements pose an increased risk for bleeding in surgical clients and should be discontinued prior to major surgery? a. black cohosh b. garlic c. ginger d. ginkgo biloba e. hawthorn

correct answer rational 1. risk of herbal medication: 1) ginkgo biloba银杏叶: (use)memory enhancement; (risk) increased bleeding risk 2) ginseng: (use) improved mental performance; (risk) increased bleeding risk 3) saw palmetto塞润榈: (use)benign prostatic hyperplasia; (risk) mild stomach discomfort 4) black cohosh黑升麻: (use) menopausal symptoms (hot flashes & vaginal dryness); (risk) hepatic injury 5) st john wort圣约翰草: (use) depression; insomnia; (risk) drug interaction: antidepressants (serotonin syndrome), OCS anticoagulants (decrease INR), digoxin; hypertensive crisis 6) kava卡瓦: (use) anxiety, insomnia; (risk) severe liver damage 7) licorice甘草: (use) stomach ulcers, bronchitis/vital infections; (risk) hypertension/hypokalemia 8) echinacea紫锥菊: (use) treatment & prevention of cold & flu; (risk) allergic reaction, dyspepsia 9) ephedra麻黄: (use) treatment of cold & flu & weight loss & improved athletic performance; (risk) hypertension; arrhythmia/MI/sudden death; stroke; seizure 2. clients are often aware of the need to discontinue prescription medication such as aspirin and anticoagulants prior to elective surgery, but they may not know that some herbal supplements can increase bleeding risk; the nurse should question the client specifically about the use of herbal supplements gingko biloba; garlic; Gineng; ginger; feverfew 3. 1) about a: black cohosh is used for treatment of menopausal symptoms; the main side effect is liver injury 2) about e: hawthorn extract is used to control hypertension and mild to moderate heart failure; hawthorn use does not increase the risk of bleeding educational objective: use of herbal supplements such as ginkgo biloba, garlic, ginseng, ginger, and feverfew should be reported to the hcp before surgery as they may increase the risk of bleeding

question the nurse is caring for a client tamoxifen for breast cancer. which client statement is most concerning and a priority to report to the hcp? a. I do not have much interest in sex lately b. I feel like I might be getting a cold c. my periods have been heavy lately d. these hot flashes are occurring a lot

correct answer rational 1. selective estrogen receptor modulators (eg, tamoxifen) have differential action in different tissues (mixed agonist/antagonist). in the breast, they block estrogen (antagonist) and are therefore helpful in inhibiting the growth of estrogen-receptor breast cancer cell 2. however, tamoxifen has estrogen-stimulating (agonist) activity in the uterus, resulting in excessive endometrial proliferation (endometrial hyperplasia). this hyperplasia can eventually lead to cancer. irregular or excessive menstrual bleeding in premenopausal woman or any bleeding in postmenopausal women can be a sign of endometrial cancer 3. due to is estrogen-agonist actions, tamoxifen also poses a risk for thromboembolic events (eg, stroke, pulmonary embolism, deep vein thrombosis) 4. clients with breast cancer take tamoxifen for several (5-10) years to prevent recurrences. therefore, monitoring for life-threatening side effects is very important. 5. 1) about 1&4: because tamoxifen blocks estrogen receptors, it can cause symptoms of menopause. vaginal dryness, hot flashes, and decreased libido (sexual dysfunction) are common and would be discussed after addressing more concerning symptoms 2) about b: tamoxifen is not associated with significant immunosuppression although it may rarely cause leukopenia educational objective: 1. tamoxifen has mixed and antagonist activity on estrogen receptors in various tissues 2. it is used for several years in estrogen-responsive breast cancer. however, it is associated with increased risk of endometrial cancer and venous thromboembolism 3. menopausal symptoms (eg, vaginal dryness, hot flashes) are the most common side effect

question the nurse complete the following drug administration. which would require an incident report? a. client with chronic stable angina and blood pressure of 84/52; isosorbide mononitrate held b. client with depression stopped phenelzine yesterday; escitalopram given today c. client with diabetes and morning glucose of 90; the daily NPH insulin 20 units given 8am d. client with pulmonary embolism and international normalized ratio of 2.5; warfarin given

correct answer rational 1. selective serotonin reuptake inhibitors (SSRI) (eg, escitalopram) can't be combined with monoamine oxidase inhibitor (MAOIs) (phenelzine) as there is a risk of serotonin syndrome. 2. MAOIs effects persist long after dosing stops. an MAOIs should be withdrawal at least 14 days before starting an SSRI 3. 1) about a: the isosorbide has actions identical to nitroglycerin and can cause hypotension from vasodilation. it should be held when the systolic blood pressure is <90. perfusion to the kidney is inadequate if the systolic blood pressure is <80, because the pressure is so low, the nurse does not want to lower it further by giving the drug 2) about c: insulin is given to control diabetes. a normal fasting glucose level (70-99) indicates that the dosing is correct and should be given to continue control of blood glucose 3) about d: the effect of warfarin (coumadin) is monitored by the INR. the therapeutic range of INR is 2-3. this result indicates that the current dosing is achieving the desire effect educational objective: there must be a minimum of 14 days between the administration of MAOIs and SSRIs to avoid serotonin syndrome; this medication cannot be administration concurrently

question a behavioral health clinic nurse assesses a 23-year-old client who started taking paroxetine 3 weeks ago. which statement made by the client is most important for the nurse to investigate? a. I don't have much of appetite since starting this medication b. I have a lot of more energy, but I am feeling just as depressed c. I have been feeling dizzy when I walk around at home d. I have experienced frequent headaches lately

correct answer rational 1. selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine, paroxetine, sertraline, citalopram) are used to treat a number of pf psychiatric conditions (eg, major depressive disorder, generalized anxiety disorder). 1) clients usually see therapeutic effects in 1-4 weeks 2) SSRIs may increase the risk of suicide, especially in young adults (age 18-24) during initial therapy or after a dosage increase. 3) a client who reports increased energy without a change in depressive feelings needs to be assessed and monitored for suicidal ideation or actions as the client may now have the energy in depressive feeling needs to be assessed and monitored for suicidal ideation or action as the client may now have the energy to execute the suicide plan 2. common side effect of SSRIs: 1) loss of appetite; weight loss or weight gain 2) gastrointestinal disturbances (nausea, vomiting, diarrhea) 3) headaches, dizziness, drowsiness, insomnia. 4) sexual dysfunction 3. side effect should gradually diminish over 3 months, although some may persist. if symptoms are intolerable or a particular SSRIS is ineffective, the client maybe switched to a different antidepressant educational objective: 1. selective serotonin reuptake inhibitors (eg, fluoxetine, paroxetine, sertraline, citalopram) are used to treat psychiatric condition (eg, major depressive disorder, generalized anxiety disorder) 2. a client reporting increased energy with little or no reduction of depression needs immediate assessment for suicide risk

