PHARM1, PHARM 2
A client has been reading about the use of flax seed to lower cholesterol. What should the client be taught about the use of oat bran and cholestyramine?
Cholestyramine absorption will be increased with flax seed. Absorption of cholestyramine is increased with flax seed. Bleeding is not increased with oat bran and cholestyramine. Hypoglycemia will not result from oat bran and cholestyramine.
An adult client has asked the nurse to recommend an OTC cold remedy. Before making a recommendation, the nurse should implement which intervention?
Consult with a pharmacist or pharmacy technician. While it is not necessary to consult with a pharmacist or pharmacy technician, before recommending a particular product, the nurse needs to assess the intended recipient for conditions or other medications that contraindicate the product's use. Herbal options do not need to precede pharmaceuticals. The client's understanding of the epidemiology of the common cold is not a high priority.
A client who has chronic bronchial asthma has had a mast cell stabilizer prescribed. What drug would the provider prescribe?
Cromolyn Cromolyn is the only mast cell stabilizer used in the treatment of asthma. Aminophylline is a xanthine. Ipratropium is an anticholinergic drug. Isoetharine is a sympathomimetic drug
A nurse is caring for a client who has been receiving a drug by the intramuscular route at a dose of 0.25 mg. After discharge, the client will be prescribed the same medication orally at a dose of 2.5 mg. What phenomenon should the nurse describe when explaining the reason for the increased dosage for the oral dose?
First-pass effect The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. After reaching the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.
A client presents to the clinic with a dry nonproductive cough. The client is diagnosed with bronchitis and it has been determined that assistance is needed in thinning the sputum so the cough can become productive. What does the nurse expect the provider will prescribe?
Guaifenesin Because this client needs to cough up respiratory secretions, he would likely be prescribed guaifenesin. This drug is an expectorant that liquefies lower respiratory secretions by reducing their viscosity and so making it easier for a client to cough them up. Benzonatate, dextromethorphan, and hydrocodone are antitussives and are given to suppress the cough reflex
The nurse is preparing to administer diltiazem and atenolol. What is the priority nursing intervention before administering these two medications to the patient?
Obtain blood glucose The cardiac effects of diltiazem and atenolol are the same. Both reduce heart rate, suppress aortic valve (AV) conduction, and suppress myocardial contractility. When these drugs are administered together, excessive cardio-suppression may result.
A client with asthma is going to begin taking an inhaled steroid. The nurse teaching the client that what adverse effects may occur when using this drug? Select all that apply.
Epistaxis, Rebound congestion, headache Adverse effects associated with the use of inhaled steroids include irritability (not depression), headache, rebound congestion, local infection (not sepsis), and epistaxis.
Which teaching intervention is a priority for the client prescribed an albuterol inhaler experiencing shortness of breath related to the physiological constriction of airways?
Stop smoking due to the bronchoconstriction. Cigarette smoking will increase bronchoconstriction, so the client should be encouraged to stop. The albuterol is known to cause hand tremors as a side effect. Insulin will not decrease hand shaking. The client will not require ibuprofen since the issue is not related to inflammation. The client should be encouraged to exercise, and it should not be limited to one time per week.
The nurse is caring for a 38-year-old client with asthma who has been started on albuterol. What assessment finding should the nurse most likely attribute to adverse medication effects?
The client's heart rate is 99 beats/minute. Adrenergic agents stimulate beta1-adrenergic receptors in the heart as well as beta2-adrenergic receptors in the lungs. Adrenergic agents do not cause polydipsia, fever, or diarrhea.
When providing medication teaching to a client prescribed spironolactone, what foods should the client be instructed to avoid?
bananas Bananas are high in potassium and should be avoided with potassium-sparing diuretics. It is acceptable for the client to eat fish, apples, and crackers because of their low sodium content.
Which factor accounts for the increased risk for drug reactions among clients aged 65 years and older?
physiologic changes affecting all pharmacokinetic processes In older adults (65 years and older), physiologic changes may alter all pharmacokinetic processes. Although drugs crossing the blood-brain barrier affect drug reaction, this factor is important in all ages. Increased drug-metabolizing enzymes are key in all ages and do not relate to age variations. A diminished immune response is important in all ages and does not affect all medications.
A 70-year-old man has enjoyed good overall health for all of his adult life, but he has been experiencing urinary frequency and dribbling that has culminated in a diagnosis of benign prostatic hypertrophy (BPH). As a result, the client has been prescribed finasteride. When teaching the client about the potential adverse effects of the drug, the nurse should ensure that he knows about the possibility of:
sexual dysfunction. Adverse effects of finasteride include various sexual dysfunctions, such as impotence, gynecomastia, reduced libido, and ejaculatory disorders. Urethral burning, kidney stones, and visual disturbances are not common adverse effects of finasteride
A client has been diagnosed with chronic obstructive pulmonary disease. The client has been prescribed bronchodilators by nebulizer for home use. The nurse should teach the client to:
sit in a fully upright position when administering the medication. Clients should sit in the Fowler's position when inhaling nebulized medications. Compressed air (not oxygen) is used. Inhalers require a prescribed number of "puffs," not nebulizers. The client should rinse his or her mouth after administration, but an alcohol-based solution is not necessary.
The nurse is conducting an admission assessment on a client. When collecting data related to medications, the nurse asks, "What medications are you currently taking?" After collecting this information, what other questions should the nurse ask? Select all that apply.
