EAQ - Pharm and Parenteral Treatment

A client with midsternal pain presents to the emergency department. Vital signs are stable. Which form of nitroglycerin would the nurse anticipate giving initially? Oral capsule Sublingual spray Intravenous solution Transdermal patch

Nitroglycerin spray provides prompt relief of symptoms. The nurse administers one to two sprays, up to a maximum of three sprays, onto or under the tongue every 5 minutes until pain is relieved. If unrelieved after three sprays, intravenous (IV) nitroglycerin may be considered. Both the transdermal and oral forms of nitroglycerin are used for prophylactic purposes, not management of acute pain.

The nurse understands which medication class may cause kernicterus in neonates? Salicylates Tetracyclines Sulfonamides Glucocorticoids

Sulfonamides may cause kernicterus in neonates. Salicylates may cause Reye syndrome. Tetracyclines may cause the discoloration of developing teeth. Glucocorticoids may cause growth suppression.

A health care provider in the emergency department identifies that a client is in cardiogenic shock. Which type of medication is indicated for management of this condition? Loop diuretic Cardiac glycoside Sympathomimetic Alpha-adrenergic blocker

Sympathomimetics are vasopressors that induce arterial constriction, which increases venous return and cardiac output. Diuretics promote excretion of fluid, which is not indicated. Cardiac glycosides slow and strengthen the heartbeat; they do not increase the blood pressure and may decrease it. Alpha-adrenergic blockers decrease peripheral resistance, resulting in a decreased blood pressure.

Which adverse effect would the nurse assess for after administering oxytocin to a client to stimulate labor? Select all that apply. One, some, or all responses may be correct. Edema Headache Confusion Blurred vision Uterine rupture

All listed are correct. Adverse effects of oxytocin include edema, headache, confusion, blurred vision, and uterine rupture.

The nurse is teaching a group of student nurses about teratogenicity. Which statement by a student indicates that teaching was effective? Select all that apply. One, some, or all responses may be correct. "Negative animal studies indicate that the medication is safe to use in pregnant clients." "Counseling must be provided to a sexually active client while using a known teratogen." "Pregnant clients can continue to take anticancer medications if they cannot be avoided." "To wean a neonate from drug dependency, he or she should be given smaller doses of the drug." "Functional defects in the newborn are the result of exposure of the fetus to teratogens in the later stages of pregnancy."

"Counseling must be provided to a sexually active client while using a known teratogen." "To wean a neonate from drug dependency, he or she should be given smaller doses of the drug." "Functional defects in the newborn are the result of exposure of the fetus to teratogens in the later stages of pregnancy." In sexually active clients, the use of a teratogen must be followed by counseling regarding the harmful effects of the teratogen on the newborn. The client should use contraception methods to prevent pregnancy until the medication regimen is completed. The use of dependence-producing drugs during pregnancy may lead to drug dependency in the newborn. This dependency can be overcome by giving smaller doses of the drug to which the newborn is dependent. Functional defects in a newborn occur as a result of exposure to a teratogen during the second and third trimesters of pregnancy. Animal studies may not be applicable to humans; therefore, a negative study of a teratogen does not mean that the medication can be used in humans with no teratogenicity. If the use of anticancer medications cannot be avoided in a pregnant woman, an abortion is recommended to avoid teratogenic effects in the newborn.

Which client statements indicate effective teaching about an automatic epinephrine injector to self-treat reactions to insect stings? Select all that apply. One, some, or all responses may be correct. "I will inject the medication into my thigh." "I will call 911 before I inject the medication." "I will store the medication in the refrigerator." "I will keep the medication with me at all times." "I will replace the medication when the expiration date is approaching."

"I will inject the medication into my thigh." "I will keep the medication with me at all times." "I will replace the medication when the expiration date is approaching." The nurse or health care provider would instruct the client to inject the medication into the thigh, keep the medication available at all times, and replace the medication when the expiration date is approaching. The medication should be injected before calling 911. The medication should be protected from temperature extremes. Storage in the refrigerator is not recommended.

