pharm modterm review

A client is taking phenytoin to treat clonic-tonic seizures. The client's phenytoin level is 16 mg/L. Which action should the nurse take?

Administering the next dose of the medication as prescribed is within the therapeutic range of 10 to 20 mg/L (40 to 80 mcmol/L); the nurse should administer the drug as prescribed. The phenytoin level is within the therapeutic range of 10 to 20 mg/L (40 to 80 mcmol/L); there is no need to hold the dose and notify the healthcare provider. Holding the next dose and then resuming administration as prescribed is unsafe and will reduce the therapeutic blood level of the drug. Calling the healthcare provider to obtain a prescription with an increased dose is unnecessary; the blood level is within the therapeutic range.

A client who is receiving phenytoin to control a seizure disorder questions the nurse regarding this medication after discharge. How will the nurse respond?

"Antiseizure drugs will probably be continued for life. Seizure disorders usually are associated with marked changes in the electrical activity of the cerebral cortex, requiring prolonged or lifelong therapy. Seizures may occur despite drug therapy; the dosage may need to be adjusted. A therapeutic blood level must be maintained through consistent administration of the drug irrespective of emotional stress. Absence of seizures will probably result from medication effectiveness rather than from correction of the pathophysiologic condition.

A 30-year-old who began lithium carbonate therapy 3 weeks ago is having blood drawn for a lithium drug level. Which range will the nurse recognize as therapeutic?

0.4 to 1.3 mEq/L (0.4 to 1.3 mmol/L) Lithium levels of 0.4 to 1.3 mEq/L (0.4 to 1.3 mmol/L) are therapeutic and effective in treating symptoms of mania. A level below 0.3 mEq/L (0.3 mmol/L) is too low to be therapeutic. At levels above 1.5 mEq/L (1.5 mmol/L), early signs of toxicity may occur; at levels of 2.0 mEq/L (2.0 mmol/L) and higher, severe lithium toxicity may occur, constituting a life-threatening emergency.

A monoamine oxidase inhibitor (MAOI) is prescribed. What should the nurse instruct the client to avoid while taking this drug?

Aged cheeses The MAOIs can cause hypertensive crisis if food or beverages that are high in tyramine are ingested. Prolonged exposure to the sun is hazardous for clients taking one of the phenothiazines. Strenuous physical exercise is not contraindicated. Antihistamines are not prohibited with MAOI medications.

An older adult with cerebral arteriosclerosis is admitted with atrial fibrillation and is started on a continuous heparin infusion. What clinical finding enables the nurse to conclude that the anticoagulant therapy is effective?

An activated partial thromboplastin (APTT) twice the usual value Desired anticoagulant effect is achieved when the activated partial thromboplastin time is 1.5 to 2 times normal. While anticoagulants help prevent thrombi that could block cerebral circulation, they do not increase cerebral perfusion, and so will not affect existing confusion. Although absence of bleeding suggests that the drug has not reached toxic levels, it does not indicate its effectiveness. This medication does not affect the viscosity of blood.

A primary healthcare provider prescribes atenolol 20 mg by mouth four times a day for a client who has had double coronary artery bypass surgery. What information is mostimportant for the nurse to include in the discharge teaching plan for this client?

Avoid abruptly discontinuing the medication. An abrupt discontinuation of atenolol may cause an acute myocardial infarction. Alcohol is contraindicated for clients taking atenolol because it can cause additive hypotension. Clients should never increase medications without a healthcare provider's direction. The pulse rate can go much lower as long as the client feels well and is not dizzy.

A client with rheumatoid arthritis has been taking a steroid medication for the past year. For which complication of prolonged use of this medication should the nurse assess the client?

Decreased white blood cells

After the nurse provides education about hydrochlorothiazide, the client will agree to notify the healthcare provider regarding the development of which symptom?

Generalized Weakness Generalized weakness is a symptom of significant hypokalemia, which may be a sequela of diuretic therapy.

At 4:30 PM, a client who is receiving human insulin (Humulin N) every morning states, "I feel very nervous." The nurse observes that the client's skin is moist and cool. What is the nurse's mostaccurate interpretation of what the client is likely experiencing?

Hypoglycemia The time of the client's response corresponds to the expected peak action (4 to 12 hours after administration) of the intermediate-acting insulin that was administered in the morning; this can result in hypoglycemia. Hypoglycemia triggers the sympathetic nervous system; epinephrine causes diaphoresis and nervousness. Osmotic diuresis causes thirst; this is related to hyperglycemia, not to hypoglycemia. Warm, dry, flushed skin and lethargy are associated with ketoacidosis. Glycogenesis, the formation of glycogen in the liver, is unrelated to nervousness and cool, moist skin.

