pharmacology exam 4

What is a contraindication to an MMR booster for an adolescent female?

Pregnancy MMR is administered to adolescent females if they are not pregnant and their rubella titer is inadequate or proof of immunization is unavailable.

A client is taking antipsychotic medication and asks the nurse what dopamine is. What is a correct response by the nurse?

"Dopamine is a neurotransmitter that deals with pleasure and reward in the brain." Dopamine is a neurotransmitter in the sympathetic nervous system that deals with pleasure and reward in the brain. Dopamine is not an enzyme or a part of the brain. Dopamine is a medication, but it does not fight infection or help with pain.

The school nurse is participating in a program to immunize students against human papillomavirus (HPV). What benefit should the nurse describe to students and their families?

Reduced risk for cervical cancer The HPV vaccine directly reduces the risk of cervical cancer, but not the risk of other sexually transmitted infections, PID, or polycystic ovary syndrome.

A nurse is caring for a patient who is receiving cyclobenzaprine. Which of is the action of the drug on the patient?

Reduction of muscle spasm Cyclobenzaprine has an effect on the muscle tone, thereby causing reduction of muscle spasm. Administration of cyclobenzaprine does not result in prevention of convulsion, relief from anxiety, or relief from nervous disorder.

A client has been prescribed phenelzine sulfate. When providing teaching, which food should the nurse instruct the client to avoid eating?

Salami When taking a monoamine oxidase inhibitor, such as phenelzine, foods high in tyramine or tyrosine should be avoided. Salami, like other cured and aged meats, is high in tyramine. None of the other listed foods are problematic.

Which is an example of naturally acquired active immunity? (Select all that apply.)

An individual who is exposed to chickenpox for the first time and has no immunity to the disease. An individual who is exposed to pertussis for the first time and has no immunity to the

The administration of immunizations to a client is a form of what type of immunity?

Artificial active immunity Immunizations are a form of artificial active immunity.

Which skeletal muscle relaxant is also available in intrathecal form?

Baclofen (Lioresal) Baclofen is available in oral and intrathecal forms and can be administered via a delivery pump for the treatment of central spasticity.

A nurse is assessing a client with Parkinson's disease. The nurse determines that the client's drug therapy is effective when the client exhibits what?

Decreased tremors Decreased tremors would indicate effective antiparkinsonism therapy. Intellectual dysfunction is not a manifestation associated with Parkinson's disease. Parkinson's disease is not associated with aggression.

A client presents at the clinic reporting weight loss despite an increased appetite. For which condition should this client be assessed?

Hyperthyroidism

All of the following are specific physiological effects of thyroid hormones, EXCEPT:

Increased pituitary secretion of TSH. Some specific physiologic effects of thyroid hormones include increased rate of cellular metabolism and oxygen consumption, with a resultant increase in heat production; increased heart rate, force of contraction, and cardiac output; increased carbohydrate metabolism; increased fat metabolism, including increased lipolytic effects of other hormones and metabolism of cholesterol to bile acids; and inhibition of pituitary secretion of TSH.

A nurse caring for a client with narcolepsy may administer which CNS stimulants? (Select all that apply.)

Methylphenidate Modafinil Armodafinil Dextroamphetamine A nurse caring for a client with narcolepsy may administer methylphenidate, modafinil, armodafinil, and dextroamphetamine.

A nurse is caring for a patient administered ethotoin. What are signs of toxicity for which the nurse should monitor the patient?

Slurred speech The nurse should monitor the patient for slurred speech which is a sign of toxicity. Constipation, diarrhea, and urinary frequency are not signs of toxicity of ethotoin. Constipation and diarrhea are adverse reactions of barbiturates. Urinary frequency is an adverse reaction of succinimides.

A client diagnosed with Parkinson's disease and hepatic disease is to begin tolcapone therapy. What intervention should be included in the client's plan of care?

a baseline liver function test The FDA has issued a black box warning stating that clients who take tolcapone risk potentially fatal acute fulminant liver failure. It is important to monitor liver function tests before therapy begins and every 2 weeks thereafter. Tolcapone is not associated with health risks that would require any of the other proposed interventions.

The vaccines for haemophilus influenza B and pneumococcal polyvalent are

bacterial vaccines

The pediatric client has been prescribed methylphenidate. Which statement should be included in the teaching plan for a client receiving methylphenidate?

"Adverse effects include hypertension and nervousness." Adverse effects of methylphenidate include hypertension, tachycardia, nervousness, and appetite suppression with resulting weight loss. The drug has a high potential for abuse and dependence. The last dose of any CNS stimulant is usually taken at least 6 hours before bedtime to prevent interference with sleep.

A female client is prescribed a benzodiazepine for anxiety. She asks the nurse if she can stop the drug when she feels better. What is the nurse's best response?

"Benzodiazepines may cause physiologic dependence, and withdrawal symptoms will occur if the drug is stopped abruptly." Benzodiazepines are widely used for anxiety and insomnia and are also used for several other indications. They have a wide margin of safety between therapeutic and toxic doses and are rarely fatal, even in overdose, unless combined with other CNS depressant drugs, such as alcohol. They are schedule IV drugs under the Controlled Substances Act. They are drugs of abuse and may cause physiologic dependence; therefore, withdrawal symptoms occur if the drugs are stopped abruptly.

The nurse provides teaching for a client diagnosed with rheumatoid arthritis (RA) about the prescribed methotrexate. Which client statement determines the need for further teaching?

