Official Pharm Exam 4**

The nurse is providing education to a patient who is prescribed metronidazole (Flagyl) for trichomoniasis. What statement by the patient indicates the patient has understood the teaching? A."I will stop taking the medication when the discharge stops." B."I will have my partner evaluated and treated." C."I can continue to have intercourse as long as we use condoms." D."I won't get this again since I have had it once."

B."I will have my partner evaluated and treated." Inform the patient taking metronidazole for a sexually transmitted disease to avoid sexual intercourse until the prescriber states otherwise. The partner, any sexual partners possibly exposed, need to be evaluated and treated if positive. All other statements would require further teaching by the nurse.

A patient is prescribed bacitracin topical ointment. What does the nurse suspect as the possible diagnosis based on the medication prescribed?

Bacterial infection Bacitracin is a polypeptide antibiotic that is applied topically for the treatment or prevention of local skin infections caused by susceptible aerobic and anaerobic gram-positive organisms such as staphylococci, streptococci, anaerobic cocci, corynebacteria, and clostridia.

2 Rationale: Dantrolene is a central-acting skeletal muscle relaxant known to be effective in managing spasticity after spinal cord injury. Dexamethasone, a corticosteroid, decreases inflammation. Spinal cord-related spasms are not caused by inflammation. Donepezil, a cholinesterase inhibitor, slows progression of Alzheimer disease in clients. Dobutamine, a beta-adrenergic agonist, acts primaril on cardiac tissue.

Because a client with a spinal cord injury has developed spasticity, the nurse should prepare to teach the client about which newly prescribed medication? 1 Dexamethasone 2 Dantrolene 3 Donepezil 4 Dobutamine

4 Rationale: High-protein foods significantly decrease absorption of levodopa. For this reason, clients are taught to take it w/ a low-protein food. Cushingoid symptoms are associated with ingestin gcortisone derivatives. There is no need to avoid vaccinations. GI disturbances associated with the drug include anorexia and nausea and vomiting but not mouth ulcerations.

Because a healthcare provider prescribed levodopa for a client newly diagnosed with Parkinson disease, the nurse should place high priority on teaching the client which information prior to discharge? 1 Side effects include cushingoid symptoms such as moon face and weight gain 2 Postpone vaccinations during levodopa therapy 3 Report any ulcerations or sores in the mouth to provider immediately 4 Avoid taking medication with high-protein foods

1,2,3,4,5 Rationale: Misoprostol is administered for open-cratered gastric ulcers. The nurse may want to elevate the head of the bed because of the high risk of aspiration of blood. Maintaining an airway and breathing are high in priority. One side effect is abdominal pain, and increased restlessness could indicate the client is experiencing pain, making this second in priority. Ingestion of misoprostol can result in diarrhea. To prevent skin breakdown, placing a bed protector beneath the buttocks as the third action will help the skin to remain clean and dry. A log would help determine the bowel pattern and would be done fourth as it is a routine care activity. One side effect of the drug is spotting. This problem lacks the immediacy of aspiration, pain, and maintaining skin integrity, and would be done last if it occurs.

Because magnetic resonance imaging (MRI) revealed an open-cratered gastric ulcer, a semi-comatose female client is receiving misoprostol. In what order should the nurse prioritize directions about client care to the unlicensed assistant personnel (UAP)? Place the activities in order of priority 1 Maintain head of bed at 35 degrees 2 Report restlessness 3 Place bed protector beneath client 4 Keep a log of client's bowel patterns 5 Report vaginal spotting

3 Rationale: Since the medication was prescribed stat, one can conclude the seizure disorder is unstable. The assessments of greatest assistance to the nurse include seizure activity, changes in mental status, and current respiratory status. To prevent toxicity, hydration needs to be attended to later along with the client's emotional needs. Although renal failure can be a side effect of the drug, impaired airway, changes in mental status, and the nature of seizure activity need to be managed first. Although altered electrolyte status and leg edema may need attention if they occur, management of the seizure activity takes priority first.

Because phenytoin was prescribed STAT for a client who was just admitted to the nursing unit from the emergency department, which set of assessments is of highest priority for the nurse to perform? 1 Hydration status and emotional response to seizures 2 Blood urea nitrogen, creatinine, and urine output 3 Seizure activity, mental status, and respiratory status 4 Electrolytes, serum osmolality, and leg edema

The nurse would monitor which laboratory values in a patient receiving intravenous gentamicin (Garamycin)?

Blood urea nitrogen (BUN) and creatinine

A patient wants to prevent problems with constipation and asks the nurse for advice about which type of laxative is safe to use for this purpose. Which class of laxative is considered safe to use on a long-term basis?

Bulk-forming laxatives Bulk-forming laxatives are the only laxatives recommended for long-term use. Stimulant laxatives are the most likely of all the laxative classes to cause dependence. The other options are incorrect.

When pyrimethamine is used to treat malaria, a sulfonamide antibiotic is often also used. The purpose of the antibiotic is to:

C. cause synergism, allowing for a stronger antimalarial effect.

In an effort to prevent superinfections of the gastrointestinal tract (e.g., from Clostridium difficile), the nurse will instruct patients to eat which foods?

Cultured dairy products such as yogurt

A nurse administering tamsulosin to a client would expect to note which THERAPUTIC outcomes? Select all that apply.

Decreased urethral obstruction Increased urine flow Decreased urinary frequency

A patient with gout has been treated with allopurinol (Zyloprim) for 2 months. The nurse will monitor laboratory results for which therapeutic effect?

Decreased uric acid levels Treatment of gout with allopurinol should result in decreased uric acid levels. The other options are incorrect.

After administering oxybutynin (Ditropan) to a patient with spina bifida, the nurse is assessing the patient for therapeutic effects. What is the nurse assessing for in the patient?

Decreased urinary frequency Oxybutynin (Ditropan) is a synthetic antimuscarinic drug used for the treatment of overactive bladder. It is also used as an antispasmodic for neurogenic bladder associated with spinal cord injuries and congenital conditions such as spina bifida.

A patient with irritable bowel syndrome (IBS) receiving 0.5 mg alosetron (Lotronex) bid orally develops constipation. What is the appropriate treatment strategy in this situation?

Discontinuing the medication Alosetron (Lotronex) is a selective serotonin 5-HT 3 receptor antagonist that helps in treating IBS and chronic diarrhea. Alosetron (Lotronex) reduces bowel movements and results in constipation. When the patient develops constipation or signs of ischemic colitis, the medication should be discontinued. Increasing the dose of medication will worsen the patient's condition. Changing the route of administration or decreasing the frequency of administration will not be beneficial for the patient.

The nurse teaches a patient prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval?

Every 72 hours

A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient?

His respiratory rate One of the most serious adverse effects of opioids is respiratory depression. The nurse must assess the patient's respiratory rate before administering an opioid. The other options are incorrect.

A patient is admitted with salicylate toxicity. When assessing the patient, the nurse anticipates which manifestation associated with salicylate toxicity?

Hyperglycemia

In developing a plan of care for a patient receiving morphine sulfate, which nursing diagnosis is a priority?

Impaired gas exchange related to respiratory depression Using Maslow's hierarchy of needs and the ABCs of prioritization, impaired gas exchange is a priority over pain, constipation, and a risk for injury. If a patient cannot oxygenate sufficiently, all of the other problems will not matter because the patient will not live to worry about them.

The nurse tells a patient who is being treated for acne to report if any signs of depression occur. Which drug is part of the patient's prescription?

Isotretinoin There have been reports of suicide and suicide attempts in patients receiving isotretinoin (Amnesteem) treatment; therefore, the nurse should instruct the patient to report any signs and symptoms of depression to the health care provider. Tretinoin (Renova) is not associated with suicide. The main adverse effect of tretinoin (Renova) is local inflammatory reactions. Clindamycin (Cleocin T) is a topical formulation of systemic antibiotic used in the treatment of acne. The adverse effects are minor local skin reactions. Clotrimazole (Lotrimin) is an antifungal drug used in the treatment of candidiasis and tinea versicolor.

During the administration of finasteride (Proscar), the nurse must remember which important precaution?

It must not be handled by pregnant women.

While recovering from surgery, a 74-year-old woman started taking a stimulant laxative, senna (Senokot), to relieve constipation caused by the pain medications. Two weeks later, at her follow-up appointment, she tells the nurse that she likes how "regular" her bowel movements are now that she is taking the laxative. Which teaching principle is appropriate for this patient?

Long-term use of laxatives often results in decreased bowel tone and may lead to dependency. Long-term use of laxatives or cathartics often results in decreased bowel tone and may lead to dependency. Patients need to be taught that daily bowel movements are not necessary for bowel health.

1 Rationale: Methylphenidate is a central nervous system stimulant that results in the release of norepinephrine and dopamine, which can lead to hypertension and life-threatening dysrhythmias in the client w/ chronic heart failure. Methylphenidate can increase the metabolic rate, which could increase the serum glucose level, but this is not significant enough to prohibit its use in a client w/ diabetes mellitus. The drug can cause anorexia, nausea, and abdominal pain, which could be troublesome for the client w/ irritable bowel syndrome, but again the risks are not as great as in congestive heart failure. The drug can result in myelosuppression, so a history of anemia should be monitored, but again this is not as great a risk as CHF

Methylphenidate is newly prescribed for a client with narcolepsy. The nurse should report which priority health history component to the prescriber? 1 Congestive heart failure (CHF) 2 Diabetes mellitus 3 Irritable bowel syndrome 4 Anemia

A patient is taking the nonsteroidal antiinflammatory drug indomethacin (Indocin) as treatment for pericarditis. The nurse will teach the patient to watch for which adverse effect?

Nausea and vomiting Gastrointestinal effects include dyspepsia, heartburn, epigastric distress, nausea, vomiting, anorexia, abdominal pain, and others. See Table 44-3 for the other adverse effects of nonsteroidal antiinflammatory drugs (NSAIDs). The other options are not adverse effects of NSAIDs.

At the time of birth, infants are often treated with erythromycin eye ointment as prophylactic treatment against what possible organism?

Neisseria gonorrhoeae Erythromycin eye ointment is indicated for the treatment of neonatal conjunctivitis caused by Chlamydia trachomatis and for the prevention of eye infections in newborns that may be caused by N. gonorrhoeae or other susceptible organisms.

An 18-year-old basketball player fell and twisted his ankle during a game. The nurse will expect to administer which type of analgesic?

Nonopioid analgesic, such as indomethacin (Indocin) Somatic pain, which originates from skeletal muscles, ligaments, and joints, usually responds to nonopioid analgesics such as nonsteroidal antiinflammatory drugs (NSAIDs). The other options are not the best choices for somatic pain.

The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform?

Notify the physician and delay drug administration. Respiratory depression is a side effect of narcotic analgesia. Therefore since the patient's respiratory rate is below normal, the nurse should withhold the morphine and notify the physician.

A patient is receiving gabapentin (Neurontin), an anticonvulsant, but has no history of seizures. The nurse expects that the patient is receiving this drug for which condition?

Pain associated with peripheral neuropathy Anticonvulsants are often used as adjuvants for treatment of neuropathic pain to enhance analgesic efficacy. The other indications listed are not correct.

A patient who has been taking isoniazid (INH) has a new prescription for pyridoxine(Vitamin B6). She is wondering why she needs this medication. The nurse explains that pyridoxine is often given concurrently with the isoniazid to prevent which condition?

Peripheral neuropathy Pyridoxine (vitamin B6) may be beneficial for isoniazid-induced peripheral neuropathy. The other options are incorrect.

Which adverse effect can result if tetracycline is administered to children under 8 years of age?

Permanent discoloration of the teeth

What is the most important action for the nurse to complete before administration of intravenous amphotericin B?

Premedicate the patient with an antipyretic, antihistamine, and antiemetic as prescribed.

A patient with a known heart condition is scheduled to have dental surgery and is prescribed antibiotics before the dental surgery. What type of therapy is this considered?

Prophylactic therapy Prophylactic antibiotic therapy is used to prevent infections in individuals who are at high risk of development of an infection during or after a procedure. The antibiotics are given before the procedure for prophylactic treatment.

Which is a complication of vancomycin infusions?

Red man syndrome

The health care provider has ordered ciprofloxacin/dexamethasone (Ciprodex) otic drops for a patient with otitis externa. The nurse knows the combination medication has both antibacterial medication and topical steroid medication. What is the purpose of the steroid in this medication?

Reduce inflammation The purpose of a steroid included in otic drops is to assist in decreasing inflammation in the canal and the itching associated with the inflammation.

During assessment of a patient with osteoarthritis pain, the nurse knows that which condition is a contraindication to the use of nonsteroidal antiinflammatory drugs (NSAIDs)?

Renal disease

A healthy adult client has been taking a laxative 3 days per week for 9 months. What primary risk should the nurse address in a teaching plan with this client?

Risk for drug dependence

The nurse is caring for a patient who is on isotretenoin treatment. Which cautionary factor does the nurse warn the patient about while using this medication?

