PassPoint: Pharmacology and Medication Management

The nurse has instructed a client on self-administration of heparin injections. The nurse determines that teaching is effective when the client makes which statement? "Heparin slows the time it takes for the blood to clot." "Heparin stops the blood from clotting." "Heparin thins the blood." "Heparin dissolves clots in the arteries of the heart."

"Heparin slows the time it takes for the blood to clot." Heparin prolongs the time needed for blood to clot. Heparin does not thin the blood. If given in large doses, heparin may stop the blood from clotting; however, this isn't why heparin is usually given. Heparin does not dissolve clots.

A nurse is caring for a client who has had extensive abdominal surgery and is in critical condition. Dextrose 5% in half-normal saline solution is infusing through a triple-lumen central catheter at 125 ml/hr. The health care provider's orders include gentamicin 80 mg IV piggyback in 50 ml D5W over 30 minutes; ranitidine 50 mg IV in 50 ml D5W over 30 minutes; one unit of 250 ml of packed red blood cells (RBCs) over three hours; and a nasogastric tube flush with 30 ml normal saline solution every two hours. How many milliliters should the nurse document as the intake for the 8-hour shift? Record your answer using a whole number.

1470 The regular IV at 125 ml × 8 hrs = 1,000 ml; gentamicin piggyback = 50 ml; ranitidine piggyback = 50 ml; packed RBCs = 250 ml; and nasogastric flushes of: 30 ml × 4 = 120 ml. (1,000+50+50+250+120) ml=1,470 m

The nurse understands that certain medications protect the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation. Which class of medications serve this function? Beta-adrenergic blockers Calcium channel blockers Opioids Nitrates

Beta-adrenergic blockers Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, and help reduce the risk of another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by reducing contractility and vasodilatation; thus, lowering afterload. Opioids reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure and systemic vascular resistance.

A nurse administers oxytocin to a client to induce labor. Which finding would indicate to the nurse that this client requires an immediate intervention? Contractions longer than 70 seconds, occurring every two minutes or less Dry mucous membranes and decreased skin turgor Fetal heart rate of 160 beats/min Maternal heart rate of 56 beats/min

Contractions longer than 70 seconds, occurring every two minutes or less Oxytocin, given to induce labor, may cause uterine tetany, which increases the risk of uterine rupture. Therefore, the infusion should be stopped and the provider notified if contractions last greater than 70 seconds and occur every two minutes or less. Oxytocin has an antidiuretic effect and can cause fluid overload, not dehydration as indicated by dry mucous membranes and decreased skin turgor. A normal fetal heart rate is 120 to 160 beats/min. Oxytocin may cause maternal tachycardia, not bradycardia.

A nurse is reviewing the health care provider's orders for a client admitted with systemic lupus erythematosus (SLE). Which medication would the nurse expect to find in this client's plan of care?

Fatigue, photosensitivity and a "butterfly" rash on the face are all signs and symptoms of SLE. Hydroxychloroquine is used in the treatment of SLE to prevent inflammation. Pharmacological treatment of SLE also involves nonsteroidal anti-inflammatory drugs, corticosteroids, and immunosuppressive agents. Morphine is an opioid analgesic, ketoconazole is an antifungal agent, and dimenhydrinate is an antiemetic.

What is the most important information for the nurse to include when teaching a client about metronidazol? Breathlessness and cough are common adverse effects. Urine may develop a greenish tinge while the client is taking this drug. Mixing this drug with alcohol causes severe nausea and vomiting. Heart palpitations may occur and should be immediately reported.

Mixing this drug with alcohol causes severe nausea and vomiting. When mixed with alcohol, metronidazole causes a disulfiram-like effect involving nausea, vomiting, and other unpleasant symptoms. Urine may turn reddish brown, not greenish, from the drug. Cardiovascular or respiratory effects are not associated with this drug.

A client diagnosed with schizophrenia has been taking haloperidol for one week when a nurse observes that the client's gaze is fixed on the ceiling. Which specific condition is the client exhibiting? Akathisia Neuroleptic malignant syndrome Oculogyric crisis Tardive dyskinesia

Oculogyric crisis An oculogyric crisis involves the eyes fixated in one direction, typically in an upward gaze. Neuroleptic malignant syndrome causes increased body temperature, muscle rigidity, and altered consciousness. Akathisia is a restlessness that can cause pacing and tapping of the fingers or feet. Stereotyped involuntary movements, such as tongue protrusion, lip smacking, chewing, blinking, and grimacing characterize tardive dyskinesia.