"I will have labs to monitor for possible bad effects of methotrexate drawn every 6 months." The nurse needs to provide further teaching about how often the client needs to have liver, renal, and complete blood count labs, which is usually every month when the client begins therapy and gradually may be increased to every 3 months. The client demonstrates an adequate understanding about the importance of taking the medication the same time once a week. Methotrexate is an immunosuppressant so the client needs to perform correct handwashing and stay away from persons known to have a contagious infection. The client is also correct that the medication will take several weeks before noting improvement in the RA symptoms.

The nurse educates a client recently diagnosed with hypothyroidism about using the prescribed levothyroxine. The client has a history of diabetes. Which client statement establishes the need for further clarification?

"It does not matter which brand of the drug I take, they are all the same." The nurse needs to clarify with further teaching the client's statement that it does not matter what brand of levothyroxine is taken. The client needs to keep taking the same brand because switching brands can lead to changes in the hormone level and affect the treatment. The other statements made by the client support an adequate understanding of various teaching points. Taking the drug before breakfast allows the medication to dissolve and be absorbed on an empty stomach. Taking the medication at the same time of day helps to maintain a steady state of the drug. Thyroid replacement may cause symptoms of diabetes to increase, so monitoring for hyperglycemia is warranted since the client has a history of diabetes. Thyroid replacement in this case is lifelong, and the client should not intentionally change a dose by increasing, decreasing, or skipping a dose.

A female client with hyperthyroidism reports nervousness and "racing" heart one week after starting antithyroid medication. How should the nurse respond to the client's report?

"It may take three to four weeks for the effects of this medication to be seen." Therapeutic effects of the antithyroid drugs may not be observed for three to four weeks. Counting the resting heart rate doesn't address the client's reports. Increasing the dosage is not initially recommended until the client has been taking the medication at least three to four weeks.

A 56-year-old woman with a diagnosis of multiple sclerosis has begun taking dantrolene. What client teaching should the nurse provide?

"Make sure to see your health care provider promptly if you develop yellowish skin or eyes." Dantrolene carries a significant risk of hepatitis; signs and symptoms must be reported promptly. It typically causes diarrhea, not constipation, and muscle weakness, not increases in strength. Dantrolene may be administered on an outpatient basis.

While reviewing the medication history of a client receiving alendronate, the nurse notes that the client also takes a multivitamin. Which instruction would be most appropriate?

"Separate taking the two drugs by about a half hour." Alendronate can interact with a multivitamin, decreasing the absorption of the bisphosphonate. Therefore, the drugs should be separated by at least a half hour. The multivitamin does not need to be stopped. The alendronate should be taken on arising in the morning before anything else. Antacids also can decrease the absorption of alendronate, and these should also be separated by at least a half hour.

A female client asks why it is not legal to have a year's worth of prescription refills for Ritalin, since she has been on it for more than a year. She would also like to have the largest dose possible, so she can use the prescription for 2 months, instead of one. She explains that it is very hard to get off work and come in for appointments. The nurse's best response would be:

"The prescription dose is always started as low as possible and the refills are monitored to prevent abuse." When a CNS stimulant is prescribed, it is started with a low dose that is then increased as necessary, usually at weekly intervals, until an effective dose (i.e., decreased symptoms) or the maximum daily dose is reached. In addition, the number of doses that can be obtained with one prescription should be limited. This action reduces the likelihood of drug dependence or diversion (use by people for whom the drug is not prescribed).

One week ago, a client began taking ethosuximide 500 mg/day PO for the treatment of absence seizures. The client reports gastrointestinal (GI) upset after taking with the drug. What health education should the nurse provide?

"Try taking your pills at the same time as you eat some food." If GI irritation occurs with ethosuximide or other anticonvulsants, the client should be encouraged to take the medication with food to reduce this adverse effect. Taking the drug 1 to 2 hours after meals would not reduce this effect. The nurse must be cautious when recommending the use of OTC medications. GI effects are unlikely to necessitate a change in medications.

A 43-year-old woman was diagnosed with multiple sclerosis 2 years ago and has experienced a recent exacerbation of her symptoms, including muscle spasticity. Consequently, she has been prescribed Dantrolene (Dantrium). In light of this new addition to her drug regimen, what teaching point should the woman's nurse provide?

"You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity." Dantrolene causes weakness because of its generalized reduction of muscle contraction. It is not associated with drug dependence, hyperglycemia, hypoglycemia, or hallucinations.

A mother brings her 18-month-old into the clinic for a well-baby check-up. A nurse will administer measles, mumps, and rubella vaccine (MMR) to the 18-month-old. What dosage will the nurse administer?

0.5 mL The nurse will administer 0.5 mL. This is the recommended dose for adults and children older than 15 months of age.

A client who is receiving phenytoin has a serum drug level drawn. Which result would the nurse interpret as within the therapeutic range?

12 mcg/mL The therapeutic serum phenytoin levels range from 10 to 20 mcg/mL. Thus, a level of 12 mcg/mL would fall within this range.

The nurse is providing nutritional counseling to a 61-year-old client. How much vitamin D should the nurse recommend consuming daily?

15 mcg/d The recommended dietary allowance, or RDA, for vitamin D is 15 mcg/d for individuals 1 to 70 years of age and 20 mcg/d for adults 71 years and older to prevent and treat osteoporosis. Adequate intake for infants 0 to 12 months is 10 mcg/d.

