Pharmacology

A client with asthma has been prescribed fluticasone, one puff every 12 hours per inhaler. Place in order the nurse's statements when teaching the client how to properly use the inhaler with a spacer. Use all options.

"Take off the cap and shake the inhaler." "Attach the spacer." "Breathe out all of your air. Hold the mouthpiece of your inhaler and spacer between your teeth with your lips closed around it." "Press down on the inhaler once and breathe in slowly." "Hold your breath for at least 10 seconds, then breathe in and out slowly." "Rinse your mouth." Explanation: Using a spacer, especially with inhaled corticosteroid, can make it easier for the medication to reach the lungs; it can also prevent excess medication remaining in the mouth and throat, which can cause minor irritation. It is important for the client to empty the lungs, breathe in slowly, and hold the breath to draw as much medication into the lungs as possible. Rinsing after using a corticosteroid inhaler may help prevent irritation and infection; rinsing will also reduce the amount of drug swallowed and absorbed systemically.

A client is prescribed adenosine for treatment of supraventricular tachycardia (SVT). When should the nurse assess the client for a response to the dose of adenosine? after 1 to 2 minutes after 5 to 10 minutes after 30 minutes after 15 to 20 minutes

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

The nurse is to administer 1200 mg of an antibiotic. The drug is prepared with 6 g of the drug in 2 mL of solution. The nurse should administer how many milliliters of the drug? Record your answer using one decimal point. mL

0.4 Explanation: First, convert grams to milligram: 6 g = 6000 mg.Next, set up a proportion:6000 mg/2 mL = 1200 mg/XX = (1200/6000) x 2 mLX = 0.4 mL.

The healthcare provider has ordered chlorpromazine for a client diagnosed with schizophrenia. What should the nurse include in the client's teaching concerning the administration of chlorpromazine? "Chlorpromazine can cause involuntary movements of the face and jaw." "Chlorpromazine can cause increased number of white blood cells." "Chlorpromazine can cause ringing in the ears." "Chlorpromazine can cause a blood clot to form and block one or more veins in your body."

"Chlorpromazine can cause involuntary movements of the face and jaw." Explanation: Antipsychotic medications commonly produce extrapyramidal symptoms as side effects. Extrapyramidal symptoms include acute dyskinesias and dystonic reactions, tardive dyskinesia (involuntary movements of the face and jaw), Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome. Extrapyramidal symptoms do not include granulocytosis (an increased number of white blood cells), tinnitus (ringing in the ears), or thrombophlebitis (when a blood clot forms and blocks one or more veins in the body).

The client was recently diagnosed with a musculoskeletal disorder and ordered carisoprodol. The nurse completes teaching about the medication. Which statement by the client indicates a need for more teaching about carisoprodol? "I'll have someone drive me to work for a few days." "I may take my medication with food or milk." "I will stop the medication as soon as the muscle spasticity goes away." "I won't have wine with dinner anymore."

"I will stop the medication as soon as the muscle spasticity goes away." Explanation: The nurse must clarify that muscle spasticity will return if the medication is suspended. Also, abrupt cessation of carisoprodol may cause withdrawal effects. Carisoprodol may be taken with or without food; it should be taken with food or milk if GI upset occurs. This medication should not be used with alcohol, and activities such as driving should be avoided until the client is assured that the drug will not cause drowsiness or dizziness.

An infusion of lidocaine hydrochloride is running at 30 mL/hour. The dilution is 1,000 mg/250 mL. What dosage is the client receiving per minute? Record your answer using a whole number. mg/min

2 Explanation: First, calculate the concentration of mg/mL: 1,000 mg divided by 250 mL equals 4mg/mL.Next, multiply the number of milligrams per milliliter by the pump setting in milliliters per hour: 4 mg/mL x 30 mL/h = 120 mg/h.Next, divide the milligrams per hour by 60 to obtain milligrams per minute: 120 mg/h divided by 60 min/h equals 2 mg/min.

A physician orders preoperative medications to be administered to a client by the I.M. route: meperidine, 50 mg; hydroxyzine pamoate, 25 mg; and glycopyrrolate, 0.3 mg. The medications are dispensed this way: meperidine, 100 mg/ml; hydroxyzine pamoate, 100 mg/2 ml; and glycopyrrolate, 0.2 mg/ml. How many milliliters in total should the nurse administer? 2.5 ml 3.8 ml 5 ml 2 ml

2.5 ml Explanation: Using the proportion method, the nurse solves for X and then adds the total number of milliliters together

The nurse is to administer chloramphenicol 50 mg IV in 100 mL of dextrose 5% in water over 30 minutes. The infusion set administers 10 gtt/mL. At what flow rate (in drops per minute) should the nurse set the infusion? Round to the nearest whole number. gtt/min

33 Explanation: The flow rate is determined by the rate of infusion and the number of drops per milliliter of the fluid being administered: gtt/mL × mL/min = IV flow rate (gtt/minute).