After undergoing a gastrectomy, a client develops pernicious anemia. Which route should the nurse use to administer cyanocobalamin (vitamin B12)? Buccal route Transdermal route Oral route Parenteral route

Parenteral route A client who has undergone gastrectomy is no longer able to produce the intrinsic factor necessary for vitamin B12 absorption through the gastrointestinal tract; therefore, supplementation via parenteral route is required. This medication isn't available for buccal or transdermal routes.

The nurse is admitting a client diagnosed with diabetic ketoacidosis (DKA). What is the nurse's priority intervention?

Rationale A client with DKA should receive IV insulin to lower glucose and IV fluids to correct hypotension. Glucagon is given to treat hypoglycemia and is not appropriate for DKA. Blood products aren't needed to correct DKA. Glucocorticoids are not used to treat DKA, and may aggravate the hyperglycemia.

What adverse reaction might the nurse observe after administering enteric-coated erythromycin to a client?

Rationale: Erythromycin is an antibiotic. Common adverse effects include nausea, vomiting, diarrhea, abdominal pain, and anorexia. It should be given with a full glass of water and after meals, or with food, to lessen gastrointestinal symptoms.

A nurse is providing in-home management instructions to the parents of a child who is receiving desmopressin acetate (DDAVP). What is the most important instruction the nurse to include?

Rationale: Excessive nasal mucus, associated with upper respiratory infection or allergic rhinitis, may interfere with DDAVP absorption because it is given intranasally. Parents should be instructed to contact the health care provider for advice in altering the hormone dose during times when nasal mucus may be increased. The DDAVP dose should remain unchanged, even if the child is experiencing polyuria just before the next dose to avoid over medicating the child.

The nurse is providing information to a client who is taking chlorpromazine. What is the most important information for the nurse to provide?

Rationale: It is important to continually assess for adverse reactions and continued therapeutic effectiveness. The dosage should be changed if ordered by the primary care provider. While chlorpromazine can exacerbate serious sunburns, medication should not be discontinued without an order from the provider. Adverse reactions should be immediately reported to the provider.

A two-year-old child has tested positive for tuberculosis (TB), and has been started on rifampin. The child's parents ask the nurse if there is any important information they should know about this medication. What important adverse effect should the nurse inform these parents about?

Rationale: Rifampin and its metabolites will turn urine, feces, sputum, tears, and sweat an orange color. This is not a serious adverse effect. Rifampin may also cause GI upset, headache, drowsiness, dizziness, visual disturbances, and fever. Liver enzyme and bilirubin levels increase because of hepatic metabolism of the drug. Parents should be taught the signs and symptoms of hepatitis and hyperbilirubinemia such as jaundice of the sclera or skin.

A child with diabetic ketoacidosis is being treated for a blood glucose level of 738 mg/dl (41.0 mmol/L). The nurse should anticipate an order for:

Rationale: Short-acting regular insulin is the only insulin used for insulin infusions. Initially, normal saline is used until blood glucose levels are reduced, then a dextrose solution may be used to prevent hypoglycemia. Ultralente, NPH, and PZI insulins have a longer duration of action and shouldn't be used for continuous infusions.

The nurse reviews information about how to take the prescribed tetracycline. Which statement, by the client, allows the nurse to determine that the client understands the information?

Rationale: Tetracycline must be taken on an empty stomach to increase absorption, and with ample water to avoid esophageal irritation. Milk products impede absorption.

A client with type 2 diabetes mellitus is prescribed capsaicin cream 0.075% What should the nurse include in a teaching plan for this medication?

Rationale: This drug reduces amounts of substance P, which is involved in pain transmission. The nurse should teach the client to apply the cream four times daily for several weeks. The cream does not prevent dry skin, debride or treat infections.

The nurse receives an order to administer morphine to a client with an acute myocardial infarction. What is the purpose of this medication? To decrease cardiac output To increase preload and afterload To increase myocardial oxygen demand To decrease myocardial oxygen demand

To decrease myocardial oxygen demand Morphine will calm and relax the client and decrease respiratory rate, anxiety, and stress, thus decreasing myocardial oxygen demand. It doesn't have any effect on cardiac output or preload or afterload.

An unemployed client cannot afford her prescription medications and has not taken her prescribed levothyroxine for some time. She states, "I've been getting sicker by the day." Which symptom is most likely related to not taking this medication? Diarrhea and vomiting Rapid heart rate Warm, dry, flushed skin Tympanic temperature of 94° F (34.4° C)

Tympanic temperature of 94° F (34.4° C) Hypothyroidism leads to a hypodynamic state, so a low body temperature is expected after the levothyroxine has been metabolized. Each of the other symptoms is indicative of a hypermetabolic state, and, although the client may exhibit these problems, they're probably related to infection and dehydration.

