NU372 EAQ Evolve Elsevier: HESI Prep Medical Surgical Drugs

A client states, "I keep my insulin in the refrigerator because that is where my parents kept it." Which reason will the nurse include when explaining why insulin should be stored at room temperature? o Its potency and effectiveness are maximized. o Absorption is enhanced and local irritation is decreased. o It is more convenient and drawing insulin into the syringe is facilitated. o Adherence of insulin to the syringe and resistance upon injection are decreased.

o Absorption is enhanced and local irritation is decreased. · Insulin that is close to body temperature prevents vasoconstriction at the site and decreases irritation of tissues. Insulin can be stored at room temperature for up to 1 month but must be kept away from heat or sunlight. Inappropriate storage of insulin can decrease its stability and decrease, not increase, its therapeutic action. Although it may be more convenient to keep insulin in the refrigerator, this is not a valid rationale; temperature of the solution does not increase the viscosity of insulin. Neither adherence of insulin to the syringe nor decreased resistance upon injection occurs.

A client with advanced cancer of the bladder is scheduled for a cystectomy and ileal conduit. Which intervention would the nurse anticipate the health care provider will prescribe to prepare the client for surgery? o Intravesical chemotherapy o Instillation of a urinary antiseptic o Administration of an antibiotic o Placement of an indwelling catheter

o Administration of an antibiotic · Intestinal antibiotics and a complete cleansing of the bowel with enemas until returns are clear are necessary to reduce the possibility of fecal contamination when the bowel is resected to construct the ileal conduit. Intravesical chemotherapy is unnecessary because the urinary bladder is removed with this surgery. Instillation of a urinary antiseptic is not necessary. There is no evidence of a urinary tract infection. The urinary bladder will be removed, so there is no need for an indwelling urinary catheter. No data indicate that the client is experiencing urinary retention before surgery.

After receiving streptomycin sulfate for 2 weeks as part of the medical regimen for tuberculosis, the client reports feeling dizzy and having some hearing loss. Which part of the body is the medication affecting? o Pyramidal tracts o Cerebellar tissue o Peripheral motor end plates o Eighth cranial nerve's vestibular branch

o Eighth cranial nerve's vestibular branch · Streptomycin sulfate is ototoxic and may cause damage to auditory and vestibular portions of the eighth cranial nerve. Pyramidal tracts, cerebellar tissue, and peripheral motor end plates are not affected by streptomycin.

The nurse identifies that a client receiving chemotherapy has lost weight. Which interventions would the nurse take to improve client nutrition? Select all that apply. o Provide low-carbohydrate meals. o Decrease fluid intake at mealtime. o Encourage the intake of preferred foods. o Promote the intake of small, frequent meals o Administer prescribed antiemetics before meals

o Encourage the intake of preferred foods. o Promote the intake of small, frequent meals o Administer prescribed antiemetics before meals · Selecting preferred foods increases the likelihood of the client eating the food. Small, frequent feedings are better tolerated than large meals. Antiemetics should be administered prophylactically to decrease nausea and enhance appetite. The diet should provide maximum protein and carbohydrates to meet demands related to restoration of body cells and energy. Decreasing fluid intake may have deleterious effects.

The nurse is administering a histamine H2 antagonist to a client who has extensive burns. Which complication will it prevent? o Colitis o Gastritis o Stress ulcer o Metabolic acidosis

o Stress ulcer · An ulcer of the upper gastrointestinal tract is related to excessive secretion of stress-related hormones, which increases hydrochloric acid production. Histamine H2 antagonists decrease acid secretion. Colitis is not a complication of burns. Gastritis is not a complication of burns. Metabolic acidosis is not a complication of burns unless hypermetabolism or renal failure occurs; metabolic acidosis is not treated with H2 antagonists.

A client with human immunodeficiency virus (HIV) infection is diagnosed with tuberculosis. Before starting antitubercular pharmacotherapy, which essential test results will the nurse review? o Liver function studies o Pulmonary function studies o Electrocardiogram and echocardiogram o White blood cell counts and sedimentation rate

o Liver function studies · Antitubercular medications, such as isoniazid (INH) and rifampin (RIF), are hepatotoxic; liver function should be assessed before initiation of pharmacological therapy. Pulmonary function studies, electrocardiogram, and echocardiogram might be done; the results of these tests are not crucial for the nurse to review before administering antitubercular medications. White blood cell counts and sedimentation will not provide information relative to starting antitubercular therapy or to its side effects.