A prescription calls for the administration of 5 mg of haloperidol intramuscularly PRN (as needed) for severely agitated and aggressive behavior. The haloperidol is available in a vial labeled 2 mg/mL. How many milliliters of solution will the nurse administer? Record your answer using one decimal place.

2.5 mL 5 mg divided by 2 mg times 1 mL = 2.5 mL

The health care provider prescribes 1000 mL of total parenteral nutrition (TPN) to be administered in 12 hours. Based on this prescription, how many milliliters of solution will be administered per hour? 83 mL/h 100 mL/h 108 mL/h 125 mL/h

83 mL/h is the correct calculation. 1000 mL of solution divided by 12 hours equals 83.3 mL/h. Always round to the nearest whole number. 100 mL/h is an incorrect calculation; it is too much solution per hour. 108 mL/h is an incorrect calculation; it is too much solution per hour. 125 mL/h is an incorrect calculation; it is too much solution per hour.

Permethrin 1% lotion is prescribed for a 5-year-old child with pediculosis capitis. Which instruction would the nurse include when teaching the parents about treatment? Personal belongings must be discarded. Side effects are nonexistent with the medicated shampoo. Other children should be kept away from the child for a week. The child's hair must be combed with a fine-toothed comb to remove nits.

A fine-toothed comb removes any nits that remain after the application of permethrin 1% lotion. Personal belongings do not need to be disposed of; clothing and linens should be laundered in hot water and dried in a hot dryer, and other personal items may be soaked in a pediculicidal solution. Excessive use of permethrin 1% lotion may cause the lice to develop resistance to the shampoo. Once the hair has been shampooed, there is no reason to isolate the child.

A client takes acetaminophen routinely. The nurse will advise the client to avoid which substance? Alcohol Caffeine Diphenhydramine Ibuprofen

Acetaminophen and alcohol are both hepatotoxic substances. Metabolites of acetaminophen, along with alcohol, can cause irreversible liver damage. Caffeine stimulates the cardiovascular system, not the liver. In addition, caffeine does not interact with acetaminophen. Diphenhydramine may be taken with acetaminophen. Ibuprofen may be taken with acetaminophen.

Which medication is often contraindicated when taking warfarin? Atenolol Ferrous sulfate Chlorpromazine Acetylsalicylic acid

Acetylsalicylic acid can cause decreased platelet aggregation, increasing the risk for undesired bleeding that may occur with administration of anticoagulants. It should not be administered unless specifically prescribed, usually by a cardiologist or other specialist, to manage serious risks of thrombosis. Ferrous sulfate does not affect warfarin; it is used for red blood cell synthesis. Atenolol is a beta-blocker that reduces blood pressure; it does not affect bleeding. Chlorpromazine is a neuroleptic; it does not affect bleeding.

Which medication is used to treat Helicobacter pylori infection? Select all that apply. One, some, or all responses may be correct. Amoxicillin Tetracycline Pantoprazole Metronidazole Bismuth subsalicylate

All meds listed: Several medications are typically prescribed because of the complexity of treating H. pylori. Antibiotics such as amoxicillin, tetracycline, and metronidazole are given to eradicate the infection. Clients may also be placed on a proton pump inhibitor such as pantoprazole and given bismuth subsalicylate to disrupt the cell wall of H. pylori bacteria.

At 10:00 AM the nurse hangs a 1000-mL bag of 5% dextrose in water (D 5W) with 20 mEq of potassium chloride to be administered at 80 mL/h. At noon the health care provider prescribes a stat infusion of an intravenous (IV) antibiotic of 100 mL to be administered via piggyback over 1 hour. How much longer than expected will it take the primary bag to empty if the nurse interrupts the primary infusion for infusion of the antibiotic? 15 minutes 30 minutes 45 minutes 60 minutes

An infusion of 1000 mL at 80 mL should take 12.5 hours. Because the primary infusion is interrupted for an hour while the antibiotic is infused, the primary bag will run an hour longer than if it were running uninterrupted. Minutes that are less than an hour are incorrect calculations.

