Pharmacology EAQs

A client develops a seizure disorder as a result of a traumatic fall. When the client returns to the clinic for a routine visit, the client states, "I have not had a seizure in 2 years. When can I stop taking my antiseizure medications?" What is the nurse's bestresponse? 1 "A gradual reduction in seizure medication may be considered." 2 "You will require medication for the rest of your life." 3 "Enough time has passed since the last seizure. The medication probably will be discontinued at this visit." 4 "A minimum of 10 years without seizures is necessary before discontinuation of medications is considered."

ANS: "a gradual reduction in seizure medication may be considered" Rationale: Specific protocols are designed to gradually reduce the dosage of antiseizure medications after a client is seizure free, provided the electroencephalogram is within acceptable limits. The client is monitored for seizure activity because recurrence is greatest within the first year after drug withdrawal. Depending on the status of the client, antiseizure medications may not be necessary for life. Medications must be withdrawn slowly to prevent an abrupt reduction in serum drug levels, which may precipitate a seizure. The response "A minimum of 10 years without seizures is necessary before discontinuation of medications is considered" indicates too long a time.

A nurse must administer streptomycin 1 g intramuscularly (IM) to a client with tuberculosis. The vial contains 500 mg/mL. How much solution must the nurse administer? Record your answer using a whole number. ___ mL

ANS: 2 mL Rationale: mL = mL/500 mg x 1000mg/1g x 1g = 2 mL

The health care provider prescribes 1000 mL of total parenteral nutrition to be administered in 12 hours. Based on this prescription, how many milliliters of solution should be administered per hour? 1 83 mL/hr 2 100 mL/hr 3 108 mL/hr 4 125 mL/hr

ANS: 83 mL/hr Rationale: 1000mL / 12 hr = 83.3 mL/hr, rounded to 83 mL/hr

What instructions should a nurse give a client for whom nitroglycerin tablets are prescribed? 1 Limit the number of tablets to four per day. 2 Discontinue the medication if a headache develops. 3 Increase the number of tablets if dizziness is experienced. 4 Ensure that the medication is stored in its original dark container.

ANS: Ensure that the medication is stored in its original dark container Rational: Nitroglycerin is sensitive to light and moisture, so it must be stored in a dark, airtight container. Limit the number of tablets to four per day, taken as needed. If more than three tablets are necessary in a 15-minute period, emergency medical attention should be received. A headache may be an expected side effect, and the medication should not be discontinued. Dizziness indicates the dosage may need to be decreased by the healthcare provider.

A child undergoing treatment in the hospital has fatigue, elevated blood pressure, sleep problems, nervousness, and gastrointestinal tract upset. Which type of drug is the child being given? 1 Barbiturates 2 Loop diuretics 3 Thiazide diuretics 4 Tricyclic antidepressants

ANS: TCAs rationale: Tricyclic antidepressants are psychotherapeutic drugs rarely given to a child younger than 12 unless he or she has attention deficit disorder and major depression. An improper dose may lead to fatigue, elevated blood pressure, sleep problems, nervousness, and gastrointestinal tract upset. Barbiturates may cause depression, confusion, and excitement. Both loop and thiazide diuretics may cause an excessive loss of fluids and electrolytes, which results in hypotension and shock.

A client is taking warfarin. If an antidote is needed, which agent will the nurse anticipate being prescribed? 1 Vitamin K 2 Fibrinogen 3 Prothrombin 4 Protamine sulfate

ANS: Vitamin K Rationale: warfarin is an anticoagulant, vitamin K has coagulation properties

A healthcare provider prescribes aspirin to be continued at home for a client with severe arthritis. What should the nurse teach the client about taking aspirin? 1 Take the medicine with meals. 2 See a dentist if bleeding gums develop. 3 Switch to acetaminophen if tinnitus occurs. 4 Avoid spicy foods while taking the medication.

ANS: Take medicine with meals Rationale: Acetylsalicylic acid is irritating to the stomach lining and can cause ulceration; the presence of food, fluid, or antacids decreases this response. Bleeding gums should be reported to the healthcare provider, not the dentist. Acetaminophen does not contain the antiinflammatory properties present in aspirin; tinnitus should be reported to the healthcare provider. Avoiding spicy foods is unnecessary as long as aspirin is taken with food.

Several hours after administering insulin, the nurse is assessing a client for an adverse response to the insulin. Which client responses are indicative of a hypoglycemic reaction? Select all that apply. 1 Tremors 2 Anorexia 3 Confusion 4 Glycosuria 5 Diaphoresis

ANS: Tremors, confusion, diaphoresis Rationale: Confusion is typically the first sign of a hypoglycemic reaction. Tremors are a sympathetic nervous system response that occurs because circulating glucose in the brain decreases. Diaphoresis is a cholinergic response to hypoglycemia. Hypoglycemia causes hunger, not anorexia. Because blood glucose is low in hypoglycemia, the renal threshold is not exceeded and glycosuria does not occur.

A school-aged child with an exacerbation of leukemia is readmitted to the pediatric unit. When does the nurse plan to administer the prescribed analgesic for bone pain? 1 At scheduled intervals 2 When the child asks for it 3 When pain becomes severe 4 Before the pain becomes severe

ANS: at scheduled intervals rationale: For maximal benefit, the analgesic should be administered at scheduled intervals that are individualized for the child; routine administration manages the pain before it becomes too intense. The goal is to keep the child pain free; by the time the child asks for the analgesic, the pain has returned. It is insensitive to allow the child to be in pain; there should be no pain.

A nurse is caring for a 3-month-old infant with severe diarrhea following antibiotic therapy. After the effects of dehydration are stabilized, the healthcare provider prescribes Lactobacillus granules. What explanation does the nurse give to the infant's parents about the reason for giving lactobacilli? 1 They diminish the inflammatory mucosal edema. 2 The discomfort caused by gastric hyperacidity is lessened. 3 They relieve the pain caused by gas in the gastrointestinal tract. 4 The flora that inhabit a healthy gastrointestinal tract must be recolonized.

ANS: the flora that inhabit a healthy gastrointestinal tract must be recolonized Rationale: Lactobacilli are part of the flora in the healthy gastrointestinal tract. The purpose of administering lactobacilli granules is to help recolonize the normal gastrointestinal flora that were destroyed with antibiotic therapy. The other options are not the actions of lactobacilli granules.

A client with laryngeal cancer is receiving chemotherapy. Which laboratory report is most important for the nurse to monitor when considering the effects of chemotherapy? 1 Platelets 2 Hemoglobin level 3 Red blood cell count 4 White blood cell count

ANS: white blood cell count Rationale:Antineoplastic drugs depress bone marrow, which results in leukopenia; the client must be protected from infection, which is a primary cause of death in the client with cancer. Platelets may decrease rapidly, but complications may be limited by infusions of platelets. Although the hemoglobin level diminishes, a transfusion with packed red blood cells (RBCs) will alleviate the anemia. RBCs diminish slowly and may be replaced with a transfusion of packed red blood cells.