The effectiveness of selective serotonin reuptake inhibitor (SSRIs) therapy, in a client with post traumatic stress disorder (PTSD), can be verified when the client states: "I'm sleeping better now." "I'm not losing my temper." "I've lost my craving for alcohol." "I've lost my phobia for water."

"I'm sleeping better now." Selective serotonin reuptake inhibitors are used to treat sleep problems, nightmares, and intrusive thoughts in individuals with PTSD. Selective serotonin reuptake inhibitors are not used to control flashbacks, to treat a specific phobia, or to decrease the craving for alcohol.

Five days after running out of medication, a client taking clonazepam tells the nurse, "I know I shouldn't have just stopped the drug like that, but I'm OK." What is the nurse's most appropriate response? "Let's monitor you for problems, in case something else happens." "You could go through withdrawal symptoms for up to two weeks." "You have handled your anxiety, and now you know how to cope with stress." "If you're fine now, chances are you won't experience withdrawal symptoms."

"You could go through withdrawal symptoms for up to two weeks." Withdrawal symptoms can appear after one or two weeks because the benzodiazepine has a long half-life. Looking for another problem unrelated to withdrawal isn't the nurse's best strategy. The act of discontinuing an antianxiety medication doesn't indicate that a client has learned to cope with stress. Every client taking medication needs to be monitored for withdrawal symptoms when the medication is abruptly stopped.

The nurse receives a prescription for amoxicillin 80 mg/kg/day to be administered in two divided does to an infant who weighs 19 lb 8 oz (9 kg). The medication is supplied as 250 mg/ml. How many milliliters should the nurse administer for one dose? Record your answer using one decimal place.

1.4 Here are the calculations 80 mg/kg/day x 9 kg = 720 mg/day 720 mg/ 2 doses = 360 mg/dose 360 mg/dose ÷ 250 mg/ml = 1.4 ml

The health care provider orders 2 g of ampicillin in 50 ml of D5W, to infuse IV piggyback (IVPB) over 30 minutes, for a client who had a right total knee replacement secondary to osteoarthritis. At what rate would the nurse set the IV infusion pump in milliliters per hour? Record your answer using a whole number.

100 60÷30×50 ml?h=100 ml?h

A client with new-onset seizures of unknown cause is started on phenytoin. The health care provider has ordered a loading dose of 15 mg/kg IV to be given at a rate of 40 mg/min. What is the loading dose in milligrams if the client weighs 176 lb (80 kg)? Record your answer using a whole number.

1200 15 mg/kg x 80 kg=1,200 mg.

A client, with heart failure, is receiving furosemide, 40 mg IV. The provider orders 40 mEq of potassium chloride in 100 ml of dextrose 5% in water, to infuse over four hours. The client's most recent serum potassium level is 3.0 mEq/L. At which infusion rate should the nurse set the IV pump? Record your answer using a whole number.

25 Use this formula to determine the infusion rate: ml/hr = total volume (in lm) to be infused / (divided by) total time of influsion (in hr)

The nurse is caring for a 12-kg child diagnosed with epiglottitis. Vancomycin 50mg/kg/day in three divided doses is prescribed. The medication is supplied as 500 mg/100 ml. How many milliliters per dose will the nurse administer? Record your answer using a whole number

40 The child should receive 40 ml per dose. Here are the calculations: 50 mg/kg/day x 12 kg = 600 mg/day 600 mg/day ÷ 3 doses/day = 200 mg/dose 200 mg/dose ÷ 5 mg/ml = 40 ml/dose

A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution. The IV is being infused via an infusion pump, and the pump is currently set at 10 ml/hr. How many units of insulin each hour is this client receiving? Record your answer using whole number.

5 To determine the number of insulin units the client is receiving per hour, the nurse must first calculate the number of units in each milliliter of fluid: (50 units)/(100 mL)= 0.5 units/mL 0.5 units x 10 mL/hour=5 units/hour

Where is the best site for the nurse to assess a client's pulse prior to administering digoxin? Inner aspect of right wrist at the base of the thumb At the left fifth intercostal space, midclavicular line The anterior aspect of the right arm at the antecubital fossa The left second intercostal space in the midclavicular line

At the left fifth intercostal space, midclavicular line The administration of digoxin requires the assessment of the client's apical pulse. The correct landmark for obtaining an apical pulse is the left fifth intercostal space at the midclavicular line. This is the point of maximum impulse, and the location of the left ventricular apex. The left second intercostal space in the midclavicular line is where pulmonic sounds are auscultated.