Cyanocobalamin (vitamin B 12) 0.2 mg intramuscularly (IM) is prescribed for a client with pernicious anemia. Each vial of the medication contains 100 mcg/mL. How many milliliters will the nurse administer? Record your answer using a whole number. __________mL

Answer: 2 mL Convert 0.2 mg to mcg = 200 mcg Divide 200 mcg by 100 mcg = 2 mcg Multiply 2 mcg by 1 mL = 2 mL

Which outcome would the nurse expect when caring for a child receiving adrenocorticosteroid therapy? Accelerated wound healing Development of hyperkalemia Increased antibody production Suppressed inflammatory process

Because of the suppression of the inflammatory process, the nurse must be alert to the subtle symptoms of infection, such as changes in appetite, sleep patterns, and behavior. Adrenocorticosteroid therapy delays (not accelerates) wound healing. Adrenocorticosteroid therapy may cause hypokalemia, not hyperkalemia, because of the accompanying retention of sodium and fluid. Adrenocorticosteroid therapy decreases (not increases) the production of antibodies.

A client receiving a betamimetic for preterm labor experiences muscle tremors, exhibits signs of nervousness, and has palpitations. The nurse assesses the client's pulse rate and notes that it is 110 beats/min and regular. Which action would the nurse take next? Discontinue the medication as per protocol. Obtain the client's laboratory results for electrolyte levels. Inform the client that these are signs of preterm labor. Reassure the client that these are expected side effects of the medication.

Betamimetics have the unpleasant side effects of nervousness, tremors, and palpitations; clients should be informed that these side effects are expected. If contractions are lessened and the maternal heart rate is less than 120 beats/min and regular, the medication is performing as expected and does not need to be discontinued. Electrolyte levels are unrelated to these side effects of the tocolytic agent. Muscle tremors and palpitations are not signs and symptoms of preterm labor.

An adolescent is prescribed an antineoplastic agent. Which instruction would the nurse give to the parents before discharge? Limit contact with all peers and family members. Withhold medications when nausea occurs to prevent vomiting. Schedule laboratory blood tests to evaluate response to the medication. Return weekly for a bone marrow aspiration to monitor effectiveness of therapy.

Blood tests indicate response to therapy; if the white blood cell count drops precipitously, therapy may be halted temporarily. Children undergo therapy for extended periods, and prolonged separation from their peers may lead to social isolation. Contact with children who have active infections should be avoided. Although nausea commonly occurs with this therapy, antiemetic measures are instituted; the medication is not withdrawn for this reason. A bone marrow aspiration is a painful procedure and is performed selectively (e.g., to confirm the diagnosis), not routinely.

The nurse notes an older adult's admission orders include gentamicin for the treatment of osteomyelitis. Which laboratory reports will the nurse review before beginning the medication? Select all that apply. One, some, or all responses may be correct. Blood urea nitrogen (BUN) and creatinine Electrolytes and urinalysis Erythrocyte count Blood platelet count Serum thyroxin levels

Blood urea nitrogen (BUN) and creatinine Electrolytes and urinalysis Because gentamicin can increase the risk of nephrotoxicity, the nurse should assess a client's renal function before starting therapy. Dehydration can further increase the risk of nephrotoxicity; therefore, the client's hydration status should also be checked before starting therapy. Gentamicin generally does not affect erythrocyte and blood platelet counts nor does it affect serum thyroxin levels.

A pregnant woman diagnosed with hypertension was administered magnesium sulfate. Which prescribed medication would the nurse administer to prevent magnesium toxicity? Nifedipine Terbutaline Indomethacin Calcium gluconate

Calcium gluconate reverses magnesium toxicity and can be administered to pregnant women taking magnesium sulfate. Nifedipine is a calcium channel blocker used as a tocolytic for the management of preterm labor. Terbutaline is a beta-adrenergic blocker used to manage preterm labor. Indomethacin is a nonsteroidal anti-inflammatory medication used as a tocolytic for the management of preterm labor.

Which medication is contraindicated during pregnancy but can be safely used by lactating mothers? Lithium Tetracycline Carbamazepine Diethylstilbestrol

Carbamazepine may cause neural tube defects when used during pregnancy but can be safely used by a lactating mother. Lithium should not be given to either pregnant or lactating mothers. Tetracycline is contraindicated in pregnant clients and in lactating clients. Diethylstilbestrol cannot be given for pregnant clients and lactating mothers because it may cause vaginal carcinoma, and its level in the breast milk may be high.