The nurse is providing care to a client with asthma. The healthcare provider orders albuterol sulfate INH 2 puffs q 6 hours for maintenance dosing. What should the nurse do Select all that apply. Hold the medication. Call the supervisor. Give the medication. Clarify the order with the healthcare provider. Call the pharmacy to clarify.

Clarify the order with the healthcare provider. Hold the medication. Explanation: This medication should be held and clarified with the healthcare provider. Albuterol sulfate is a rescue inhaler, meant to be used for the quick-relief of wheezing, coughing, and chest tightness, it should not be used as a maintenance inhaler. The supervisor and the pharmacy should not be called, the healthcare provider should be called to clarify the order.

What assessment findings would lead the nurse to suspect that the client has an addiction to a pain medication? Select all that apply. Client tapers off pain medication. Client requests acetaminophen instead of the pain medication. Client loses control of use of pain medication. Client compulsively uses the pain medication. Client continues use of pain medication despite of risk of harm.

Client compulsively uses the pain medication. Client loses control of use of pain medication. Client continues use of pain medication despite of risk of harm. Explanation: The hallmarks of addiction include compulsive use, loss of control of use, and continued use despite risk of harm. A client who has addictive behavior would know what is effective for them and ask for that medication; usually do not ask for pain medications less effective than what they have been abusing, and the client usually does not taper off pain medication, will continue to use.

A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated? IgG IgB IgE IgA

IgE Explanation: Immunoglobulin E (IgE) is involved with an allergic reaction. IgA combines with antigens and activates the complement system. IgB coats the surface of B lymphocytes. IgG is the principal immunoglobulin formed in response to most infectious agents.

A client presents with severe headache, blurred vision, anxiety and confusion. The client's blood pressure is 224/137 mm Hg. The family reports that the client has hypertension, but has not been taking the prescribed blood pressure medications. The nurse anticipates giving which medication? Methotrexate Norepinephrine Labetalol Amiodarone

Labetalol Explanation: This client is showing signs and symptoms of a hypertensive crisis, or hypertensive emergency, and the nurse should anticipate treatment/medications to lower the blood pressure. Labetalol is a beta-blocker medication given intravenously that is often a first-line treatment for hypertensive crisis. Norepinephrine is not indicated for this client as it is a vasopressor and increases blood pressure. Amiodarone is given for cardiac arrythmias and would not help lower blood pressure. Methotrexate is an antineoplastic medication used for treating various cancers and severe rheumatoid arthritis.

A client with a subarachnoid hemorrhage is prescribed a 1,000 mg loading dose of I.V. phenytoin. What information is most important when administering this dose? Phenytoin should be mixed in dextrose in water before administration. Rapid phenytoin administration can cause cardiac arrhythmias. Therapeutic drug levels should be maintained between 20 and 30 mg/ml. Phenytoin should be administered through an I.V. catheter in the client's hand.

Rapid phenytoin administration can cause cardiac arrhythmias. Explanation: Intravenous phenytoin should not exceed 50 mg/min, as rapid administration can depress the myocardium, causing lethal dysrhythmias. Therapeutic drug levels range from 10 to 20 mg/ml. Phenytoin is only compatible with normal saline, not dextrose in water. Phenytoin is very irritating to the blood vessels, and may cause purple glove syndrome when administered I.V. into a hand.

A nurse is caring for a client with a percutaneous feeding tube. The client has a prescription for 325 mg enteric coated aspirin to be given via the feeding tube once daily. How should the nurse give this medication? Crush the tablet, mix with a small amount of water, and infuse into the feeding tube, followed by a flush Give the tablet by mouth Add the tablet to the feeding tube whole, followed by a flush Request an alternate formulation

Request an alternate formulation Explanation: The nurse must request an alternate formulation of this medication, as enteric coated medications cannot be given via feeding tube. Enteric coated tablets cannot be crushed to administer through the feeding tube, because altering the integrity of this type of medication is dangerous. The tablet cannot be added to the feeding tube whole as it will be too large and can occlude the tube, if it even fits in the opening whole. Giving the tablet by mouth would be a medication error, because it is prescribed to be administered via the feeding tube, and the client may not be able to safely take PO medications.