Carbidopa-levodopa is prescribed for a client with Parkinson disease. The nurse assesses for which adverse responses that are associated with this medication? Select all that apply

Nausea. Emotional changes. Nausea and vomiting may occur; this reflects a central emetic reaction to levodopa. Changes in affect, mood, and behavior are related to toxic effects of carbidopa-levodopa. Insomnia, tremors, and agitation are side effects that may occur, not lethargy. Tachycardia and palpitations, not bradycardia, occur. Anemia and leukopenia, not polycythemia, are adverse reaction

An 8-year-old child is being given insulin glargine (Lantus) before breakfast. What is the most appropriate information for the nurse to give the parents concerning a bedtime snack?

Offer a snack to prevent hypoglycemia during the night. Insulin glargine is released continuously throughout the 24-hour period; a bedtime snack will prevent hypoglycemia during the night. Providing a snack when signs of hyperglycemia are present is unsafe because it intensifies hyperglycemia; if hyperglycemia is present, the child needs insulin. Because insulin glargine is a long-acting insulin, bedtime snacks are recommended to prevent a hypoglycemic episode during the night. When hypoglycemia develops, the child will be asleep; the snack should be eaten before going to bed.

A male client who is receiving prolonged steroid therapy complains of always being thirsty and urinating frequently. What is the nurse's best initial action?

Perform a finger stick to test the client's blood glucose level.

A male client who is receiving prolonged steroid therapy complains of always being thirsty and urinating frequently. What is the nurse's best initial action?

Perform a finger stick to test the client's blood glucose level. The client has signs of an increased serum glucose level, which may result from steroid therapy; testing the blood glucose level is a method of gathering more data. The symptoms are not those of benign prostatic hyperplasia. The blood glucose level, not the amount of ketones in the urine, should be assessed. The symptoms presented are not those of fluid retention but of hyperglycemia.

A school-aged child is receiving 45 units of intermediate-acting insulin at 7:00 AM and 7:00 PM. What will the nurse tell the parents regarding a bedtime snack?

Provide a bedtime snack to prevent hypoglycemia during the night. Intermediate-acting insulin peaks in 4 to 12 hours; a bedtime snack will prevent hypoglycemia during the night. Offering a snack at bedtime if there are signs of hyperglycemia is unsafe because it will intensify the hyperglycemia; if hyperglycemia is present, the child needs insulin. Bedtime snacks are recommended for people taking intermediate-acting insulin. When hypoglycemia develops, the child will be asleep; the snack should be eaten before bed.

A client who has a habit of smoking is on estrogen therapy. What condition is the client at risk of developing?

Thrombosis

A client has been taking levothyroxine (Synthroid) for hypothyroidism for three weeks. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? Select all that apply.

Tremors and Heat intolerance Excessive levothyroxine produces adaptations similar to hyperthyroidism, including tremors, tachycardia, hypertension, heat intolerance, and insomnia. These adaptations are related to the increase in the metabolic rate associated with hyperthyroidism. Bradycardia is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Somnolence is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Hypotension is a sign of hypothyroidism and a need to increase the dose of levothyroxine.

A nurse is monitoring a child for toxicity precipitated by digoxin. For what sign of digoxin toxicity will the nurse assess the child?

Vomiting is a sign of digoxin toxicity in children. Oliguria is associated with renal failure, not toxicity. Tachypnea is associated with heart failure, not toxicity. Splenomegaly is associated with heart failure, specifically right ventricular failure.

A depressed client has been prescribed a tricyclic antidepressant. How long should the nurse inform the client that it will take before the client notices a significant change in the depression?

2 to 4 weeks It takes 2 to 4 weeks for the tricyclic antidepressant to reach a therapeutic blood level. Four to 6 days and 12 to 16 hours are both too short of time spans for a therapeutic blood level of the drug to be achieved. Improvement in depression should be demonstrated earlier than 5 to 6 weeks.

A beta-blocker, atenolol (Tenormin), is prescribed for a client with moderate hypertension. What information should the nurse include when teaching the client about this medication? Select all that apply.

A side effect of this medication is orthostatic hypotension. The client should be advised to move to a standing position slowly to allow the vasomotor response of the body to adjust to the new position. The rate of the pulse should be taken before administering the medication; ventricular dysrhythmias and heart block may occur. Mild weakness and fatigue, as well as dizziness and depression, are side effects of this medication. The blood pressure decreases when the client is sleeping; the medication usually is prescribed to be administered earlier in the day. The medication should be taken with food. No OTC medication should be taken without consulting the prescribing health care provider; decreased or increased effects can occur when there is an interaction with another medication. Test-Taking Tip: Attempt to select the answer that is most complete and includes the other answers within it. For example, a stem might read, "A child's intelligence is influenced by:" and three options might be genetic inheritance, environmental factors, and past experiences. The fourth option might be multiple factors, which is a more inclusive choice and therefore the correct answer.