Which medication would the nurse administer to prevent maternal transmission of infection to the newborn of a client with gonorrhea? Select all that apply. One, some, or all responses may be correct. Penicillin Acyclovir Ceftriaxone Doxycycline Levofloxacin

Ceftriaxone is used to prevent transmission of maternal gonorrheal infection to the newborn during the birthing process. Penicillin is used to treat syphilis. Acyclovir is administered for neonatal herpes infection. Doxycycline is used to treat chlamydia. Levofloxacin is used for sexually acquired epididymitis.

Cholinergic agonists are prescribed for which type of urinary condition? Kidney stones Urine retention Spastic bladder Urinary tract infections

Cholinergics intensify and prolong the action of acetylcholine, which increases the tone in the genitourinary tract, preventing urinary retention. Cholinergics will not prevent renal calculi. Anticholinergics, not cholinergic agonists, are prescribed for the frequency and urgency associated with a spastic bladder. Preventing urinary tract infections is a secondary gain because cholinergics help prevent urinary retention that can lead to a urinary tract infection, but this is not the purpose for administering these medications.

The nurse understands that clozapine is contraindicated in the client with which condition? Seizures Glaucoma Dysrhythmias Bone marrow depression

Clozapine is an atypical antipsychotic medication that is contraindicated in clients with bone marrow depression. Clozapine should be used with caution in clients with seizures. First-generation antipsychotics should be used with caution in clients with glaucoma. Ziprasidone is contraindicated in clients with a history of dysrhythmias.

A 7-year-old child has a peripherally inserted central venous catheter placed into the left arm. A peripheral intravenous (IV) line is still in place, and an antibiotic is to be administered immediately. Which action would the nurse take next? Connect the IV antibiotic to the peripheral line. Administer the antibiotic through the central venous catheter. Order an x-ray confirmation report on central line placement. Document a verbal prescription on the chart stating the central line can be used.

Connect the IV antibiotic to the peripheral line. The peripheral line must be used until the placement of the central venous line is confirmed with radiography or fluoroscopy; this prevents the instillation of fluid into the lung or interstitial space if the catheter is misplaced. The central line should not be used until placement is confirmed. A verbal prescription is not the best choice, because the nurse is required to confirm placement, which is done via radiography in this situation.

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? Plan daily intake incorporating diabetic diet guidelines. Demonstrate proper subcutaneous insulin injection technique. Demonstrate correct use of the insulin pump. List three self-care activities that help control the diabetes.

Demonstrating correct use of the insulin pump is the short-term, client-oriented goal necessary for the client to manage the pump and avoid hypoglycemia 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; it is a plan to obtain glucose control. Planning daily intake around a diabetic diet is important but will not control glucose levels to the extent that using an insulin pump will. Mastering subcutaneous insulin injection technique is not a priority for the client who will be using the insulin pump to deliver insulin except as a backup plan. 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 client requires intravenous fluids postoperatively. The health care provider has prescribed 5% dextrose in water (D 5W) to infuse at 125 mL/h. To deliver the solution at the correct drip rate, which information would the nurse require to calculate the rate? Total fluid volume in the bag Diameter of the tubing being used Size of the needle or catheter in the vein Drops per milliliter delivered by the infusion set

Drops per milliliter delivered by the infusion set Knowing the number of drops per milliliter delivered by the infusion set is necessary to calculate the drip rate of an intravenous infusion. The total fluid volume in the bag does not determine the drip rate. The diameter of the tubing being used does not determine the drip rate, only the size of the drop. The size of the needle or catheter in the vein does not determine the drip rate. Different infusion sets deliver different, preset numbers of drops per milliliter.

