pharmacy evolve questions
A female client tells the practical nurse (PN) that she started taking an over-the-counter herbal supplement, St. John's Wort (Hypericum perforatum), last week. Which question should the PN ask the client?
"Have you felt sad or depressed lately?" St. John's Wort is an herbal supplement that is often used for depression. The nurse should further explore why the client felt the need for taking this over-the-counter (OTC) herb and determine if the client is at risk for suicide (B). Gingko, not St. John's Wort, is often used to improve memory (A). Although all OTC medications should be included in the client's medication list, (C) is not indicated at this time. The vitamin niacin causes facial flushing (D)
An elderly female client who is starting a pain management program using opioid analgesia receives a prescription for codeine 10 mg PO q4 hours PRN for pain, or codeine 15 mg PO q4 hours PRN for pain, or codeine 30 mg PO q4 hours PRN for pain. Which statement by the client is most important to consider when deciding on the dose to administer at this time?
"I wonder if I will have to stop taking my diuretic for my kidney problem." Decreased kidney function in an elderly client can cause life-threatening complications, such as respiratory depression, when opioid analgesics, such as codeine, are introduced (C). The correct action is to start with the lowest dose when the client is known to have decreased kidney function. Addiction is not as common of an occurrence when the medication is used for a legitimate need (A). Sedation is an expected side effect of the narcotic, but is not life-threatening (B). Constipation is a treatable side effect (D).
Enoxaparin (Lovenox) 40 mg subcutaneous is prescribed to be administered twice within 24 hours. Which times of administration are best for the practical nurse (PN) to give the injections?
0700 and 1900 Twice a day in 24 hours is best spaced q12 hours (D), which is the best time frame for the administration of low-molecular weight heparin dosing. (A) is a common time schedule for BID or twice a day medication administration that does not need to be evenly spaced within the 24 hour clock. (B) is 8 hours apart. (C) is 14 hours apart.
The practical nurse (PN) is orienting a new nurse at the immunization clinic. What information provided by the new nurse indicates a need for further orientation?
A 40-year-old client is encouraged to receive yearly influenza and pneumonia vaccinations. Annual flu shots are recommended and a one-time pneumonia vaccination should be given to all persons over 65 years of age unless comorbidities increase one's risk for pneumococcal infection. The new nurse should be given further information about vaccination recommendations (C). (A, B, and D) are accurate
Which client situation requires a response from the practical nurse?
A client who takes metformin (Glucophage) is scheduled for a test using iodine dye. Glucophage, which is used to treat type 2 diabetes, should be temporarily discontinued before a client has a diagnostic test that requires the use of iodine-based dye, which places the client at risk for renal complications (C). (A) is a harmless, common side effect of Niacin. (B) is a common side effect of albuterol (Ventolin). Ampicillin can alter the normal bowel flora and cause (D), a common side effect.
An older client with a broken humerus received an IV dose of morphine in the emergent care center. Thirty minutes later, the client complained of feeling lightheaded and vomits once. The practical nurse (PN) understands which process is most likely the cause for these symptoms?
A side-effect. A common side effect (C) of opiate narcotic agents is nausea and vomiting. Although the PN should consider (A, B, and D), the recently administer morphine is likely causing side effects.
Glipizide (Glucotrol) 10 mg BID is prescribed for a client with type 2 diabetes mellitus. Breakfast is served at 0800, and dinner is served at 1700. Which action should the practical nurse (PN) implement?
Administer 30 minutes before a meal BID if capillary glucose is greater than 70 mg/dl. Glipizide, an oral hypoglycemic agent that stimulates the pancreas to secrete more insulin, should be administered 30 minutes prior to a meal if the blood glucose is within a normal range (70 to 110 mg/dl) (A). Capillary glucose is evaluated just prior to the administration of glipizide, not 2 hours after meals (B). This hypoglycemic agent should be administered before a meal so the drug can be effective when the client eats, not (C). The client's preprandial blood glucose level is used to determine if glipizide should be withheld (D)
A client with type 2 diabetes mellitus receives glargine (Lantus) insulin 10 units every evening and lispro (Humalog) insulin 5 units TID. Which information should the practical nurse (PN) reinforce in a teaching session?