The client was found not breathing and was transported to the hospital. A family member states the client may have taken too much pain medication because the client frequently forgets if the medication was taken. Which observation(s) by the nurse indicates therapeutic effect of naloxone hydrochloride in the client? Select all that apply. Increases nerve pain. Reverses decreased level of consciousness. Reverses decreased respiratory rate of 10. Reverses blood pressure of 90/58. Increases inflammation.

Reverses decreased respiratory rate of 10. Reverses decreased level of consciousness. Reverses blood pressure of 90/58. Therapeutic effect includes reversal of respiratory depression, sedation, and hypotension. Therapeutic effect does not include increasing nerve pain or increasing inflammation.

A 5-year-old child diagnosed with cerebral palsy has just been prescribed oral baclofen. Which assessment finding by the nurse would indicate effective drug therapy? The child is better able to concentrate on mental activities. The child is exhibiting less spasticity. The child has less frequent seizures. The child no longer sleeps during the daytime.

The child is exhibiting less spasticity. Explanation: Baclofen is a skeletal muscle relaxant that is effective in reducing overall spasticity. It is not an anti-seizure drug. Significant side effects of this drug are drowsiness and confusion, so this child would not be sleeping less, nor demonstrating a better ability to concentrate on mental activities.

Which assessment finding supports the administration of protamine sulfate? RBCs of 5.4 million/mm3 INR 8 aPTT 3.5-5 times normal platelets of 152

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

A healthcare provider prescribes an antibiotic for a 6-year-old client with an upper respiratory tract infection. For what prescribed antibiotic will the nurse seek clarification from the healthcare provider? erythromycin penicillin amoxicillin tetracycline

tetracycline Explanation: Tetracycline should be avoided in children younger than age 8 because it may cause enamel hypoplasia and permanent yellowish gray to brownish tooth discoloration. Penicillin, erythromycin, and amoxicillin are not contraindicated.

The nurse receives an order to administer morphine to a client with an acute myocardial infarction. What is the purpose of this medication? to increase myocardial oxygen demand to increase preload and afterload to decrease myocardial oxygen demand to decrease cardiac output

to decrease myocardial oxygen demand Explanation: Morphine will calm and relax the client and decrease respiratory rate, anxiety, and stress, thus decreasing myocardial oxygen demand. It doesn't have any effect on cardiac output or preload or afterload.

The nurse is administering medications to a client who has a gastrostomy tube (G-tube). The nurse reads the order for aspirin PO and crushes the aspirin and administers through the G-tube. What medication error did the nurse commit? wrong time wrong route wrong dosage wrong client wrong drug

wrong route Explanation: Crushing enteric-coated tablets and caplets via a G-tube would be considered a medication error because the nurse did not administer the medication using the right route. The client could suffer erosion of the esophagus or stomach resulting in a bleeding ulcer, and the medication was enteric coated to move beyond the stomach before dissolving, and prevent erosion of the gastrointestinal tissue.

The client who is 28 weeks gestation is at the obstetric (OB) clinic reviewing lab work. The human immunodeficiency virus (HIV) test is positive, and treatment is indicated. Which medication should the nurse expect to administer that will help to prevent transmission of the virus to the fetus? zidovudine dimenhydrinate fluvastatin disulfiram

zidovudine Explanation: Zidovudine is an antiretroviral used to help to prevent the transmission of HIV infection to the neonate. The other medications are not appropriate for this client. Fluvastatin is an antilipemic used for hypercholesterolemia, dimenhydrinate is an antiemetic used for motion sickness, and disulfiram is an alcohol deterrent.

The nurse is caring for a client taking risperidone 2 mg daily. It is most important for the nurse to follow up on which client statement? "I'm constantly sick and feel like I always have a fever." "Sometimes I get dizzy if I stand up quickly." "I take my medication every morning before breakfast." "I've been exercising regularly and lost 5 pounds."

"I'm constantly sick and feel like I always have a fever." Explanation: A major adverse reaction of risperidone is agranulocytosis. Therefore, it is a priority for the nurse to follow up if the client reports constantly being sick. Risperidone can be given without regard to meals; taking it at the same time every day is encouraged. Clients are encouraged to exercise regularly; the nurse should monitor the client taking risperidone for weight gain. Orthostatic hypotension is a common side effect of risperidone, and the nurse should follow up; however, the priority concern is agranulocytosis. Additionally, the client indicates experiencing dizziness "sometimes" but the feeling sick "constantly."

A client with diverticular disease is receiving psyllium hydrophilic mucilloid. Which response from the client indicates to the nurse that the drug is having the intended effect? "I have occasional diarrhea." "I don't expel gas." "My stool is firm." "I can pass stool without cramping."