Risk to the fetus in pregnancy Isotretinoin is a pregnancy category X drug, which is proven to be a human teratogen. Female patients should be warned not to get pregnant while using this drug. Patients who are on clindamycin may experience oiliness of the skin. Patients on benzoyl peroxide treatment may experience swelling or blistering of the skin, which is an allergic reaction to the drug and is an indication that the treatment should be stopped. Patients on tretinoin treatment may experience temporary alterations in the skin pigmentation.

A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections?

Sulfonamides Sulfonamides achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, they are often used in the treatment of urinary tract infections.

A 79-year-old patient is receiving ciprofloxin a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs?

Tendonitis and tendon rupture A black-box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk for tendonitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone). The other options are not common adverse effects.

A patient visits the health care provider for treatment of tinea pedis (athlete's foot). Which medication would the nurse most likely instruct the patient on to treat this condition?

Terbinafine (Lamisil)

1,3,4 Rationale: Dantrolene is a skeletal muscle relaxan. Hepatotoxicity is an adverse reaction for dantrolene, which may be manifested by abdominal pain and scleral jaundice. Diarrhea is a common side effect, but persistent diarrhea may cause dehydration. Hepatic necrosis may result in changes in the serum glucose levels, but other signs are more indicative of this serious impairment. Painful urination and urinary frequency may occur and should be reported. Changes in hearing or smell are not common side effects of dantrolene.

The client with a spinal cord injury is taking dantrolene for spasticity. The nurse should instruct the client to notify the healthcare provider immediately if which adverse effects occur? Select all that apply. 1 Persistent diarrhea 2 Change in blood or urine glucose levels 3 Abdominal pain, scleral jaundice 4 Painful urination and urinary frequency 5 Change in hearing or smell

4 Rationale: Cyclobenzaprine can cause edema of the tongue, which can place the client at risk for airway obstruction. Because the medication can cause drowsiness, the client should avoid driving and other activities that could lead to injury while taking the medication; however, walking should be safe. The side effects affecting the skin include pruritus and skin rash. The drug is recommended for short-term rather than long-term treatment.

The healthcare provider has prescribed cyclobenzaprine for a 16 yr old football player who sustained a back injury during the first game of the season. The pediatric office nurse provides which instruction to the client and his parents? 1 Client should avoid prolonged walking while taking the medication 2 Client should use sunscreen and protective clothing while taking the medication 3 Client may need to take the drug for the rest of the football season 4 Client should report edema of the tongue immediately

A patient has been taking tolterodine (Detrol), which is an Anticholenergic medication. Which side effect would be expected?

The incidence of dry mouth

2,3,5 Rationale: Docusate sodium is appropriate for the postoperaive client taking opioid analgesics, the client who had a myocardial infarction 24 hrs ago, and the client with painful hemorrhoids. The client preparing for a colonoscopy would likely use a stimulant laxative. The client trying to reduce the chances of chronic constipation would likely use a bulk-forming laxative.

The nurse concludes that docusate sodium is appropriate for use in which of the following clients? SATA 1 A client preparing for a colonoscopy who needs a bowel prep 2 A postoperative client taking opiod analgesics for pain 3 A client who experienced a myocardial infarction 24 hrs ago 4 A client trying to reduce the chances of chronic constipation 5 A client with painful hemorrhoids

4 Rationale: Metamucil is a bulk-forming laxative that could aggravate diarrhea, and this statement indicates that the client has a lack of understanding. The other statements made by the client are true and indicate proper understanding. Dairy products may aggravate diarrhea and it is helpful to avoid these during a bout of diarrhea. Kaopectate is an antidiarrheal agent that is commonly used to manage this health problem, which is usually self-limiting. The client should contact the healthcare provider if diarrhea persists more than 2 days.

The nurse determines that further instructions are needed if a client with diarrhea makes which statement? 1. I need to avoid intake of dairy products 2. I should take bismuth subsalicylate as directed. 3. I should call my healthcare provider if diarrhea lasts more than 2 days. 4. If the diarrhea persists, I should start taking psyllium mucilloid

3 Rationale: Clients with eating disorders such as anorexia nervosa or bulimia nervosa are most likely to abuse laxatives. Older adults often believe having a stool every day is healthy and they are also a group that may excessively use laxatives, but they are not as at risk as clients who have eating disorders. Clients with irritable bowel syndrome (IBS) are not likely to disturb the GI tract with drugs that could further irritate the tissue. Clients who are obese are more likely to be inactive and ingest diets high in fat and cholesterol.

The nurse is selecting candidates for a health screening project regarding the abuse of laxatives. The best client group includes which of the following? 1 Older adult clients with congestive heart failure (CHF) 2 Clients with irritable bowel syndrome (IBS) 3 Clients with bulima nervosa or anorexia nervosa 4 Clients who are obese

1,2,3,5 Rationale: Mineral oil should not be administered to clients with swallowing problems due to increased risk of aspiration leading to lipoid pneumonia. If a drug that may increase peristalsis is introduced, it may intensify the signs or symptoms or blur the clinical picture in a client with appendicitis. The client with fecal impaction needs to be disimpacted and may require enemas. Steatorrhea causes excessive stimulation of peristalsis because of the excessive fat content in the stool. There is no contraindication to giving this medication to a client with occasional heartburn, since this is likely due to food intolerance.

The nurse should consult with the prescriber if oral mineral oil is prescribed for which of the following clients? SATA 1. Client with dysphagia following a cerebral vascular accident (CVA) 2. Client who has suspected appendicitis 3. Client who has a fecal impaction 4. Client who has infrequent heartburn 5. Client who has steatorrhea

2 Rationale: Amphetamines and anorexiants increase the secretion of norepinephrine, resulting in a decrease in the seizure threshold. Seizures are often associated with the excessive release of acetylcholine. When these drug groups are used concurrently with antiepileptics, the seizure control is more efficient. A reduction in RBCs may be compounded if given concurrently w/ nonsteroidal anti-inflammatory drugs (NSAIDs). Since anticholinergics may cause tremors and cerebral dystonia, they would be contraindicated in a client w/ a seizure disorder. Because of a potential increase in metabolism, administration w/ other antiepileptics may result in decreased serum levels.

The nurse should include in teaching plan for a client diagnosed with seizure disorder that which drug groups can potentiate the effects of the prescribed carbamazepine? 1 Nonsteroidal anti-inflammatory drugs (NSAIDs) 2 Anorexiants and amphetamines 3 Anticholinergics 4 Hydantoins and benzodiazepines

4 Cluster headaches are aggravated by light. Darkening the room reduces this noxious environmental stimulus, thereby promoting maximum therapeutic effects. Ergotamine tartrate should be given orally 1-2mg followed by 1-2mg every 30 min until the headache abates or until the maximum dose of 6 mg/24 hours. It is unnecessary to drink large amounts of fluids. Tachycardia can be a side effect of this drug, but increased warmth and energy are not associated w/ this medication

The nurse should include which instruction when teaching a client prescribed ergotamine tartrate for treatment of cluster headaches? 1 Take the medication every 4 hours 2 Take the medication with plenty of water 3 You will feel energetic and warm after taking the medication 4 Lie down in a darkened room after taking the medication

2 Rationale: A client with liver disease may be at risk for toxicity with acetaminophen, or at increased risk of bleeding if taking aspirin or NSAIDs. Unless temperature elevation is the reason for the prescription, it does not need to be measured. Tachycardia can occur if the drugs are combined with various cold remedies. There is no evidence that changes in cholesterol levels influence administration of these drugs. These drugs may be abruptly withdrawn and do not need to be tapered.

The nurse should include which precaution when teaching client with liver disease about use of the OTC acetaminophen, aspirin, or nonsteroidal anit-inflammatory drugs (NSAIDs)? 1 Take your temp before taking one of these drugs 2 Consult your healthcare provider before taking one of these medications 3 You should have your cholesterol level measured before using these medications 4 Taper the discontinuance of any of these medications over a 3-day period

4 Rationale: Since methylphenidate is a stimulant, a history of Tourette syndrome is a contraindication for its use. There are other medications that could be used for treatment of attention-deficit/hyperactivity disorder (ADHD), such as pemoline or dextroamphetamine. Methylphenidate has a calming effect on pediatric clients and is appropriate for use with this age group. Aplastic anemia is a side effect of Cylert. Because it is a stimulant, the use of methylphenidate in pts w/ a seizure disorder should be done with caution

The provider prescribed methylphenidate for a client diagnosed with attention-deficit/hyperactivity disorder (ADHD). The nurse should question the prescription if the client has which contraindication? 1 Age less than 12 yrs 2 History of anemia 3 History of seizures 4 History of Tourette syndrome

When administering a bulk-forming laxative, the nurse instructs the patient to drink the medication mixed in a full 8-ounce glass of water. Which statement best explains the rationale for this instruction?

These laxatives may cause esophageal obstruction if taken with insufficient water.

The drug nalbuphine (Nubain) is an agonist-antagonist (partial agonist). The nurse understands that which is a characteristic of partial agonists?

They have a lower dependency potential than agonists.

A teenage patient is taking tetracycline for severe acne.What education should be included?

Use sunscreen or avoid exsposure to sunlight.

How is the effectiveness of antiviral drugs administered to treat HIV infection assessed and evaluated?

Viral load All antiretroviral drugs work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood.

1 Rationale: Anticholinergic effects include drying of mucous membranes, dilated pupils, and decreased motility of the GI tract, which may result in constipation. Pupillary constriction, bronchoconstriction, and bradycardia are the opposite of anticholinergic outcomes. The parasympathetic system participates in establishing an erection, hence, blockers would result in erectile dysfunction, and the drugs increase the HR. Because dry mouth is an anticholinergic effect, excessive salivation is incorrect.

When the nurse teaches a client about the side effects of anticholinergic medications, what set of signs or symptoms should be included? 1 Urinary retention, constipation, or dilated pupils 2 Pupillary constriction, bronchoconstriction or bradycardia 3 Inability to obtain an erection, irregular heart rhythm 4 Increased salivation, dysphagia, confusion, restlessness

3 Rationale: Doses must be taken regularly to maintain therapeutic blood levels, even w/o seizure activity. The side effects of antiepileptic drugs varies widely. A mild drowsiness can occur w/ some of them, but it should not be significant enough to require lying down. There is no evidence of an impact on serum cholesterol levels. Most common side effects involve the CNS and hematologic system. Antiepileptic therapy is prescribed for long-term or lifelong use.

Which statement made by the client indicates an understanding of client teaching regarding antiepileptic drug therapy? 1 After taking the medication, I should lie down 2 I must be sure to have my cholesterol levels checked regularly 3 I need to take this medication regularly to avoid the recurrence of seizures 4 I probably will not need this medication very long

A patient is diagnosed with onychomycosis. The nurse anticipates use of which medication for the treatment of this condition?

a. terbinafine (Lamisil)

a laxative has been ordered for a pt. the nu checks the pts medical hx and would be concerned if which condition is present?

abdominal pain of unknown origin

While admitting a patient for treatment of an acetaminophen overdose, the nurse prepares to administer which medication to prevent toxicity?

acetylcysteine (Mucomyst) Acetylcysteine is the antidote for acetaminophen overdose. It must be administered as a loading dose followed by subsequent doses every 4 hours for 17 more doses and started as soon as possible after the acetaminophen ingestion (ideally within 12 hours).

The nurse is obtaining a medication history from an 18-year-old female patient who has been diagnosed with genital herpes. Which drug would the nurse expect this patient to be prescribed?

acyclovir (Zovirax) Acyclovir is the drug of choice to treat herpes simplex infections. Ribavirin is effective against respiratory syncytial virus (RSV), zidovudine against human immunodeficiency virus (HIV), and amantadine against Haemophilus influenzae type A.