"Do you take any herbs, vitamins, or supplements?""What over-the-counter (OTC) medications do you take?" Clients often neglect to mention OTC drugs or alternative therapies (e.g., herbals) because they do not consider them to be actual drugs or they may be unwilling to admit their use to the health care provider. Ask clients specifically about OTC drug and alternative therapy use. The nurse must assess whether the client is taking medications safely, but this cannot be determined simply by asking the client if this is so. The name of the prescriber and the client's perception of doses/quantities are not priorities.
A client with a diagnosis of chronic renal failure will soon begin a regimen of epoetin that will be administered by the client at home. Which statement indicates that the nurse's initial health education has been successful?
"I'll make sure to take my epoetin pill on a strict schedule and make sure I never miss a dose." The client's statement indicates an understanding of the appropriate route of administration of this medication. Epoetin is administered parenterally, not orally. It acts by stimulating erythroid progenitor cells to produce RBCs but does not enhance overall renal function. Epoetin does not enhance immune function.
What is the nurse's priority assessment question before giving a female client her prescription for an angiotensin II-receptor blocker (ARB)?
"When was your last menstrual period (LMP)?" It would be important to know when the client's LMP occurred and that the client was not pregnant. These drugs can cause fetal abnormalities and fetal death. Questions on food intake, physical activity, and weight are appropriate and would help the nurse plan care for the client; however, it would not be as important as assessing for the possibility of pregnancy before beginning of therapy. The nurse should teach the client the need to avoid pregnancy using a barrier contraceptive
What would be the nurse's best response if a client calls the clinic and reports that he has had a persistent cough for 2 weeks and asks the nurse for a recommendation for a cough medicine?
"You should come to the clinic to be evaluated. A cough that lasts that long might indicate a medical problem." A cough that has persisted for 2 weeks could be indicative of an underlying medical condition that should be addressed before treating the cough. The client should be asked to present to clinic for an evaluation. Dextromethorphan could help stop the cough, but suppressing the cough might not be in the client's best interest. Drying the mucosa with an antihistamine could aggravate the cough. Aspirin would not be indicated for relieving throat irritation.
A client is scheduled to have serum triglyceride level assessed. How long should the client be without food or fluids prior to the serum triglyceride test?
12 hours For accurate interpretation of a client's lipid profile, blood samples for laboratory testing of triglycerides should be drawn after the client has fasted for 12 hours. A fasting state of 12 hours is essential for triglycerides estimation because the effects of recently ingested foods artificially raise the results for several hours after a meal. Twenty-four-hour fasting is not necessary and would be an undue burden on the client.
The nurse is assisting with a phase I drug study. What potential participant would be most appropriate?
22-year-old male with an unremarkable health history. Phase I drug trials usually involve healthy male volunteers because chemicals may exert an unknown and harmful effect on ova in women that could result in fetal damage when the woman becomes pregnant. Drugs are tested on both men and women, but women must be fully informed of risks and sign a consent stating they understand the potential for birth defects. A 17-year-old would normally be too young to participate.
In which client would the use of a beta-blocker most likely be contraindicated?
A client with angina pectoris who is trying to become pregnant Pregnancy and lactation preclude the use of a beta-blocker. Beta-blockers can be used concurrently with bisphosphonates and antibiotics. Complications of diabetes do not preclude the use of beta-blockers for the treatment of angina.
A patient has benign prostatic hyperplasia (BPH). Which classes of drugs does the nurse anticipate administering for this condition? Select all that apply.
Alpha 1-adrenergic antagonists,5-alpha-reductase inhibitors Drugs for BPH include 5-alpha-reductase inhibitors and alpha 1-adrenergic antagonists. Cardiac glycoside, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors are not given for BPH but can cause erectile dysfunction.
The nurse is taking a medication history on a client. What action by the nurse best reduces the possibility of adverse interactions?
Ask the client about the use of any complementary or alternative therapies Alternative therapies often involve the use of herbal products, which contain natural chemicals that affect the body. Many drug-alternative therapy interactions have been reported that could cause serious adverse effects, but clients often don't think to mention these therapies when asked about the medications they are taking. The nurse should assess the client's ability to pay, nutritional status, and overall stat
The nurse, caring for a client taking a beta-blocker and a nitrate to treat angina, recognizes the need for careful monitoring because of what comorbidity?
Chronic obstructive pulmonary disease (COPD) The nurse should assess for COPD, because the effect of beta-blockers in reducing effects of the sympathetic nervous system could exacerbate the respiratory condition. RA, IBS, and chronic UTI are not affected by the use of beta-blockers or nitrates to treat angina.
A client, being treated in the hospital for a femoral fracture, is scheduled to receive a daily dose of metoprolol that was prescribed 3 years ago. Prior to administering this drug, the nurse should assess and document which client data? Select all that apply.
Heart rate, blood pressure Beta-blockers reduce heart rate and blood pressure; both parameters should be assessed prior to administration. Beta-blockers do not significantly affect potassium levels, oxygen levels, or peripheral circulation.
A nurse is preparing to administer a beta blocker to a patient. The nurse recognizes that beta blockers are used to treat which conditions? Select all that apply
Hypertension, angina pectoris, heart failure Beta blockers are effective in treating hypertension (secondary to negative inotropic effects) and angina pectoris (decreases cardiac workload when decreasing heart rate and contractility). Beta blockade has also been shown to reduce mortality in patients with heart failure.
