Pharm EXAM 7 18+15+21+20

A patient has purchased capsaicin OTC cream to use for muscle aches and pains. What education is most important to give this patient? a. Apply with a gloved hand only to the site of pain b. Apply the medication liberally above and below the site of pain c. Apply to areas of redness and irritation only d. Apply liberally with a bare hand to the affected limb

a. Apply with a gloved hand only to the site of pain Capsaicin should be applied to the site of pain with a gloved hand to avoid introducing the capsaicin to the eyes or other parts of the body not under treatment.

The client is prescribed clonazepam (Klonopin) for treatment of a seizure disorder. What would be important for the nurse to monitor in this client? (Select all that apply.) a. Maintaining therapeutic blood levels of the drug b. Determining the pregnancy status of the client c. Increase in the client's pancreatic enzyme levels d. Changes in stool color or darkened color of urine e. Bleeding of the gums when brushing the teeth

a. Maintaining therapeutic blood levels of the drug b. Determining the pregnancy status of the client d. Changes in stool color or darkened color of urine Clonazepam (Klonopin) is a benzodiazepine used for treatment of seizure disorders. Antiseizure drugs require periodic drug levels to correlate the level with symptoms. Benzodiazepines are Category D drugs, and are contraindicated during pregnancy. Antiseizure drugs may cause hepatotoxicity, which may be evidenced by changes in the color of the stool and darkening of the urine. Valproic acid may cause pancreatitis as an adverse effect. Hydantoins and phenytoin-like drugs affect the absorption of vitamin K, which can lead to unusual bleeding.

A nurse is caring for a pediatric client who is being treated for spastic cerebral palsy. Which pharmacotherapy should the nurse prepare for client and family teaching? a. Oral tizanidine (Zanaflex) b. Intrathecal baclofen pump c. Intramuscular diazepam (Valium) d. Oral cyclobenzaprine (Flexeril)

b. Intrathecal baclofen pump Intrathecal baclofen, delivered directly into the spinal fluid circulation by an implanted pump, has demonstrated significant improvements in the treatment of spastic CP with reduced systemic effects. Pharmacotherapy for patients with CP has included diazepam (Valium), dantrolene (Dantrium), and baclofen (Lioresal)—all administered orally. Cyclobenzaprine is not recommended for pediatric use.

When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects? a. Fatigue and depression b. Anxiety and peripheral vasoconstriction c. Headache and rapid heart rate d. Oral candidiasis and dry mouth

d. Oral candidiasis and dry mouth Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids. The nurse should teach the patient to rinse the mouth after each use of the inhaler and to spit out after rinsing if a corticosteroid inhaler is used.

The lab results of a client treated for Alzheimer's disease reveals increased liver function tests. The nurse recognizes that the drug most likely to cause this side effect is: a. Rivastigmine tartrate (Exelon). b. Donepezil (Aricept). c. Tacrine (Cognex). d. Galantamine (Reminyl).

Answer: c. Tacrine (Cognex). Rationale: Acetylcholinesterase inhibitors used for treatment of Alzheimer's disease cause a variety of side effects. Elevated liver enzymes are specifically associated with tacrine (Cognex) use.

Donepezil (Aricept) is prescribed for a client with Alzheimer's disease. The nurse determines that the medication is having positive effects when what is observed? a. Absence of wandering b. Decreased progression of memory loss c. Increase in "pin rolling" d. Regaining the ability to drive a car

Answer: b. Decreased progression of memory loss Rationale: Aricept is effective in the early stages of Alzheimer's disease. It might slow or decrease progression of symptoms, but it will not reverse behaviors that are lost.

The nurse completes a history and physical on a client admitted with an exacerbation of a seizure disorder. The client is currently taking ethosuximide (Zarontin) 500 mg twice daily by mouth. Which information warrants immediate notification of the healthcare provider? a. Use of the herb Ginkgo biloba b. History of asthma c. Use of aspirin daily d. History of diabetes mellitus

a. Use of the herb Ginkgo biloba Ginkgo biloba decreases the effectiveness of anti-seizure medications such as succinimide ethosuximide (Zarontin), and could have led to the exacerbation of the client's seizure episodes.

The patient is scheduled ro receive rimabotulinum-toxin B (Myobloc) for treatment of muscle spasticity. Which of the following will the nurse teach the patient to report immediately? a. Fever, aches, chills b. Difficulty swallowing, ptosis, blurred vision c. Continuous spasms and pain on the affected side d. Moderate levels of muscle weakness on the affected side

b. Difficulty swallowing, ptosis, blurred vision Dysphagia,ptosis,andblurredvi- sion are all symptoms of possible botulinum toxin B toxicity and must be reported immediately.

A client is using an intranasal oxymetazoline (Afrin) for treatment of nasal congestion. Which instruction should the nurse include during client teaching? a. Monitor respiratory rate. b. Limit use of the drug to 3-5 days. c. Drink plenty of fluids. d. Use with caution with SSRIs.

b. Limit use of the drug to 3-5 days. Because of the rebound congestion associated with the drug, intranasal sympathomimetics should be used for no longer than 3-5 days.

A nurse is caring for a client who is taking dextromethorphan (Delsym). The client presents at the clinical with symptoms of hypotension and hyperpyrexia. For which drug interaction should the nurse assess in the client? a. Opioids b. Barbiturates c. MAOIs d. Grapefruit juice

c. MAOIs Drug interactions with dextromethorphan include excitation, hypotension, and hyperpyrexia when used concurrently with MAOIs. Use with alcohol, opioids, or other CNS depressants may result in sedation. Grapefruit juice can raise serum levels of dextromethorphan and cause CNS toxicity.

A nurse is caring for a client receiving pharmacotherapy for progressive multiple sclerosis. Which medication should the nurse anticipate administering? a. Peginterferon beta-1a (Plegridy) b. Glatiramer (Copaxone) c. Mitoxantrone (Novantrone) d. Interferon beta-1b (Betaseron)

c. Mitoxantrone (Novantrone) For progressive forms of MS (progressive-relapsing MS and primary progressive MS), mitoxantrone (Novantrone) is the drug approved by the FDA for patients who have not responded to interferon or glatiramer therapy.

A nurse is caring for a client who is prescribed fluticasone (Afrin) for allergic rhinitis. Which assessment finding should the nurse report immediately to the healthcare provider? a. Headache b. Hypertension c. Sore throat d. Hyperglycemia

c. Sore throat A sore throat can be a sign of an upper respiratory infection and should be evaluated further by the client's healthcare provider. Because corticosteroids can mask signs of infection, patients with known bacterial, viral, fungal, or parasitic infections (especially of the respiratory tract) should not receive intranasal corticosteroids.

A patient has been using a fluticasone (Flovent) inhaler as a component of his asthma therapy. He returns to his health care providers office complaining o sore mouth. On inspection the nurse notices white patches in his mouth. What is a possible explanation? a. The patient has been consuming hot beverages after use of inhaler b. The patient has limited fluid intake, resulting in dry mouth c. The residue of the inhaler propellant is coating the inside of the mouth d. The patient has developed thrush as a result of the fluticasone

d. The patient has developed thrush as a result of the fluticasone The patient likely has developed a thrush (Candida) infection of the mouth secondary to the use of the corticosteroid inhaler. After the use of ICS inhalers such as fluticasone (Flovent), patients should be taught to rinse the mouth and spit out the residue. Drinking fluids will also prevent irritation, ul- cerations, and thrush infections of the throat.

A client has been started on benztropine (Cogentin) for relief of parkinsonian symptoms. Which of the following statements made by the client best indicates that the drug is producing a therapeutic effect? a. "My hands aren't as shaky as they used to be." b. "I feel so calm and relaxed." c. "I can tie my shoes now without difficulty." d. "That annoying lip smacking is much less frequent."

Answer: a. "My hands aren't as shaky as they used to be." Rationale: Cogentin blocks excess cholinergic stimulation and helps to suppress tremors. It does not affect symptoms of tardive dyskinesia, such as lip smacking. It does not affect mood.

A client with Alzheimer's disease has been receiving medication therapy for several months. The nurse should teach the client and caregiver to report signs of overdose, which include: a. Bradycardia and muscle weakness. b. Tachycardia and hypertension. c. Abdominal pain and dry mouth. d. Emotional withdrawal and tachypnea

Answer: a. Bradycardia and muscle weakness. Rationale: An overdose of drugs to treat Alzheimer's disease could occur if they are taken improperly, or if decreased liver or renal function occurs. Symptoms of overdose include severe nausea/vomiting, sweating, salivation, hypotension, bradycardia, convulsions, and increased muscle weakness, including respiratory muscles.

A client receiving an anticholinergic drug for treatment of Parkinson's disease complains of dry mouth. Nursing intervention should include advising the client to: a. Take the drug with food or milk. b. Chew sugarless gum, and suck on sugarless hard candy. c. Use mouthwash before taking the drug. d. Rinse mouth with warm water

Answer: b. Chew sugarless gum, and suck on sugarless hard candy. Rationale: Frequent drinking of cool liquids, sucking on hard candy or ice chips, and chewing sugarless gum can add moisture to the mucous membranes.

The nurse discusses the disease process of multiple sclerosis with the client and caregiver. The client will begin taking glatiramer acetate (Copaxone), and the nurse is teaching the client about the drug. Which of the following points should be included? a. Drink extra fluids while this drug is given. b. Local injection site irritation is a common affect. c. Take the drug with plenty of water and remain in an upright position for at least 30 minutes. d. The drug causes a loss of vitamin C so include extra citrus and foods containing vitamin C in the diet.

Answer: b. Local injection site irritation is a common affect. Rationale: Glatiramer acetate (Copaxone) is given by injection and often causes injection site irritation. Options a, c, and d are incorrect. Extra fluids do not need to be included and the drug is not given orally. It does not deplete vitamin C from the body.

The client asks what can be expected from the levodopa/carbidopa (Sinemet) he is taking for treatment of parkinsonism. What is the best response by the nurse? a. "A cure can be expected within 6 months." b. "Symptoms can be reduced and the ability to perform ADLs can be improved." c. "Disease progression will be stopped." d. "EPS will be prevented."

Answer: b. Symptoms can be reduced and the ability to perform ADLs can be improved. Rationale: Pharmacotherapy does not cure or stop the disease process but does improve client's ability to perform normal activities such as eating, bathing and walking. Options a, c, and d are incorrect. Drug therapy in Parkinson's disease does not cure or halt progression of the disease. Depending on the drug therapy, EPS may be an adverse effect.

The client asks what can be expected from drug therapy for treatment of parkinsonism. The best response by the nurse would be: a. That a cure can be expected within six months. b. That symptoms can be reduced, and the ability to perform ADLs can be improved. c. That disease progression will be stopped. d. That EPS will be prevented

Answer: b. That symptoms can be reduced, and the ability to perform ADLs can be improved. Rationale: Pharmacotherapy does not cure the disease, but it does improve the client's ability to perform normal activities, such as eating, bathing, and walking. The symptoms are often reversed if medications are taken long-term.

The family member caring for a client with Parkinson's disease at home notifies the nurse that the client is demonstrating extrapyramidal symptoms. The nurse should instruct the caregiver to: a. Give diphenhydramine (Benadryl) 25 mg p.o. b. Transport the client to the Emergency Department. c. Increase dosage of antiparkinsonism drugs. d. Make an appointment with the health care provider for evaluation.

Answer: b. Transport the client to the Emergency Department. Rationale: The symptoms can cause severe muscle spasms and can be life-threatening without intervention. The client should be transported to the Emergency Department. Diphenhydramine must be given parenterally for effective treatment.

Which of the following client statements indicates that the levodopa/carbidopa (Sinemet) is effective? a. "I'm sleeping a lot more, especially during the day." b. "My appetite has improved." c. "I'm able to shower by myself." d. "My skin doesn't itch anymore."

Answer: c. "I'm able to shower myself" Rationale: Becoming more independent in ADLs shows an improvement in physical abilities. Options a, b, and d are incorrect. Drowsiness is a common adverse effect of anti-Parkinson's medications. Anorexia or loss of appetite is also a common adverse effect and skin itching is not related to medication use.

The nurse provides nutritional counseling for a client receiving levodopa. The client should be encouraged to: a. Lower the intake of simple carbohydrates. b. Increase vitamin B6 intake. c. Avoid foods such as ham, sweet potatoes, and oatmeal. d. Decrease intake of dairy products

Answer: c. Avoid foods such as ham, sweet potatoes, and oatmeal. Rationale: Ham, sweet potatoes, and oatmeal are high in pyridoxine (vitamin B6). Pyridoxine reduces the effects of levodopa.

During the initial treatment with levodopa for clients with Parkinson's disease, nursing interventions should include: a. Monitoring for suicidal ideation. b. Observing for EPS. c. Providing safety to prevent falls. d. Increasing foods high in vitamin B6, such as bananas and liver

Answer: c. Providing safety to prevent falls. Rationale: Orthostatic hypotension is likely during early treatment. Clients should be protected from falls. Suicidal ideation is monitored when clients are first started on antidepressants. EPS occurs with some antipsychotic medications. Bananas and liver are high in vitamin B6 and will decrease absorption of levodopa.

An early sign(s) of levodopa toxocity is (are) which of the following? a. Orthostatic hypotension b. Drooling c. Spasmodic eye winking and muscle twitching d. Nausea, vomiting and diarrhea

Answer: c. Spasmodic eye winking and muscle twitching. Rationale: Blepharospasm (spasmodic eye winking) and muscle twitching are early signs of potential overdose or toxicity. Options a, b, and d are incorrect. Orthostatic hypotension is a common adverse effect of both Parkinson's disease and many drugs used to treat the condition but is not a symptom of over-dosage or toxicity. Drooling, nausea, vomiting, and diarrhea are also not symptoms of overdose or toxicity.

Levodopa (Larodopa) is prescribed for a client with Parkinson's disease. At discharge, which of the following teaching points should the nurse include? a. Monitor blood pressure every 2 hours for the first 2 weeks. b. Report development of diarrhea. c. Take the pill on an empty stomach or 2 hours after a meal containing protein. d. If tremors seem to worsen, take a double dose for two doses and call the provider

Answer: c. Take the pill on an empty stomach or 2 hours after a meal containing protein. Rationale: Taking dopamine replacement drugs such as levodopa (Larodopa) with meals containing protein significantly impairs absorption. The drug should be taken on an empty stomach or 2 or more hours after a meal containing protein. Options a, b, and d are incorrect. Although the client should be taught to rise gradually from lying or sitting to standing, the client does not need to monitor blood pressure every 2 hours. Diarrhea should be reported bur is unrelated to the effects of levodopa, and other causes should be explored. An increase in tremors should be evaluated and the dose of the drug should not be independently increased.

