NURS125 Practice HESI
A client develops a fever after surgery. Ceftriaxone is prescribed. For which potential adverse effect should the nurse monitor the client? A. Dehydration B. Heart failure C. Constipation D. Allergic response
D. Allergic response Rash, urticaria, pruritus, angioedema, and other signs and symptoms of an allergic response may occur a few days after therapy is instituted. Ceftriaxone does not cause dehydration, does not affect the heart, and may cause diarrhea, not constipation.
A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? Select all that apply. A. Irritability B. Glycosuria C. Dry, hot skin D. Heart palpitations E. Fruity odor of breath
A, and C Irritability, a neuroglycopenic symptom, occurs when the glucose in the brain declines to a low level. Heart palpitations, a neurogenic symptom, occur when the sympathetic nervous system responds to a rapid decline in blood glucose. Because the blood glucose level is decreased, the renal threshold is not exceeded, and there is no glycosuria. Dry, hot skin is consistent with dehydration, which often is associated with hyperglycemic states. Fruity odor of the breath is associated with hyperglycemia; it is caused by the breakdown of fats as a result of inadequate insulin supply.
A client with a new diagnosis of type 1 diabetes is told that lifelong insulin will be needed. The client becomes agitated and says, "I am scared of shots. If that is my only option, I'll just have to go into a coma and die!" What is the nurse's best response? A. "Injections are not the only option available for insulin." B. "It won't be so bad; you will get used to it if you will only try." C. "This is one of those times when you need to act like an adult." D. "Clients have the right to refuse treatment, but I need you to sign this form that removes us from liability for your decision."
A. "Injections are not the only option available for insulin." An insulin nasal spray was approved by the Food and Drug Administration (FDA) in 2014 and is available for clients who do not want insulin injections. The nurse should use therapeutic communication in interacting with clients. Intimidating the client by suggesting that actions are childlike and suggesting that the client's concerns are not significant are not therapeutic responses. The nurse's primary concern should be for the client's well-being, not protection from liability.
A client with tuberculosis is to begin combination therapy with isoniazid, rifampin, pyrazinamide, and streptomycin. The client says, "I've never had to take so much medication for an infection before." How will the nurse respond? A. "This type of organism is difficult to destroy." B. "Streptomycin prevents side effects of the other drugs." C. "You'll only need to take the medications for a couple of weeks." D. "Aggressive therapy is needed because the infection is well advanced."
A. "This type of organism is difficult to destroy." Multiple drugs are administered because of the concern regarding drug resistance. Streptomycin sulfate is an antibiotic; it does not prevent the side effects of other drugs used in therapy. Multiple antitubercular drugs are necessary for an extended period, approximately 6 to 8 months depending on the individual. Aggressive therapy may increase anxiety and may not be needed even when the infection is well advanced.
A nurse determines that the teaching about the side effects of azithromycin has been understood when the adolescent client identifies which problem as the most common side effect of this medication? A. Tinnitus B. Diarrhea C. Dizziness D. Headache
B. Diarrhea Diarrhea initially is related to gastrointestinal irritation; later it is related to loss of intestinal flora, which may lead to overgrowth of drug-resistant microbes, resulting in superinfection. This also causes diarrhea. Tinnitus, dizziness (vertigo), and headache all may occur, but none is the most common side effect.
A health care provider prescribes ranitidine for a client with heartburn. During a teaching session, which information will the nurse share with the client about how this drug works? A. Ranitidine increases gastrointestinal peristalsis. B. Ranitidine reduces gastric acidity in the stomach. C. Ranitidine neutralizes the acid that is present in the stomach. D. Ranitidine stops production of hydrochloric acid in the stomach.
B. Rantidine reduces gastric acidity in the stomach. Ranitidine (Zantac) inhibits histamine at H2 receptor sites in the stomach, resulting in reduced gastric acid secretion. Ranitidine reduces, rather than neutralizes, gastric acidity. Ranitidine does not increase gastrointestinal peristalsis, and it does not completely stop production of hydrochloric acid in the stomach.