question a client with generalized anxiety disorder has received a new prescription for sertraline. the nurse should teach this client about which side effect? a. constipation b. sedation c. sexual dysfunction d. weight loss

correct answer rational 1. selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat major depression and anxiety disorders. 1) SSRIs (eg, fluoxetine, paroxetine, citalopram, sertraline) are generally well tolerated except sexual dysfunction. 2) clients often underreport this side effect. however, when asked specifically, over 50% of clients taking SSRIs may be experiencing some types of sexual dysfunction. this can be a decrease in sexual desire, arousal, or orgasm and vary by gender. 3) the nurse should discuss this with the client. the side effect may decrease or cease after 2 to 4 week waiting period for the therapeutic effect, or the client may be able to switch to be a different antidepressant medication (eg, bupropion) 2. 1) about a: constipation is uncommon with SSRIs. drugs with anticholinergic activity (eg, tricyclic antidepressants such as amitriptyline) may result in constipation or urinary retention 2) about b: sedation is a common side effect of benzodiazepines (eg, alprazolam, lorazepam, diazepam, and chlordiazepoxide), first generation antihistamines, and narcotic medication. SSRIs may cause insomnia. 3) about d: weight gain is a common side effect of most SSRIs, especially with long-term therapy educational objective: 1. SSRIs (eg, fluoxetine, paroxetine, citalopram, escitalopram, sertraline) can cause sexual dysfunction 2. the client should be encouraged to report this to the hcp if they are still present 2-4 weeks after treatment initiation.

question the nurse is caring for a client admitted with serotonin syndrome after taking citalopram and tramadol. which assessment findings does the nurse expect to find? select all that apply a. absent deep tendon reflexes b. cold, clammy skin c. muscle rigidity d. restlessness and agitation e. sinus tachycardia

correct answer rational 1. serotonin syndrome: a potentially life-threatening condition, develops when drugs affecting the body's serotonin levels are administered simultaneously or in overdose 2. drug, which may trigger this reaction, including selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), dextromethorphan (cough suppressant; it affects the signals in the brain that trigger cough reflex), ondansetron (Zofran), st. john's wort, and tramadol (Conzip; pain medication) 3. the diagnosis is primarily clinical and based on medication history and clinical findings. symptoms may include mental status changes (eg, anxiety, agitation, disorientation), autonomic dysregulation (eg, hyperthermia, diaphoresis, tachycardia/hypertension) and neuromuscular hyperactivity (eg, tumor, muscle rigidity, clonus, hyperreflective) 4. 1) about a: the client experiencing serotonin syndrome would exhibit hyperreflexia 2) about b: the client experiencing serotonin syndrome would exhibit warm skin and a fever educational objective: clinical manifestations of serotonin syndrome include mental status changes (eg, anxiety, agitation, disorientation), autonomic dysfunction (eg, hyperthermia, diaphoresis, tachycardia/hypertension)

question a client recently diagnosed with a major depressive disorder reports use of herbal supplements. it is most important for the nurse to provide education about which education about which supplement reported by the client? a. echinacea b. garlic c. glucosamine d. st. john's wort

correct answer rational 1. st. john's wort is an herbal. supplement commonly used to treat depression and anxiety. some clients with mild or moderate depression claim that its antidepressant effect is comparable to that of prescription medications. 1) the herbal supplement mimics the action of selective serotonin reuptake inhibitors (SSRI) by increasing available serotonin in the brain. 2) taken in combination with an SSRI (eg, sertraline, fluoxetine, citalopram, paroxetine), st john's wort may cause an excess of serotonin, resulting in serotonin syndrome, which is characterized by mental status changes, autonomic dysregulation, and neuromuscular hyperactivity 3) the client with a newly diagnosed depressive disorder will likely be prescribed an antidepressant. the nurse should teach the client not to take st. john wort concurrently with SSRIs to prevent serotonin syndrome educational objective 1. selective serotonin reuptake inhibitors and st. john's wort increase serotonin levels in the brain 2. clients taking both products concurrently are at risk for potentially life-threatening serotonin syndrome (agitation, confusion, tachycardia, diaphoresis, tremors, hyperreflexia)

question the nurse provides discharge teaching for the parent of a child newly prescribed methylphenidate for attention-deficit hyperactivity disorder (ADHD). the nurse adverse the parent that the child might experience which side effect? a. decreased blood pressure and growth delays b. heart palpitations and weight gain c. loss of appetite and restlessness d. trouble sleeping and a dry cough

correct answer rational 1. stimulant medications are commonly used to treat ADHD in children and adults. methylphenidate (Ritalin) and amphetamines 苯丙胺(eg, dextroamphetamine, lisdexamfetamine) are the most common commonly used stimulants 2. the major problems with stimulant medication: 1) decreased appetite and weight loss—can lead to growth delays 2) cardiovascular effect---hypertension and tachycardia (articular in adults) 3) appearance of new or exacerbation of vocal/motor tics 4) excess brain stimulation—restlessness, insomnia 5) abuse potential—misuse, diversion, addiction 3. 1) about a: growth delays are common side effect. the medication may cause hypertension, not hypotension 2) about b: heart palpitation is a common side effect, weight loss, not weight gain 3) about d: trouble sleeping is a common effect, but the medication do not cause a dry cough educational objective: methylphenidate (Ritalin) is a central nervous stimulant with the following potential side effect: anorexia and weight loss/growth delays, restlessness and insomnia, hypertension, and tachycardia, vocal or motor tics, and abuse potential

question a nurse is observing a nursing student reinforce teaching to a client on how to take sucralfate. which statement made by the student would require intervention by the nurse? a. take this in the morning 1 hour before breakfast b. take this with your other stomach medications c. take your heart medication 2 hours after sucralfate d. you might experience constipation while taking this

correct answer rational 1. sucralfate (Carafate) is an oral medication that forms a protective layer in the gastrointestinal mucosa, which provides a physical barrier against stomach acids and enzymes. 1) it does not neutralize or reduce acid production but is prescribed to treat and prevent both stomach and duodenal ulcers. 2) prescribed 1 hour before meals and at bedtime and, for effective results, is taken on an empty stomach with a glass of water. 3) sucralfate forms a better layer at a low PH level, therefore, antacid, or other acid-reducing medications (eg, proton pump inhibitors, H2 blockers) should be avoided within 30 minutes of taking sucralfate to prevent altered absorption 2. 1) about a: sucralfate should be taken 1 hour before meals to protect the stomach 2) about c: sucralfate binds with many medications (eg, digoxin, warfarin, phenytoin), reducing their bioavailability and effectiveness. therefore, all other medications are generally taken>=1-2 hours before or after taking sucralfate 3) about d: constipation is a common side effect of sucralfate educational objective: 1. sucralfate should be taken on an empty stomach with a glass of water because it forms a better protective layer at a low PH level 2. acid-reducing agents (eg, antacids, proton pump inhibitors, H2 blockers) should be avoided within 30 minutes of taking sucralfate, and all other medication should be taken >=1-2 hours before or after sucralfate