A priority assessment of a patient on antibiotic therapy includes questioning the patient about

allergies

The nurse will question the use of a floroquinolone antibiotic in a patient already prescribed which medication?

amiodarone

a child has a fever and otitis media. which drug does the nurse expect to act as the first line of tx for the child?

amoxicillin

A nurse needs to be aware that the antifungal drug with the most common adverse events is which drug?

amphotericin B

Medications used to treat HIV infections are more specifically classified as

antiretroviral drugs. HIV is a member of the retrovirus family; therefore drugs used to treat this virus are classified as antiretroviral drugs. Although antiretroviral drugs also fall under the broader category of antiviral drugs in general, their mechanisms of action are unique to the AIDS virus. So, they are more commonly referred to by their subclassification as antiretroviral drugs.

a patient is perscribed bacitracin topical ointment. what does the nurse suspect as the possible diagnosis based on the medication perscibed?

bacterial infection

When teaching a patient about potential side effects of NSAID therapy, the nurse will teach the patient to promptly report which effect?

black tarry stool A major side effect of NSAID therapy is gastrointestinal (GI) distress with potential GI bleeding. Black tarry stools are indicative of a GI bleed.

a patient who is allergic to penicillin is at an increased risk for an allergy to which drug?

cephalexin

A patient who is allergic to penicillin is at increased risk for an allergy to which drug?

cephalexin sodium (Ancef) Patients who are allergic to penicillins have a fourfold to sixfold increased risk of allergy to other beta-lactam antibiotics. The incidence of cross-reactivity between cephalosporins and penicillins is reported to be between 1% and 4%.

a nurse is administering tamsulosin to a client would expect to note which therapeutic outcomes?

decreased urethral obstruction increased urine flow decreased urinary frequency

after administering oxybutynin (ditropan) to a pt with spina bifida, the nu is assessing the pt for therapeutic effects. what is the nu assessing for in the pt?

decreased urinary frequency

a patient with irriitable bowel syndrome (IBS) receiving 0.5 mg alosetron (lotronex) big orally develops constipation. what is the appropriate tx strategy in this situation?

discontinuing the medication

During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and anorexia. The nurse's best advice to the patient would be which of the following? A. "Take it with cheese and crackers or yogurt." B. "Take each dose with a glass of milk." C. "Take an antacid with each dose as needed." D. "Drink a full glass of water with each dose."

drink a full glass of water with each dose

Which antifungal drug can be given intravenously to treat severe yeast infections as well as a one-time oral dose to treat vaginal yeast infections?

fluconazole (Diflucan)

A patient is admitted to the emergency department with a severe overdose of a benzodiazepine. The nurse immediately prepares to administer which antidote from the emergency drug cart?

flumazenil (Romazicon) Flumazenil is the antidote for benzodiazepine overdose. The other options are only effective against opioid effects.

which drug is used to identify corneal defects?

fluorescein

The nurse should assess a patient for nephrotoxicity and ototoxicity when administering which antimicrobial?

gentamicin

A patient receiving narcotic analgesics for chronic pain can minimize the gastrointestinal (GI) side effects by

increasing fluid and fiber in the diet. Narcotic analgesics decrease intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can prevent constipation.

Most nonsteroidal antiinflammatory drugs (NSAIDs) work by

inhibiting prostaglandin production.

the nurse tells a patient who is being treated for acne to report if any signs of depression occur. which drug is part of the patients perscription?

isotretnoin

Which NSAID would the nurse anticipate administering parenterally for the treatment of acute postoperative pain?

ketorolac (Toradol)

During drug therapy for pneumonia, a female patient develops a superinfection. The nurse explains that this infection is caused by A. large doses of antibiotics that kill normal flora. B. the infection spreading from her lungs to the new site of infection. C. resistance of the pneumonia-causing bacteria to the drugs. D. an allergic reaction to the antibiotics.

large doses of antibiotics that kill normal flora

During drug therapy for pneumonia, a female patient develops a vaginal superinfection. The nurse explains that this infection is caused by

large doses of antibiotics that kill normal flora. Normally occurring bacteria are killed during antibiotic therapy, allowing other flora to take over and resulting in superinfections. The other options are incorrect.

While recovering from surgery, a 74 year old women stated taking a stimulant laxative, senna (senokot), to relieve constipation caused by the pain medications. She tells the nurse that she likes how "regular" her bowel movements are now that she is taking the laxative. While teaching principle is appropriate for this patient? a. Use of a stimulant laxative will not affect teh absorption of her other medications. b. It is important to have a daily bowel movement to promote bowel health. c.Long-term use of laxatives often results in decreased bowel tone and may lead to dependency. d. She should switch to glycerin suppositories to continue having daily bowel movements

long term use of laxatives often results in decreased bowel tone and may lead to dependency

A patient is admitted to the psychiatric unit for detoxification treatment of narcotic addiction. The nurse would anticipate administration of which medication?

methadone Methadone is a synthetic opioid analgesic with gentler withdrawal symptoms and is the drug of choice for detoxification treatment.

the nurse is administering intravenous vancmycin to a patient who has had a gastrointestional surgery. which measures are appropriate?

monitoring serum creatinine levels warning the pt that a flushed feeling or facial itching may occur instructing the patient to report dizziness or a feeling of fullness in the ears

Which medication is used to treat a patient suffering from severe adverse effects of a narcotic analgesic?

naloxone (Narcan) Naloxone is the narcotic antagonist that will reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

What is the most common drug used to treat oropharyngeal candidiasis?

nystatin (Mycostatin)

A client has a new prescription to take bisacodyl. To enhance a rapid medication effect, the nurse instructs the client to take the medication in which way.

on an empty stomach

a client has a new perscription to take bisacodyl. to enhance a rapid med effect, the nu instructs the client to take the med in which way?

on an empty stomach

The nurse will teach patients taking rifampin and INH prophylactically secondary to tuberculosis exposure that

oral contraceptives become ineffective when given with rifampin.

The nurse plans pharmacologic therapy for a patient with pain based on the knowledge that

pain relief is best obtained by administering analgesics around the clock.

a patient who has been taking isoniazid (INH) has a new persciption for pyridoxine (VB6). she is wondering why she needs this medication. the nu explains that pyridoxine is often given concurrently with the isoniazid to prevent which condition?

peripheral neuropathy

The nurse would question an order to administer misoprostol (Cytotec) to a patient with which condition?

pregnancy Misoprostol is an abortifacient and thus is contraindicated in pregnancy.

a patient with a known heart condition is scheduled to have dental surgery and is perscibed antibiotics beforethe dental surgery. what type of therapy is this considered?

prophylactic therapy

the health care provider has ordered ciprofloxacin/dexamethasone (ciprodex) otic drops for a patient with otitis externa. the nurse knows the combination medication has both antibacterial medication and topical steroid medication. what is the purpose of the steroid in this medication?

reduce inflammation

An 82-year-old woman is taking ibuprofen (Motrin) 3200 mg divided three times daily as treatment for arthritis. She has had no other health problems. What is the most important assessment for the nurse to monitor while the patient is on this therapy?

renal function studies NSAIDs disrupt the prostaglandins, which stimulate vasodilation and increase renal blood flow. This disruption may precipitate chronic or acute renal failure in some patients, and elderly patients are at greater risk for this adverse drug reaction.

When assessing for the most serious adverse reaction to a narcotic analgesic, what does the nurse monitor for in the patient?

respiratory rate The most serious side effect of narcotic analgesics is respiratory depression.

a healthy adult client has been taking a laxative 3 days per week for 9 mo. what primary risk should the nu address in a teaching plan with this client?

risk for drug dependence

the nurse is caring for a patient who is on isotretenoin treatment. which cautionary factor does the nurse warn the patient about while using the medication?

risk to the fetus in pregnancy

A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections? A. Sulfonamides B. Carbapenems C. Macrolides D. Tetracyclines

sulfonamides

During antibiotic therapy, the nurse will assess the patient for a condition that may occur due to the disruption of normal flora. The nurse recognizes this as:

superinfection

a 79-year-old patient is receiving ciprofloxin a quinolone as tx for a complicated incision infection. the nurse will monitor for which adverse effect that is assoc. w these drugs?

tendonitis and tendon rupture

a client has been started on med therapy with nitrofurantion as chronic suppressive therapy for UTI. what statements should the nu include when teaching the client about this?

this med causes harmless brown color to the urine monitor your urine for cloudiness or foul smelling promptly report muscle weakness, tingling, or numbness to the perscriber nausea can be a common side effect of this med

The nurse is administering medications. One patient has an order for aspirin 325 mg by mouth daily and another patient has an order for aspirin 650 mg 4 to 6 times daily (maximum 4 g/day). The nurse understands that the indication for the 325 mg of aspirin once daily is

thromboprevention "Low-dose" aspirin, such as 81 or 325 mg once daily, is given for thromboprevention. Dosages for pain, fever, or arthritis are much higher usually

Nausea and vomiting are frequent adverse effects associated with antineoplastic therapy. Patients who are experiencing this unpleasant effect will be advised

to try to maintain hydration and nutrition, which are very important during treatment.

A teenage patient is taking a tetracycline drug as part of treatment for severe acne. When the nurse teaches this patient about drug-related precautions, which is the most important information to convey? a) When the acne clears up, the medication may be discontinued. b) This medication needs to be taken with antacids to reduce GI upset. c) The patient needs to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity. d) The teeth should be observed closely for signs of mottling or other color changes.

use sunscreen or avoid exposure to sunlight

A 6-year-old child who has chickenpox also has a fever of 102.9° F (39.4° C). The child's mother asks the nurse if she should use aspirin to reduce the fever. What is the best response by the nurse?

"Acetaminophen (Tylenol) should be used to reduce his fever, not aspirin."

A 6-year-old child who has chickenpox also has a fever of 102.9° F (39.4° C). The child's mother asks the nurse if she should use aspirin to reduce the fever. What is the best response by the nurse?

"Acetaminophen (Tylenol) should be used to reduce his fever, not aspirin." Aspirin is contraindicated in children with flulike symptoms because the use of this drug has been strongly associated with Reye's syndrome. This is an acute and potentially life-threatening condition involving progressive neurologic deficits that can lead to coma and may also involve liver damage. Acetaminophen is appropriate for this patient. The other responses are incorrect.

A patient has used enteric aspirin for several years as treatment for osteoarthritis. However, the symptoms are now worse and she is given a prescription for a nonsteroidal antiinflammatory drug (NSAID) and misoprostol (Cytotec). The patient asks the nurse, "Why am I now taking two pills for arthritis?" What is the nurse's best response?

"Cytotec may help to prevent gastric ulcers that may occur in patients taking NSAIDs."

A patient has used enteric aspirin for several years as treatment for osteoarthritis. However, the symptoms are now worse and she is given a prescription for a nonsteroidal antiinflammatory drug (NSAID) and misoprostol (Cytotec). The patient asks the nurse, "Why am I now taking two pills for arthritis?" What is the nurse's best response?

"Cytotec may help to prevent gastric ulcers that may occur in patients taking NSAIDs." Cytotec inhibits gastric acid secretions and stimulates mucous secretions; it has proved successful in preventing the gastric ulcers that may occur in patients taking NSAIDs.

During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and decreased appetite. Which statement is the nurse's best advice to the patient?

"Drink a full glass of water with each dose." Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal upset; however, antacids and dairy products will bind with the tetracycline and make it inactive.

The nurse is teaching the mother of a 1-year-old patient how to instill ear drops for OE. What instructions on instillation does the nurse provide to the mother?

"Hold the pinna down and back." When administering eardrops to adults, hold the pinna up and back. In children younger than 3 years of age, hold the pinna down and back. Allow a period of time for adequate coverage of the ear by the medication. Store eardrops, solutions, and ointments at room temperature before instillation. Administration of solutions that are too cold may cause a vestibular type of reaction with vomiting and dizziness.

Which statement, if made by a patient with HIV infection, demonstrates a need for continued patient teaching?

"I don't need to use condoms as long as I take my medication as prescribed." Antiretroviral drugs do not stop the transmission of HIV, and patients need to continue standard precautions.

Which statement, if made by a patient with HIV infection, demonstrates a need for continued patient teaching? A."I will change my position slowly to prevent dizziness and potential injury." B."I must take these medications exactly as prescribed for the rest of my life." C."I don't need to use condoms as long as I take my medication as prescribed." D."I should remain upright for 30 minutes after taking my zidovudine."

"I don't need to use condoms as long as I take my medication as prescribed." Antiretroviral drugs do not stop the transmission of HIV, and patients need to continue standard precautions.

which statement, if made by a patient with HIV infection, demonstrates a need for continued patient teaching?

"I dont need to use condoms as long as i take my medication as perscribed."

a female patient has been taking isotretinoin (amnesteem) for 3mo. as a nu you know that there has been case reports of suicide and suicide attempts in pts taking isotretinoin (amnesteem). during a follow-up appointment, which statement by the pt would be of highest concern to the nu?

"I have been feeling rather down and lonely lately."

A patient tells the nurse that he likes to drink kava herbal tea to help him relax. Which statement by the patient indicates that additional teaching about this herbal product is needed?

"I will be able to drive my car after drinking this tea."

which statement, made by a patient, indicates the need for further patient teaching regarding proper administration of eyedrops?

"I will rinse the eyedropper with tap water after each use"

Which statement, made by a patient, indicates the need for further patient teaching regarding proper administration of eyedrops?

"I will rinse the eyedropper with tap water after each use." It is important to maintain sterility of the eyedrop container, and therefore it should not be rinsed; the cap should be put immediately back on the container.

A patient asks the nurse about the difference between diphenoxylate with atropine (Lomotil) and the over-the-counter drug loperamide (Imodium). Which response by the nurse is correct?

"Imodium does not cause physical dependence." Although the drug exhibits many characteristics of the opiate class, physical dependence on loperamide has not been reported. All antidiarrheal drugs are orally administered. The other options are incorrect.

Patient teaching for a patient receiving allopurinol (Zyloprim) should include which information?

"Increase your fluid intake to 3 L per day."

When reviewing a patient's medication regimen before discharge, the patient asks why he is taking pyridoxine when he is already taking isoniazid (INH) to treat tuberculosis. What is the nurse's best response?

"Pyridoxine will help prevent numbness and tingling that can occur secondary to the isoniazid."