Levodopa (Laradopa) is prescribed for a client with Parkinson's disease. The nurse's discharge teaching should include: (Select all that apply.) a. Monitor the blood pressure every two hours for the first two weeks. b. Expect the urine color to be orange. c. Report the development of diarrhea. d. Report to the lab for a follow-up of liver and renal function tests. e. Avoid taking the medication with high-protein meals

Answer: d. Report to the lab for a follow-up of liver and renal function tests.; e. Avoid taking the medication with high-protein meals. Rationale: A decrease in kidney and liver function could slow the metabolism and excretion of the drug, leading to overdose and toxicity. Protein decreases the absorption of levodopa. Blood pressure needs to be closely monitored when the dose is adjusted. It might cause urine and sweat to darken in color. It does not cause diarrhea.

A client has been started on benztropine (Cogentin) for relief of parkinsonian symptoms. Which statement made by the client best indicates that the drug is producing a therapeutic effect? a. "My hands aren't as shaky as they used to be." b. "I feel so much more calm and relaxed." c. "I still have some difficulty tying my shoes." d. "That annoying lip smacking is much less frequent."

a. "My hands aren't as shaky as they used to be." Benztropine (Cogentin) blocks excess cholinergic stimulation and helps to suppress tremors. It does not affect symptoms of tardive dyskinesia, such as lip smacking, or affect mood.

A nurse cares for clients who receive botulinum toxin for treatment of muscle spasticity. Which client should the nurse monitor closely for adverse effects during administration of this drug? a. A pediatric client with strabismus b. An adult client with overactive bladder c. An adult client with migraine headaches d. A pediatric client with excessive sweating

a. A pediatric client with strabismus Children being treated for muscle spasms have the greatest risk of adverse effects, along with patients with debilitating conditions such as muscular dystrophy or musculoskeletal disorders. The chances of serious adverse effects occurring are unlikely when botulinum toxin is used to treat migraines or for excessive sweating in adults.

A 65-year old patient is prescribed ipratropium (Atrovent) for the treatment of asthma. Which of the following conditions should be reported to the health care provider before giving this patient the ipratropium? a. A reported allergy to peanuts b. A history of intolerance to albuterol (Proventil) c. A history of bronchospasm d. A reported allergy to chocolate

a. A reported allergy to peanuts Ipratropium (Atrovent) is con- traindicated in patients with hypersensitivity to soya lecithin or related food products such as soybean and peanut. Options 2, 3, and 4 are incorrect. A history of intolerance to albuterol or bronchospasms is an indica- tion for ipratropium. A history of allergy to chocolate is not a contraindication for this drug.

Cycobenzapine (Amrix, Flexural) is prescribed for a patient with muscle spasms of the lower back. Appropriate nursing interventions would include which of the following (select all that apply) a. Assessing the heart rate for tachycardia b. Assessing the home environment for patient safety concerns c. Encouraging frequent ambulation d. Providing oral suction for excessive oral secretions e. Providing assistance with activities of daily living such as reading

a. Assessing the heart rate for tachycardia b. Assessing the home environment for patient safety concerns e. Providing assistance with activities of daily living such as reading Adversereactionstocycloben- zaprine include drowsiness, dizziness, dry mouth, rash, blurred vision, and tachycardia. Because the medication can cause drowsiness and dizziness, ensuring patient safety must be a priority. The patient may need assis- tance with reading or other activities requiring visual acuity if blurred vision occurs.

Cyclobenzaprine (Flexeril) is prescribed for an older adult client experiencing muscle spasm of the lower back. Which nursing intervention should the nurse include in the client's plan of care? a. Assisting with patient repositioning b. Encouraging independent ambulation c. Assessing heart rate for bradycardia d. Providing oral suction for secretions

a. Assisting with patient repositioning Orthostatic hypotension is a possible adverse effect of cyclobenzaprine (Flexeril), so the nurse should include interventions to assist the patient with changing positions from lying to sitting or standing slowly to avoid dizziness or falls. In addition, muscles spasms, pain, or rigidity may increase the risk of falls or injury. The patient should be encouraged not to attempt standing or walking without assistance. Tachycardia and dry mouth are adverse effects of the medication.

A nurse is caring for a client brought in to the emergency department for donepezil overdose. The nurse should anticipate administering which medication? a. Atropine sulfate b. Dexamethasone c. Epinephrine d. Physostigmine

a. Atropine sulfate Anticholinergics such as atropine may be used as an antidote for donepezil overdose. Intravenous atropine sulfate titrated to effect is recommended: an initial dose of 1-2 mg IV with subsequent doses based on clinical response. Physostigmine is the treatment for overdose of anticholinergic toxicity.

When planning care for a client with muscle spasms, which goal of treatment is most appropriate for the nurse to consider? a. Decrease pain and increase range of motion. b. Restrict mobility until symptoms are relieved. c. Avoid long-term treatment of the disorder. d. Prevent occurrence of liver and renal damage.

a. Decrease pain and increase range of motion. The goals of therapy, both pharmacological and nonpharmacological, for clients with muscle spasms include minimizing pain and discomfort, increasing range of motion, and improving the client's ability to function independently. Long-term treatment might be needed, and mobility does not always need to be restricted.

The nurse is providing education for a 12-year-old patient with partial seizures currently prescribed valproic acid (Depakene). The nurse will teach the patient and the parents to immediately report which symptom? a. Increasing or severe abdominal pain b. Decreased or foul taste in the mouth c. Pruritus and dry skin d. Bone and joint pain

a. Increasing or severe abdominal pain Valproic acid may cause life- threatening pancreatitis, and any severe or increas- ing abdominal pain should be reported immediately.

A nurse is caring for a client with chronic bronchitis and is prescribed acetylcysteine to loosen bronchial secretions. The nurse should administer this medication by which route? a. Inhalation b. Oral c. Intravenous d. Intramuscular injection

a. Inhalation Acetylcysteine is delivered by the inhalation route and is not available OTC. It is used in patients who have cystic fibrosis, chronic bronchitis, or other diseases that produce large amounts of thick bronchial secretions. Acetylcysteine (Acetadote) is also administered by the IV route as an antidote for patients who have received an overdose of acetaminophen.

The patient has been prescribed oxymetazoline (Afrin) nasal spray for seasonal rhinitis. The nurse will provide which of the following instructions? a. Limit use of this spray to 5 days or less b. The drug may be sedating so be cautious with activities requiring alertness c. This drug should not be used in conjunction with antihistamines d. This is an OTC drug and may be used as needed for congestion

a. Limit use of this spray to 5 days or less Prolonged use of oxymetazoline (Afrin) causes hypersecretion of mucus and worsen- ing nasal congestion, resulting in increased daily use. Options b, c, and d are incorrect. This medication should not be used for longer than 5 days unless otherwise directed. It may be used with antihistamines for symp- tomatic relief and it is not sedating.

A client receiving phenytoin (Dilantin) has been experiencing fluctuating serum blood levels of the medication. Which symptoms, if experienced by the client, should prompt the nurse to notify the primary healthcare provider immediately? (Select all that apply.) a. Nystagmus and muscle twitching b. Tachycardia and respiratory depression c. Hyperglycemia and hypotension d. Aplastic anemia and agranulocytosis e. Abdominal cramping and diarrhea

a. Nystagmus and muscle twitching d. Aplastic anemia and agranulocytosis c. Hyperglycemia and hypotension Because of the very narrow range between a therapeutic dose and a toxic dose of phenytoin, patients must be carefully monitored for adverse effects of the drug, which include: CNS symptoms such as nystagmus, twitching, ataxia, confusion and slurred speech; multiple blood dyscrasias, including agranulocytosis and aplastic anemia; cardiac symptoms such as dysrhythmias (bradycardia or ventricular fibrillation) and severe hypotension; hyperglycemia; and severe skin reactions. GI adverse effects are characteristic of valproates, not of hydantoins. Tachycardia and respiratory depression are characteristic of benzodiazepines.

Which of the following medications may be used to treat partial seizures? (select all that apply) a. Phenytoin (Dilantin) b. Valproic Acid (Depakene) c. Diazepam (Valium) d. Carbamazepine (Tegretol) e. Ethosuximide (Zarontin)

a. Phenytoin (Dilantin) b. Valproic Acid (Depakene) d. Carbamazepine (Tegretol) The phenytoin-like drugs in- cluding phenytoin (Dilantin), valproic acid (Depakene), and carbamazepine (Tegretol) are used to treat partial sei- zures. Options c and e are incorrect. Diazepam (Valium) is a benzodiazepine that is used to treat tonic-clonic sei- zures and status epilepticus. Ethosuximide (Zarontin) is used in the control of generalized seizures such as absence seizures.

A nurse is conducting a health history assessment of a patient and determines which findings as risk factors for development of peptic ulcer disease (PUD)? (Select all that apply.) a. Smoking cigarettes b. Having blood type A c. Drinking caffeinated beverages d. Using NSAIDs e. Having a family history of PUD

a. Smoking cigarettes c. Drinking caffeinated beverages d. Using NSAIDs e. Having a family history of PUD Peptic ulcer disease (PUD) risk factors include the following: close family history of PUD; blood group O; smoking tobacco; consumption of beverages and foods containing caffeine; use of NSAIDs, corticosteroids, and platelet inhibitors; excessive psychological stress; and H. pylori infection.

A patient is receiving treatment for asthma with albuterol (Proventil). The nurse teaches the patient that while serious adverse effects are uncommon, the following may occur (select all that apply) a. Tachycardia b. Sedation c. Temporary dyspnea d. Nervousness e. Headache

a. Tachycardia d. Nervousness e. Headache Tachycardia, nervousness, and headache may occur with the use of albuterol (Proventil, VoSpire) inhalers. Options 2 and 3 are incorrect. Seda- tion and dyspnea are not adverse effects of albuterol.

A patient is taking omeprazole (Prilosec) for the treatment of gastroesophageal reflux disease (GERD). Which information should the nurse emphasize when teaching about this medication? (Select all that apply.) a. The medication should not be taken with alcohol. b. This medication is for long-term therapy. c. The medication can affect kidney function. d. Although rare, blood disorders may occur. e. Common side effects include headache and diarrhea.

a. The medication should not be taken with alcohol. d. Although rare, blood disorders may occur. e. Common side effects include headache and diarrhea. Alcohol can aggravate the stomach mucosa and decrease the effectiveness of omeprazole. Although rare, blood disorders may occur, causing unusual fatigue and weakness. Adverse effects are generally minor and include headache, nausea, diarrhea, rash, and abdominal pain. Omeprazole is intended for short-term therapy, generally limited to 2 months. The medication has no effect on kidney function, but may elevate liver enzymes.

A patient who has been prescribed baclofen (Lioresal) returns to the health care provider after a week of drug therapy, complaining of continued muscle spasms of the lower back. What further assessment data will the nurse gather? a. Whether the patient has been taking the medication consistently or only when the pain is severe b. Whether the patient has been consuming alcohol during this time c. Whether the patient has increased the dosage without consulting the health care provider d. Whether the patients log of symptoms indicates that the patient is telling the truth

a. Whether the patient has been taking the medication consistently or only when the pain is severe Muscle relaxers such as baclofen (Lioresal) work best when taken consistently and not prn. Noting consistency of dosing helps to determine the appropriateness of dose, frequency, and drug ef- fects. Options 2, 3, and 4 are incorrect. Consumption of alcohol or increasing the dose of muscle relaxers will increase the risk of sedation and drowsiness. The pa- tient's log of symptoms and drug dose and frequency may assist the provider in determining the therapeutic outcome of the medication. The patient's report of pain or continued spasms should be considered an accurate account.

A client asks the nurse whether convulsions and seizures are the same. Which response by the nurse is most accurate? a. "The terms can be used interchangeably." b. "Convulsions always involve violent skeletal muscle activity." c. "Seizures involve muscle spasms on one side only." d. "Seizure activity is more harmful than are convulsions."

b. "Convulsions always involve violent skeletal muscle activity." Convulsions specifically refer to involuntary, violent spasms of the large muscles of the face, neck, arms, and legs. Although some types of seizures involve convulsions, other seizures do not. Thus, it may be stated that all convulsions are seizures, but not all seizures are convulsions.

The client is prescribed diphenhydramine (Benadryl) for treatment of a respiratory allergy. Which statement best indicates that the client understands the drug therapy? a. "I will use my bronchodilator if my wheezing increases." b. "I will report blurred vision, constipation, or urinary retention." c. "This is the only drug I will need to treat my asthma attacks." d. "I will use this drug only when I feel an attack coming on."

b. "I will report blurred vision, constipation, or urinary retention." Clients should be knowledgeable of the adverse effects of antihistamines, like diphenhydramine, which include anticholinergic effects evidenced by increased heart rate, urinary retention, constipation, and blurred vision.

The patient is receiving theophylline (Theo-Dur) for treatment of asthma. Nursing intervention is required if the patient makes which statement? a. "I will check my heart rate each day." b. "I will take my medicine with my coffee each morning." c. "I will notify my doctor if my vision changes." d. "I will use my inhaler if I am wheezing."

b. "I will take my medicine with my coffee each morning." The methylxanthines comprise a group of bronchodilators chemically related to caffeine. Because of the drugs' chemical similarities, patients should avoid foods and beverages containing caffeine when taking these drugs.

The client is receiving an antitussive with codeine for treatment of a cough. Which statement made by the client requires further teaching by the nurse? a. "I will avoid driving while I am on this medication." b. "I will take my medicine with red wine to help me sleep." c. "I will notify my doctor if my breathing changes." d. "I will keep this medication away from my children."

b. "I will take my medicine with red wine to help me sleep." The antitussive medications containing codeine should not be taken with alcohol, because the combination can cause increased CNS depression.

The patient asks what can be expected from the levodopa/carbidopa (Sinemet) he is taking for treatment of Parkinson's Disease. What is the best response by the nurse? a. "A cure can be expected within 6 months" b. "Symptoms can be reduced and the ability to perform ADLs can be improved" c. "Disease progression will be stopped" d. Extrapyramidal symptoms will be prevented"

b. "Symptoms can be reduced and the ability to perform ADLs can be improved" Pharmacotherapy does not cure or stop the disease process but does improve the patient's ability to perform ADLs such as eating, bathing, and walking.

