Pharm Hesi
A client being discharged home is prescribed an antibiotic with a dosage three times higher than it was administered when the client was in the hospital. Which route of administration should the nurse anticipate will be prescribed for the greatest first-pass effect? -Oral. -Sublingual. -Intravenous. -Subcutaneous.
Oral The first-pass effect is a pharmacokinetic phenomenon that is related to the drug's metabolism in the liver. After oral medications are absorbed from the gastrointestinal tract, the drug is carried directly to the liver via the hepatic portal circulation, where hepatic inactivation occurs and reduces the bioavailability (strength/concentration) of the drug.
A client being discharged is prescribed warfarin for the treatment following a pulmonary embolism. Which diagnostic test should the nurse instruct the client to receive once a month? Perfusion scan. Prothrombin Time (PT). Activated partial thromboplastin (aPTT). Serum Coumadin level (SCL).
Prothrombin Time (PT). When used for a client with pulmonary embolus, the therapeutic goal for warfarin therapy is a PT 1 to 2 times greater than the control, or an INR of 2 to 3. A client prescribed warfarin should have the PT or INR levels checked at a minimum once a month.
The nurse is making early morning rounds on a group of clients when a client begins exhibiting symptoms of an acute asthma attack. The nurse administers a PRN prescription for a Beta 2 receptor agonist agent. Which client response should the nurse expect? Tachycardia. Increased blood pressure. Rapid resolution of wheezing. Improved pulse oximetry values. Reduce fever airway inflammation
Rapid resolution of wheezing. Improved pulse oximetry values. Beta 2 receptor agonist agents should provide immediate return of airflow and resolve wheezing and improve oxygenation.
A client receives a new prescription for sustained release levodopa/carbidopa PO BID for the treatment of Parkinson's disease. The client's previous prescription was levodopa PO TID. The client's last dose of levodopa was at 0800 hr. Which set of instructions should the nurse give to the client? -"Take the first dose of levodopa/carbidopa today, as soon as your prescription is filled." -"Since you already took your levodopa, wait until tomorrow to take the levodopa/carbidopa." -"Take both drugs for the first week, then switch to taking only the levodopa/carbidopa." -"You can begin taking the levodopa/carbidopa this evening, but do not take any more levodopa."
-"You can begin taking the levodopa/carbidopa this evening, but do not take any more levodopa." Carbidopa combined with the levodopa significantly reduces the need for levodopa in clients with Parkinson's disease, so the new prescription should not be started until eight hours after the previous dose of levodopa, but can be started the same day.
A client receives a new prescription for sustained release levodopa/carbidopa PO BID for the treatment of Parkinson's disease. The client's previous prescription was levodopa PO TID. The client's last dose of levodopa was at 0800 hr. Which set of instructions should the nurse give to the client? -"Take the first dose of levodopa/carbidopa today, as soon as your prescription is filled." -"Since you already took your levodopa, wait until tomorrow to take the levodopa/carbidopa." -"Take both drugs for the first week, then switch to taking only the levodopa/carbidopa." -"You can begin taking the levodopa/carbidopa this evening, but do not take any more levodopa."
-"You can begin taking the levodopa/carbidopa this evening, but do not take any more levodopa." Carbidopa combined with the levodopa significantly reduces the need for levodopa in clients with Parkinson's disease, so the new prescription should not be started until eight hours after the previous dose of levodopa, but can be started the same day.
When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most important for the nurse to assess for pain in which area of the body? -Flank. -Abdomen. -Chest. -Head
-Abdomen. Acetaminophen toxicity can result in liver damage; therefore, it is especially important for the nurse to assess for pain in the right upper quadrant of the abdomen, which might indicate liver damage, along with nausea and vomiting.
