pharm practice

After thoracic surgery for removal of a cancerous lesion in the lung, the client is drowsy, complains of pain when awakened, and then falls asleep. The client has a prescription for morphine sulfate via IV every 3 hours as needed for pain. The client's preoperative blood pressure was 128/76 mm Hg. Postoperative assessments reveal that the client's blood pressure ranges between 90/60 and 100/70 mm Hg. What is the nurse's best initial action?

Withhold morphine until the blood pressure stabilizes. Morphine is an opioid analgesic that may decrease the blood pressure further. It should be withheld and not administered at this time. A vasoconstrictor will not relieve the pain. Administration of a medication dosage other than that prescribed is not an independent nursing function.

A woman with type 2 diabetes mellitus continues taking oral tolbutamide during her pregnancy. What type of malformation may the newborn develop?

1) Hypoglycemia Hypoglycemia may be seen in the newborn if the mother takes oral hypoglycemic agents during pregnancy. Diethylstilbestrol may cause congenital defects in the newborn. Valproic acid may cause neural tube defects. Nitrofurantoin and topiramate may cause cleft lips with cleft palates.

A client with metastatic breast cancer is started on a multiple drug regimen that includes docetaxel. The nurse assesses the client for which nontherapeutic effects of docetaxel? Select all that apply. Correct 1

1) Alopecia 3) Febrile neutropenia 5) Hypersensitivity reaction Alopecia is a nontherapeutic response to docetaxel. Docetaxel affects interphase and mitosis of the cell cycle. Febrile neutropenia is a common nontherapeutic effect. Clients should concurrently receive a growth factor support agent such as pegfilgrastim when given a regimen of docetaxel. Hypersensitivity reactions (e.g., flushing, rash, local eruption) are common nontherapeutic reactions, particularly within the first few minutes of the infusion. Minor reactions do not require discontinuation of the therapy. Nausea, vomiting, and diarrhea, not constipation, are nontherapeutic effects of docetaxel. Hypotension, not hypertension, is a nontherapeutic effect of docetaxel.

What are the adverse effects of mirtazapine? Select all that apply.

1) Asthenia 2) Drowsiness 3) Abnormal dreams Mirtazapine is a second-generation antidepressant drug with potential adverse effects of asthenia, drowsiness, and abnormal dreams. Dyskinesia and gynecomastia are the side effects of first-generation antidepressant drugs

A client was administered oxytocin to induce labor, but the client was not responsive to the treatment. Which oral uterine stimulant is the next choice in this condition?

1) Misoprostol Misoprostol is an oral uterine stimulant that helps in inducing labor when the uterus is insensitive to oxytocin. Mifepristone can induce elective abortion. Dinoprostone induces the uterine contractions but is only available for vaginal use. Methylergonovine helps to prevent postpartum hemorrhage.

A client newly diagnosed with type 1 diabetes receives information about insulin. The client states, "I hate shots. Why can't I take the insulin in tablet form?" What is the nurse's best response?

2) "Insulin is poorly absorbed orally so it is not available in a tablet." The chemical structure of insulin is altered by gastric secretions, rendering it ineffective. There is no such thing as oral insulin; this comment about the seriousness of the diabetic condition may increase anxiety. There are no data to support the statement regarding allergic or adverse reactions, and insulin is given parenterally, not orally. Insulin is not absorbed but is destroyed by gastric secretions; there is no insulin that is effective if taken by mouth.

Which statement about primary anxiolytic drugs requires correction?

2) Benzodiazepines block gamma-aminobutyric acid receptors. Benzodiazepines stimulate gamma-aminobutyric acid receptors, which reduces neuron excitability and produces an overall inhibitory effect. Apart from its indication in the treatment of depression, benzodiazepines are also prescribed for ethanol withdrawal, insomnia, and muscle spasms. Benzodiazepines are the drug of choice in acute and chronic anxiety disorders. Benzodiazepines act by depressing activity in the brainstem and limbic system.

A nurse is administering hydroxyzine to a client. The nurse will monitor the client for which common side effects of this drug?

2) Drowsiness and dry mouth Hydroxyzine suppresses activity in key regions of the subcortical area of the central nervous system; it also has antihistaminic and anticholinergic effects. Ataxia and confusion, vertigo and impaired vision, and slurred speech and headache are not associated with hydroxyzine.

A lactating woman has developed thromboembolism. Which drug should be prescribed if she wishes to continue breast-feeding?

2) Heparin Heparin is the drug of choice to treat thromboembolism in a lactating woman because it is not absorbed in the breast milk. Aspirin may cause severe bleeding so is not preferred. Dicumarol may cause a hemorrhage and therefore is not preferred. Phenindione may cause a bruising effect and therefore is not the drug of choice.

The primary healthcare provider prescribes an atypical antipsychotic drug to a client and asks the nurse to set up an appointment for the client to see an ophthalmologist. Which drug was prescribed to the client?

2) Quetiapine Quetiapine is a second-generation antipsychotic drug that may pose a risk of cataracts. Therefore, the prescriber would refer the client to an ophthalmologist for an examination of the lenses. Clozapine is a second-generation antipsychotic drug that does not have any risk of causing cataracts. Ziprasidone may cause alterations in the QT intervals. Chlorpromazine is a first-generation antipsychotic drug that does not cause cataracts.