Which is a second-generation antidepressant drug?

Citalopram is an example of a second-generation antidepressant drug. Doxepin, protriptyline, and trimipramine are examples of first-generation antidepressant drugs.

A nurse is admitting a 2-year-old toddler with a tentative diagnosis of cystic fibrosis to the pediatric unit. Pilocarpine is used as part of the diagnostic process. The nurse knows that the pilocarpine will stimulate which process? 1 Secretion of mucus 2 Activity of sweat glands 3 Excretion of pancreatic enzymes 4 Release of bile from the gallbladder

ANS activity of sweat glands rationale: A nurse is admitting a 2-year-old toddler with a tentative diagnosis of cystic fibrosis to the pediatric unit. Pilocarpine is used as part of the diagnostic process. The nurse knows that the pilocarpine will stimulate which process? 1 Secretion of mucus 2 Activity of sweat glands 3 Excretion of pancreatic enzymes 4 Release of bile from the gallbladder

Which drug may lead to bruxism?

Levomilnacipran Serotonin reuptake inhibitors and serotonin/epinephrine reuptake inhibitors may lead to bruxism. Levomilnacipran is a serotonin/epinephrine reuptake inhibitor that may cause bruxism. Vilazodone is an atypical antidepressant that does not cause bruxism. Isocarboxazid is a monoamine oxidase inhibitor that does not cause bruxism. Clomipramine is a tricyclic antidepressant that does not cause bruxism.

Which adverse effect is least likely to occur in a client who is prescribed clozapine?

Myocarditis Rationale:

Which monoamine oxidase inhibitor is used to treat Parkinson disease?

Selegiline It is a monoamine oxidase-B inhibitor used to treat Parkinson disease. Phenelzine, isocarboxazid, and tranylcypromine are nonselective inhibitors of both type A and B used in the treatment of depression.

Nortriptyline three times a day is prescribed for a depressed client. When does the nurse expect a therapeutic response?

2-3 weeks Rationale: most tricyclics take 2-3 weeks for optimal therapeutic effects to occur

A 5-year-old child is given fluoroquinolones. Which potential adverse effect unique to pediatric clients should the nurse anticipate? 1 Tendon rupture 2 Cartilage erosion 3 Staining of developing teeth 4 Central nervous system toxicity

ANS: Tendon Rupture Rationale: Fluoroquinolones may cause tendon rupture in children. Nalidixic acid can cause cartilage erosion, and tetracycline can cause staining of developing teeth. Hexachlorophene may cause central nervous system toxicity in infants.

An antianxiety medication is prescribed for an extremely anxious client. The client says, "I'm afraid to take this medication because I heard they're addictive." The nurse teaches the client that antianxiety medications have what properties?

Antianxiety medications have the potential for physiologic and psychological dependence; the nurse should teach the client about both the advantages and disadvantages of taking this drug. Physiologic or psychological dependence may develop, even when the dosage is controlled. Tolerance does develop and can lead to dependence.

Which statement about primary anxiolytic drugs requires correction?

Benzodiazepines block gamma-aminobutyric acid receptors Rationale: Benzodiazepines stimulate gamma-aminobutyric acid receptors, which reduces neuron excitability and produces an overall inhibitory effect. Apart from its indication in the treatment of depression, benzodiazepines are also prescribed for ethanol withdrawal, insomnia, and muscle spasms. Benzodiazepines are the drug of choice in acute and chronic anxiety disorders. Benzodiazepines act by depressing activity in the brainstem and limbic system.

A client with schizophrenia is started on a regimen of chlorpromazine. After 10 days a shuffling gait, tremors, and some rigidity are apparent. Benztropine mesylate 2 mg by mouth daily is prescribed. What does the nurse remember when administering these medications together?

Both medications block central acetylcholine receptors. Neither medication inhibits cholinesterase; neostigmine (Prostigmin) acts in this manner. Although benztropine mesylate can cause mental confusion when given in large doses, it does not reduce the antipsychotic effect of chlorpromazine. Both medications cause dry mouth.

A primary healthcare provider prescribes oxazepam for a client who is beginning to experience withdrawal symptoms while undergoing detoxification. What are the primary reasons that oxazepam is given during detoxification?

Reduces the anxiety-tremor state and prevents more serious withdrawal symptoms Rationale: Oxazepam potentiates the actions of gamma-aminobutyric acid, especially in the limbic system and reticular formation and thus minimizes withdrawal symptoms. This drug helps reduce the risk for seizures but does not prevent injury or protect the client during a seizure.

A client with a history of methamphetamine use is admitted to the medical unit. What clinical manifestation does the nurse expect when assessing the client?

Increased heart rate Methamphetamine is a stimulant that causes the release of adrenaline, which activates the sympathetic nervous system. The pupils will dilate, not constrict, because the sympathetic nervous system is activated. Clients withdrawing from opioids, not methamphetamine, experience diarrhea. The respirations will be increased, not decreased, because of the activation of the sympathetic nervous system.

A nurse prepares to administer prednisone to a 4-year-old child who weighs 48 lb (21.8 kg). The dose for children is 2 mg/kg/day in four divided doses. How much prednisone will the nurse administer for one dose? Round your answer to nearest whole number. ___ mg

ANS: 11 rationale: 21.8 x 2 / 4

A client with rheumatoid arthritis asks the nurse why it is necessary to inject hydrocortisone into the knee joint. What reason should the nurse include in a response to this question? 1 Lubricate the joint 2 Reduce inflammation 3 Provide physiotherapy 4 Prevent ankylosis of the joint

ANS: reduce inflammation Rationale: hydrocortisone is a steroid with antiinflammatory properties, helpful in reducing the inflammation seen in rheumatoid arthritis

A nurse is assessing an adolescent after the administration of epinephrine. What side effect is most important for the nurse to identify? 1 Tachycardia 2 Hypoglycemia 3 Constricted pupils 4 Decreased blood pressure

ANS: tachycardia rationale: Epinephrine is a sympathetic nervous system stimulant that causes tachycardia. Hyperglycemia, not hypoglycemia, may result. The pupils will be dilated, not constricted. Epinephrine is more likely to cause hypertension than hypotension.