A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers should the nurse give to the patient? a. "The corticosteroid should be taken first." b. "The bronchodilator should be taken first." c. "The two drugs should be taken at least 2 hours apart." d. "The order of administration does not matter with these two drugs."

b. "The bronchodilator should be taken first." An inhaled beta-2 agonist may be used before the inhaled corticosteroid to provide bronchodilation before administration of the anti-inflammatory drug. If using bronchodilator and corticosteroid inhalers, use the bronchodilator first, wait 5-10 minutes, then use the corticosteroid to ensure that the drug reaches deeper into the bronchi.

A client will be receiving an opioid antitussive for a cough associated with a cold infection. For what should the nurse assess in the client prior to administering the medication? a. Hypertension b. Asthma c. Headache d. Sore throat

b. Asthma Care must be taken when using opioid antitussive medications in patients with asthma, because bronchoconstriction may occur, which can trigger an asthma attack.

A client is receiving an antihistamine through intranasal route for treatment of an upper respiratory condition. The nurse should expect to administer which medication? a. Beclomethasone (Beconase) b. Azelastine (Astelin) c. Cetirizine (Zyrtec) d. Mometasone (Nasonex)

b. Azelastine (Astelin) The medication used is azelastine (Astelin), an intranasal antihistamine. Beclomethasone (Beconase) and mometasone (Nasonex) are intranasal corticosteroids. Cetirizine (Zyrtec) is a second-generation antihistamine that is taken orally.

A nurse is providing nutritional counseling for a client receiving levodopa. Which instruction is most appropriate for the nurse to provide? a. Lower intake of simple carbohydrates. b. Decrease intake of foods high in vitamin B6. c. Avoid foods with high tyramine content. d. Decrease intake of dairy products.

b. Decrease intake of foods high in vitamin B6. Absorption of levodopa taken for PD decreases with high consumption of foods or vitamins that contain vitamin B6 [pyridoxine]. The nurse should encourage the client to avoid excessive consumption of vitamin B6-rich foods such as bananas, wheat germ, fortified cereals, green vegetables, meat, and legumes.

A patient has been taking phenytoin (Dilantin) for control of generalized seizures, tonic-clonic type. The patient is admitted to the medical unit with symptoms of nystagmus, confusion, and ataxia. What change in phenytoin dosage does the nurse anticipate will be made based on these symptoms? a. Dosage will be increased b. Dosage will be decreased c. Dosage will remain unchanged; these are symptoms unrelated to phenytoin d. Dosage will remain unchanged but additional anti seizure medication may be added

b. Dosage will be decreased Nystagmus, confusion, and ataxia may occur with phenytoin, particularly with higher dos- ages. The dosage is likely to be decreased.

Levodopa (Laradopa) is prescribed for a client with Parkinson's disease. Which information related to this drug administration should the nurse include during discharge teaching? (Select all that apply.) a. Kava may be taken as an adjunct therapy. b. Expect the urine and sweat to darken in color. c. Immediately report development of diarrhea. d. Follow-up lab tests include liver and renal function. e. Avoid taking the medication with high-protein meals.

b. Expect the urine and sweat to darken in color. d. Follow-up lab tests include liver and renal function. e. Avoid taking the medication with high-protein meals. PD drug-replacement therapy may cause urine and perspiration to darken in color. Advise the patient that urine or sweat may darken and that undershirts or dress shields may help to avoid staining of clothing. Teach the patient, family, or caregiver about the importance of returning for follow-up laboratory studies for hepatic and renal function. A decrease in these functions may slow the metabolism and excretion of the drug, possibly leading to overdose or toxicity. Teach the patient to take medication for PD on an empty stomach or to avoid taking together with a high-protein meal to maximize drug absorption. Symptoms may dramatically increase if absorption is impaired. Kava may worsen the symptoms of Parkinson's disease. Diarrhea is not an adverse effect of levodopa.

A nurse is caring for a 45-year-old female client with multiple sclerosis who is prescribed dantrolene sodium (Dantrium). For which adverse effect should the nurse monitor closely in this client? a. Constipation b. Hepatotoxicity c. Urinary obstruction d. Photosensitivity

b. Hepatotoxicity Women over the age of 35 taking dantrolene (Dantrium) are at greater risk for hepatotoxicity, so liver function should be monitored frequently. The older adult is at increased risk of constipation due to slowed peristalsis. The male older adult with an enlarged prostate is at higher risk for mechanical obstruction. Photosensitivity is an adverse effect of the drug that the nurse can expect, but not as significant as hepatotoxicity.

Donepezil (Aricept) is prescribed for a client with Alzheimer's disease. Which nurse assessment finding supports that the pharmacotherapy is effective? a. Absence of wandering episodes b. Improvements in memory c. Increase in "pin rolling" behavior d. Regaining the ability to drive a car

b. Improvements in memory Donepezil (Aricept) improves memory in cases of mild to moderate Alzheimer's dementia. Improvement in memory may be observed as early as 1 -4 weeks following initiation of pharmacotherapy.

A female patient is prescribed dantrolene (Dantrium) for painful muscle spasms associate with multiple sclerosis. The nurse is writing the discharge plan for the patient and will include which of the following teaching points? (Select all that apply) a. If muscle spasms are severe, supplement the medication with hot baths or showers three times per day b. Inform the health care provider if she is taking estrogen products c. Sip water, ice, or hard candy to relieve dry mouth d. Return periodically for required lab work e. Obtain at least 20 minutes of sun exposure per day to boost vitamin D levels

b. Inform the health care provider if she is taking estrogen products c. Sip water, ice, or hard candy to relieve dry mouth d. Return periodically for required lab work Dantrolene (Dantrium) may cause hepatotoxicity with the greatest risk occurring for women over age 35, and periodic laboratory tests will be required for monitoring. Estrogen taken concurrently with dantrolene may increase this risk. The drug may cause dry mouth and sucking on hard candy, sucking ice chips, or sipping water may help relieve the dryness. Options a and e are incorrect. Dantrolene may cause erratic blood pressure, including hypotension, and hot baths or showers cause vasodilation, increasing the risk for syncope and falls. The drug may cause photosensi- tivity and direct exposure to the sun should be avoided.

The nurse knows that which of the following are major disadvantages for the use of donzepil (Aricept) to treat symptoms of early alheimers disease? (select all that apply) a. It must be administered 4 times a day b. It may cause significant weight loss c. It may cause serious hepatic damage d. It may cause potentially fatal cardiac dysrhythmias e. It results in only modest cognitive improvement and results do not last

b. It may cause significant weight loss c. It may cause serious hepatic damage d. It may cause potentially fatal cardiac dysrhythmias e. It results in only modest cognitive improvement and results do not last Donepezil (Aricept) may cause serious liver damage and potentially fatal dys- rhythmias including severe bradycardia and heart block. It may also cause significant weight loss, and the patient's weight should be monitored. While cogni- tive improvement may be observed in as few as 1 to 4 weeks, patients should receive pharmacotherapy for at least 6 months prior to assessing maximum benefits of drug therapy. Unfortunately, cognitive improvement is only modest and short-term. Option 1 is incorrect. Donepezil is taken once per day usually at bedtime.

The nurse discusses the disease process of multiple sclerosis with the patient and the caregiver. The patient will begin taking glatiramer (Copaxone), and the nurse is teaching the patient about the drug. Which of the following points should be included? a. Drink extra fluids while this drug is given b. Local injection site irritation is a common effect. c. Take the drug with plenty of water and remain in an upright position for at least 30 minutes d. The drug causes a loss of vitamin C so include extra citrus and foods containing vitamin C in the diet

b. Local injection site irritation is a common effect. Glatiramer(Copaxone)isgivenby injection and often causes injection site irritation.

An 8-year old boy is evaluated and diagnosed with absence seizures. He is started on ethosuximide (Zarontin). Which information should the nurse provide the parents? a. After-school sports activities will need to be stopped b. Monitor height and weight to assess that growth is progressing normally c. Fractures may occur, so increase the amount of vitamin D and calcium rich foods in the diet d. Avoid dehydration with activities and increase fluid intake

b. Monitor height and weight to assess that growth is progressing normally Because adverse drug effects such as nausea, anorexia, or abdominal pain may occur with ethosuximide (Zarontin), the parents should monitor the child's height and weight to assess whether nutri- tional intake is sufficient for normal growth and de- velopment.

A 30-year-old female client is prescribed phenobarbital (Luminal) for treatment of seizure activity. Which information should the nurse emphasize during medication teaching with the client? a. Prevent mixing the drug with carbonated drinks. b. Plans for contraception, including barrier methods c. Proper oral hygiene and regular dental check-ups d. Peripheral neuropathy may occur with long-term use.

b. Plans for contraception, including barrier methods Barbiturates are pregnancy category D and decrease the effectiveness of oral contraceptives; therefore, the nurse should discuss the need for additional forms of contraception, including barrier methods, with patients taking barbiturates for seizure control.

The nurse should be concerned with which aspect of the health history of a patient who is taking a magnesium-based antacid? a. Peptic ulcer disease b. Renal failure c. Hypertension d. Heart failure

b. Renal failure The failing kidney cannot excrete the extra magnesium, and accumulation may occur.

A patient receiving intravenous (IV) infusion of phenytoin (Dilantin) is complaining of pain at the IV site. Which action should the nurse implement first? a. Place an ice pack on the IV site. b. Stop the IV infusion of the drug. c. Assess the site for blanching. d. Notify the healthcare provider.

b. Stop the IV infusion of the drug. Pain at the IV site can indicate extravasation, so the IV infusion should be immediately stopped. The nurse should next assess for blanching at the IV site to confirm extravasation, then contact the provider for further treatment orders.

The client asks what can be expected from drug therapy for treatment of Parkinson's disease. Which response by the nurse is most appropriate? a. A cure can be expected within 6 months. b. Symptoms related to the condition can be reduced. c. Disease progression will be stopped. d. Extrapyramidal symptoms will be prevented.

b. Symptoms related to the condition can be reduced. The goal of pharmacotherapy for Parkinson's disease is to increase the ability of the patient to perform normal activities of daily living (ADLs). Although pharmacotherapy does not cure this disorder, symptoms may be dramatically reduced in some patients.

A family member caring for a client with Parkinson's disease at home notifies the nurse that the client is demonstrating extrapyramidal symptoms (EPS). Which instruction should the nurse provide to the caregiver? a. Give diphenhydramine (Benadryl) 25 mg by mouth. b. Take the client to the nearest emergency department. c. Increase the dosage of the antiparkinsonism drugs. d. Make an appointment with the healthcare provider for evaluation.

b. Take the client to the nearest emergency department. If acute EPS is recognized outside the healthcare setting, the patient should immediately be taken to the emergency department, because untreated intense muscle spasms can be fatal. For acute episodes of EPS, diphenhydramine (Benadryl) is given parenterally, not orally. The nurse cannot instruct to change dosages of medications without authorization or prescription from a healthcare provider.

A patient using a beta-adrenergic agonist for treatment of asthma asks the nurse how the medication works. What is the nurse's best response? a. The drug reduces mucus production. b. The drug causes bronchodilation. c. The drug liquefies thick mucus. d. The drug suppresses the cough reflex.

b. The drug causes bronchodilation. Beta-adrenergic agonists (sympathomimetics) act by relaxing bronchial smooth muscle, resulting in a bronchodilation that lowers airway resistance and makes breathing easier for the patient.

A patient receiving treatment for a respiratory condition asks the nurse why the medication is given through aerosol therapy. What is the nurse's best response? a. The aerosol has no systemic side effects. b. The medication is delivered to the site of action. c. The patient requires no skill to use it. d. The delivery method is safe for all patients.

b. The medication is delivered to the site of action. The major advantage of aerosol therapy is that it delivers medications to their immediate site of action, reducing systemic side effects. Aerosol therapy can give immediate relief for bronchospasm and can loosen thick mucus.

A patient has been prescribe fluticasone (Flonase) to use with oxymetazoline (Afrin). How should the patient be taught to use these drugs? a. Use the fluticasone first, then the oxymetazoline after waiting 5 minutes b. Use th eoxymetazoline first, then the fluticasone after waiting 5 minutes c. The drugs may be used in either order d. The fluticasone should be used only if the oxymetazoline fails to relieve nasal congestion

b. Use th eoxymetazoline first, then the fluticasone after waiting 5 minutes The oxymetazoline (Afrin) should be used first, followed by the fluticasone (Flonase) in 5 to 10 minutes. When a decongestant and corticosteroid nasal spray are used together, the decongestant spray should be used first to allow time for the nasal passages to open, allowing the corticosteroid to reach deeper into the nasal passages. Options 1, 3, and 4 are incorrect. The drugs are ordered in combination for better con- trol of nasal rhinitis. The oxymetazoline should not be used for over 5 days unless otherwise directed.

A nurse is caring for an 8-year-old client who is prescribed phenobarbital (Luminal) for treatment of a seizure disorder. Which adverse effects should the nurse monitor closely in caring for this client? (Select all that apply.) a. Hyperthermia b. Vitamin B deficiency c. Hyperactive behavior d. Pancreatitis e. Laryngospasms

b. Vitamin B deficiency e. Laryngospasms Common side effects include vitamin B deficiencies (folate [B9] and B12) and laryngospasms. Children can experience a paradoxical response to barbiturates, as evidenced by hyperactivity. Valproic acid, not phenobarbital, can produce life-threatening pancreatitis.

A nurse is providing discharge teaching to a client who is prescribed valproic acid (Depakene) orally twice daily. Which statement by the client warrants further teaching? a. "I will take this medication with food to prevent stomach upset." b. "I will not mix this liquid medication with any carbonated drinks." c. "I can chew the extended-release tablets, so I can swallow it easier." d. "I can open the capsules and sprinkle the medication on soft food."

c. "I can chew the extended-release tablets, so I can swallow it easier." It is important that the patient understands proper medication administration of antiseizure drugs for maximum efficacy and minimizing adverse effects. Valproic acid is a gastrointestinal (GI) irritant, so it should be taken with food to decrease GI upset. The nurse should advise the patient not to chew extended-release tablets, because mouth soreness will occur. Valproic acid syrup should not be mixed with carbonated beverages, because it will trigger immediate release of the drug, which causes severe mouth and throat irritation. If the patient cannot swallow the capsule form of the medication, the patient can break the capsules open and sprinkle the medication on soft foods.