The nurse is explaining a schedule for vaccinations to the parents of a new client. When would the nurse explain that the measles, mumps, and rubella (MMR) vaccine is initially administered?

15 months MMR is administered initially as a combined vaccine at 15 months.

The nurse is monitoring the serum carbamazepine level of a client. Which result would lead the nurse to notify the prescriber that the client most likely needs an increased dosage?

2 mcg/mL Therapeutic serum carbamazepine levels range from 4 to 12 mcg/mL. Therefore, a level under 4 mcg/mL would suggest that the drug has not reached therapeutic levels, so the dosage may need to be increased.

A nurse who gives care on a neurological floor is working with several clients. Which client should the nurse prioritize for further assessment and possible interventions?

A client receiving pregabalin who is not responsive to verbal stimuli A client's decreased level of consciousness would be a priority for further assessment. It could be indicative of excessive CNS depression if the client is unable to be roused by voice. The client with a blood pressure of 106/69 may require further monitoring and possible interventions, but this blood pressure is not so low as to be considered an emergency. Addressing clients' learning needs and anxiety is also important, but less time dependent than a client who is not rousable.

A client with symptomatic hyperthyroidism is prescribed propranolol. Which clinical manifestation would the nurse identify that indicates the medication is having the desired effect?

A heart rate of 72 beats/min Propranolol is recommended for use in all clients with symptomatic hyperthyroidism because it blocks beta-adrenergic receptors in various organs and thereby controls symptoms of hyperthyroidism resulting from excessive stimulation of the sympathetic nervous system. Since tachycardia is associated with hyperthyroidism, a heart rate of 72 beats/min indicates that the drug is having the desired effect. Profuse diaphoresis indicates that the medication is not effective or having the desired effect intended. The blood glucose is not affected by the propranolol use. The blood pressure of this client is not well controlled and still considered hypertensive.

A male client has a history of hepatic dysfunction secondary to alcoholism. Based on the client's diagnostic history, what would the nurse expect his health care provider to order?

A lower dose of the antidepressant Hepatic impairment leads to reduced first-pass metabolism of most antidepressant drugs, resulting in higher plasma levels. The drugs should be used cautiously in clients with severe liver impairment. Cautious use means lower doses, longer intervals between doses, and slower dose increases than usual.

What client is being treated with a typical antipsychotic?

An agitated client who was given haloperidol during acute psychosis Haloperidol is a typical antipsychotic. Ziprasidone, clozapine, and paliperidone are atypical antipsychotics.

An older adult client diagnosed with Parkinson's disease will soon begin treatment with levodopa, carbidopa, and entacapone. Prior to starting this course of treatment, the nurse must ensure the implementation of which intervention?

Assess renal function It is necessary to administer this medication therapy with caution in clients with severe renal impairment. None of the other interventions are necessary (related to this therapy) since the medication is not likely to be affected by or to effect the cardiac, respiratory, or gastrointestinal systems.

Which medication would the nurse expect to administer if prescribed to achieve skeletal muscle relaxation?

Baclofen Baclofen is an example of a skeletal muscle relaxant. Allopurinol would be administered to treat gout. Alendronate would be administered to treat osteoporosis. Hydroxychloroquine would be used to treat rheumatoid arthritis.

Antivenins are used for passive, transient protection from which bites? (Select all that apply.)

Black widow Rattlesnake Copperhead Antivenins are used for passive, transient protection from the toxic effects of bites by black widows, rattlesnakes, copperheads, cottonmouth, and coral snakes.

The nurse knows that which assessment finding suggests hyperthyroidism?

Blood pressure 145/87 Moderate hypertension is a sign of hyperthyroidism. Bradycardia, cool and dry skin, and hard, thick nails are suggestive of hypothyroidism.

A home care nurse is caring for a 70-year-old female client who has been diagnosed with osteoporosis. When developing a plan of care for this client, the nurse should include measures to prevent what complication of the disease?

Bone fracture Bone fracture is a major complication of osteoporosis, a disease characterized by reduced bone mineral density. Low levels of estrogen and calcium increase the risk of developing the disease, but they do not cause it.

Which agent has no sedative, anticonvulsant, or muscle relaxant properties but does reduce the signs and symptoms of anxiety?

Buspirone Buspirone has no sedative, anticonvulsant, or muscle relaxant properties, but it does reduce the signs and symptoms of anxiety. Diphenhydramine is an antihistamine that can be sedating. Zaleplon causes sedation and is used for short-term treatment of insomnia. Meprobamate has some anticonvulsant properties and CNS-relaxing effects.

A patient with cortical focal seizures has been prescribed phenobarbital. What adverse reaction should the nurse monitor for in the patient?

CNS depression The nurse should monitor CNS depression in the patient undergoing phenobarbital treatment. Gingival hyperplasia is an adverse reaction in a patient administered ethotoins. Ataxia and urticaria are adverse reactions in patients undergoing anticonvulsant ethosuximide therapy.

When describing the parafollicular cells to a group of students, which hormone would the instructor identify as being produced by these cells?

Calcitonin The parafollicular cells of the thyroid produce calcitonin. Parathormone is produced by the parathyroid glands. Levothyroxine and liothyronine are produced by the thyroid gland and stored in the follicular cells.

The client reports taking a phenothiazine antipsychotic. What medication does the nurse suspect the client has been prescribed?

Chlorpromazine Chlorpromazine is the prototype phenothiazine. Theophylline is a xanthine agent administered to treat some respiratory disorders. Haloperidol and thiothixene are nonphenothiazine antipsychotics.