The laboratory has just notified the nurse that a client on the unit has a phenytoin level of 32 mg/dl. Which symptoms should the nurse anticipate from this client? Ataxia and confusion Sodium depletion Tonic-clonic seizure Urinary incontinence

Ataxia and confusion A level of 32 mg/dl indicates phenytoin toxicity. Symptoms of toxicity include confusion and ataxia. Phenytoin doesn't cause hyponatremia, seizure, or urinary incontinence. Incontinence may occur during or after a seizure.

One hour after receiving pyridostigmine bromide for myasthenia gravis, a client reports difficulty swallowing and excessive respiratory secretions. What medication would the nurse anticipate to reverse the effects of pyridostigmine bromide? Additional pyridostigmine bromide Atropine Edrophonium Acyclovir

Atropine These symptoms suggest cholinergic crisis or excessive acetylcholinesterase medication, typically appearing 45 to 60 minutes after the last dose of acetylcholinesterase inhibitor. Atropine, an anticholinergic drug, is used to antagonize acetylcholinesterase inhibitors. The other drugs are acetylcholinesterase inhibitors. Edrophonium is used for diagnosis, and pyridostigmine bromide is used to treat myasthenia gravis and would worsen these symptoms. Acyclovir is an antiviral and would not be used to treat these symptoms.

A client calls the clinic worried about experiencing new symptoms after taking antipsychotic medicine. The client reports persistent, uncontrollable restlessness of the limbs and head despite improvement in psychotic symptoms. What is the most appropriate intervention by the nurse? Inform the client to ignore these symptoms because they will go away Advise the client to experiment with different dosages to see how he feels Tell the client to go to the emergency room if blurred vision or fever develops Direct the client to see the provider for medication to address these side effects

Direct the client to see the provider for medication to address these side effects Symptoms of tardive dyskinesia include tongue protrusion, lip smacking, chewing, blinking, grimacing, choreiform movements of limbs and trunk, and foot tapping. Primary prevention of tardive dyskinesia is achieved by using the lowest effective dose of a neuroleptic for the shortest time. However, with diseases of chronic psychosis such as schizophrenia, this strategy must be balanced with the fact that increased dosages are more beneficial in preventing recurrence of psychosis. If tardive dyskinesia is diagnosed, the causative drug should be discontinued. Blurred vision is a common adverse reaction of antipsychotic drugs and usually disappears after a few weeks of therapy. Restlessness is associated with akathisia. Sudden fever is a symptom of a malignant neurological disorder. The prescribing provider will make appropriate changes to meet the client's need. Clients should not ignore such symptoms, or adjust their own medication dosage.

A definitive diagnosis of pulmonary embolism has been made for a client. Which medication would the nurse anticipate for this client? Warfarin Heparin Streptokinase Acyclovir

Heparin Intravenous heparin is started once a pulmonary embolism is diagnosed to reduce clot formation. When a therapeutic level of heparin is established, warfarin is started. It can take up to three days before a therapeutic level of warfarin is achieved. Streptokinase is a fibrinolytic, usefulness in the management of pulmonary embolism. Acyclovir is an antiviral and is not prescribed after a pulmonary embolism.

The nurse is providing discharge instructions for a client who is receiving chemotherapeutic medications. Which intervention is most important to prevent hemorrhagic cystitis? Administering antacids Administering antibiotics Increasing calcium intake Increasing fluid intake

Increasing fluid intake Sterile hemorrhagic cystitis is an adverse effect of chemical irritation of the bladder from cyclophosphamide. It can be prevented by liberal fluid intake (at least one-and-a-half times the recommended daily fluid requirement). Antibiotics do not aid in the prevention of sterile hemorrhagic cystitis. Increasing calcium intake does not alter the risk of developing cystitis. Antacids would not be indicated for treatment.

A neonate is admitted to the neonatal intensive care unit with persistent pulmonary hypertension. Which medication should the nurse anticipate for this neonate? Dobutamine Isoproterenol Prostaglandin E2 Inhaled nitric oxide

Inhaled nitric oxide Inhaled nitric oxide is a potent selective pulmonary vasodilator. Dobutamine is a vasopressor, not a vasodilator. Isoproterenol dilates pulmonary arteries but does not decrease pulmonary vascular resistance. Prostaglandin E2 is an oxytocic substance used to induce labor and does not affect pulmonary vasodilation.