Which information will the nurse include in discharge teaching for a patient receiving doxycycline?

"Use sunscreen and protective clothing when outdoors."

A patient arrives at the urgent care center complaining of leg pain after a fall when rock climbing. The x-rays show no broken bones, but he has a large bruise on his thigh. The patient says he drives a truck and does not want to take anything strong because he needs to stay awake. Which statement by the nurse is most appropriate?

"You can take acetaminophen, also known as Tylenol, for pain, but no more than 3000 mg per day." Acetaminophen is indicated for mild to moderate pain and does not cause drowsiness, as an opioid would. Currently, the maximum daily amount of acetaminophen is 3000 mg per day. The 1000-mg amount per day is too low. Telling the patient not to take any pain medications is incorrect.

the nurse is teaching the mother of a 1y patient how to instill ear drops for OE. what instructions on instillation does the nurse provide to the mother?

"hold the pinna down and back."

a patient asks the nurse about the difference bewteen diphenoxylate with atropine (lomotil) and the over-the-counter drug ioperamide (imodium). which response by the nu is correct?

"immodium does not cause physical dependence."

a female patient will be starting therapy with oral isotretinoin (amnesteem) as part of tx for severe acne and the nu is providing teaching. which teaching point will the nu include in her teaching plan about isotretinoin.

"you will have to use two contraceptive methods while on this drug."

Which are general adverse effects of chemotherapy? (Select all that apply.)

- Alopecia - Thrombocytopenia

A client with open-angle glaucoma is being treated with acetazolamide 250 mg tablets by mouth twice daily. Which client statements indicate to the nurse an understanding of therapy with this drug?SATA

-"I can take the medication with milk" -"I should take the medication in the morning" -"I can crush the tablet and mix it in with juice"

A female patient has been taking isotretinoin (Amnesteem) for 3 months .As a nurse you know that there has been case reports of suicide and suicide attempts in patients taking isotretinoin (Amnesteem). During a follow-up appointment, which statement by the patient would be of highest concern to the nurse?

-"I have been feeling rather down and lonely lately." There have been case reports of suicide and suicide attempts in patients receiving isotretinoin. Instruct patients to report immediately to their prescribers any signs of depression. Follow-up treatment may be needed, and simply stopping the drug may be insufficient.

The nurse should conclude that a client understands instructions about how to self-administer a prescribed otic solution when the client makes which statement?

-"I place the bottle of medication under warm running water before using"

A client who has a new prescription for dorzolamide asks the nurse how the medication will help treat glaucoma. The nurse's best response should include which item of information?

-"It decreases the production of aqueous humor"

A client telephones the outpatient clinic and reports severe car pain that ceased suddenly when copious drainage came from the ear. The client wants to instill remnants of a 2-month-old otic antibiotic prescription left over from a previous ear infection. What is the best response by the nurse?

-"See a healthcare provider. Do not treat the ear with the antibiotic"

The nurse should conclude that a client newly diagnoses with glaucoma understands the purpose for the prescribed timolo when the client makes which statement?

-"This eye drop will reduce the intraocular pressure"

A client is scheduled for an annual eye exam. What instructions should the nurse provide? SATA

-"Wear sunglasses after the exam because atropine will cause photophobia" -"Tropicamide may be administered to dilate the pupil" -"Because you have dry eyes the doctor may prescribe cyclosporine drugs"

A female patient will be starting therapy with oral isotretinoin (Amnesteem) as part of treatment for severe acne, and the nurse is providing teaching. Which teaching point will the nurse include in her teaching plan about isotretinoin?

-"You will have to use two contraceptive methods while on this drug." It is now officially required that at least two contraceptive methods be used by sexually active women during and for 1 month after completion of therapy with isotretinoin. The other statements are incorrect.

The nurse concludes that docusate sodium is appropriate for use in which of the following clients? Select all that apply.

-A postoperative client taking opioid anagesics for pain -A client who experienced a myocardial infarction -A client with painful hemorrhoids

Fluroquinolones are a class of antibiotics known for several significant complications. Which are possible adverse effects with these drugs? (Select all that apply.)

-Abnormal cartilage development in children -Prolongation of the QT interval -Tendon rupture

Because a client with glaucoma is scheduled for removal of a cataract from the left eye, the nurse should anticipate a prescription from the surgeon to administer which drug?

-Acetazolamide

A child has a fever and otitis media. Which drug does the nurse expect to act as the first line of treatment for the child?

-Amoxicillin -Amox is a systemic antibiotic that acts as the first line of treatment for conditions such as fever and otitis media, and will likely be prescribed by a health care provider to children with these issues. Floxin is a higher class of antibiotic, which upon administration may lead to unwanted reactions, and the child may easily develop resistance to the drug. Acetasol HC is an antifungal agent that helps to treat fungal ear infections. Debrox helps to remove earwax accumulated in the ear canal.

What should be the priority of the nurse in assessing a client prior to administering the first dose of an ophthalmic medication?

-Client's history of medication allergies

When providing instructions to patients on use of antibiotics, which instructions would the nurse include in the teaching? (Select all that apply.)

-Complete the entire course of therapy. -Notify the provider of any possible reactions that occur. -Increase fluid intake. -Wash hands before and after preparing food.

Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.)

-Constipation -Lightheadedness -Urinary retention -Itching

Which drug is used to identify corneal defects?

-Fluorescein Fluorescein is an ophthalmic diagnostic dye used to identify corneal defects. Atropine sulfate is a mydriatic and cycloplegic drug used to assist eye examination and treat uveal tract inflammation. Cromolyn sodium is an antiallergic drug used in the treatment of vernal keratoconjunctivitis. Cyclopentolate solution is used in diagnostics as a mydriatic and cycloplegic drug.

After a nurse provides instructions about betaxolol to a client with chronic obstructive pulmonary disease (COPD), the client asks, "How can eyedrops affect the lungs?" The nurse's best response includes which information?

-If betaxolo is systemically absorbed, it can exert the same systemic effects as other beta-blockers

Bacterial resistance to antibiotics can occur with which situations? (Select all that apply.)

-Patients stop taking an antibiotic once they feel better. -Antibiotics are prescribed to treat a viral infection.

A nurse should conclude that a client can safely self-administer ophthalmic medications after the client demonstrates which aspects of correct technique? SATA

-Pulls lower lid down and instills medication into conjunctival sac -Applies gentle pressure to inner canthus for 30 seconds after medication administration -Cleanses exudates from eye before instillation of medication

When providing education to a patient undergoing antineoplastic drug therapy, the nurse would teach the patient that which signs and symptoms indicate an oncologic emergency that requires immediate notification of the health care provider? (Select all that apply.)

-Swollen tongue -Bleeding gums -New and persistent cough -Blood in urine

A client has been started on medication therapy with nitrofurantion as chronic suppressive therapy for urinary tract infection. What statements should the nurse include when teaching the client about this? Select all that apply.

-This medication causes harmless brown color to the urine -Monitor your urine for cloudiness or foul smell. -Promptly report muscle weakness, tingling, or numbness to the presciber. -Nausea can be a common side effect of this medication.

Before administering preoperative medications to a client with a history of glaucoma, the nurse would question which medication prescription?

-atropine

A client with diabetes and glaucoma has NPH insulin and carteolol listed on the medication administration record. The nurse should consider which assessment to be of priority when seeing the client?

-blood glucose

A patient is seen in the clinic for signs and symptoms of malaria after a trip to South America. What drug would the nurse expect to be prescribed?

-chloroquine (Aralen) -Chloroquine is a standard drug used for the treatment of malaria in an acute stage.

The nurse should question an order for brinzolamide for a client who has which disorder listed in the health history section of the EMR?

-chronic renal failure

The nurse should conclude that a client is demonstrating appropriate technique for instilling ophthalmic medication when the client performs which action?

-cleanses crust from eye by wiping from the inner cannthus outward with a cotton ball

The nurse should conclude that a 68-year-old client understands proper otic medication administration after observing the client perform which actions during self-administration? SATA

-client pulls pinna up and back before administering medication -client gently massages the anterior ear area after medication administration

The external ear canal of a client with an ear infection is obstructed due to swelling. The nurse should instruct the client to use which techniques during otic medication administration? SATA

-insert gauze ear wick and apply medication to wick -avoid using pressure to insert tip of the fluid container

Because a prescription of gentamicin sulfate for an ear infection reads "for ophthalmic use," the client refuses to instill the medication. After verifying the prescription with the client's chart, what is the most appropriate conclusion by the nurse?

-it is an accepted and safe practice in the US for clinicians to prescribe ophthalmic gentamicin for otic use

A client is prescribed the ophthalmic medication latanoprost. The nurse should teach the client about what common effects of this drug? SATA

-maintenance of visual fields -thickening of eyelashes

A client is receiving an ophthalmic anesthetic agent prior to removal of sutures. The nurse should consider implementing which priority nursing measures?

-measures to protect the eye

When providing health promotion teaching at a senior citizen center, the nurse would include information about which medication used to decrease the duration of influenza A and B?

-oseltamivir (Tamiflu) and zanamivir (Relenza) -both are active against influenza virus types A and B and have been shown to reduce the duration of influenza infection by several days.

A client with a history of asthma is describing symptoms that began after starting drug therapy with pilocarpine to treat glaucoma. The nurse should conclude that which symptom indicates a side effect associated with systemic absorption of this drug?

-wheezing

A client newly diagnosed with psoriasis has been prescribed betamethasone as treatment for the disorder. What statement made by the client indicates further information is needed about this medication? 1. This drug will also help cure my acne. 2. I should report an elevated temperature if it occurs. 3. After applying the medication, I should either leave the skin exposed or cover it lightly. 4. It should only be applied to the affected skin area.

1

After 5-fluorouracil cream is prescribed for a client diagnosed with basal cell carcinoma, what should the nurse teach the client? 1. The drug will cause increasing tenderness as lesions ooze and erode. 2. The drug will cause the lesions to become dry, shrink, and fall off. 3. THe drug will decrease the sensitivity of the lesion. 4. Vigorously massage the lesion after application.

1

After administering silver sulfadiazine to a client with burns, the nurse should perform which assessment to determine the effectiveness of the medication? 1. Measure body temperature 2. Weigh client daily 3. Review serum potassium levels 4. Asses separation of eschar

1

During the first 24 hours, the nurse should manage one of the most common complications associated with burn injury by administering which medications as prescribed for the client? 1. Famotidine 20 mg intravenous every 12 hours 2. Calcium-based antacids by mouth after meals 3. Furosemide 20 mg intravenous twice daily 4. Crotamiton cream, once daily for 2 days

1

The nurse should conclude that a client with bacterial pneumonia understands self-administration of a prescribed oral antibiotic after the client makes which statement? 1. I will continue to take the antibiotic as it is prescribed, even though I no longer have a cough with yellow sputum 2. When I missed a does of my antibiotic this morning, I made up by taking two doses at the time of the next dose 3. I am careful to take the antibiotic every day at break-fast, lunch, and dinner 4. Even though my provider prescribed a chewable tablet, I have no problem swallowing it whole

1 Rationale: A full course of antibiotic therapy must be taken in order to decrease the risk of resistance to the antibiotic or recurrence of the infection. Missed doses should be taken as soon as they are remembered and the dose should not be doubled. Antibiotic doses are to be taken at regular intervals spaced throughout the 24 hours, w/o interrupting sleep when possible, to maintain effective therapeutic blood level of the antibiotic. Chewable tablets must be crushed or chewed of the drug may not absorb adequately. Attempting to swallow chewable tablets could also put the client at risk for airway obstruction.

Because finasteride was prescribed for a 45 yr old man, the nurse should include which priority instruction during a teaching session about the medication? 1 Use a contraceptive barrier during sexual intercourse 2 Sexual performance level may decrease 3 Increase daiky fluid intake 4 Take the drug for 1 month

1 Rationale: Finasteride is an androgen inhibitor that may be used to treat enlarged prostate. It reduces the serum levels of testosterone, resulting in decreased prostate gland size and indirectly improving the flow of urine during voiding. Because of the risk of abnormalities to the fetus, pregnant women or women of childbearing age should not be exposed to semen fluid of a male taking finasteride. The decreased serum level of testosterone may result in decreased libido, but is not as relevant as the risk to the developing fetus. Because of urinary stasis that accompanies enlarged prostate, the pt should increase fluid intake to prevent infection. Once again however, this is not as relevant as the health of a developing fetus. It may take 6-12 months to reach full therapeutic effectiveness so 3 wks is too short a time frame.

A client's sputum specimen is sent to the laboratory for a gram stain testing. The nurse should assess the client for signs of what type of infection? 1. Bacterial 2. Acute viral 3. Parasitic 4. Fungal

1 Rationale: Gram stain testing is a method of classifying bacteria. Bacteria with a thick cell wall retain a purple color after staining and are called gram-positive bacteria. Bacteria with thinner cell walls lose that violet stain and are called gram-negative bacteria. Some antibiotics are only effective for gram positive or gram-negative bacteria, so this is necessary information. Gram stain has no use in determining drug therapy for acute viral infection, parasitic infection, or fungal infection.

