Pharm Overview

A nurse is preparing discharge teaching for a client with a new prescription for digoxin. Which foods will the nurse teach the client to avoid when taking digoxin? A. large amounts of bran products B. dairy products such as milk, yogurt, and cheese C. foods high in purines such as organ meats and fish D. foods high in vitamin K such as green leafy vegetables

Answer: A Bran can interfere with and decrease the absorption of digoxin resulting in unexpectedly low serum concentration levels. Dairy products, foods high in purines, and foods high in vitamin K do not contain bran and do not decrease the absorption of digoxin.

The healthcare provider orders digoxin for the client with congestive heart failure. What should the nurse include in the client's teaching concerning the administration of digoxin? Select all that apply. A. "Digoxin can cause swelling of the face, lips, or tongue." B. "Digoxin can cause seizures." C. "Digoxin can cause a decreased urinary output." D. "Digoxin can cause a fast, irregular heartbeat." E. "Digoxin can cause decreased respiratory rate."

Answer: A, D The nurse should explain to the client that digoxin can cause allergic reactions, such as skin rash, itching or hives, swelling of the face, lips or tongue, changes in behavior, mood, or mental ability, changes in vision, confusion, a fast, irregular heartbeat, or feeling faint or lightheaded. Digoxin does not cause decreased respiratory rate, decreased urinary output, or seizures.

A 3-month-old infant is being discharged on digoxin. The nurse should instruct the parents to report which signs and symptoms? Select all that apply. A. signs of constipation or painful straining B. decrease in the amount of infant formula taken or a refusal to take it C. pulse rate greater than 140 bpm or less than 100 bpm D. signs that the infant is not following moving objects E. sudden vomiting or sudden drowsiness

Answer: B, C, D, E Anorexia is commonly the first indication of digoxin toxicity. Arrhythmias are also common with digoxin toxicity. Although bradycardia is the most common sign of toxicity, other tachycardic arrhythmias can occur. A normal pulse rate for a 3-month-old child at rest is about 120 bpm. Blurred vision can be associated with digoxin toxicity and may be detected in an infant if he stops following moving objects. Sudden vomiting or drowsiness can be associated with digoxin toxicity. Constipation is not associated with digoxin toxicity and is not an adverse effect of digoxin.

A client who has been diagnosed with tuberculosis has been placed on drug therapy. The medication regimen includes rifampin. Which instruction should the nurse give the client about potential adverse effects of rifampin? Select all that apply. A. Have eye examinations every 6 months. B. Maintain follow-up monitoring of liver enzymes. C. Decrease protein intake in the diet. D. Avoid alcohol intake. E. The urine may have an orange color.

Answer: B, D, E A potential adverse effect of rifampin is hepatotoxicity. Clients should be instructed to avoid alcohol intake while taking rifampin and keep follow-up appointments for periodic monitoring of liver enzyme levels to detect liver toxicity. Rifampin causes the urine to turn an orange color, and the client should understand that this is normal. It is not necessary to restrict protein intake in the diet or have the eyes examined due to rifampin therapy.

After being treated with heparin therapy for thrombophlebitis, a multiparous client who gave birth 4 days ago is to be discharged on oral warfarin. After the nurse teaches the client about the medication and possible effects, which client statement indicates successful teaching? A. "I can take ibuprofen if I get uterine cramps." B. "I will need my INR drawn every week." C. "I should use only waxed dental floss when caring for my teeth." D. "I need to refrain from eating green leafy vegetables."

Answer: C Anticoagulant therapy can cause the gums to bleed, so a soft toothbrush and waxed dental floss should be used to minimize this adverse effect. Use nonsteroidal anti-inflammatory medications should be avoided because of the increased risk for possible hemorrhage. Clients will need frequent INRs at the beginning of treatment which could be more often than weekly. Once IRN levels have stabilized, clients may need INR levels only monthly. Clients should be advised to keep the consumption of foods high in vitamin K consistent from day to day rather that eliminate them totally from their diets.

A 24-year old female client with active tuberculosis is receiving rifampin 600 mg daily. Which should this client avoid because of the significant interaction with rifampin? A. gingko biloba B. pancreatic enzymes C. oral contraceptives D. arthritis medications

Answer: C Oral contraceptives may have decreased effectiveness while taking rifampin, and may also cause breakthrough bleeding, spotting or pregnancy. Pancreatic enzymes and arthritis medications and supplements do not interfere with rifampin or cause adverse effects.