Pyridoxine (vitamin B6) and isoniazid (INH) are prescribed as part of the chemotherapy protocol for a client with tuberculosis. Which response indicates to the nurse that vitamin B6 is effective? A. Weight gain B. Absence of stomatitis C. Absence of numbness and tingling in extremities D. Acceleration of dormant tubercular bacilli destruction
C. Absence of numbness and tingling in extremities One of the most common side effects of INH is peripheral neuritis, and vitamin B6 will counteract this problem. Although it does help nutrition, this may not result in weight gain. B6 does not affect stomatitis. It does not speed the destruction of the causative organism.
A client has severe diarrhea, and the health care provider prescribes intravenous fluids, sodium bicarbonate, and an antidiarrheal medication. Which drug does the nurse expect the health care provider to prescribe? A. Psyllium B. Bisacodyl C. Loperamide D. Docusate sodium
C. Loperamide Loperamide inhibits peristalsis and prolongs transit time by its effect on the nerves in the muscle wall of the intestines. Bisacodyl is a laxative, not an antidiarrheal; it increases gastrointestinal motility. Psyllium is not an antidiarrheal; it is a bulk laxative that promotes easier expulsion of feces. Docusate sodium corrects constipation, not diarrhea; water and fat are increased in the intestine, permitting easier expulsion of feces.
A client is receiving penicillin G and probenecid for syphilis. What rationale should the nurse give for the need to take these two drugs? A. Each drug attacks the organism during different stages of cell multiplication. B. The penicillin treats the syphilis, whereas the probenecid relieves the severe urethritis. C. Probenecid delays excretion of penicillin, thus maintaining blood levels for longer periods. D. Probenecid decreases the potential for an allergic reaction to penicillin, which treats the syphilis.
C. Probenecid delays excretion of penicillin, thus maintaining blood levels for longer periods. Probenecid results in better use of penicillin by delaying the excretion of penicillin through the kidneys. Penicillin destroys Treponemapallidum during all stages of its development; probenecid delays the excretion of penicillin. Probenecid does not treat urethritis. Probenecid does not prevent allergic reactions.
A client is diagnosed with pulmonary tuberculosis, and the healthcare provider prescribes a combination of rifampin and isoniazid. The nurse evaluates that the teaching regarding the drug is effective when the client reports which action as most important? A. "Report any changes in vision." B. "Take the medicine with my meals." C. "Call my doctor if my urine or tears turn red-orange." D. "Continue taking the medicine even after I feel better."
D. "Continue taking the medicine even after I feel better." The medication should be taken for the full course of therapy; most regimens last from 6 to 9 months, depending on the state of the disease. Visual changes are not side effects of this medication. The medication should be taken 1 hour before meals or 2 hours after meals for better absorption. Urine or tears turning red-orange is a side effect of rifampin; although this should be reported, it is not an adverse side effect.
A mother complains that her child's teeth have become yellow in color. With prolonged use, which medication may be responsible for the child's condition? A. Tetracycline B. Promethazine C. Chloramphenicol D. Fluoroquinolones
A. Tetracycline When administered to neonates and infants, tetracycline may cause staining of developing teeth. Promethazine can cause respiratory depression in children under 2 years of age. Chloramphenicol can cause Gray baby syndrome, and fluoroquinolones may cause tendon rupture in pediatric clients.
A health care provider prescribes vancomycin peak and trough levels for a client who is receiving vancomycin intravenous piggyback (IVPB). When should the nurse have the laboratory obtain a blood sample to determine a peak level of the antibiotic? A. Halfway between two doses of the drug B. Between 30 and 60 minutes after a dose C. Immediately before the medication is administered D. Anytime it is convenient for the client and the laboratory
B. Between 30 and 60 minutes after a dose. Because the drug was administered IV, the blood level of the drug will be at its highest shortly after administration. A drug blood level measured halfway between two doses will not obtain the peak level. Immediately before the medication is administered is done for a trough level, when the drug level is at its lowest. Anytime it is convenient for the client and the laboratory will produce inaccurate results; peak and trough levels are measured in relation to the time a drug is administered.