Administer Humalog 15 minutes before each meal. Humalog is a rapid acting insulin with a short duration and should be administered within 15 minutes of meals (C). Lantus is a basal insulin which does not have a peak action, so (A) is unlikely. Serum glucose levels are controlled by ongoing insulin administration and is given even if the current glucose is within the normal range, not just at levels above 140 mg/dl (B). Lantus insulin should not be mixed with any other insulin in the same syringe (D).
A postoperative client is receiving hydromorphone (Dilaudid) via an epidural administration. The practical nurse (PN) notes the client is constantly scratching his arms. Which action should the PN take?
Administer diphenhydramine (Benadryl) PRN. Pruritis (itching) is a common side effect of opioids that are administered via intraspinal (i.e., epidural, intrathecal) routes. An antihistamine, such as diphenhydramine (Benadryl) (B), should be given to relieve the client's itching. Pruritis is a known side effect, not an allergic response, so (A) is not indicated. The client is not experiencing an overdose response, so (C) is not indicated. Although lotion applied to the client's dry skin (D) can provide some relief, the use of Benadryl is most effective in relieving the client's response to epidural administration of an opioid.
A client returns to the postoperative unit with prescriptions for morphine 5 mg IM q4 hours PRN pain and morphine 10 mg IM q4 hours PRN pain. At 1300, the practical nurse (PN) administers morphine 5 mg IM for the client's rated pain of "8" on a 0 to 10 scale. At 1500, the client rates the pain at "7." Which intervention should the PN implement?
Administer morphine 5 mg IM now. Additional analgesia within the prescribed range may be administered (A) 20 to 30 minutes after the first administration. The client should receive additional pain medication within the prescription range and time frame, not (B). The client continues to experience significant pain, and the total amount of prescribed analgesia should be given prior to contacting the healthcare provider (C). (D) is not a prescribed dose.
An older male has a PRN prescription for lorazepam (Ativan) for intermittent agitation and confusion. After observing that the client is becoming increasingly restless and making inappropriate comments, what action should the practical nurse take?
Administer the Ativan as prescribed. Because the client is currently exhibiting agitation and confusion, Ativan should be administered as prescribed (B). A client who is agitated and inappropriate should not be given the choice regarding the need for the medication (A). There is no need to wait for worsening symptoms when the current symptoms, which most likely will escalate, indicate the need for the drug (C). The client has significant signs beyond behavioral interventions (D) that indicates the need for "chemical restraint" as prescribed.
The practical nurse (PN) is giving gabapentin (Neurontin) to a male client and asks him if he has a history of seizures. The client states he does not have seizures but has a history of chronic burning and numbing pain in both legs. What action should the PN take?
Administer the medication as prescribed. Neurontin is effective for painful neuropathies, so the PN should administer the medication (A). (B and C) are unnecessary. (D) is not indicated.
Which medication prescription should the practical nurse administer for a client who is having an asthmatic episode?
Albuterol (Proventil). Albuterol (Proventil) (D), a rescue bronchodialator used for clients with asthma, is indicated for this client's acute asthmatic episode. (A, B, and C) are not indicated for asthmatic bronchospasm.
Which finding by the practical nurse indicates that the client's use of ipratropium bromide (Atrovent) inhaler was effective?
Bilateral breath sounds are clear. Atrovent, an anticholinergic, antimuscarinic bronchodilator, decreases excessive bronchiole secretions and clears wheezing. Clear bilateral breath sounds (D) provide the best evaluation of the drug's effectiveness. It is not used as an anti-infective treatment (A and C). Although the respiration rate (B) is within normal limits, the client may continue to manifest wheezing.
A client is receiving a nitroglycerin transdermal patch daily. Which assessment finding indicates that the practical nurse (PN) should withhold the next dose?