A 49-year-old client is admitted with uncontrolled chest pain. He is currently taking nitroglycerin. His physician orders nifedipine added to his regimen. The nurse should observe the client for what adverse effects?
Hypotension Both nitroglycerin and nifedipine have hypotension as a potential adverse effect so frequent assessment of blood pressure is important. Other cardiovascular effects include bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. Adverse effects do not include renal insufficiency, hypokalemia, or hypoglycemia.
A client presents to the emergency department in acute respiratory distress. A quick assessment by the triage nurse indicates that the client has experienced difficulty breathing immediately after taking Combivent for the first time. The nurse suspects that the client may be allergic to what?
Peanuts Combivent is a combination drug of ipratropium and albuterol. The propellant used to make ipratropium has a cross-sensitivity to the antigen that causes peanut allergies. Aspirin, penicillin, and ragweed pollen allergies are not associated with this drug reaction.
A client's unexpected response to a new medication has been attributed to characteristics of the client's genetic make-up. What area of study best explains this client's medication response?
Pharmacogenomics Pharmacogenomics is the area of study that includes mapping of the human genome. In the future, medical care and drug regimens may be personally designed based on a client's unique genetic make-up. Pharmacotherapeutics is the branch of pharmacology that deals with the uses of drugs to treat, prevent, and diagnose disease. Pharmacodynamics involves how a drug affects the body. Pharmacoeconomics includes the costs involved in drug therapy.
A premature newborn is being treated for respiratory distress syndrome. What action should the nurse perform in anticipation of beractant administration?
Position the client for intratracheal administration Beractant is administered intratracheal, not intravenously. It would be unsafe and unnecessary to discontinue the client's supplementary oxygen. Liver enzyme levels are not a priority during this time of acute distress.
A male client has been diagnosed with moderately increased LDL, and his primary care provider wishes to begin him on a statin. What is a potential disadvantage of statins that the care provider should consider? Select all that apply.
Statins are expensive, Statins require regularly scheduled blood work Because liver enzymes may be elevated during atorvastatin use, clients need liver function tests and repeat lipid profile testing on a routine basis. These drugs are also expensive. They are not nephrotoxic and do not suppress the immune system. Previous MI is an indication for their use, not a contraindication.
A stepped care management approach to treating hypertension includes weight loss, smoking cessation, decreased use of alcohol, reducing salt in the diet, and increased physical exercise. During a stepped-care management approach, when should the nurse teach about these changes in lifestyle?
Steps 1, 2, 3, and 4 Lifestyle changes are encouraged in all four steps and should be advocated for the maintenance of good health. These changes are stressed in steps 1 and 2 in the hope that drug therapy will not be necessary. However, these changes should occur in steps 3 and 4 as well.
A client taking a calcium channel blocker is seen in the clinic and diagnosed with drug toxicity. When collecting the nursing history, what finding would indicate the likely cause of this drug toxicity?
The ingestion of grapefruit juice The calcium channel blockers are a class of drugs that interact with grapefruit juice. When grapefruit juice is present in the body, the concentrations of calcium channel blockers increase, sometimes to toxic levels. Advise clients to avoid drinking grapefruit juice taking a calcium channel blocker. If a client on a calcium channel blocker reports toxic effects, ask whether he or she is drinking grapefruit juice. Use of alcohol could be important if the client was ingesting large amounts, but that would not be the most likely cause of drug toxicity. Dairy and cheese should not cause any food-drug interaction.
A client, diagnosed with heart failure, asks the nurse for further details about heart failure. Which statement is most accurate?
The use of digoxin increases the force of myocardial contraction and prevents the development of congestive heart failure in clients whose heart cannot pump blood to meet tissue needs. Endothelial dysfunction allows processes that narrow the blood vessel lumen and lead to blood clot formation and vasoconstriction that further narrow the blood vessel lumen. These are major factors in coronary artery disease and hypertension, the most common conditions leading to heart failure. Hyperthyroidism, not hypothyroidism, is a cause of heart failure. The administration of diuretics decreases fluid volume, which prevents the symptoms of heart failure. A high-fat diet does not directly cause heart failure.
A client with hypertension has been started on losartan. After 6 weeks of therapy, it is decided that the losartan alone is not controlling the client's hypertension. What does the nurse anticipate will be added to the losartan regimen for better control of this client's hypertension?
When losartan therapy is started, maximal effects on blood pressure usually occur within 3 to 6 weeks. If losartan alone does not control blood pressure, a low dose of a diuretic may be added. A combination product of losartan and hydrochlorothiazide is available. Adding a second ARB such as candesartan or captopril would risk causing toxic adverse effects. ADH causes retention of water in the nephrons, which would further increase blood pressure.
Which antihypertensive medications can be administered by transdermal patch?
clonidine Clonidine is available as a transdermal patch. Enalapril, candesartan, and amlodipine are not available by this route
A client, having an allergic reaction to mold, describes chest tightness and difficulty breathing. Which body effect is occurring?
contraction of smooth muscle in the bronchi An allergic reaction produces contraction of the smooth muscle in the bronchi and bronchioles. The client will have stimulation, not suppression, of the vagus nerve endings. The client will have increased, not decreased, permeability of the veins and capillaries. The client will have increased secretion from the mucous glands, producing nasal congestion.