A client is taking hydromorphone (Dilaudid) PO every 4 hours at home. Following surgery, Dilaudid IV every 4 hours PRN and butorphanol tartrate (Stadol) IV every 4 hours PRN are prescribed for pain. The client received a dose of the Dilaudid IV four hours ago, and is again requesting pain medication. Which intervention should the nurse implement? -Alternate the two medications every 4 hours PRN for pain. -Alternate the two medications every 2 hours PRN for pain. -Administer only the Dilaudid every 4 hours PRN for pain. -Administer only the Stadol every 4 hours PRN for pain.
-Administer only the Dilaudid every 4 hours PRN for pain. Dilaudid is an opioid agonist. Stadol is an opioid agonist-antagonist. Use of an agonist-antagonist for the client who has been receiving opioid agonists may result in abrupt withdrawal symptoms, and should be avoided.
A client's dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily. When the client reports the onset of a headache prior to the next scheduled dose, which action should the nurse implement? -Hold the next scheduled dose of Imdur 60 mg and administer a PRN dose of acetaminophen (Tylenol). -Administer the 40 mg of Imdur and then contact the healthcare provider. -Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol). -Do not administer the next dose of Imdur or any acetaminophen until notifying the healthcare provider.
-Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol). Imdur is a nitrate which causes vasodilation. This vasodilation can result in headaches, which can generally be controlled with acetaminophen until the client develops a tolerance to this adverse effect.
A client prescribed albuterol tablets reports nausea every evening with the 9:00 p.m. dose. Which action should the nurse perform to alleviate this side effect? -Change the time of the dose. -Hold the 9 p.m. dose. -Administer the dose with a snack. -Offer an antiemetic with the dose.
-Administer the dose with a snack Administering oral doses of albuterol with food helps minimize gastrointestinal discomfort such as nausea.
The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide? -The frequency of the dosing is necessary to increase the effectiveness. -Therapeutic blood levels of this drug are reached in 4 to 6 weeks. -Another type of non-steroidal anti-inflammatory drug may be indicated. -Systemic corticosteroids are the next drugs of choice for pain relief.
-Another type of non-steroidal anti-inflammatory drug may be indicated. Individual responses to nonsteroidal antiinflammatory drugs are vary from person to person, so another nonsteroidal antiinflammatory drug (NSAID) may be indicated for this particular client.
Which action is most important for the nurse to implement prior to the administration of the antiarrhythmic drug adenosine (Adenocard)? -Assess pupillary response to light. -Instruct the client that facial flushing may occur. -Apply continuous cardiac monitoring. -Request that family members leave the room.
-Apply continuous cardiac monitoring. Adenosine (Adenocard) is an antiarrhythmic drug used to restore a normal sinus rhythm in clients with rapid supraventricular tachycardia. The client's heart rate should be monitored continuously (C) for the onset of additional arrhythmias while receiving adenosine. (A and B) are valuable nursing interventions, but are of less importance than monitoring for potentially fatal arrhythmias. Family members may be asked to leave the room because of the potential for an emergency situation (D), however, this is also of less priority than (C).
An adult client is given a prescription for a scopolamine patch (Transderm Scop) to prevent motion sickness while on a cruise. Which information should the nurse provide to the client? -Apply the patch at least 4 hours prior to departure. -Change the patch every other day while on the cruise. -Place the patch on a hairless area at the base of the skull. -Drink no more than 2 alcoholic drinks during the cruise
-Apply the patch at least 4 hours prior to departure. Scopolamine, an anticholinergic agent, is used to prevent motion sickness and has a peak onset in 6 hours, so the client should be instructed to apply the patch at least 4 hours before departure on the cruise ship. The duration of the transdermal patch is 72 hours. Scolopamine blocks muscarinic receptors in the inner ear and to the vomiting center, so the best application site of the patch is behind the ear. Anticholinergic medications are CNS depressants, so the client should be instructed to avoid alcohol while using the patch.
Which instruction) should the nurse give to a female client who just received a prescription for oral metronidazole (Flagyl) for treatment of trichomonas vaginalis? (Select all that apply.) -Increase fluid intake, especially cranberry juice. -Do not abruptly discontinue the medication; taper use. -Check blood pressure daily to detect hypertension. -Avoid drinking alcohol while taking this medication. -Use condoms until treatment is completed. -Ensure that all sexual partners are treated at the same time.