Blood pressure 90/60 mmHg. Nitroglycerin causes vasodilation and can result in hypotension (A), which is an indication to withhold the dose and notify the healthcare provider. (B) is not an indication to withhold the drug. Crackles (C) are an abnormal finding but do not necessitate withholding the transdermal patch. (D) indicates the need to rotate the application site, not withhold the medication.
The practical nurse (PN) is administering a daily dose of nifedipine (Procardia) 60 mg extended release to a client with angina pectoris. Which finding should the PN consider withholding the medication?
Blood pressure of 96/52. Procardia is a potent vasodilator and lowers blood pressure. Although daily calcium channel blockers should be given regularly, the PN should withhold the next dose for a low blood pressure (A) and report the finding to the healthcare provider. Procardia does not have a significant effect on (B, C, and D).
The practical nurse (PN) is reviewing the laboratory results for a client who is taking sulfasalazine (Azulfidine) for an exacerbation of inflammatory bowel disease (IBD). Before administering the next dose, which laboratory results warrant further action by the PN?
Blood urea nitrogen (BUN) is 30 mg/dL and creatinine is 1.5 mg/dL. The BUN and creatinine levels (A) (norm BUN 10-20 mg/dL and serum creatinine 0.5-1.1 mg/dL) are higher than normal, which indicate the need for hydration that requires further treatment. The client is likely to have an elevated WBC and elevated neutrophils due to the IBD exacerbation (B). Anemia (C) and low potassium (norm 3.5-5.0 mEq/L) (D) can occur due to the IBD exacerbation, but these findings do not affect the drug administration.
The practical nurse (PN) is administering secondary infusions of vancomycin (Vancocin) and gentamicin (Garamycin) to a client with kidney infection and colitis due to Clostridium difficile . Which laboratory results should the PN review before administering the medications?
Blood urea nitrogen and serum creatinine. Vancomycin and gentamicin are nephrotoxic, which should be evaluated by reviewing the client's current serum values for blood urea nitrogen and creatinine (D). (A, B and C) do not provide the best evaluation of renal function.
The practical nurse (PN) is caring for a client with hypokalemia who is receiving IV potassium chloride (KCl). Which finding should the PN identify as a therapeutic response?
Bowel sounds auscultated at 20 gurgles/minute. Potassium replacement for a client with hypokalemia should improve smooth and skeletal muscle strength, so normal peristalsis findings are indicative of a therapeutic response (A). (B) is not a therapeutic response of KCl replacement. (C) is indicative of hyperkalemia, not a return to a normal serum level. Muscle strength of 2+ indicates significant weakness (D), which is not a therapeutic response.
After a thyroidectomy, a client's facial muscles twitch when the practical nurse (PN) taps the skin surface in front of the ear. Which prescription should the PN administer?
Calcium gluconate. A potential complication for a client after thyroidectomy is damage to the parathyroid glands that can cause hypocalcemia, which is manifested by a positive Chvostek's sign. Supplemental calcium gluconate (D) should be administered immediately. (A, B, and C) are not indicated by the client's findings.
Forty minutes after a client with pulmonary edema receives furosemide (Lasix) 40 mg, 50 ml of concentrated dark amber urine is in the indwelling urinary catheter's bedside drainage bag. What action should the practical nurse (PN) implement first?
Check the urinary drainage system for kinks. Lasix is a high ceiling diuretic and urinary output should increase readily after IV administration. The urinary drainage system should be checked (A) to ensure that urine flow is not obstructed. (B, C, and D) can be implemented after (A).
A client who is admitted for bradycardia receives a prescription for atropine. Which client information should the practical nurse report to the healthcare provider?
Chronic constipation and diverticulosis. Anticholinergics agents increase the heart rate but also slow peristalsis. The client's history of chronic constipation and diverticulosis (C) should be reported to the healthcare provider so additional treatment can be implemented to manage potential side effects, such as constipation. (A, B, and D) do not impact the use of atropine.