Which of the following patient statements indicates that the levodopa/carbidopa (Sinemet) is effective? a. "I'm sleeping a lot more, especially during the day b. "My appetite has improved" c. "I'm able to shower by myself" d. "My skin doesn't itch anymore"

c. "I'm able to shower by myself" Becoming more independent in ADLs shows an improvement in physical abilities.

A patient presents at the emergency department with an acute asthma attack. The nurse expects that which medication will be used for initial treatment? a. An anticholinergic such as ipratropium (Atrovent) b. A leukotriene receptor antagonist such as montelukast (Singulair) c. A beta-2 agonist such as albuterol (Proventil) d. A corticosteroid such as fluticasone (Flovent)

c. A beta-2 agonist such as albuterol (Proventil) The beta-agonists are commonly used during the acute phase of an asthmatic attack to reduce airway constriction quickly and to restore airflow to normal levels. The other drugs listed are not appropriate for acute asthma attacks. Anticholinergic drugs are used to prevent attacks; leukotriene receptor antagonists and corticosteroids are used to reduce airway inflammation.

Which of the following drugs is most immediately helpful in treating a severe acute asthma attack? a. Beclomethasone (Qvar) b. Zileuton (Zyflo CR) c. Albuterol (Proventil, Ventolin) d. Salmeterol (Servant Diskus)

c. Albuterol (Proventil, Ventolin) Beta-adrenergic drugs such as al- buterol (Proventil, Ventolin) are most often used for rapid bronchodilation. Options 1, 2, and 4 are incorrect. Corticosteroids such as beclomethasone, leukotriene modifiers such as zileuton, and LABAs such as salme- terol may be used for maintenance therapy to prevent or control asthma attacks but do not act quickly enough for acute attacks.

A patient has been prescribed clonzapam (Klonopin) for muscle spasms and stiffness secondary to an automobile accident. While the patient is taking this drug what is the nurses primary concern? a. Monitor the hepatic lab work b. Encouraging fluid intake to prevent dehydration c. Assess for drowsiness and implementing safety measures d. Providing social services referral for patient concerns about the cost of the drug

c. Assess for drowsiness and implementing safety measures Clonazepam (Klonopin) is a ben- zodiazepine; because it works on the CNS, it may cause significant drowsiness and dizziness. Safety measures should be implemented to prevent falls and injury.

Which of the following is the best advice that the nurse can give a patient with viral rhinitis who intends to purchase an OTC combination cold remedy? a. Dosages in these remedies provide precise dosing for each symptom that are experiencing b. These drugs are best used in conjunction with an antibiotic c. It is safer to use a single-drug preparation if you are experiencing only one symptom d. Since these drugs are available over the counter, it is safe to use any of them as long as needed

c. It is safer to use a single-drug preparation if you are experiencing only one symptom Single-symptomOTCpreparations are preferred over multiuse preparations to avoid addi- tional drugs that are not needed for symptom relief and to decrease risk of additional adverse effects. Options 1, 2, and 4 are incorrect. Dosing of any OTC prepara- tion is carefully calculated to provide precise dosing for age and symptoms. Antibiotics may be required for serious infections, but for common symptoms OTC rem- edies are recognized as safe and effective. However, they should not be used indefinitely without consultation with a health care provider.

A client being treated for status epilepticus with diazepam (Valium) is also receiving metoprolol (Lopressor) for management of hypertension. What is the nurse's priority in caring for this client? a. Hold the metoprolol dose until seizures are controlled. b. Keep the client in a high Fowler's position. c. Monitor the client for severe hypotension. d. Instruct the client to eat foods high in potassium.

c. Monitor the client for severe hypotension. Metoprolol (Lopressor) can potentiate the action of diazepam (Valium), as such places the patient at high risk for severe hypotension with administration of both drugs. The blood pressure medication should not be held unless symptoms of adverse effects are apparent. Positioning should protect the client from injury during the seizure, preferably recumbent and on the side. Potassium is not indicated in this patient's case.

Which intervention should the nurse implement when caring for a patient on long-term oral glucocorticoids? a. Monitoring liver function tests b. Monitoring for cardiac dysrhythmias c. Monitoring for signs of GI bleeding d. Monitoring blood glucose levels

c. Monitoring for signs of GI bleeding If taken for longer than 10 days, oral glucocorticoids can produce significant adverse effects, including adrenal gland atrophy, peptic ulcers, and hyperglycemia.

A patient has been using over-the-counter omeprazole (Prilosec) for relief of gastric upset. The nurse should provide which teaching regarding appropriate administration of this medication? a. Drink a full glass of water with administration. b. Do not take the medication with antacids. c. Never crush or chew the medication. d. Take medication 30 minutes after meals.

c. Never crush or chew the medication. The nurse should stress the importance that capsules and tablets not be chewed, divided, or crushed. The medication may be taken with antacids. Because the proton pump is activated by food intake, the PPI should be taken 20-30 minutes before the first major meal of the day.

A nurse conducting a health history with a patient identifies that which health condition places the patient at risk for developing gastroesophageal reflux disease (GERD)? a. Cigarette smoking b. Type II diabetes mellitus c. Obesity d. Alcohol use

c. Obesity Development of GERD (gastroesophageal reflux disease) is often associated with obesity.

The nurse is providing discharge teaching for a client receiving carbamazepine (Tegretol) for seizure management. What information should the nurse include during the medication teaching? a. Take on an empty stomach for better absorption. b. Expect a discoloration of the contact lenses. c. Report unusual bleeding or bruises immediately. d. Caffeinated drinks can decrease the drug's efficacy.

c. Report unusual bleeding or bruises immediately. Carbamazepine (Tegretol), a phenytoin-like drug, affects the metabolism and absorption of vitamin K, which can lead to impaired clotting activity as evidenced by unusual bleeding or bruising. The drug can be taken with food to decrease GI upset. This drug does not change the color of body fluids. Caffeine may decrease the effectiveness of the benzodiazepines.

A nurse is caring for a client with a spinal cord injury and is receiving baclofen (Lioresal) and clonazepam (Klonopin). For which adverse effect should the nurse monitor closely in this client? a. Insomnia b. Cardiac dysrhythmia c. Respiratory depression d. Hypertension

c. Respiratory depression Respiratory depression is a serious adverse effect of both baclofen (Lioresal) and clonazepam (Klonopin). Insomnia, cardiac dysrhythmia, and hypertension are not adverse effects associated with these medications.

An early sign(s) of levodopa toxicity is (are) which of the following? a. Orthostatic hypotension b. Drooling c. Spasmodic eye winking and muscle twitching d. Nausea, vomiting, and diarrhea

c. Spasmodic eye winking and muscle twitching Blepharospasm (spasmodic eye winking) and muscle twitching are early signs of poten- tial overdose or toxicity. Options 1, 2, and 4 are incorrect. Orthostatic hypotension is a common adverse effect of both PD and many drugs used to treat the condition but adverse effect of dalfampridine is seizure activity. Because of this concern, you would first assess for a prior history of seizures. Ampyra is contraindicated in patients with a known seizure disorder.

Levodopa is prescribed for a patient with Parkinson's disease. At discharge, which of the following teaching points should the nurse include? a. Monitor BP every 2 hours for the first 2 weeks b. Report development of diarrhea c. Take the pill on an empty stomach or 2 hours after a meal containing protein d. If tremors seem to worsen, take a double dose for two doses and call the provider

c. Take the pill on an empty stomach or 2 hours after a meal containing protein Taking dopamine replacement drugs such as levodopa with meals containing protein significantly impairs absorption. The drug should be taken on an empty stomach or 2 or more hours after a meal containing protein.

An elderly male patient with benign prostatic hypertrophy is prescribed ipratropium (Atrovent) for the treatment of asthma. Which nursing intervention is most appropriate? a. Teaching the patient to avoid caffeine in the diet b. Assessing the patient for enlarged liver c. Teaching the patient to report inability to urinate d. Monitoring for development of diarrhea

c. Teaching the patient to report inability to urinate Anticholinergic bronchodilators should be used cautiously in elderly men with benign prostatic hypertrophy and in all patients with glaucoma.

A patient who received a prescription for montelukast (Singulair) returns to his providers office after three days complaining that the drug is not working. She reports mild but continued dyspnea and has had to maintain consistent use of her bronchodilator inhaler, albuterol (Proventil). What does the nurse suspect is the cause of the failure of the montelukatst? a. The patient is not taking the drug correctly b. The patient is not responding to the drug and will need to be switched to another formulation c. The drug has not has sufficient time of use to have full effects d. The albuterol inhaler is interacting with the montelukast

c. The drug has not has sufficient time of use to have full effects Leukotriene modifiers such as montelukast (Singulair) take up to 1 week or longer to develop full effects. The patient should continue to use her bronchodilator as needed while the drug reaches full therapeutic effects. If no change in effects is noted after 7-10 days, the therapy should be re-evaluated. Options 1, 2, and 4 are incorrect. Because the drug is taken PO, the patient should be self-administering the montelukast correctly. More time is needed before de- termining whether the drug will have full effects, and it is often used as an adjunct to bronchodilation therapy.

A nurse is caring for a client receiving the antitussive dextromethorphan (Robitussin A-C). What should the nurse emphasize during medication teaching with the client? a. The medication is irritating to the bronchial tree. b. The cost of the medication can be expensive. c. The medication can cause motor dysfunction. d. The client may use the medication for 14 days.

c. The medication can cause motor dysfunction. The nurse's priority concern is the client's safety. Dextromethorphan is chemically similar to the opioids. Large amounts of dextromethorphan produce symptoms that include lack of motor coordination, hallucinations, slurred speech, dizziness, drowsiness, and euphoria. The nurse should advise the client not to perform activities that require motor coordination, such as driving, when on the medication.

A patient with asthma has a prescription for two inhalers, albuterol (Proventil) and beclomethasone (Qvar). How should the nurse instruct this patient on the proper use of the inhalers? a. Use the albuterol inhale, and use the beclomethasone only if symptoms are not relieved b. Use the beclomethasone inhaler, and use albuterol only if symptoms are not relieved c. Use albuterol inhaler, wait 5-10 minutes, then use the beclomethasone inhaler d. Use beclomethasone inhaler, wait 5-10 minutes, then use the albuterol inhaler

c. Use albuterol inhaler, wait 5-10 minutes, then use the beclomethasone inhaler Using a bronchodilating inhaler such as albuterol (Proventil, VoSpire) first, then waiting 5-10 minutes before using an ICS inhaler such as beclo- methasone (Qvar), will allow the corticosteroid to reach deeper into the lungs following bronchodilation. Op- tions 1, 2, and 4 are incorrect. The two inhalers have been prescribed together to maximize therapeutic effects. Us- ing the beclomethasone before the albuterol may not allow the drug to reach deeply into the lungs for best effects.

The nurse determines that which statement made by a client who is prescribed dantrolene sodium (Dantrium) indicates understanding of the side effects of the drug? a. "I will be able to do my regular work as soon as I get home." b. "I will not be concerned if I cannot empty my bladder." c. "I will be able to drive myself home from the hospital." d. "I will report frequent changes in my blood pressure to my doctor."

d. "I will report frequent changes in my blood pressure to my doctor." Adverse effects of dantrolene sodium (Dantrium) include erratic blood pressure and urinary retention. The client should not drive until the full effect of the drug has been established. Activity should be restricted.

A nurse is caring for a client receiving cyclobenzaprine (Flexeril) for management of acute back muscle spasms. Which evaluation data supports effective pharmacotherapy with cyclobenzaprine (Flexeril)? a. Muscle spasms occur only with exercise. b. Complaints of dry mouth have decreased. c. Reports episodes of dizziness or drowsiness. d. Ability to ambulate without complaint of pain

d. Ability to ambulate without complaint of pain Cyclobenzaprine relieves muscle spasms of local origin without interfering with general muscle function. Expected outcomes include relief of pain and spasms and increased range of motion of the affected body part.

The nurse is teaching a patient about the use of extromethophan with guaifenism (Robitussin-DM) syrup for a cough accompanied by thick mucus. Which instruction should be included in the patients teaching? a. Lie supine for 30 minutes after taking the liquid b. Drink minimal fluids to avoid stimulating cough reflex c. Take the drug with food for best results d. Avoid drinking fluids immediately after the syrup but increase overall fluid intake throughout the day

d. Avoid drinking fluids immediately after the syrup but increase overall fluid intake throughout the day The syrup base of dextromethor- phan will help soothe throat irritation, and fluids should be avoided immediately following administration. Overall fluid intake should be increased throughout the day. Options 1, 2, and 3 are incorrect. The patient does not need to remain supine after taking this drug, take the drug with food, or avoid fluid intake.

Teaching for a patient receiving carbamazepine (Tegretol) should include instructions that the patient should immediately report which symptoms? a. Leg cramping b. Blurred vision c. Lethargy d. Blister-like rash

d. Blister-like rash Carbamazepine (Tegretol) is as- sociated with Stevens-Johnson syndrome and exfolia- tive dermatitis. A blister-like skin rash may indicate that these conditions are developing.

A client is prescribed benztropine (Cogentin) for treatment of Parkinson's disease. Which nursing instruction regarding medication administration is most appropriate? a. Stop taking the medication if symptoms persist. b. The entire daily dose may be taken with breakfast. c. Increase the dose if muscle weakness occurs. d. Divide the doses to be taken three times a day.

d. Divide the doses to be taken three times a day. Benztropine (Cogentin) may be taken in divided doses, 2-4 times a day, or the entire day's dose may be taken at bedtime. The dose should be reduced, not increased, if muscle weakness occurs. The patient should not stop taking the medication abruptly. The nurse should teach the patient, family, or caregiver that improvement in PD symptoms may be gradual. The patient should report increasing symptoms that are similar to those noted before drug therapy was initiated.

A client diagnosed with Alzheimer's disease is prescribed to take donepezil (Aricept). Which assessment finding warrants immediate notification of the healthcare provider? a. Emotional withdrawal b. Vomiting and diarrhea c. Urinary incontinence d. Gastrointestinal bleeding

d. Gastrointestinal bleeding Donepezil is contraindicated in patients with gastrointestinal bleeding and jaundice; therefore, the nurse should notify the healthcare provider immediately.

A client who is prescribed dantrolene sodium (Dantrium) reports taking a calcium channel blocker for a heart condition. Which nursing action is most appropriate? a. Holding the drug until the healthcare provider arrives b. Monitoring the client's neurological status c. Encouraging the client to drink plenty of fluids d. Monitoring the client closely for cardiac dysrhythmias

d. Monitoring the client closely for cardiac dysrhythmias Verapamil is a calcium channel blocker and increases the risk for ventricular fibrillations and cardiovascular collapse when taken with dantrolene sodium (Dantrium).