-Avoid drinking alcohol while taking this medication. -Use condoms until treatment is completed. -Ensure that all sexual partners are treated at the same time. -Increase fluid intake, especially cranberry juice. Increased fluid intake and cranberry juice are recommended for prevention and treatment of urinary tract infections, which frequently accompany vaginal infections. It is not necessary to taper use of this drug or to check the blood pressure daily, as this condition is not related to hypertension. Flagyl can cause a disulfiram-like reaction if taken in conjunction with ingestion of alcohol, so the client should be instructed to avoid alcohol. All sexual partners should be treated at the same time and condoms should be used until after treatment is completed to avoid reinfection.
Which medications should the nurse caution the client about taking while receiving an opioid analgesic? -Antacids. -Benzodiazepines. -Antihypertensives. -Oral antidiabetics.
-Benzodiazepines. Respiratory depression increases with the concurrent use of opioid analgesics and other central nervous system depressant agents, such as alcohol, barbiturates, and benzodiazepines (B). (A and D) do not interact with opiates to produce adverse effects. Antihypertensives (C) may cause morphine-induced hypotension, but should not be withheld without notifying the healthcare provider.
Which antidiarrheal agent should be used with caution in clients taking high dosages of aspirin for arthritis? -Loperamide (Imodium). -Probanthine (Propantheline). -Bismuth subsalicylate (Pepto Bismol). -Diphenoxylate hydrochloride with atropine (Lomotil)
-Bismuth subsalicylate (Pepto Bismol). Bismuth subsalicylate (Pepto Bismol) contains a subsalicylate that increases the potential for salicylate toxicity when used concurrently with aspirin (acetylsalicylic acid, another salicylate preparation).
A client is receiving clonidine (Catapres) 0.1 mg/24hr via transdermal patch. Which assessment finding indicates that the desired effect of the medication has been achieved? -Client denies recent episodes of angina. -Change in peripheral edema from +3 to +1. -Client denies recent nausea or vomiting. -Blood pressure has changed from 180/120 to 140/70.
-Blood pressure has changed from 180/120 to 140/70. Catapres acts as a centrally-acting analgesic and antihypertensive agent. (D) indicates a reduction in hypertension. Catapres does not affect (A, B, or C), so these findings do not indicate desired outcomes of Catapres.
While taking a medical history, the client states, "I am allergic to penicillin." What related allergy to another type of antiinfective agent should the nurse ask the client about when taking the nursing history? -Aminoglycosides. -Cephalosporins. -Sulfonamides. -Tetracyclines.
-Cephalosporins. According to research, there appears to be a cross sensitivity between penicillins and first generation cephalosporins; however, research shows there is no evidence of cross sensitivity between PCN and third or fourth generation cephalosporins.
Following the administration of sublingual nitroglycerin to a client experiencing an acute anginal attack, which assessment finding indicates to the nurse that the desired effect has been achieved? -Client states chest pain is relieved. -Client's pulse decreases from 120 to 90. -Client's systolic blood pressure decreases from 180 to 90. -Client's SaO2 level increases from 92% to 96%
-Client states chest pain is relieved Nitroglycerin reduces myocardial oxygen consumption which decreases ischemia and reduces chest pain.
The nurse is preparing an education session for a client prescribed opioids for intractable cancer pain. The nurse should include strategies to help prevent which common side effect associated with long-term use of opioids? -Sedation. -Constipation. -Urinary retention. -Respiratory depression.
-Constipation. The client should be prepared to implement measures for constipation, which is the most likely persistent side effect related to opioid use. Tolerance to opiate narcotics is common, and the client may experience less sedation and respiratory depression as analgesic use continues. Opioids increase the tone in the urinary bladder sphincter, which causes retention but may subside. The most likely persistent side effect is constipation.