What information should the nurse include when teaching a client about antacid tablets? A. Take them at 4-hour intervals. B. Take them 1 hour before meals. C. They are as effective as the liquid forms. D. They interfere with the absorption of other drugs.
D. They interfere with the absorption of other drugs. Antacids interfere with absorption of drugs such as anticholinergics, barbiturates, some antibiotics, and cardiac drugs. They may be taken as frequently as every 1 to 2 hours without adverse effects. Antacids should be given 1 or 2 hours after meals and at bedtime. Liquid antacids have a faster onset of action than tablets.
A client with diabetes experiences tremors, pallor, and diaphoresis. What should the nurse consider is a possible cause of these clinical manifestations? A. Overeating B. Intestinal virus C. Aerobic exercise D. Missed insulin dose
C. Aerobic exercise These responses are indicative of hypoglycemia, which can be caused by increased activity; activity decreases insulin resistance and increases glucose metabolism. Overeating causes hyperglycemia. Infections cause hyperglycemia because of the release of stress-related hormones. Missing an insulin dose causes hyperglycemia.
Which statement regarding treatment with interferon indicates that the client understands the nurse's teaching? A. "I will drink 2 to 3 quarts (2 to 3 liters) of fluid a day." B. "Any reconstituted solution must be discarded in 1 week." C. "I can continue driving my car as long as I have the stamina." D. "While taking this medicine I should be able to continue my usual activity."
A. "I will drink two to three quarts (2 to 3 liters) of fluid a day." Adequate fluid intake helps to flush the kidneys and prevent nephrotoxicity, especially during the early phase of treatment. Reconstituted solution may be stored in the refrigerator for 1 month. Confusion, dizziness, and hallucinations are side effects of this drug; the client should avoid hazardous tasks, such as driving or using machinery. Activity may have to be altered because fatigue and other flulike symptoms are common with this drug.
A client with type 1 diabetes self-administers NPH insulin every morning at 8 am. The nurse evaluates that the client understands the action of the insulin when the client identifies which time range as the highest risk for hypoglycemia? A. 2 pm to 8 pm B. 8 pm to noon C. 9 am to 10 am D. 10 am to 11 am
A. 2 pm to 8 pm The time of greatest risk for hypoglycemia occurs when the insulin is at its peak. The action of intermediate-acting insulins peaks in 6 to 12 hours. Nine to 10 am and 10 am to 11 am are too soon for NPH to produce a hypoglycemic response. NPH insulin will have produced a hypoglycemic response before 8 pm and noon. A hypoglycemic response that occurs in 45 to 60 minutes after administration is associated with rapid-acting insulins.
Which first line medication would the nurse state is used to treat anaphylactic reactions? A. Epinephrine B. Norepinephrine C. Dexamethasone D. Diphenhydramine
A. Epinephrine Epinephrine is the first line drug for treating anaphylactic reactions. Norepinephrine is also used in treating anaphylactic reactions as a supportive drug. Diphenhydramine and dexamethasone are second line drugs for treating anaphylactic reactions.
What are the desired outcomes that the nurse expects when administering a nonsteroidal antiinflammatory drug (NSAID)? Select all that apply. A. Diuresis B. Pain relief C. Antipyresis D. Bronchodilation E. Anticoagulation F. Reduced inflammation
A. Pain relief, B. Antipyresis, F. Reduced inflammation Prostaglandins accumulate at the site of an injury, causing pain; NSAIDs inhibit COX-1 and COX-2 (both are isoforms of the enzyme cyclooxygenase), which inhibit the production of prostaglandins, thereby contributing to analgesia. NSAIDs inhibit COX-2, which is associated with fever, thereby causing antipyresis. NSAIDs inhibit COX-2, which is associated with inflammation, thereby reducing inflammation. NSAIDs do not cause diuresis; reversible renal ischemia and renal insufficiency in clients with heart failure, cirrhosis, or hypovolemia can be potential adverse effects of NSAIDs. NSAIDs do not cause bronchodilation. Anticoagulation is an adverse effect, not a desired outcome; NSAIDs can impair platelet function by inhibiting thromboxane, an aggregating agent, resulting in bleeding.