The nurse is caring for a client with severe hypothyroidism and knows to contact the health care provider if which symptoms of (myxedema severely advanced hypothyroidism) coma occur? (Select all that apply.)

Decreased level of consciousness Decreased respirations Decreased blood pressure Symptoms of myxedema coma include coma, hypothermia, cardiovascular collapse, hypoventilation, hypoglycemia, and lactic acidosis.

The nurse is caring for a client with severe hypothyroidism and knows to contact the health care provider if which symptoms of myxedema coma occur? (Select all that apply.)

Decreased level of consciousness Decreased respirations Decreased blood pressure Symptoms of myxedema coma include coma, hypothermia, cardiovascular collapse, hypoventilation, hypoglycemia, and lactic acidosis.

A nurse has noted that a newly admitted client has been taking ramelteon for the past several weeks. The nurse is justified in suspecting that this client was experiencing what problem prior to starting this drug?

Difficulty falling asleep at night Ramelteon is use for the long-term treatment of insomnia characterized by difficulty with sleep onset. Ramelteon is not effective in managing any of the other suggested sleep-related issues.

A nurse should include which information when educating the client's parents on the varicella vaccine? (Select all that apply.)

Discuss common adverse reactions. Provide the date for return for the next vaccination. The risk of contracting vaccine-preventable diseases. The benefits of immunization. Instruct the parents to bring immunization records to all visits.

When combination therapy is ineffective, what needs to be reassessed?

Drug-drug interactions Many of the AEDs have drug-drug interactions. Therefore, it is important to monitor for drug-drug interactions to arrange to adjust dosages appropriately if any drug is added or withdrawn from the drug regimen. The age and gender of the patient would not need to be reassessed and neither would whether or not the patient is truly having seizures.

A client who was bitten by a pit viper is to receive antivenin. What is the nurse's best action?

Establish IV access Antivenin given to neutralize the venom of a pit viper is administered intravenously.

When reviewing a journal article about seizure disorders, the nurse would expect to find tonic-clonic seizures and myoclonic seizures being classified as which type of seizures?

Generalized seizures Tonic-clonic seizures and myoclonic seizures are classified as generalized seizures. Partial seizures can be simple or complex. Complex seizures are partial seizures that involve impaired consciousness and variable unconscious repetitive actions, staring gaze, and hallucinations/delusions. Atonic seizures are a type of generalized seizure involving the loss of muscle tone where the person suddenly drops.

The nurse is teaching a course to students about immunologic agents. In order for the students to understand active immunity, the nurse explains that there are agents that provide active immunity. Which is an active immunity agent?

Haemophilus influenzae type B conjugate A vaccine is an active immunity agent. Haemophilus influenzae type B conjugate is a live vaccination. The remaining answer options offer agents that are either Immune globulins or antivenins which are passive immunity agents.

The nurse is preparing to administer levothyroxine to a client. Which assessment finding would cause the nurse to hold the medication?

Heart rate of 110 beats per minute Levothyroxine should be held if the client's heart rate is over 100 beats per minute.

The perinatal nurse recognizes that what vaccine can be safely given to a neonate?

Hepatitis B Hepatitis B is the only common vaccine that can be given to neonates.

What is the best position for the client after the administration of a bisphosphonate medication?

High Fowler's The client should be instructed to remain upright (avoid lying down - supine, prone, or lateral recumbent) for at least 30 minutes after taking bisphosphonate drugs. Therefore, the best position is high Fowler's.

A client receiving a dopaminergic agent has recently experienced nausea, vomiting, and dysphagia. Which nursing diagnosis would be most appropriate for this client?

Imbalanced nutrition: less than body requirements The client's reports suggest that the client's intake of food and fluids may be altered, leading to problems with inadequate nutritional intake. Risk for injury would be more appropriate if the client was experiencing CNS effects. These symptoms are unlikely to affect the client's dentition or skin integrity.

The pharmacology instructor is providing education regarding propylthiouracil to the nursing students. What would the instructor identify as the primary mode of action for this medication?

Inhibition of production of thyroid hormone Propylthiouracil acts by inhibiting production of thyroid hormones and peripheral conversion of thyroxine (T4) to the more active triiodothyronine (T3).

For a client diagnosed with Parkinson's and narrow angle glaucoma, what medication would be contraindicated?

Levodopa Levodopa is contraindicated in clients with known hypersensitivity to the drug. Because levodopa can dilate pupils and raise intraocular pressure, it is contraindicated in narrow-angle glaucoma (because it increases intraocular pressure).

An adolescent client has been taking dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) for 3 years, achieving significant improvements in behavior and mood. When assessing the child during a scheduled follow-up appointment, the nurse should prioritize what physical assessment to monitor for a potential adverse reaction to the therapy?

Measurement of height and body weight Suppression of weight and height may occur in children taking amphetamines, and the nurse ensures that growth is monitored during drug therapy. Assessments for edema, diminished reflexes, and sensory deficits are not normally warranted.

Serotonin abnormalities are thought to be involved in the following disorders:

Mental depression and sleep disorders. Normal levels of serotonin in the brain produce mood elevation or euphoria, increasing mental alertness and capacity for work, decrease fatigue and drowsiness, and prolong wakefulness. Abnormalities alter these functions.

The daughter of an older adult client asks the nurse if her father should be aware of any special precautions while taking lorazepam (Ativan). What is the nurse's best response?

