pharm test 4

0820 Pramlintide, an amylin mimetic, peaks 20 min after administration. The nurse should monitor the client for indications of hypoglycemia, such as diaphoresis and tremors. Aspart insulin is an injectable hypoglycemic drug that can exert its peak action at 1hr. Regular insulin is an injectable hypoglycemic drug that can exert its peak action at that time.2.5-3 hr.

A nurse administers pramlintide at 0800 to a client who has type 1 diabetes mellitus. At which of the following times should the nurse expect the drug to exert its peak action?

Hypotension Hypotension and fatigue are findings of adrenal insufficiency. During times of stress, the client might need a dosage increase to prevent adrenal insufficiency. The nurse should report the findings to the provider. hypoglycemia as an indication that the client's dosage is too low. weight loss as an indication that the client's dosage is too low. The nurse should identify fat redistribution as an indication that the client's dosage is too high.

A nurse at a provider's office is assessing a client who has been taking hydrocortisone for adrenal insufficiency. The client reports fatigue and feeling overwhelmed by personal responsibilities. Which of the following findings should the nurse identify as an indication the provider might need to increase the client's dosage?

"Bring in a stool sample for testing." Abdominal cramping and bloody diarrhea can be caused by an overgrowth of the organism Clostridium difficile. The client should bring a stool sample in to be tested for the presence of this organism.

A nurse in a provider's office receives a call from a client who has been taking penicillin V three times daily and reports abdominal cramping with bloody diarrhea for several days. Which of the following instructions should the nurse give the client?

Edema Desmopressin, an antidiuretic hormone, can cause fluid retention and edema. The nurse should monitor fluid intake and output for clients receiving this drug.

A nurse is caring for a client who has hemophilia A and is about to begin taking desmopressin to prevent bleeding. The nurse should monitor the client for which of the following adverse reactions?

Hypertension Epoetin, an erythropoietic growth factor, can cause hypertension. The nurse should monitor the client's BP before and during therapy and inform the provider if it increases.

A nurse is caring for a client who has renal failure and is receiving epoetin. The nurse should monitor the client for which of the following adverse effects?

Aminocaproic acid Aminocaproic acid, a coagulator, inhibits fibrinolysis and stops excessive fibrinolytic bleeding, a severe adverse effect of alteplase.

A nurse is caring for a client who is about to begin alteplase therapy to treat pulmonary embolism. Which of the following drugs should the nurse have available in the event of a severe adverse reaction?

Dehydration Acyclovir, an antiviral drug, can cause renal toxicity, especially in clients who are dehydrated. Hydration during and after IV infusion of the drug can help prevent crystalluria. Metronidazole, an antiparasitic drug, is an antimicrobial drug that requires cautious use with clients who have heart failure. Amoxicillin, a penicillin, is an antimicrobial drug that requires cautious use with clients who have asthma. Vancomycin is an antimicrobial drug that requires cautious use with clients who have tinnitus.

A nurse is caring for a client who is about to begin receiving acyclovir IV to treat a viral infection. The nurse should recognize that cautious use of the drug is essential if the client also has which of the following conditions?

Cough Nitrofurantoin, a urinary tract antiseptic, can cause cough, shortness of breath, chest pain, and fever. These adverse effects can indicate an acute allergic reaction and require immediate discontinuation of drug therapy. is more likely to cause diarrhea than constipation. can turn urine a dark brown color, but it is a harmless effect. The drug can also stain teeth, so clients should rinse their mouth after drinking the oral suspension. it can cause peripheral neuropathy.

A nurse is caring for a client who is about to begin taking nitrofurantoin to treat a urinary tract infection. The nurse should tell the client to report which of the following adverse effects of the drug?

Uncontrolled bleeding Aspirin is a salicylate (antiplatelet) that irreversibly binds to and inhibits platelet activation. Because the lifespan of a platelet is 7 to 10 days, this is the average span of time needed after discontinuing antiplatelet therapy with aspirin before its effects are no longer present and the chance of an uncontrolled bleeding event is decreased.

A nurse is caring for a client who is scheduled for an outpatient surgical procedure and reports taking aspirin 81 mg daily, including this morning. The nurse should identify that this places the client at risk for which of the following complications?

Weight gain Pioglitazone, a thiazolidinedione, can cause fluid retention. The nurse should monitor the client for weight gain and other indications of fluid retention or heart failure, including dyspnea, crackles, and wheezing.

A nurse is caring for a client who is taking pioglitazone to treat type 2 diabetes mellitus. The nurse should monitor for which of the following findings?

Constipation Oral iron supplementation is associated with constipation. The nurse should encourage the client to consume adequate amounts of fiber and fluids in their diet to minimize this effect.

A nurse is monitoring a client following ferrous sulfate administration. The nurse should monitor the client for which of the following adverse effects?

Heparin Heparin therapy should be initiated before alteplase therapy and continued for at least 48 to 72 hr after the fibrinolytic therapy to reduce the risk of additional clot formation.

A nurse is reviewing the medication record of a client who is receiving alteplase following an acute myocardial infarction (MI). Which of the following medications should the nurse expect the client to be taking in addition to the alteplase?

Dietary modifications Warfarin is an anticoagulant drug that functions by inhibiting the action of vitamin K. Many foods, such as green, leafy vegetables, are rich in vitamin K. The client should maintain a consistent intake of vitamin K to avoid excesses or deficits and ensure the therapeutic effects of warfarin are consistent.