An older adult client with a history of chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) has begun tapering off of prednisone. The nurse should prioritize which assessment during this phase of care? Select all that apply.
daily weights, extremity edema, level of consciousness assessment
A client has been diagnosed with chronic renal failure. Which agent will assist in raising the client's hemoglobin levels?
epoetin alfa Uses of epoetin include the prevention and treatment of anemia associated with chronic renal failure, hepatic impairment, or anticancer chemotherapy. Pentoxifylline is used for intermittent claudication to maintain the flexibility of red blood cells. Estazolam is a benzodiazepine agent used short term for insomnia. Dextromethorphan hydrobromide is used to relieve cough.
A client has edema of the lower extremities with crackles in the lung bases. What diuretic is most likely to be prescribed for a client assessed with lower extremity edema and bilateral lung crackles?
furosemide Acute pulmonary edema is an indication for the use of furosemide. HCTZ, spironolactone, and mannitol are not used for this purpose, largely due to their slower onset of action.
Which dietary choice is most appropriate and should be encouraged by the nurse for a client diagnosed with hypertension?
grilled chicken, green salad, and apple Potassium-sparing diuretics may precipitate hyperkalemia. Potassium-sparing diuretics would not precipitate hypernatremia, hyponatremia, or hypokalemia.
What electrolyte imbalance might a diabetic client be prone to develop when prescribed captopril?
hyperkalemia By blocking production of angiotensin II, the ACE inhibitors decrease aldosterone production (thus reducing retention of sodium and water and increasing the retention of potassium). Hyperkalemia may develop in clients who have diabetes mellitus or renal impairment. Hypokalemia is not a risk in clients with diabetes mellitus. Hypernatremia is not a major risk in clients with diabetes who are taking captopril. Hypermagnesemia is not a risk in clients with diabetes who are taking captopril.
To help liquefy cold-related secretions, the nurse should encourage the client to implement which measure?
increasing fluid intake Drinking plenty of water while taking guaifenesin may help loosen mucus in the lungs. Deep breathing, gargling with normal saline, and reducing salt intake do not necessarily help liquefy and mobilize secretions.
A client has begun taking cholestyramine. Which are noted as the most common adverse effects?
nausea, flatulence, and constipation Cholestyramine is not absorbed systemically, so the main adverse effects are gastrointestinal (GI) ones (abdominal fullness, flatulence, diarrhea, and constipation). Constipation is especially common, and a bowel program may be necessary to control this problem.
The majority of reabsorption process takes place in what anatomical location?
proximal tubule Most reabsorption occurs in the proximal tubule. Almost all glucose and amino acids are reabsorbed; about 80% of water, sodium, potassium, chloride, and most other substances are reabsorbed. Arterial blood enters the glomerulus by the afferent arteriole, and blood that does not become part of the glomerular filtrate leaves the glomerulus through the efferent arteriole. The ureters connect the kidneys to the bladder.
The nurse is taking a health history of a 58-year-old man who is taking atorvastatin for high cholesterol. What assessment question should the nurse prioritize related to the safe use of this drug?
"How many alcoholic drinks do you have in a typical day or week?" Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors are contraindicated with active liver disease or a history of alcohol-related liver disease so it is important for the nurse to ask about the client's use of alcohol. For most clients, heavy alcohol use would be more dangerous than high caffeine intake or the use of OTC medications. Exercise has multiple benefits and should be addressed by the nurse, but it is unrelated to safe medication use.
The nurse is educating an older adult client diagnosed with rhinosinusitis in an outpatient clinic about the prescribed topical oxymetazoline. The client has a history of hypertension and coronary artery disease. Which statement made by the client establishes the need for further clarification?
"I can take over-the-counter pseudoephedrine, too." The nurse needs to clarify the statement that the client made regarding taking pseudoephedrine PO in addition to the nasal spray the prescriber provided. The client has a history of hypertension and coronary artery disease, both contraindications for the adrenergic drug, pseudoephedrine. Pseudoephedrine would increase blood pressure, heart rate, and cause heart muscle irritability. Topical decongestants are chosen for clients with cardiovascular disease for this reason. The other statements are correct. Blowing the nose clears the passage, so the drug is more effective. The spray tip needs rinsed off after each use. The drug causes rebound congestion if used more often than recommended on the package or longer than 3 days.
The nurse is educating an adult client diagnosed with a nonproductive cough about the prescribed dextromethorphan. Which statement made by the client establishes the need for further clarification?
"I will dilute the drug syrup with an equal amount of water." The nurse needs to clarify the statement that the client made regarding diluting the drug with equal amount of water because this would decrease the soothing effect on pharyngeal mucosa. The other statements are correct. Eating or drinking decreases effectiveness of drug to soothe mucosa of the pharynx. The drug is only to be taken for nonproductive dry, hacking cough. If the cough becomes productive, the client should stop the drug and notify the prescriber. The drug should be taken only as directed on the package or by prescriber because exceeding the dosage can result in hallucinations.
An adult client recently diagnosed with hypertension has begun combination therapy. Which client statement would suggest a need for further health education?
"I'll only need to take these drugs on days when my blood pressure is particularly high." Antihypertensive drug therapy is usually long term and is taken regularly, except in instances of hypotension or bradycardia. Therapy should not be seen as a response to short-term hypertensive readings. The other listed statements are appropriate responses to diagnosis and treatment.
When providing drug education about nitroglycerin to the client, what should the nurse include in the teaching plan about a nitroglycerin patch?