A client who is starting medication therapy with furosemide 20 mg PO daily asks the nurse what would be the best time of the day to take the pill. What time should the nurse recommend? 1. 8:00 a.m. 2. 12 noon 3. 6:00 p.m. 4. At bedtime

1 Rationale: If the nurse is to advise the client appropriately, knowledge of pharmacokinetics is necessary. For example onset: 20-60 minutes; peak: 60-70 minutes; duration: 2 hrs; elimination: 50% every 24hrs. Since clients may not respond as expected, the client should ingest the drug as early as possible to prevent nocturia that could disrupt the client's sleep. Therefore, 0800 is best answer. While 12 noon is a more a more appropriate time than 1800 or bedtime, it is not the best time. Since 50% will remain in the body for each 24-hr period, a cumulative effect could disrupt the client's sleep-rest pattern. An onset of 20-60 mins would result in a direct interruption of the sleep- rest pattern.

While teaching the client about newly prescribed oral metronidazole, what information would be most important for the nurse to include? 1. Avoid intake of alcoholic beverages 2. Headache may accompany drug ingestion 3. Drug may cause constipation 4. Drug may cause vaginal dryness

1 Rationale: Ingesting alcoholic beverages with metronidazole can result in a disulfiram reaction, including exaggerated sympathomimetic signs/symptoms. Headache, constipation, and vaginal dryness may occur and can be easily managed, but are not as significant as tachycardia and flushing.

A nurse notes that a client has methenamine on the list of prescribed medications. The nurse should suspect that the client has a diagnosis of which health problem? 1. Urinary tract infection 2. Bladder incontinence 3. Acute kidney injury 4. Chronic renal failure

1 Rationale: Methenamine is a urinary tract anti-infective that is useful in treating urinary tract infections. Some types of bladder incontinence may be treated with drugs that reduce bladder spasms. Methenamine is not useful in treating acute kidney injury, which would be characterized by a sudden drop in urine output. Methenamine would not counteract the effects of chronic renal failure, which is an irreversible health problem.

A client with hypertension and diabetes mellitus is taking hydrochlorothiazide. The client reports onset of an enlarged, red, painful right great toe soon after beginning therapy with this medication. The home health nurse should request a prescription from the healthcare provider for which serum laboratory test? 1. Uric acid level 2. Alanine aminotransferase 3. Serum glucose 4. Serum sodium

1 rationale: hyperuricemia is a side effect of thiazide diuretics such as hydrochlorothiazide, and this could lead to symptoms resembling gout ( such as an enlarged, painful great toe ). An increase in liver enzymes such as alanine aminotransferase (ALT) is not associated with thiazide diuretics. Clients may experience hyperglycemia, but this is more likely related to the comorbidity of diabetes mellitus than to a drug side effect, and pain from diabetic neuropathy ( if present ) is not likely to occur in the toe. The drug is more likely to cause hypokalemia than a change in Na level.

A client is diagnosed with atopic dermatitis. The nurse should expect that which classes of drugs will be prescribed either alone or in combination? Select all that apply. 1. Antihistamines 2. Analgesics 3. Antimicrobials 4. Topical anesthetics 5. Antifungals

1, 2, 4

A nurse working in a burn center frequently applies topical burn medications to burn wounds. The nurse should anticipate that which medications may be prescribed topically for a newly admitted client with burns? Select all that apply. 1. Mafenide 2. Sulfisoxazole 3. Silver sulfadiazine 4. Nitrofurazone 5. Trimethoprim

1, 3, 4

The nurse is administering intravenous vancomycin (Vancocin) to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply.) 1. Monitoring serum creatinine levels 2.Restricting fluids while the patient is on this medication 3. Warning the patient that a flushed feeling or facial itching may occur 4. Instructing the patient to report dizziness or a feeling of fullness in the ears

1, 3, 4 Constant monitoring for drug-related neurotoxicity, nephrotoxicity, ototoxicity, and superinfection remain critical to patient safety. Monitor for nephrotoxicity by monitoring serum creatinine levels. Ototoxicity may be indicated if the patient experiences dizziness or a feeling of fullness in the ears, and these symptoms must be reported immediately. Vancomycin infusions may cause red man syndrome, which is characterized by flushing of the neck and face and a decrease in blood pressure. In addition, adequate hydration (at least 2 liters of fluids every 24 hours unless contraindicated) is most important to prevent nephrotoxicity. Optimal trough blood levels of vancomycin are 10 to 20 mcg/mL; therefore, the drug should not be administered when there is a trough level of 24 mcg/mL.

A client has been started on medication therapy with nitrofurantion as chronic suppressive therapy for urinary tract infection. What statements should the nurse include when teaching the cliet about this? Select all that apply. 1. This medication causes harmless brown color to the urine 2. You should greatly increase your daily fluid intake to about 3 liters/day. 3. Monitor your urine for cloudiness or foul smell. 4. Promptly report muscle weakness, tingling, or numbness to the presciber. 5. Nausea can be a common side effect of this medication.

1, 3, 4, 5

A client has received a prescription for supplemental potassium chloride. Which client teaching points should the nurse include in a discussion with the client? SATA 1. Take supplement with meals to reduce GI upset 2. Report irregular pulse, fatigue, or weakness in legs 3. Expect diarrhea or vomiting as side effects 4. Dissolve soluble tablet in at least 120 mL (4 oz) of water of juice 5. Avoid use of salt substitutes while taking potassium

1,2,4,5 Rationale: Potassium can be irritating to the GI tract so the client should take the dose with meals. Because hyperkalemia is a risk if there is excessive potssium supplementation, the client should report signs of hyperkalemia such as irregular pulse, fatigue, or weakness in legs. Soluble tablets should be dissolved in at least 4 ounces of liquid, while whole tablets should be taken with a large glass of liquid ( if allowed). The client should avoid the use of salt substitutes while taking potassium chloride because salt substitutes are high in potassium and could lead to hyperkalemia. Diarrhea and vomiting are not expected side effects and should be reported.

A client will be starting drug therapy with spironolactone to manage edema associated with cirrhosis of the liver. The nurse should encourage the client to avoid excessive amounts of which foods? SATA 1. Bananas 2. Cantaloupe 3. Grapes 4. Green beans 5. Spinach

1,2,5 Rationale: Spironolactone is a potassium-sparing diuretic, so the client should avoid excessive intake of foods high in potassium. Bananas, cantaloupe (and other melons), and spinach are high in potassium and should be avoided or limited while taking spironolactone. Grapes and green or wax beans are lower in potassium and may be eaten regularly while taking spironolactone.

A client is scheduled to receive fidaxomicin. What information should the nurse include in client teaching? SATA 1. Because the drug is not absorbed, it is effective against Clostridium difficile 2. This is one of the medications used for combination therapy of tuberculosis 3. This medication is not effective for treatment of systemic infections 4. Do not stop taking until full course of treatment is completed 5. Do not take if allergic to erythromycin

1,3,4,5 Rationale: Fidaxomicin is a macrolide antibiotic that does not absorb and therefore is effective against Clostridium difficile or pseudomembranous colitis. It is not used for tuberculosis. It is not effective for treatment of systemic infections. As with other antibiotics, the client should not stop taking until full course of treatment is completed. Because it is a macrolide antibiotic, it should not be taken if the client is allergic to erythromycin, another macrolide antibiotic.

When overseeing drug therapy for a client taking isoniazid, the nurse should assess for which of the following? SATA 1. Elevated aspartate aminotransferase (AST) 2. Clinical manifestations hypercalcemia 3. Concurrent self-administration of aluminum antacids 4. Compliance with ingestion of pyridoxine vitamin Vitamin B6 supplements 5. Excessive bruising on the skin

1,3,4,5 Rationale: Isoniazid can be hepatotoxic and aspartate aminotransferase (AST) levels refect liver inflammation or damage. The pt should be monitored for elevated levels. Antacids interfere with absorption of isoniazid when taken within 1-2 hours of the isoniazid, so the nurse should ensure that ingestion of the antacid dose is seperated from the isoniazid dose by 2 hours. Vit B6 should be administered with isoniazid therapy to reduce the incidence of peripheral neuritis. Thrombocytopenia is an adverse effect of isonizid, which can lead to the potential for bleeding and excessive brusing. Isoniazid can cause hypocalcemia, not hypercalcemia.

A client has been started on medication therapy with nitrogurantoin as chronic suppressive therapy for urinary tract infection. What statements should the nurse include when teaching the client about this medication? SATA 1 "This medication causes a harmless brown color to the urine." 2 "You should greatly increase your daily fluid intake to about 3 L/day." 3 "Monitor your urine for cloudiness or foul smell." 4 "Promptly report muscle weakness, tingling, or numbness to the prescriber." 5 "Nausea can be a common side effect of this medication."

1,3,4,5 rationale: Nitrofurantoin does cause a harmless brown discoloration to the urine. Pts should be made aware of this so it does not cause them concern. The client should continues to monitor for signs and symptoms of urinary tract infection, which can include cloudy or foul-smelling urine, in addition to classic symptoms of frequency, urgency, and dysuria. Muscle weakness, tingling, and numbness can be signs of neuropathy, which can be severe and irreversible. For this reason, these symptoms should be reported immediately to the prescriber. Nausea is a common side effect of this medication, although it can be reduced by using the macrocrystal form of nitrofuantoin. The pt should maintain adequate fluid intake, but fluids are not generally "forced" or increased to high levels durging chronic therapy

After taking amoxicillin for 10 days, the client has developed diarrhea, with approximately eight watery stools per day. The nurse should anticipate the need for which priority interventions? SATA 1. Monitor for clinical manifestations of metabolic acidosis 2. Administer an antiperistaltic agent such as dicyclomine hydrochloride. 3. Administer an antidiarrheal agent such as kaolin and pectin 4. Collect stool specimen for a cytotoxin assay to detect Clostridium difficile 5. Instruct client to increase intake of fruit juices

1,4 Rationale: The client is at risk for developing metabolic acidosis because of increased loss of bowel contents that consist primarily of alkaline fluids. Excessive watery stools or stools that contain blood may indicate pseudomembranous colitis, caused by the toxins released by C. difficile. A stool specimen should be collected as a priority measure. If the cause of the diarrhea is C. difficile, the toxin needs to be eliminated. Antiperistaltic agents or antidiarrheal agents can promote retention of toxins and should not be given. Some fruit juices could further exacerbate diarrhea and would not be encouraged.

A client is admitted with muscle cramps and frequent premature ventricular contractions associated with hypokalemia. When the client is prescribed a continuous IV infusion containing potassium chloride, the nurse should verify that the infusion rate does not exceed how many milliequivalents (mEq) of potassium per hour?

10 Rationale: because rapid administration of K chloride can lead to cardiac dysrhythmias and cardiac arrest, the recommended IV infusion rate should not exceed 10 mEq/hr

The nurse should question an order written to administer acetylsalicylic acid (aspirin) to which patient?

14-year-old boy with a history of flulike symptoms

A nurse is administering a very high-potency topical corticosteroid clobetasol to certain assigned clients. Which client is most at risk for systemic absorption. 1. 35 year old with psoriasis 2. 72 year old with eczema 3. 59 year old with seborrhea 4. 38 year old with contact dermititus

2

AN adult client with a pediculosis infestations has a prescription for a drug to treat the condition. The nurse anticipates providing which information as an instruction to the client about application methods. 1. Chlorhexidine: Apply with sterile gloves 2. Lindane: Leave in place for 12-24 hours 3. Collagenase: Apply with fingertips 4. Terbinafine: Apply a thin layer

2

After a healthcare provider prescribed minocycline for a client with acne, the nurse explains to the client which disadvantage of the medication? 1. Suppression of sebum production 2. Lupuslike syndrome and pigmentation changes 3. Open pores promoting excessive production of accumulated sebum 4. Occurrence of spontaneous abortion

2

The nurse teaches the client with acne that which preparations is one of the most effective agents for acne treatment? 1. Mafenide 2. Benzoyl peroxide 3. Chlorhexidine 4. Coal tar

2

The nurse teaches the parents of a child with impetigo to apply which topical medications as prescribed to the affected area of the child's skin? 1. Ketoconazole 2. Mupirocin 3. Capsaicin 4. Acyclovir

2

A client is receiving oseltamivir for influenza A. The nurse should monitor for which common side effect? 1. Stevens-Johnson syndrome 2. Diarrhea 3. Excessive urination 4. Nephrotoxicity

2 Rationale: A common side effect of oseltamivir is diarrhea; others include nausea and vomiting and dizziness. Stevens-Johnson syndrome is a rare side effect of peramivir. Urinary frequency is not associated with oseltamivir. Nephrotoxicity is not associated with oseltamivir, although it is an adverse effet of aminoglycoside antiobiotics

The nurse notes that the diuretic acetazolamide is listed on the client's medication reconciliation sheet. The nurse should check the client's health history for which anticipated health problem? 1. Addison disease 2. Open-angle glaucoma 3. Liver cirrhosis 4. Heart Failure

2 Rationale: Acetazolamide is a carbonic anhydrase inhibitor that has uses as a diuretic and antiglaucoma agent. The nurse should anticipate that the client has open-angle glaucoma as part of the health history. Addison disease or other adrenocortical insufficiency would be a contraindication to the use of acetazolamide. Acetazolamide is contraindicated for use in severe liver disease. Diuretics such as loop diuretics or thiazide diuretics are commonly used to treat HF

The nurse is providing information to a client who has started drug therapy with sulfisoxazole. Which instruction would be the highest priority of the nurse to provide? 1. Check the urine pH to prevent crystals from forming in the urine. 2. Report sudden onset of fever, pruritus, and malaise. 3. Restrict your oral fluid intake to an amount between 500 and 1,000 mL/day. 4. Keep your urine at an alkaline level.