A nurse is teaching a client who is starting treatment with warfarin. The nurse should plan to include information on which of the following topics to promote the effectiveness of the drug?

Cardiac dysrhythmias Erythromycin, a macrolide, can cause ECG changes, including a prolonged QT interval, and put the client at risk for a potentially fatal ventricular dysrhythmia. The nurse should monitor the client's ECG and tell the client to report palpitations, fainting, or dizziness. The drug is contraindicated for clients who have a history of QT prolongation. Erythromycin, a macrolide, is more likely to cause diarrhea. is more likely to cause hearing loss.is more likely to cause fever.

When administering oral erythromycin to a client who has acute diphtheria, a nurse should monitor for which of the following adverse effects?

Call emergency services immediately. Amoxicillin can cause a severe anaphylactic reaction. A client who has difficulty breathing should call emergency services and seek immediate care. The client will need to be treated with epinephrine and an antihistamine, such as diphenhydramine, to treat an anaphylactic reaction. An NSAID is unlikely to reverse that progression, although an antihistamine, such as diphenhydramine, can help.

A nurse in a provider's office receives a call from a client who is taking amoxicillin to treat a respiratory infection and reports a rash and wheezing. Which of the following instructions should the nurse give the client?

Superinfection Imipenem, a carbapenem, can cause the superinfection Candida albicans in the mouth, throat, or vagina. It can also cause glossitis, an inflammation or infection of the tongue. Clients taking the drug should report any mouth pain or vaginal discharge and itching because they might require treatment with an antifungal drug. it can cause gastroenteritis, abdominal pain, and vomiting. cause glossitis, an inflammation or infection of the tongue, nausea, heartburn, and diarrhea.

A nurse in a provider's office receives a call from a client who was recently hospitalized and treated with imipenem IV for a bacterial infection and reports an inability to eat due to mouth pain. The nurse should identify that the client might be experiencing which of the following as an adverse effect of this drug?

Recent myocardial infarction Levothyroxine, a thyroid replacement hormone, can cause tachycardia, palpitations, and hypertension, especially when the client requires a dosage adjustment. Therefore, it is contraindicated for clients who have recently had a myocardial infarction. Propylthiouracil (PTU) is an endocrine-system drug that requires cautious use with clients who are immunosuppressed. It requires cautious use with clients who have diabetes mellitus. Fludrocortisone is an endocrine-system drug that requires cautious use with clients who have bacterial skin infection

A nurse is assessing a client who has a new prescription for levothyroxine. The nurse should identify which of the following findings as a contraindication for this drug?

Cefotetan is correct. Cefotetan, a second-generation cephalosporin, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension. Metronidazole is correct. Metronidazole, an antiparasitic drug, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension.

A nurse is caring for a client who has a gynecologic infection and a history of alcohol use disorder. The nurse should identify that which of the following drugs can cause a reaction similar to disulfiram if the client drinks alcohol while taking it? (Select all that apply.)

Clopidogrel Clopidogrel is an antiplatelet medication that blocks the ADP receptors on platelets, preventing platelet aggregation. This effect is irreversible and lasts the lifespan of the platelets (7 to 10 days).

A nurse is caring for a client who has chronic stable angina. The nurse should identify that which of the following drugs inhibits the action of adenosine diphosphate receptors (ADP) on platelets and can be prescribed to reduce the client's risk for myocardial infarction?

Hgb Epoetin, an erythropoietic growth factor, increases the production of RBCs for clients who have anemia due to chronic renal failure or chemotherapy. Hgb and Hct should increase with effective therapy.

A nurse is caring for a client who is about to begin taking epoetin. An increase in which of the following laboratory values should indicate to the nurse that the therapy is effective?

Alanine aminotransferase (ALT) is correct. Pioglitazone can cause liver injury. The nurse should monitor ALT at the start of therapy and then every 3 to 6 months thereafter. The nurse should tell the client to report jaundice, dark-colored urine, or abdominal pain. LDL is correct. Pioglitazone can cause elevations in both high-density lipoproteins, which is a beneficial effect, and LDLs, which is a detrimental effect. The nurse should monitor the client's plasma lipid levels at baseline and periodically throughout drug therapy. Levothyroxine, a thyroid hormone replacement, is an endocrine-system drug that requires monitoring of T4 and TSH. Hydrocortisone, a glucocorticoid, is an endocrine-system drug that requires monitoring of CBC. Desmopressin, an antidiuretic hormone, is an endocrine-system drug that requires monitoring of creatinine clearance.

A nurse is caring for a client who is about to begin taking pioglitazone to treat type 2 diabetes mellitus. The nurse should explain to the client about the need to monitor which of the following laboratory values? (Select all that apply.)

Sore throat is correct. Propylthiouracil, an antithyroid drug, can cause agranulocytosis. The nurse should monitor the client's CBC and instruct the client to report fever or sore throat.Joint pain is correct. Propylthiouracil can cause arthralgia and myalgia. The nurse should instruct the client to report these effects and take over-the-counter analgesics for pain relief. Bradycardia is correct. Propylthiouracil can cause hypothyroidism, which manifests as bradycardia, drowsiness, and weight gain. The nurse should instruct the client to report these effects.Rash is correct. Propylthiouracil can cause urticaria or a skin rash. The nurse should instruct the client to report these effects. Propylthiouracil is more likely to cause drowsiness than insomnia.