The practical nurse (PN) reinforces preoperative instructions to a client scheduled for abdominal surgery. Which medication should the PN tell the client to stop taking 7 days prior to the surgery?
Clopidogrel (Plavix). Plavix (A) prevents platelet aggregation and prolongs bleeding time, so it should be discontinued for 7 days preceding surgery. ACE inhibitors (B), potassium-sparing diuretics (C), and angiotensin II receptor blocker agents (D) should not be discontinued preoperatively.
For the past 3 months, a client has taken prednisone (Deltasone) 40 mg PO daily. What information is most important for the practical nurse (PN) to reinforce with the client about this medication?
Do not abruptly stop the medication. The PN should reinforce the information that glucocorticosteroids, such as prednisone, should not be abruptly stopped because abrupt withdrawal can precipitate Addison's crisis (A). Instructions regarding the possible side effects, such as fluid retention (B), cataracts (C), and gastric irritation (D) do not have the priority of (A).
Which action should the practical nurse (PN) implement for a client who is recently diagnosed with myasthenia gravis?
Give neostigmine bromide (Prostigmin) before meals. Myasthenia gravis affects upper body muscles and muscles used for swallowing. Prostigmin, which intensifies transmission in the neuromuscular junction, should be given before meals (A) to provide a therapeutic response that reduces the risk of dysphagia and aspiration during meals. Prednisone, which has been used in autoimmune diseases such as myasthenia gravis, should be administered with food, not (B). Distal extremities are least likely to be affected, so (C) is not required. Although the client's eye movement can be affected, (D) is not indicated at this time.
A client with increased intracranial pressure (ICP) is receiving an infusion of mannitol 25% (Osmitrol). Which finding indicates to the practical nurse (PN) that the medication is effective?
Glasgow Coma Scale (GCS) score of 15. Mannitol is an osmotic diuretic that is administered to reduce intracranial swelling, so a GCS of 15 (B) is a sensitive indicator of neurologic status that changes as cerebral edema resolves. (A) is an expected response of mannitol but is not indicative of a therapeutic decrease in cerebral edema. Although headache is a symptom of ICP, (C) does not imply a reduction in ICP. Mannitol does not affect body temperature (D).
Which co-morbidity of a client who is starting thyroid replacement should the practical nurse report to the healthcare provider?
History of dysrhythmias. Thyroid supplement can increase the heart rate and precipitate angina in a client who has a history of cardiac disease and dysrhythmia (C). (A, B, and D) do not impact the client's use of thyroid replacement therapy.
The healthcare provider calls in a telephone prescription for digoxin (Lanoxin) of 2.5 mg PO now. The practical nurse (PN) questions the dosage, and the provider confirms that the dose is correct. Which action should the PN take?
Hold the administration of the drug dose and notify the charge nurse. The drug dosage is outside the therapeutic dosing range and should not be administered (C) and the charge nurse should be notified for additional support with this decision. Although (B) may be indicated for a client receiving digoxin, the dose should be corrected before administering. Regardless of the client's current digoxin level (A) or apical heart rate (D), a dose higher than a safe range should not be administered (A).
A male client whose postoperative patient-controlled analgesia (PCA) pump is discontinued receives a prescription for hydrocordone bitartrate with acetaminophen (Vicodin) 2 tablets PO every 4 hours for pain. One hour after receiving the prescribed dose of Vicodin, the client states he is having pain rated as "11" on a 0 to 10 pain scale. Which action should the practical nurse (PN) implement?Inform the charge nurse about the client's status.
Inform the charge nurse about the client's status. The client's rating should be evaluated because the client is indicating that the pain is unbearable. The PN should inform the charge nurse (A) so that a new prescription can be obtained from the healthcare provider. (B, C, and D) are not indicated at this time.
The practical nurse (PN) is reinforcing medication teaching to a client who receives a prescription for lovastatin (Mevacor). Which symptom should the PN tell the client to report immediately?