Monitor for increased signs of confusion or forgetfulness. Recent studies link the chronic use of benzodiazepines by those over 65 years of age to a greater chance of developing dementia. Antianxiety drugs are not known to cause kidney or liver damage but should be used cautiously in elderly clients, and in clients with impaired liver function or impaired kidney function. Antianxiety drugs more likely can cause muscle relaxation than rigidity. A symptom of withdrawal from antianxiety drugs is muscle tension.

A client's morning blood work reveals a serum calcium level of 3.1 mg/dL (0.78 mmol/L) (normal 8.5-10.5 mg/dL or 2.05-2.55 mmol/L). The nurse should consequently assess this client for which function?

Muscle tone Low calcium levels can result in tetany. Decreased LOC and altered respiratory function are not characteristic of hypocalcemia.

The nurse is caring for a client who is seeking care for a chronic condition. The nurse is aware that the FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of what condition?

Obesity The FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of obesity or for weight loss, either alone or with other therapeutic agents. Significant and serious complications may develop in euthyroid people taking thyroid hormones.

A client is to receive ethotoin. The nurse would expect to administer this drug by which route?

Oral Ethotoin is administered orally.

A client is to receive trihexyphenidyl as adjunctive treatment for Parkinson's disease. The nurse would expect to administer this drug by which route?

Oral Trihexyphenidyl is available only in an oral form.

The nurse is preparing to administer the rotavirus vaccine to an infant. The nurse would expect to administer this vaccine by which route?

Oral The rotavirus vaccine is only administered orally.

The nurse is discussing the use of corticosteroids with a group of nursing students and tells that students that both men and women who take corticosteroids are at risk for what side effect?

Osteoporosis Both men and women who take corticosteroids are at risk for osteoporosis.

A nurse is preparing a presentation to a local community group about biological weapons. The nurse would identify which disease as lacking an available vaccine?

Plague There is no vaccine available for plague. There is a vaccine for anthrax, but it is available only for military use. There is a vaccine for smallpox and a botulinum toxoid for botulism.

What would the nurse identify as a vaccine that is a toxoid?

Tetanus The vaccine for tetanus is a toxoid

A group of students are reviewing hypo- and hypercalcemia. The students demonstrate a need for additional review when they identify what as indicating hypercalcemia?

Tetany Tetany is an indication of hypocalcemia. Lethargy, muscle weakness, and personality changes occur with hypercalcemia.

To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued?

The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks. To avoid antidepressant discontinuation syndrome, it is essential to taper the dosage of the antidepressant and discontinue it gradually, over 6 to 8 weeks, unless severe drug toxicity, anaphylactic reaction, or another life-threatening condition is present. ECT will not avoid this syndrome. Concurrent use of an MAO inhibitor is dangerous. Avoiding stress is advisable but will not minimize the risk of injury in this situation.

A nurse is teaching the client about CNS medications and how they are addictive. What is primary reason CNS medications are addictive?

The medication stimulates the brain's pleasure centers with enhanced neurotransmission of dopamine. CNS medications have a high degree of addiction potential because they stimulate the brain's pleasure centers with enhanced neurotransmission of dopamine. CNS stimulants do not promote sleep. CNS stimulants do not change visual acuity. Decreased dopamine does not produce feelings of euphoria.

A 52-year-old male client is being treated for Parkinson's disease. The nurse is aware that Parkinson's disease results in several physical manifestations. What occurs in the neurons that causes these symptoms?

There is an imbalance between dopamine and acetylcholine. In Parkinson's disease, degeneration of the neurons that supply dopamine to the striatum occurs, resulting in reduced dopamine in the nerve terminals of the nigrostriatal tract. Consequently, an imbalance exists between dopamine inhibition and acetylcholine excitation. Additionally, unopposed acetylcholine stimulates the release of gamma-aminobutyric acid (GABA). The combination of excessive acetylcholine and GABA is the basis for most symptoms of Parkinson's disease, such as the physical manifestations seen such as muscle rigidity, tremor at rest, akinesia (loss of voluntary movement) or bradykinesia (abnormal slowness of movement), and postural instability.

Calcitonin balances the effects of parathyroid hormone. True or False

True Cells found around the follicle of the thyroid gland are called parafollicular cells. These cells produce another hormone, calcitonin, which affects calcium levels and acts to balance the effects of the parathyroid hormone (PTH), parathormone.

Muscle spasms are thought to arise from the flood of sensory impulses coming to the spinal cord from an injured area. True or false?

True It is thought that muscle spasms are caused by the flood of sensory impulses coming to the spinal cord from the injured area.

Spinal reflexes are the simplest nerve pathways that monitor movement and posture. True or false?

True The spinal reflexes are the simplest nerve pathways that monitor movement and posture.

A nurse is preparing a teaching plan for a client who is receiving baclofen therapy. Which would the nurse include as possible adverse effects? (Select all that apply.)

Urinary frequency Drowsiness Constipation Adverse effects associated with baclofen therapy include drowsiness, urinary frequency, constipation, hypotension, fatigue, weakness, and dry mouth.

Which vitamin supplements should the nurse recommend while a postmenopausal client is taking alendronate (Fosamax)?

Vitamin D and calcium Fosamax is a bisphosphonate medication. An intake of 1500 mg calcium and 400 to 800 units of vitamin D are recommended daily while taking bisphosphonates.

A client has been prescribed an anticholinergic agent for treatment of Parkinson-related symptoms. What client education should be provided?