A client with tuberculosis is started on a chemotherapy protocol that includes rifampin. The nurse evaluates that the teaching about rifampin is effective when the client makes which statement? A. "I need to drink a lot of fluid while I take this medication." B. "I can expect my urine to turn orange from this medication." C. "I should have my hearing tested while I take this medication." D. "I might get a skin rash because it is an expected side effect of this medication."
B. "I can expect my urine to turn orange from this medication." Rifampin causes body fluids, such as sweat, tears, and urine, to turn orange. It is not necessary to drink large amounts of fluid with this drug; it is not nephrotoxic. Damage to the eighth cranial nerve is not a side effect of rifampin; it is a side effect of streptomycin sulfate, sometimes used to treat tuberculosis. A skin rash is not a side effect of rifampin.
A nurse evaluates that a client understands appropriately how to take the antacids prescribed by the primary health care provider when the client makes which statement? A. "I will take this antacid at the onset of pain." B. "I will take this antacid 30 minutes after meals." C. "I will take this antacid every 4 hours around the clock." D. "I will take this antacid each time I have something to eat."
B. "I will take this antacid 30 minutes after meals." Antacids are most effective when taken after digestion has started but before the stomach begins to empty. Antacids should be taken before the onset of pain; pain indicates that gastric irritation has begun, and the aim of treatment is to protect the gastrointestinal mucosa. Antacids taken every 4 hours around the clock interfere with the absorption of nutrients. Antacids taken with food interfere with the absorption of nutrients.
A nurse is caring for several clients with type 1 diabetes, and they each have a prescription for a specific type of insulin. Which insulin does the nurse conclude has the fastest onset of action? A. NPH insulin B. Insulin lispro C. Regular insulin D. Insulin glargine
B. Insulin lispro Insulin lispro has an onset of 0.25 hours, a peak action of 0.5 to 1.5 hours, and a duration of 3 to 4 hours. Insulin glargine has an onset of 1 to 1.5 hours, no peak action, and a duration of 20 to 24 hours. NPH insulin has an onset of 1.5 hours, a peak action of 4 to 12 hours, and a duration of 18 to 24 hours. Regular insulin has an onset of 0.5 hours, a peak action of 1 to 5 hours, and a duration of 6 to 10 hours.
A healthcare provider prescribes ampicillin for a client with an infection. What information should the nurse include in the teaching plan about this medication? A. Take the ampicillin with meals. B. Store the ampicillin in a light-resistant container. C. Notify the healthcare provider if diarrhea develops. D. Continue the drug until a negative culture is obtained.
C. Notify the healthcare provider if diarrhea develops. Diarrhea is a possible side effect that can be related to superinfection or to destruction of bacterial flora in the intestine; it can lead to fluid and electrolyte imbalance. Ampicillin is absorbed best when taken with water on an empty stomach. Although storage in an airtight container is necessary, protection from light is not. A culture generally is not repeated unless the client's condition indicates that the medication was ineffective.
A client is prescribed metformin extended release to control type 2 diabetes mellitus. Which statement made by this client indicates the need for further education? A. "I will take the drug with food." B. "I must swallow my medication whole and not crush or chew it." C. "I will notify my doctor if I develop muscular or abdominal discomfort." D. "I will stop taking metformin for 24 hours before and after having a test involving dye."
D. "I will stop taking metformin for 24 hours before and after having a test involving dye." Metformin must be withheld for 48 hours before the use of iodinated contrast materials to prevent lactic acidosis. Metformin is restarted when kidney function has returned to normal. Metformin is taken with food to avoid adverse gastrointestinal effects. If crushed or chewed, metformin XL will be released too rapidly and may lead to hypoglycemia. Muscular and abdominal discomfort is a potential sign of lactic acidosis and must be reported to the health care provider.