A nurse is caring for a client who is about to begin taking propylthiouracil (PTU) to treat hyperthyroidism. The nurse should instruct the client to report which of the following adverse effects? (Select all that apply.)

Creutzfeldt-Jakob disease Recombinant factor IX is safer than the plasma-derived formulation because it practically eliminates the risk for Creutzfeldt-Jakob disease, a prion-transmitted infection, from human sources.

A nurse is caring for a client who is about to begin therapy with recombinant factor IX to treat hemophilia B. The client asks the nurse about the risk of disease transmission with recombinant factor IX as compared with plasma-derived factor IX. The nurse should explain that recombinant factor IX practically eliminates the risk for which of the following?

Alteplase Alteplase is a thrombolytic drug, meaning it can dissolve existing thrombi, whereas anticoagulant/antiplatelet drugs do not. An acute ischemic cerebrovascular event is often caused by the occlusion of a cerebral vessel by a thrombus. Administration of alteplase should be within 3 hr of the original onset of symptoms for the drug to be effective.

A nurse is caring for a client who is experiencing an acute ischemic cerebrovascular event due to a thrombus in a cerebral vessel. Which of the following drugs should the nurse expect to administer?

Tendon pain Ciprofloxacin, a fluoroquinolone, can cause tendon rupture, most often of the Achilles tendon. This adverse effect is especially common for older adults or clients who take glucocorticoids, such as prednisolone. The nurse should tell the client to report tendon pain and stop taking the drug.it can cause photosensitivity. Clients should wear sunscreen and protective clothing while outdoors to prevent severe sunburn.it can cause vertigo and malaise. Amphotericin B is an antimicrobial drug that can cause tachycardia

A nurse is caring for a client who is taking ciprofloxacin to treat a urinary tract infection. The client also takes prednisolone to treat rheumatoid arthritis. Recognizing the adverse effects of ciprofloxacin, the nurse should instruct the client to report which of the following adverse effects?

ThrombocytopeniaClopidogrel, an antiplatelet drug, can cause thrombotic thrombocytopenic purpura. The nurse should monitor the client's platelet count and also monitor for bruising, bleeding gums, and petechiae.

A nurse is caring for a client who is taking clopidogrel to prevent stent restenosis. The nurse should monitor the client for which of the following adverse reactions?

Deferoxamine Indications of iron toxicity include nausea, vomiting, and diarrhea. Iron toxicity can lead to acidosis and shock. A chelating agent, such as deferoxamine, binds to the iron to reduce toxicity.

A nurse is caring for a client who is taking ferrous sulfate to treat iron-deficiency anemia and develops iron toxicity. Which of the following drugs should the nurse expect to use to treat this complication?

Acute renal failure Metformin, a biguanide, can interact with iodine-containing contrast dye and cause acute renal failure and lactic acidosis. The nurse should withhold metformin for 48 hr prior to and following the procedure. The nurse should also monitor the client for indications of acute renal failure or lactic acidosis, such as reduced urine output, hyperventilation, and abdominal pain. Regular insulin is an endocrine-system drug that can cause hypokalemia. Glucagon is an endocrine-system drug that can cause hyperglycemia. Exenatide is an endocrine-system drug that can cause can cause acute pancreatitis.

A nurse is caring for a client who is taking metformin and is scheduled to undergo angiography using iodine-containing contrast dye. The nurse should identify that an interaction between metformin and the IV contrast dye increases the client's risk for which of the following conditions?

Lactic acidosis Metformin, a biguanide, can cause lactic acidosis, which is a life-threatening complication that manifests as muscle aches, sleepiness, malaise, and hyperventilation. The client should stop taking the drug and seek medical care immediately. it can cause nausea, diarrhea, and anorexia. The nurse should inform the client that these effects should diminish with continued therapy. it can cause dizziness and fatigue. it can cause vitamin B12 or folic acid deficiencies, which would manifest as weakness, fatigue, pallor, or a reddened tongue.

A nurse is caring for a client who is taking metformin to treat type 2 diabetes mellitus and reports muscle pain. Which of the following adverse reactions should the nurse suspect?

Bleeding Trimethoprim/sulfamethoxazole, a sulfonamide combination, can increase the effects of warfarin and increase the client's risk for bleeding. The nurse should request another prescription to treat the infection, or, if the client decides to take the drug, ask the provider to prescribe a lower warfarin dose and monitor prothrombin time carefully. The client should report any sign of bleeding, such as easy or unexplained bruising. Rifampin is an antimicrobial drug that decreases warfarin levels and increases the risk for thrombosis. Erythromycin is an antimicrobial drug that can cause ECG changes, such as a prolonged QT interval. Several antimicrobial drugs can cause ototoxicity, including erythromycin and gentamicin.

A nurse is caring for a client who is taking warfarin and has a new prescription for trimethoprim/sulfamethoxazole to treat a urinary tract infection. The nurse should clarify the prescriptions with the provider because taking these two drugs concurrently can increase the client's risk for which of the following?

Headache Alteplase, a thrombolytic drug, can cause intracranial bleeding. The nurse should monitor the client for changes in level of consciousness, headache, one-sided weakness, and other indications of intracranial bleeding.