A 13-year-old child with type 1 diabetes is receiving 15 units of regular insulin and 20 units of NPH insulin at 7:00 AM each day. At what time does the nurse anticipate a hypoglycemic reaction from the NPH insulin to occur? 1 Before noon 2 In the afternoon 3 Within 30 minutes 4 During the evening

ANS: in the afternoon rationale: NPH insulin is an intermediate-acting insulin that peaks approximately 6 to 8 hours after administration. It was administered at 7:00 AM, so between 1:00 and 3:00 PM is when the nurse should anticipate that a hypoglycemic reaction will occur. Noon is when a reaction from a short-acting insulin is expected. Short-acting insulin peaks in 2 to 4 hours after administration. Within 30 minutes of administration is when a reaction from a rapid-acting insulin is expected. Rapid-acting insulin peaks 30 to 60 minutes after administration. During the evening or night is when a reaction from a long-acting insulin is expected. Long-acting insulin has a small peak 10 to 16 hours after administration.

A client is receiving combination chemotherapy for treatment of metastatic carcinoma. For which systemic side effect should the nurse monitor the client? 1 Ascites 2 Nystagmus 3 Leukopenia 4 Polycythemia

ANS: leukopenia Rationale: Leukopenia, a reduction in white blood cells, is a systemic effect of chemotherapy as a result of myelosuppression. Ascites is not a side effect of chemotherapy. Chemotherapy does not affect the eyes; nystagmus is an involuntary, rapid rhythmic movement of the eyeballs. Also, nystagmus is a local, not a systemic, response. The red blood cells will be decreased, not increased.

A combination of drugs, including vincristine and prednisone, is prescribed for a child with leukemia. For which adverse effect of vincristine will the nurse assess the child? 1 Hemolytic anemia 2 Irreversible alopecia 3 Hyperglycemia 4 Neurologic complications

ANS: neurological complications Rationale:Vincristine is highly neurotoxic, causing paresthesias, muscle weakness, ptosis, diplopia, paralytic ileus, vocal cord paralysis, and loss of deep tendon reflexes. Hematologic effects are rare; mild anemia may occur, but hemolytic anemia is not anticipated. Alopecia is reversible with cessation of the drug. Hyperglycemia is not an anticipated adverse effect.

The nurse advises the client to refrain from skin contact of the prescribed liquid formulation. Which antipsychotic drug is prescribed to the client? A. Loxapene b. Alsenapine c. Alprazolam d. Thorazine

ANS: thorazine rationale: Antipsychotics are available in tablet, capsule, and liquid dosage forms. Liquid formulations require special handling. Phenothiazines such as thorazine that are formulated in liquid dosages require safety precautions while handling. The nurse should advise the client to avoid contact with the skin to avoid dermatitis. Loxapine is prescribed to clients with schizophrenia; it is available as inhaled powder. Asenapine is administered as a sublingual tablet. Alprazolam is an adjunctive drug used to treat anxiety and promote sleep; this drug does not cause contact dermatitis.

A nurse administers an antipsychotic medication to a client. The nurse will assess the client for which common manageable side effect? a. Jaundice b. Melanocytosis c. Drooping eyelids d. Unintentional tremors

ANS: unintentional tremors rationale: Unintentional tremor is one of the extrapyramidal side effects of antipsychotic medications; it is considered common and manageable. Jaundice is a severe but not a common occurrence; periodic liver function tests should be performed. An excessive number of melanocytes is not a side effect of antipsychotics. Drooping of the eyelids is not a common side effect.

When considering the side effects of dactinomycin and doxorubicin therapy, the nurse can suggest to the parents of a child receiving these medications that the child should take which precaution? 1 Wear a baseball cap 2 Eat three meals daily 3 Avoid dairy products 4 Dress in light clothing

ANS: wear a baseball cap Rationale: Antineoplastic drugs exert their effect on rapidly dividing tissues such as hair follicles, resulting in alopecia. Eating regular meals, avoiding dairy products, and wearing certain types of clothing are not related to the side effects of the antineoplastics that are being used.

A nurse counsels a child's mother about preventive measures associated with accidental poisoning. Which statement of the mother indicates effective learning? Select all that apply. 1 "I should refer to medicines as candy." 2 "I should keep potential poisons out of reach." 3 "I should not transfer the drug's contents to another container." 4 "I should not dispose of all unused and unneeded medications." 5 "I should securely seal all containers and keep them in a safe place."

ANS:2,3,5 rationale: Potentially poisonous substances should always be kept away from the reach of children. Potentially poison contents should not be transferred to alternate containers because of the risks of mislabeling. All containers containing poisons or potential poisons should be properly sealed and locked inside a cabinet to further reduce the accidental exposure. Referring to medication as candy will confuse and tempt the child. All unused and unneeded medications should be disposed in a proper manner to avoid accidental exposure.

An insulin pump is instituted for a client with type 1 diabetes. The nurse plans discharge instructions. Which short-term goal is the priority for this client? 1 "Adhere to the medical regimen." 2 "Remain normoglycemic for 3 weeks." 3 "Demonstrate correct use of the insulin pump." 4 "List three self-care activities that help control the diabetes

ANS: "demonstrate correct use of the insulin pump" Rationale: Demonstrating correct use of the insulin pump is the short-term, client-oriented goal necessary for the client to manage the pump and avoid hypo- and hyperglycemia; this outcome can be measured by observing a return demonstration by the client. Adhering to the medical regimen is not a short-term goal. Remaining normoglycemic for 3 weeks is measurable but requires the client to manage the insulin pump. Although listing three self-care activities that help control the diabetes is a measurable short-term goal, it is not the priority when the client must master use of the insulin pump.

A child is admitted to the hospital with diarrhea and is prescribed antidiarrheal medications. Which nursing actions indicate that the nurse is skilled in safe drug administration to pediatric clients? Select all that apply. 1 The nurse calculates the drug dose according to the weight. 2 The nurse recommends long-term use of the medication. 3 The nurse promotes fluid and electrolyte balance. 4 The nurse assesses the child for the presence of any eating disorders. 5 The nurse assesses the severity of diarrhea by counting the number of stools every 48 hours.

ANS: 1,3,4 rationale: The nurse should calculate the dose according to the weight of the child to ensure accurate dosing. Diarrhea causes rapid loss of fluid volume and electrolytes through the stools; therefore, the nurse should promote fluid and electrolyte balance by ensuring the appropriate intake of fluids. The nurse should assess the child for the presence of eating disorders such as bulimia and anorexia to check for the abuse of laxatives. The nurse should not recommend the long-term use of antidiarrheal medications because they cause toxic effects. The nurse should measure the amount of diarrhea by the number of stools every 24 hours and not for 48 hours.

