Passpoint Pharm

A nurse is teaching a 16-year-old female client with inflammatory bowel disease about corticosteroid treatment. Which adverse effects are likely to be concerns for this client? Select all that apply.

The adverse effects of corticosteroids include acne, hirsutism, mood swings, osteoporosis, and adrenal suppression. Steroid use in children and adolescents may cause delayed growth, not growth spurts.

A nurse is caring for a client admitted with arching of the back, extension and rotation of the neck, and slow involuntary contractions of the arms and neck. After review of the client's medication list, the nurse would be correct in associating these symptoms with which medication?

haloperidol Slow, involuntary contractions of the arms and neck, arching of the back, and extension and rotation of the neck are signs of dystonia. Dystonia is a common adverse effect of antipsychotic medications such as haloperidol. Benztropine is an antiparkinsonian drug, pantoprazole is an antiulcer medication, and propranolol is an antihypertensive.

The nurse is administering oxycodone for leg pain, as requested by the client. What priority actions will the nurse implement? Select all that apply.

The nurse will verify the order, assess for allergies, and identify the client for safe medication administration. The nurse needs to assess the client's respiratory system because oxycodone can cause respiratory depression. The nurse does not have to assess the client's activity level for the pain medication administration.

A child is receiving I.V. gamma globulin for treatment of Kawasaki disease. The order is for 8 g over 12 hours. The concentration is 8 g in 300 ml of normal saline. How many milliliters per hour will this child receive? Record your answer using a whole number.

25 Use the following equation: 300 ml/12 hr = 25 ml/hr

The client is diagnosed with absence seizures and is prescribed pentobarbital sodium. What should the nurse include in the client's teaching concerning the administration of pentobarbital sodium?

"Pentobarbital sodium can cause confusion." The nurse should explain that adverse effects of pentobarbital sodium include confusion, slurred speech, slow physical movement, blood dyscrasias, nausea, vomiting, constipation, gingival hyperplasia, and hirsutism. Hypotension, hand tremors, and anxiety are not adverse effects of pentobarbital sodium.

While receiving heparin to treat a pulmonary embolus, a client passes bright red urine. What should the nurse do first?

Prepare to administer protamine sulfate. Frank hematuria indicates excessive anticoagulation and bleeding—and heparin overdose. The nurse should discontinue the heparin infusion immediately and prepare to administer protamine sulfate, the antidote for heparin. Merely decreasing the heparin infusion rate wouldn't prevent further bleeding. Although the nurse should continue to monitor PTT, this action should occur later. An I.V. infusion of D5W may be administered, but only after protamine has been given.

A 20-month-old toddler has been treated with permethrin for scabies. The toddler's parent asks, "Is this medication working? My child is still itching." Which response by the nurse is most appropriate?

Pruritus can be present for weeks after treatment. Pruritus may be present for weeks following treatment with permethrin. The drug is safe for use in infants as young as age 2 months. Treatment with permethrin can be safely repeated in 2 weeks. Pruritus is caused by secondary reactions of the mites.

An infant has been transferred from the ICU to the pediatric floor after undergoing surgery to correct a heart defect. Which tasks can the nurse delegate to the licensed practical/vocational nurse (LPN/VN)? Select all that apply.

The RN's scope of practice includes assessment, planning, implementing, and evaluation. Only aspects of care implementation may be delegated to the LPN/VN, and the exact skills that may be delegated vary by state and institution. In general, LPN/VNs have been trained to perform the tasks of administering oral medications, performing hygiene, and recording the intake and output. LPN/VNs may also take vital signs to gather data, but the nurse must interpret the data. Administering IV morphine requires assessment of the client's respiratory status before, during, and after the procedure. Circulation checks are assessments the RN should complete.

A client experiencing alcohol withdrawal is prescribed lorazepam. The client's family asks the nurse about the purpose of the medication. What is the nurse's best response?

The lorazepam will reduce the your family member's symptoms of withdrawal. Lorazepam is a short-acting benzodiazepine usually given for 1 week to ease the effects of alcohol withdrawal. It is not used to reduce cravings and, although it will help the client feel more relaxed and can enhance sleep, this is not the primary indication. Though it is a benzodiazepine, telling the family this information does not address the question of why the client has been prescribed this medication.