question the nurse is caring for a client with an inflammatory bowel disease exacerbation. the client is prescribed sulfasalazine. which finding would require a priority follow up by the nurse? a. elevated erythrocyte sedimentation rate b. hemoglobin 10.5 c. urine with yellow orange discoloration d. urine specific gravity

correct answer rational 1. sulfasalazine (Azulfidine) contains sulphapyridine and aspirin (5-ASA) and is used as a topical gastroinstinal anti-inflammatory and immunomodulatory agent in inflammatory bowel disease (IBD) 1) when the 5-asa is combined with the sulfa preparation, the drug does not become absorbed until it reaches the colon. 2) dehydration is a risk with IBD as the client can have up to 20 diarrheal stools a day 3) the client usually does not feel thirsty until after there is a fluid volume deficit. sulfa can crystalize in the kidney if the client is dehydrated 2. 1) about a: due to the inflammatory nature of IBD, erythrocyte sedimentation rate, C-reactive protein, and white blood cells can be elevated. this si an expected finding during an exacerbation 2) about b: mild to moderate anemia (normal hemoglobin 13.2-17.3 for males, 11.7-15.5 for females) is common with most chronic inflammatory conditions (eg, rheumatoid arthrisit, IBD) as the body can't use the available iron in bone narrow with active inflammation. in addition, IBD exacerbation usually includes bloody stools, resulting in blood loss iron deficiency anemia. this needs follow-up but is not a priority 3) about c: yellow-orange discoloration of the client's skin and urine is an expected side effect from the drug. educational objective: 1. dehydration is a concern with sulfasalazine and most other "sulfa" medications due to the risk of crystal formation in the kidney 2. it is also a potential complication of inflammatory bowel disease

question the nurse receives a new prescription for tamoxifen for a client with breast cancer. which information found in the client's medical record require follow up with the hcp? a. documentation of an allergy to shellfish and peanuts b. history of quitting cigarette smoking 5 years ago c. hospitalization with deep venous thrombosis 1 year ago d. previous treatment foe depression following the death of a parent

correct answer rational 1. tamoxifen is a selective receptor modulator that is prescribed to treat certain types of cancer and to prevent breast cancer recurrence. 1) tamoxifen works by blocking estrogen in certain estrogen-sensitive tissues (eg, breast, vagina), but it also increases affinity for estrogen in some tissue, such as the uterus. 2) in the treatment of breast cancer, tamoxifen inhibits growth of estrogen receptor-positive tumors 2. clients typically take tamoxifen for several (eg, 5-10) years after treatment to prevent breast cancer recurrence. 1) common side effect of tamoxifen therapy, like the effects typically seen in menopause (eg, hot flashes, vaginal dryness, menstrual irregularities), are related to decreased estrogen. 2) follow up would be required for clients with symptoms or a history of tamoxifen's most serious side effect: thromboembolic events (eg, deep venous thrombosis, pulmonary embolism, stroke) endometrial cancer (eg, abnormal vaginal bleeding) 3. about abd: shellfish and peanut allergies, previous smoking history, and history of depression are not contraindication for treatment with tamoxifen educational objective: 1) tamoxifen is a selective estrogen receptor modulator prescribed for the treatment and prevention of estrogen receptor-positive breast cancers 2) serious side effects include thromboembolic events (eg, deep venous thrombosis) and endometrial cancer

question the nurse is working in the emergency department. which client should the nurse see first? a. a 12-year-old with severe neck muscle spasms who is taking haloperidol for Tourette syndrome b. 80-year-old with irritability and agitation who has taken alprazolam for 2 weeks c. client taking clozapine who has sudden onset of high fever, diaphoresis, and change in mental status d. client taking olanzapine who has dry mouth, blurry vision, and constipation

correct answer rational 1. the client taking clozapine is exhibiting classic sins of neurologic malignant syndrome, an uncommon but life-threatening adverse reaction to anti-psychotic medication. neurologic malignant syndrome by high fever, muscular rigidity, altered mental status, and autonomic dysfunction 2. treatment includes supportive care (eg, rehydration, cooling body temperature) and immediate discontinuing of the medication. due to the life-threatening nature of neuroleptic malignant syndrome, this client needs to be seen first to assess for generalized muscle rigidity 3. 1) about a: severe neck spasms in an individual taking haloperidol (and other psychotropic medication) indicate a dystonic reaction. this client is in no immediate danger but needs treatment with IV benztropine (Cogentin) as soon as possible. the client should be seen second 2) about b: benzodiazepines can cause paradoxical worsening of agitation in elderly clients. this client needs a change in medication but does not need to be seen immediately 3) about d: dry mouth, blurry vision, and constipation are common anti-cholinergic side effect of olanzapine (and other psychotropic medication). these symotoms usually resolve after the client has taken the medication for a few weeks; treatment is symptomatic (eg, increased fluids, sugar-free chewing gum, high-fiber foods, avoidance of driving). this client can be seen last. educational objective: 1. neuroleptic malignant syndrome (NMS) usually presents with mental status changes, muscle rigidity, and autonomic instability after starting antipsychotic medication 2. treatment involves discontinuation of the medication and supportive care (eg, rehydration, cooling body temperature) 3. neuroleptic malignant syndrome is life-threatening condition

question the hospice nurse is caring for an activity dying client who is unresponsive and has developed a loud rattling sound with breathing (death rattle) that distress family members. which prescription would be most appropriate to treat this symptom? a. atropine sublingual drops b. lorazepam sublingual tablet c. morphine sublingual liquid d. ondansetron sublingual tablet