A nurse is caring for a client who recently started alteplase therapy. The nurse should monitor the client for which of the following adverse effects?

Skip the dose. To avoid a sudden and serious drop in blood glucose level, the client should skip the dose of repaglinide, a meglitinide, whenever skipping a meal. The nurse should also instruct the client to try to avoid skipping meals.

A nurse is caring for a client who takes repaglinide 15 to 30 min before each meal to treat type 2 diabetes mellitus. The client asks, "If I skip a meal, what should I do?" Which of the following responses should the nurse make?

Obtain weight measurement daily is correct. Fludrocortisone, a mineralocorticoid, can cause fluid and electrolyte imbalances, such as hypernatremia. Tracking weight on a daily basis can help identify weight gain and edema; reporting it can expedite any essential interventions.Report weakness or palpitations is correct. Fludrocortisone can cause hypokalemia. The nurse should monitor the client's potassium levels and tell the client to report muscle weakness or palpitations.Have blood pressure checked regularly is correct. Fludrocortisone can cause fluid retention and hypertension. The nurse should monitor the client's fluid balance and blood pressure to expedite any essential interventions. it can cause thrombocytopenia.

A nurse is providing teaching to a client about taking fludrocortisone to treat adrenocortical insufficiency. Which of the following instructions should the nurse include? (Select all that apply.)

Inject the drug subcutaneously is correct. The client should inject exenatide, an incretin mimetic, into the subcutaneous tissue of the thigh, upper arm, or abdomen.Expect the peak effect in 2 hr is correct. Levels of exenatide peak 2 hr after administration and then decrease gradually, with a half-life of 2.4 hr.Use the drug as a supplement to an oral hypoglycemic is correct. Exenatide supplements the action of an oral hypoglycemic, such as a sulfonylurea or metformin. The client should inject exenatide twice per day up to 60 min prior to the morning and evening meals, rather than after a meal. The client can keep prefilled exenatide injector pens in use at room temperature for up to 30 days.

A nurse is providing teaching to a client who is about to begin exenatide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? (Select all that apply.)

Ethacrynic acid Gentamicin, an aminoglycoside, and ethacrynic acid, a loop diuretic, are ototoxic drugs. The nurse should identify that concurrent use increases the client's risk for hearing loss. Amphotericin B is an antifungal drug that interacts adversely with gentamicin to increase the risk for nephrotoxicity. NSAIDs, such as ibuprofen, interact adversely with gentamicin to increase the risk for nephrotoxicity. Vancomycin is an antimicrobial drug that interacts adversely with gentamicin to increase the risk for ototoxicity.

A nurse is reviewing a client's prescriptions prior to administering gentamicin to the client to treat a systemic infection. The nurse should clarify the use of gentamicin with the provider if the client is taking which of the following drugs?

Perform a fingerstick blood glucose check. Glipizide, a sulfonylurea, can cause hypoglycemia, which can manifest as diaphoresis, shakiness, hunger, and fatigue. The nurse should tell the client to check their blood glucose level and, if it indicates hypoglycemia, to consume a snack of 15 to 20 g (0.5 to 0.7 oz) of carbohydrates, retest in 15 to 20 min, and repeat if their blood glucose level is still low. Glipizide, a sulfonylurea, can cause diarrhea. Clients who develop this adverse reaction should maintain hydration by drinking plenty of fluids. Clients do not take the drug PRN, but rather on a fixed, once-daily dosing schedule.

A nurse is speaking with a client who is taking glipizide to treat type 2 diabetes mellitus and has called to report feeling shaky, hungry, and fatigued. Which of the following actions should the nurse instruct the client to take?

Eat more iron-rich foods. Acarbose, an alpha-glucosidase inhibitor, can cause iron-deficiency anemia. The nurse should instruct the client to increase their intake of iron-rich foods, such as red meat, spinach, and grains. The nurse should also monitor the client's CBC. More than 1 L of grapefruit juice per day can increase the hypoglycemic effects of repaglinide, a meglitinide. It can cause diarrhea and flatulence. Metformin can worsen the gastrointestinal effects of the drug. Green tea can increase the hypoglycemic effects of pioglitazone, another endocrine-system drug.

A nurse is teaching a client about acarbose therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include?

Lipohypertrophy Lipohypertrophy is a proliferation of fat at the sites of repeated insulin injections. It affects skin sensitivity and appearance. To prevent it, the client should rotate injection sites, keeping them at least 2.5 cm (1 in) apart, and avoid using the same spot within the same month. Using the same injection site, specifically the abdomen, speeds absorption, while using the thigh allows for the slowest absorption.

A nurse is teaching a client about self-administering regular insulin. The nurse should instruct the client to rotate injection sites to prevent which of the following?

Vitamin B12Clients who have megaloblastic anemia have a deficiency of vitamin B12, folic acid, or both. Cyanocobalamin (vitamin B12) treats moderate vitamin B12 deficiencies. Clients who have a severe vitamin B12 deficiency should take cyanocobalamin and folic acid.

A nurse should assess a client who has megaloblastic anemia for indications of which of the following vitamin deficiencies?

Hydrocortisone Hydrocortisone, a glucocorticoid, provides replacement therapy for acute and chronic adrenocortical insufficiency, such as Addison's disease. Hydrocortisone is identical to cortisol, the primary glucocorticoid the adrenal cortex generates.