2 Rationale: Early signs of hypersensitivity require immediate intervention, so the client should report sudden onset of fever, pruritis, or malaise. Checking the urine pH decreases the potential for stone formation, a very painful but not life-threatening problem. Fluid intake should produce 1,500 mL/day, and the client needs to take in at least 2 L of fluid per day. The medication is more soluble in alkaline urine, but attending to a hypersensitive reaction takes priority.

A 45-year-old female has been taking indapamide 2.5 mg daily. She reported to the clinic today with leg cramps and a blood pressure of 126/70. The nurse should consult with the prescriber to do which of the following? 1. Stop the indapamide 2. Evaluate the electrolytes 3. Change prescription to furosemide 4. Change prescription to a nonsteroidal anti-inflammatory drug.

2 Rationale: Indapamide is a thiazide diuretic that may cause hypokalemia. Because the function of potassium involves the action potential of smooth muscles such as arteries, hypokalemia can result in irregular muscle contractions. Hence, muscle weakness and leg cramps can occur. Since the cause of the signs and symptoms is manageable and the problems do not significantly impact the client's health, terminating the drug is not necessary. Furosemide is a loop diuretic that can also result of hypokalemia, a nonsteriodal anti-inflammatory drug (NSAID) is not the appropriate treatment for the symptom.

A client has been prescribed to take both a tetracyline and a sulfonamide drug. When providing client teaching, what priority information should the nurse give the client R/T adverse drug effects? 1 Avoid exposure to upper respiratory infections 2 Use protective measures when exposed to the sun 3 Report problems with constipation to your provider 4 Change position slowly to avoid orthostatic hypotension

2 Rationale: Photosensitivity is a side effect of both classes of antibiotics. The client should avoid sun exposure and tanning beds. These drugs would not increase the client's risk for upper respiratory infections. Orthostatic hypotension and constipation are not side effects of either drug.

The nurse should include which information when instructing a client who has been started on mebendazole for the treatment of pinworms? 1 Do not chew or crush the tablets 2 Take the medication with fatty foods 3 Use sunscreen when going outdoors 4 The drug may cause constipation

2 Rationale: Taking mebendazole with fatty food will help to improve absorption. The tablets may be chewed for a maximum effectiveness, swallowed whole, crushed, or mixed with food. Mebendazole does not cause photosensitivity so sunscreen is not necessary because of this drug. It may cause abdominal cramping and diarrhea, but not constipation.

After liquid tetracycline is prescribed for a 2-year-old child, the nurse provides which most important instruction to the LPN/LVN who is administering the medication? 1. Have the client drink the dose through a straw 2. Withhold the dose until I telephone the prescriber 3. Monitor the client for diarrhea 4. Administer with 6-8 ounces of milk

2 Rationale: Tetracycline is contraindicated in children less than 8 years of age because it causes permanent tooth discoloration. The prescription should be questioned by the nurse. Drinking through a straw is necessary when administering liquid iron preparations, but not tetracycline. Tooth discoloration is caused by systemic absorption, not direct contact. The drug may cause diarrhea, but this is not the most important consideration. Milk and other diary products will decrease the absorption of tetracycline.

A client is prescribed trimethoprim. The nurse should assess for changes in which laboratory test to determine possible adverse effects of the drug? 1 Potassium level 2 White blood cell count 3 Uric acid level 4 Serum osmolality

2 Rationale: Trimethoprim can cause serious adverse effects on the hematologic system, decreasing the RBC, WBC, and platelet count. These changes can be detected by a complete blood count. A K level would most commonly be of concern with drugs such as diuretics or digoxin. A uric acid level would be useful to detect side effects of thiazide diuretics or to detect gout. A serum osmolality would be useful in determining fluid volume status, such as for clients who have increased intracranial pressure.

A nurse is discussing treatment options for a client with acne vulgaris. The nurse should explain to the client that anti-acne medications work in which ways. SATA. 1. Inhibiting viral replication 2. Inhibiting sebaceous gland overactivity 3. Reducing bacterial colonization 4. Preventing follicles from becoming plugged with keratin 5. Reducing inflammation of lesions

2, 3, 4, 5

Permethrin is prescribed for an adult client, and the nurse needs to provide the client with instructions for use. Place the directions in proper sequence that the nurse should provide to the client. 1. Comb hair with a fine-toothed comb 2. Shampoo hair 3. Apply permethrin cream to hair and work through to scalp 4. Let sit for 10 minutes 5. Wash hair to remove drug

2, 3, 4, 5, 1

A client has been started on medication therapy with tolterodine. The home health nurse making a follow up visit should assess for resolution of which symptoms? SATA 1. Reduced urine output 2. Urinary urgency 3. Urinary frequency 4. Leakage of urine 5. Hematuria

2,3,4 Rationale: Tolterodine is an antimuscarinic type of anticholinergic agent used to control symptoms of overactive bladder. It helps to control symptoms such as urinary frequency, urgency, and leakage of urine. Tolterodine does not treat conditions leading to decreased urine output. Tolterodine does not treat urinary infection or other conditions associated with hematuria

The nurse should anticipate that mannitol may be prescribed to reduce symptoms in clients recently admitted to the unit with which conditions? SATA 1 Pancreatitis 2 Increased intracranial pressure 3 Diarrhea 4 Increased intraocular pressure 5 Congestive heart failure

2,4 Rationale: Mannitol may be prescribed for clients with increased intracranial pressure or increased intraocular pressure by causing diuresis. It would not be prescribed for the clients with pancreatitis, diarrhea, and congestive heart failure. Clients with pancreatitis wold not experience a benefit from a drug that promotes diuresis. Mannitol is known to precipitate pulmonary edema and HF because of its osmotic action.

When assessing a client for toxicities associated with tobramycin therapy, the nurse should include evaluation of which client data? SATA 1. Hand strength 2. Creatinine levels 3. Alanine aminotransferase (ALT) levels 4. Amylase levels 5. Ringing in the ears

2,5 Rationale: Aminoglycosides, such as tobramycin, can cause ototoxicity and nephrotoxicity. The nurse should review the client's creatinine level to detect onset of nephrotoxicity. The nurse should assess for ringing in the ears as an indicator of ototoxicity. Hand strength is a routine neurologic assessment that is not required during aminoglycoside therapy. ALT levels are an indicator of liver function. Amylase levels are an indicator of pancreatic functioin.

After listening to the nurse explain the use of isotrentinoin to a 19 year old female client, the client demonstrates understanding of the most important point by making which statement at the end of the teaching lesson. 1. Apply a thick layer of isotrentinoin twice a day. 2. Increase exposure to the sun for added benefits 3. Having pregnancy test prior to beginning therapy and use contraception. 4. Keep lips moist and lubricated to prevent inflammation

3

The client with a burn injury reports a stinging and burning sensation when topical mafenide acetate is applied. Which action should the nurse take? 1. Withhold medication and notify the prescriber 2. Remove that dose of the medication 3. Premedicate client with moderate analgesic before applying. 4. Chill preparation before applying.

3

The nurse teaches the client how to manage an infestation of scabies with crotamiton by providing which direction. 1. Rotate the container gently before using. Do not shake. 2. Vigorously massage the solution into the skin 3. Be sure to apply medication also in skin creases and under fingernails. 4. Apply the product to inflamed areas first.

3

A client who is taking hydralazine has also been started on drug therapy with amiloride. Which change in client data should the nurse attribute to the interactive effects of these medications? 1. Urine output increases from 40-75 mL/hr 2. Pulse rate decrease from 100/min- 85/min 3. Blood pressure decrease from 140-120 mmHg when standing 4. Oxygen saturation increase from 90%- 95% on room air

3 Rationale: A BP decrease when standing up from a lying or sitting position is called orthostatic hypotension. This can occur when a diuretic such as amiloride is added to antihypertensive drug therapy with hydralazine. An increase in urine output is an intended drug effect of a diuretic such as amiloride, but it is not an interactive drug effect. The pulse rate should not decrease with the addition of a diuretic to the client's medication list. A change in oxygen saturation is not expected with the addition of amiloride a diuretic to the pt medication list

Which statement by an immunocompromised client to the nurse best indicates that the client understands self-application of the topical drug acyclovir? 1. I need to wash my hands for at least 10 seconds before and after applying the drug 2. I need to apply several thin layers of the medication on the lesions 3. I need to avoid touching the lesions and opening the container with the same finger cot 4. I should not allow anyone else to use this drug

3 Rationale: A different gloved finger or a different finger cot should be used to apply acyclovir to each lesion not only to prevent spread of the virus. Hand hygiene is a standard precaution associated with infection control for all clients. One thin layer of medication is sufficient. Not sharing medication with others is a universal principle associated with drug therapy.

When hanging an IV dose of vancomycin, the nurse administers the drug over 90 minutes to prevent which speed-related adverse drug effect? 1. Hypertension 2. Projectile vomiting 3. Flushing of face, neck, and chest 4. Pseudomembranous colitis

3 Rationale: Flushing of the face, neck, and chest, which is known as "red man syndrome" or "red neck syndrome," is associated with too-rapid administration of vancomycin. Hypotension, not hypertension, is associated with vancomycin administration. Vancomycin may cause nausea, but not projectile vomiting. Vancomycin is often used to treat C. diff., associated with pseudomembranous colitis. This complication is not associated with speed of transfusion.

A nurse is assigned to a client who has received amphotericin B 0.3 mg/kg/day IV for 5 days. The nurse should place priority on reviewing the client's record for which data? 1. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels 2. Sodium level and serum protein 3. Blood urea nitrogen (BUN) and creatinine 4. Number and consistency of stools in the past 24 hours

3 Rationale: Since this drug can be nephrotoxic, it would be most important to check BUN and creatinine as indicators of renal function. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) reflect liver function and damage and would be assessed prior to beginning drug therapy as a general routine measure. Serum sodium levels could indirectly reflect renal function, but are not as important as checking direct indicators of kidney function. Monitoring serum protein is not necessary. Diarrhea can be a side effect but the priority assessment is the client's renal function.

A client was started on drug therapy with bumetanide 1 month ago. At a follow-up health visit, the nurse should be most concerned with which most recent laboratory test result? 1. Blood urea nitrogen 22 mg/dL 2. Blood glucose 130 mg/dL 3. Potassium 3.1 mEq/L 4. Calcium 9.5 mEq/L

3 Rationale: The nurse should be most concerned with the low serum potassium result (normal 3.5-5.1 mEq/L) because bumetanide is a potassium-wasting diuretic. The blood urea nitrogen is within normal limits (8-22 mg/dL) and is not of concern. The blood glucose is only slightly elevated (normal 70-110 mg/dL) so it is not the priority and is not related to therapy with bumetanide. The calcium level is within normal limits (8.5-11 mg/dL).

A client with chronic renal failure is beginning drug therapy with epoetin alfa. The nurse should monitor the trend of which vital sign to detect an adverse effect of this medication? 1 Temperature 2 Pulse 3 Blood pressure 4 Oxygen saturation

3 Rationale: The pt's BP may increase during early therapy as the hematocrit rises. The nurse should monitor the trend in this VS and alert the HP if there is significant increase, which could warrant a dosage reduction. Epoetin alfa does not cause a rise or drop in body temperature. The pt's PR is not expected to change significantly during drug therapy w/ epoetin alfa. A change in oxygen saturation is not an adverse drug effect of epoetin alfa.

A nurse administering tamsulosin to a client would expect to note which THERAPUTIC outcomes? Select all that apply. 1. Hypotension 2. Syncope 3. Decreased urethral obstruction 4. Increased urine flow 5. Decreased urinary frequency

3, 4, 5

A client is receiving combinatioin drug therapy of isoniazid, rifampin, and pyrazinamide for treatment of tuberculosis. What information should the nurse include in client education? SATA 1. Treatment will take 2 weeks 2. Finish taking all doses of isoniazid before starting ethambutol 3. Eliminate alcohol intake during drug therapy 4. Aluminum-containing antacids decrease the absorption of isoniazid 5. Vitamin B6 may help prevent side effects such as seizures and metabolic acidosis

3,4,5 Rationale: Drug therapy for tuberculosis lasts 6-24 months. The medications are taken concurrently, not one after another. Alcohol intake can cause hepatotoxicity when ingested in combination with these drugs. Aluminum-containing antiacids decrease the absorption of isoniazid. Vitamin B6 is used to prevent seizures and to prevent or correct metabolic acidosis. The dose may be repeated several times.