The primary healthcare provider instructs the nurse to administer a high dose of acyclovir 60 mg/kg/day to a neonate with a body weight of 4.4 lb. What dose does the nurse administer to the neonate each day? Record your answer using a whole number. _______ mg

ANS: 120 Rationale: 4.4 lb/kg x 1 kg/2.2 lb x 60 mg

Cyanocobalamin (vitamin B12) 0.2 mg intramuscularly (IM) is prescribed for a client with pernicious anemia. A vial of the drug labeled "1 mL = 100 mcg" is available. How many milliliters should the nurse administer? Record your answer using a whole number. ___mL

ANS: 2 mL Rationale: mL = 1mL/100 mcg x 1000mcg/1 mg x 0.2 mg

Certain foods and drugs are known to cause serious adverse effects when used in combination with monoamine oxidase inhibitors (MAOIs). Which adverse effect could occur in clients treated with MAOIs for depression? 1 A serious drop in blood pressure 2 A serious increase in blood pressure 3 A significant increase in liver enzymes 4 A significant increase in cholesterol levels

ANS: A serious increase in blood pressure Rationale:MAOIs, when taken with foods high in tyramine (e.g., pickled foods, beer, wine, aged cheeses), drugs such as antidepressants, certain pain medications, and decongestants can cause a life-threatening increase (not decrease) in blood pressure or hypertensive crisis. For this reason they are seldom used to treat symptoms of depression. MAOIs do not increase liver enzymes or cholesterol levels. Test-Taking Tip: Monitor questions that you answer with an educated guess or changed your answer from the first option you selected. This will help you to analyze your ability to think critically. Usually your first answer is correct and should not be changed without reason.

A nurse is planning to administer albuterol to a 4-year-old child. How will the nurse evaluate the effectiveness of this medication? 1 Auscultate breath sounds 2 Collect a sputum sample 3 Conduct a brief neurologic examination 4 Palpate chest excursion to gauge promotion of intercostal contractility

ANS: Auscultate breathe sounds Rationale: Albuterol is an adrenergic drug that stimulates beta-receptors, leading to relaxation of the smooth muscles of the airway. The lungs should be auscultated to evaluate the effectiveness of this medication. Albuterol does not affect the consistency of pulmonary secretions. Albuterol will not cause central nervous system stimulation. Albuterol does not affect intercostal contractility; chest excursion is not the appropriate assessment.

A client residing in an assisted living facility is diagnosed with Parkinson disease, and the healthcare provider prescribes selegiline. What precaution will the nurse teach the client? 1 Change to a standing position slowly. 2 Take the medication between meals. 3 Perform self-blood glucose monitoring. 4 Withhold the next dose if nausea occurs.

ANS: Change to a standing position slowly Rationale: A common side effect of selegiline is dizziness. Safety precautions are necessary to prevent falls caused by orthostatic hypotension. Taking the medication with food or milk limits gastrointestinal irritation. Monitoring blood glucose levels is not necessary. Nausea is a common side effect of selegiline; the medication should not be withheld without the healthcare provider's supervision. Abrupt withdrawal may precipitate a parkinsonian crisis.

A client is admitted for treatment of obsessive-compulsive disorder that is interfering with activities of daily living. Which medication does the nurse anticipate the primary healthcare provider will prescribe? 1 Benztropine 2 Amantadine 3 Clomipramine 4 Diphenhydramine

ANS: Clomipramine Rationale: Clomipramine potentiates the effects of serotonin (antiobsessional effect) and norepinephrine in the central nervous system; it diminishes obsessive-compulsive behaviors. Benztropine and amantadine are antiparkinsonian agents, not antianxiety agents. Diphenhydramine is an antihistamine, not an antianxiety agent.

A healthcare provider prescribes milrinone for a client with a diagnosis of congestive heart failure who was unresponsive to conventional drug therapy. What is most important for the nurse to do first? 1 Administer the loading dose over 10 minutes. 2 Monitor the ECG continuously for dysrhythmias during infusion. 3 Assess the heart rate and blood pressure continuously during infusion. 4 Have the prescription, dosage calculations, and pump settings checked by a second nurse.

ANS: Have the prescription, dosage calculations, and pump settings checked by a second nurse Rationale: Accidental overdose can cause death. Another nurse should verify accuracy of the prescription, dose, and pump settings to prevent harm to the client. Although administering the loading dose over 10 minutes is an appropriate intervention, it is not the first thing the nurse should do. Although monitoring for dysrhythmias is important because they are common with this medication and may be life threatening, it is not the first thing the nurse should do. Although taking the vital signs continuously during the infusion is important because the dose needs be slowed or discontinued if the blood pressure decreases excessively, it is not the first thing the nurse should do.

The nurse suspects serotonin syndrome in a client prescribed second-generation antidepressants for depression. Which assessment findings observed by the nurse would be beneficial in diagnosing the severity of the syndrome? Select all that apply. 1 Delirium 2 Hyperreflexia 3 Hyperthermia 4 Muscle spasms 5 Rhabdomyolysis

ANS: Hyperthermia, rhabdomyolysis Rationale: Serotonin syndrome is a potentially hazardous adverse effect of second-generation antidepressants that are used to treat depression. Hyperthermia and rhabdomyolysis are symptoms observed in severe cases of serotonin syndrome. Delirium, hyperreflexia, and muscle spasms are common symptoms of this syndrome.

Which medication is prescribed to an infant with congenital syphilis? 1 Vidarabine 2 Intravenous (IV) penicillin 3 Pyrimethamine 4 Trimethoprim-sulfamethoxazole

ANS: Intravenous (IV) penicillin Rationale: IV penicillin destroys the cell wall of Treponema pallidum, the causative organism of syphilis. Vidarabine is an antiviral drug; it does not treat congenital syphilis in an infant. Pyrimethamine and trimethoprim-sulfamethoxazole are ineffective in the treatment of syphilis.

The nurse cares for a client with schizophrenia and who is receiving ziprasidone. Which conditions in the client may indicate discontinuation of the drug? Select all that apply. 1 Leukopenia 2 Tachycardia 3 Hypokalemia 4 Hypermagnesemia 5 Prolonged QT interval

ANS: Leukopenia, hypokalemia, prolonged QT interval Rationale: Ziprasidone is a second generation antipsychotic drug indicated for schizophrenia. The drug may cause leukopenia, hypokalemia, and hypomagnesemia. This drug may cause a prolonged QT interval, which indicates torsades de points. Bradycardia may occur in torsades de pointes, but not tachycardia.