Void before taking the medication. To avoid urinary retention associated with the administration of an anticholinergic agent, the client should be instructed to void before taking the medication. The client should be instructed to avoid the use of over-the-counter sleep aids. The client should avoid high environmental temperatures. The client should avoid strenuous activity and should not enroll in an exercise class.

Which test should be scheduled every week for a patient taking clozapine?

WBC count Use of the drug clozapine has been associated with severe agranulocytosis, (i.e., decreased white blood cells), so weekly WBC count tests are scheduled. Serum lithium tests are taken for patients who have been administered lithium, not clozapine. There is no need to take blood glucose or pH level tests.

The nurse should advise a client who is taking levothyroxine for the first time that resolution of hypothyroid symptoms may not occur for how long after therapy is started?

Weeks The nurse should advise clients taking levothyroxine for the first time that resolution of hypothyroid symptoms may not occur for weeks after therapy is initiated. Results will not be seen in hours or a few days. Results should be seen before months of administration, if results are not seen in a few weeks, then the primary care provider should be notified.

Knowing that thyroid hormones are principally concerned with the increase in metabolic rate of tissues, which symptoms would a nurse observe in a client with uncontrolled hypothyroidism? (Select all that apply.)

Weight gain Bradycardia Sleepiness The signs and symptoms of hypothyroidism include: decreased metabolism, cold intolerance, low body temperature, weight gain, bradycardia, hypotension, lethargy, sleepiness, pale, cool, dry skin, face appears puffy, coarse hair, thick, hard nails, heavy menses, fertility problems, and low sperm count.

Which statement best summarizes the negative feedback loop of the hormones that regulate calcium and bone metabolism?

When serum calcium levels are decreased, hormonal mechanisms increase them. Three hormones regulate calcium and bone metabolism: parathyroid hormone, calcitonin, and vitamin D. They all act to maintain normal serum levels of calcium. When serum calcium levels are decreased, hormonal mechanisms raise them. When the serum calcium levels are increased, hormonal mechanisms lower them. Overall, the hormones alter absorption of the dietary calcium from the gastrointestinal tract, movement of calcium from bone to serum, and excretion of calcium through the kidneys.

If the client experiences a rash while taking methimazole or propylthiouracil, the nurse needs to inform the client to

apply soothing creams or lubricants.

A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client?

avoid use of soy sauce in the diet. The client should be instructed to avoid soy sauce, which contains high levels of tyramine. Potentially fatal pharmacodynamic interactions can occur with MAOIs when they are combined with foods rich in tyramine. The client's willingness to adhere to the combination therapy and the cultural significance of taking an MAOI, although important factors to be assessed, are not as important as this safety-related dietary consideration.

When preparing a presentation for a local parent group about vaccines, the nurse would describe vaccines as being used to stimulate a. passive immunity to a foreign protein. b. active immunity to a foreign protein. c. serum sickness. d. a mild disease in healthy people.

b. Active immunity to a foreign protein

Indications for use of anticholinergic drugs in the treatment for Parkinsonism include to:

decrease salivation, spasticity, and tremors. Anticholinergic drugs are used in idiopathic parkinsonism to decrease salivation, spasticity, and tremors. They are used primarily in people who have minimal symptoms or who cannot tolerate levodopa, or in combination with other antiparkinson drugs.

A client with schizophrenia is prescribed clozapine. For which information in the medical record will the nurse question giving this medication to the client?

history of seizure disorder Clozapine is contraindicated for use in a client with a history of seizure disorders. The medication is not contraindicated for any specific eating plan. Treatment for rheumatoid arthritis is not a contraindication for this medication. The type of employment is not identified as a contraindication for this medication.

What is a common cause of primary hypothyroidism? Select all that apply.

hyperthyroidism medication therapy Hashimoto's thyroiditis radiation to the neck Common causes of primary hypothyroidism include chronic (Hashimoto's) thyroiditis, an autoimmune disorder characterized by inflammation of the thyroid gland, and treatment of hyperthyroidism with antithyroid drugs, radiation therapy, or surgery. Secondary hypothyroidism occurs when there is decreased TSH from the anterior pituitary gland or decreased thyrotropin-releasing hormone (TRH) secreted from the hypothalamus, which disrupts the negative feedback mechanism.

A nurse is educating a client who has Parkinson's disease and family regarding possible adverse effects of carbidopa-levodopa. The nurse emphasizes which should be a closely monitored effect?

involuntary movements. Abnormal and involuntary movements are among the most common and serious adverse effects of carbidopa-levodopa therapy. Increased appetite, thirst, and perspiration are not common adverse effects, and increased mobility is a desired outcome of treatment.

When describing thyroid function, the nurse would emphasize the need for intake of:

iodine Iodine intake is necessary for the production of thyroid hormones.

The nurse is caring for a client who has been diagnosed with both Parkinson's disease and narrow-angle glaucoma. What medication should cause the nurse concern?

levodopa Because levodopa can dilate pupils and raise intraocular pressure, it is contraindicated in narrow-angle glaucoma. The other listed medications are not necessarily contraindicated.

A nurse is preparing to administer a scheduled dose of levothyroxine to an older adult client who is being treated in the hospital for a respiratory infection. Prior to administering the drug, the nurse should perform what assessment?

measurement of blood pressure In older adults receiving levothyroxine, regular monitoring of blood pressure and pulse is essential. Temperature, pupillary response, and chest auscultation are not necessary before safe administration of this medication.