Which medication worsens uncontrolled angle-closure glaucoma when used for the treatment of generalized anxiety disorder? Buspirone Duloxetine Chlorpromazine Lithium carbonate

Duloxetine is an antidepressant medication used in the treatment of generalized anxiety disorder. A contraindication is that it can worsen uncontrolled angle-closure glaucoma. Lithium carbonate is used to treat manic episodes but is contraindicated in clients with renal disease. Buspirone is an antidepressant medication contraindicated in clients with known allergic reactions to this medication. Chlorpromazine is an antipsychotic medication contraindicated in clients with blood dyscrasias.

The nurse is teaching a 10-year-old child with type 1 diabetes about insulin requirements. Which statement by the nurse correctly identifies when insulin needs decrease? 'Insulin needs often decrease when puberty is reached.' 'When there is an infection is present, the body requires less insulin.' 'Emotional stress can cause insulin needs to decrease.' 'Increased muscle activity such as exercise, cause insulin needs to decrease.'

Exercise reduces the body's need for insulin. Increased muscle activity accelerates transport of glucose into muscle cells, thus producing an insulin like effect. With increased growth and associated dietary intake, the need for insulin increases during puberty. An infectious process may require increased insulin. Emotional stress increases the need for insulin.

A client diagnosed with adrenal gland hypofunction receives a prescription for oral fludrocortisone therapy. Which instruction would the nurse provide to the client? Because drowsiness is a side effect, do not operate heavy machinery. If prescribed for once a day, take the medication at bedtime. Do not crush the medication. Regularly monitor blood pressure.

Fludrocortisone, prednisone, and cortisone are the medications prescribed for the treatment of adrenal gland hypofunction. During fludrocortisone therapy, the blood pressure of the client should be regularly monitored because fludrocortisone has a potential to cause hypertension. Drowsiness is not a side effect. If taking the dose once a day, the client should be instructed to take the medication in the morning. The medication can be cut or crushed.

Which sexually transmitted infection receives antiviral medications as the treatment of choice? Syphilis Gonorrhea Genital herpes Chlamydial infection

Genital herpes is a sexually transmitted infection caused by the herpes simplex virus and treated with antiviral medications. Bacteria cause syphilis, gonorrhea, and chlamydial infections.

A depressed client is prescribed citalopram hydrobromide. Six days later, the client tearfully says to the nurse, 'I'm taking an antidepressant, but it's not working. I'm hopeless.' Which response would the nurse give? 'You feel hopeless.' 'It's easy to get discouraged.' 'It takes 2 or 3 weeks before it begins to relieve depression.' 'Give it a little more time; it works more slowly in some people.'

Informing the client about the expected response to the medication is factual information that may decrease the client's sense of hopelessness. Although empathic responses may be helpful, at this time the client needs information and reassurance based on fact. Citalopram hydrobromide does not work more slowly in some people.

Which gonadotropin-releasing hormone agonists are used to treat endometriosis? Select all that apply. One, some, or all responses may be correct. Trazodone Diclofenac Leuprolide Isotretinoin Nafarelin acetate

Leuprolide and nafarelin acetate are gonadotropin-releasing hormone (GnRH) agonists used to treat endometriosis. Trazodone is used in cases of erectile dysfunction. Diclofenac is a nonsteroidal anti-inflammatory drug used to relieve pain in endometriosis. Isotretinoin is an oral agent that is effective against severe cystic acne.

The laboratory report of a pediatric client who is taking psychotherapeutic medications indicates decreased bone density. The nurse suspects which medication might be responsible for this condition? Lithium Haloperidol Amitriptyline Phenothiazine

Lithium, a mood-stabilizing medication, may decrease bone density or bone formation in children. Haloperidol is associated with extrapyramidal side effects. Amitriptyline, a tricyclic antidepressant, is associated with nervousness, sleep disorders, increased blood pressure, and gastrointestinal upset. Phenothiazine is associated with extrapyramidal side effects and anticholinergic side effects such as dry mouth, constipation, and urine retention.

A client who is being treated for pruritus complains of sedation. Which medication would the nurse anticipate being prescribed by the primary health care provider to treat this side effect? Loratadine Hydroxyzine Diphenhydramine Triamcinolone acetonide

Loratadine is a nonsedative medication used in treating sedation caused by antihistamine medications. Hydroxyzine and diphenhydramine are antihistamine medications used in the treatment of pruritus; sedation is a side effect of these medications. Triamcinolone acetonide is an intralesional corticosteroid used in the treatment of psoriasis.