A client who takes daily megadoses of vitamins is hospitalized with joint pain, loss of hair, yellow pigmentation of the skin, and an enlarged liver due to vitamin toxicity. Which type of toxicity would the nurse suspect? o Retinol (vitamin A) o Thiamine (vitamin B1) o Pyridoxine (vitamin B6) o Ascorbic acid (vitamin C)

o Retinol (vitamin A) · Retinol is lipid soluble and eliminated by the liver. Joint pain, hair loss, jaundice, anemia, irritability, pruritus, and enlarged liver and spleen are signs of vitamin A toxicity. Thiamine, pyridoxine, and ascorbic acid are water soluble, so they are typically excreted in the urine before toxic blood levels can be achieved. However, excess thiamine may elicit an allergic reaction in some individuals, excess vitamin C (ascorbic acid) may cause diarrhea or renal calculi, and ultrahigh doses (about 800 times the normal dose) of pyridoxine (vitamin B6) can promote neuropathy. Remember that lipid-soluble vitamins normally take longer to eliminate and accumulate faster than water-soluble vitamins.

Carbidopa-levodopa is prescribed for a client with Parkinson's disease. The nurse monitors the client for which side effects of the medication? Select all that apply. o Vomiting o Involuntary movements o Slow heart rate o Changes in mood o Peripheral edema

o Vomiting o Involuntary movements o Changes in mood · Nausea and vomiting may occur, which reflect a central emetic reaction to levodopa. About 80% of clients develop involuntary movements. Changes in affect, mood, and behavior are related to toxic effects of the medication. Tachycardia and palpitations, not bradycardia, occur. Peripheral edema is not a side effect of carbidopa-levodopa.

The nurse assesses a client with tuberculosis for adverse responses to isoniazid (INH). The nurse determines that prompt intervention is needed for which client response? o Orange feces o Yellow sclera o Temperature of 96.8°F (36°C) o Weight gain of 5 pounds (2.3 kilograms)

o Yellow sclera · An adverse reaction to isoniazid (INH) is hepatitis, resulting in jaundice. Rifampin, an antitubercular medication, can color excretions orange, which is not harmful. A temperature of 96.8°F (36°C) is within expected limits. Weight gain indicates improvement in the client's health status.

A client with a history of tuberculosis reports difficulty hearing. Which medication would the nurse consider is causing this response? o Streptomycin o Pyrazinamide o Isoniazid o Ethambutol

o Streptomycin · Ototoxicity is an adverse effect of aminoglycosides such as streptomycin. Ototoxicity is not an adverse effect of pyrazinamide, isoniazid, or ethambutol.

A primary health care provider prescribes total parenteral nutrition (TPN) for a client with cancer of the pancreas. A central venous access device is inserted. Which reason would the nurse identify as the purpose for using this type of access? o Infection is uncommon. o It permits free use of the hands. o The chance of the infusion infiltrating is decreased. o The amount of blood in a major vein helps dilute the solution.

o The amount of blood in a major vein helps dilute the solution. · Unless diluted, the highly concentrated solution can cause vein irritation or occlusion. Although it permits free use of the hands, this is not the primary reason for a central line. Infection can occur at any invasive site and requires diligent care to avoid this complication. The chance of the infusion infiltration decreasing is not the primary reason, although the infusion at this site is more secure than a peripheral site and promotes free use of the hands.

After a short hospitalization for an episode of a transient ischemic attack (TIA) related to hypertension, a client is discharged on a regimen that includes chlorothiazide. Which instruction will the nurse give the client regarding nutrition? o "Eat more dark green, leafy vegetables such as spinach." o "Substitute a potassium-based salt substitute for table salt." o "Return to previous eating habits." o "Increase intake of dairy products."

o "Eat more dark green, leafy vegetables such as spinach." · The client should increase the dietary intake of potassium because of potassium loss associated with chlorothiazide. Leafy green vegetables are high in potassium and should be encouraged. Salt substitutes should only be used if prescribed by the provider; otherwise, they should be discouraged because electrolyte abnormalities may occur without close monitoring. Returning to previous eating habits may be unsafe for those who do not consume a nutritional diet; the client should be taught about medication-induced deficiencies and how to try to prevent future TIAs. Dairy products should be limited, unless fat-free, because they are high in saturated fats.