"One patch lasts an entire day." Transdermal nitroglycerin has a long 24-hour duration of action compared with the sublingual form that lasts 30 to 60 minutes or oral tablets that last 8 to 12 hours. Transdermal patches are neither more nor less effective, but rather it is the speed of onset and duration of action that differ.
A client has been prescribed losartan for hypertension. What client teaching points should the nurse include about this drug?
"Report onset of a fever or persistent cough to your health care provider." Losartan is an angiotensin II receptor blocker that is associated with a cough, back pain, fever, muscle weakness, and upper respiratory tract infections, so the client should be taught to report a fever or cough to his health care provider. Fluid intake should be normal and the drug is best taken in the morning. Blood pressure should be monitored daily, especially when first starting the drug when adverse effects are not yet known.
An older adult client is taking a sustained-release antihypertensive drug. What is the nurse's priority teaching point about this medication?
"Swallow the drug whole and do not to cut, crush, or chew it." Sustained-release drugs cannot be cut, crushed, or chewed; it destroys the matrix system and allows absorption of the complete dose all at once. Older clients should be especially cautioned about sustained-release antihypertensives that cannot be cut, crushed, or chewed to avoid the potential for excessive dosing if these drugs are inappropriately cut. Many OTC drugs contain ingredients that increase blood pressure and so are not recommended for clients with hypertension. The client can take his or her blood pressure any time in the day but it is usually recommended for the morning.
An older client diagnosed with hypertension is requesting a oral nasal decongestant for cold symptoms. Which statement by the nurse best describes the effect of decongestants on blood pressure?
"The administration of a nasal decongestant will increase blood pressure due to vasoconstriction of blood vessels." The administration of a nasal decongestant will increase blood pressure due to vasoconstriction of blood vessels" is indicative of good client teaching. Nasal decongestants are not known to cause bradycardia, decrease thyroid production, increase gastric reflux. The administration of a nasal decongestant does not act on the central nervous system.
The nurse is educating an adult client diagnosed with rhinosinusitis with viscous clear mucous about the prescribed guaifenesin 400 mg PO every 4 hours. Which statement made by the client establishes the need for further clarification?
"The drug will suppress my cough so I can sleep easier." The nurse needs to clarify the statement that the client made regarding that the drug suppresses a cough. The drug liquefies respiratory secretions, so it is easier for the client to expectorate or cough the mucous out of the respiratory tract. The other statements are correct. The client needs to ask a pharmacist before using any over-the-counter preparation to prevent drug interactions, or overdosing drug ingredients that are the same or similar. Drinking adequate amounts of water will help loosen the mucous making it easier to expectorate. The drug absorption is not affected by food intake, so it may be taken with or without meals.
A client, diagnosed with heart failure, asks the nurse for further details about heart failure. Which statement is most accurate?
"The use of digoxin will slow heart rate to make your heart more efficient." The use of digoxin increases the force of myocardial contraction and prevents the development of congestive heart failure in clients whose heart cannot pump blood to meet tissue needs. Endothelial dysfunction allows processes that narrow the blood vessel lumen and lead to blood clot formation and vasoconstriction that further narrow the blood vessel lumen. These are major factors in coronary artery disease and hypertension, the most common conditions leading to heart failure. Hyperthyroidism, not hypothyroidism, is a cause of heart failure. The administration of diuretics decreases fluid volume, which prevents the symptoms of heart failure. A high-fat diet does not directly cause heart failure.
A client asks, "why my prescription is being switched from furosemide to spironolactone?" What is the nurse's best response?
"You will lose less potassium with spironolactone than with furosemide." Spironolactone promotes retention of sodium and water and excretion of potassium by stimulating the sodium-potassium exchange mechanism in the distal tubule. The client will not have greater potassium losses, water losses, or sodium losses with spironolactone rather than furosemide.
The nurse knows that the lunch trays are usually distributed at approximately 12:15. The nurse should plan to administer the client's prescribed 4 units of regular insulin at what time?
11:45 With regular insulin before meals, it is very important that the medication be injected 30 to 45 minutes before meals so that the insulin is available when blood sugar increases after meals. Keeping this in mind the only correct option is 11:45.
A client with chronic obstructive pulmonary disease (COPD) presents to the emergency department in acute respiratory distress. The client's family tells the nurse that the client's problems began right after the client took her first dose of ipratropium. The nurse should prioritize assessment for what potential cause?
An allergy to soy products The use of ipratropium or tiotropium is contraindicated in the presence of known allergy to the drug or to soy products or peanuts (the vehicle used to make ipratropium, an aerosol, contains a protein associated with peanut allergies) to prevent hypersensitivity reactions. An allergy to milk is not associated with sensitivity to ipratropium. Overexertion would not cause the client to develop respiratory distress after using ipratropium for the first time. Misuse of the inhaler would not cause respiratory distress.
The client is a 34-year-old man who recently started taking theophylline. The nurse knows that medication teaching has been successful when he agrees to what activity?
Avoiding beverages that contain caffeine Both theophylline and caffeine are xanthenes. Theophylline increases cardiac output and heart rate. Caffeine also stimulates heart rate. This can have an additive effect. Eating foods high in potassium, limiting fluid intake, or taking the medicine on an empty stomach is not an indication that the client has understood the nurse's teaching.