A hospital client's current medication administration record specifies oral administration of propylthiouracil (PTU) every 8 hours. What sign or symptom may have originally prompted the care provider to prescribe this drug?

persistent tachycardia Propylthiouracil (PTU) is used for the treatment of hyperthyroidism; one of the characteristic symptoms of this disease is tachycardia. Tinnitus, visual disturbances, and hypotension are not associated with hyperthyroidism.

The nurse elicits a positive Chvostek sign when tapping on the facial nerve. What action by the nurse is a priority after this assessment is complete?

Assess the client's calcium level for hypocalcemia. Hypocalcemia is indicated by a positive Chvostek sign and the nurse should assess the calcium level for the deficit and prepare to administer calcium. Low levels of potassium, thyroid hormone, and sodium do not elicit the response of tetany.

What would expected findings during an assessment of a client with hyperthyroidism include? (Select all that apply.)

Increased appetite Tachycardia Goiter Signs and symptoms of hyperthyroidism include increased metabolism with increased appetite; weight loss; tachycardia; flushed, warm skin; thinning hair; goiter.

The nurse is caring for a client with osteoporosis. Which electrolyte will the nurse assess to determine the action of exogenous calcitonin in this client?

calcium Calcitonin is a hormone from the thyroid gland whose secretion is controlled by the concentration of ionized calcium in the blood flowing through the thyroid gland. When the serum level of ionized calcium increases, secretion of calcitonin increases. The function of calcitonin is to lower serum calcium in the presence of hypercalcemia, which it does by decreasing movement of calcium from bone to serum and increasing urinary excretion of calcium. The action of exogenous calcitonin is rapid, but short in duration. This hormone has little effect on long-term calcium metabolism. Sodium, magnesium, and potassium are not used to monitor the action of calcitonin.

Increases in what specific physiologic effects are expected outcomes of thyroid hormone therapy? Select all that apply.

carbohydrate metabolism cellular metabolism oxygen consumption cardiac output Some specific physiologic effects of thyroid hormones include increased rate of cellular metabolism and oxygen consumption, with a resultant increase in heat production; increased heart rate, force of contraction, and cardiac output; increased carbohydrate metabolism; increased fat metabolism, including increased lipolytic effects of other hormones and metabolism of cholesterol to bile acids; and inhibition of pituitary secretion of thyroid-stimulating hormone (TSH).

A nurse is caring for a client with chronic lymphocytic thyroiditis. The health care provider has prescribed liothyronine. For which condition of the client should the nurse be cautious before administering the drug?

cardiac disease The nurse should be cautious about existing conditions such as cardiac disease and also cautious about lactating clients before administering liothyronine to clients with chronic lymphocytic thyroiditis. The nurse need not be cautious about administering liothyronine to those with upper respiratory tract infection, diabetes, or elevated body temperature. The nurse should observe for elevated body temperature while managing the needs of a client administered thyroid hormones. Reference:

A 45-year-old male client tells the nurse that he has not slept well for the past 2 weeks. Which drug might the physician prescribe for this client?

eszopiclone Eszopiclone (Lunesta) is a newer medication commonly prescribed to treat insomnia. Phenytoin (Dilantin) is an anticonvulsive that depresses the brain's sensory areas located in the motor cortex. Loratadine (Claritin) is an antihistamine that causes the least amount of drowsiness in this class of drugs. Norepinephrine (levarterenol, Levophed) is a potent sympathetic neurotransmitter. Its primary action is to increase blood pressure as a result of vasoconstriction of peripheral blood vessels.

What is the primary medication prescribed to relieve pain associated with shingles?

gabapentin Gabapentin is the first oral medication approved by the FDA for the management of postherpetic neuralgia. Meperidine and morphine sulfate will provide pain relief, but neither are effective in postherpetic neuralgia relief. Naproxen sodium will decrease inflammation but is not effective for postherpetic neuralgia relief.

An older adult client has been using levothyroxine for several years on an outpatient basis. Which client statement should the nurse attribute to the decreased effect of levothyroxine?

"I've been using a lot of antacids lately because of my indigestion." Antacids may decrease the effect of levothyroxine. Acetaminophen, stress, and high protein intake do not have this effect.

The nurse should be prepared to administer an infant's first dose of polio vaccine at what age?

2 months

Serum levels of calcium must be maintained in a narrow range within the body. What is the normal range of serum calcium?

9 and 11 mg/dL Calcium is an electrolyte that is used in many of the body's metabolic processes. These processes include membrane transport systems, conduction of nerve impulses, muscle contraction, and blood clotting. To achieve all of these effects, serum levels of calcium must be maintained between 9 and 11 mg/dL.

Which finding is most characteristic of Paget's disease?

Abnormal bone remodeling Paget's disease is described as a chronic bone disorder with abnormal bone remodeling. Arthritis is joint inflammation. Osteoarthritis, or degenerative joint disease, is noninflammatory degeneration of the articular cartilage. Hypercalcemia of malignancy is an advanced-stage, malignant disease.

The nurse is caring for a child who needs replacement of the parathyroid hormone. A student nurse asks the nurse what the most common cause of hypoparathyroidism is. What would be the best correct response?

Accidental removal of glands The absence of PTH results in a low calcium level (hypocalcemia) and a relatively rare condition called hypoparathyroidism. This is most likely to occur with the accidental removal of the parathyroid glands during thyroid surgery.