Which information should the nurse include during patient teaching on long-term therapy with beta-adrenergic agonists for asthma treatment? a. Discontinuing the drug if heart rate increases b. Monitoring daily intake and output c. Reducing dosage of the drug if insomnia occurs d. Notifying the healthcare provider if the drug no longer seems effective

d. Notifying the healthcare provider if the drug no longer seems effective Tolerance can develop to the therapeutic effects of the beta-agonists; therefore, the patient must be instructed to seek medical attention should the drugs become less effective with continued use.

The nurse is caring for a 72-year old patient taking gabapentin (Grails, Horizant, Neurotoxin) for a seizure disorder. Because of this patients age, the nurse would establish which nursing diagnosis related to the drugs common adverse effects? a. Risk for deficient fluid volume b. Risk for impaired verbal communication c. Risk for constipation d. Risk for falls

d. Risk for falls CNS depression including diz- ziness and drowsiness is a common adverse effect of gabapentin (Gralise, Horizant, Neurontin). Because of this patient's age, these effects may increase the risk of falls.

A nurse is caring for a client who is prescribed benzonatate (Tessalon) to suppress coughing from a cold infection. Which instruction should the nurse include during client teaching? a. Monitor blood pressure. b. Chew the gel tablet thoroughly. c. Check pulse before taking the drug. d. Stand up slowly and carefully.

d. Stand up slowly and carefully. Common adverse effects of benzonatate include sedation, dizziness, nausea, and headache. The nurse's priority is the client's safety, and the nurse should inform the client to change positions slowly and ambulate with assistance as necessary. If chewed, the drug can cause the side effect of numbing the mouth and pharynx.

A client asks the nurse about using a capsaicin ointment for occasional shoulder pain. The nurse should give which instruction for use of this medication? a. A prescription from the healthcare provider is required. b. The medication should be applied to the skin once daily. c. The capsule formulation of this drug is taken as needed. d. The hands must be washed thoroughly after application.

d. The hands must be washed thoroughly after application. Patients may prefer to treat minor muscle aches and spasms with herbal remedies, such as topical formulations of capsaicin. The hands must be washed thoroughly after use, and the medication should be kept away from the eyes and mucous membranes to avoid burning. Capsaicin cream (0.025% to 0.075%) is available over the counter and may be applied directly to the affected area up to four times a day. Oral formulations are used for digestive problems.

A client tells the nurse he plans to use a cayenne-based ointment for occasional muscle spasms in his shoulder. The nurse gives what instructions for use of the cream? (Select all that apply.) a. Use the full strength for no more than two days. b. Only apply it to the skin once a day. c. Avoid applying the cream to broken skin. d. The capsule formulation of this drug is more effective. e. Wash your hands thoroughly after applying the cream

Answer: a. Use the full strength for no more than two days.; c. Avoid applying the cream to broken skin.; e. Wash your hands thoroughly after applying the cream. Rationale: The active ingredient in cayenne is capsaicin. When applied in a cream base, it diminishes the sensation of pain. Use for more than two days can cause skin inflammation, blisters, and ulcers, and it should not be applied to open or broken skin. Thorough hand washing after use prevents accidental exposure of the cream to mucous membranes and the eyes. To be effective, it must be applied regularly, up to four times a day. Oral formulations are used for digestive problems.

Which of the following medications may be used to treat partial seizures? (Select all that apply) 1. Phenytoin (Dilantin) 2. Valproic acid (Depakene) 3. Diazepam (Valium) 4. Carbamazepine (Tegretol) 5. Ethosuximide (Zarontin)

Answer: 1, 2, 4; 1. Phenytoin (Dilantin); 2. Valproic acid (Depakene); 4. Carbamazepine (Tegretol) Rationale: The phenytoin-like drugs including phenytoin (Dilantin), Valproic acid (Depakene), and Carbamazepine (Tegretol) are used to treat partial seizures. Options 3 and 5 are incorrect. Diazepam (Valium) is a benzodiazepine that is used to treat tonic-clonic seizures and status epilepticus. Ethosuximide (Zarontin) is used in the control of generalized seizures such as absence seizures.

The nurse is providing education for a 12-year-old client with partial seizures currently prescribed valproic acid (Depakene). The nurse will teach the client and the parents to immediately report which symptom? 1. Increasing or severe abdominal pain 2. Decreased or foul taste in the mouth 3. Pruritus and dry skin 4. Bone and joint pain

Answer: 1. Increasing or severe abdominal pain Rationale: Valporic acid may cause life threatening pancreatitis and any severe or increasing abdominal pain should be reported immediately. Options 2, 3, and 4 are in correct. The drug is not known to cause dysgeusia (altered sense of taste) or effects on bones or joints. Although pruritus is an adverse effect associated with valproic acid, it may be managed with simple therapies, and unless it progresses to a more serious rash, it does not need to be reported immediately.

An 8-year-old boy is evaluated and diagnosed with absence seizures. He is started on ethosuximide (Zarontin). Which information should the nurse provide the parents? 1. After-school sports activities will need to be stopped because they will increase the risk of seizures. 2. Monitor height and weight to assess that growth is progressing normally 3. Fractures may occur, so increase the amount of vitamin D and calcium-rich foods in the diet. 4. Avoid dehydration with activities and increase fluid intake.

Answer: 2. Monitor height and weight to assess that growth is progressing normally Rationale: Because adverse drug effects such as nausea, anorexia, or abdominal pain may occur with ethossuximide (Zarontin), the parents should monitor the child's height and weight to access whether nutritional intake is sufficient for normal growth and development. Options 1, 3, and 4 are incorrect. Physical activity does not increase the risk of seizure activity or need to be curtailed, and the drug does not affect bone growth or require extra vitamin D or calcium in the diet. Dehydration is a condition to be avoided in all clients, although increasing fluid intake is not necessary related to the use of ethosuximide.

A client has been taking phenytoin (Dilantin) for control of generalized seizures, tonic-clonic type. The client is admitted to the medical unit with symptoms of nystagmus, confusion, and ataxia. What change in the phenytoin dosage does the nurse anticipate will be made based on these symptoms? 1. The dosage will be increased 2. The dosage will be decreased 3. The dosage will remain unchanged; these are symptoms unrelated to phenytoin 4. The dosage will remain unchanged but an additional antiseizure medication may be added

Answer: 2. The dosage will be decreased Rationale: Nystagmus, confusion and ataxia may occur with phenytoin, particularly with higher doses. The dosage is likely to be decreased. Options 1, 3, and 4 are incorrect. The dosage would not remain the same or be increased because these are adverse effects of phenytoin that are related to overdosage.

Teaching for a client receiving carbamazepine (Tegretol) should include instructions that the client should immediately report which symptom? 1. Leg cramping 2. Blurred vision 3. Lethargy 4. Blister-like rash

Answer: 4. Blister-like rash Rationale: Carbamazepine (Tegretol) is associated with Stevens-Johnson Syndrome (SJS) and exfoliative dermatitis. A blister-like skin rash may indicate that these conditions are developing. Options 1, 2, and 3 are incorrect. Blurred vision, leg cramping , and drowsiness or lethargy are adverse effects of carbamazepine but do not require immediate reporting and may diminish over time.

The nurse is caring for a 72-year-old client taking gabapentin (Neurontin) for a seizure disorder. Because of this client's age, the nurse would establish which nursing diagnosis related to the drug's common adverse effects? 1. Risk for Deficient Fluid Volume 2. Risk for Impaired Verbal Communication 3. Risk for Constipation 4. Risk for Falls

Answer: 4. Risk for Falls Rationale: Common adverse effects to gabapentin (Neurontin) include CNS depression including dizziness and drowsiness. Because of this client's age, these effects may increase the risk of falls. Options 1, 2, and 3 are incorrect. The drug is not known to cause dehydration (fluid volume deficit) or constipation or impair the ability to communicate.

A client has purchased capsaicin OTC cream to use for muscle aches and pains. What education is most important to give this client? a. Apply with a gloved hand only to the site of pain. b. Apply the medication liberally above and below the site of pain. c. Apply to areas of redness and irritation only. d. Apply liberally with a bare hand to the affected limb.

Answer: a. Apply with a gloved hand only to the site of pain. Rationale: Capsaicin should be applied to the site of pain with a gloved hand to avoid introducing the capsaicin to the eyes or other parts of the body not under treatment. Options b,c, and d are incorrect. Capsaicin should be applied only to the site of pain and never with a bare hand. it should not be applied to irritated or open skin areas and should be discontinued if irritation occurs.

A client is scheduled to receive botulinum toxin type B (Myoblocare) for treatment of muscle spasticity. When preparing the medication, the nurse informs the client to expect: a. Local anesthesia, to decrease the pain of the injection. b. Relief of muscle spasms in several days. c. A rapid return of energy. d. Drowsiness

Answer: a. Local anesthesia, to decrease the pain of the injection. Rationale: An adverse effect of botulinum is pain. The drug is injected directly into muscle tissue, and pain associated with the injection usually is blocked by a local anesthetic. Relief might not be obtained for several weeks. Drowsiness does not occur, and energy levels are not increased by the drug.

Cyclobenzaprine (Clycloflex, Flexeril) is prescribed for a client with muscle spasm of the lower back. Appropriate nursing intervention will include: a. Providing for client safety. b. Encouraging frequent ambulation. c. Assessing the heart rate for bradycardia. d. Providing oral suction for excessive oral secretions

Answer: a. Providing for client safety. Rationale: Adverse reactions to cyclobenzaprine include drowsiness, dry mouth, rash, and tachycardia. Ambulation would be restricted with back muscle spasms.

A client who has been prescribed baclofen (Lioresal) returns to the health care provider after a week of drug therapy, complaining of continued muscle spasms of the lower back. What further assessment data will the nurse gather? a. Whether the client has been taking the medication consistently or only when the pain is severe b. Whether the client has been consuming alcohol during this time. c. Whether the client has increased the dosage without consulting the health care provider d. Whether the client's log of symptoms indicates that the client is telling the truth.

Answer: a. Whether the client has been taking the medication consistently or only when the pain is severe Rationale: Muscle relaxers such as baclofen (Lioresal) work best when taken consistently and not prn. Noting consistency of dosing helps to determine the appropriateness of dose, frequency, and drug effects. Options b,c, and d are incorrect. Consumption of alcohol or increasing the dose of muscle relaxers will increase the risk of sedation and drowsiness. The client's log of symptoms and drug dose and frequency may assist the provider in determining the therapeutic outcome of the medication. The client's report of pain or continued spasms should be considered an accurate account.

The client is scheduled to receive rimabotulinumtoxinB (Myobloc) for treatment of muscle spasticity. Which of the following will the nurse teach the client to report immediately? a. Fever, aches, or chills b. Difficulty swallowing, ptosis, blurred vision c. Continuous spasms and pain on the affected side d. Moderate levels of muscle weakness on the affected side

Answer: b. Difficulty swallowing, ptosis, blurred vision Rationale: Dysphagia, ptosis, and blurred vision are all symptoms of possible botulinum toxin B toxicity and must be reported immediately. Options a, c, and d are incorrect. Fever, aches, and chills are not anticipated side effects of this drug. Moderate levels of muscle weakness may occur after the drug is administered, and strengthening exercises may be needed on the affected side. Continuous muscle spasms and pain should not occur because the drug blocks muscle contraction

Which of the following medication orders should the nurse clarify with the physician before administering the drug to a client? a. Cyclobenzaprine (Flexeril) 15 mg t.i.d. b. Lorazepam (Ativan) 5 mg q.i.d c. Baclofen (Lioresal) 10 mg b.i.d. d. Carisoprodol (Soma) 350 mg t.i.d.

Answer: b. Lorazepam (Ativan) 5 mg q.i.d Rationale: The usual dose of lorazepam (Ativan) is 1 to 2 mg p.o. b.i.d. to t.i.d. The maximum dosage is 10 mg/day. The other doses are within limits.

When planning care for a client with muscle spasms, the nurse recognizes that a goal of the treatment is to: a. Decrease pain and increase range of motion. b. Restrict mobility until symptoms are relieved. c. Avoid long-term treatment of the disorder. d. Prevent liver and renal damage

Answer: b. Restrict mobility until symptoms are relieved. Rationale: Pharmacotherapy used for muscle spasms usually includes analgesics, anti-inflammatory agents, or centrally acting antispasmodic drugs. The goals of therapy include minimizing pain and discomfort, increasing range of motion, and improving the client's ability to function independently. Long-term treatment might be needed, and mobility does not always need to be restricted.

A client has been prescribed clonazepam (Klonopin) for muscle spasms and stiffness secondary to an automobile accident. While the client is taking this drug, what is the nurse's primary concern? a. Monitoring hepatic laboratory work b. Encouraging fluid intake to prevent dehydration c. Assessing for drowsiness and implementing safety measures. d. Providing social services referral for client concerns about the cost of the drug.

Answer: c. Assessing for drowsiness and implementing safety measures. Rationale: Clonazepam (Klonopin) is a benzodiazepine: because it works on the CNS, it may cause significant drowsiness and dizziness. Safety measures should be implemented to prevent falls and injury. Options a,b, and d are incorrect. Benzodiazepines ma cause hepatotoxicity in clients with existing hepatic insufficiency and may be needed for long-term monitoring. This drug was prescribed after a health care provider's assessment and is currently given to treat a potential short-term condition. The drug should not cause dehydration and is available in generic form. If cost is a concern, social service aid may be needed, but the primary concern for the nurse is safety.

The nurse explains to the client that botulinum toxin Type A (Botox) is administered: a. Intravenously over one hour. b. By mouth in at least 8 ounces of juice. c. Intramuscularly into a target muscle. d. By subcutaneous injection in the affected area

Answer: c. Intramuscularly into a target muscle. Rationale: Botox is injected into target muscle.

The nurse determines that which of the following statements made by a client prescribed dantrolene sodium (Dantrium) indicates an understanding of the side effects of the drug? a. "I will be able to do my regular work as soon as I get home." b. "I will not be concerned if I cannot empty my bladder; it is probably my prostate." c. "I will be able to drive myself home from the hospital." d. "I will report frequent changes in my blood pressure to my doctor

Answer: d. "I will report frequent changes in my blood pressure to my doctor." Rationale: The client should be observed for side effects such as muscle weakness, drowsiness, dry mouth, dizziness, nausea, diarrhea, tachycardia, erratic blood pressure, photosensitivity, and urinary retention. The client should not drive until the full effect of the drug has been established. Activity should be restricted.

