Pharmacology

*An intramuscular injection was given instead of a subcutaneous injection.* Performance deficits such as using an improper route of administration for a medication are the most common causes of medication errors that result from human error.

A nurse has administered a medication to a client. Which circumstance should the nurse identify as a medication error that resulted from a performance deficit by the nurse?

*"The excretion of medication is reduced."* Additional info: Gastric emptying and motility slow with age, decreasing the absorption level of medications. The rate at which the liver metabolizes medication declines with age. The amount of medication stored in fatty tissue does not decrease, but the amount of lean body mass tends to decrease with age, which can reduce available sites for protein-bound medications. The total amount of water in the body also decreases with age and can increase the concentration of water-soluble medications.

A nurse in a LTF is administering medications to a group of older adults. Which factor of pharmacokinetics should the nurse consider when caring for this age group?

*Tuberculosis* Isoniazid and rifampin are the first-line antitubercular medications used to treat active tuberculosis. The medications are used in combination therapy.

A nurse in a community health clinic is assessing a new client who has prescriptions for isoniazid and rifampin. Which disorder should the nurse expect the client to have?

*Provide the client and the next care provider with a list of medications the client will take after discharge*

A nurse in a cute care facility is preparing a reconciled list of medications being discharged home. Which action should the nurse take?

*Dry mouth* Hydroxyzine has anticholinergic properties. Dry mouth is a common adverse effect of this medication. The nurse should instruct the client to take sips of water or suck hard candies to minimize this effect.

A nurse is administering oral hydroxyzine to a client. Which adverse effect should the nurse instruct the client to expect?

*Parenteral thiamine* The nurse should identify that a client who has a history of alcohol use disorder and displays ataxia, and altered LOC, and nystagmus is exhibiting manifestations of Wernicke-Korsakoff syndrome due to a thiamine deficiency. Therefore, the nurse should anticipate administering parenteral thiamine.

A nurse is assessing a client who was recently admitted and has a history of alcohol use disorder. The client displays ataxia, and altered LOC, and nystagmus. Which medication should the nurse anticipate administering to the client?

*Bleeding* The nurse should identify that an adverse effect of alteplase is bleeding.

A nurse is caring for a client who had a myocardial infarction 2 hrs ago and is receiving alteplase. Which finding should the nurse identify as an adverse effect of receiving this medication?

*Check the client's apical pulse* Nausea, anorexia, fatigue, visual effects, and cardiac dysrhythmias are possible findings in digoxin toxicity.

A nurse is caring for a client who has CHF and is taking digoxin. The client reports nausea and refuses to eat breakfast. Which action should the nurse take first?

*Celecoxib* The nurse should anticipate that the provider will prescribe celecoxib, which is a NSAID. This medication or another NSAID should be initiated for a client who has a new diagnosis of rheumatoid arthritis.

A nurse is caring for a client who has a new diagnosis of rheumatoid arthritis. The nurse should anticipate a prescription from the provider for which medication for daily management of this condition?

*Migraine headaches* Ergotamine prevents or stops a migraine headache by blocking alpha-adrenergic receptors in the cranial peripheral vascular smooth muscle, which causes vasoconstriction of dilated cerebral blood vessels.

A nurse is caring for a client who has a new prescription for ergotamine. The nurse should recognize that ergotamine is administered to treat which condition?

*Reduced cramping, aching, and burning neuropathic pain* The nurse should identify that gabapentin is administered to treat neuropathic pain that is sharp and darting. The medication can also decrease cramping, aching, and burning pain and suppress spontaneous neuronal firing that causes pain.

A nurse is caring for a client who has cancer involving the lumbar vertebrae and has been prescribed gabapentin. Which therapeutic effect should the nurse identify for the client when taking this medication?

*Grapefruit juice* Grapefruit juice is contraindicated for a client who is taking simvastatin because it raises blood levels of the medication significantly by inactivating a liver enzyme that is responsible for metabolism.

A nurse is caring for a client who has hyperlipidemia and is receiving simvastatin 40 mg PO daily. Which item should the nurse remove from the client's breakfast tray before it is delivered to the room?

*"My body aches all over."* The adverse effects of interferon beta-1a can include flu-like symptoms such as general body and muscle aches.

