Pharmacological and Parenteral Therapies Prep U
The nurse is caring for a client who is using a patient-controlled analgesia (PCA) pump for postoperative pain. The nurse enters the room and finds the client asleep and the significant other delivering a dose from the PCA. What is the best response by the nurse? "It is a good idea that the client can rest well." "Call me if you think the client needs more pain medication." "The client should decide when more pain medication is needed." "Why do you think the client needs more medication when visibly sleeping?"
"The client should decide when more pain medication is needed." The nurse should explain to the significant other that the client is the only one who should deliver medication from the PCA pump. When the client cannot do so, the provider may assign a family member to do so.
The nurse is monitoring a client with metastatic breast cancer who is receiving morphine for pain control. The nurse would be alert for which of the following? Excessive sedation, confusion, and weakness Malaise, diarrhea, and stomatitis Bone marrow depression, granulocytopenia, and anemia Central nervous system (CNS) depression, amenorrhea, and anemia
Excessive sedation, confusion, and weakness Clients taking morphine, an opioid analgesic, should be monitored for adverse reactions that include excessive sedation, confusion, weakness, hypotension, constipation, dry mouth, nausea, vomiting, and anorexia. Although CNS depression may occur, amenorrhea and anemia are not associated with morphine. Malaise, diarrhea, stomatitis, bone marrow depression, granulocytopenia, and anemia are often associated with antineoplastic agents.
A client is brought to the crisis intervention center by the partner, who states that the client has recently become increasingly listless and less involved with the family. The partner reports that the client sleeps poorly, eats little, and can barely perform basic self-care. The partner also reveals that 3 months ago the client was in a car accident in which the client's best friend was killed. After the physician diagnoses acute depression, the nurse should anticipate administering: paroxetine, 20 mg by mouth (P.O.) every morning. amitriptyline hydrochloride, 20 mg P.O. daily. doxepin, 500 mg daily. imipramine, 500 mg daily.
paroxetine, 20 mg by mouth (P.O.) every morning. Paroxetine, amitriptyline, doxepin, and imipramine are all antidepressants that may be ordered for this client. However, paroxetine, 20 mg P.O. every morning, is the only correct dosage. Amitriptyline is usually started at 75 to 150 mg P.O. daily in divided doses. Doxepin is started at 25 to 50 mg daily and may be titrated upward to a maximum daily dose of 300 mg. Imipramine is started at 50 to 75 mg daily and, if tolerated, titrated upward to a maximum daily dose of 300 mg.
A young female client has received chemotherapeutic medications and asks about any effects the treatments will have related to her sexual health. The most appropriate statement by the nurse is
"You will need to practice birth control measures." Following chemotherapy female clients may experience normal ovulation, early menopause, or permanent sterility. Clients are advised to use reliable methods of birth control until reproductivity is known.
When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind?
Accuracy of the dosage The measurement of insulin is most important and must be accurate because clients may be sensitive to minute dose changes. The duration, area, and technique for injecting should also to be noted.
To avoid the side effects of corticosteroids, which medication classification is used as an alternative to treating inflammatory conditions of the eyes?
Nonsteroidal anti-inflammatory drugs (NSAIDs) NSAIDs are used as an alternative in controlling inflammatory eye conditions and postoperatively to reduce inflammation. Miotics are used to cause the pupil to constrict. Mydriatics cause the pupil to dilate. Cycloplegics cause paralysis of the iris sphincter.
Fentanyl is categorized as which type of intravenous anesthetic agent? Tranquilizer Opioid Dissociative agent Neuroleptanalgesic
Opioid Fentanyl is 75 to 100 times more potent than morphine and has about 25% of the duration of morphine (IV). Examples of tranquilizers include midazolam and diazepam. Ketamine is a dissociative agent.
A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? Urine output of 400 ml in 8 hours Serum potassium level of [2.6 mEq/L (2.6 mmol/L)} Blood pressure of 120/64 to 130/72 mm Hg Sodium level of [142 mEq/L (142 mmol/L)]
Serum potassium level of [2.6 mEq/L (2.6 mmol/L)} Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings.
Which of the following is a disadvantage to using the IV route of administration for analgesics? Short duration Slower entry into bloodstream No risk of respiratory depression Long duration
Short duration Disadvantages of using the IV route for analgesic administration include short duration, the occurrence of possible respiratory depression, and that careful dosage calculations are needed. Intramuscular analgesics have a slower entry into the bloodstream.