The nurse would expect which of the following evaluation data to support effective treatment with cyclobenzaprine (Flexeril)? a. Muscle spasms occur only with exercise. b. Complaints of dry mouth have decreased. c. Reports of less dizziness d. Ability to ambulate in hallway without complaint of pain

Answer: d. Ability to ambulate in hallway without complaint of pain Rationale: Expected outcomes include relief of pain and spasms, increased range of motion of affected body part, and the ability to demonstrate knowledge of drug therapy and side effects.

Prior to administration of Cyclobenzaprine (Clycloflex), the nurse notes that the client's liver enzymes are elevated. The appropriate action for the nurse to take is to: a. Place the lab report on the medical record, and await instructions from the health care provider. b. Give the medication as ordered. c. Give the medication as ordered, and schedule a laboratory blood draw for liver enzymes in six hours. d. Hold the medication, and report the lab results to the primary health care provider

Answer: d. Hold the medication, and report the lab results to the primary health care provider. Rationale: Since cyclobenzaprine can cause serious liver damage, the elevated enzymes should be reported to the physician, and the drug held. It would not be the nurse's responsibility to order lab tests in this situation.

A client prescribed dantrolene sodium (Dantrium) reports taking verapamil (Calan) as part of the drug regimen. Appropriate nursing interventions include: a. Holding the drug until the physician arrives. b. Monitoring neurological status. c. Encouraging the client to drink plenty of fluids. d. Monitoring closely for cardiac arrhythmias

Answer: d. Monitoring closely for cardiac arrhythmias. Rationale: Verapamil is a calcium channel blocker and increases the risk for ventricular fibrillations and cardiovascular collapse when taken with dantrolene sodium.

A client who has not responded well to other drug therapy for Alzheimer's disease is placed on tacrine (Cognex). Which of the following are major disadvantages to the use of tacrine? (Select all that apply) a. It must be administered four times per day. b. It causes weight gain. c. It may cause vision difficulties. d. it may cause serious hepatic damage. e. It may be purchased over the counter

Answers: a. It must be administered four times a day. d. It may cause serious hepatic damage. Rationale: It is difficult to remember to take a drug four times a day; as the client's cognitive function declines, it may be increasingly difficult to administer it. Serious liver damage is a possibility with tacrine, which decreases its usefulness. Options b,c, and e are incorrect. Tacring may cause weight loss, rather than gain, and it does not cause vision difficulties. Tacrine is available by prescription only.

Cyclobenzaprine (Amrix, Flexeril) is prescribed for a client with muscle spasms of the lower back. Appropriate nursing intervention would include which of the following? (Select all the apply) a. Assessing the heart rate for tachycardia. b. Assessing the home environment for client safety concerns. c. Encouraging frequent ambulation. d. Providing oral suction for excessive oral secretions. e. Providing assistance with ADLs such as reading

Answers: a. Assessing the heart rate for tachycardia b. Assessing the home environment for client safety concerns e. Providing assistance with ADLs such as reading Rationale: Adverse reactions to cyclobenzaprine include drowsiness, dizziness, dry mouth, rash, blurred vision, and tachycardia. Because the medication can cause drowsiness and dizziness, ensuring client safety must be a priority. The client may need assistance with reading or other activities requiring visual acuity if blurred vision occurs. Options c and d are incorrect. Clients who are experiencing back pain often have orders for limited ambulation until muscle spasms have subsided. Suctioning should not be required related to this drug.

A female client is prescribed dantrolene sodium (Dantrium) for painful muscle spasms associated with multiple sclerosis. The nurse is writing the discharge plan for the client and will include which of the following teaching points? (Select all the apply) a. If muscle spasms are severe, supplement the medication with hot baths or showers three times per day. b. Inform the health care provider if she is taking estrogen products. c. Sip water, ice, or hard candy to relieve dry mouth. d. Return periodically for required laboratory work. e. Obtain at least 20 minutes of sun exposure per day to boost vitamin D levels.

Answers: b. Inform the health care provider is she is taking estrogen products. c. Sip water, ice, or hard candy to relieve dry mouth d. Return periodically for required laboratory work Rationale: Dantrolene (Dantrium) may cause hepatotoxicity with the greatest risk occurring for women over 35, and periodic laboratory tests will be required for monitoring. Estrogen taken concurrently with dantrolene may increase risk. The drug may cause dry mouth and sucking on hard candy, sucking ice chips, or sipping water may help relieve the dryness. Options a and e are incorrect. Dantrolene may cause erratic blood pressure, including hypotension, and hot baths or showers cause vasodilation, increasing risk for syncope and falls. The drug may cause photo-sensitivity and direct exposure to the sun should be avoided.

The nurse recognizes that several chemicals inhibit neurotransmitter function in the brain. The primary inhibitory transmitter in the brain is _______________________.

GABA Rationale: GABA drugs mimic GABA by stimulating the influx of chloride ions into the neuron, leading to the suppression of neuron firing.

The patient is using beclomethasone (Beclovent) for treatment of chronic asthma. Which statement indicates that the patient understands this drug therapy? a. "I will use my bronchodilator if my wheezing increases." b. "I will not need a flu shot now that I'm taking this medicine." c. "This is the only drug I will need to treat my asthma attacks." d. "I will use this drug only when I feel an attack coming on."

a. "I will use my bronchodilator if my wheezing increases." Patients should be informed that inhaled glucocorticoids must be taken daily to produce their therapeutic effect, and that these medications are not effective at terminating episodes in progress. Inhaled corticosteroids are the preferred therapy for preventing asthma attacks.

A male, age 67, reports taking diphenhydramine (Benadryl) for hay fever. Considering this patients age, the nurse assesses for which of the following findings? a. A history of prostatic or urinary conditions b. Any recent weight gain c. A history of allergic reactions d. A history of peptic ulcer disease

a. A history of prostatic or urinary conditions Diphenhydramine (Benadryl) and other anithistamines are contraindicated in patients with BPH or lower urinary tract obstruction because anticho- linergic effects may worsen these conditions. Options 2, 3, and 4 are incorrect. Diphenhydramine (Benadryl) is a common treatment for allergic conditions and has no effects on weight gain or peptic ulcer disease.

The nurse is assisting the older adult diagnosed with a gastric ulcer to schedule her medication administration . what would be the most appropriate time for this patient to take her lansoprazole (Prevecid)? a. About 30 minutes before her morning meal b. At night before bed c. After fasting at least 2 hours d. 30 minutes after each meal

a. About 30 minutes before her morning meal PPIssuchaslansoprazole(Prevacid) should be taken before the first meal of the day. The pro- ton pump is activated by food intake. The administration of a PPI 20 to 30 minutes before the first major meal of the day will allow peak serum levels to coincide with the occurrence of maximum acidity from the proton pump activity. Options 2, 3, and 4 are incorrect. PPIs should be taken before the first major meal of the day, not at night or after meals. Fasting is not required for this drug.

The nurse is caring for a patient with gastroesophageal reflux disease and would question an order for which of the following? a. Amoxicillin (Amoxil) b. Ranitidine (Zantac) c. Pantoprazole (Protonix) d. Calcium Carbonate (Tums)

a. Amoxicillin (Amoxil) Antibiotics such as amoxicillin (Amoxil) are used in the treatment of PUD caused by H. pylori. They are not indicated for the treatment of GERD. Options 2, 3, and 4 are incorrect. Antacids, H2 blockers, and PPIs are used in the treatment of GERD. Calcium carbonate, ranitidine, and pantoprazole would be appropriate drugs to use.

Simethicone (Gas-X, Mylicon) may be added to some medications or given plain for what therapeutic effect? a. Decrease the amount of gas associated with GI disorders b. Increase the acid-fighting ability of some medications c. Prevent constipation associated with gastroenteritis d. Prevent diarrhea associated with gastrointestinal drugs

a. Decrease the amount of gas associated with GI disorders Simethicone is used along with other GI drugs or alone to decrease the amount of gas bubbles that accumulate with GI disorders or indiges- tion. Options 2, 3, and 4 are incorrect. Simethicone will not affect the acid-fighting ability of medications or pre- vent constipation or diarrhea from developing.

Which drug should the nurse prepare to administer to prevent constipation in a client who had a surgical procedure? a. Docusate sodium (Colace) b. Prochlorperazine (Compazine) c. Loperamide (Imodium) d. Promethazine (Phenergan)

a. Docusate sodium (Colace) Stool softeners and surfactant laxatives cause more water and fat to be absorbed into the stools. They are most often used to prevent constipation, especially in patients who have undergone recent surgery.

A patient asks the nurse why the healthcare provider had advised against use of calcium carbonate as an antacid. What is the nurse's best response? a. Its use may result in kidney stones. b. It causes decreased gastric acid production. c. It often causes severe diarrhea. d. It may result in fluid retention and edema.

a. Its use may result in kidney stones. Antacids containing calcium can cause constipation and may cause or aggravate kidney stones. In addition, administering calcium carbonate antacids with milk or any items with vitamin D can cause milk-alkali syndrome to occur. Milk-alkali syndrome may result in permanent renal damage if the drug is continued at high doses.

A client receiving phenytoin (Dilantin) has been experiencing fluctuating serum blood levels of the medication. Development of which symptoms in the client should prompt the nurse to notify the primary health care provider immediately? (Select all that apply.) a. Migraine headaches and nausea b. Double vision and lethargy c. Dry skin and constipation d. GI cramping and diarrhea

a. Migraine headaches and nausea; b. Double vision and lethargy Rationale: Although all the symptoms should prompt further assessment by the nurse, dizziness, ataxia, diplopia, and lethargy are signs of hydantoin toxicity and should be reported

A client presents at the clinic with intractable diarrhea for 2 weeks. The nurse would expect to administer what type of drug for the treatment of this condition? a. Opioids b. Laxatives c. Cathartics d. Bulk-forming agents

a. Opioids The most effective drugs for the symptomatic treatment of diarrhea are the opioids, which can dramatically slow peristalsis in the colon. Laxatives, cathartics, and bulk-forming agents would contribute to more diarrhea.

When treating a patient experiencing nausea and vomiting with antiemetics, which is important for the nurse to consider? a. Patient safety is a concern, as drowsiness is a common side effect. b. Over-the-counter antiemetics are just as effective in relieving nausea. c. Sports drinks replace the essential ingredients lost by dehydration. d. The most effective antiemetic is determined by trial and error.

a. Patient safety is a concern, as drowsiness is a common side effect. Many of the antiemetic medications cause drowsiness or dizziness, therefore the nurse should ensure patient safety as priority.

A patient being treated for peptic ulcer disease (PUD) due to Helicobacter pylori asks the nurse why two or more antibiotics need to be taken. What is the nurse's best response? a. They lower the potential for bacterial resistance. b. They decrease the chances of development of duodenal ulcers. c. They completely eliminate redevelopment of gastric ulcers. d. They decrease the cost of future drug therapies.

a. They lower the potential for bacterial resistance. Two or more antibiotics are used in order to lower the potential for bacterial resistance.

A 32-year-old female client comes to the clinic to update her immunizations. Which assessment information should the nurse obtain? (Select all that apply.) a. Possibility of pregnancy b. Sensitivity to albumin c. Quarantine status d. History of actual disease e. Previous reaction to vaccines

a. Possibility of pregnancy b. Sensitivity to albumin d. History of actual disease e. Previous reaction to vaccines When assessing a client prior to administration of immunizations, the nurse should obtain a complete health history, including pregnancy or breast-feeding, previous history of actual disease (e.g., chickenpox), any previous allergic response to immunizations or to products contained within immunization (e.g., yeast sensitivity, sensitivity to eggs or albumin products), and immunization history and any unusual reactions or responses that occurred.

The nurse would question an order for peg interferon alfa-2a (Pegasys) if the patient had which of the following conditions? (Select all that apply) a. Pregnancy b. Renal disease c. Hepatitis d. Liver disease e. Malignant melanoma

a. Pregnancy b. Renal disease d. Liver disease Pregnancy and renal or liver disease are contraindications to the use of immunos- timulant drugs such as peginterferon alfa-2a (Pegasys). Options 3 and 5 are incorrect. Chronic hepatitis and malignant melanoma are indications for use of these drugs.

The nurse administers DPT, polio, Hib, and hepatitis B immunizations to a 2-month-old child. Which instruction should the nurse provide to this child's mother? a. Remain in the clinic for 30 minutes for observation. b. Administer baby aspirin for fever and discomfort. c. Call the clinic if redness develops at the site of the injections. d. Return to the clinic for the next immunizations at 6 months of age.

a. Remain in the clinic for 30 minutes for observation. The client should be observed for any immediate adverse reactions, especially anaphylaxis, following the administration of the immunizations. Common side effects of vaccines include fever and redness/discomfort at the site of the injection. Acetaminophen, not aspirin, is recommended to treat these common side effects. Cool compresses to the injection site may help alleviate malaise, fever, or injection site soreness. The next set of immunizations for this 2-month-old child will be at 4 months of age.

Pancrelipase (Pancreas) granules are ordered for a patient. Which of the following will the nurse complete before administering the drug? (select all that apply) a. Sprinkle the granules on a nonacididc food b. Give the granules with or just before a meal c. Mix the granules with orange or grapefruit juice d. Ask the patient about an allergy to pork or pro products e. Administer the granules followed by an antacid

a. Sprinkle the granules on a nonacididc food b. Give the granules with or just before a meal d. Ask the patient about an allergy to pork or pro products Before administering pancre- lipase (Pancreaze) the nurse should assess for an al- lergy to pork or pork products. The granules may be sprinkled on nonacidic foods and should be given 30 minutes before a meal or with meals. Options 3 and 5 are incorrect. Pancrealipase should not be given with acidic foods or beverages because the drug will be inactivated. It should not be taken with an antacid because the effect of the pancrelipase will be decreased.

A nurse is conducting a health history assessment of a client and determines that which factor places the client at risk for development of irritable bowel disease (IBD)? a. Stress b. Peptic ulcers c. GERD (gastroesophageal reflux disease) d. Helicobacter pylori

a. Stress Stress is one of the major factors for developing irritable bowel syndrome (IBS), along with dietary factors.