The nurse is preparing to administer digoxin to an infant. What is the most important intervention by the nurse?

Withhold the dose if the apical pulse rate is less than 90/bpm Digoxin is used to decrease the heart rate; however, the apical pulse must be carefully monitored to detect a severe reduction. Administering digoxin to an infant with a heart rate of less than 90/bpm could further reduce the rate and compromise cardiac output. Mixing digoxin with food may interfere with accurate dosing. Double dosing should never be done. Antacids may decrease drug absorption.

Which assessment finding supports the administration of protamine sulfate?

aPTT 3.5-5 times normal Protamine sulfate is the antidote specific to heparin. The RBC, and platelet levels are normal. Normal aPTT in heparinized clients is 2-2.5 times normal. INR measurement relates to therapy with warfarin, not heparin. An INR value of 8 is abnormally high and would likely require administration of vitamin K, the antidote for warfarin.

Which medication can the nurse administer through a nasogastric (NG) tube?

acetaminophen Most oral medications can be given through an NG tube because they're intended for passage into the stomach. Some oral drugs have special coatings intended to keep the pill intact until it passes into the small intestine. These enteric-coated pills shouldn't be crushed and put through an NG tube. Some parenteral medications, such as insulin, may be destroyed by gastric juices. Sublingual medications must be given under the tongue.

The nurse is instructing a client with acute asthma who is taking short-term corticosteroid therapy. The nurse should tell the client that steroids will have which expected outcome? Steroids will:

have an anti-inflammatory effect. Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections.

Which assessment finding is expected in a client receiving bicalutamide and leuprolide for advanced prostate cancer?

hot flashes Bicalutamide, a nonsteroidal antiandrogen, and leuprolide, a gonadotropin-releasing hormone agonist, decrease the production of testosterone. This helps decrease the production of cancer cells involved in prostate cancer. Because androgens are responsible for the development of male genitalia and secondary male sex characteristics, low androgen levels can cause genital atrophy, breast enlargement, and hot flashes. Abdominal distention, acromegaly, and colicky pain aren't caused by bicalutamide and leuprolide therapy.

The nurse is caring for a newborn with unrepaired transposition of the great vessels. Which medication should the nurse anticipate giving first for treatment of this defect?

prostaglandin E1 Prostaglandin E1 is necessary to maintain patency of the patent ductus arteriosus, and improve systemic arterial flow in children with inadequate intracardiac mixing. Digoxin, furosemide, and enalapril will treat heart failure when present.

Which physical assessment data would alert the nurse to a possible mild toxic reaction in a client receiving lithium?

vomiting and diarrhea Vomiting and diarrhea are signs of mild to moderate lithium toxicity. Hypotension and seizures occur with moderate to severe toxic reactions. Anorexia occurs with mild toxic reactions.

A client is receiving magnesium sulfate at 3 g/h intravenously. The bag of 1,000 mL normal saline contains 20 g of magnesium sulfate. At what rate (in mL/hour) should the nurse set the IV pump to deliver 3 g/h? Record your answer using a whole number.

150 The rate can be calculated as follows: Rate = (Volume to infuse)/(Time to infuse) Volume to infuse = (Desired dose/Dose on hand) X Supply = (3 g/20 g) X 1000 mL Therefore, Rate = ((3 g/20 g) X 1000 mL)/1 hr = 150 mL/hr.

An adolescent client is using glargine and lispro to manage type 1 diabetes. The nurse reviews the prescription for sliding scale lispro (see exhibit). Lispro subcutaneous give units according to sliding scale:Blood glucose: 70 - 150 mg/dL (3.9 to 8.3 mmol/L) = 0 units151-200 mg/dL (8.4 to 11.1 mmol/L) = 1 unit201-250 mg/dL (11.2 to 13.9 mmol/L) = 2 units251-300 mg/dL (14 to 16.7 mmol/L) = 3 units301-350 mg/dL (16.8 to 19.4 mmol/L) = 4 unitsCall for blood glucose > 350 (19.4 mmol/L)In addition give 1 unit for every 15 grams of carbohydrate.The morning blood glucose is 202 mg/dL (11.2 mmol/L) and the client is going to eat 2 carbohydrate exchanges. The nurse has the client administer how many units of lispro? Record your answer using a whole number.