In the postanesthesia care unit a client received intrathecal morphine intraoperatively to control pain. Considering the administration of this medication, what should the nurse include as part of the client's initial 24-hour postoperative care? 1 Monitoring of respiratory rate hourly 2 Assessing the client for tachycardia 3 Administering naloxone every 3 to 4 hours 4 Observing the client for signs of central nervous system (CNS) excitement

ANS: Monitoring of respiratory rate hourly Rationale: Intrathecal morphine can depress respiratory function depending on the level it reaches within the spinal column; hourly assessments during the first 12 to 24 hours will allow for early intervention with an antidote if respiratory depression needs to be corrected. Bradycardia, not tachycardia, and hypotension occur. Administering naloxone every 3 to 4 hours is too infrequent if the client's respirations are depressed. The recommended adult dosage usually is 0.4 to 2 mg every 2 to 3 minutes, if indicated. CNS depression occurs secondary to hypoxia.

What are the major reasons that the pediatric population is more sensitive to drugs when compared to adults? Select all that apply. 1 Age 2 Protein binding 3 Blood-brain barrier 4 Renal drug excretion 5 Hepatic drug metabolism

ANS: Protein binding, BBB, Renal drug excretion, hepatic drug metabolism Rationale:In the pediatric population, drugs do not readily bind to protein. This increases the blood concentration of the drug, which potentiates the drug action. Because the blood-brain barrier is not fully developed in infants, these clients would be more sensitive to drugs than adults. The metabolizing capacity of the liver and the excretion capacity of the kidney are very low in children; these factors lead to increased drug sensitivity in the pediatric population. A child's age does not affect the pediatric sensitivity.

A school-aged child is receiving 45 units of intermediate-acting insulin at 7:00 AM and 7:00 PM. What will the nurse tell the parents regarding a bedtime snack? 1 Offer a snack at bedtime if there are signs of hyperglycemia. 2 Provide a bedtime snack to prevent hypoglycemia during the night. 3 Withhold the snack after dinner to prevent hyperglycemia during sleep. 4 Leave a snack at the bedside in case the child becomes hungry during the night.

ANS: Provide a bedtime snack to prevent hypoglycemia during the night rationale: Intermediate-acting insulin peaks in 4 to 12 hours; a bedtime snack will prevent hypoglycemia during the night. Offering a snack at bedtime if there are signs of hyperglycemia is unsafe because it will intensify the hyperglycemia; if hyperglycemia is present, the child needs insulin. Bedtime snacks are recommended for people taking intermediate-acting insulin. When hypoglycemia develops, the child will be asleep; the snack should be eaten before bed.

Which vaccine may cause intussusception in children? 1 Rotavirus 2 Hepatitis 3 Measles, mumps, and rubella 4 Diphtheria, tetanus, and pertussis

ANS: Rotavirus rationale: Rotavirus vaccines very rarely cause intussusception, a form of bowel obstruction in which the bowel telescopes in on itself. Hepatitis vaccines can cause anaphylactic reactions. The measles, mumps, and rubella vaccine may cause thrombocytopenia. The diphtheria, tetanus, and pertussis vaccine carries a small risk of causing acute encephalopathy, convulsions, and a shock-like state.

A client with ascites is scheduled to receive albumin. To have the greatest therapeutic effect, the nurse expects what infusion rate and what oral fluid intake? 1 Slow intravenous (IV) rate and liberal fluid intake 2 Slow IV rate and restricted fluid intake 3 Rapid IV rate and withheld fluid intake 4 Rapid IV rate and moderate fluid intake

ANS: Slow IV rate and restricted fluid intake Rationale: When albumin is administered slowly and oral fluid intake is restricted, fluid moves from the interstitial spaces into the circulatory system so it can be eliminated by the kidneys. Administration should not exceed 5 to 10 mL/min. Oral fluids are restricted to facilitate the optimal effects of the albumin, which shifts fluids from the interstitial spaces to the intravascular compartment. Rapid administration may cause circulatory overload; fluid is restricted, not withheld. Unrestricted fluid intake will limit the shift of fluid from the interstitial to the intravascular compartment, interfering with the optimal effects of the albumin.

A 14-year-old girl in whom scoliosis has been diagnosed undergoes spinal fusion. On the first postoperative day her face is red, she is rigid, and she is crying because she is in pain. She has prescriptions for morphine sulfate for severe pain and an acetaminophen-codeine compound for moderate pain. What information should influence the nurse's choice of analgesic? 1 One dose of morphine may be given, but the drug should be restricted thereafter because it is addictive. 2 Adolescents tend to exaggerate their discomfort, particularly when they are immobilized by surgery or injury. 3 Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic. 4 The acetaminophen-codeine compound is preferred because morphine can cause respiratory depression or respiratory arrest.

ANS: Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic rationale: Spinal fusion causes considerable pain for several days and requires a strong analgesic. The first postoperative day is too early to begin weaning the client from opiates. Adolescents are no more prone to exaggerating their discomfort than clients in any other age group. A more potent analgesic, such as morphine, is needed, and the prescribed dosage should not cause respiratory problems.

A primary healthcare provider prescribes venlafaxine for a client with the diagnosis of major depressive disorder who has been taking herbal medications. When discussing this medication with the client, the nurse will determine whether the client is taking which herbal supplement? 1 Ginseng 2 Valerian 3 Kava-kava 4 St. John's wort

ANS: St. John's wort Rationale: A client who takes venlafaxine, a selective serotonin reuptake inhibitor (SSRI), and St. John's wort concurrently is at risk for serotonin syndrome, a drug-induced excess of intrasynaptic serotonin. Ginseng can precipitate a hypertensive crisis in clients taking a monoamine oxidase inhibitor. Valerian (valerian root) can enhance sedation in clients taking a tricyclic antidepressant. Kava-kava can increase the risk of dystonic reactions in clients taking an antipsychotic medication.

Considering the anticholinergic-like side effects of many of the psychotropic drugs, the nurse will encourage clients taking these drugs to take which action? 1 Restrict their fluid intake. 2 Eat a diet high in carbohydrates. 3 Suck on sugar-free hard candies. 4 Avoid products that contain aspirin

ANS: Suck on sugar-free hard candies Rationale: Hard candy may produce salivation, which helps alleviate the anticholinergic-like side effect of dry mouth that is experienced with some psychotropics. Dry mouth increases the risk for cavities; candy with sugar adds to this risk. Fluids should be encouraged, not discouraged; fluids may alleviate the dry mouth. A diet high in carbohydrates and avoiding aspirin are unnecessary. Test-Taking Tip: What happens if you find yourself in a slump over the examination? Take a time-out to refocus and reenergize! Talk to friends and family who support your efforts in achieving one of your major accomplishments in life. This effort will help you regain confidence in yourself and get you back on track toward the realization of your long-anticipated goal.

A client has received instructions to take 650 mg aspirin every 6 hours as needed for arthritic pain. What should the nurse include in the client's medication teaching? Select all that apply. 1 Take the aspirin with meals or a snack. 2 Make an appointment with a dentist if bleeding gums develop. 3 Do not chew enteric-coated tablets. 4 Switch to acetaminophen if tinnitus occurs. 5 Report persistent abdominal pain.