A female client calls the clinic and talks with the nurse to inquire about a possible reaction after taking amoxicillin for 5 days. She reports having vaginal discomfort, itching, and a white discharge. The nurse should discuss which action with the client? -Discontinue the antibiotic because original symptoms have subsided. -Continue taking medication until finished until the symptoms subside. -Consult with healthcare provider about another treatment for this effect. -Use an over-the-counter (OTC) vaginal wash to flush out the secretions.
-Consult with healthcare provider about another treatment for this effect. A superinfection with normal flora yeast may occur during antibiotic therapy. If suspected, the new onset of findings should be reported to the healthcare provider for another prescribed treatment to treat the superinfection.
Which drug is used as a palliative treatment for a client with tumor-induced spinal cord compression? -Morphine Sulfate (Duromorph). -Ibuprofen (Advil). -Amitriptyline (Amitril). -Dexamethasone (Decadron)
-Dexamethasone (Decadron) Dexamethasone (D) is a palliative treatment modality to manage symptoms related to compression due to tumor growth. Morphine sulphate (A) is an opioid analgesic used in oncology to manage severe or intractable pain. Ibuprofen (B), a nonsteroidal antiinflammatory drug (NSAID), provides relief for mild to moderate pain, suppression of inflammation, and reduction of fever. Amitriptyline (C), a tricyclic antidepressant, is often prescribed for pain related to neuropathic origin and provides a reduction in opioid dosage.
A client with heart failure is being discharged with a new prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten). The nurse's discharge instructions should include reporting which problem to the healthcare provider? -Weight loss. -Dizziness. -Muscle cramps. -Dry mucous membranes
-Dizziness Angiotensin-converting enzyme (ACE) inhibitors are used in heart failure to reduce afterload by reversing vasoconstriction common in heart failure. This vasodilation can cause hypotension and resultant dizziness. Weight loss is desired if fluid overload is present, and may occur as the result of effective combination drug therapy such as diuretics with ACE inhibitors. It does not require reporting to the healthcare provider. Unlike ACE inhibitors, diuretics may result in hypokalemia and excessive diuretic administration may result in fluid volume deficit manifested by symptoms of dehydration.
A client is experiencing anaphylaxis from an insect sting. Which medication should the nurse administer? -Dopamine. -Ephedrine. -Epinephrine. -Diphenhydramine.
-Epinephrine. Epinephrine is an adrenergic agent that stimulates beta receptors to increase cardiac automaticity in cardiac arrest and relax bronchospasms in anaphylaxis. Epinephrine is the medication of choice in treating anaphylaxis.
A client with a dysrhythmia is prescribed procainamide (Pronestyl) in 4 divided doses over the next 24 hours. Which dosing schedule is best for the nurse to implement? -Every 6 hours. -QID. -AC and bedtime. -PC and bedtime
-Every 6 hours. Pronestyl is a class 1A antidysrhythmic. It should be taken around the clock, so that a stable blood level of the drug can be maintained, thereby decreasing the possibility of hypotension (an adverse effect) occurring because of too much of the drug circulating systemically at any particular time of day. Pronestyl may be given with food if GI distress is a problem.
A client with hyperlipidemia receives a prescription for niacin (Niaspan). Which client teaching is most important for the nurse to provide? -Expected duration of flushing. -Symptoms of hyperglycemia. -Diets that minimize GI irritation. -Comfort measures for pruritus.
-Expected duration of flushing. Flushing of the face and neck, lasting up to an hour, is a frequent reason for discontinuing niacin. Inclusion of this effect in client teaching may promote compliance in taking the medication. While nutrition tips and managing pruritus are worthwhile instructions to help clients minimize or cope with normal side effects associated with niacin (Niaspan), flushing is intense and causes the most concern for the client.
A client prescribed atenolol has a blood pressure of 120/68 mmHg, displaying a sinus bradycardia with a rate of 58 beats/minute, and a P-R interval of 0.24. Which action should the nurse take? -Lower the head of the bed and assess the client for orthostatic vital sign changes. -Give the medication as prescribed and continue to monitor the client. -Prepare to administer atropine sulfate IV push. -Hold the prescribed dose and contact the healthcare provider.