A dose of naloxone (Narcan) is administered to a client with severe respiratory depression and suspected drug overdose. After 10 minutes, the client remains unresponsive. What is the most likely explanation for this evaluation finding? a. The client did not use an opioid drug. b. The dose of naloxone was inadequate. c. The client is tolerant of this drug. d. The drug overdose is irreversible.

a. The client did not use an opioid drug.

The nurse completes a history and physical on a client admitted with exacerbation of a seizure disorder. What datum collected by the nurse requires intervention? a. Use of herb Ginkgo biloba b. History of asthma c. Use of aspirin daily d. History of diabetes mellitus

a. Use of herb Ginkgo biloba Rationale: Ginkgo biloba decreases the effectiveness of anti-seizure medication.

A client with chronic migraine headaches is prescribed prophylactic medication for management of the condition. The nurse should anticipate providing client education for which drugs? (Select all that apply.) a. Valproic acid (Depakene) b. Amitriptyline (Elavil) c. Propranolol (Inderal) d. Ergotamine (Ergostat) e. Verapamil (Isoptin SR)

a. Valproic acid (Depakene) b. Amitriptyline (Elavil) c. Propranolol (Inderal) e. Verapamil (Isoptin SR)

The nurse is preparing to administer chemotherapy to an oncology patient who also has an order for ondansetron (Zoran). When should the nurse administer the odansetron? a. Every time the patient complains of nausea b. 30 to 60 minutes before starting chemo c. Only if the patient complains of nausea d. When the patient begins to experience vomiting during chemo

b. 30 to 60 minutes before starting chemo To be most effective, ondansetron (Zofran) or other antiemetics should be administered 30 to 60 minutes before initiating the chemotherapy drugs. Options 1, 3, and 4 are incorrect. Almost all chemother- apy drugs have emetic potential and the nurse should not wait until the patient complains of nausea or experi- ences vomiting before giving the drug. The patient may complain of nausea more frequently than is possible to give the drug. Other nondrug relief strategies such as diversion techniques or ginger ale should also be tried

The nurse should question the use of barbiturates for the treatment of seizure activity if prescribed for which of the following clients? a. 24-year-old male with new diagnosis of seizures b. 30-year-old pregnant female c. 45-year-old male with history of hypertension d. 55-year-old female with history of diabetes mellitus

b. 30-year-old pregnant female Rationale: Barbiturates cross the placental barrier and are excreted in breast milk, and are not recommended for women who are pregnant or nursing. Folic acid absorption also is decreased, and congenital malformations can occur if barbiturates are taken during the first trimester.

The nurse has administered portlier[erazine (Compazine) to a patient for postoperative nausea. Before administering this medication, it is essential that the nurse check which of the following? a. Pain level b. BP c. Breath sounds d. Temperature

b. BP Prochlorperazine (Compazine) may cause decreased blood pressure or hypotension as an adverse effect. The blood pressure should be taken before administering and the drug held if the BP is be- low 90/60 mmHg or is below parameters as ordered by the provider. Options 1, 3, and 4 are incorrect. Although it is important to assess pain level, breath sounds, and temperature in the postoperative patient, prochlorpera- zine does not directly affect these parameters.

A client asks if convulsions and seizures are the same. The nurse's response is based on the knowledge that: a. The terms can be used interchangeably. b. Convulsions always involve violent skeletal muscle activity. c. Seizures involve muscle spasms on one side only. d. Seizure activity is more harmful than are convulsions.

b. Convulsions always involve violent skeletal muscle activity. Rationale: Convulsions specifically refer to involuntary, violent spasms of the large muscles of the face, neck, arms, and legs. Seizure activity does not always involve these characteristics.

A client received a drug for treatment of nausea and vomiting and is now complaining of dry mouth, constipation, and a rapid heart rate. The nurse concludes that which drug was taken by the client? a. Loperamide (Imodium) b. Prochlorperazine (Compazine) c. Peppermint d. Diphenoxylate (Lomotil)

b. Prochlorperazine (Compazine) Prochlorperazine (Compazine) can cause dry mouth, constipation, and a rapid heart rate.

A 35-year old male patient has been prescribed omeprazole (Prilosec) for treatment of gastroesophageal reflux disease. Which of the following assessment findings would assist the nurse to determine whether drug therapy was effective? (select all that apply) a. Decreased "gnawing" upper abdominal pain on an empty stomach b. Decreased belching c. Decreased appetite d. Decreased nausea e. Decreased dysphagia

b. Decreased belching d. Decreased nausea e. Decreased dysphagia SymptomsofGERDincludedys- phagia, dyspepsia, nausea, belching, and chest pain. Thera- peutic effects of omeprazole (Prilosec) would include relief of these symptoms. Options 1 and 3 are incorrect. Gnaw- ing or burning upper abdominal pain is symptomatic of PUD, not GERD. A decreased appetite should not occur with omeprazole.

The client is prescribed clonazepam (Klonopin) for treatment of a seizure disorder. Appropriate nursing action includes: a. Maintaining available dose for treating status epilepticus. b. Determining the pregnancy status of the client. c. Administrating with other CNS depressants. d. Assuring the client that a history of glaucoma will not affect treatment.

b. Determining the pregnancy status of the client. Rationale: Benzodiazepines are Category D drugs, and are contraindicated during pregnancy. The question does not indicate that the client has status epilepticus. CNS depressants should not be given with benzodiazepines. The drug could produce changes in intraocular pressure and is contraindicated in narrow-angle glaucoma

Planning teaching needs for a patient who is to be discharged postoperatively with a prescription of oxycodone with acetaminophen (Percocet) should include which of the following? a. Refer the patient to a drug treatment center if addiction occurs b. Encourage increased fluids and fiber in the diet c. Monitor for GI bleeding d. Teach the patient to self-assess blood pressure

b. Encourage increased fluids and fiber in the diet

A nurse is caring for a client receiving opioid analgesics over an extended period of time. What should the nurse include in the client's plan of care? a. Referring the client to a drug treatment center b. Encouraging increased fluids and fiber in the diet c. Monitoring for signs of gastrointestinal bleeding d. Administering medication as needed for severe pain

b. Encouraging increased fluids and fiber in the diet

The nurse is evaluating drug effects in a patient who has been given interferon alfa-2b (Intron-A) for hepatitis B and C. Which of the following is a common adverse effect? a. Depression and thoughts of suicide b. Flulike symptoms of fever, chills, or fatigue c. Edema, hypotension, and tachycardia d. Hypertension, renal or hepatic insufficiency

b. Flulike symptoms of fever, chills, or fatigue Interferon alfa-2b (Intron-A) com- monly causes flulike symptoms in up to 50% of patients receiving the drug. Options 1, 3, and 4 are incorrect. De- pression with suicidal thoughts, hypo- or hypertension, tachycardia, edema, and renal or hepatic insufficiency are not common adverse effects of the drug.

A patient on chemotherapy is receiving ondansetron (Zofran) for treatment of nausea. The nurse will instruct the patient to watch for which adverse effect from this drug? a. Hiccups b. Headache c. Dry mouth d. Blurred vision

b. Headache Ondansetron (Zofran) is a serotonin antagonist with few adverse effects, including headache, constipation or diarrhea, and dizziness.

A nurse is caring for a client who has been on a prolonged interferon alfa-2b (Intron A) therapy. For what should the nurse monitor in this client? a. Nephrotoxicity b. Hepatotoxicity c. Hypertension d. Diabetes

b. Hepatotoxicity Prolonged therapy with interferon alfa-2b can result in serious toxicities such as immunosuppression, hepatotoxicity, and neurotoxicity.

A nurse is caring for a client who has been taking methotrexate (Rheumatrex) tablets for treatment of rheumatoid arthritis. Which assessment should the nurse conduct to determine whether the client is experiencing a serious adverse effect of the medication? a. Neurologic status b. Lung sounds c. Musculoskeletal function d. Sexual dysfunction

b. Lung sounds Pulmonary fibrosis and pneumonia are serious adverse effects of methotrexate; therefore, the nurse should obtain baseline and follow-up assessments of the client's lung sounds.

A client presents to the emergency department with severe nausea and vomiting following a case of food poisoning. Which antiemetic drug should concern the nurse if the client is taking quinidine? a. Metoclopramide (Reglan) b. Prochlorperazine (Compazine) c. Scopolamine (Transderm-Scop) d. Dronabinol (Marinol)

b. Prochlorperazine (Compazine) Patients taking quinidine have an underlying dysrhythmia, and prochlorperazine is contraindicated in patients with cardiac impairment.

A nurse is caring for a client who will be receiving a vaccination to confer passive immunity. Which agent should the nurse anticipate administering to the client? a. Poliovirus, inactivated (poliovax) b. Rh0(D) immune globulin (RhoGAM) c. Pneumococcal, polyvalent (Pneumovax 23) d. Measles, mumps, and rubella (MMR II)

b. Rh0(D) immune globulin (RhoGAM) To confer passive immunity, the individual is given antibodies—in the form of immunoglobulins—against the foreign agent. This form of immunity has a fast onset, but lasts only 3-6 months, and the immune system does not mount a response. The administration of RhoGAM is an example of this type of indication. The other agents are vaccines that confer active immunity.

A nurse is caring for a client receiving chemotherapy with high emetogenic potential. Which drugs should the nurse prepare to administer prior to chemotherapy administration? (Select all that apply.) a. Anticholinergics b. Serotonin (5-HT3) antagonists c. Corticosteroids d. Neurokinin receptor antagonists e. Phenothiazines

b. Serotonin (5-HT3) antagonists c. Corticosteroids d. Neurokinin receptor antagonists e. Phenothiazines Classes of antiemetic medications used for treatment of chemotherapy-induced nausea and vomiting include serotonin (5-HT3) antagonists, corticosteroids, neurokinin receptor antagonists, and phenothiazines.

The nurse should monitor a transplant patient for the major adverse effect of cyclosporine therapy by evaluating which laboratory test? a. Complete blood count (CBC) b. Serum creatinine c. Liver enzymes d. Electrolyte levels

b. Serum creatinine The primary adverse effect of cyclosporine occurs in the kidneys, with up to 75 percent of patients experiencing reduction in urine output. Serum creatinine level is a good indicator of renal function.

A client who will be traveling on a plane is prescribed dimenhydrinate (Dramamine) for management of motion sickness. Which instruction about administration of the drug should the nurse provide the client? a. Apply the patch behind the ear the day before travel. b. Take the medication by mouth 20-60 minutes prior to the trip. c. Take the medication by mouth at onset of motion sickness. d. Inject the medication on the thigh intramuscularly.

b. Take the medication by mouth 20-60 minutes prior to the trip. Drugs used to treat motion sickness, like dimenhydrinate, are most effective when taken 20-60 minutes before travel is expected. Dimenhydrinate is taken orally.

A 24-year-old patient has been taking sulfasaline (Azulfidine) for irritable bowel syndrome and complains to the nurse that he wants to stop taking the drug beecause of the nausea, headaches, and abdominal pain it causes. What would the nurses best recommendation be for this patient? a. The drug is absolutely necessary, even with th e adverse effects b. Talk to the health care provider about dividing the doses throughout the day c. Stop taking the drug and see if the symptoms of the irritable bowel syndrome have resolved d. Take an antidiarrheal drug such as loperamide (Imodium) along with the sulfasalazine

b. Talk to the health care provider about dividing the doses throughout the day Nausea, vomiting, diarrhea, dys- pepsia, abdominal pain, and headache are common ad- verse effects of sulfasalazine (Azulfidine). Dividing the total daily dose evenly throughout the day and using the enteric-coated tablets may improve adherence. Options 1, 3, and 4 are incorrect. Patients who experience significant adverse effects of drug therapy are unlikely to comply with a drug regimen if the effects are severe. Suggesting that the patient take an antidiarrheal drug or that he stop drug therapy is not within the scope of a nurse's practice and should be items that he discusses with his health care provider.

When teaching a patient who is taking twice-daily dosages of an aluminum antacid along with other medications, which instruction should the nurse provide? a. The other medications can be taken with the antacid, as long as it is with meals. b. The antacid should be taken at least 2 hours before or after the other medications. c. The antacid should be taken at least 4-6 hours apart from the other medications. d. The patient will not be able to take the antacid therapy at this time.

b. The antacid should be taken at least 2 hours before or after the other medications. Administration of aluminum antacids should be at least 2 hours before or after other drugs because absorption could be affected.

The nurse teaches the client relaxation techniques and guided imagery as an adjunct to medication for treatment of pain. Which is the best nursing rationale regarding the major benefit of these techniques? a. They are less costly than other alternative therapies. b. They allow lower doses of drugs with fewer side effects. c. They can be used at home or in any environment. d. They do not require professional oversight.

b. They allow lower doses of drugs with fewer side effects.

The nurse teaches the patient relaxation techniques and guided imagery as an adjunct to medication for treatment of pain. What is the main rationale for the use of these techniques as adjuncts to analgesic medication? a. They are less costly techniques b. They may allow lower doses of drugs with fewer adverse effects c. They can be used at home d. They do not require self-injection

b. They may allow lower doses of drugs with fewer adverse effects

The nurse evaluates teaching related to causes of seizures. Further teaching is needed if the client makes which of the following statements? a. "Seizures can be caused by inflammation of the brain." b. "Seizures can be caused by low blood sugar." c. "My relative had seizures because of a large tumor growing in his muscles." d. "Seizures can occur after a head injury."

c. "My relative had seizures because of a large tumor growing in his muscles." Rationale: Rapid-growing, space-occupying lesions in the brain, not muscles, that increase intracranial pressure can cause seizures. Seizures may be caused by inflammation of the brain, low blood sugar, and head injuries.

In addition to the use of multiple antibiotics, the nurse should anticipate which medication to be included in the patient's treatment of PUD due to H. pylori infection? a. Antacids b. H2-receptor inhibitors c. Bismuth compounds d. Vitamin E compounds

c. Bismuth compounds Bismuth compounds may be added to the regimen of treatment for PUD caused by H. pylori. Although technically not antibiotics, bismuth compounds inhibit bacterial growth and prevent H. pylori from adhering to the gastric mucosa.

A nurse is caring for a patient preparing to undergo a colonoscopy. The nurse should anticipate administering which drug? a. Laxative b. Diuretic c. Cathartic d. Antihypertensive

c. Cathartic A cathartic drug is used for a client preparing to undergo a colonoscopy.

A client who is being treated for hepatitis B is prescribed hydrocodone 5 mg/acetaminophen 500 mg (Vicodin) two tablets every 6 hours as needed for pain. Which action should the nurse take? a. Administer the drug as prescribed. b. Administer only one tablet per dose. c. Clarify the order with the healthcare provider. d. Hold the medication until lab results are available.

c. Clarify the order with the healthcare provider.