The nurse is preparing to administer an intravenous piggyback antibiotic that has been newly prescribed. Shortly after initiation, the client becomes restless and flushed and begins to wheeze. The nurse determines the that appropriate priority action will be to stop the antibiotic infusion and then do what? A. Notify the physician immediately about the client's condition. B. Take the client's blood pressure. C. Obtain the client's pulse oximetry. D. Assess the client's respiratory status.
D. Assess the client's respiratory status. The client is experiencing an allergic reaction that may progress to anaphylaxis. Anaphylactic shock can lead to respiratory distress as a result of laryngeal edema or severe bronchospasm. Assessing and maintaining the client's airway is the priority. In most facilities, the rapid response team will be called to assist the client. Another staff member can notify the physician of the client's condition while the nurse assesses the client. Vital signs, including blood pressure and pulse oximetry, are obtained after airway patency is ensured and maintained.
A nurse is administering a histamine H2 antagonist to a client who has extensive burns. The nurse explains to the client that this drug is given prophylactically during the first few weeks after extensive burns. What complication of burns will it prevent? A. Colitis B. Gastritis C. Stress ulcer D. Metabolic acidosis
C. Stress ulcer An ulcer of the upper gastrointestinal tract is related to excessive secretion of stress-related hormones, which increases hydrochloric acid production. Histamine H2 antagonists decrease acid secretion. Colitis is not a complication of burns. Gastritis is not a complication of burns. Metabolic acidosis is not a complication of burns unless hypermetabolism or renal failure occurs; metabolic acidosis is not treated with H2 antagonists.
Naltrexone is used to treat clients with substance abuse problems. In which situation does the nurse anticipate that naltrexone will be administered? A. To treat opioid overdose B. To block the systemic effects of cocaine C. To decrease the recovering alcoholic's desire to drink alcohol D. To prevent severe withdrawal symptoms from antianxiety agents
C. To decrease the recovering alcoholic's desire to drink alcohol. Naltrexone is effective in reducing the risk of relapse among recovering alcoholics in conjunction with other types of therapy. Naloxone, not naltrexone, is used for opioid overdose. Naltrexone is not used to treat the effects of cocaine. Naltrexone is an opioid antagonist. It is not used for antianxiety agent withdrawal.
A nurse is caring for a female client who is receiving rifampin for tuberculosis. Which statements indicate that the client understands the teaching about rifampin? Select all that apply. A. "This drug may be hard on my liver so I must avoid alcoholic drinks while taking it." B. "This drug may reduce the effectiveness of the oral contraceptive I am taking." C. "I Cannot take an antacid within 2 hours before taking my medicine." D. "My healthcare provider must be called immediately if my eyes and skin become yellow."
A, B, D. Alcohol may increase the risk of hepatotoxicity. Rifampin has teratogenic properties and may reduce the effectiveness of oral contraceptives. Yellowing of the eyes and skin are signs of hepatitis and should be reported immediately. An antacid may be taken 1 hour before taking the medication. The capsule may be opened and the powder mixed with applesauce.
A client is diagnosed with tuberculosis associated with human immunodeficiency virus infection. What crucial laboratory test results should the nurse review before antitubercular pharmacotherapy is started? A. Liver function studies B. Pulmonary function studies C. Electrocardiogram and echocardiogram D. White blood cell (WBC) count and sedimentation rate
A. Liver function studies Antitubercular drugs, such as isoniazid and rifampin are hepatotoxic. Pulmonary function studies, electrocardiogram, and echocardiogram are not related to the administration of antitubercular drugs or to their side effects. The WBC count is expected to be higher in the presence of infection, but with acquired immunodeficiency syndrome, the WBC count will be less than 2500/cm3 (2.5 × 109/L), and helper T cells will number less than 200 mm3; the T4/T8 ratio will be 1:2. These tests will not provide information relative to starting antitubercular therapy or to its side effects.