-Give the medication as prescribed and continue to monitor the client. Since the client's blood pressure is within normal limits, and the pulse is above 50 beats/min with a first degree block, the medication can be administered. Atenolol is a beta-blocker that slows the heart rate and lowers the blood pressure; this drug is generally held if the heart rate is less than 50 beats/min or the client exhibits dizziness related to hypotension.
A medication that is classified as a beta-1 agonist is most commonly prescribed for a client with which condition? -Glaucoma. -Hypertension. -Heart failure. -Asthma.
-Heart failure. Beta-1 agonists improve cardiac output by increasing the heart rate and blood pressure and are indicated in heart failure (C), shock, atrioventricular block dysrhythmias, and cardiac arrest. Glaucoma (A) is managed using adrenergic agents and beta-adrenergic blocking agents. Beta-1 blocking agents are used in the management of hypertension (B). Medications that stimulate beta-2 receptors in the bronchi are effective for bronchoconstriction in respiratory disorders, such as asthma (D).
A peak and trough level is prescribed for a client receiving antibiotic therapy. When should the nurse should obtain the trough level? -Sixty minutes after the antibiotic dose is administered. -Immediately before the next antibiotic dose is given. -Upon completion of the prescribed antibiotic regime. -An hour before the next antibiotic dose is give
-Immediately before the next antibiotic dose is given. Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given.
A client is prescribed aluminum hydroxide for peptic ulcer disease. Which statement by the client demonstrates an understanding of the action of the medication? -It decreases the production of gastric secretions. -It produces an adherent barrier over the ulcer. -It helps maintain a gastric pH of 3.5 or above. -It slows down the gastric motor activity.
-It helps maintain a gastric pH of 3.5 or above. The objective of antacids is to neutralize gastric acids and keep a gastric pH of 3.5 or above, which is necessary for pepsinogen inactivity.
A client being treated for hyperthyroidism with propylthiouracil (PTU) asks the nurse how the medication works. Which is the best response to give the client? -It decreases the amount of thyroid-stimulating hormone circulating in the blood. -It increases the amount of thyroid-stimulating hormone circulating in the blood. -It enhances the amount of T4 and diminishes the amount of T3 produced by the thyroid. -It inhibits the synthesis of T3 and T4 by the thyroid gland.
-It inhibits the synthesis of T3 and T4 by the thyroid gland. Propylthiouracil (PTU) is an adjunct therapy used to control hyperthyroidism by inhibiting the production of thyroid hormones. It is often prescribed in preparation for thyroidectomy or radioactive iodine therapy.
A client with Parkinson's disease is taking carbidopa-levodopa (Sinemet). Which observation by the nurse would indicate that the desired outcome of the medication is being achieved? -Decreased blood pressure. -Lessening of tremors. -Increased salivation. -Increased attention span.
-Lessening of tremors Sinemet increases the amount of levodopa to the CNS (dopamine to the brain). Increased amounts of dopamine improve the symptoms of Parkinson's, such as involuntary movements, resting tremors, shuffling gait, etc. Decreased drooling would be a desired effect, not increased salivation.
A client who was prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs. Which statement reflects the correct drug-specific teaching the nurse should provide to this client? -Increase consumption of potassium-rich foods since low potassium levels can cause muscle spasms. -Have serum electrolytes checked at the next scheduled appointment to assess hyponatremia, a cause of cramping. -Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. -Be sure to consume a low-cholesterol diet while taking the drug to enhance the effectiveness of the drug.
-Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. Myopathy, suggested by the leg pain and weakness, is a serious and potentially life-threatening complication of Lipitor, and should be evaluated immediately by the healthcare provider.
The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports hearing non-stop ringing in the ears. Which action should the nurse implement? -Refer the client to an audiologist for evaluation of her hearing. -Advise the client that this is a common side effect. -Notify the healthcare provider of the finding immediately. -Face the client directly and speak in a low, monotone voice.