correct answer rational 1. the death rattle is a loud rattling sound with breathing that occurs in a client who is actively dying. when the client cannot manage airway secretions, the movement of these secretions during breathing causes a noisy rattling sound. this can distress family and friends at the bedside of the dying client 2. the death rattle can be treated using anticholinergic medications to dry the clients' secretions 3. medications include atropine drops administered sublingually or a transdermal scopolamine patch 4. 1) about b: lorazepam is a benzodiazepine that is used to treat anxiety and restlessness in terminally ill clients. it can be effective for alleviating dyspnea exacerbated by anxiety, but it is ineffective for controlling secretion (the cause of the death rattle) 2) about c: morphine is an opioid analgesic that is effective for pain treatment as well as terminal dyspnea. the client is not exhibiting these symptoms, so morphine would be inappropriate 3) about d: ondansetron (Zofran) will help the nausea and vomiting but is not very effective for treating the death rattle educational objective: 1. the death rattle is a noisy rattling sound with breathing commonly seen in a dying client who is unresponsive and no longer able to management airway secretion. 2. anticholinergic medications such as transdermal scopolamine or atropine sublingual drops effectively treat this symptom by drying up the excess secretion

question the nurse is teaching a client with advanced chronic obstructive pulmonary disease who was prescribed oral theophylline. which client statement indicates that the additional teaching is required? a. I need to avoid caffeinated products b. I need to get my blood drug levels checked periodically c. I need to report anorexia and sleeplessness d. I take cimetidine rather than omeprazole for heartburn

correct answer rational 1. theophylline is a bronchodilator with a low therapeutic index and a narrow therapeutic range (10-20). the serum level should be monitored frequently to avoid severe effects 1) toxicity is likely to occur at level >20. individual titration is based on peak serum theophylline level, so it is necessary to draw a blood level 30 minutes after dosing 2) theophylline can cause seizure and life-threatening arrhythmias. toxicity is usually due to international overdose or concurrent intake of medications that increase serum theophylline level. cimetidine and ciprofloxacin can dramatically increase serum theophylline level (>80) therefore, they should not be used in these clients 2. 1) about a: caffeinated products (eg, coffee, cola, chocolate) should be avoided periodically and adult the dose 2) about b: the best way to prevent toxicity is to monitor drug levels periodically and adjust the dose 3) about c: the sign of toxicity that should be reported to anorexia, nausea, vomiting, restlessness, and insomnia. educational objective: 1. theophylline can cause seizure and life-threatening arrhythmias due to its narrow therapeutic range (10-29). 2. the dose is adjusted based on peak drug levels, obtained 30 minutes after the dose is given. 3. clients should avoid caffeinated products and medications that increase serum theophylline level (eg, cimetidine, ciprofloxacin)

question an elderly client with a history of stable chronic obstructive pulmonary disease, alcohol abuse, and cirrhosis has a serum theophylline level of 25.8. which clinical manifestation associated with theophylline toxicity should the nurse worry most? a. alteration in color vision b. gum (gingival) hypertrophy c. hyperthermia d. seizure activity

correct answer rational 1. theophylline 茶碱has narrow therapeutic index and plasma concentrations >20 are associated with theophylline drug toxicity. 1) toxicity can be acute or chronic. conditions associated with chronic toxicity include advanced age (>60), drug interactions (eg, alcohol, marmolite and quinolone antibiotics), and liver disease. acute toxicity is associated with insertional or accidental overdose 2) symptoms of toxicity: central nervous system stimulation (eg, headache, insomnia, seizure), gastrointestinal disturbances (eg, nausea, vomiting) and cardiac toxicity (eg, arrhythmia) 2. 1) about a: alteration in color perception and visual changes are commonly seen with digoxin toxicity 2) about b: gum hypertrophy is seen with phenytoin toxicity 3) about c: hyperthermia and tinnitus are often with aspirin overdose education objective: 1. theophylline plasma concentrations >20 are associated with theophylline drug toxicity. 2. seizure (central nervous stimulation) and cardiac arrythmias are the most serious and lethal consequences

question the nurse working on the inpatient psychiatric unit is preparing to administer 9am medications to a client. the medication administration record is shown in the exhibit. on assessment, the client is tremulous, exhibits muscle rigidity, and has a temperature of 101.1. which action should the nurse take? exhibit: medication: haloperidol: 5 mg orally, twice a day 0900,2100 hydrochlorothiazide: 25 mg orally 0900 omeprazole: 20 mg orally 0900 acetaminophen 650 mg prn every 4 hours a. give all medication, including acetaminophen, and reassess in 30 minutes b. hold the haloperidol, give acetaminophen, and reassess in 30 minutes c. hold the haloperidol and notify the hcp immediately d. hold the hydrochlorothiazide and notify the hcp immediately

correct answer rational 1. this client is exhibiting signs and symptoms of neuroleptic malignant syndrome, a rare but potentially life-threatening reaction. NMS is most often seen with typical antipsychotics (eg, haloperidol, fluphenazine). however even the newer atypical antipsychotic drugs (eg, clozapine, risperidone, olanzapine) can cause the syndrome 2. neuroleptic malignant syndrome is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction (eg, sweating, hypertension, tachycardia). 3. treatment is supportive and is directed at reducing fever and muscle rigidity and preventing complications. treatment in an icu maybe required. the most important intervention is to immediately discontinue the antipsychotic medication and notify the hcp for further assessment 4. 1) about a: administering acetaminophen may be appropriate, but it is more important to discontinue the haloperidol and notify the hcp immediately 2) about b: due to the life-threatening nature of neurologic malignant syndrome, the hcp should be informed immediately. the hcp may order muscle enzyme, administer IV fluid/medications, and move the client for close monitoring 3) about d: hydrochlorothiazide is a diuretic commonly used for hypertension. it does not cause NMS syndrome educational objective: 1. neurologic malignant syndrome by fever, muscle rigidity, altered mental status, and autonomic dysfunction. 2. the most important intervention is to discontinue the antipsychotic medication

question a client with bronchial asthma and sinusitis has increased wheezing and decreased peak flow readings. during the admission interview, the nurse reconciles the medication and notes that which of following oct medications taken by the client could be contributing to increased asthma symptoms? a. guaifenesin 600 mg orally twice a day as needed b. ibuprofen 400 mg orally every 6 hours for pain as needed c. loratadine 1 tablet orally every day as needed d. vitamin d 2000 units orally every day

correct answer rational 1. two groups of commonly used drugs, nonsteroidal anti-inflammatory drugs and beta-adrenergic antagonists (beta blockers) have the potential to cause problems for clients with asthma 2. ibuprofen (Motrin) and aspirin are common oct anti-inflammatory drugs that effective in relieving pain, discomfort, and fever. about 10-20% of asthmatics are sensitive to these medications and can experience severe bronchospasm after ingestion. this is prevalent in clients with nasal polyposis 3. 1) about a: guaifenesin (Mucinex) is an expectorant used to facilitate mobilization of mucus and should not have the potential to exacerbate asthma or cause an attack 2) about c: loratadine (Claritin) is an antihistamine and should not have the potential to exacerbate asthma or cause an attack 3) about d: vitamin d is used to help maintain bone density and should not have the potential to exacerbate asthma or cause an attack educational objective: ibuprofen and aspirin are common oct anti-inflammatory drugs that can cause bronchospasm in some clients with asthma