A nurse administers the drug desmopressin acetate (DDAVP) to a client with diabetes insipidus. What should the nurse monitor to evaluate the effectiveness of the drug? A. Arterial blood pH B. Intake and output C. Fasting serum glucose D. Pulse and respiratory rates
B. Intake and output DDAVP replaces antidiuretic hormone, facilitating reabsorption of water and consequent return of a balanced fluid intake and urinary output. The mechanisms that regulate pH are not affected. DDAVP does not alter serum glucose levels; diabetes mellitus, not diabetes insipidus, results in hyperglycemia. Although correction of tachycardia is consistent with correction of dehydration, the client is not dehydrated if the fluid intake is adequate; respirations are unaffected.
Which nursing action is the priority when administering chelation therapy for a toddler-age client? A. Assessing vital signs B. Monitoring urine output C. Conducting a behavioral assessment D. Providing education to reduce lead exposure
B. Monitoring urine output Adequate urinary output must be ensured with administration of calcium EDTA, the medication used for chelation therapy. Children receiving the drug intramuscularly must be able to maintain adequate oral intake of fluids. Monitoring vital signs, conducting a behavioral assessment, and providing education to reduce lead exposure are not priority nursing actions when administering chelation therapy.
A client will be taking nitrofurantoin 50 mg orally every evening at home to manage recurrent urinary tract infections. What instructions should the nurse give to the client? A. Increase the intake of fluids. B. Strain the urine for crystals and stones. C. Stop the drug if urinary output increases. D. Maintain the exact time schedule for taking the drug.
A. Increase the intake of fluids. To prevent crystal formation, the client should have sufficient intake to produce 1000 to 1500 mL of urine daily while taking this drug. Straining urine is not indicated when the client is taking a urinary antiinfective. Urinary decrease is of concern because it may indicate renal failure. If fluids are encouraged, the client's output should increase. The drug need not be taken at a strict time daily.
During a teaching session about insulin injections, a client asks the nurse, "Why can't I take the insulin in pills instead of taking shots?" What is the nurse's best response? A. "Insulin cannot be manufactured in pill form." B. "Insulin is destroyed by gastric juices, rendering it ineffective." C. "Your health care provider decides the route of administration." D. "Your health care provider will prescribe pills when you are ready."
B. "Insulin is destroyed by gastric juices, rendering it ineffective." Insulin in tablet form is inactivated by gastric juices; insulin given by injection avoids exposure to digestive enzymes. Insulin is not given orally at this time because it is inactivated by digestive enzymes. The response "Your health care provider will prescribe pills when you are ready" is incorrect information and provides false reassurance; the client currently is insulin dependent. The response "Your health care provider decides the route of administration" does not answer the client's question; insulin is administered intravenously or subcutaneously, and the route depends on the client's needs.
Which Food and Drug Administration pregnancy risk category do drugs that have not undergone any studies in animal and pregnant women belong to? A. Category B B. Category C C. Category D D. Category X
B. Category C Category C constitutes drugs on which no studies have been done. It also constitutes the drugs that have shown positive fetal risks in animal studies but with no studies conducted in humans. Category X constitutes drugs that have shown risks of fetal abnormalities in both animal and human studies. Category B constitutes drugs that show no fetal risk in animals; these drugs have not been involved in controlled studies in humans. Category D constitutes drugs that show a fetal risk in human studies but cannot be prohibited because of the safety of use.
A nurse administers beclomethasone by inhalation to a client with asthma, and the client asks why this medication is necessary. What should the nurse explain is the purpose of this pharmacologic therapy? A. Promotes comfort B. Decreases inflammation C. Stimulates smooth muscle relaxation D. Reduces bacteria in the respiratory tract
B. Decreases inflammation Beclomethasone reduces the inflammatory response in bronchial walls by suppression of polymorphonuclear leukocytes and fibroblasts and the reversal of capillary permeability. Beclomethasone does not directly promote comfort. Beclomethasone does not stimulate smooth muscle relaxation. Beclomethasone is not an antibiotic.
A client is admitted to the hospital with a diagnosis of an exacerbation of asthma. What should the nurse plan to do to best help this client? A .Determine the client's emotional state. B. Give prescribed drugs to promote bronchiolar dilation. C. Provide education about the impact of a family history. D. Encourage the client to use an incentive spirometer routinely.