-Notify the healthcare provider of the finding immediately. Tinnitus (ringing in the ears) is an early sign of salicylate toxicity. The healthcare provider should be notified immediately, and the medication discontinued.
A client has a continuous IV infusion of dopamine (Intropin) and an IV of normal saline at 50 mL/hour. The nurse notes that the client's urinary output has been 20 mL/hour for the last 2 hours. Which intervention should the nurse initiate? -Stop the infusion of dopamine. -Change the normal saline to a keep open rate. -Replace the urinary catheter. -Notify the healthcare provider of the urinary output.
-Notify the healthcare provider of the urinary output. The main effect of dopamine is adrenergic stimulation used to increase cardiac output, which should also result in increased urinary output. A urinary output of less than 20 mL/hour is oliguria and should be reported to the healthcare provider, so the dose of dopamine can be adjusted. Depending on the current rate of administration, the dose may need to be increased or decreased.
A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) orally for symptom management. The nurse notes the client is allergic to sulfa. Which action is most important for the nurse to implement prior to administering the first dose? -Review the client's hemoglobin results. -Notify the healthcare provider. -Inquire about the reaction to sulfa. Incorrect -Record the client's vital signs.
-Notify the healthcare provider. Celebrex contains a sulfur molecule, which can lead to an allergic reaction in individuals who are sensitive to sulfonamides, so the healthcare provider should be notified of the client's allergies.
The nurse is reviewing admission prescriptions for a client with myxedema. The nurse should clarify with the healthcare provider which prescription for the client? -Liothyronine to replace iodine. -Furosemid for relief of fluid retention. -Pentobarbital sodium for sleep. -Nitroglycerin for angina pain.
-Pentobarbital sodium for sleep. Clients with myxedema are dangerously hypersensitive to narcotics, barbiturates and anesthetics and should not be prescribed these medications if possible.
A client is admitted to the hospital for a new onset of supraventricular tachycardia (SVT) and is prescribed digoxin. For which laboratory finding should the nurse notify the healthcare provider immediately? -Potassium level of 3.1 mEq/L. -Sodium level of 132 mEq/L. -Calcium level of 8.6 mg/dL. -Magnesium level of 1.2 mEq/L
-Potassium level of 3.1 mEq/L. Hypokalemia affects myocardial contractility and places this client at greatest risk for dysrhythmias that may be unresponsive to drug therapy. Although an imbalance of serum sodium, calcium, and magnesium can effect cardiac rhythm, the greatest risk for a client receiving digoxin is low potassium.
A client is prescribed ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs? -Rash. -Nausea. -Headache. -Dizziness.
-Rash. Rash is the most common adverse effect of all penicillins, indicating an allergy to the medication that could result in anaphylactic shock, a medical emergency.
The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room. Which assessment data would indicate that the naloxone has been effective? -A client's statement that the chest pain is better. -Respiratory rate is 16 breaths/minute. -Seizure activity has stopped temporarily. -Pupils are constricted bilaterally.
-Respiratory rate is 16 breaths/minute. Naloxone (Narcan) is a narcotic antagonist that reverses the respiratory depression effects of opiate overdose, so assessment of a normal respiratory rate would indicate that the respiratory depression has been reversed.
The nurse is caring for a client who has taken atenolol for 2 years. The healthcare provider recently changed the medication to enalapril to manage the client's blood pressure. Which instruction should the nurse provide the client regarding the new medication? -Take the medication at bedtime. -Report presence of increased bruising. -Check pulse before taking medication. -Rise slowly when getting out of bed or chair
-Rise slowly when getting out of bed or chair The client's new medication is an angiotensin-converting enzyme (ACE) inhibitor, which has the side effect of orthostatic hypotension. Instructing the client to rise slowly from a sitting or lying down position is important to teach the client to avoid dizziness and potentially falling.
Which nursing diagnosis is important to include in the plan of care for a client receiving the angiotensin-2 receptor antagonist irbesartan (Avapro)? -Fluid volume deficit. -Risk for infection. -Risk for injury. -Impaired sleep patterns.