question a client with cancer is to receive a third dose of cisplatin. the client's lab resulrs are shown in the exhibit. which factors would be important for the nurse to assess before confirming the dose with the hcp? lab: hemoglobin: 12; creatinine: 2.2 blood urea nitrogen: 28 a. blood pressure b. capillary refill c. skin turgor d. urine output

correct answer rational 1. urine output is a good indicator of renal function. cisplatin is an antineoplastic medication that zcan cause renal toxicity. the client's elevated bun (normal 6-20) maybe due to dehydration or decreased kidney function. the creatinine is also elevated (normal 0.6-1.3), is an indication of kidney injury 2. in addition to lab results, the hcp will also know urine output. the medication dosage may then be adjusted or discontinued. 3. 1) about a: blood pressure may be part of the assessment of kidney function, but multiple disorder can cause changes in blood pressure; urine output is a better indicator of renal function 2) about b: capillary refill is used to assess the circulatory system and is not a good indicator of a decrease in renal function 3) about c: skin turgor is important in assessing hydration status. however, this client's lab results indicate the possibility of renal toxicity from the cisplatin. urine output is a better indicator of renal function educational objective: 1. cisplatin is an antineoplastic drug that may cause kidney injury 2. assessment of renal function includes lab values and urine output

question a client with chronic kidney disease has received a continuous intravenous infusion of heparin for 5 days. the nurse reviews the coagulation studies and the medication administration record. which prescription would the nurse question? lab: activated partial thromboplastin time (aptt): 53 second; international normalized ratio: 2.3 a. epoetin b. sodium polystyrene sulfonate c. vitamin k d. warfarin

correct answer rational 1. vitamin k (phytonadione) is a fat-soluble vitamin that is administered as an antidote for warfarin-related bleeding. this medication prescription should be questioned as vitamin k reverse anticoagulant effect of warfarin, and the client's coagulation studies are in the therapeutic range (aPTT: 46-70 seconds, INR 2-3 seconds) 2. 1) about a: epoetin (Procrit) is a synthetic hormone that stimulates the production of erythropoietin and is used to treat anemia associated with chronic kidney disease. this is an appropriate prescription 2) about b: sodium polystyrene sulfonate (kayexalate) is a sodium exchange resin administered to reduce elevated serum potassium level in clients with chronic kidney disease and hyperkalemia. this is an appropriate prescription for this client 3) about d: warfarin (coumadin) is a vitamin k antagonist used for long-term anticoagulation that is started about 5 days before a continuous heparin infusion is discontinued. an overleap of the parenteral and oral anticoagulant is required for about 5 days as this is the time it takes warfarin to reach therapeutic level. this is an appropriate prescription for this client. educational objective: 1. anticoagulants stop thrombus formation by interfering with the coagulation cascade. 2. parenteral heparin and oral warfarin affect the clotting cascade differently; therefore, a 5-day overlap for the 2 drugs is required. this allows warfarin to reach a therapeutic level before the continuous heparin infusion is stopped

question the nurse is in the medication room preparing medication due at 1800 for a client who had an aortic valve replacement 5 days ago. which action should the nurse implement first? medication: levofloxacin; potassium chloride; docusate sodium; warfarin; simvastatin a. assess the client's most recent potassium level b. check the client's INR c. measure the client's vital signs d. verify the client's name and date of birth at the bedside

correct answer rational 1. warfarin (coumadin) is an anticoagulant given to clients with a mechanical valve replacement. to determine if the client is receiving an appropriate dose, the INR needs to be checked regularly. 1) a therapeutic INR for a client with a mechanical heart valve is 2.5-3.5. 2) the nurse should not administer warfarin without checking the INR first. if the INR>3.5, the nurse should hold the dose and contact the hcp for under direction 2. 1) about a: although the nurse should assess the client's potassium level prior to administering supplemental potassium, this medication was scheduled at 0900 is not indicated at this time. there is no pharmacologic interaction between potassium levels and warfarin 2) about c: the client's vital signs should be measured routinely, but administration of warfarin and simvastatin are not contingent on the results 3) about d: verification of the client's name and date of birth is an important safety measure that should be performed at the bedside immediately before medication administration educational objective: 1. the nurse should check the client's most recent INR level prior to administering warfarin. 2. a therapeutic INR is 2.5-3.5 for clients with mechanical heart valves. the nurse should hold the dose and contact the hcp if the INR>3.5

question the nurse develops a teaching care plan for the client with a prescription to change antidepressant medications form imipramine to phenelzine. which instruction is appropriate to include in the teaching? a. continue avoiding foods high in tyramine until the imipramine withdrawal period is over b. skip the nighttime dose of imipramine and start the phenelzine the next morning c. taper down the imipramine, then discontinue for 2 weeks before starting phenelzine d. taper down the imipramine while gradually increasing the phenelzine

correct answer rational 1. when a client switches from a tricyclic antidepressant (TCA) (eg, imipramine, amitriptyline, nortriptyline) to monoamine oxidase inhibitor (MAOI) (eg, phenelzine, isocarboxazid, tranylcypromine), a drug free period of at least 2 weeks should elapse between the tapered discontinuation of the TCA and initiation of the MAOI. this timing is based on the half-time value and allows for the first medication to leave the system 2. without a washout period, the client could experience hypertensive crisis (eg, blurred vision, dizziness, severe headache, shortness of breath). if the TCA is withdrawal abruptly, the client may experience a discontinuation syndrome 3. 1) about a: a tyramine-restricted diet is indicated for clients on an antidepressant regiment containing an MAOI to decrease the risk of hypertensive crisis. a. because this client is starting an MAOI, the diet should be initiated 2 weeks prior to starting the medication. b. if the switch was from an MAOI inhibitor to another antidepressant, the client would need to continue to follow the dietary restrictions for 2 weeks after discontinuing the MAOI 2) about b: an overnight washout period is inadequate to clear the imipramine from the client's system before starting the phenelzine. 3) about d: TCAs and MAOIs cannot be taken at the same time due to the risk of hypertensive crisis educational objective: 1. caution must be taken a client switch from a tricyclic antidepressant to a monoamine oxidase inhibitor to avoid adverse (eg, hypertensive crisis, discontinuation syndrome) 2. usually, antidepressants are withdrawn gradually with a drug-free period before the new antidepressant is initiated