A client is brought to the ED with narcotic overdose and respiratory depression. The client is administered naloxone hydrochloride, and then asks the nurse, "What if I am allergic to what you gave me?" What adverse effects should the nurse communicate to the client? Select all that apply.
tachycardia tremors Adverse effects of naloxone hydrochloride include tachycardia, hyperventilation, and tremors. Adverse effects of opioids include seizures, hypoventilation, and decreased urine output.
A client recovering from a pulmonary embolism is receiving warfarin. To counteract a warfarin overdose, the nurse should administer
vitamin K1 (phytonadione). Vitamin K1 is the antidote for a warfarin overdose. Heparin is a parenteral anticoagulant. Vitamin C isn't an antidote. Protamine sulfate is the antidote for heparin.
The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? NPH Iletin II Lispro (Humalog) Glargine (Lantus)
NPH
A nurse is providing health teaching about pediatric immunizations to the parents of a child. Which of the following is the most appropriate information for the nurse to give the parents about immunizations?
"Your child may need medication for a low-grade fever." Fever with most vaccines begins within 24 hours, lasts 2 to 3 days, and may require pharmacologic intervention. The other options are incorrect.
The maximum transfusion time for a unit of packed red blood cells (RBCs) is
4 hours. A unit of packed RBCs may be transfused over a period of between 1 and 4 hours. It shouldn't infuse for longer than 4 hours because the risk of contamination and sepsis increases after that time. The nurse should discard any blood not given within this time, or return it to the blood bank, in accordance with facility policy.
A client is typed and cross-matched for three units of packed cells. What are important precautions for the nurse to take before initiating the transfusion? Select all that apply.
Have two nurses check the blood type and identity. Initiate an IV with normal saline. Take baseline vital signs. Prior to administering blood, the unit must be checked by two registered nurses. Baseline vital signs are obtained before the transfusion is started so any changes would be identified. Blood is always transfused with normal saline as other IV fluids are incompatible with blood. Warming to room temperature is not necessary.
A nurse teaches a client with angina pectoris that he or she needs to take up to three sublingual nitroglycerin tablets at 5-minute intervals and immediately notify the health care provider if chest pain doesn't subside within 15 minutes. What symptoms may the client experience after taking the nitroglycerin? Nausea, vomiting, depression, fatigue, and impotence. Sedation, nausea, vomiting, constipation, and respiratory depression. Headache, hypotension, dizziness, and flushing. Flushing, dizziness, headache, and pedal edema.
Headache, hypotension, dizziness, and flushing.
The nurse is caring for a client who has a diagnosis of human immunodeficiency virus (HIV). Part of this client's teaching plan is educating the client about his or her medications. What is essential for the nurse to include in the teaching of this client regarding medications?
Side effects of drug therapy Describing the side effects of drug therapy is essential, with the admonition to refrain from discontinuing any of the prescribed drugs without first consulting the prescribing physician. Although the client may want to know how the drugs work in general, the specific action of each antiretroviral drug is not essential information. Teaching about condoms and vaccinations may be appropriate, but these topics are not directly related to the client's HIV medications.
A client has been diagnosed with atrial fibrillation and has been prescribed warfarin therapy. What should the nurse prioritize when providing health education to the client? The need to have regular blood levels drawn The importance of taking the medication 1 hour before or 2 hours after a meal The need to sit upright for 30 minutes after taking the medication The importance of adequate fluid intake
The need to have regular blood levels drawn One drawback of warfarin therapy is the need to have blood levels drawn on a regular basis. The medication does not need to be taken on an empty stomach, and the client does not have to sit upright. Adequate fluid intake is useful in a general way, but the need for fluids is not increased by taking warfarin.
The nurse is administering newly ordered narcotic medication to a client. What safety steps are included in the process? Select all that apply.
Verify the healthcare provider's order. Assess the client for allergies. Identify the client. Assess client's pain level. When administering a medication, the nurse will verify the healthcare provider's order and assess the client for allergies. The nurse will also identify the client and assess the client's pain level prior to administering the new narcotic medication. The client's meal consumption documentation is not a safety part of the medication administration process.
After a 3-month trial of dietary therapy, a client with type 2 diabetes still has blood glucose levels above 180 mg/dl (9.99mmol/L). The physician adds glyburide, 2.5 mg P.O. daily, to the treatment regimen. The nurse should instruct the client to take the glyburide:
at breakfast. Like other oral antidiabetic agents ordered in a single daily dose, glyburide should be taken with breakfast. If the client takes glyburide later, such as in mid-morning, after dinner, or at bedtime, the drug won't provide adequate coverage for all meals consumed during the day.