A client with a diagnosis of bipolar I disorder, manic episode, is started on a regimen of an antipsychotic agent and lithium carbonate. The nurse explains to the client that the rationale behind this regimen is that the antipsychotic has which action?

Acts to quiet the client while allowing time for the lithium to reach a therapeutic level Antipsychotics usually are prescribed to calm agitated clients during the 3-week period it takes for the lithium to become effective. Antipsychotic drugs have a different, not a potentiating, mechanism of action. The drugs are used to control symptoms of mania, not to prevent depression. The neuroleptic drug has no effect on lithium toxicity.

Which action may cause lipohypertrophy in a client who is receiving insulin injections?

Administering insulin into the same site each time Lipohypertrophy is a subcutaneous skin disorder in which a firm lump develops under the skin. Injecting the insulin into the same site each time may cause lipohypertrophy. Insulin is administered subcutaneously. Insulin should be stored in the refrigerator and brought to room temperature before use. Buffered regular insulin is substituted in clients who are unable to use rapid-acting insulin to improve postprandial blood glucose readings and long-term glucose control.

A client is receiving hydrochlorothiazide (HCTZ). What should the nurse monitor to best determine the effectiveness of the client's hydrochlorothiazide therapy?

Blood pressure Diuretics promote urinary excretion, which reduces the volume of fluid in the intravascular compartment, thus lowering blood pressure. Assessing the extent of edema is subjective and difficult; blood pressure is an objective assessment that measures intravascular pressure. The serum sodium level remains stable unless the dosage is excessive; an altered sodium level is not a therapeutic response. Although specific gravity decreases with increased urinary output, this does not reflect the desired reduction in intravascular pressure.

A client who has a long leg cast for a fractured bone is to be discharged from the emergency department. When discussing pain management, the nurse should advise the client to take the prescribed as needed oxycodone and acetaminophen when?

Correct4 When the discomfort begins

A client is to be discharged on a regimen of lithium carbonate. What will the nurse include in the discharge teaching plan?

Encouraging the client to have the lithium blood level tested regularly The blood level must be checked monthly or bimonthly when the client is undergoing maintenance therapy, because there is only a small difference between the therapeutic and toxic ranges. A regular diet should be encouraged if the client does not have gluten enteropathy. There is no need to take lithium carbonate with milk, because it does not cause gastrointestinal problems. Lithium carbonate does not affect the blood cells.

A client is receiving furosemide (Lasix) to relieve edema. The nurse should monitor the client for which response to the medication?

Excessive loss of potassium ions Furosemide is a potent diuretic used to provide rapid diuresis; it acts in the loop of Henle and causes depletion of electrolytes, such as potassium and sodium. Furosemide inhibits the reabsorption, not retention, of sodium. Furosemide does not affect protein metabolism. With edema, the specific gravity of the fluid more likely will be low.

A nurse prepares to administer metformin (Glucophage XR) to an older adult who has asked that it be crushed because it is difficult to swallow. The nurse explains that this drug cannot be crushed because of what reason?

It is released slow

A nurse prepares to administer metformin (Glucophage XR) to an older adult who has asked that it be crushed because it is difficult to swallow. The nurse explains that this drug cannot be crushed because of what reason?

It is released slow The slow-release formulary will be compromised, and the client will not receive the entire dose if it is chewed or crushed. The capsules are not difficult to crush. Irritation of the mucosal tissue is not the reason the medication should not be crushed; however, this drug should be given with meals to prevent gastrointestinal irritation. Although taste could be a factor, it is not the priority issue

A client with arthritis, "Can I take Tylenol instead of aspirin? Aspirin irritates my stomach." The nurse explains what about acetaminophen (Tylenol)?

It lacks an anti-inflammatory action Although acetaminophen (Tylenol) reduces pain, it lacks the anti-inflammatory action needed to limit joint inflammation associated with arthritis. People with arthritis do not need anticoagulants unless prescribed for a concomitant cardiovascular problem or cardiovascular prophylaxis. Although they are both analgesics, acetaminophen is not an anti-inflammatory agent. There are fewer side effects with acetaminophen than with aspirin.

A client is taking furosemide (Lasix) and digoxin (Lanoxin) for heart failure. Why does the nurse advise the client to drink a glass of orange juice every day?

Maintaining potassium levels Orange juice is an excellent source of potassium. Furosemide promotes excretion of potassium, which can result in hypokalemia. Digitalis toxicity can occur in the presence of hypokalemia. Neither drug increases sodium levels. Digoxin does not potentiate the action of furosemide; therefore, the client should not experience dehydration. Orange juice will not prevent an interaction between digoxin and furosemide.

Alprazolam is prescribed for a client who is anxious. For what therapeutic effect will the nurse monitor the client?