When considering replacement therapy options for a client who has chronic adrenocortical insufficiency, a nurse should recognize that the provider will choose which of the following drugs?

Take an antacid at least 2 hr after taking the drug. The nurse should recommend that the client take an antacid to relieve the dyspepsia at least 2 hr after taking ciprofloxacin, a fluoroquinolone. This is because antacids decrease the absorption of the drug. Clients who are taking ciprofloxacin, a fluoroquinolone, should avoid caffeine because it can increase the drug's CNS effects, including insomnia, restlessness, and anxiety. Clients who are taking ciprofloxacin, a fluoroquinolone, should avoid taking the drug with supplemental iron because iron decreases the absorption of the drug. Clients who are taking ciprofloxacin, a fluoroquinolone, should avoid taking the drug with milk or other dairy products because the calcium in these products decreases the absorption of the drug.

A nurse in a provider's office receives a call from a client who is taking ciprofloxacin to treat a respiratory tract infection and reports dyspepsia. Which of the following instructions should the nurse give the client?

Clostridium difficile-associated diarrhea Severe diarrhea, often containing mucus and blood, can indicate Clostridium difficile-associated diarrhea. Treatment includes stopping drug therapy and replacing fluids and electrolytes. Clients should immediately report severe diarrhea and blood in the stools. Tetracycline, an antibiotic, is unlikely to cause hemorrhoids, although adverse effects include diarrhea, which can cause existing hemorrhoids to bleed. The nurse should assess the client for more serious causes of blood-tinged diarrhea if the client does have hemorrhoids.

A nurse in a provider's office receives a call from a client who is taking tetracycline orally to treat a chlamydia infection and reports severe blood-tinged diarrhea. The nurse should suspect the client is experiencing which of the following?

Vitamin K Vitamin K reverses the effects of warfarin by promoting the synthesis of coagulation factors VI, IX, X, and prothrombin.

A nurse in an emergency department is assessing a client who has been taking warfarin and is experiencing rectal bleeding. Which of the following drugs should the nurse expect to administer to the client?

Stop the cefotetan infusion. The nurse should stop the infusion, remove the IV catheter, assess for tissue damage, and treat the client accordingly. The nurse should then initiate IV access via another site, continuing cefotetan therapy according to prescribed parameters.

A nurse is administering cefotetan IV to a client to treat an intra-abdominal infection. The nurse notes that the IV insertion site is warm, edematous, and painful to the touch. Which of the following actions should the nurse take?

Administer via IV bolus over 1 to 3 min. Instructions for administering the drug include administering it via IV bolus over 1 to 3 min.

A nurse is administering epoetin intravenously to a client who has renal failure. Which of the following actions should the nurse take?

Third generation cephalosporins Later generation cephalosporins are used to treat infections that cross the blood-brain barrier, and third-generation are specifically prescribed to treat bacterial meningitis. First generation cephalosporins are primarily used to treat infections of the skin, bone, and joints. Monobactams are typically prescribed to treat infections of the abdomen, respiratory system, and female reproductive tract. Macrolides, such as erythromycin, are typically used to treat severe infections, such as whooping cough, diphtheria, and chlamydia.

A nurse is caring for a client who has a new diagnosis of bacterial meningitis. The nurse should expect the provider to prescribe a drug from which of the following classifications of antibiotics?

BUN Acyclovir, an antiviral drug, can cause renal toxicity due to drug accumulation in renal tubules. The nurse should monitor the client's urine output, BUN, and creatinine levels, and increase fluid intake to hydrate and flush the kidneys. Cefotetan, a second-generation cephalosporin, is an antimicrobial drug that can cause thrombocytopenia and prolonged bleeding times so check prothrombin time. Amphotericin B is an antimicrobial drug that can cause anemia due to RBC suppression so check Hct.Ketoconazole is an antimicrobial drug that can cause liver toxicity and requires monitoring of liver function so check Aspartate aminotransferase.

A nurse is caring for a client who has a new prescription for acyclovir to treat a herpes simplex infection. Which of the following laboratory values should the nurse monitor for this client?

Renal impairment Aztreonam, a monobactam, requires cautious use with clients who have renal dysfunction because it is excreted in the urine. Renal impairment could affect the excretion of aztreonam, allowing the level of the drug to accumulate. The nurse should report this finding to the provider, so the provider can prescribe a lower dose for the client or prescribe a different antimicrobial drug. The drug requires cautious use with older adults. Viral infection is a contraindication for the use of the drug. Metronidazole is an antimicrobial drug that requires cautious use with clients who have heart failure.

A nurse is caring for a client who has a new prescription for aztreonam to treat a respiratory tract infection. Which of the following findings in the client's medical record should the nurse recognize as requiring cautious use for this prescription and report to the provider?

Isoniazid Isoniazid is used to treat tuberculosis and reduces the possibility of resistance to rifampin when combined with the drug. Drug resistance can develop quickly if the client only takes rifampin. Gentamicin is not used to treat tuberculosis. It is prescribed to treat infective endocarditis and is used for management of enterococcal infections. Vancomycin is not used to treat tuberculosis. It is effective for treating osteomyelitis, pneumonia, and Clostridium difficile-associated diarrhea. Metronidazole is not used to treat tuberculosis. It is effective for treating septicemia or protozoal infections, such as giardiasis.