-Risk for injury. Avapro is an antihypertensive agent, which acts by blocking vasoconstrictor effects at various receptor sites. This can cause hypotension and dizziness, placing the client at high risk for injury.
A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has completed discharge teaching regarding medication administration. Which morning schedule would indicate to the nurse that the client teaching has been effective? -Take medication, go for a 30 minute morning walk, then eat breakfast. -Take medication, rest in bed for 30 minutes, eat breakfast, go for morning walk. -Take medication with breakfast, then take a 30 minute morning walk. -Go for a 30 minute morning walk, eat breakfast, then take medication.
-Take medication, go for a 30 minute morning walk, then eat breakfast. Alendronate (Fosamax) is best absorbed when taken thirty minutes before eating in the morning. The client should also be advised to remain in an upright position for at least thirty minutes after taking the medication to reduce the risk of esophageal reflux and irritation.
A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information should the nurse include in the client's instruction? -Notify the clinic of any changes in the color of urine. -Avoid overexposure to the sun. -Stop the medication after the diarrhea resolves. -Take the medication with food.
-Take the medication with food. Flagyl, an amoebicide and antibacterial agent, may cause gastric distress, so the client should be instructed to take the medication on a full stomach. Urine may be red-brown or dark from taking Flagyl, but this side effect is an expectant finding and not necessary to report tot he healthcare provider.
In evaluating the effects of lactulose (Cephulac), which outcome would indicate that the drug is performing as intended? -An increase in urine output. -Two or three soft stools per day. -Watery, diarrhea stools. -Increased serum bilirubin
-Two or three soft stools per day. Lactulose is administered to reduce blood ammonia by excretion of ammonia through the stool. Two to three stools a day indicate that lactulose is performing as intended (B). (A) would be expected if the patient received a diuretic. (C) would indicate an overdose of lactulose and is not expected. Lactulose does not affect (D).
A Category X drug is prescribed for a young adult female client. Which instruction is most important for the nurse to teach this client? -Use a reliable form of birth control. .-Avoid exposure to ultra violet light. -Refuse this medication if planning pregnancy. -Abstain from intercourse while on this drug.
-Use a reliable form of birth control. Drugs classified in the Category X place a client who is in the first trimester of pregnancy at risk for teratogenesis, so women in the childbearing years should be counseled to use a reliable form of birth control during drug therapy. If the client is planning to become pregnant, she should be encouraged to discuss plans for pregnancy with the healthcare provider, so a safer alternative prescription can be provided if pregnancy occurs.
A female client with rheumatoid arthritis takes ibuprofen (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which information is most important for the nurse to include in client teaching? -Use contraception during intercourse. -Ensure the Cytotec is taken on an empty stomach. -Encourage oral fluid intake to prevent constipation. -Take Cytotec 30 minutes prior to Motrin
-Use contraception during intercourse. Cytotec, a synthetic form of a prostaglandin, is classified as pregnancy Category X and can act as an abortifacient, so the client should be instructed to use contraception during intercourse to prevent loss of an early pregnancy. A common side effect of Cytotec is diarrhea, so constipation prevention strategies are usually not needed. Cytotec and Motrin should be taken together to provide protective properties against gastrointestinal bleeding.
The nurse is transcribing a new prescription for spironolactone (Aldactone) for a client who receives an angiotensin-converting enzyme (ACE) inhibitor. Which action should the nurse implement? -Verify both prescriptions with the healthcare provider. -Report the medication interactions to the nurse manager. -Hold the ACE inhibitor and give the new prescription. -Transcribe and send the prescription to the pharmacy.
-Verify both prescriptions with the healthcare provider. The concomitant use of an angiotensin-converting enzyme (ACE) inhibitor and a potassium-sparing diuretic such as spironolactone, should be given with caution because the two drugs may interact to cause an elevation in serum potassium levels. Although the client is currently receiving an ACE inhibitor, verifying both prescriptions alerts the healthcare provider about the client's medication regimen and provides the safest action before administering the medication.