Muscle aching. Severe muscle aching (B) can be a sign of rhabdomyolysis, a potential serious complication of statins. Although constipation and diarrhea are side effects of statins, (A) does not need to be reported immediately. (C) is unrelated to the use of statins. A hacking cough (D) is most commonly associated with ACE inhibitors, not statins.
What criterion provides the best indication to the practical nurse that albuterol (Ventolin) nebulizing treatment is effective for a client with asthma?
No wheezing is audible or auscultated. Ventolin, a bronchodilator, allows an increased airflow through bronchioles, which reduces adventitious sounds. No audible or auscultated wheezing (A) indicates that the treatment for bronchospasm was effective. (B) is not indicative of adequate oxygenation. (C) is a therapeutic response to supplemental oxygen. (D) is not indicative of effective treatment using Ventolin.
Which action should the practical nurse implement prior to administering furosemide (Lasix) 60 mg and hydrochlorothiazide (HydroDIURIL) 25 mg to a client?
Obtain the client's heart rate and blood pressure. Since both drugs can lower blood pressure, it is important to establish that the client is not hypotensive, so obtaining the client's heart rate and blood pressure (A) should be implemented prior to administration. Although these two medications can affect serum potassium (norm 3.5 to 5.0 mEq/L) and serum sodium (norm 135 to 150 mEq/L, (B and D) are within normal ranges. A positive Trousseau's sign (C) indicates hypocalcemia, which is not related to these diuretics.
The practical nurse (PN) is caring for a client who overdosed with 10 tablets of buproprion (Wellbutrin) 150 mg tablets and a pint of vodka. Which priority action should the PN implement?
Pad side rails for seizure precaution. Wellbutrin, an antidepressant, in doses higher than 450 mg is potentiated by alcohol and places the client at risk for seizures; padding side rails (A) is a priority in the prevention of client injury related to seizures. (B, C, and D) are not common adverse effects of Wellbutrin.
The practical nurse (PN) is caring for a client who is receiving hydromorphone (Dilaudid) per patient-controlled analgesia (PCA) pump at 1 mg/hour basal rate for postoperative pain. The PCA pump is programmed for a 0.1 mg bolus dose and the lock out time is 6 minutes. Which finding should the PN report to the charge nurse?
Pain rating of 9 on a 0 to 10 pain scale. Although analgesic medication is provided via the PCA pump, the client's pain level of 9 on a 0 to 10 pain scale indicates the infusion, current PCA dosage, or type of medication is ineffective, and the charge nurse should be notified of the client's persistent pain (A). (B, C, and D) are expected findings postoperatively and are not significantly variant.
After an albuterol (Ventolin) nebulizer treatment is given to a client with asthma, what finding by the practical nurse indicates that the treatment was effective?
Peak flow reading is raised to 80% of personal best. Albuterol (Ventolin) is a bronchodilator that relaxes constricted bronchiole muscles to increase air flow to the lungs, which is determined by an increased peak flow meter (C) that indicates the client has an improved ability to move air as a result of bronchodilation. (B) is normal tidal volume, which is the air volume with a normal inspiratory effort and exhalation but does not reveal a change related to albuterol. (A and D) are not indicative of the effectiveness of albuterol
The practical nurse (PN) is preparing to administer medications and identifies that the pharmacy has delivered a substituted drug for one of the prescribed drugs. Which drug should the PN identify as the trade name equivalent for administration?
Prescribed morphine; dispensed Roxanol. Roxanol is an oral form of morphine sulfate (C) and may be substituted if prescribed orally. Dopamine and dobutamine (A), Pitressin or vasopressin, a potent vasoconstrictor, and Pitocin, an oxytocic agent, (B) are not the same drug and carry a published warning about look-alike drug names that cause potential confusion. Albuterol, a bronchodilator, and Atrovent, an anticholinergic, (D) are not the same drug.
When caring for a client receiving warfarin (Coumadin), what action should the practical nurse implement?