ANS: Take aspirin with meals or a snack, do not chew enteric-coated tablets, Report persistent abdominal pain Rationale: Aspirin is irritating to the stomach lining and can cause ulceration; the presence of food, fluid, or antacids decreases this response. Enteric-coated tablets must not be crushed or chewed. Aspirin therapy may lead to gastrointestinal bleeding, which may be manifested by abdominal pain; if present, the prescriber must be notified immediately. Bleeding gums should be reported to the practitioner, not the dentist. Acetaminophen does not contain the antiinflammatory properties present in aspirin; tinnitus should be reported to the practitioner.

At 7:00 AM a nurse learns that an adolescent with diabetes had a 6:30 AM fasting blood glucose level of 180 mg/dL (10.0 mmol/L). What is the priority nursing action at this time? 1 Encouraging the adolescent to start exercising 2 Asking the adolescent to obtain an immediate glucometer reading 3 Informing the adolescent that a complex carbohydrate such as cheese should be eaten 4 Telling the adolescent that the prescribed dose of rapid-acting insulin should be administered

ANS: Telling the adolescent that the prescribed dose of rapid-acting insulin should be eaten Rationale: A blood glucose level of 180 mg/dL (10.0 mmol/L) is above the average range, and the prescribed rapid-acting insulin is needed. Although exercise does decrease insulin requirements and does lower the blood glucose level, the immediate action of insulin is needed. Asking the adolescent to obtain an immediate glucometer reading is an action that will not correct the problem; the blood glucose level is already known. Food intake at this time will increase the level of blood glucose.

Allopurinol is prescribed for a 6-year-old child undergoing chemotherapy for cancer of the bone. When given the medication, the child asks, "Why do I have to take this pill?" What is the best response by the nurse? 1 "It protects your body from getting new problems after your treatment is over." 2 "It stops your sick white cells from going to other parts of your body." 3 "You know the healthcare provider wouldn't prescribe anything for you unless it was very important." 4 "With the other medicines, it helps you get rid of the things that are making you sick."

ANS: With the other medicines, it helps you get rid of the things that are making you sick Rationale: Telling the child it helps get rid of the things making the child sick is the most accurate and age-appropriate response to the child's question. Telling the child that the medicine protects the body from new problems is inaccurate, and not being truthful will interfere with the development of the child's trust in the nurse. Telling the child that it stops sick white cells from spreading is inaccurate and may instill more fear. Telling the child that it is needed because the healthcare provider says so is insensitive to the question and does not provide an explanation.

A client with a recent history of sinusitis develops meningitis and demonstrates a positive Brudzinski sign. What is the priority nursing care? 1 Monitoring intracranial pressure 2 Adding pads to the side of the bed 3 Administering prescribed antibiotics 4 Hydrating the client with hypotonic saline

ANS: administering prescribed antibiotics rationale: The Brudzinski sign (when the neck is flexed while in the supine position, flexion of the hips occurs) indicates bacterial meningitis, a complication of sinusitis; the client's greatest need is a regimen of antibiotics to which the causative agent is sensitive. Bacterial meningitis causes increased intracranial pressure and it is important for the nurse to monitor for manifestations of increased intracranial pressure; however, in this circumstance, it is not the priority because monitoring alone does not affect outcomes.Because of the risk for seizures in bacterial meningitis, padded side rails are an important nursing intervention; however, this intervention does not have priority over instituting the appropriate antibiotic therapy to eradicate the cause of the meningitis. The data do not indicate a need for a hypotonic solution for hydrating the client.

what ways can a nurse prevent medication errors? Select all that apply. 1 Avoid using abbreviations and acronyms 2 Minimize the use of verbal and telephone orders 3 Try to guess what the client is saying if the language is not understood 4 Document each dose of the drug using trailing zeros when recording the dose 5 Check three times before giving a drug by comparing the drug order and medication profile

ANS: avoid using abbreviations and acronyms, minimize the use of verbal and telephone orders, check 3 times before giving the drug by comparing the drug and the med profile Rationale: The use of abbreviations is avoided because this action may cause confusion and increase the risk of error. The use of verbal and telephone orders should be minimized to avoid confusion over drugs that have similar names. Before a drug is administered, the dosage order should be checked three times to verify the five rights: right drug, right dose, right time, right route, and right client. The use of trailing zeros should be avoided because it increases the risk of overdose. If the client's language is not understood, a translator's help should be enlisted.

A child who reports shortness of breath, wheezing, and coughing is found to have pulmonary edema and is prescribed furosemide. Which nursing interventions would be beneficial to the client? Select all that apply. 1 Administering the drug on an empty stomach 2 Checking the child's weight every day 3 Calculating the dose of drug as carefully as possible 4 Exposing the child to sunlight for increasing periods 5 Assessing the child regularly to help prevent electrolyte loss

ANS: checking the child's weight everyday, calculating the dose of drug as carefully as possible, assessing the child regularly to prevent electrolyte loss rationale: The child's weight should be checked and recorded daily to aid in the assessment of therapeutic and adverse effects. Pediatric doses should be calculated carefully to prevent an accidental overdose. Pediatric clients are at greater risk of electrolyte loss; therefore, they require closer and more cautious assessment to help prevent hypertension and stroke. Furosemide may cause stomach upset if it is taken on an empty stomach; the child should be given the drug with food to help prevent gastric upset. A child taking diuretics should not be exposed to sunlight for long periods because this action may precipitate fluid volume loss and heatstroke.

The alkylating chemotherapeutic agent cyclophosphamide is prescribed for a school-aged child with cancer. What is the mostimportant nursing assessment while the child is receiving this medication? 1 Extent of alopecia 2 Changes in appetite 3 Hyperplasia of gums 4 Daily intake and output

ANS: daily intake and output Rationale: Hemorrhagic cystitis is a potentially serious adverse reaction to cyclophosphamide that can sometimes be prevented with increased fluid intake because the fluid flushes the bladder. The extent of hydration can be measured with hourly documentation of intake and output. Alopecia is expected; however, it is a benign side effect, and the hair will regrow when therapy is completed. A change in appetite is expected but is not a serious side effect of cyclophosphamide administration. Hyperplasia of the gums is unrelated to cyclophosphamide administration.