question the client is brought to the emergency department in handcuffs by the police. witness said the client becomes violent and confused after consuming large amount of alcohol at a party. the client is placed in 4-point restraints, and ziprasidone hydrochloride is administered. the client is sleeping 30 minutes laterwhat is a priority action for the nurse currently? a. check for a history of bipolar disease b. determine if restraints can now be removed c. monitor for widened QT intervals and hypotension d. obtain blood for the current blood alcohol level

correct answer rational 1. ziprasidone hydrochloride (Geodon) is an atypical antipsychotic drug that is used for acuter mania, acute psychosis, and agitation. 1) its use carries a risk for QT prolongation leading to torsade de pointes. a baseline electrocardiogram and potassium are usually checked. 2) at a minimum, the client should be placed on a cardiac monitor. the client should also be monitored for hypotension and seizures, especially if the previous medical history is not known or obtainable. the risk for adverse effect is interested with the interaction of alcohol 2. 1) about a: although knowing past psychiatric history will assist in deterring the cause of this episode, this knowledge is not essential when caring to this client's current needs. a. any physical reasons for the behavior should be ruled out before focusing on psychiatric history. b. risk for suicide also need to be assessed after the client is alert and sober 2) about b: this should be reassessed after the drug is wearing off, not before the medicine is peaking. the client could suddenly wake up and become violent again. also, it is a priority to perform restraint monitoring per protocol, including checks on circulation and hydration/elimination needs. the client's physiological response is priority 3) about d: it would be beneficial to know the current alcohol level in order level in other to estimate the client's level of intoxication and when the client will be sober. the body normally clears alcohol at a rate of 25-50 per hour. however, there is a reliable history that the client had been drinking, and the presence of alcohol in the blood carries a risk for drug interaction. therefore, it is more important to monitor the client for any negative effect (adverse physiological response) from the drug than to quantify the current alcohol level educational objective: 1. after ziprasidone hydrochloride administer, clients should be monitored for cardiac effects (including prolonged QT interval), hypotension, and/or seizure activity. 2. alcohol interacts with ziprasidone and increase the potential for an adverse effect from the drug

question a diabetic client is prescribed metoclopramide. which of the following side effect must the nurse teach the client to report immediately to the hcp? select all that apply a. excess blinking of eye b. dry mouth c. dull headache d. lip smacking e. puffing of cheeks

correct answer rational1. metoclopramide (Reglan) is prescribed for the treatment of delayed gastric emptying, gastroesophageal reflex (GERD), and as an antiemetic. 1) like antipsychotic used is associated with extrapyramidal adverse effects, including tardive dyskinesia (TD) 2) this is especially common in older adults with long-term use. the client should call the hcp immediately if TD symptoms develop, including uncontrolled movement such as: protruding and twisting of the tongue; lip smacking; puffing of checks; chewing movements; frowning or blinking of eyes; twisting fingers; twisted or rotated neck (torticollis) 3) about c&d: common side effects of metoclopramide such as sedation, fatigue, restlessness, headache, sleeplessness, dry mouth, constipation and diarrhea need not be reported to the hcp educational objective: 1. both antipsychotic medication and metoclopramide use can be associated with significant extrapyramidal side effect (eg, tardive dyskinesia). 2. the nurse should teach the client the importance of immediately communicating these to the hcp

question a 21-year-old client is being evaluated in the outpatient psychiatric clinic after starting isocarboxazid 2 weeks ago. which of client's statement needs to be addressed first? a. I am not sleeping well at night and would like a sleeping aid b. I do not know how well I will do on this restricted diet c. I have been having quite a bit of nausea and constipation d. this medicine is not working, I am so tired of being depressed

correct answer rational: 1. commonly used monoamine oxidase inhibitors (MAOIs) include isocarboxazid, phenelzine, and tranylcypromine. 1) these first-generation antidepressants are used only for resistant depression due to serious adverse effects. 2) these medications inhibit the enzyme that breaks up norepinephrine serotonin, and dopamine, thereby increasing their availability in the body 2. clients taking MAOIs or other antidepressants are at increased risk for suicidal ideation, particular children, adolescents, and young adults. 1) the risk of suicidal thoughts can be more prevalent when starting the medication or with dose increase 2) feeling of hopelessness or despair must be evaluated to assess if suicidal ideation or thoughts of self-harm are present 3. 1) about a: MAOIs should be administered in the morning, as sleep dysfunction is common. this client statement should prompt a discussion of current medication habits, but is not the priority 2) about b: clients taking MAOIs need to avoid tyramine-containing foods (eg, cheese, overripe fruit, liquor, beef/chicken liver, fermented products) due to risk of hypertensive crisis. a medication change might be considered if a client is unable to adhere to the retraction, but would not be priority 3) about c: nausea and constipation are adverse effects of MAOIs. although strategies for management of adverse effects should be discussed, this is not priority. educational objective: 1. MAOIs and other antidepressants are associated with increased risk of suicidal ideation during the first few weeks of treatment. 2. clients taking MAOIs need to avoid tyramine-containing foods due to risk of hypertensive crisis

question the nurse is reviewing prescription for the assigned clients. which prescription should the nurse question? a. allopurinol for a client who developed tumor lysis syndrome form chemotherapy b. dicyclomine for a client with a history of irritable bowel syndrome who develops a postoperative paralytic ileus c. IV morphine for a client after percutaneous nephrolithiasis who reports the last bowel movement was 2 days ago d. levofloxacin for a client with a urinary tract infection who has a history of anaphylaxis to penicillin drug

correct answer rational: 1. dicyclomine (Bentyl) is an anticholinergic/antispasmodic drug prescribed to manage of intestinal hypermotility in clients with irritable bowel syndrome. 1) dicyclomine is contraindicated in clients with paralytic ileus as it decreases intestinal motility and would exacerbate the condition 2) the nurse should question this prescription and contact the hcp 2. 1) about a: tumor lysis syndrome due to rapid lysis of cells and the resulting release of intracellular potassium and phosphorus into serum 1. phosphorus binds to calcium, leading to hypocalcemia. the breakdown of cellular nucleic acids causes severe hyperuricemia. 2. IV hydration and hypouricemic medication (eg, allopurinol) are prescribed to promote purine excretion and prevent acute kidney injury 2) about c: although opioids (eg, morphine) can cause constipation, symptoms can be managed with pharmacologic (eg, docusate sodium, sennoside) are nonpharmacologic interventions (eg, increased activity, increased fiber, and fluid intake). --percutaneous nephrolithotripsy breaks and removes kidney stones and can lead to severe pain. therefore, pain medication is appropriate 3) about d: levofloxacin, a fluoroquinolone antibiotic prescribed to treat urinary tract infection, has no known cross-sensitivity to penicillin. however, cross-sensitivity with other fluroquinolones can occur educational objective: dicyclomine is an antispasmodic drug that decrease intestinal motility and is contraindicated in clients with paralytic ileus