"I can pass stool without cramping." Explanation: Diverticular disease is treated with a high-fiber diet and bulk laxatives such as psyllium hydrophilic mucilloid. Fiber decreases the intraluminal pressure and makes it easier for stool to pass through the colon. Bulk laxatives do not manage diarrhea or relieve gas formation. The stool should remain soft and easy to expel.

Betamethasone syrup 0.9 mg has been prescribed. It is available in a 0.6 mg/5 mL solution. How many milliliters should the nurse administer? Record your answer using one decimal place.

7.5 Explanation: 0.9 mg/X = 0.6 mg/5 mLX = (0.9 mg/0.6 mg) x 5 mL

The health care provider prescribes an intravenous infusion of 5% dextrose in 0.45% saline to be infused at 2 mL/kg per hour in an infant who weighs 9 lb (4.1 kg). How many milliliters per hour of the solution should the nurse infuse? Round to one decimal place. _____ mL per hour. mL per hour

8.2 Explanation: 4.1 kg × 2 mL/kg = 8.2 mL/hour

The nurse administers the first dose of warfarin to an older adult client. Which important client teaching point(s) should the nurse emphasize regarding this new medication? Select all that apply. Eat a diet high in fiber. Take extra care to avoid injuries. You can take an extra dose of this medication if you feel like you need it. Limit intake of foods high in vitamin K. Watch for signs and symptoms of bleeding.

Limit intake of foods high in vitamin K. Watch for signs and symptoms of bleeding. Take extra care to avoid injuries. Explanation: Warfarin is an anticoagulant medication that helps prevent the formation of blood clots. Important client teaching considerations for this medication include limiting the intake of foods high in vitamin K, as too much vitamin K can inhibit the action of warfarin. Clients must also be taught to watch for signs and symptoms of bleeding and to take precautions to avoid injury while taking an anticoagulant. There is no need to increase fiber intake while on this medication, as it does not cause constipation. The client should never take an extra dose of any medication without being instructed to by the provider, and doing so with this medication could cause dangerous bleeding.

The client presents at the emergency department (ED) with dyspnea, cough, and wheezing. The healthcare provider diagnoses the client with asthma and orders salmeterol. How will the nurse determine if the medication has had a therapeutic effect? Select all that apply. The client's heart rate presents bradycardia. The client's cough is no longer productive of sputum. The nurse auscultates clear breath sounds. An x-ray is needed to determine effectiveness. The client is no longer dyspneic

The nurse auscultates clear breath sounds. The client is no longer dyspneic. Explanation: Treating the client with salmeterol should open the airways and, in turn, the wheezes should diminish and the dyspnea should dissipate. No x-ray is needed to determine the medication's effectiveness. Salmeterol can cause tachycardia, not bradycardia, and the client may still have a productive cough.

The nurse is preparing the client newly diagnosed with peripheral arterial disease for discharge with the medication atorvastatin. What laboratory work should the nurse obtain to establish a baseline before starting the medication? white blood cell count and blood sugar platelet count and urinalysis hemoglobin and hematocrit levels creatinine level and liver function tests

creatinine level and liver function tests Explanation: Atorvastatin has serious adverse reactions of hepatotoxicity and acute renal failure, so it is recommended that creatinine level and liver function tests be performed at baseline as a monitoring parameter. Diabetes, upper respiratory infections, urinary tract infections, anemia, and thrombocytopenia can also be adverse reactions, but these are not included in recommendations for baseline safety monitoring.

The nurse is monitoring a client who received midazolam for moderate sedation. The client begins experiencing difficulty staying awake, becomes hypotensive, and demonstrates a decreased respiratory drive. Which medication should the nurse anticipate giving this client? acetylcysteine naloxone protamine flumazenil

flumazenil Explanation: This client is experiencing oversedation from the benzodiazepine, midazolam. Flumazenil is the reversal agent for benzodiazepines such as midazolam, and the nurse should anticipate this medication will be needed. Naloxone is the reversal medication for narcotic and opioid medications, not midazolam. Acetylcysteine is the reversal medication for an acetaminophen overdose, not the reversal for midazolam. Protamine is a reversal medication for anticoagulants.

A client is receiving streptomycin to treat tuberculosis. What should the nurse evaluate to determine an adverse effect of the drug? hearing loss IV infiltration decreased serum creatinine difficulty swallowing

hearing loss Explanation: Streptomycin can cause toxicity to the eighth cranial nerve, which is responsible for hearing, balance, and body position sense. Nephrotoxicity is a side effect that would be indicated with an increase in creatinine. Streptomycin does not cause difficulty in swallowing. Streptomycin is given via intramuscular injection.