A client is in the clinic to have blood drawn to assess theophylline levels. The client appears to being responding well to the medication and is not experiencing any adverse effects. What serum level will the nurse expect the client to have?
Between 10 and 20 mcg/mL Therapeutic theophylline levels should be between 10 and 20 mcg/mL. A level between 0.5 and 5 mcg/mL would be low and would not produce a therapeutic effect. Levels between 25 and 50 mcg/mL would be too high and could cause serious adverse effects.
An older adult client who is taking metformin has just been seen in the clinic. The health care provider has prescribed metoprolol for angina. What assessment data should the nurse prioritize due to this drug combination?
Blood glucose Metformin is an antidiabetic drug and the nurse should monitor the client's blood glucose frequently throughout the day because the client may not have the usual signs and symptoms of hypoglycemia or hyperglycemia. Urine specific gravity, leukocyte counts and intake and output are less likely to be affected by this drug-drug combination.
The nurse administers a medication to the client that induces the secondary action of hypoglycemia. What organ will be most acutely impacted by inadequate circulating glucose?
Brain While all cells require glucose to function, the brain uses the greatest amount. As a result, hypoglycemia has the greatest impact on the brain, which explains why hypoglycemia has so many neurological signs and symptoms including fatigue, drowsiness, anxiety, headache, shaking, lack of coordination, and numbness and tingling of the mouth, tongue, and/or lips; confusion and, in severe cases, seizures or coma may occur because the brain cannot function without adequate supplies of glucose.
A client with a diagnosis of renal failure is being treated with epoetin alfa. Frequent assessment of which laboratory values should be prioritized before and during treatment?
CBC With the use of hematopoietic and immune-stimulant drugs, a CBC with WBC differential and platelet count should be done before and during treatment to monitor response and prevent avoidable adverse reactions. It is less imperative to monitor liver enzymes or CRP levels.
Which event occurs in a client diagnosed with hypertension?
Cardiac output increases and in turn causes an increase in blood pressure. When arterial blood pressure is elevated, the kidneys excrete more fluid. The loss of fluid will reduce, not increase, blood volume. The decreased blood volume will decrease cardiac output. The decreased cardiac output decreases blood pressure.
The nurse is engaged in client teaching about a newly prescribed bile acid sequestrant, stating, "You can mix this with soda or seltzer if you'd prefer." What bile acid sequestrant is the nurse describing?
Colestipol can be mixed with a carbonated beverage. The mixture should be stirred and all of the liquid should be swallowed. Ezetimibe is a cholesterol absorption inhibitor and comes in tablet form. Cholestyramine and colesevelam are bile acid sequestrants, but should not be taken with carbonated beverages. The carbonation interferes with the absorption of the drug.
A nurse is caring for a client taking multiple drugs and is concerned about a possible drug-drug interaction. How should the nurse best avoid a drug-drug interaction?
Consult a drug guide prior to drug administration Whenever two or more drugs are being given together, first consult a drug guide for a listing of clinically significant drug-drug interactions. There may be a possibility of changing administration times, but the nurse cannot unilaterally make this decision. Health assessment prior to administration has no direct effect on the likelihood of a drug-drug interaction. It is prudent to collaborate with the prescriber and/or the pharmacist, but this does not negate the need to consult reputable published information.
The nurse is assessing a client who reports taking cholestyramine mixed with diet cola twice per day. What is the most appropriate nursing diagnosis for this client?
Deficient knowledge regarding drug therapy Cholestyramine should be mixed with water or other noncarbonated fluids so the nurse now recognizes the need for medication teaching and chooses the nursing diagnosis related to deficient knowledge. Nothing in this question indicates that the client is experiencing any adverse effects from the drug so constipation would not be optimal nursing diagnosis. This practice does not create a risk for infection or malnutrition.
A client tells the nurse that a friend has recommended the use of herbs to treat the client's asthma. The client wants to "give this a try before taking drugs." The nurse counsels the client to begin treatment immediately with the prescribed medications for what reason?
Delays in appropriate treatment can have serious, even fatal, consequences. Delays in appropriate treatment can have serious, even fatal, consequences. Natural products do not decrease the future effectiveness of adrenergic bronchodilators. Natural products have not been proven to be less toxic or more potent than prescribed asthma medications.
The nurse is caring for several patients prescribed propranolol [Inderal]. In which patient condition is propranolol [Inderal] used with caution?
Diabetes Propranolol inhibits glycogenolysis and thus can produce hypoglycemia, which can cause problems in patients with diabetes. It also suppresses tachycardia, which is an important warning sign of hypoglycemia in patients with diabetes. It is safe to use propranolol in dysrhythmias, hypertension, and angina.
Which single drug class is known to be most effective in reducing the major types of dyslipidemia?
For single-drug therapy, a statin is preferred for the treatment of dyslipidemia. To lower cholesterol and triglycerides, a statin, a cholesterol absorption inhibitor, gemfibrozil, a fibrate, or the vitamin niacin may be used. To lower triglycerides, gemfibrozil, ezetimibe, a cholesterol absorption inhibitor, or niacin may be given.
A client with a diagnosis of cardiovascular disease is taking atorvastatin to reduce serum cholesterol. What is the goal of therapy for LDL cholesterol for a client taking atorvastatin calcium?
In clients with a diagnosis of cardiovascular disease, the goal of therapy is an LDL below 130 mg/dL.
What is the nurse's ultimate concern when administering a drug?