Which drug may cause fetal facial malformations when taken by a pregnant client?

3) HMG-CoA reductase inhibitors HMG-CoA reductase inhibitors may cause fetal facial malformations and central nervous system anomalies, including holoprosencephaly and neural tube defects. Beta2-adrenergic agonists and antihyperglycemic medications have not shown that they promote fetal facial malformations. Nonsteroidal antiinflammatory drugs can cause premature closure of the ductus arteriosus in rare instances.

A nurse in the prenatal clinic is obtaining the health history of a 39-year-old primigravida. What question should the nurse ask to elicit information about exposure to diethylstilbestrol (DES)?

4) "Do you know if your mother took hormones during her pregnancy?" Problems of the reproductive system may occur in the daughters of women who took the synthetic hormone diethylstilbestrol during pregnancy. Use of oral contraceptives is not associated with DES exposure. Although clients exposed to DES may exhibit abnormal bleeding or a heavy mucoid vaginal discharge, there are other causes for these problems, such as chlamydial infection. Lesions on the perineum are not related to exposure to DES.

A woman questions the nurse about the effectiveness of oral contraceptives. What most important factor about the effectiveness of oral contraceptives should be included in the reply to this question?

1) User motivation Conception will not be prevented unless the user is motivated to use the method correctly and consistently. No matter how simple, the method must be used consistently. Reliability record is not relevant if the method is not used correctly and consistently by the woman. Risk factors have little influence on the effectiveness of the contraceptive method.

Which client condition is contraindicated for prescribing clozapine?

4) Bone marrow depression. Clozapine is an atypical antipsychotic drug that is contraindicated in clients with bone marrow depression. Clozapine should be used with caution in clients with seizures. First-generation antipsychotics should be used with caution in clients with glaucoma. Ziprasidone is contraindicated in clients with a history of dysrhythmias

A client with human immunodeficiency virus-associated Pneumocystis jiroveci pneumonia is to receive pentamidine intravenously once daily. What should the nurse do to ensure client safety?

4) Tell the client to report any evidence of bleeding immediately. 5) Assess blood glucose levels daily and several times after therapy is completed. Any signs of bleeding (e.g., bleeding gums or blood in the urine, stool, or emesis), unusual bruising, or petechiae should be reported to the healthcare provider. Pentamidine may cause hypoglycemia or hyperglycemia even after therapy has been discontinued; therefore blood glucose levels should be monitored. Pentamidine may increase, not decrease, serum potassium levels. Administering the drug over a period of 30 minutes is too quick; the drug should be given over at least 60 minutes. Clients should be monitored closely for sudden, severe hypotension; they should lie flat when receiving the drug.

What will the nurse do to assess a client's response to ongoing serum albumin therapy for cirrhosis of the liver?

40 Determine the client's urine albumin level each shift. The increased osmotic effect after the administration of albumin increases intravascular volume and urinary output; weight loss reflects fluid loss. Vital signs do not change drastically; however, they should be checked routinely. Urinary output is measured hourly, every 8 hours, and every 24 hours; half-hour outputs are insignificant in this instance. Serum albumin levels are significant; however, albumin in the urine indicates kidney dysfunction, not liver dysfunction.

What dietary choices should the nurse instruct the client taking spironolactone to avoid increasing? Select all that apply.

Potatoes, Cantaloupe. Spironolactone is potassium-sparing, and therefore beverages and foods containing potassium such as potatoes, cantaloupe, bananas, avocados, oranges, dates, apricots, and raisins should not be increased beyond the client's ordinary consumption to prevent hyperkalemia. Red meat may need to be limited for other reasons not related to spironolactone. Whole grains are associated with prevention of constipation and should not be avoided. Dairy products are rich in sodium and calcium; spironolactone may cause hyponatremia.

A client with a partial occlusion of the left common carotid artery is to be discharged while still receiving warfarin. Which clinical adverse effect should the nurse identify as a reason for the client to seek medical consultation? Select all that apply.

Presence of blood in the urine (Hematuria). Vomiting coffee-ground emesis. Warfarin causes an increase in the prothrombin time and international normalized ratio (INR) level, leading to an increased risk for bleeding. Any abnormal or prolonged bleeding must be reported, because it may indicate an excessive level of the drug. Common side effects including bruising, delayed clotting and bleeding gums do not require immediate intervention. However, hematuria and hemoptysis are evidence of more serious bleeding and require immediate attention. Coffee-ground emesis is a sign of gastric bleeding. Even though the emesis is not bright red, it still requires immediate attention by a healthcare provider.

A client is to receive donepezil for treatment of dementia of the Alzheimer type. The nurse sits down with the primary caregiver and the client and reviews the purpose of the drug, its dosage, and the usual side effects. What side effect identified by the caregiver leads the nurse to conclude that further teaching is needed?

4) Constipation Donepezil, a cholinesterase inhibitor, may cause nausea, vomiting, increased salivation, diarrhea, and involuntary defecation related to the increase in gastrointestinal secretions and activity caused by parasympathetic nervous stimulation; it does not cause constipation. Common side effects of donepezil include anorexia, nausea, and vomiting that result from stimulation of the parasympathetic nervous system. Dizziness and headache are common side effects of donepezil that result from central nervous system cholinergic effects.