Resting quietly Alprazolam, an anxiolytic, promotes muscle relaxation, reduces anxiety, and facilitates rest. Possible adverse reactions to alprazolam are anger and hostility. Although drowsiness is a side effect of alprazolam, caused by depression of central nervous system activity, it is not a hypnotic. Transient hypotension is a side effect of alprazolam, but this is not why it is given to an anxious client.

A client who takes four 325-mg tablets of buffered aspirin four times a day for severe arthritis complains of dizziness and ringing in the ears. Which complication does the nurse conclude that the client probably is experiencing?

Salicylate toxicity Excessive acetylsalicylic acid (aspirin) ingestion can influence the vestibulocochlear nerve (cranial nerve VIII), causing tinnitus and dizziness. The client is experiencing symptoms of toxicity, not an anaphylactic response. Withdrawal symptoms occur when a medication is no longer being administered. Buffered aspirin contains acetylsalicylic acid, not acetaminophen.

A client who recently started receiving oral corticosteroids for a severe allergic reaction is instructed that the dosage will be reduced gradually until all medication is stopped at the end of two weeks. What reason does the nurse provide for this gradual reduction in dosage?

Slow reduction of the drug will prevent a physiologic crisis because the adrenal glands are suppressed.

A client is experiencing diplopia, ptosis, and mild dysphagia. Myasthenia gravis is diagnosed and an anticholinergic medication is prescribed. The nurse is planning care with the client and spouse. What direction is the priority?

Take the medication according to a specific schedule A priority of care for a client with myasthenia gravis is to take medication according to a specific schedule; for example, the anticholinergic medication should be taken before meals because it enhances chewing and swallowing. Dysphagia usually is not an initial problem with myasthenia gravis. A variety of foods in texture and taste should be encouraged. Mechanical soft foods or chopped foods should be eaten until the dysphagia progresses to the point that pureed foods are necessary. Although movement and mobility are important, range-of-motion exercises prevent joint contractures rather than promote muscle strength. Anticholinergic medications taken for myasthenia gravis cause relaxation of smooth muscle, resulting in diarrhea rather than constipation.

An adolescent with a major depressive disorder is prescribed venlafaxine (Effexor). What signs or symptoms related to the medication should the nurse communicate immediately to the prescribing provider? Select all that apply.

blurred vision suicidal ideation difficult urination Abnormal vision (e.g., blurred or double vision) is a side effect of venlafaxine (Effexor). Central nervous system effects such as emotional lability, vertigo, anxiety, insomnia, and suicidal ideation in children and adolescents are side effects of venlafaxine. Difficult or painful urination is a serious side effect of venlafaxine; impairment of urine flow can lead to urinary tract infection and renal failure. Extrapyramidal side effects such as tardive dyskinesia do not occur with venlafaxine. Transient hypoglycemia is not a side effect of venlafaxine. Test-Taking Tip: Choose the best answer for questions asking for a single answer. More than one answer may be correct, but one answer may contain more information or more important information than another answer.

A 13-year-old-child with type 1 diabetes is receiving 15 units of Novolin R insulin and 20 units of Novolin N insulin at 7 am each day. At what time should the nurse anticipate a hypoglycemic reaction from the Novolin N to occur?

in the afternoon Novolin N is an intermediate-acting insulin that peaks approximately 6 to 8 hours after administration. It was administered at 7 am, so between 1 and 3 p.m. is when the nurse should anticipate that a hypoglycemic reaction will occur. During the evening or night is when a reaction from a long-acting insulin is expected. Long-acting insulin has a small peak 10 to 16 hours after administration. Noon is when a reaction from a short-acting insulin is expected. Short-acting insulin peaks in 2 to 4 hours after administration. Within 30 minutes of administration is when a reaction from a rapid-acting insulin is expected. Rapid-acting insulin peaks 30 to 60 minutes after administration.

A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? Select all that apply.

irritability heat palpitations Irritability, a neuroglycopenic symptom, occurs when the glucose in the brain declines to a low level. Heart palpitations, a neurogenic symptom, occur when the sympathetic nervous system responds to a rapid decline in blood glucose. Because the blood glucose level is decreased, the renal threshold is not exceeded, and there is no glycosuria. Dry, hot skin is consistent with dehydration, which often is associated with hyperglycemic states. Fruity odor of the breath is associated with hyperglycemia; it is caused by the breakdown of fats as a result of inadequate insulin supply.s

A client receiving morphine is being monitored by the nurse for signs and symptoms of overdose. Which clinical findings support a conclusion of overdose? Select all that apply.

lethargy bradycardia slow respiration The central nervous system (CNS) depressant effect of morphine causes lethargy. The CNS depressant effect of morphine causes bradycardia. The CNS depressant effect of morphine causes bradypnea. Morphine does not increase urine output. Morphine causes constriction of pupils.