A nurse administering tamsulosin to a client would expect to note which therapeutic outcomes of drug therapy? SATA 1. Hypotension 2. Syncope 3. Decreased urethral obstruction 4. Increased urine flow 5. Decreased urinary frequency

3,4,5 Rationale: Therapeutic outcomes of tamsulosin would include decreased urethral obstruction, increased urine flow, and decreased urinary frequency. Hypotension and syncope are adverse effects of tamsulosin.

Which client statement indicates an understanding of the use of erythromycin? SATA 1. I will always take this medication with fruit juices 2. If I experience abdominal fullness I will contact my provider 3. I know I should not crush the pills 4. I understand it is common to have some hearing loss while taking this medication 5. I will let my provider know if I begin to have a lot of diarrhea

3,5 Rationale: The tablets should not be crushed because it can alter drug release for absorption. Erythromycin can cause severe diarrhea with life-threatening pseudomembranous colitis, so the provider should be notified if this occurs. Erythromycin should be taken with a full glass of water for best absorption. Fruit juices and some carbonated beverages can interfere with complete absorption and so should be avoided. Abdominal fullness is a vague symptom that is not expected during therapy with erythromycin therapy, because it is a mavrolide antibiotic, not an aminoglycoside.

When planning care for a patient receiving once-daily intravenous gentamicin therapy, the nurse schedules a trough drug level to be drawn:.

30 minutes before beginning the next antibiotic infusion.

A client diagnosed with psoriasis vulgaris is using a prescribed topical corticosteroid. What activity should the nurse perform? 1. Protect the unaffected skin from staining 2. HEat cream before applying 3. Provide continuous occlusive therapy 4. Apply warm, moist dressing over occlusive dressing

4

A participant in a skin care research project asks the nurse educator to justify the recommendation of a sunscreen. Which response by the nurse provides the best rationale. 1. Sunscreens neutralize the suns rays 2. Sunscreens are waterproof and thus block the suns rays 3. Sunscreens absorb the suns rays and distribute the heat to other body parts 4. Sunscreens prevent sunburn by absorbing and reflecting the suns rays

4

The nurse is most likely to apply a hydrocolloid dressing during wound care for which client? 1. CLient who has a necrotic wound with a thick layer of eschar attached. 2. CLient who has a new, partial thickness burn 3. Client who has a wound that needs debriding 4. Client who has an uninfected venous stasis ulcer

4

The school nurse explains to a group of adolescents at a school health fair that which medication is considered the more effective for the treatment of acne. 1. Tetracycline 2. Penicillin G 3. Clindamycin 4. Isotrentinoin

4

Which intervention is of highest priority for the nurse working with a client who has herpes zoster (shingles) and who recently began drug therapy with acyclovir? 1. Monitor for jaundice and elevated liver enzymes 2. Teach client to avoid sexual intercourse during therapy 3. Administer the dose early in the day, as it may cause insomnia 4. Encourage fluid intake of 2,500-3,000 mL daily if not contraindicated

4 Rationale: Acyclovir can be nephrotoxic and so it is important to ensure high fluid intake to keep the client well hydrated and perfuse the kidneys. Acyclovir is not hepatotoxic. It would not be necessary to avoid sexual intercourse while taking this medication. Acyclovir drug may cause headaches and nausea and vomiting, but not insomnia

The nurse is teaching a group of clients who are infected with HIV about the various available drug treatments. Which point of information would be important for the nurse to explain during the discussion using appropriate terminology? 1. Entry inhibitors enhance release of reverse transcriptase 2. Protease inhibitors are the most potent anti-HIV 3. Nonnucleoside reverse transcriptase inhibitors (NNRTIs) prevent replication of HIV 4. Nucleoside transcriptase inhibitors (NRTIs) suppress production of reverse transcriptase

4 Rationale: NRTIs suppress production of reverse transcriptase, which prevents conversion of viral RNA to DNA similar to human DNA. Entry inhibitors work by blocking attachment of the HIV virus to the host cell. Protease inhibitors block protease (which is needed for cell replication) and are used in conjunction with other drugs to reduce the viral load in HIV. NNRTI drugs work by reducing the synthesis of reverse transcriptor A.

The healthcare provider prescribed oxybutynin for a 65-year-old female with urinary frequency and urgency. The nurse should include which instruction to manage a primary side effect when providing medicstiin instruction? 1 Wear protective underwear 2 Avoid activities that may cause injury or bleeding 3 Carry an OTC antidiarrheal agent when traveling 4 Rinse yiur mouth or use sugarless hard candy frequently

4 Rationale: Oxybutynin is an antispasmodic used for urinary incontinence and bladder spasms. It causes anticholinergic side effects such as dry mouth, constipation, urinary hesitancy, and decreased gastroenteritis motility. For this reason the client needs to use measures to counteract dry mouth. Wearing protection is an appropriate action for urinary incontinence, but retention and hesitancy is associated with this drug. The drug has no effect on the clotting process so there is no unusual risk of injury. The anticholinergic actions are more likely to cause constipation than diarrhea.

After phenazopyridine is prescribed for a client, the nurse teaches the client which of the following items of information? 1. Continue taking drug until infection is resolved. 2. Long-term use of drug requires no follow-up. 3. With appropriate hydration, it is safe to breastfeed. 4. Report sign of yellow-tinged skin of sclera.

4 Rationale: Phenazopyridine is a urinary tract analgesic that may be prescribed alone or may be combined with an antibiotic appropriate for urinary tract infections. Yellow-tinged skin is a sign of drug accumulation R/T renal impairment. This sign should be reported to the prescriber, if noted. Although it may be manufactured in combination with an antibiotic, it could also be discontinued after pain with urination is relieved, often after 1-2 days of antibiotic therapy. Any drug that is used long term would require follow-up, but this drug during breastfeeding is unsubstantiated.

The prescriber has just ordered cefdinir, a third-generation cephalosporin, for a client with a staphylococcal infection. The nurse collaborates with the prescriber about which data R/T the client? 1. Blood urea nitrogen (BUN) 14 mg/dL 2. Elevated granulocyte count 3. Culture and sensitivity (C+S) results not yet available 4. History of Type I hypersensitivity to penicillin

4 Rationale: There is a small chance that the client may have a cross-allergenicity with penicillin, and it is worth discussing with the prescriber, who may choose a drug from another category. The BUN is within normal limits. It is expected that granulocytosis (such as elevated neutrophils) would occur in response to a bacterial infection. It is common practice to collect the specimen for culture and sensitivity (C+S), then begin therapy with a broad-spectrum antibiotic, which can be changed if the C+S reveals that a different drug would be more appropriate.

A client receiving an intravenous infusion of a cephalosporin medication reports pain and irritation at the infusion site. After noting thrombophlebitis at the site, in what order should the nurse complete these actions? 1. Elevate extremity 2. Remove the peripheral catheter 3. Apply a warm compress 4. Stop the infusion 5. Apply a sterile dressing

4,2,5,1,3 Rationale: The client is manifesting indications of an infiltrated IV line. The nurse should first stop the infusion. After stopping the infusion, the nurse should remove the peripheral catheter. apply sterile dressing-elevate extremity-apply warm compress to help reabsorb IV fluid that has infiltrated tissue

To avoid fecal impaction, psyllium (Metamucil) should be administered with at least how many ounces of fluid? A) 4 B) 6 C) 8 D) 10

8

To avoid fecal impaction, psyllium (Metamucil) should be administered with at least how many ounces of fluid?

8 Bulk-forming laxatives such as psyllium must be given with at least 8 ounces of liquid plus additional liquid each day to avoid intestinal impaction.

1 Prolonged phenytoin therapy may result in osteoporosis, especially in pts with limited sun exposure and who are more at risk of the disease. Since osteoporosis is a chronic condition, it is perceived as the greatest risk to the client. The dark glasses reduce the sensitivity occurring with photophobia but do not necessarily prevent its occurrence. Taking the dose with food may decrease the rate of absorption, but may also be effective in reducing nausea and vomiting; however, this is not the greatest health promotion concern. Massaging the gums can prevent gingival hyperplasia caused by phenytoin, but is less significant than the risk of developing osteoporosis

A 71 yr man client in long-term care has been taking phenytoin 100mg by mouth three times daily for some time. The nurse carries out which most important health promotion measure as prescribed? 1 Administer calcium supplements as well as vitamin D 2 Wear dark glasses when exposed to the sun 3 Give medication with food to prevent nausea 4 Client to massage gums every morning after brushing teeth

1 Rationale: Diphenoxylate inhibits nerve endings that cause intestinal movement. Decreasing the velocity increases opportunity for absorption of fluid resulting in increased viscosity of the stools. The drug is a narcotic w/ a structure similar to meperidine and has no effect on the shifts of sodium. Increased bulk would increase peristalsis. The drug primarily affects the NS, not the CS

A client asks, "How does diphenoxylate help stop diarrhea?" Which of the following is the best response by the nurse? 1 "It slows down the motility of the intestine, thereby increasing fluid absorption" 2 "Because of the increased sodium in the stool, fluid moves into the bloodstream." 3 "It increases the bulk in the intestines, resulting in decreased peristalsis." 4 "It decreases circulation of blood to the bowels, making them less reactive to stimulation."

1 Rationale: Taking bisacodyl on an empty stomach will result in a more rapid effect. Drinking plenty of fluids is a good general measure to reduce the risk of constipation. Taking the medication with a meal will delay absorption. If taking at bedtime, the client will have a bowel movement in the morning.

A client has a new prescription to take bisacodyl. To enhance a rapid medication effect, the nurse instructs the client to take the medication in which way? 1 On an empty stomach 2 With plenty of fluids 3 With meals 4 At bedtime

2 Rationale: Anticholinergic medications block the action of acetylcholine, resulting in decreased stimulation in the GI and urinary tract systems. This leads to urinary and bowel problems such as urinary retention, hesitancy, and constipation. Anticholinergic drugs stimulate the parasympathetic system and tachycardia and hypertension indicate sympathetic stimulation. Cholinergic agonists, not anticholinergics, cause biliary contractions. Renal colic is also more commonly associated w/ cholinergic agonists rather than anticholinergics.

A client has begun taking an anticholinergic medication. The nurse should make it a priority to assess for which unintended manifestations? 1 Bradycardia and hypotension 2 Urinary retention, hesitancy, and constipation 3 Pain resembling the pattern associated w/ cholecystitis 4 Pain resembling renal colic

1 Rationale: Ursodiol is a naturally occurring bile acid used to dissolve gallstones. It is believed to suppress hepatic synthesis and secretion of cholesterol as well as intestinal absorption. Omeprazole is a proton pump inhibitor that reduces gastric acid production. Cimetidine is an H2 antagonist that reduces gastric acid production, but is not designed to treat cholelithiasis. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) and may be needed should the client develop a fever secondary to the process of inflammation.

A client has cholelithiasis, but is a poor surgical candidate because of comorbid conditions. The nurse is most likely to teach the pt about which of the following medications? 1 Ursodiol 2 Omeprazole 3 Cimetidine 4 Ibuprofen

4 Rationale: Since the joints are inflamed, it will take some time to reduce the inflammation and thereby relieve the pain. The therapeutic effect of naproxen does not occur for 3-4 wks, making 4 the correct number of weeks to identify because of the words up to

A client is prescribed naproxen for the treatment of rheumatoid arthritis. The home care nurse should explain to the client that maximum relief may take up to how many weeks to occur?

2 Rationale: Selegiline is a monoamine oxidase inhibitor (MAOI). Concurrent administration of meperidine, an opioid analgesic, and selegiline can lead to a life-threatening hypertensive crisis, so the blood pressure will require careful monitoring. Selegiline can lead to a life-threatening hypertensive crisis, so the blood pressure will require careful monitoring. Selegiline primarily affects the dopamine levels in the brain and has no effect on the immune system. The client will need to refrain from all activity until it is determined that there is no risk of a hypertensive crisis. Decreased stimulation will be needed if it is determined that the client's BP has become significantly elevated.

A client is receiving both selegiline and meperidine. What instructions should the nurse provide to the unlicensed assistive personnel? 1 Set up infection control precautions 2 Use automatic BP machine to measure client's BP at preset frequencies 3 Assist client w/ activities of daily living 4 Place a "no visitors" sign on door

2 Rationale: A serious side effect of hydromorphone is respiratory depression, so respiratory assessment is appropriate. The client does not need to void before receiving hydromorphone. Hyrdromorphone does not cause airway blockage, so a suction kit is not needed. Hydromorphone is not associated with change in potassium level.