A client with severe abdominal pain is on meperidine treatment and later develops seizures. Which intervention is given highest priority? Stop administration of meperidine. Administer transdermal scopolamine. Administer oxygen (O 2) through facial mask. Monitor respiratory status and sedation level.

Opioids such as meperidine are associated with neurotoxicity and seizures, which are caused by accumulation of its metabolite, normeperidine. The administration of the medication must be stopped immediately. Transdermal scopolamine helps reduce nausea and vomiting associated with administration of the meperidine. O 2 is administered when the client has oversedation and respiratory distress because of meperidine. Frequent monitoring of both the sedation level and respiratory rate is essential in clients receiving opioid analgesics but is of moderate priority in this situation.

A child with pinworms is prescribed mebendazole. Which expected response to the medication would the nurse teach the parents watch for? Blood Constipation Yellow stools Passage of worms

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

The nurse teaches a client about the dangers of using sodium bicarbonate regularly. Which effect of sodium bicarbonate is the nurse trying to prevent? Gastric distention Metabolic alkalosis Chronic constipation Cardiac dysrhythmias

Prolonged use of sodium bicarbonate may cause systemic alkalosis, as well as retention of sodium and water. Gastric distention is not an effect of sodium bicarbonate. Chronic constipation is not an effect of sodium bicarbonate. Cardiac dysrhythmias are not an effect of sodium bicarbonate.

The surgeon prescribes vitamin K before surgery. The nurse recognizes that this is prescribed because vitamin K contributes to the formation of which substance? Bilirubin Prothrombin Thromboplastin Cholecystokinin

Prothrombin Vitamin K is necessary in the formation of prothrombin to prevent bleeding. It is a fat-soluble vitamin and is not absorbed from the gastrointestinal (GI) tract in the absence of bile. Bilirubin is the bile pigment formed by the breakdown of erythrocytes. Thromboplastin converts prothrombin into thrombin during the process of coagulation. Cholecystokinin is the hormone that stimulates contraction of the gallbladder.

Neomycin is prescribed for a client with cirrhosis. Which reason will the nurse explain is the purpose for taking this medication? Prevents an infection Limits abdominal distention Minimizes intestinal edema Reduces the blood ammonia level

Reducing the blood ammonia level decreases the effect of bacterial activity on blood and wastes in the gastrointestinal tract. Although neomycin is an aminoglycoside antimicrobial, it is not administered to prevent infection. Neomycin has little or no effect on intestinal edema. Neomycin does not reduce abdominal distention.

A health care provider prescribes 10 mL of a 10% solution (100 mg/mL) of calcium gluconate to be administered intravenously. The client has an intravenous (IV) solution of D 5W. Which action will the nurse take to administer the medication safely? Administer IV push over 2 minutes into the current IV line. Insert a separate IV line and administer the medication as a continuous infusion. Dilute with 100 mL normal saline and piggyback the medication into the current IV line. Request insertion of a central line for administration of this medication.

Request insertion of a central line for administration of this medication. Calcium gluconate may be administered either directly or by infusion. It is compatible with D 5W, so a separate line is not required. Calcium gluconate should be administered at a rate not to exceed 200 mg/minute; because the client is prescribed 1000 mg, administration should take at least 5 minutes. A central line is recommended only if calcium chloride, a less preferred option than calcium gluconate, will be administered by IV push because it is irritating to veins and should not be injected into tissues.

The nurse reviews the laboratory data of four active labor clients. The nurse would anticipate administering Rho (D) immune globulin to the client with which laboratory values after delivery? Rh positive and Coombs positive Rh negative and Coombs positive Rh positive and Coombs negative Rh negative and Coombs negative

Rho(D) immune globulin is given to an Rh-negative mother after birth if the infant is Rh positive and the Coombs test reveals that the mother was not previously sensitized (negative). An Rh-positive mother will not develop antibodies to a fetus who is either Rh positive or Rh negative; therefore the Coombs test is not performed. A positive Coombs test result in an Rh-negative mother indicates that the mother has Rh-positive antibodies; Rho(D) immune globulin is not given because it will not be effective.