Recommend the use of a soft toothbrush. To reduce the risk of bleeding, soft toothbrushes (A) and electric razors are recommended for a client who is taking Coumadin, an anticoagulant. Platelet production (B) is not affected by the use of Coumadin. Dairy foods (C) do not interfere with the effectiveness of Coumadin. A low serum potassium level (D) is not directly related to the administration of Coumadin.
A client who is admitted with diabetic ketoacidosis (DKA) and an initial serum glucose level of 300 mg/dl has a prescription of IV insulin per sliding scale. The nurse asks the practical nurse (PN) to retrieve the insulin from the automated medication dispensing system. Which insulin vial should the PN obtain?
Regular insulin (Humulin R). The only preparation of insulin that should be administered IV is regular insulin (B). (A, B, and C) are for subcutaneous administration only.
A client with chronic stable angina receives a prescription for nitroglycerin (Nitro-Dur) 0.4 mg topical patch. The practical nurse (PN) applies the first patch at 0730. Which intervention should the PN take next?
Remove the patch at 1930. A transdermal nitroglycerin patch is replaced daily and should be removed after 12 to 14 hours to prevent tolerance to the drug (A). The PN should note that the patch is in place during nursing assessments until it is time for removal in 12 hours, not (B). Transdermal patches provide sustained release of the drug and are applied once per day, not (C). (D) is not indicated.
A client who sustains a severe blunt head trauma during a motor vehicle collision receives a prescription for phenytoin (Dilantin). Which therapeutic response should the practical nurse (PN) observe in the client?
Seizure free during the last 24 hours. Phenytoin (Dilantin) is administered to prevent seizures, which exacerbate increased intracranial pressure after a head injury. Absence of seizures is the therapeutic response of anticonvulsants (D). (A, B, and C) are not indicators of therapeutic effects for Dilantin.
A client is hospitalized with an asthma exacerbation and is being treated with methylprednisolone (Solu-Medrol) 125 mg q6 hours. Which laboratory value should the practical nurse (PN) to monitor?
Serum blood glucose. side effect of large doses of steroids can cause in elevation in the serum glucose levels, so the PN should monitor the client's serum glucose (A). (B, C, and D) are not affected by the administration of corticosteroids.
A client with hyperkalemia receives a prescription for sodium polystyrene sulfonate (Kayexalate). Which finding should the practical nurse (PN) monitor to evaluate the effectiveness of the prescription?
Serum potassium level. Hyperkalemia (serum potassium level greater than 5.0 mEq/L) increases the client risk for fatal cardiac dysrhythmias. Kayexalate is used to decrease the serum potassium level, so the PN should monitor the client's serum potassium level (C) to determine if the prescription is effective. (A, B, and D) do not evaluate the effectiveness of Kayexalate on serum potassium levels.
The practical nurse (PN) is giving medications to a client with hyperlipidemia who receives a new prescription for cholestyramine (Questran). Which information should the PN reinforce with the client?
Take before meals and apart from other drugs. Cholestyramine is used to treat hyperlipidemia of primary hypercholesterolemia and binds with bile in the intestines to reduce fat and cholesterol absorption from foods. The systemic absorption of oral medications, such as digoxin and warfarin, can also be reduced, so the medication should be taken before meals and apart from other drugs (C). (A and B) are not necessary when taking Questran. Although constipation is a side effect, a diet high in fiber, not (D), should be recommended.
The healthcare provider prescribes hydromorphone (Dilaudid) 2 mg PO every 4 hours as needed for pain for a client with a kidney stone. When the client asks for pain medication, the practical nurse (PN) reviews a drug reference and finds the usual adult dosage, Dilaudid 1 to 4 mg every 4 to 6 hours. What information is most important for the PN to know prior to administering the analgesic?
The amount and time of the previous dose. The most important information that the PN should obtain to minimize the cumulative dosage of Dilaudid is the time and dosage of the last analgesic administration (A), which usually requires an interval of 4 hours to excrete the drug's metabolites. Although opioid tolerance (B) can influence the client's response to narcotic analgesic dosages, the time frame between dosing provides the best parameter for evaluating the next administration. (C and D) are important findings that influence the client's response to a narcotic analgesic, but time and previous dose are most important in deciding to give the next prescribed dose of Dilaudid.