B. Give prescribed drugs to promote bronchiolar dilation Asthma involves spasms of the bronchi and bronchioles as well as increased production of mucus; this decreases the size of the lumina, interfering with inhalation and exhalation. Bronchiolar dilation will reduce airway resistance and improve the client's breathing. Although identifying and addressing a client's emotional state is important, maintaining airway and breathing are the priority. In addition, emotional stress is only one of many precipitating factors, such as allergens, temperature changes, odors, and chemicals. Although recent studies indicate a genetic correlation along with other factors that may predispose a person to develop asthma, exploring this issue is not the priority. Use of an incentive spirometer is not helpful because of mucosal edema, bronchoconstriction, and secretions, all of which cause airway obstruction.
Which information should be included in the teaching plan for the elderly client with peptic ulcer disease who is taking an antacid and sucralfate? A. Antacids should be taken 30 minutes before a meal. B. Sucralfate should be taken on an empty stomach one hour before meals. C. Sucralfate is prescribed for the long-term maintenance of peptic ulcer disease. D. Sodium bicarbonate is an inexpensive over-the-counter antacid with few adverse effects.
B. Sucralfate should be taken on an empty stomach one hour before meals. Sucralfate works best in a low pH environment; therefore it should be given on an empty stomach either one hour before or two hours after meals. Sucralfate also should be administered no sooner than 30 minutes before or after an antacid. The acid-neutralizing effects of antacids last approximately 30 minutes when taken on an empty stomach and 3 to 4 hours when taken after meals. When sucralfate and an antacid are both prescribed, they are each most effective when the sucralfate is scheduled an hour before meals and the antacid is scheduled after meals. Sucralfate is prescribed for the short-term treatment of peptic ulcers. Its use is limited to 4 to 8 weeks. The client should follow the recommendations of the primary health care provider with regard to antacid selection. Sodium bicarbonate can produce acid-base imbalances which could be harmful, especially in elderly clients.
The nurse provides teaching to a client who has received a prescription for oral pancreatic enzymes, pancrelipase. The nurse evaluates that teaching is understood when the client identifies which time for medication scheduling? A. At bedtime B. With meals C. One hour before meals D. Upon arising each morning
B. With meals The pancreatic enzymes (amylase, trypsin, and lipase) must be present when food is ingested for digestion to take place. At bedtime the food eaten for dinner has passed beyond the duodenum; at bedtime the enzyme is given too late to aid digestion. Taking pancrelipase one hour before meals or on arising each morning will have no chyme in the duodenum on which the enzyme can act.
A 67-year-old client has tested positive for influenza A. The client also has asthma. Which drug would the nurse recommend be avoided in this client? A. Ribavirin B. Zanamivir C. Oseltamivir D. Amantadine
B. Zanamivir Zanamivir is used with caution in clients who have asthma or chronic obstructive pulmonary disease (COPD) and in older adults. Ribavirin is used for the treatment of severe influenza B. Oseltamivir may be used in treating both influenza A and B. Amantadine may be used for the treatment of influenza A.
Steroid therapy is prescribed for a client with an exacerbation of ulcerative colitis. The nurse evaluates that teaching is effective when the client identifies which times for the medication schedule? A. At bedtime with a snack B. Three times a day with meals C. In the early morning with food D. One hour before or two hours after eating
C. In the early morning with food Taking the drug in the early morning mimics usual adrenal secretions; food helps reduce gastric irritation. Diurnal rhythms may be altered, and steroids are ulcerogenic; they should be taken with more than just a snack. Steroids cause gastric irritation and should be taken with food. Although food helps decrease gastric irritation, dividing the dose and taking it throughout the day may alter regular diurnal rhythms; it should be taken in the early morning with food.