A female patient reports using OTC aluminum hydroxide (AlternaGel) for relief of gastric upset. She is on renal dialysis 3 times a week. What should the nurse teach this patient? a. Continue using antacids but if she needs to continue them beyond a few months, she should consult the health care provider about different therapies b. Take the unattached no longer than for 2 weeks; if it has not worked by then it will not be effective c. Consult with the health care provider about the appropriate amount and type of antacid d. Continue to take the antacid; it is OTC and safe

c. Consult with the health care provider about the appropriate amount and type of antacid Antacids are generally combina- tions of aluminum hydroxide, calcium, and/or mag- nesium hydroxide. Hypermagnesemia, hypercalcemia, or hypophosphatemia can develop with use of OTC antacids. Because this patient is on renal dialysis, her kidneys are unable to adequately control the excretion of electrolytes. The nephrologist should be contacted about whether an antacid is appropriate for this pa- tient. Options 1, 2, and 4 are incorrect. Because of con- cerns about electrolyte imbalance, taking the antacid for limited periods may not be advisable. Because a drug is OTC does not guarantee its safety and it may pro- duce adverse effects in patients. Cognitive Level: Ana- lyzing.

A patient with severe diarrhea has an order for diphenoxylate with atropine (Lomotil). When assessing for therapeutic effects, which of the following will the nurse expect to find? a. Increased bowel sounds b. Decreased belching and flatus c. Decrease in loose, watery stools d. Decreased abdominal cramping

c. Decrease in loose, watery stools A decrease in the number and con- sistency of stools is a therapeutic effect of diphenoxylate with atropine (Lomotil). Options 1, 2, and 4 are incorrect. A decrease in bowel sounds rather than an increase would be noted if the drug is having therapeutic effects. The drug has no direct effect on the causes of belching or flatus. Al- though reduction in abdominal cramping may occur due to decreased peristalsis, it is not the therapeutic indication for the drug.

What is the most appropriate method to ensure adequate pain relief in the immediate postoperative period from an opioid drug? a. Give the drug only when the family members report that the patient is complaining of pain b. Give the drug every time the patient complains of acute pain c. Give the drug as consistently as possible for the first 24-48 hours d. Give the drug only when the nurse observes signs and symptoms of pain

c. Give the drug as consistently as possible for the first 24-48 hours

A patient tells the nurse that she has been taking sodium bicarbonate antacid 3-4 times a day for the past 3 weeks to relieve symptoms of GERD. For what should the nurse assess in this patient? a. Constipation b. Respiratory acidosis c. Metabolic alkalosis d. Hypokalemia

c. Metabolic alkalosis Adverse effects of sodium bicarbonate antacid include metabolic alkalosis, fluid retention, edema, and hypernatremia.

A client receiving digoxin (Lanoxin) therapy is being treated for status epilepticus with diazepam (Valium). The nurse places priority on: a. Holding the digoxin until the seizure has subsided. b. Keeping the client in a high Fowler's position. c. Monitoring the client for nausea and GI cramping. d. Instructing the client to eat foods high in potassium.

c. Monitoring the client for nausea and GI cramping. Rationale: Valium is a benzodiazepine, which can potentate the action of digoxin and raise blood levels. Nausea, vomiting, GI cramping, blurred vision, and bigeminy are signs of digoxin toxicity. The digoxin should not be held unless symptoms of toxicity are seen. Positioning should protect the client from injury during the seizure-most likely recumbent and on the side, if possible. Potassium is not indicated.

A client who incurred an arm injury describes his pain as "sharp and localized to the lower arm." The nurse recognizes that this type of pain would be relieved best by administration of which type of medication? a. Muscle relaxant b. Acetaminophen c. Opiate analgesics d. Anesthetic drug

c. Opiate analgesics

A nurse is preparing to administer immunostimulant therapy to a client. Which client condition would warrant immediate notification of the healthcare provider? a. Viral infection b. Immunodeficiency c. Pregnancy d. Cancer

c. Pregnancy Immunostimulant drugs should be used with high precaution in pregnant clients due to the neurological adverse effects, which can harm the fetus. Viral infection, immunodeficiency disease, and cancer are indications for use of immunostimulant drugs.

A patient admitted with hepatitis B is prescribed hydrocodone with acetaminophen (Vicodin) 2 tablets for pain. What is the most appropriate action for the nurse to take? a. Administer the drug as ordered b. Administer 1 tablet only c. Recheck the order with the health care provider d. Hold the drug until the health care provider arrives

c. Recheck the order with the health care provider

The nurse giving discharge teaching for a client receiving carbamazepine (Tegretol) should include: a. Monitor blood glucose, and report decreased levels. b. Expect a discoloration of the contact lenses. c. Report unusual bleeding or bruises to the health care provider immediately. d. Expect an orange discoloration of urine.

c. Report unusual bleeding or bruises to the health care provider immediately. Rationale: Carbamazepine affects vitamin K metabolism and can lead to blood dyscraisias and bleeding. It does not significantly lower blood sugar or change the color of body fluids.

The client, age 8, is prescribed valproic acid (Depokene) for treatment of a seizure disorder. The nurse should monitor the client closely for: a. Hyperthermia. b. Vitamin B deficiency. c. Restlessness and agitation. d. Respiratory distress.

c. Restlessness and agitation. Rationale: Valproic acid can produce an idiosyncratic response in children, including restlessness and psychomotor agitation.

9. Celecoxib (Celebrex) is added to the treatment regimen of a client with arthritis. What is the nurse's best response to the client who asks for the indication of this medication? a. The drug is less expensive than other brand NSAIDs. b. The drug has a lower side effect profile than NSAIDs. c. The drug has specific anti-inflammatory properties. d. The drug's effectiveness is the same as opioids.

c. The drug has specific anti-inflammatory properties.

A nurse is administering pneumonia vaccinations to older adults during a community health fair. Which significant information should the nurse emphasize with the clients regarding this immunization? a. The immunization is free of charge. b. The immunization is required annually. c. The immunization can decrease mortality. d. The immunization can eradicate the disease.

c. The immunization can decrease mortality. Of the vaccine-preventable diseases, pneumococcal pneumonia is the most lethal, with about 4,250 deaths occurring annually in the United States. The Centers for Disease Control and Prevention (CDC, 2015) recommends 1 or 2 doses of the pneumococcal vaccine for adults age 19 and older. Nurses play a key role in encouraging patients to be vaccinated according to established guidelines.

A nurse is preparing to administer a hepatitis B vaccine to a patient. Which of the following would cause the nurse to withhold the vaccine and check with the health care provider? a. The patient smokes cigarettes, 1 pack a day b. The patient is frightened by needles c. The patient is allergic to yeast and yeast products d. The patient has hypertension

c. The patient is allergic to yeast and yeast products An allergy to yeast or yeast products is a contraindication to the hepatitis B vaccination. Options 1, 2, and 4 are incorrect. Smoking, HTN, and a fear of needles or injections are not contraindications for the drug. These conditions may be managed with appropri- ate health teaching.

The nurse administers morphine 4 mg IV to a patient for treatment of severe pain. Which of the following assessments require immediate nursing interventions? SATA a. The patients blood pressure is 110/70 b. The patient is drowsy c. The patients pain is unrelieved in 15 minutes d. The patients respiratory rate is 1- breaths per minute e. The patient becomes unresponsive

c. The patients pain is unrelieved in 15 minutes d. The patients respiratory rate is 1- breaths per minute e. The patient becomes unresponsive

Which statement by a client taking cyclosporine would indicate a need for further teaching by the nurse? a. "I will report any reduction in urine output to my healthcare provider." b. "I will wash my hands frequently and thoroughly." c. "I will take my blood pressure at home every day." d. "I will take cyclosporine at breakfast with a glass of grapefruit juice."

d. "I will take cyclosporine at breakfast with a glass of grapefruit juice." Grapefruit juice will increase cyclosporine levels 50 percent to 200 percent, resulting in drug toxicity. Thus, the nurse should instruct the client to avoid taking cyclosporine with grapefruit juice. Handwashing is important to prevent infection while taking cyclosporine. Renal toxicity and hypertension are adverse effects of cyclosporine therapy for which the client should monitor and which the client should report to the healthcare provider.

Which of the following statements by a patient who is taking cyclosporine (Neural, Sandiummune) would indicate the need for more teaching by the nurse? a. "I will report any reduction in urine output" b. "I will wash my hands frequently" c. "I will take my BP at home each day" d. "I will take my cyclosporine at breakfast with a glass of grapefruit juice"

d. "I will take my cyclosporine at breakfast with a glass of grapefruit juice" Grapefruit juice increases cyclo- sporine levels 50% to 200%, resulting in drug toxicity. Options 1, 2, and 3 are incorrect. These statements re- flect an understanding of the nurse's teaching. Hand washing is important to prevent infection. Renal toxicity and HTN are adverse effects of cyclosporine therapy.

In taking a new patients history, the nurse notices that he has been taking omeprazole (Prilosec) consistently over the past 6 months for treatment of epigastric pain. Which recommendation would be the best for the nurse to give this patient? a. Try switching to a different form of the drug b. Try a drug like cimetidine (Tagamet) or famotidine (Pepcid) c. Try taking the drug after meals instead of before meals d. Check with his health care provider about his continued discomfort

d. Check with his health care provider about his continued discomfort PPIssuchasomeprazole(Prilosec) are recommended for short-term therapy, approximately 4 to 8 weeks in length. If symptoms of epigastric pain and discomfort continue, other therapies and screen- ing for H. pylori may be indicated. Options 1, 2, and 3 are incorrect. Switching to another PPI still exceeds the recommended time of use for this category of drugs. H2- receptor blockers such as cimetidine (Tagamet) and fa- motidine (Pepcid) may be indicated but their use should be evaluated by a health care provider because more definitive treatment (e.g., for H. pylori) may be required. PPIs should be taken 30 minutes before meals.

The nurse should expect to administer which medication to a client receiving treatment for opioid dependence? a. Naloxone injection (Evzio) b. Meperidine (Demerol) c. Fentanyl (Duragesic) d. Dolophine (Methadone)

d. Dolophine (Methadone)

A 55 year-end patient wis receiving cyclosporine (Neural, Sandimmune) after a heart transplant. The patient exhibits a WBC count of 12,000 cells/mm3, a sore throat, fatigue, and a low-grade fever. The nurse suspects which of the following conditions? a. Transplant rejection b. Heart failure c. Dehydration d. Infection

d. Infection Duetoimmunesystemsuppression by the cyclosporine (Neoral, Sandimmune), infections are common. While the WBC count is slightly elevated, this drug suppresses the function of the immune cells (T-cells) and does not suppress bone marrow produc- tion of WBCs. Options 1, 2, and 3 are incorrect. Preven- tion of transplant rejection is a therapeutic indication for the use of cyclosporine. The patient's symptoms of sore throat and low-grade fever are not symptomatic of heart failure or dehydration.

A client who is receiving cyclosporine after a heart transplant exhibits a sore throat, fatigue, low-grade fever, and white blood count of 12,000 cells/mm3. The nurse should anticipate planning interventions for which client condition? a. Transplant rejection b. Heart failure c. Dehydration d. Infection

d. Infection Transplant patients on immunosuppressant therapy are at high risk for infections, and the client is exhibiting such symptoms. Therefore, the nurse should plan to implement interventions for treatment and management of an infection.

A patient with constipation is prescibred psyllium (Metamucil) by his health care provider. What essential teaching will the nurse provide to the patient ? a. Take the drugs with meals and at bedtime b. Take the drug with minimal water so that it will not be diluted in the GI tract c. Avoid caffeine and chocolate while taking this medication d. Mix the product with a full glass of water and drink another glassful after taking

d. Mix the product with a full glass of water and drink another glassful after taking Toavoidesophagealorgastricob- struction, psyllium (Metamucil) should be mixed with a full glass of water or juice and followed by another full glass of liquid. Options 1, 2, and 3 are incorrect. The drug should not be taken directly with meals because nutri- ents in the food may be bound into the psyllium and not absorbed. Psyllium should not be taken dry and should be taken with plenty of fluids. Caffeine and chocolate do not need to be avoided while on this medication. Cognitive Level: Analyzing.

The nurse administers morphine sulfate 4 mg IV to a client for treatment of severe pain. Which assessment finding requires immediate nursing action? a. Blood pressure is 110/70 mmHg. b. The client is drowsy upon arousal. c. Pain is unrelieved in 15 minutes. d. Respiratory rate is 10 breaths/minute.

d. Respiratory rate is 10 breaths/minute.

The emergency department nurse is caring for a patient with a migraine. Which drug would the nurse anticipate administering to abort the patients migraine attack? a. Morphine b. Propranolol (Inderal) c. Ibuprofen (Motrin) d. Sumatriptan (Imitrex)

d. Sumatriptan (Imitrex)

A nurse is caring for a client who is experiencing onset of a severe migraine headache with a pain level of 10/10. Which medication should the nurse administer to quickly abort the client's migraine headache? a. Ibuprofen (Motrin) 800 mg orally b. Acetaminophen (Tylenol ES) 1,000 mg orally c. Morphine sulfate 8 mg intravenously d. Sumatriptan (Imitrex) 25 mg subcutaneously

d. Sumatriptan (Imitrex) 25 mg subcutaneously

A 5-year-old child is due for prekindergarten immunizations. After interviewing her mother, which of the following responses may indicate a possible contraindication for giving this preschooler a live vaccine (e.g. measles, mumps, and rubella MMR) at this visit and would require further exploration by the nurse? a. Her cousin has the flu b. The mother has just finished her series of hepatitis B vaccines c. Her arm became very sore after her last tetanus shot d. They are caring for her grandmother who has just finished her second chemotherapy treatment for breast cancer

d. They are caring for her grandmother who has just finished her second chemotherapy treatment for breast cancer Live vaccines may be contraindi- cated when patients present an exposure risk of the infectious agent to immunocompromised people such as those on chemotherapy or immunosuppressant therapy. Options 1, 2, and 3 are incorrect. Assuming that the cousin has a normal and active immune system, the cousin's flu would not be a contraindication. The mother would not be at risk and because she has re- ceived recent vaccinations, assessment of her immune system would have been completed at that time. Local- ized soreness or tenderness is a potential (mild) adverse effect of immunizations and can be managed symptom- atically.