When should the practical nurse (PN) withhold administration of oral levothyroxine (Levothroid)?
The pulse is greater than 100 beats/minute. Thyroid supplemental medication, such as Levothroid, increase basal metabolic rate and should be withheld if the client's pulse is greater than 100 beats/minute (B), which is an indication of excessive dosage. (A) is not an indication to withhold Levothroid. Finger and toe paresthesia (C) is not related to thyroid supplements. Although excess thyroid hormone can cause diarrhea (D), other symptoms of toxicity should be manifested before withholding the medication.
A client with hypertension receives a prescription for irbesartan (Avapro). Which finding by the practical nurse indicates that the client needs additional instruction regarding the medication?
Uses a salt substitute that has potassium. Avapro, angiotensin II receptor blocking (ARB) agent, causes vasodilation to reduce blood pressure. Since ARBs can raise the concentration of potassium in the blood, the client should be reinstructed to avoid the use of salt substitutes containing potassium (A). Avapro, an antihypertensive, is also used to treat diabetic nephropathy, so having type 2 diabetes (B) is not a contraindication for taking this drug. Dizziness (C) is a common side effect. The drug can be taken with or without food (D).
The practical nurse (PN) is administering medications to several clients. Which client statement indicates that additional action should be taken by the PN?
While on fluorouracil (5-FU) chemotherapy, the client reports tarry, loose stools. Fluorouracil is an antineoplastic drug, and signs of toxicity include black, tarry-colored stools (D) that indicate GI bleeding, which requires further investigation into the source of the bleeding and discontinuation of the medication to reduce the risk of hemorrhage. Mucomyst normally smells like "rotten eggs", so this is an expected finding that does not indicate any need to alter the medication administration routines (A). Expected side effects of anticholinergics, such as pseudoephedrine, include dried mucous membranes and and dry mouth (B). Statins, such as lovastatin, can cause constipation, which is a manageable side effect (C).
The practical nurse (PN) is preparing the next secondary infusion of gentamicin IV q18 hours for an older client. The PN reviews the client's serum values for gentamicin, which is 14 ug/ml (therapeutic range is 4-10 ug/ml.) Which action should the practical nurse take?
Withhold the dose and report findings to the charge nurse. The medication doses should be spaced out to allow the body to adequately clear the drug, so the PN should withhold the dose and contact the healthcare provider (B). Administering the drug at a slower rate (A) or in a more dilute solution (C) does not change the drug's serum level, which is above its narrow therapeutic range. Since urine output (D) is influenced by many factors, its value alone does not indicate any further action at this time.
An older client who is receiving digoxin (Lanoxin) 0.25 mg PO at 0800 has an apical pulse of 68 beats/minute and respirations of 16 breaths/minute. The practical nurse (PN) identifies that the client's serum digoxin level is 3.2 ng/ml. What action should the practical nurse implement?
Withhold the dose of digoxin. Since digoxin has a narrow therapeutic index (serum ranges between 0.5 and 0.8 ng/ml), toxicity can occur at levels greater than 2.0 ng/ml, and the dose should be withheld (B), even if no other symptoms are present. Giving the medication (A) contributes to worsening the condition. Obtaining a blood pressure (C) and determining the client's mental status (D) provide useful information, but the digoxin should be withheld.
The practical nurse (PN) is caring for a client who is receiving a secondary infusion of procainamide (Pronestyl) IV. Which assessment should the PN obtain during the administration of the medication?
blood pressure Pronestyl is an antiarrhythmic that decreases myocardial excitability by slowing down conductivity of cardiac tissue. The client's telemetry and blood pressure (C) should be monitored continuously during IV administration. Pronestyl does not cause effects related to pupillary response (A). Pronestyl's side effects do not significantly affect (B and D).