A client is scheduled to undergo an exploratory laparoscopy. The registered nurse (RN) asks the licensed practical nurse (LPN) to prepare the client for surgery. The RN must confirm that the LPN has specialized training before delegating which task? teaching the client how to collect a urine specimen initiating I.V. therapy, as ordered teaching the client coughing and deep breathing exercises weighing the client

initiating I.V. therapy, as ordered Explanation: The RN must confirm that the LPN has specialized I.V. training before asking the LPN to begin I.V. therapy for this client. Initiating I.V. therapy is beyond the usual scope of practice for an LPN. Weighing the client, teaching coughing and deep breathing exercises, and teaching the client how to collect a urine specimen are within the scope of LPN practice and don't require additional training.

A client has just started treatment with rifampin for tuberculosis. Which statement indicates that the client has a good understanding of this medication? "I told my partner to throw away all the spoons and forks before I come home." "My urine will look orange because of the medication." "I don't need to cover my mouth or nose when I sneeze or cough." "I won't go to family gatherings for 6 months."

"My urine will look orange because of the medication." Explanation: Rifampin discolors body fluids, such as urine and tears. The client can go to family functions and eat with normal utensils. The client should cover the mouth and nose when coughing and sneezing until the client has been on the medication at least 2 weeks.

A client who weighs 187 lb (85 kg) has an order to receive enoxaparin 1 mg/kg. This drug is available in a concentration of 30 mg/0.3 mL. What dose would the nurse administer in milliliters? Record your answer to two decimal places.

0.85 Explanation: The prescription is for the client to receive enoxaparin 1 mg/kg. Therefore, the client is to receive 85 mg. The desired dose in milliliters then can be calculated by using the formula of desired dose (D) divided by dose or strength of dose on hand (H) times volume (V).85 (mg) × 0.3 mL = 25.5 mg/mL 25.5 mg divided by 30 = 0.85 mL.

The physician prescribes furosemide, 2 mg/kg PO, as a one-time dose for an infant with fluid overload. The infant's documented weight is 14 lb (6.4 kg). The oral solution contains 10 mg/mL. How many milliliters of solution should the nurse administer? Round the answer to the nearest tenth of a millilter.

1.3 Explanation: Perform the calculation to determine the total dose prescribed: 2 mg/kg = X/6.4 kg. This yields X = 12.8 mg. Then set up the proportion to determine the volume of medication to administer: 10 mg/mL = 12.8 mg/X. Therefore, X = 1.3 mL.

The nurse is to administer chloramphenicol 50 mg IV in 100 mL of dextrose 5% in water over 30 minutes. The infusion set administers 10 gtt/mL. At what flow rate (in drops per minute) should the nurse set the infusion? Round to the nearest whole number. gtt/mi

33 Explanation: The flow rate is determined by the rate of infusion and the number of drops per milliliter of the fluid being administered: gtt/mL × mL/min = IV flow rate (gtt/minute).Therefore:10 gtt/mL × 100 mL/30 min = 33 gtt/min.

The nurse is caring for a neonate who has a suspected neonatal sepsis. The healthcare provider's order is for ampicillin 100 mg/kg/day to be given in four divided doses. The client weighs 7 lb, 8 oz (3.4 kg). How many milligrams would the nurse give with each dose? Record your answer using a whole number. mg

85 Explanation: First, convert the weight to kilograms (in the United States):7 lb, 8 oz = 7.5 lb7.5 lb ÷ 2.2 lb/kg = 3.4 kgThen, multiply the kilograms of body weight by 100 mg (dose given):3.4 kg X 100 mg/kg/day = 340 mg/day.Next, divide the total daily dose by the number of doses per day:340 mg/day ÷ 4 dose/day = 85 mg/dose.

A child weighing 44 lb (20 kg) is to receive 45 mg/kg/day of penicillin V potassium oral suspension in 4 divided doses for every 6 hours. The suspension that is available is penicillin V potassium 125 mg/5 ml. How many milliliters would the nurse administer for each dose? Record your answer using a whole number. ml

9 Explanation: First, convert the child's weight to kilograms (if not already done):44 lb ÷ 2.2 lb/kg = 20 kg.Next, determine the daily dose:45 mg/1 kg = X/20 kgX = 45 mg/kg X 20 kg = 900 mg.Then, determine the dose to administer every 6 hours (four doses):900 mg ÷ 4 = 225 mg.Finally, determine the volume to be given at each dose:125 mg/5 ml = 225 mg/X.X = (225 mg X 5 ml) ÷ 125 mg = 9 ml.