Intensity of the response The ultimate concern for the nurse when administering a drug is the intensity of the response, which is determined by the dosage size, route of administration, and timing of administration.
What is the major purpose in administering a combination diuretic agent?
It prevents potassium imbalance. The major purpose of the diuretic combinations is to prevent potassium imbalances. The combination products do not prevent sodium imbalance. The combination products are not less expensive than taking two medications. The combination products do not prevent allergic reactions.
The nurse wants to evaluate the cardiac status of a patient with heart failure. Which laboratory result should the nurse check?
Levels of circulating B-natriuretic peptide (BNP) are an important index of cardiac status in heart failure (HF) patients and can be a predictor of long-term survival. High levels of BNP indicate poor cardiac health and can predict a lower chance of survival. Conversely, low levels of BNP indicate better cardiac health and can predict a higher chance of survival. While sodium and potassium can provide information on electrolyte status, they cannot predict cardiac status of heart failure. Digoxin level predicts only levels of digoxin, not cardiac status.
The client, diagnosed with angina, reports chest pain. There is an order for oral sublingual nitroglycerin as needed. What action should the nurse take?
Place one tablet under the client's tongue and repeat every 5 minutes to a maximum of three tablets until pain has been relieved The correct administration for sublingual administration is to place one tablet under the client's tongue and repeat every 5 minutes for a total of three tablets until pain is relieved. If pain is not relieved after three sublingual tablets, the health care provider should be notified. Transdermal application would be inappropriate and nitroglycerin is not swallowed. Administering two tablets at one time would be an inappropriate dosage and could cause serious adverse effects.
An older client diagnosed with hypertension is requesting a oral nasal decongestant for cold symptoms. Which statement by the nurse best describes the effect of decongestants on blood pressure?
The administration of a nasal decongestant will increase blood pressure due to vasoconstriction of blood vessels." The administration of a nasal decongestant will increase blood pressure due to vasoconstriction of blood vessels" is indicative of good client teaching. Nasal decongestants are not known to cause bradycardia, decrease thyroid production, increase gastric reflux. The administration of a nasal decongestant does not act on the central nervous system.
A client who works on road construction has been diagnosed with hypertension. After attempting to decrease his blood pressure with lifestyle changes and a mild diuretic, it is determined that he will need to be placed on an angiotensin-converting enzyme (ACE) inhibitor. In an effort to prevent adverse effects, the nurse should address what client variable?
The client sweats excessively on the job A client taking an ACE inhibitor should be sure to maintain fluid intake, so excessive sweating on the job places him at risk for a drop in fluid volume. Excessive sweating, vomiting, diarrhea, or dehydration need to be monitored and treated if they occur while taking an ACE inhibitor. Six smaller meals rather than three larger ones would be better and should be encouraged. However, this could be a problem with his job. The best treatment for constipation would be to increase fluid and fiber and one beer a night would be within reason when considering alcohol intake.
A client who works on road construction has been diagnosed with hypertension. After attempting to decrease his blood pressure with lifestyle changes and a mild diuretic, it is determined that he will need to be placed on an angiotensin-converting enzyme (ACE) inhibitor. In an effort to prevent adverse effects, the nurse should address what client variable?
The client sweats excessively on the job. A client taking an ACE inhibitor should be sure to maintain fluid intake, so excessive sweating on the job places him at risk for a drop in fluid volume. Excessive sweating, vomiting, diarrhea, or dehydration need to be monitored and treated if they occur while taking an ACE inhibitor. Six smaller meals rather than three larger ones would be better and should be encouraged. However, this could be a problem with his job. The best treatment for constipation would be to increase fluid and fiber and one beer a night would be within reason when considering alcohol intake.
An adult client with a diagnosis of hypertension has been prescribed oral furosemide. What goal should the nurse identify when planning this client's medication teaching session?
The client will identify strategies for limiting his or her sodium intake. The reason for furosemide use should guide client teaching. In most instances, it is necessary to initiate measures to limit sodium intake. Key considerations should include not adding salt to food during preparation or at the dinner table, reading food labels carefully to be aware of hidden sources of sodium, and avoiding processed or high-sodium foods. Blood glucose monitoring is not indicated, and there is no need for increased fluid intake. Renal anatomy and physiology are not priority teaching points.
What is the nurse's priority assessment question before giving a female client her prescription for an angiotensin II-receptor blocker (ARB)?
When was your last menstrual period (LMP)?" It would be important to know when the client's LMP occurred and that the client was not pregnant. These drugs can cause fetal abnormalities and fetal death. Questions on food intake, physical activity, and weight are appropriate and would help the nurse plan care for the client; however, it would not be as important as assessing for the possibility of pregnancy before beginning of therapy. The nurse should teach the client the need to avoid pregnancy using a barrier contraceptive.
Which client should not be administered an antihistamine?
a male client with prostatic hypertrophy Antihistamines are contraindicated in clients with prostatic hypertrophy. There is no current research to suggest that antihistamine agents cannot be administered to clients with Parkinson's disease, asthma, and diabetes mellitus.
A client has purchased an over-the-counter (OTC) cold remedy that advertises a "non-drowsy" formulation. The nurse explains to the client that such a medication is likely what classification of drug?
a nasal decongestant "Non-drowsy" or "daytime" cold formulas typically contain a nasal decongestant but not an antihistamine. Such medications would contain neither a narcotic nor a benzodiazepine.