4 Each carbohydrate food exchange has 15 grams of carbohydrate. Two units are needed to cover the current blood glucose, and 2 units are needed to cover the anticipated carbohydrate intake.

A client is receiving fluid replacement with lactated Ringer's after 40% of the body was burned 10 hours ago. The assessment reveals temperature 97.1°F (36.2°C), heart rate 122 bpm, blood pressure 84/42 mm Hg, central venous pressure (CVP) 2 mm Hg, and urine output 25 mL for the last 2 hours. The IV rate is currently at 375 mL/h. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, what prescription should the nurse request from the health care provider?

IV rate increase The decreased urine output, low blood pressure, low CVP, and high heart rate indicate hypovolemia and the need to increase fluid volume replacement. Furosemide is a diuretic that should not be given due to the existing fluid volume deficit. Fresh frozen plasma is not indicated. It is given for clients with deficient clotting factors who are bleeding. Fluid replacement used for burns is Lactated Ringer's solution, normal saline, or albumin.

A client with lung cancer has developed an intractable, nonproductive cough that is unrelieved by nonopioid antitussive agents. The health care provider orders codeine, 10 mg PO every 4 hours. Which statement accurately describes codeine?

It's a centrally-acting antitussive and can cause dependence. As a centrally-acting antitussive, codeine suppresses the cough reflex by directly affecting the sensitivity of the cough center in the medulla to incoming stimuli. Because codeine is an opioid, it can cause dependence.

The client is in the postanesthesia care unit (PACU) recovering from surgery. The nurse administers the prescribed hydromorphone IV push (IVP). Five minutes later the nurse notes a respiratory rate of 9 breaths per minute on the same client. Which interventions should the nurse implement? Select all that apply.

The nurse should administer naloxone and reassess every 5 minutes. The nurse should not wait for the anesthesiologist, the nurse should intervene immediately. CPR and ventilation's are not needed, the client is breathing and the heart is beating on its own.

The client is admitted to the hospital with cardiomyopathy, pulmonary edema, and dyspnea. The client is started on dobutamine. What should the nurse include in the client's teaching about dobutamine? Select all that apply.

The nurse should explain that Dobutamine helps increase the strength of the heart muscle and urinary output. Dobutamine does not increase blood pressure or activity tolerance, and it does not produce arrhythmias.

After administering prescribed medications to clients, which client requires immediate intervention?

a client taking digoxin who has a morning potassium level of 3.0 mEq/L The client's low potassium level increases the risk for digoxin toxicity and potential dysrhythmias. Digoxin inhibits the action of the sodium-potassium pump that moves sodium and potassium across the cell membrane and slows the electrical impulses through the atrioventricular node. This leads to a rapid reduction of the remainder of potassium ions available for the "pump" action, which can cause a buildup of toxic serum levels of digoxin. Digoxin toxicity can cause many types of cardiac dysrhythmias due to the increased intracellular calcium release and decreased AV conduction time slowing the heart rate. The nurse should notify the healthcare provider about the potassium level to prevent toxicity from occurring. The other clients are experiencing expected effects of the prescribed medication.

A nurse is developing a drug therapy regimen that won't interfere with a client's lifestyle. When doing this, the nurse must consider the drug's

adverse effects. When developing a drug therapy regimen that won't interfere with a client's lifestyle, the nurse must consider the drug's adverse effects because these may result in noncompliance. A drug's excretion route, peak concentration time, and steady-state duration of action are important considerations when developing a drug therapy regimen; however, they're related to the drug's physiologic effects and don't affect the client's lifestyle.

A client is prescribed adenosine for treatment of supraventricular tachycardia (SVT). When should the nurse assess the client for a response to the dose of adenosine?

after 1 to 2 minutes Adenosine is the first-line medication for SVT, and can convert the heart rhythm to a normal rate and rhythm. It is given as an emergent medication and should be delivered as rapid intravenous (IV) bolus over 1 to 2 seconds. It should be administered at the peripheral IV site that is closest to the client's core. Once administered, the IV site should be flushed with 20 ml of normal saline immediately. The client's response is known within 1 to 2 minutes of administration, at which time the cardiac rhythm will dictate if the dose needs to be repeated. Waiting longer than 2 minutes to assess the response would delay potentially life-saving treatment.