The nurse has prepared hydromorphone 1 mg I.V. for a client reporting pain 7/10. Just prior to administration, the client requests an oral pain medication instead. What is the priority action by the nurse? Dispose of the prepared medication in the sharps container and obtain an oral medication. Return the prepared medication to the client's medication drawer and obtain an oral medication as requested. Explain to the client that once a medication is prepared, it should be administered and that an oral medication can be given at the next dose. Ask another nurse to witness the waste of the prepared medication.

Ask another nurse to witness the waste of the prepared medication. Explanation: Hydromorphone is a Schedule II controlled substance and federal law requires accurate records of administration to prevent diversion and misuse of the substance. If a controlled substance is not immediately administered after removing from the locked cabinet, it should be wasted in the sink or approved pharmaceutical waste container with witness and documentation by two nurses. Controlled substances should never be wasted in a sharps container or stored in an unlocked medication drawer as this provides access to the medication for potential misuse. The client's wishes for oral pain management should be honored. The prepared dose should be wasted per facility protocol and the oral medication be administered.

The nurse is caring for four clients who will all be undergoing moderate sedation procedures today. The health care provider (HCP) has ordered midazolam to be given to all four clients. The nurse notifies the HCP to clarify the prescription for which client? a 4-year-old client who has an autism spectrum disorder a 30-year-old client who is pregnant a 74-year-old client who has arthritis a 42-year-old Black client"

a 30-year-old client who is pregnant Explanation: Midazolam is a benzodiazepine commonly used for moderate sedation procedures. It is contraindicated in pregnancy because it causes a predictable syndrome of cleft lip or palate, inguinal hernia, cardiac defects, pyloric stenosis, or microcephaly when given in the first trimester, and can cause sedation and withdrawal symptoms in the neonate in later pregnancy. Midazolam can be given to a pediatric client, but special care should be taken when calculating the weight-based dosage. Older adult clients can be given midazolam with caution, because they may have unpredictable reactions to the medication, and they may have renal or hepatic dysfunction that would alter the metabolism and excretion of the medication. Black clients can be given midazolam, but special care should be taken. In Black Americans, 15% to 20% are genetically predisposed to have delayed metabolism of benzodiazepines, causing an increased risk of oversedation and adverse reactions. Arthritis and autism spectrum disorders are not contraindications to midazolam usage, nor do they require extra caution to be taken.

The nurse is teaching a client with Addison disease to anticipate the need for increased glucocorticoid supplementation. When will the client likely need to increase the dose of glucocorticoids? after having oral surgery after having a routine medical checkup after returning to work after a weekend after going on vacation

after having oral surgery Explanation: Illness or surgery places tremendous stress on the body, necessitating increased glucocorticoid dosage. Extreme psychological stress also necessitates dosage adjustment. Increased dosages are needed in times of stress to prevent drug-induced adrenal insufficiency. Returning to work after the weekend, a vacation, or a routine checkup usually will not alter glucocorticoid dosage needs.

The nurse is caring for a client prescribed IV heparin for treatment of thromboembolism. The client is prescribed 18 units/kg/hr. The client weighs 145 lb (66 kg). The heparin comes from the pharmacy as 25,000 units in 250 mL of D5W. How many mL/hr should this client receive? Round to the nearest whole number.

12 Explanation: The recommended dose of 18 units/kg should be obtained by multiplying the weight in kilograms by 18 units. 66 kg × 18 units = 1188 units/hr. Concentration for the medication is 25,000 units/250 mL. Use the formula Desired/Have × Volume: 1188 units/25,000 units × 250 mL = 11.88 mL/hr or 12 mL/hr.

A physician prescribes penicillin potassium oral suspension 56 mg/kg/day in four divided doses for a client with anorexia nervosa who weighs 25 kg. The medication dispensed by the pharmacy contains a dosage strength of 125 mg/5 mL. How many milliliters of solution should the nurse administer with each dose? Record your answer using a whole number.

14 Explanation: To determine the total daily dosage, set up this proportion: 25 kg/X = 1 kg/56 mg X = 1,400 mg. Next, divide the daily dosage by four doses to determine the dose to administer every 6 hours: X = 1,400 mg/4 doses X = 350 mg/dose. The adolescent should receive 350 mg every 6 hours. Lastly, calculate the volume to give for each dose by setting up this proportion: X/350 mg = 5 mL/125 mg X = 14 mL.