A nurse is caring for a client who has multiple sclerosis and is receiving interferon beta-1a. The nurse should identify that which client statement indicates a potential adverse effect of the medication?

*"I have noticed my urine is orange in color."* The nurse should identify that an adverse effect of rifampin can be red-orange colored urine, saliva, sweat, and tears as the medication is excreted from the body. This adverse effect is harmless.

A nurse is caring for a client who has tuberculosis and is taking rifampin. Which client statement should indicate to the nurse that the client is experiencing an adverse effect of the medication?

*Chlordiazepoxide* The nurse should expect to administer chlordiazepoxide to a client who is experiencing manifestations of acute alcohol withdrawal. Chlordiazepoxide is a benzodiazepine; this class of medications is often used to facilitate alcohol withdrawal by decreasing withdrawal manifestations, stabilizing vital signs, and preventing seizures and delirium tremens.

A nurse is caring for a client who is experiencing acute alcohol withdrawal. The nurse should expect to administer which medication?

*Nitroglycerin* The nurse should administer nitroglycerin to treat angina. Nitroglycerin acts directly on vascular smooth muscle to promote vasodilation.

A nurse is caring for a client who reports crushing chest pain. The nurse reviews the client's ECG results and notes ST changes. Which medication should the nurse administer?

*CBC* The nurse should identify that sulfasalazine can cause bone marrow suppression, which can lead to agranulocytosis, hemolytic anemia, and macrocytic anemia. As a result, the client's CBC should be periodically monitored, and the nurse should review it prior to administering this medication.

A nurse is caring for a client who takes sulfasalazine twice daily for rheumatoid arthritis. Which value should the nurse review prior to the administration of the medication?

*Weight* The nurse should use the child's weight to calculate the medication dose. Children's doses are generally written in units of measure per body weight.

A nurse is preparing to administer a medication to a preschooler. The nurse should use which measurement to calculate the medication dosage?

*"I'm likely to develop higher blood pressure while taking this medication."* Half of the clients who take cyclosporine develop a 10%-15% increase in blood pressure and might need to start antihypertensive therapy.

A nurse is providing discharge teaching to a client who had a kidney transplant and has a prescription for oral cyclosporine. Which statement by the client indicates an understanding of the teaching?

*"Verapamil is used to treat both high blood pressure and angina."* Verapamil is a CCB that is used for both HTN and anginal pain because of its ability to dilate arteries and decrease afterload.

A nurse is providing discharge teaching to a client who has angina pectoris and a new prescription for verapamil. The client tells the nurse, "My brother takes verapamil for high blood pressure. Do you think the provider made a mistake?" Which response should the nurse make?

*"Stop taking the cyclosporine for 24 hr and then begin taking the tacrolimus."* The nurse should instruct the client that these medications should not be taken concurrently due to the increased risk of developing nephrotoxicity. The client should stop cyclosporine for 24 hr prior to beginning tacrolimus prescription.

A nurse is providing teaching for a client who has received a liver transplant and has a prescription to transition from cyclosporine to tacrolimus. Which instruction should the nurse include in the teaching?

*"I should notify my provider immediately if my urine turns an orange color."* Phenazopyridine is a urinary tract analgesic used to relieve pain and burning during urination. The medication can cause the client's urine to turn a reddish-orange color. This coloration is an expected effect of this medication and does not need to be reported to the provider.

A nurse is providing teaching to a client who has a UTI and new prescriptions for phenazopyridine and ciprofloxacin. Which statement by the client indicates a need for further teaching?

*Absolute neutrophil count 1200 mm^2* The nurse should identify that an absolute neutrophil count of 1200 mm^3 is less than expected reference range of 2500-8000. An adverse effect of clozapine can include agranulocytosis, which is a life threatening condition in which WBCs are severely decreased.

A nurse is reviewing the laboratory data for a client who is receiving clozapine for schizophrenia. The nurse should identify which finding as a potential adverse effect of the medication?

*"If I experience severe diarrhea, I will call my doctor."* Clients who experience diarrhea while taking omeprazole or other PPIs should report this finding to the provider immediately. Omeprazole and other PPIs are associated with a dose-related increase in the risk of infection with C. difficile, which is a bacterium that causes severe diarrhea.