A 2-year-old child is admitted with gastroenteritis and dehydration. Peripheral intravenous fluids are prescribed. What is the mostappropriate site for the first intravenous insertion? 1 Scalp vein near the fontanel 2 Venous arch on top of the foot 3 Dorsal metacarpals of the hand 4 Basilic vein at the antecubital fossa

ANS: dorsal metacarpals rationale: The choice of first insertion site should be distal (low) on the periphery of an extremity and progress proximally (upward) toward the trunk; the upper extremities are the most appropriate sites for intravenous insertions for adults and children older than 1 year. Scalp veins are used for infants only if peripheral veins are inaccessible. Foot veins should not be used once a child is walking. The antecubital fossa should be avoided because the arm will have to be immobilized to stabilize the intravenous insertion site to prevent an infiltration.

Which vaccine provides protection from precancerous lesions and cancers of the vulva, cervix, and vagina in young girls and women? 1 Rotarix 2 Varivax 3 Gardasil 4 Menactra

ANS: gardasil rationale: Gardasil is a human papilloma virus (HPV) vaccine used to help prevent precancerous lesions of the cervix, vulva, and vagina caused by HPV types 16 and 18. Rotarix is a monovalent vaccine developed to provide protection against certain rotaviruses, such as G1, G3, G4, and G9. Varivax is a vaccine administered to provide protection against the varicella virus. Menactra is a tetravalent conjugate vaccine that provides protection against certain serotypes of meningococcus, such as A, C, Y, and W-135.

A mother brings her 6-month-old infant with a 3-day history of gastroenteritis to the emergency department. What priority intervention does the nurse anticipate? 1 Placement in a heated crib 2 Withdrawal of blood for testing 3 Insertion of an intravenous catheter 4 Institution of intestinal decompression

ANS: insertion of an intravenous catheter rationale: Gastroenteritis causes a disturbance in intestinal motility and absorption, accelerating excretion and fluid loss, which quickly leads to severe dehydration and fluid and electrolyte imbalance. Intravenous fluids are necessary. A 6-month-old infant does not need the protection of a heated crib; heated cribs are used for newborns and preterm infants. Withdrawal of blood may be done later; it is not the priority in this life-threatening situation. Intestinal intubation with suction is not necessary. Intestinal decompression is used to remove intestinal contents when there is an obstruction or when it is necessary to have the gastrointestinal tract clear of contents.

The health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. What is an action of PTU that the nurse will include in teaching? 1 Increases the uptake of iodine 2 Causes the thyroid gland to atrophy 3 Interferes with the synthesis of thyroid hormone 4 Decreases the secretion of thyroid-stimulating hormone (TSH)

ANS: interferes with the synthesis of thyroid hormone Rationale: PTU, used in the treatment of hyperthyroidism, blocks the synthesis of thyroid hormones by preventing iodination of tyrosine. Propylthiouracil does not increase the uptake of iodine. Iodine solutions reduce the size and vascularity of the thyroid gland. TSH, secreted by the anterior pituitary, is not affected by propylthiouracil.

The nurse is teaching parents about the side effects of immunization vaccines. What expected side effect associated with the Haemophilus influenzae (Hib) vaccine will the nurse include in the teaching? 1 Urticaria 2 Lethargy 3 Low-grade fever 4 Generalized rash

ANS: low-grade fever rationale: The Hib vaccine may cause a low-grade fever as the body reacts to the vaccine. Urticaria is more likely to occur with the tetanus and pertussis vaccines. Lethargy is not expected. There may be a mild reaction at the injection site, but a generalized rash is not expected.

A 55-year-old client who has a long history of drug and alcohol abuse mentions taking ginkgo biloba. The nurse knows that ginkgo biloba is taken to treat what condition? 1 Insomnia 2 Depression 3 Memory impairment 4 Anxiety and nervousness

ANS: memory impairment Rationale: Ginkgo biloba is an herb used to treat age-related memory impairment and dementia. It has not been shown to be effective in treating insomnia, depression, or anxiety. Test-Taking Tip: Do not read too much into the question or worry that it is a "trick." If you have nursing experience, ask yourself how a classmate who is inexperienced would answer this question from only the information provided in the textbooks or given in the lectures.

A 7-year-old child contracts a urinary tract infection. A sulfonamide preparation is prescribed. What is the priority nursing responsibility when the nurse is administering this drug? 1 Weighing the child daily 2 Giving the medication with milk 3 Taking the child's temperature frequently 4 Administering the drug at the prescribed times

ANS administer at scheduled time rationale For the desired blood level to be maintained, the medication must be administered in the exact amount at the times directed. If the blood level of the drug falls, the microorganisms have an opportunity to build resistance to the drug. Weighing is important with drugs that affect fluid balance, such as diuretics. Sulfa medications should be given on an empty stomach to promote absorption. Monitoring the temperature is important with antipyretic drugs.

A client with schizophrenia is given an antipsychotic drug. The nurse recalls all the extrapyramidal effects associated with this type of medication and anticipates that the drug will be discontinued if which occurs?

Tardive dyskinesia Rationale: The protrusion and ventricular movement of the tongue, chewing and puckering of the lips and puffing of the cheeks. Adverse effects may not be reversed when antipsychotic drugs are withdrawn

A client with type 2 diabetes is taking one oral hypoglycemic tablet daily. The client asks whether an extra tablet should be taken before exercise. What is the best response by the nurse? 1 "You will need to decrease your exercise." 2 "An extra tablet will help your body use glucose correctly." 3 "When taking medicine, your diet will not be affected by exercise." 4 "No, but you should observe for signs of hypoglycemia while exercising."

ANS: "No, but you should observe for signs of hypoglycemia while exercising." Rationale: Exercise improves glucose metabolism; with exercise there is a risk of developing hypoglycemia, not hyperglycemia. Exercise should not be decreased because it improves glucose metabolism. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through a balance of diet, exercise, and pharmacologic therapy.

What will a nurse teach the parents of a toddler with newly diagnosed cystic fibrosis about the administration of vitamins A, D, E, and K? 1 Offer them in a water-miscible form. 2 Give them during meals and snack times. 3 The dosage is based on the child's height and weight. 4 Present them to the child with fruit juice rather than milk.

ANS: offer them in a water-miscible form Rationale: Because children with cystic fibrosis do not absorb fat-soluble vitamins effectively, they should be given in a water-miscible form. These vitamins may be given with other vitamins once a day; pancreatic enzymes are administered with meals and snacks. The nurse does not have to base the dosage of these vitamins on the child's height and weight. There is no reason to select juice over milk when administering these vitamins.

To prevent excessive bruising when administering subcutaneous heparin, what technique will the nurse employ? 1 Administer the injection via the Z-track technique 2 Avoid massaging the injection site after the injection 3 Use 2 mL of sterile normal saline to dilute the heparin 4 Inject the drug into the vastus lateralis muscle in the thigh

ANS: Avoid massaging the injection site after the injection Rationale: The site of the injection should not be massaged to avoid dispersion of the heparin around the site and subsequent bleeding into the area. The Z-track technique and the intramuscular route are not used with heparin; subcutaneous injection and intravenous administration are the routes appropriate for heparin administration. The drug should be injected into the subcutaneous tissue slowly, not quickly. Diluting heparin with normal saline is unnecessary. Generally heparin is provided by the pharmacy department in single-dose syringes.