The nurse teaching a client about theophylline will include the identification of which possible symptoms of toxicity?
agitation and dysrhythmias Signs and symptoms of theophylline overdose include anorexia, nausea, vomiting, agitation, nervousness, insomnia, tachycardia and other dysrhythmias, and tonic-clonic convulsions. Ventricular dysrhythmias or convulsions may be the first sign of toxicity. Chest pain, shortness of breath, polyuria, polyphagia, and decreased level of consciousness do not accompany theophylline overdose
A client is experiencing a cough associated with an upper respiratory infection. Which oral medication will likely produce the quickest therapeutic effect?
an expectorant Liquid medications are absorbed faster than tablets or capsules. Expectorants are liquid medications. A tablet is an oral medication that has a slower onset of action than a liquid medication. A topical spray can be sprayed to the back of the throat and provides only a local effect. A timed-release tablet is an oral medication that has a slower onset and longer duration of action.
On the advice of his brother, a 53-year-old man has made an appointment to request a prescription for sildenafil. The nurse who works at the clinic is reviewing the man's medical history and would recognize what health problem as being prohibitive to this treatment?
angina, treated with nitroglycerin Prescribers should not order sildenafil for men who also take organic nitrates, commonly used to treat angina, because the sildenafil-nitrate combination can cause severe hypotension resulting in dizziness, syncope, heart attack, or stroke. Metformin, metoprolol, and simvastatin are not likely to cause adverse effects.
A client with angina is prescribed propranolol. Following absorption of the drug, the nurse should monitor the client for what desired effect?
decreased heart rate Beta-blockers cause a slowing of the heart rate referred to as negative chronotropy. They do not normally cause drowsiness, short-term relief from fatigue, or a notable increase in SaO2 since the action of this medication is to inhibit beta2 receptors in the bronchial and vascular musculature.
A client prescribed codeine for a persistent, debilitating cough tells the nurse, "I was sure that codeine was a narcotic that people take for pain." The nurse should cite what mechanism of action when describing this use of codeine?
depression of the cough center in the medulla oblongata Antitussives such as codeine suppress cough by depressing the cough center in the medulla oblongata. They do not influence blood flow or desensitize peripheral cough receptors. The RAS is not involved in the cough reflex.
A client is diagnosed with hypertension and is being treated with captopril. A client with which diagnosis should be prescribed with captopril as the first-line treatment?
diabetes mellitus Captopril is the first-line agent for treating hypertension in diabetic clients, particularly those with type 1 diabetes. Captopril can be used for hypertension in clients with asthma, glaucoma, and angina pectoris but is not the first-line agent, as noted in diabetes mellitus.
An older adult client, who leads a sedentary lifestyle, has recently been diagnosed with dyslipidemia. The client is disappointed to learn about this condition, stating, "First it was the diabetes and then the arthritis, now this." The nurse has performed health education with the client and has described metabolic syndrome. In addition to the elevated cholesterol levels, what aspect of the client's health is congruent with a diagnosis of metabolic syndrome?
diabetes mellitus Diagnostic criteria for metabolic syndrome include a cluster of several cardiovascular risk factors linked with obesity: increased waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose. Age, gender, and joint disorders are not among these criteria.
Heavy intake of which herb should be avoided by a client who is prescribed an antidiabetic medication?
garlic Garlic has been known to cause hypoglycemia when taken with antidiabetic medications. Anise, basil, and oregano are not noted to carry this risk.
A nurse who provides care on a postsurgical unit frequently administers Schedule II drugs to clients. Which aspect of administering these drugs falls under the auspices of the Drug Enforcement Administration?
informing clients of the potential risks and benefits of such drugs prior to the first dose (THIS WAS INCORRECT) Nurses are responsible for storing controlled substances in locked containers, administering them only to people for whom they are prescribed, recording each dose given on agency narcotic sheets and on the client's medication administration record, maintaining an accurate inventory, and reporting discrepancies to the proper authorities. The other given actions are appropriate nursing activities, but they are not within the scope of the DEA authority.
Which site is preferred when consideration must be made to identifying an exceptionally large surface area for drug absorption?
lungs The lungs have a large surface area for absorption of anesthetic gases and a few other drugs. The rectum absorbs the medication through the mucous membranes and has a smaller surface area than the lungs. The fundus and esophagus have comparatively small surface areas.
A client with a history of heart failure is being treated with digoxin. The nurse knows that this medication increases the force of contractions of the heart. What effect improves the contractility of the heart?
positive inotropic effect In heart failure, digoxin exerts cardiotonic or positive inotropic effect that improves the contractility and pumping ability of the heart. A positive chronotropic effect accelerates the rate of the heart, which is not recommended in a client with heart failure. A negative inotropic effect accelerates the heart, which is not recommended in a client with heart failure. A negative dromotropic effect changes the conductivity of muscle fiber, increasing heart rate.
A nurse who provides care on a postsurgical unit frequently administers Schedule II drugs to clients. Which aspect of administering these drugs falls under the auspices of the Drug Enforcement Administration?
recording each dose administration on an agency narcotic sheet Nurses are responsible for storing controlled substances in locked containers, administering them only to people for whom they are prescribed, recording each dose given on agency narcotic sheets and on the client's medication administration record, maintaining an accurate inventory, and reporting discrepancies to the proper authorities. The other given actions are appropriate nursing activities, but they are not within the scope of the DEA authority.