The health care provider prescribes finasteride for a client with benign prostatic hyperplasia (BPH). The client would like to take saw palmetto instead of the finasteride. Which information would the nurse provide to the client about this herbal supplement? 'Research has shown that saw palmetto is no better than a placebo.' 'You can take both; saw palmetto doesn't require a prescription.' 'The herbal supplement will relieve symptoms by altering the size of the prostate.' 'Substituting saw palmetto is a good option to avoid all the bad side effects of finasteride.'

Rigorous research has demonstrated no significant difference between saw palmetto and a placebo. The health care provider must be consulted regarding the client's desire to change the prescribed therapy. Saw palmetto should be taken with food to limit gastrointestinal side effects. Saw palmetto does not alter the size of the prostate gland. Substituting something that is ineffective is not a good solution regardless of issues surrounding side effects.

A client abruptly stops taking a barbiturate. Which withdrawal complication would the nurse anticipate that the client may experience? Ataxia Seizures Diarrhea Urticaria

Seizures are a serious side effect that may occur with abrupt withdrawal from barbiturates. Ataxia, diarrhea, and urticaria are not associated with barbiturate withdrawal.

The nurse observed seizures in a client who is taking lithium for cycles of mania. Which laboratory parameters may lead to this condition? 1 mEq/L (1 mmol/L) serum lithium levels 3 mEq/L (3 mmol/L) serum lithium levels 135 mEq/L (135 mmol/L) serum sodium levels 140 mEq/L (140 mmol/L) serum sodium levels

Serum lithium levels exceeding 2.5 mEq/L (2.5 mmol/L) may cause seizures, gastrointestinal discomfort, tremors, confusion, and somnolence. A serum lithium level of 3 mEq/L (3 mmol/L) serum may lead to seizures. The desired long-term serum lithium level is 1 mEq/L (1 mmol/L). The normal range of serum sodium levels is from 135 to 145 mEq/L (135-145 mmol/L).

Which is the best response by the nurse to a client prescribed phenelzine who makes the selections listed below for tomorrow's menu? 'Your diet tends to be high in cholesterol and fat, so let's discuss some changes.' 'You've made appropriate choices, but remember your increased need for protein.' 'You've made wise selections that are healthy and appropriate for your medication.' 'Your selections show that we need to discuss how to avoid foods that contain tyramine.'

The main concern for a client taking phenelzine, a monoamine oxidase inhibitor (MAOI), is avoiding foods containing tyramine. The client's selections avoided such foods. Although cholesterol and fat should be limited, the client's selections are not particularly high in fat, and the main concern is avoiding foods containing tyramine. There is no particular need to increase protein while taking an MAOI such as phenelzine.

The nurse reviews the medication reconciliation charts of four clients prescribed cytokines. Which client's condition and prescribed medication indicates a need for the nurse to contact the primary health provider?

The nurse should intervene in the client taking anakinra. Colony-stimulating factors such as filgrastim and pegfilgrastim are effective in treating chemotherapy-induced neutropenia in client C. Anakinra is used to treat rheumatoid arthritis. All the rest are correct treatments. Cytokines are the soluble factors secreted by white blood cells that act as messengers between the cell types. Cytokines instruct cells to alter their proliferation, differentiation, secretion, and activity from immunomodulatory effects. Etanercept is used in the treatment of rheumatoid arthritis in client A and should not be questioned. Interleukin 11 (platelet growth factor) such as oprelvekin helps prevent chemotherapy-induced thrombocytopenia in client B and should not be questioned. Aldesleukin is interleukin 2 that reduces metastatic melanoma in client D and metastatic renal cell carcinoma and should not require follow-up.

After reviewing the immunization record of a 4-year-old child with acute bronchitis and mild febrile illness, the nurse notes the need for a consecutive vaccination of DTaP. Which advice would the nurse give to the child's parent? 'The child needs the DTP vaccine.' 'The child needs to receive another Tdap vaccine.' 'The child needs immediate immunization against pertussis.' 'The child needs the Tdap vaccine after the acute bronchitis has subsided.'