A nurse is caring for a client who has a prescription for rifampin to treat tuberculosis. The nurse should expect the provider to prescribe which of the following drugs to the client to prevent possible resistance to rifampin?

Azithromycin Azithromycin, a macrolide, is an acceptable alternative to penicillin for patients who have bacterial infections and are allergic to penicillin. The medication is effective against many gram-positive and gram-negative bacteria and is used for streptococcal pharyngitis. A small percentage of clients who are allergic to penicillin have a cross sensitivity to cephalosporins. Cephalexin is a cephalosporin and is an inappropriate choice for the client.

A nurse is caring for a client who has streptococcal pharyngitis and an allergy to penicillin. The nurse should recognize that which of the following drugs can be safely administered to this client?

Have emergency equipment ready. Factor VIII can cause a hypersensitive reaction and anaphylaxis. The nurse should monitor the client for hives, fever, wheezing, and difficulty breathing and have emergency equipment and drugs readily available.

A nurse is caring for a client who is about to begin factor VIII therapy to treat hemophilia A. When administering factor VIII, which of the following actions should the nurse take?

Urine output Gentamicin, an aminoglycoside, can cause nephrotoxicity. The nurse should monitor the client's BUN and creatinine levels and for an increased output of diluted urine. It is also essential to monitor serum gentamicin levels and maintain a therapeutic range. can cause nausea and vomiting. cause either hypotension or hypertension. cause vertigo and skeletal muscle weakness.

A nurse is caring for a client who is about to begin gentamicin therapy to treat an infection. The nurse should monitor the client for an alteration in which of the following?

Beta blockers Clients who take both insulin and beta blockers are at risk for failing to promptly recognize the symptoms of hypoglycemia because beta blockers mask symptoms such as tachycardia and tremors. Beta blockers also increase hypoglycemic effects. Exenatide, another endocrine-system drug, slows the absorption of oral contraceptives. Calcium supplements do not specifically interact with insulin. They do, however, reduce the absorption of levothyroxine, another endocrine-system drug. Iron supplements do not specifically interact with insulin. They do, however, reduce the absorption of levothyroxine, another endocrine-system drug.

A nurse is caring for a client who is about to begin insulin glargine therapy. The nurse should identify the need for additional precautions because the client also takes which of the following types of drugs?

Inhibiting cyclooxygenase action in platelets Salicylates, such as aspirin, work by inhibiting platelet aggregation. They do this by blocking the action of cyclooxygenase on platelets. As a result, activation of thromboxane A2 does not occur.

A nurse is caring for a client who is about to begin taking aspirin to reduce the risk of a cardiovascular event. The nurse should identify that the drug inhibits platelet aggregation by which of the following mechanisms?

Reticulocyte count A reticulocyte count measures the amount of immature RBCs. Folic acid, also called folate, is essential for erythropoiesis. Clients who have a folic acid deficiency require a baseline reticulocyte count, as well as a serum folate, Hgb, Hct, and RBC count and periodic monitoring during folic acid therapy to determine effectiveness.

A nurse is caring for a client who is about to begin taking folic acid to treat megaloblastic anemia. The nurse should monitor which of the following laboratory values to determine therapeutic effectiveness?

Jaundice is correct. Isoniazid, an antimycobacterial drug, can cause liver toxicity, especially in clients who abuse alcohol. The nurse should monitor liver enzymes during therapy and instruct the client to report indications of liver damage, such as jaundice, abdominal pain, and fatigue.Numbness of the hands is correct. Isoniazid can cause peripheral neuropathy. The nurse should instruct the client to report numbness, pain, or tingling in the hands or feet. Administering pyridoxine (vitamin B6) can help minimize these effects.Dizziness is correct. Isoniazid can cause dizziness, ataxia, and seizures. The nurse should instruct the client to report these CNS effects. Isoniazid is more likely to cause visual disturbances than hearing loss. Isoniazid is unlikely to cause a superinfection and oral ulcers, but it can cause dry mouth.

A nurse is caring for a client who is about to begin taking isoniazid to treat tuberculosis. The nurse should instruct the client to report which of the following adverse effects of the drug? (Select all that apply.)

Swelling of hands or feet Itraconazole, an azole antifungal drug, can cause edema, which can also indicate heart dysfunction, and should be monitored closely. cause headaches.it can cause skin rashes, photosensitivity, and dry mouth. Isoniazid is an antimicrobial drug that can cause tingling and numbness in the hands and feet.

A nurse is caring for a client who is about to begin taking itraconazole to treat a fungal infection. The nurse should instruct the client to report which of the following adverse effects of the drug?

Seizure disorder Metronidazole, an antiparasitic drug, can cause ataxia, vertigo, and seizures. It requires cautious use with clients who have a history of seizure activity, liver or renal failure, or heart failure. Vancomycin is an antimicrobial drug that requires cautious use with clients who have hearing loss. Amoxicillin, a penicillin, is an antimicrobial drug that requires cautious use with clients who have asthma Amphotericin B, a polyene antibiotic, is an antimicrobial drug that requires cautious use with clients who have anemia.