A client is scheduled to take 4 mg of hydromorphone intravenously. Prior to administering the drug, what should the nurse do? 1 Assist the client to the bathroom to void 2 Obtain a baseline respiratory assessment 3 Place a suction kit at the head of the bed 4 Check the client's serum potassium level

4 Rationale: Dicyclomine hydrochloride relieves GI smooth muscle spasm, alleviating the symptoms and leading to a balanced state of nutritional and fluid status. Presence of mucus in the stool is one of the Manning criteria associated with irritable bowel syndrome (IBS). During the recovery phase the weight should be stable with no further weight loss. Bowel sounds should be normal, not hypoactive.

A client is taking dicyclomine for irritable bowel syndrome (IBS). Which nursing assessment is the best indicator that the client is self-administering the medication properly? 1. Presence of mucus in stool. 2. Weighs 4.5 kg (10 lb) less than last examination 3. Bowel sounds are hypoactive 4. Nutritional intake within normal ranges

1 Rationale: There is evidence that certain life-style patterns contribute to development of migraine headaches, which cannot be completely controlled by medications. If the client can identify the triggering factors, the nurse and the client can collaborate and design a plan of care that will reduce or eliminate the headaches. The client should continue to exercise for general health and stress management. The client should take the pain medication when pain is experienced, but frequent ongoing self-administration could result in tolerance. Unless pt is continually impaired, driving is permitted.

A client suffers from migraine headaches. Which statement indicates the client knows what activity may help to reduce or eliminate the headaches? 1 I keep a diary of my headaches so that I can see if there is a pattern 2 I stopped my exercise program since it has not helped my headaches 3 I take the pain medication every 4 hrs 4 I have taken the bus to work instead of driving

2 Rationale: All of the drugs listed are histamine 2 (H2)-receptor blockers that inhibit the secretion of gastric acid. Cimetidine interacts with a large number of drugs. Because it decreases the hepatic metabolism of phenytoin therapy. Ranitidine reduces the absorption of several antibiotics.

A client who has a history of a seizure disorder is newly diagnosed with a gastric ulcer. The pt has maintained seizure-free status using phenytoin. The nurse would question a new prescription for which of the following drugs to treat symptoms caused by the ulcer? 1 Famotidine 2 Cimetidine 3 Nizatidine 4 Ranitidine

2 Rationale: Bismuth subsalicylate has a salicylate base and is containdicated in clients who are allergic to aspirin, also known as acetylsalicylic acid. Attapulgite and loperamide may be given safely to a client allergic to aspirin. Diphenoxylate with atropine contains codeine as well as atropine as ingredients.

A client who is allergic to aspirin has acute diarrhea. Based on the aspirin allergy, which medication should the nurse avoid administering? 1. Attapulgite 2. Bismuth subsalicylate 3. Diphenoxylate with atropine 4. Loperamide

1,2,4 Rationale: Both propranolol, a beta blocker, and monoamine oxidase inhibitors (MAOIs) such as phenelzine have hypotensive effects and should not be administered concurrently. Hyperpyrexia may occur if meperidine and MAIOs are administered concurrently. Because carbamazepine can significantly compound the depressant and anticholinergic effects of MAOIs, it should not be administered w/n 14 days of taking MAIOs. The outcome of the interactions of the two drugs is potentially fatal. Glucagon increases glucogenesis, while MAOIs potentiate hypoglycemic activity of oral hypoglycemics, thus offsetting each other's effects. Dicyclomine is a parasympatholytic resulting in antispasmodic activity, while MAOIs are more likely to compound sympathomimetic activity.

A client with chronic depression has a new medication prescription for phenelzine. The nurse calls the prescriber to clarify the prescription if the client is already taking which medications? Select all that apply. 1 Propranolol 2 Meperidine 3 Glucagon 4 Carbamazepine 5 Dicyclomine

1 Rationale: Metoclopramide is a GI stimulant, increasing motility of the GI tract, shortening gastric emptying time, and thus reducing the risk of the esophagus being exposed to gastric contents. Decreased lower esophageal sphincter (LES) tone will increase the risk of gastric contents being regurgitated upward into the esophagus. Because the drug increases GI motility, it can cause diarrhea rather than combating it. GERD can place clients at increased risk for H. pylori bacterial infection; however, anti-infectives would be used to treat this infection.

A client with gastroesophageal reflux disease (GERD) is taking metoclopramide as prescribed. What client is statement indicates to the nurse that the medication intruction was effective? 1. The purpose of this drug is to increase GI motility. 2. This drug will prevent or stop diarrhea from occuring. 3. This drug decreases the tone of the lower esophageal sphincter. 4. This drug kills the H. pylori organism that causes peptic ulcer disease.

2 Rationale: Psyllium mucilloid should be mixed with 8 ounces of water and an additional 8 ounces of water should be consumed after the initial dose to avoid esophageal obstruction. There is no need to refrain from physical activity while taking psyllium mucilloid. Psyllium mucilloid should be mixed in water consumption, not sprinkled on food.

A constipated client is given a prescription to use psyllium mucilloid. What information should the nurse provide during client education about the medicatioin? 1. Refrain from physical activity for 2 hrs 2. Follow the initial dose with an additional 8 oz of water 3. Take an antiemetic 4. Sprinkle the powder formulation on food

2 Rationale: Laxatives are included on the list of drugs in which misuse results in dependence. A healthy client who regularly ingests a laxative needs to be taught about laxatives and physical dependence. A fluid and/or electrolyte imbalance may be present, but the primary focus is to address the cause and not the outcome. Since the client is healthy, one can presume the nutritional status is adequate.

A healthy adult client has been taking a laxative 3 days per week for 9 months. What primary risk should the nurse address in a teaching plan with this client? 1 Risk of electrolyte imbalance 2 Risk of drug dependence 3 Risk of fluid imbalance 4 Risk for inadequate nutritional status

2,3,5 Rationale: For seizure control, medication must be taken to maintain therapeutic blood levels, even if there is no seizure activity. Seizures affecting adults usually do not resolve spontaneously in the absence of treatment. The most frequent adverse effects of phenytoin present as central nervous system symptoms. In most states driving is permitted after a client is seizure free for 6-12 months. Obtaining a therapeutic blood level between 10-20 mcg/mL may take time, particularly initially.

A medication regimen that includes phenytoin has controlled the seizures of an adult client for several days. Prior to discharge, the nurse should place highest priority on including which information in the teaching plan? Select all that apply. 1 Many seizure disorders will eventually stop on their own 2 Adherence to medication therapy is essential to avoid recurrence of seizures 3 Side effects include confusion and headache 4 The client cannot drive a vehicle permanently 5 Labwork for drug levels will need to be done routinely.

The nurse notes in the patient's medication history that the patient is taking cyclobenzaprine (Flexeril). Based on this finding, the nurse interprets that the patient has which disorder?

A musculoskeletal injury

What information must be provided to a patient receiving rifampin?

A nonharmful side effect of the drug is red-orange discoloration of urine, sweat, and tears.

3 Rationale: Because it may induce premature labor, castor oil is a Pregnancy Category X preparation. Bisacodyl is Pregnancy Category C. Mineral oil and sodium biphosphate are listed as unknown. It is recommended that the client utilize preventive methods such as adequate dietary fiber and at least 8 glasses of fluid per day.

A pregnant client asks the nurse about laxative use during pregnancy. After recommending that the healthcare provider be consulted before using any drug, the nurse should instruct the client to avoid using which laxative during pregnancy? 1. Bisacodyl 2. Mineral oil 3 Castor oil 4 Sodium biphosphate

The nurse is aware that viruses can enter the body through various routes. By which methods can viruses enter the body? (Select all that apply.) A. Inhalation through the respiratory tract B. Ingestion via the gastrointestinal (GI) tract C. Transplacentally from mother to infant D. Through an animal bite

A, B, C, D

A patient taking an anthelmintic drug should be instructed to notify the physician immediately if he or she experiences which side effect?

A. Darkened urine Darkened urine may be a sign of hemolysis, a serious side effect of anthelmintic drugs.

A laxative has been ordered for a patient. The nurse checks the patient's medical history and would be concerned if which condition is present?

Abdominal pain of unknown origin All categories of laxatives share the same general contraindications and precautions, including avoidance in cases of drug allergy and the need for cautious use in the presence of the following: acute surgical abdomen; appendicitis symptoms such as abdominal pain, nausea, and vomiting; fecal impaction (mineral oil enemas excepted); intestinal obstruction; and undiagnosed abdominal pain. The other options are possible indications for laxatives.

A patient has been admitted after overdosing on acetaminophen (Tylenol), with a total ingested dose of 14 g over a period of 1 hour. The nurse plans to monitor this patient for development of which of the following signs and symptoms related to the overdose?

Acute hepatic necrosis Acetaminophen in large doses over a short period is extremely hepatotoxic. The long-term ingestion of large doses of acetaminophen is more likely to result in nephropathy.

4 Rationale: Elevated serum ammonia levels are commonly associated with hepatic encephalopathy. AST and ALT are liver enzymes indicating liver impairment. The enzyme level does not have a direct relationship to the cause of the impaired mental function. BUN and creatinine levels provide evidence of renal function. Bilirubin is elevated and urobilinogen may be normal or decreased in liver disease. Neither test would provide information regarding the hepatic encephalopathy.

After a family member reported altered mental function in a client with end-stage liver disease, the healthcare provider prescribed lactulose 30 mL by mouth, three times daily. The home health nurse reviews the client's chart for which lab test(s) to monitor medication effectiveness? 1 Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) 2 Blood urea nitrogen (BUN) and creatinine 3 Bilirubin and urobilinogen 4 Serum ammonia

2,4,5 Rationale: Discussion of feelings with another person helps the client manage emotional reactions. The nurse does not know why the client manage emotional reactions. The nurse does not know why the client is crying. Although the client is emotionally upset, the nurse is obligated to inform the client of the risks associated with refusing medication. Although the client does need to know that ranitidine is an H2-receptor blocker that reduces gastric acid production, resulting in less exposure of the open crater to irritants, the client does not appear to be ready for teaching. Because it seals the open crater and protects it from gastric contents, misoprostol is commonly used in open-crater gastric ulcers. The nurse should encourage the client to take the medication to reduce risk of perforation.

After being diagnosed with an open cratered gastric ulcer, a 19 yr old female client starts crying and refuses to take the prescribed medications. The nurse should perform which activities at this time? SATA 1 Explain in detail the action of ranitidine 2 Sit with client to allow her to express her feelings 3 Teach client about ways to prevent future ulcerations 4 Explain risks associated with not treating the open-crater gastric ulcer 5 Encourage the client to ingest the dose of misoprostol

4 Rationale: Loperamide is indicated for the treatment of diarrhea. If this is a new prescription, then critical thinking suggests that the diarrhea is relatively new in onset. Placing a commode at the bedside would provide for proper management of an older adult client with diarrhea. There is no evidence that ingestion of normal dosages of this drug places the client at significant risk for falls or significant changes in V.S.

After noting a new prescription for loperamide 4 mg by mouth, every 6 hrs as needed for a 71-year-old client, the nurse should provide which instruction to unlicensed assistive personnel (UAP)? 1 Set up seizure precautions 2 Set up safety precautions 3 Measure vital signs every 4 hrs 4 Place a commode at the bedside

1,2,5 Rationale: The primary purpose of administering opioid analgesics is pain relief. Side effects placing the client at greatest risk are respiratory depression and reduced level of consciousness (LOC). Blood pressure and heart rate could decrease because of diminished sympathetic nervous system stimulation following effective pain relief. Concerns about drug interactions are preadministration concerns also, and should be investigated before the dose is administered. History drug abuse and past experiences with pain management are preadministration concerns.

An opioid analgesic has been administered to a client postoperatively. The nurse should make which priority follow-up assessments? Select all that apply. 1. Respiratory rate and level of consciousness 2. Blood pressure and heart rate 3. Interactions with foods and other prescribed drugs 4. History of drug 5. Pain level

4 Rationale: Morphine sulfate is the drug of choice of the options listed because it is an opioid analgesic that is strong enough to relieve the pain, and it does not intensify biliary spasms, although this was a widely held notion in the past. Codeine sulfate is not utilized because it is a weaker opioid analgesic, although morphine sulfate is commonly administered. Bethanecol is a cholinergic drug that results increased smooth muscle tone and motility. Dicyclomine is an antispasmodic that could decrease the biliary spasms, but is not an analgesic. The pain is also related to the inflammotory process.

An otherwise healthy client diagnosed with cholecystitis reports to the ED with severe pain. The nurse is most likely to administer which of the following drugs with an appropriate order? 1 Codeine sulfate 2 Bethanecol 3 Dicyclomine 4 Morphine sulfate

Fifteen minutes after an infusion of amphotericin B was started, the patient begins to complain of fever, chills, muscle pain, and nausea. His heart rate has increased slightly, but his blood pressure is down to 100/68. What is the nurse's priority?

Assess for other symptoms of this expected infusion related reaction

A patient is taking ibuprofen 800 mg three times a day by mouth as treatment for osteoarthritis. While taking a health history, the nurse finds out that the patient has few beers on weekends. What concern would there be with the interaction of the alcohol and ibuprofen?

B. Increased chance for gastrointestinal bleeding NSAIDs taken with alcohol may result in increased risk of gastrointestinal bleeding