A client is admitted to the neurologic intensive care unit for an intracranial hemorrhage. Which medication prescription should the nurse question for this client? ondansetron morphine famotidine enoxaparin

enoxaparin Explanation: The nurse should question the prescription for enoxaparin for this client. Enoxaparin is a low-molecular weight heparin, and is an anticoagulant, which causes increased bleeding and impaired clotting, and would cause further complications in the client with bleeding in the brain. Famotidine is a common peptic ulcer prevention agent, and is often given to intensive care unit clients to help prevent gastric ulcers due to the stress of hospital admission. Ondansetron is a common antiemetic, and would be appropriate for this client to treat or prevent nausea and vomiting, because vomiting increases intracranial pressure. Morphine is a narcotic pain reliever, and would be an appropriate analgesic medication for the client with an intracranial hemorrhage.

The client has been admitted to the hospital with generalized seizures and the healthcare provider ordered pentobarbital sodium. What discharge teaching will the nurse include about pentobarbital sodium? "Alcohol can cause drug toxicity with pentobarbital sodium." "In the initial period of dosage regulation, you may experience visual problems." "Smoking decreases the absorption of pentobarbital sodium." "Pentobarbital sodium is available without a prescription."

"Alcohol can cause drug toxicity with pentobarbital sodium." Explanation: Discharge teaching for pentobarbital sodium includes reporting jaundice, abrupt withdrawal can cause seizures, withdrawal should be done gradually, avoid potentially dangerous activities, alcohol can cause drug toxicity, and receiving a flu shot during therapy can increase seizure occurrence. The potential to experience visual problems during the initial period of regulation, smoking leading to decreased absorption, and the availability of the drug without a prescription are included in discharge teaching for insulin, not pentobarbital sodium.

An 8-month-old infant is admitted with a febrile seizure. The infant weighs 17 lb (7.7 kg). The physician orders ceftriaxone, 270 mg I.M. every 12 hours. (The safe dosage range is 50 to 75 mg/kg daily.) The pharmacy sends a vial containing 500 mg, to which the nurse adds 2 ml of preservative-free normal saline solution. The nurse should administer how many milliliters? None, because this is not a safe dosage 1.8 ml 1.08 ml 0.08 ml

1.08 ml Explanation: Because the infant weighs 17 lb (7.7 kg), the safe dosage range is within 385 to 578 mg daily. The ordered dosage, 270 mg every 12 hours or 540 mg daily, is safe. To calculate the amount to administer, the nurse may set up the following proportion of ceftriaxone to solution: 500 mg / 2 ml = 270 mg / x ml Cross multiply: 500x = 540 Divide to isolate x: x = 540/500 = 1.08 ml Double-check: Because the 270 mg dose is slightly more than half the 500 mg in solution, giving slightly more than half the 2 ml solution makes sense.

A 4-year-old child is ordered to receive 25 mL/hour of intravenous solution. The nurse is using a pediatric microdrip (60 gtt/mL) chamber to administer the medication. For how many drops per minute would the microdrip chamber be set? Record your answer using a whole number.

25 Explanation: When using a pediatric microdrip chamber (60 gtt/mL), the number of milliliters per hour equals the number of drops per minute. If 25 mL/hour is ordered, the solution should infuse at 25 drops/minute. Thus, if the drip factor on a microdrip tubing is 60 and the infusion time is 60 minutes, these cancel and the answer is the volume (ml).

A child is prescribed high-dose aspirin as part of the therapy for Kawasaki disease. The order is for 80 mg/kg/day PO in four divided doses until the child is afebrile. The child weighs 33.1 lb (15 kg). How many milligrams is given in one dose? Record your answer using a whole number. mg

300 Explanation: Aspirin is used for the treatment of Kawasaki disease due to its anti-inflammatory properties. The benefits of aspirin outweigh the risks in this situation. Use the following equation: First, determine how many milligrams should be given in one day: 80 mg/kg x 15 kg = 1200 mg. Then, determine how many milligrams should be given in one dose: 1200 mg/4 doses = 300 mg/dose

After administering prescribed medications to clients, which client requires immediate intervention? a client with a nitroglycerine patch who has a headache a client taking captopril who has a nonproductive cough a client taking atenolol who has a heart rate of 58 a client taking digoxin who has a morning potassium level of 3.0 mEq/L

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

A client is 2 days postoperative of a hip replacement. The prescriber removed the gauze dressing and gave the patient and nurse instructions to keep the site open to air. In the afternoon, the nurse observed the client rubbing an oil on the surgical site. What is likely the client's rationale regarding the application of the complementary oil? Antiperspirant will aid with vasoconstriction. Baby oil can assist with smooth skin. Fish oil has antiviral properties. Tea tree oil has antibacterial properties.