The nurse would advise the mother that the child needs to receive the consecutive dose of Tdap in accordance with the immunization schedule. The DTP vaccine should not be administered when the child's DTaP vaccination has already been started. Children who are not fully immunized against pertussis do not receive a single dose of Tdap; the nurse would not advise immediate immunization against pertussis. Tdap may be administered in the presence of acute bronchitis associated with mild febrile illness.

Status epilepticus develops in an adolescent with a seizure disorder who is taking antiseizure medication. Which reason would the nurse identify as the most common reason for the development of status epilepticus? The provider failed to account for a growth spurt. The amount prescribed is insufficient to cover activities. The prescribed antiseizure medication probably is not taken consistently. The client is prescribed a medication that is ineffective in preventing seizures.

The prescribed antiseizure medication probably is not taken consistently. Skipping doses of the medication is a form of denial that an adolescent client may engage in once the seizures are controlled; also, adolescents tend to feel invincible. The dosage is based not on activity but on the type of seizure. Medications are prescribed according to the type of seizure and are effective if taken consistently. The dosage of antiepileptic medications is based on many factors, including age, type of medication, and presence of infection, as well as on changes in height and weight.

A client is receiving heparin sodium intravenously at 1500 units/h. The concentration in the bag is 25,000 units/500 milliliters. How many milliliters will infuse during the nurse's 8-hour shift? Record your answer using a whole

The prescribed rate is 1500 units/h. The available concentration is 25,000 units in 500 mL. Make the necessary conversions and use dimensional analysis to determine the appropriate rate in mL/h. The ratio and proportion method is not appropriate for this situation.

en minutes after the initiation of a blood transfusion, a client reports chills and flank pain. Which nursing action would be performed first? Stop the transfusion. Obtain the vital signs. Notify the health care provider. Maintain the flow with normal saline.

This is a sign of an acute hemolytic transfusion reaction, indicating that the recipient's blood is incompatible with the transfused blood; pain is caused by hemolysis, agglutination, and capillary plugging in the kidneys. Obtaining the vital signs is important but must not precede stopping the transfusion because more incompatible blood will be infused, increasing the severity of the transfusion reaction. After the infusion is stopped, the provider should be notified and normal saline should be infused to keep the line patent.

A child infected with human immunodeficiency virus (HIV) is admitted with Pneumocystis jiroveci pneumonia and receives trimethoprim/sulfamethoxazole. Which common side effects would the nurse anticipate? Select all that apply. One, some, or all responses may be correct. Jaundice Vomiting Headache Crystalluria Photosensitivity

Vomiting, crystalluria, photosensitivity Nausea and vomiting may occur as a result of gastrointestinal irritation. Crystalluria may occur with this medication, especially in the presence of restricted fluid intake secondary to nausea and vomiting. Skin reactions such as photosensitivity are also common. Hepatic side effects such as jaundice may occur but are not common. Central nervous system side effects such as headache are rare adverse reactions.

The nurse assesses that an intravenous (IV) infusion of a vesicant has extravasated. Which action would the nurse perform first? Elevate the IV site. Stop the infusion. Contact the prescriber. Aspirate residual medication from the IV catheter.

When an IV infusion of a vesicant extravasates, it should be stopped immediately to prevent further damage. After this action is taken, the nurse can contract the provider, aspirate any remaining medication from the IV catheter, and elevate the site of IV placement.

The nurse reviews the data of four clients. Which client would the nurse identify as being at high risk of Stevens-Johnson syndrome? A) 300 mg/day lithium initial dose B) 400 mg/day lithium combined with valproate slow release C) 100 mg/day lamotrigine initial dose D) 40 mg/day lamotrigine combined with valproate initial dose

With an initial dose of lamotrigine 100 mg/day, client C is at a high risk for developing Stevens-Johnson syndrome, an integumentary side effect of the medication. To minimize the risk of a serious rash, the dosage should be low (roughly 25-50 mg/day). Lithium is not associated with any side effects related to Stevens-Johnson syndrome.