A nurse is teaching a client about adverse effects of omeprazole. Which client statement indicates an understanding of the teaching?

*"Limit your consumption of dairy products while taking this medication."* The nurse should tell the client to avoid or limit the consumption of dair products while taking tetracycline. An interval of at least 2 hrs should separate tetracycline ingestion and the ingestion of products that can chelate this medication such as milk or calcium.

A nurse is teaching a client about taking tetracycline PO. Which statement should the nurse include in the teaching?

*"I should change positions slowly while getting out of bed."* The nurse should identify that isosorbide mononitrate is an antianginal medication that produces vasodilation. Therefore, this medication can cause orthostatic hpotension.

A nurse is teaching a client who has a new diagnosis of angina and has a prescription for isosorbide mononitrate 10 mg PO twice daily. Which client statement indicates an understanding of the teaching?

*"I should let my doctor know if I have yellowing of my eyes."* The nurse should include in the teaching that jaundice can be an adverse effect of ezetimibe as a result of hepatitis. The client should notify the provider if this occurs.

A nurse is teaching a client who has a new ezetimibe prescription for hyperlipidemia. Which client statement should indicate that the teaching was effective?

*"I should apply this patch behind my ear."* The nurse should identify that scopolamine patches should be applied behind the ear.

A nurse is teaching a client who has a prescription for scopolamine patches for the treatment of motion sickness. Which client statement should indicate to the nurse that the teaching has been effective?

*"I should take a calcium supplement while on this medication."* An adverse effect of systemic glucocorticoid therapy is osteoporosis. Increasing calcium-rich foods in the diet and adding calcium and vitamin D supplements should be encouraged to prevent osteoporosis and decrease the risk of fractures.

A nurse is teaching a client who has systemic lupus erythematosus about a new prescription for oral glucocorticoid therapy. Which client statement indicates an understanding of the teaching?

*"This method works by keeping my opioid levels steady."* The nurse should tell the client that a PCA pump is effective for pain control because it delivers a small amount of medication continuously rather than administering a large amount of medication infrequently.

A nurse is teaching a client who is starting patient controlled PCA following a procedure. Which client statement indicates an understanding of the teaching?

*Apply topical lidocaine to affected areas that are intact.* The nurse should tell the client to apply topical lidocaine to skin that is intact rather than blistered, broken, or irritate to prevent a large amount of medication from being absorbed and to decrease the risk of systemic toxicity.

A nurse is teaching a client who is using topical lidocaine about preventing systemic toxicity. Which piece of information should the nurse include about the application of topical lidocaine?

*"This medication can decrease bacteria in the GI tract."* The nurse should include in the teaching that bismuth subsalicylate can assist by eliminating the bacteria H. pylori, which can cause PUD.

A nurse is teaching a client with a new diagnosis of PUD who has a prescription of bismuth subsalicylate. The client asks the nurse, "How will this medication help my ulcer?" Which statement should the nurse make?

*Having a second nurse check the PCA setting* The nurse should have a second nurse check the PCA setting to ensure the correct amount of medication is being administered to the client.

A nurse is teaching a newly licensed nurse about caring for a client who is receiving patient-controlled analgesia. Which action by the newly licensed nurse indicates an understanding of the teachinig?

*Piperacillin* Clients who have a severe allergy to piperacillin, which is a penicillin, can have a cross sensitivity to ceftriaxone, a third-generation cephalosporin. Ceftriaxone is contraindicated for the client who has an allergy to cephalosporins or a severe allergy to penicillin.

A nurse is teaching a newly licensed nurse about contraindications to ceftriaxone. The nurse should include a severe allergy to which medication?

*"Your child will not be able to receive the MMR vaccine for at least 3 months after discharge."* The nurse should explain to the guardian that IVIG given for the treatment of KD contains antibodies that can interfere with the action of live-virus vaccines like MMR. The MMR immunization should be postponed for 3-6 mos.

An 18-month old toddler who has Kawasaki disease is receiving IV immune globulin. The guardian asks the nurse to administer the child's schedule measles, mumps, and rubella vaccine before discharge. Which response should the nurse provide?