question the nurse is reviewing about newly prescribed clonazepam with a client who is receiving palliative care for cancer, which client shows a correct understanding of the nurse's teaching? a. I am glad that I can continue to take my kava supplement each morning b. if I cannot sleep, I will take some melatonin with evening dose of clonazepam c. if I feel restless, I can put some drops of lavender essential oil in a diffuser to calm my self d. when my anxiety is getting really intense, I will drink some valerian tea to help me to relax

correct answer rational: 1. lavender aromatherapy is a safe low risk intervention to implement in conjunction with anxiolytic medication. the nurse must evaluate the client's use of all complementary and alternative therapies to ensure that there are no potential interactions with prescribed medication and therapies. 2. the active compounds in lavender essential oil promote relaxation and sleep without interacting with prescription medications. essential oils can be inhaled directly as a vapor, diffused via a mist, or dropped onto linens 3. 1) about a&d: the herbal supplements kava valerian root-both used for anxiety, insomnia, and depression -may increase central nervous system depression when used with benzodiazepine (eg, clonazepam). kava should not be combined with benzodiazepines because this increase the risk of hepatotoxicity 2) melatonin is a hormone supplement used at bedtime to promote sleep and may increase drowsiness and CNS depression when taken with clonazepam. coming melatonin with benzodiazepine medication can exaggerate side effect of the benzodiazepine (eg, dizziness, impaired concentration, daytime sleepiness) educational objective: 1. lavender aromatherapy is a safe, low risk complementary intervention for clients experiencing anxiety. 2. valerian root, kava and melatonin may potential the adverse effect of clonazepam or other benzodiazepines, and should not be combined with them

question a nurse is discharging a client who is receiving lithium for treatment of a bipolar disorder. its most important for the nurse to provide which instruction to the client? a. avoid a high potassium diet b. excessive regularly and maintain a high fiber diet c. maintain oral hygiene d. report excessive urination and increased thirst

correct answer rational: 1. lithium is a mood stabilizer most often used to treat affective disorders. it has narrow therapeutic index (0.6-1.2). 2. risk factors for lithium toxicity include dehydration, decreased renal function (in the elderly), diet low in sodium, and drug-drug interactions (eg, nonsteroidal anti-inflammatory drugs and thiazide diuretics) 3. chronic toxicity: 1) neurologic manifestation: ataxia, confusion or agitation, and neuromuscular excitability (tremor, myoclonic jerk) 2) nephrogenic disease insipidus: polyuria and polydipsia (increased thirst) 4. 1) about a: dietary potassium should be avoided when taking drugs such as potassium-sparing diuretics (eg, spironolactone, triamterene, amiloride) and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers 2) about b: regular exercise and a high fiber can prevent constipation, which is not a known side effect of lithium. opioids, anticholinergic, and iron supplement are medication that cause constipation 3) about c: good oral hygiene is ideal for every client but is not specially indicated for those taking lithium. clients taking phenytoin should maintain oral hygiene to prevent gingival hyperplasia educational objective: 1. risk factors for lithium toxicity include dehydration, decreased renal function, low-sodium diet, and drug-drug interaction (eg, NSAIDs and thiazide diuretics) 2. chronic toxicity manifests with neurologic symptoms (ataxia, confusion or agitation, and neuromuscular excitability) and/or diabetes insipidus (polyuria and polydipsia)

question a client with bipolar is admitted to the psychiatric unit with acute mania and dehydration. which prescription does the nurse question? a. administer zolpidem at bedtime as needed for insomnia b. continue prescribed home dose of 300 mg lithium po every 8 hours c. give haloperidol and lorazepam IM together for aggressive behavior d. infuse 500 mL saline IV bolus over 1 hour

correct answer rational: 1. lithium toxicity features: 1) acute: gastrointestinal findings: nausea, vomiting, diarrhea, neurologic findings occur later 2) chronic: neurologic-ataxia, sluggishness, confusion, agitation, neuromuscular excitability (coarse tremor) 2. lithium toxicity prevention: 1) avoid sodium depletion, low sodium precipitates lithium toxicity 2) eat regular diet & drink adequate fluid 3) therapeutic level is 0.6-1.2 4) level >1.5 is considered toxic 3. lithium is a mood stabilizer commonly prescribed for mania (eg, bipolar disorder) as long-term maintenance therapy. because lithium has a narrow therapeutic range (eg, 0.6-1.2), serum level should be monitored regularly to prevent toxicity>1.5 4. lithium is excreted through the kidney. to prevent toxicity the nurse should hold doses and clarify prescription for clients who have: 1) conditions/illness in which the kidney tries to conserve sodium (eg, hyponatremia, dehydration) as sodium and lithium are absorbed in proximal tubules simultaneously 2) decreased glomerular filtration rate (eg, severe renal dysfunction) as less of the drug is filtered into the urine 5. consistent amount of fluid (2-3) and sodium prevent fluctuations in serum lithium. client should report signs (eg, weight changes, dizziness) and precipitating factors (eg, vomiting, diarrhea, increased sweating) of fluid and electrolyte imbalance. 6. 1) about a: zolpidem (Ambien) is a hypnotic medication that induces sleep for clients with sleep disturbances (eg, acute mania) 2) about c: haloperidol (a first-generation antipsychotic) and lorazepam (a benzodiazepine) are commonly administered together to depress the central nervous system and decrease aggressive behaviors 3) about d: isotonic IV fluid boluses (eg, normal saline) are often required to reverse moderate to severe dehydration and prevent lithium toxicity educational objective: 1. lithium, a mood stabilizer commonly prescribed for clients with mania, has a narrow therapeutic range clients with conditions that increase serum lithium levels (eg, dehydration, hyponatremia, severe renal dysfunction) are at increased risk for toxicity (>1.5)

question: the nurse is caring who had surgery yesterday. when administering, the client asks "what is that for" I do not take if at home. which replay by the nurse is most appropriate? a. omeprazole helps prevent nausea by making your stomach empty faster b. omeprazole helps prevent you from developing an ulcer due to the stress of surgery c. omeprazole protects you from getting an infection while on antibiotics d. this medication will treat your gastroesophageal reflux disease (GERD)