A nurse provides discharge teaching about ampicillin that is prescribed for a client. The nurse evaluates that the teaching is effective when the client makes which statement? 1 "I will miss eating grapefruit." 2 "I must increase my fluid intake." 3 "I can stop taking this medication any time." 4 "I should take this medication just after eating."

ANS: "I must increase my fluid intake" Rationale: The client should increase fluid intake when taking ampicillin to prevent nephrotoxicity; side effects include oliguria, hematuria, proteinuria, and glomerulonephritis. An antibiotic should be continued until the entire prescription is completed; discontinuing before completion lowers its serum level, thereby decreasing its effectiveness. Ampicillin should be taken when the stomach is empty, either one to two hours before eating or three to four hours after eating. There are no restrictions on eating grapefruit when taking an antibiotic; this is contraindicated when taking some calcium channel blockers because grapefruit juice increases their serum level.

A 4-year-old child with newly diagnosed leukemia is admitted for chemotherapy. While assisting with morning care the nurse observes bloody expectorant after the child has brushed the teeth. How will the nurse respond to this occurrence? 1 By securing a smaller toothbrush for the child to use 2 By documenting and reporting the incident 3 By telling the child to be more careful when brushing the teeth 4 By rinsing the child's mouth with half-strength hydrogen peroxide

ANS documenting and reporting the incident rationale

A nurse is counseling a client who is taking lithium carbonate. What is the priority nursing assessment when a client is taking this medication? 1 Daily weights 2 Psychomotor activity 3 Red blood cell counts 4 Blood level of the drug

ANS: Blood level of the drug Rationale: The therapeutic level of lithium carbonate is very close to the toxic level. Therefore it is vital that blood levels of the drug be checked twice a week during the acute phase and bimonthly once the client is on a maintenance dosage. Lithium does cause some weight gain, but daily weights are not necessary. Although psychomotor activity assessment should be done, it is not the priority. Lithium does not affect red blood cells.

The healthcare provider prescribes mebendazole for a 4-year-old child with pinworms. For which expected response to the medication does the nurse teach the parents to be alert? 1 Blood 2 Constipation 3 Yellow stools 4 Passage of worms

ANS: passage worms rationale: Passage of worms is the expected response because the medication causes the death of the worms. Neither the drug nor the worms cause intestinal bleeding. Transient diarrhea, not constipation, may occur. The medication may color the stool red, not yellow.

A 4-year-old child who weighs 44 lb (20 kg) is prescribed prednisone. The recommended dosage for children is 2 mg/kg/day given in four divided doses. What will the child receive in each dose? Express your answer as a whole number. ______ mg

ANS: 10 mg Rationale: mg = 2 mg / kg x 20 kg / 4 doses

Which drugs are used as the first-line treatment for posttraumatic stress disorder (PTSD)? Select all that apply. 1 Sertraline 2 Paroxetine 3 Phenelzine 4 Venlafaxine 5 Amitriptyline

ANS: Sertraline, Paroxetine Rationale: Sertraline and paroxetine are selective serotonin reuptake inhibitors that are approved by the Food and Drug Administration as a first-line treatment for posttraumatic stress disorder (PTSD). If these drugs are ineffective, the use of phenelzine, venlafaxine, and amitriptyline is indicated.

A client who is on long-term corticosteroid therapy following an adrenalectomy is admitted to the surgical intensive care unit after being involved in a motor vehicle crash. What is the nurse's most important concern related to the client's history? 1 The dosage of steroids may have to be tapered down slowly. 2 Steroid therapy will need to be increased to avert a life-threatening crisis. 3 Osteoporosis secondary to long-term corticosteroids increases fracture risk. 4 The client will be at greater risk of infection secondary to immunosuppression.

ANS: steroid therapy will need to be increased to avert a life-threatening crisis rationale: Clients with adrenocorticoid insufficiency who are receiving steroid therapy usually require increased amounts of medication during periods of stress because they are unable to produce the excess needed by the body. With severe stress, a failure to ensure adequate corticosteroid levels can be life threatening. Increased stress requires an increase, not decrease, in glucocorticoids. Although osteoporosis may have contributed to fractures secondary to trauma, this does not present a current risk in the critical care unit. Although immunosuppression is a risk concern, the issue of inadequate corticosteroid is an actual concern, and prompt treatment for adrenal insufficiency is urgent.

A nurse is educating a client who is taking clozapine to treat schizophrenia. Which adverse effect of clozapine will the nurse emphasize to the client as being important to report to the healthcare provider? A. High risk for falls b. Inability to sit still c. Temperature rise d. Tardive dyskinesia

ANS: temperature rise Rationale: The nurse should emphasize to the client that it is important to report a rise in body temperature (fever) to the healthcare provider because clozapine can cause agranulocytosis (diminished immunity), which can promote infection. The inability to sit still (akathisia), tardive dyskinesia (involuntary repetitive body movements), and a higher risk for falls are more common with typical antipsychotics because of extrapyramidal side effects.

A child is diagnosed with classic hemophilia. A nurse teaches the child's parents how to administer the plasma component factor VIII through a venous port. It is to be given three times a week. When should the parents administer this therapy? 1 Whenever a bleed is suspected 2 In the morning on scheduled days 3 At bedtime while the child is lying quietly in bed 4 On a regular schedule at the parents' convenience

Ans: in the morning on scheduled days rationale: Factor VIII has a short half-life; therefore prophylactic treatment involves administering the factor on the scheduled days in the morning so the child will get the most benefit during the day, while he is most active. Prophylactic treatment is administered on a scheduled basis to prevent bleeds from occurring. Administering the drug at bedtime will limit its effectiveness because bleeds are more common when the child is active. Administering the medicine on a regular schedule at the parents' convenience does not take into consideration the properties of the drug.

A nurse notes that haloperidol is most effective for clients who exhibit which type of behavior?

Overactivity Rationale: Haloperidol reduces emotional tension, excessive psychomotor activity, panic, and fear. It is used for clients with thought disorders and hyperactivity. Clients exhibiting excited-depressed behavior do not respond well to haloperidol, because it tends to worsen the depression. Haloperidol appears to have few stimulating effects for a withdrawn client and, in fact, increases feelings of lassitude and fatigue. Haloperidol does not decrease manipulative behavior. Clients who are capable of manipulation usually do not exhibit behavior that involves overactivity, fear, and panic.