During the administration of total parenteral nutrition (TPN), an assessment of the client reveals a bounding pulse, distended jugular veins, dyspnea, and cough. What is the priority nursing intervention? A. Restart the client's infusion at another site. B. Slow the rate of the client's infusion of the TPN. C. Interrupt the client's infusion and notify the healthcare provider. D. Obtain the vital signs and continue monitoring the client's status.
C. Interrupt the client's infusion and notify the healthcare provider. The client is experiencing pulmonary edema because of a fluid volume excess. The high concentration of TPN precipitates a fluid shift from the interstitial compartment into the intravascular compartment. Fluid will continue to be infused, which will continue to increase the intravascular volume.
A client is diagnosed with diabetic ketoacidosis. Which insulin should the nurse expect the health care provider to prescribe? A. NPH insulin B. Inhaled insulin C. Regular insulin D. Insulin glargine
C. Regular insulin Regular insulin is rapid acting and should be used for diabetic coma. Insulin glargine is long-acting insulin, which is not indicated in an emergency. NPH insulin is intermediate-acting insulin; it is not indicated for use in an emergency. Inhaled insulin has not been approved for management of diabetic ketoacidosis.
A client admitted to the hospital with a diagnosis of chronic obstructive pulmonary disease has received a prescription for a medication that is delivered via a nebulizer. When teaching about use of the nebulizer, the nurse should teach the client to do what? A. Hold the breath while spraying the medication into the mouth. B. Position the lips loosely around the mouthpiece and take rapid, shallow breaths. C. Seal the lips around the mouthpiece and breathe in and out, taking slow, deep breaths. D. Inhale the medication from the nebulizer, remove the mouthpiece from the mouth, and then exhale.
C. Seal the lips around the mouthpiece and breathe in and out, taking slow, deep breaths. Sealing the lips around the mouthpiece ensures that medication is delivered on inspiration; slow, deep breaths promote better deposition and efficacy of medication deep into the lungs. The breath should not be held; a nebulizer treatment delivers medication by inhaling it into the mouth through a mouthpiece. Positioning the lips loosely around the mouthpiece may allow room air to be inhaled, which will dilute the aerosolized medication; rapid, shallow breaths mainly will deposit medication in the oral cavity and will not effectively deliver medication deep into the lung. Inhaling the medication from the nebulizer, removing the mouthpiece from the mouth, and then exhaling allows valuable aerosolized medication to be deposited into the air when the client removes the mouthpiece from the mouth to exhale; the client will not receive the full dose of aerosolized medication.
Famotidine (Pepcid) is prescribed for a client with peptic ulcer disease. The client asks the nurse what this medication does. Which action does the nurse mention when replying? A. Increases gastric motility B. Neutralizes gastric acidity C. Facilitates histamine release D. Inhibits gastric acid secretion
D. Inhibits gastric acid secretion Famotidine decreases gastric secretion by inhibiting histamine at H2 receptors. Increases gastric motility, neutralizes gastric acidity, and facilitates histamine release are not actions of famotidine.
A client is diagnosed with type 2 diabetes, and the health care provider prescribes an oral hypoglycemic. For what side effect should the nurse teach this client to monitor? A. Ketonuria B. Weight loss C. Ketoacidosis D. Low blood sugar
D. Low blood sugar Oral hypoglycemic agents decrease serum glucose levels that may precipitate hypoglycemia. Ketonuria occurs with insulin-dependent diabetes. Weight gain usually is noted in adult-onset diabetes. Ketoacidosis occurs with insulin-dependent diabetes.
A health care provider prescribes daily docusate sodium for a client. The nurse explains to the client that this drug has what action? A. Lubricates the feces B. Creates an osmotic effect C. Stimulates motor activity D. Lowers the surface tension of feces
D. Lowers the surface tension of feces The detergent action of docusate sodium promotes the drawing of fluid into the stool, which softens the feces. Lubricating the feces in the gastrointestinal (GI) tract is the action of lubricant laxatives such as mineral oil. Creating an osmotic effect in the GI tract is the action of saline laxatives, such as magnesium hydroxide, or other osmotics such as lactulose. Stimulating motor activity of the GI tract is the action of peristaltic stimulants, such as cascara.