The nurse is providing care for a client prescribed propranolol. Which symptoms should the nurse report to the healthcare provider immediately? -Headache, hypertension, and blurred vision. -Wheezing, hypotension, and AV block. -Vomiting, dilated pupils, and papilledema. -Tinnitus, muscle weakness, and tachypnea.
-Wheezing, hypotension, and AV block. Wheezing, hypotension, and AV block represents the most serious adverse effects of beta-blocking agents. AV block is generally associated with bradycardia and results in potentially life-threatening decreases in cardiac output. Additionally, wheezing secondary to bronchospasm and hypotension represent life-threatening respiratory and cardiac disorders.
The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker (ARB), for a client with hypertension and heart failure. The nurse reviews the client's laboratory results and notes that the client's serum potassium level is 5.9 mEq/L. Which action should the nurse take first? -Withhold the scheduled dose. -Check the client's apical pulse. -Notify the healthcare provider. -Repeat the serum potassium level.
-Withhold the scheduled dose The nurse should first withhold the scheduled dose of Cozaar because the client is hyperkalemic (normal range 3.5 to 5 mEq/l). Although hypokalemia is usually associated with diuretic therapy in heart failure, hyperkalemia is associated with several heart failure medications, including ARBs. Because hyperkalemia may lead to cardiac dysrhythmias, the nurse should check the apical pulse for rate and rhythm, and blood pressure.
Upon admission to the emergency center, an adult client with acute status asthmaticus is prescribed this series of medications. In which order should the nurse administer the prescribed medications? (Arrange from first to last.) Albuterol (Proventil) puffs. Prednisone (Deltasone) orally. Gentamicin (Garamycin) IM. Salmeterol (Serevent Diskus)
Albuterol (Proventil) puffs. Salmeterol (Serevent Diskus). Prednisone (Deltasone) orally. Gentamicin (Garamycin) IM Status asthmaticus is potentially a life-threatening respiratory event, so albuterol, a beta2 adrenergic agonist and short acting bronchodilator, should be administered by inhalation first to provide rapid and deep topical penetration to relieve bronchospasms, dilate the bronchioles, and increase oxygenation. In stepwise management of persistent asthma, a long-action bronchodilator, such as salmeterol (Serevent Diskus), with a 12-hour duration of action should be given next. Prednisone, an oral corticosteroid, provides prolonged anti-inflammatory effects and should be given after the client's respiratory distress begins to resolves. Gentamicin, an antibiotic, is given deep IM, which can be painful, and may require repositioning the client, so should be last in the sequence.
The nurse administers a dose of metoprolol for a client. Which assessment is most important for the nurse to obtain? -Temperature. -Lung sounds. -Blood pressure. -Urinary output.
Blood pressure It is most important to monitor the blood pressure of clients taking this medication because metoprolol is an antianginal, antiarrhythmic, antihypertensive agent.
A postoperative client receiving a continuous IV infusion of meperidine 35 mg/hr for the past four days has become increasingly restless and irritable, and begins to hallucinate. Which action should the nurse take first? -Administer a PRN dose of the PO lithium. -Administer naloxone IV push. -Decrease the IV infusion rate of the meperidine. -Increase the IV infusion rate of the meperidine.
Decrease the IV infusion rate of the meperidine. The client is exhibiting symptoms of meperidine toxicity, which is consistent with the large doses of meperidine received over four days. Decreasing the infusion rate of the meperidine as per protocol is the most effective action to immediately decrease the amount of serum meperidine. The next nursing action is for the nurse to notify the healthcare provider.
An older client with a decreased percentage of lean body mass is admitted to the hospital. Which pharmacokinetic process is affected and should be considered in the client's dosing of medication? -Absorption. -Metabolism. -Elimination. -has Distribution
Distribution A decreased lean body mass in an older adult affects the distribution of drugs, which affects the pharmacokinetics of drug and how the medication is distributed throughout the body.