A nurse is caring for a client who is about to begin taking metronidazole to treat an anaerobic intra-abdominal bacterial infection. The nurse should recognize that cautious use of the drug is indicated if the client also has which of the following conditions?

Urine calcium is correct. Somatropin can cause hypercalciuria. The nurse should monitor the client's urine calcium and instruct the client to report flank pain, urinary frequency, or hematuria.Blood glucose is correct. Somatropin can cause hyperglycemia. The nurse should monitor the client's blood glucose levels and instruct the client to report polyphagia, polydipsia, and polyuria. Sitagliptin, an antithyroid drug, is an endocrine-system drug that requires monitoring of blood amylase levels because it can cause pancreatitis. Desmopressin, an antidiuretic hormone, is an endocrine-system drug that requires monitoring of creatinine clearance. Radioactive iodine-131, an antithyroid drug, is an endocrine-system drug that requires monitoring CBC.

A nurse is caring for a client who is about to begin taking somatropin. The nurse should explain the need to monitor which of the following laboratory values? (Select all that apply.)

Urine output Desmopressin, an antidiuretic hormone, treats diabetes insipidus. The nurse should monitor the client's fluid intake and urine output along with urine and serum osmolality and blood pressure. Vasopressin, another antidiuretic hormone, can cause vasoconstriction and angina pectoris. Desmopressin does not alter hemodynamics. Propylthiouracil (PTU), an antithyroid drug, is an endocrine-system drug that requires integumentary monitoring because it can cause a rash. it can cause hyponatremia. The nurse should monitor the client's sodium levels.

A nurse is caring for a client who is taking desmopressin. The nurse should make which of the following assessments to evaluate the drug's effectiveness?

Enlarged spleen With long-term use, filgrastim, a leukopoietic growth factor, can cause an enlarged spleen. The nurse should tell the client to monitor and report abdominal pain or fullness.

A nurse is caring for a client who is taking filgrastim to treat neutropenia. The nurse should assess the client for which of the following adverse effects?

Hypothyroidism Propylthiouracil, an antithyroid drug, can cause hypothyroidism, which manifests as drowsiness, depression, weight gain, edema, and bradycardia. The nurse should request that the provider prescribe a lower dosage of the drug for the client. treats thyrotoxicosis, or hyperthyroidism. Indications of thyrotoxicosis include anxiety, palpitations, and weight loss. Sitagliptin is an endocrine-system drug that can cause lactic acidosis, which manifests as muscle aches, sleepiness, malaise, and hyperventilation. Radioactive iodine-131 is an endocrine-system drug that can cause radiation sickness, which manifests as hematemesis, epistaxis, and intense nausea and vomiting.

A nurse is caring for a client who is taking propylthiouracil (PTU) and reports weight gain, drowsiness, and depression. The nurse should identify that the client is experiencing which of the following adverse reactions to the drug?

Vancomycin Vancomycin, a potentially toxic antibiotic, is used primarily to treat serious infections in clients who are allergic to penicillin or whose infecting bacteria are resistant to penicillin, such as MRSA. The term methicillin-resistant refers generally to a lack of susceptibility to methicillin (no longer prescribed), all penicillins, cephalosporins, tetracyclines, beta-lactams, and many other antimicrobial drugs.

A nurse is caring for a client whose sputum culture results indicate methicillin-resistant Staphylococcus aureus (MRSA). The nurse should recognize that which of the following medications will likely be administered to this client?

"We will use a different spot for injection each time we give the medication." To avoid atrophy of the tissue, administration of somatropin includes rotating the injection site each time. The nurse should identify this statement as an understanding of somatropin administration. The parents should administer the somatropin injection subcutaneously rather than intramuscularly to decrease pain Growth hormone administration can cause diabetes mellitus and can increase the occurrence of hyperglycemia for clients who have diabetes. The parents should closely monitor the child for polyphagia, polydipsia, and polyuria while on growth hormone therapy .Pediatric clients who have PWS and are taking growth hormone must be weighed often to assess for weight gain that could become problematic. Obesity is a contraindication for using somatropin for clients who have PWS.

A nurse is educating the parents of a child who has a new diagnosis of Prader-Willi Syndrome (PWS) and has been prescribed somatropin. Which of the following statements by a parent indicates understanding of the teaching?

Rapid pulse In the event of a moderate to severe hemorrhage, the volume of blood in the circulatory system decreases significantly, resulting in hypotension. Tachycardia is a compensatory mechanism of the heart that serves to combat the hypotension that results from the decreased volume of blood. Tachycardia can be detected by checking the client's pulse.

A nurse is monitoring a client who is undergoing anticoagulant therapy with heparin. Which of the following findings should the nurse identify as a possible indication of hemorrhage?

Clarify the prescription with the provider. Hyponatremia and fluid retention can occur with the administration of desmopressin, an antidiuretic hormone used in the treatment of hemophilia A. The client's sodium level is below the expected range of 136 to 145 mEq/L. The nurse should notify the provider of the client's current sodium level and clarify the prescription prior to administration.

A nurse is preparing to administer a prescribed dose of desmopressin to a client who has hemophilia A. The client's laboratory results indicate that the client has a sodium level of 130 mEq/L. Which of the following actions should the nurse take?