correct answer rational: 1. omeprazole is a proton pump inhibitor (PPI) that suppresses the production of gastric acid by inhibiting the proton pump in the parietal cells of the stomach 2. In the most hospitalized clients without a history of GERD or ulcers, PPIs are prescribed to prevent stress ulcers from developing during a surgery or major illness 3. although evidence has shown that two-thirds of clients who receives PPIs do not need them, these medications are still widely prescribed in hospitalized clients. PPIs can be identified by "prazole" 4. 1) about a: metoclopramide (Reglan) is not a PPI, it decreases postoperative nausea by promoting gastric emptying 2) about c: PPIs maybe associated with an increased risk of clostridium difficile infection with antibiotic use 3) about d: the client does not take this medication at home. the nurse is assuming that the client has a history of GERD rather than assessing for this condition first education objective: PPI such as omeprazole are often prescribed to hospitalized clients without GERD or ulcers to prevent stress ulcers from developing during surgery or a major illness

question the registered nurse is counseling the parent of a child who was diagnosed with attenditon-deficit hyperactivity disorder and received a prescription for methylphenidate immediate-release tablet. which statement by the parent demonstrates that teaching has been effective? a. an additive-free, low-sugar diet will reduce my child's symptoms b. I can now manage my child's condition on my own c. my child should not take the last daily dose after 6 pm d. once medication is started, I will not have to monitor my child anymore

correct answer retinal 1. stimulant medications (eg, methylphenidate, dextroamphetamine, lisdexamfetamine) are first-line agents in the treatment of attention-deficit hyperactivity disorder (ADHD). 1) methpphenidate (Ritalin) is administered in divided doses 2 or 3 times daily, usually 30-45 minutes before meals. 2) as a stimulant, methylphenidate may interfere with sleep and should be given no later than around 6 pm. 3) the dosage in children is usually started low and titrated to the desired response 2. 1) about a: contrary to popular myth, sugar dose not increase hyperactivity, although an additive-free diet may be a healthy approach for children, eliminating additives or food colorings does not increase the symptoms of ADHD 2) about b: a team approach (parents, teachers, health care providers) is the most effective way to help with ADHD. school-based interventions may include specifics classroom modifications or accommodations to be incorporated into the treatment plan 3) about d: children should be monitored closely initial treatment for development of tics and contemptibly for adherence and response to therapy educational objective 1. methylphenidate is a stimulant drug with the potential to cause insomnia. 2. parents are instructed to administer the last dose no later than 6 pm to prevent sleep disruption

question a client is being discharged of enoxaparin following total knee replacement surgery. which teaching instruction does the nurse include in the teaching plan? a. eliminate green leafy vitamin k-rich vegetable form your diet b. mild brushing or red ness may occur at the injection site c. you can take the oct drugs such as ibuprofen mild discomfort d. you will need pt/inr assessment at regular intervals while on enoxaparin therapy

correct answer rational 1. enoxaparin (love NOx) is a low molecular weight haring (LMWH) that maybe prescribed for up to 10-14 days following hip and knee surgery to prevent deep venous thrombosis. 1) pinch an inch of skin upwards and insert the needle at a 90-degree angle into the fold skin 2) continue to hold the skin fold throughout the injection and then remove the needle at 90 degrees 3) mild pain, bruising, irritation, or redness of the skin at the injection site is common. do not rub the site with the hand, using an ice cube on the injection can provide relief 4) avoid taking aspirin, nonsteroid anti-inflammatory drugs (NSAIDS) and herbal supplements (ginkgo biloba, vitamin e) without hcp approval as these can increase the risk of bleeding 5) monitor complete blood count to assess for thrombocytopenia 血小板减少症 2. 1) about a: vitamin k-rich foods do not need to be eliminated from diet during enoxaparin therapy; prothrombin time and international normalized ratio are not affected. however, PT and INR are decreased when a vitamin k antagonist (eg, warfarin) is taken with vitamin k-rich foods 2) about d: routine coagulation studies (eg PT, INR thromboplastin time) do not need to be monitored in a client who is taking enoxaparin. however, periodic assessment of complete blood count is usually required to monitor for hidden bleeding and thrombocytopenic (especially in older client with renal insullficiency) educational objective: 1. LMWH (enoxaparin) requires monitoring of CBC (thrombocytopenia) but not coagulation studies. 2. administer of unfractionated heparin need requires with PTT, warfarin need PT/INR 3. clients on this medication should avoid aspirin and NSAIDs

question in which scenarios should the nurse hold the prescribed medication and question its administration? select all that apply a. client on iv heparin and the platelet count is 50000 b. client on newly prescribed and is at 8 weeks gestation c. client on nitroglycerin path for heart and blood pressure is 84/56 d. clients on phenytoin for epilepsy and the nurse notes gingival hyperplasia e. client on warfarin and prothrombin time/international normalized ratio is 1.5 times control time

correct answer rational 1. heparin is a natural anticoagulant. its risk is heparin-induced thrombocytopenia (HIT), also known as heparin-associated thrombocytopenia. 1) normal platelet range is 150,000-400,000. 2) a mild lowering of platelets may occur and resolve spontaneously around the 4th day. of administration. 3) the danger is type II HIT, a more severe form in which there is an acute drop in the number of platelets (more than 50% from baseline), which requires discontinuing heparin 2. angiotensin-converting enzyme ACE inhibitor such as lisinopril are teratogenic. lisinopril can cause embryonic/fetal development abnormalities (cardiovascular and central nervous system) if taken during pregnancy, especially during the first 13 weeks of gestation. during the 2nd and 3nd trimester, ACE inhibitors interfere with fetal renal hemodynamics, resulting in low fetal urine output (oligohydramnios) and fetal growth restriction 3. nitroglycerin causes vasodilation and can lower blood pressure. systolic blood pressure should be >90 hg to ensure renal perfusion 4. 1) about d: gingival hyperplasia or hypertrophy is a known side effect of phenytoin (Dilantin) and is not a reason to stop the drug. vigorous dental hygiene beginning within 10 days of initiation of phenytoin therapy can help control it. signs and symptoms that require discontinuation include toxic levels or phenytoin hypercreativity syndrome (fever, skin rash, and lymphadenopathy) 2) about e: warfarin (coumadin) is used to prolong clotting so that the desired result is a therapeutic range rather than the client's normal control value when not on the drug. therapeutic range is considered roughly 1.5-2.5 times the control (international normalized ration of 2-3), but up to 3-4 times the control (INR of 2.5-3.5) in high-risk situation such as an artificial heart valve. educational objective: 1. heparin should be held when there is significant thrombocytopenia. 2. angiotensin-covering enzyme inhibitors are not administered to pregnant women, and nitrates are not administered when a client is hypotension 3. prothrombin time/international normalized ratio is expected to be 1.5-2.5 (up to 4) times the control value when therapeutic effects are reached. 4. gingival hyperplasia is a side effect of phenytoin (Dilantin) administration and is not a reason to stop the drug