What is the nurse's priority action when administering phenytoin to a client intravenously? Administer rapidly Withhold other anticonvulsants Mix phenytoin with saline solution only Use only dextrose solution when flushing the IV catheter

Mix phenytoin with saline solution only Phenytoin is only compatible with saline solutions. Dextrose will cause an insoluble precipitate to form. Phenytoin should be administered at a rate of less than 50 mg/min. There is no need to withhold additional anticonvulsants.

The nurse is caring for a newborn with unrepaired transposition of the great vessels. Which medication should the nurse anticipate giving first for treatment of this defect?

Prostaglandin E1 is necessary to maintain patency of the patent ductus arteriosus, and improve systemic arterial flow in children with inadequate intracardiac mixing. Digoxin, furosemide, and enalapril will treat heart failure when present.

A client with a subarachnoid hemorrhage is prescribed a 1,000 mg loading dose of IV phenytoin. What information is most important when administering this dose? Therapeutic drug levels should be maintained between 20 and 30 mg/ml. Rapid phenytoin administration can cause cardiac arrhythmias. Phenytoin should be mixed in dextrose in water before administration. Phenytoin should be administered through an IV catheter in the client's hand.

Rapid phenytoin administration can cause cardiac arrhythmias. Intravenous phenytoin should not exceed 50 mg/min, as rapid administration can depress the myocardium, causing lethal dysrhythmias. Therapeutic drug levels range from 10 to 20 mg/ml. Phenytoin is only compatible with normal saline, not dextrose in water. Phenytoin is very irritating to the blood vessels, and may cause purple glove syndrome when administered IV into a hand.

What is the most important information for the nurse to include when teaching a 17-year-old female client about the adverse effects of isotretinoin? Diarrhea Gram-negative folliculitis Teratogenicity Vaginal candidiasis

Teratogenicity The use of even small amounts of isotretinoin has been associated with severe birth defects. Most female clients taking this medication are prescribed hormonal contraceptives. Cleocin T, another medicine used in the treatment of acne, is associated with both diarrhea and gram-negative folliculitis. Tetracycline is associated with yeast infections.

A mother asks why she can't use 2.5% hydrocortisone cream prescribed for eczema for longer than one week. What is the nurse's best response? The drug loses its efficacy after prolonged use. This reduces adverse effects, such as skin atrophy and fragility. If no improvement is seen, a stronger concentration will be prescribed. If no improvement is seen after one week, an antibiotic will be prescribed.

This reduces adverse effects, such as skin atrophy and fragility. Hydrocortisone cream should be used for brief periods to decrease adverse effects such as skin atrophy. The drug doesn't lose efficacy after prolonged use. A stronger concentration may not be prescribed if no improvement is seen, and an antibiotic would be inappropriate.

Which physical assessment data would alert the nurse to a possible mild toxic reaction in a client receiving lithium? Vomiting and diarrhea Hypotension Seizures Increased appetite

Vomiting and diarrhea Vomiting and diarrhea are signs of mild to moderate lithium toxicity. Hypotension and seizures occur with moderate to severe toxic reactions. Anorexia occurs with mild toxic reactions.

A client is taking fluphenazine. The nurse understands that teaching and discharge instructions are understood when the client states:

rationale: Fluphenazine is an antipsychotic drug that can cause photosensitivity and sunburn. Clients taking this drug don't need to increase fluid intake, avoid cheese or eggs, or plan rest periods.

The nurse is aware that antihypertensives should be used cautiously in clients already taking: ibuprofen. diphenhydramine. thioridazine. vitamins.

thioridazine. Thioridazine affects the neurotransmitter norepinephrine, which causes hypotension and other cardiovascular effects. Administering an antihypertensive to a client who already has hypotension could have serious adverse effects. Ibuprofen is an anti-inflammatory that doesn't interfere with the cardiovascular system. Although diphenhydramine does have histaminic effects such as sedation, it isn't known to decrease blood pressure. Vitamins are not drugs and don't interfere with cardiovascular function.

Before starting treatment for leukemia, a client receives IV fluids and allopurinol. These interventions reduce the risk for: disseminated intravascular coagulation (DIC). pancytopenia. tumor lysis syndrome. mucositis.

tumor lysis syndrome. During chemotherapy for leukemia, tumor lysis syndrome may occur as cell destruction releases intracellular components, resulting in hyperuricemia. Large fluid quantities and allopurinol therapy help reduce the amount of uric acid that result from tumor lysis syndrome but don't stop the cell lysis. Although DIC, pancytopenia, and mucositis are possible chemotherapy complications, they're not treated with IV fluids and allopurinol.