Acetaminophen is correct. Infusion reactions to amphotericin B IV, such as fever, chills, nausea, and headache, start 1 to 2 hr after the infusion begins and subside within 4 hr. The nurse can help prevent these effects by administering acetaminophen prior to the infusion.Diphenhydramine is correct. The nurse can help prevent adverse reactions by administering diphenhydramine prior to the infusion. Aspirin is incorrect. Infusion reactions to IV amphotericin B include fever, chills, nausea, and headache. Although aspirin, an NSAID, can help for these symptoms, it also increases the client's risk for renal injury because aspirin is nephrotoxic and is therefore not an appropriate drug to prevent or minimize adverse reactions. Hydrocortisone is incorrect. Although a hydrocortisone, a glucocorticoid, can reduce fever and chills, it can also decrease the client's resistance to infection and is therefore not an appropriate drug to prevent or minimize adverse reactions. Ibuprofen is incorrect. Although ibuprofen, an NSAID, can help prevent adverse reactions, it also increases the client's risk for renal injury because ibuprofen is nephrotoxic and is therefore not an appropriate drug to prevent or minimize adverse reactions.

A nurse is preparing to administer amphotericin B IV to a client who has a systemic fungal infection. Which of the following drugs should the nurse prepare to administer prior to the infusion to prevent or minimize adverse reactions? (Select all that apply.)

Use a non-hormonal form of contraception. Rifampin, an antimycobacterial drug, can increase the metabolism of oral contraceptives, reducing their effectiveness. Clients who are taking oral contraceptives and rifampin should use additional, non-hormonal contraceptive methods to prevent an unwanted pregnancy.

A nurse is providing teaching for a client who takes an oral contraceptive and is about to begin rifampin therapy to treat tuberculosis. Which of the following instructions should the nurse include?

Expect life-long therapy with the drug. Therapy with levothyroxine, a thyroid replacement hormone, usually continues for life because there are no other therapies that can restore thyroid function. The nurse should instruct the client to take it on an empty stomach at least 30 min before eating. The nurse should instruct the client to allow 4 hr between taking levothyroxine and taking an antacid. Clients who are taking hypoglycemics, such as exenatide, should always carry a carbohydrate snack to treat hypoglycemia.

A nurse is providing teaching to a client who is about to begin levothyroxine therapy to treat hypothyroidism. Which of the following instructions should the nurse include?

Eat iron-enriched foods is correct. A client who has iron-deficiency anemia should increase iron intake by eating foods such as egg yolks, wheat germ, meat, and fish. Spread the dosage across each day is correct. Spreading out the iron intake throughout the client's waking hours allows the bone marrow to maximize the production of RBCs. Take the drug on an empty stomach is correct. Food reduces the absorption of ferrous sulfate. The client should take the drug on an empty stomach to increase drug absorption. If GI effects are troublesome, they can take the drug with food. Increase dietary fiber intake is correct. Ferrous sulfate can cause constipation. The client should increase fiber and fluid intake and exercise more often or more intensely.

A nurse is teaching a client about taking ferrous sulfate to treat iron-deficiency anemia. Which of the following instructions should the nurse include? (Select all that apply.)

Avoid drinking alcohol. The nurse should instruct the client to avoid drinking alcohol. Alcohol can interact with glipizide, a sulfonylurea, causing nausea, palpitations, and flushing. Alcohol also increases the drug's hypoglycemic effects. it can cause gastrointestinal distress with heartburn. it can cause diarrhea. Clients who develop this adverse reaction should maintain hydration by drinking plenty of electrolyte-rich fluids. lipizide, a sulfonylurea, helps control hyperglycemia caused by type 2 diabetes mellitus. The client should take the drug 30 min before the first meal of the day.

A nurse is teaching a client who has a prescription for glipizide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include?

Administer pramlintide before meals. The nurse should instruct the client to inject pramlintide, an amylin mimetic, 20 min before any meal that contains at least 30 g of carbohydrates. Pramlintide, an amylin mimetic, supplements the effects of insulin and oral hypoglycemic drugs. However, clients should not mix it in the same syringe with insulin. Clients should take pramlintide, an amylin mimetic, three times per day with meals. Metformin, a biguanide, is an endocrine-system drug that clients take orally once per day with their evening meal. Clients should inject pramlintide, an amylin mimetic, subcutaneously into the abdomen or thigh, rather than the upper arm.

A nurse is teaching a client who has a prescription for pramlintide therapy to treat type 1 diabetes mellitus. Which of the following instructions should the nurse include?

Peptic ulcer disease Clients who have peptic ulcer disease should not take clopidogrel, because it can cause gastric bleeding.

A nurse should identify that clopidogrel is contraindicated for clients who have which of the following conditions?

Renal impairment Sitagliptin, a gliptin, requires cautious use with clients who have renal dysfunction and low creatinine clearance because the kidneys eliminate the drug virtually intact. The provider should prescribe a lower dose for this client or prescribe a different hypoglycemic drug.

A nurse should recognize that a provider will prescribe a lower dose of sitagliptin for a client who has type 2 diabetes mellitus and who also has which of the following?

Glucagon Glucagon, a hyperglycemic that can be given subcutaneously, IM, or IV, is used to treat severe hypoglycemia from insulin toxicity in clients who are unconscious and for whom IV glucose is not readily available. If the client does not respond to glucagon, the nurse should administer a glucose solution IV.

Which of the following drugs should a nurse have available for a client who is experiencing insulin toxicity?