Tea tree oil has antibacterial properties. Explanation: Tea tree oil is an alternative therapy that has antifungal and antibacterial uses. Clients use it to treat burns, insect bites, irritated skin, and acne. The nurse should review the prescriber's instructions with the client and also call the prescriber to report the tea tree oil application on the surgical site. Fish oil is an oral therapy used for treatment of coronary disease. Baby oil can make the skin smooth but does not make the skin of a surgical incision smooth. Antiperspirants decrease the secretion of moisture and not vasoconstriction.

The nurse is reviewing assessment data and admission orders of a client. The provider has ordered the I.V. administration of phenytoin. The nurse determines that further intervention is required when the admission assessment includes which findings? Select all that apply. episodic nosebleeds increased appetite history of bone marrow depression history of Stokes-Adams syndrome attention deficit hyperactivity disorder (ADHD)

episodic nosebleeds history of Stokes-Adams syndrome history of bone marrow depression Intravenous administration of phenytoin can lead to arrhythmia and hypotension, and is contraindicated when a history of sinus bradycardia, sinoatrial block, second or third-degree heart block, or Stokes-Adams syndrome is present. Phenytoin would be administered cautiously in clients with episodic nosebleeds or bone marrow depression due to its adverse effects of leukopenia, anemia, and thrombocytopenia. Phenytoin has no known effect on ADHD but can interfere with cognitive function in excessive doses. There is no increased appetite reported by people who take phenytoin.

A client experiencing alcohol withdrawal is prescribed lorazepam. The client's family asks the nurse about the purpose of the medication. What is the nurse's best response? The lorazepam will reduce the your family member's symptoms of withdrawal. Lorazepam is a type of benzodiazepine medication. The medication can help your family member relax and sleep. This medication will reduce your family member's cravings for alcohol.

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

Question 1 of 10 The nurse is caring for a client with peripheral arterial occlusive disease (PAD). What nursing intervention is most appropriate to reduce platelet aggregation and promote circulation? Administer clopidogrel. Administer cilostazal. Administer oxycodone. Administer atorvastatin.

Administer clopidogrel. Explanation: Pharmacologic therapy for clients with PAD and claudication include pentoxifylline and cilostazal because these medications increase erythrocyte flexibility and decrease blood fibrinogen concentrations. Aspirin and clopidogrel are antiplatelet agents that prevent the formulation of emboli by reducing platelet aggregation. Statins are used to improve endothelial function. Therefore, clopidogrel should be administered because it is an antiplatelet agent that prevents the formulation of emboli by reducing platelet aggregation.

The nurse is teaching a client with unstable angina to use sublingual nitroglycerin tablets when chest pain occurs. What should the nurse tell the client? "Sit down, and then take one tablet. If pain persists after 5 minutes, call 911." "Sit down, and then take one tablet every 2 to 5 minutes until the pain stops." "Sit down, and then take one tablet and rest for 15 minutes. Call the health care provider (HCP) if pain persists after 15 minutes." "Sit down, and then take one tablet; if the pain persists, take two additional tablets in 5 minutes. Call the HCP if the pain persists after 15 minutes."

"Sit down, and then take one tablet. If pain persists after 5 minutes, call 911." Explanation: The nurse should instruct the client that the correct protocol for using sublingual nitroglycerin involves immediate administration when chest pain occurs. Sublingual nitroglycerin appears in the bloodstream within 2 to 3 minutes and is metabolized within about 10 minutes. The client should sit down and place the tablet under the tongue. If the chest pain is not relieved within 5 minutes, the client should call 911. Although some HCPs may recommend taking a second or third tablet spaced 5 minutes apart and then calling for emergency assistance, it is not appropriate to take two tablets at once. Nitroglycerin acts within 2 to 3 minutes, and the client should not wait 15 minutes to take further action. The client should call 911 to obtain emergency help rather than calling the HCP.

The nurse is caring for a client prescribed a tocolytic agent. The nurse takes immediate action based on what assessment finding? blood glucose of 170 mg/dL (9.4 mmol/L) peripheral pulse strength of +2 maternal heart rate of 114 beats/min bilateral crackles on lung auscultation

bilateral crackles on lung auscultation Explanation: Tocolytics are used to stop labor contractions. The most common adverse effect associated with the use of these drugs is pulmonary edema. Bilateral crackles on lung auscultation is a sign of pulmonary edema, and prompt action would be required. A serum glucose level of 170 mg/dL (9.4 mmol/L) is elevated and should be reported, but it is not life-threatening. Tocolytics may cause tachycardia and increased cardiac output with bounding arterial pulsations. A peripheral pulse strength of +2 indicates a slightly lower than normal level that is not an immediate cause for concern.