A nurse is caring for a patient who has received carbidopa/levodopa. After administration of the first dose of the drug, the patient has developed gastrointestinal disturbances. Which nursing intervention should the nurse perform when caring for this patient?

Administer the next drug dose with meals. The nurse should administer the next drug dose with meals to manage gastrointestinal disturbances in a patient who has been administered antiparkinsonism drugs. Withholding the next dose of the drug, administering the next drug dose with milk, or observing alterations in the patient's blood pressure are not appropriate interventions when caring for a patient who is experiencing GI disturbances with the first dose of antiparkinsonism drugs.

The nurse should not administer sedatives or hypnotic drugs to which client?

Comatose client The nurse should not administer these drugs to comatose clients, those with severe respiratory problems, those with a history of habitual drug and alcohol use, or pregnant or lactating women. The nurse could safely administer sedatives or hypnotics to a client with a history of asthma as long as the client is not having an acute attack. A woman of childbearing age can receive sedatives or hypnotics after it is confirmed she is not currently pregnant. An egg allergy is not a contraindication to sedative or hypnotic administration.

A nurse is caring for 70-year-old patient who is undergoing anticholinergic drug therapy. The nurse should assess for which condition when caring for this elderly patient?

Confusion and disorientation The nurse should assess for confusion and disorientation when caring for this elderly patient undergoing anticholinergic drug therapy. Individuals older than 60 years frequently develop increased sensitivity to anticholinergic drugs and require careful monitoring. Lower doses may also be required in such cases. Choreiform movements, suicidal tendencies, and psychotic episodes are serious adverse reactions associated with the use of levodopa, which is a dopaminergic drug.

A client with a history of malignant hyperthermia is scheduled for surgery. Which agent would the nurse most likely expect to administer?

Dantrolene Dantrolene is the drug that would be used as prevention and treatment of malignant hyperthermia.

A nurse is caring for a patient with hypothyroidism. The nurse would know that the effects of hypothyroidism include:

Decreased cardiac output Decreased cardiac output is an effect of hypothyroidism. Low-grade fever, nervousness and restlessness, and increased systolic blood pressure are among the effects of hyperthyroidism.

Which medication is classified as an antianxiety medication but is also used to treat muscle spasms?

Diazepam (Valium) Diazepam (Valium), a drug widely used as an anxiety agent, also has been shown to be an effective centrally acting skeletal muscle relaxant. It may be advantageous in situations in which anxiety may be precipitating the muscle spasm.

Which anticonvulsants exert their effect by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain? (Select all that apply.)

Ethotoin (Peganone) Phenytoin (Dilantin) Hydantoins, like phenytoin (Dilantin) and ethotoin , exert their effect by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain.

A female client is prescribed centrally acting anticholinergics for her Parkinson's disease. Six weeks later, her daughter asks the health care provider to hospitalize the client for a psychiatric evaluation. The nurse anticipates that the provider will respond in what way to the daughter's request?

Evaluate the client for adverse reactions from the centrally acting anticholinergics When centrally active anticholinergics are given for Parkinson's disease, agitation, mental confusion, hallucinations, and psychosis may occur.

The nurse instructs the parent of a young school-age child with a seizure disorder who takes an AED to be alert for what signs and symptoms?

Excessive sedation and interference with learning and social development AEDs must be used cautiously to avoid excessive sedation and interference with learning and social development.

A client presents to the emergency department with severe pain and receives methocarbamol by injection. As part of the nurse's safety care plan, the nurse should instruct the client that she may experience which common adverse reaction?

Fainting, incoordination, and hypotension Common adverse effects with methocarbamol drug include drowsiness, dizziness, nausea, urticaria, fainting, incoordination, and hypotension.

A client is prescribed ibandronate. The nurse instructs the client to take the drug at which frequency?

Once a month Ibandronate is taken once a month on the same day each month.

After teaching a group of students about bisphosphonates, the students demonstrate understanding of the information when they identify which drug as an example?

Pamidronate Pamidronate is an example of a bisphosphonate. Teriparatide and dihydrotachysterol are antihypocalcemic agents. Calcitonin-salmon is a calcitonin used to treat hypercalcemia.

A nurse is participating in an influenza vaccination clinic on a college campus. What action will best prepare the nurse for this role?

Review the procedure for intramuscular injection Influenza vaccinations are given by the IM route. The nurse must monitor for adverse effects, but it is unnecessary to teach each client the details of serum sickness. Clients do not need to know their blood types.

A 29-year-old client who experienced a lower back injury has seen his range of motion decrease and his pain increase over the past several weeks. As a result, he has been prescribed cyclobenzaprine. What nursing diagnosis should the nurse prioritize in light of the client's drug regimen?

Risk for Injury related to CNS depression The common adverse effects of cyclobenzaprine are related to its CNS depression and anticholinergic activity. The drug is not noted to impact the patient's ability to swallow, cough, or function sexually.

An infant is seen in the clinic for first immunizations. When providing client teaching to the parent, which is no longer recommended for administration?

Smallpox vaccine Smallpox has been eradicated and is no longer administered to children. By 4 to 6 years of age, children should have received vaccinations for chickenpox, diphtheria, hepatitis A and B, influenza, measles, mumps, pertussis, polio, pneumococcal diseases, rubella, tetanus, and Haemophilus influenzae and rotavirus infections.

A client diagnosed with Parkinson's disease has been prescribed rasagiline. When educating this client on this medication, which herbal supplement should be identified as having the potential to produce hyperpyrexia and death?

St. John's wort Rasagiline administered with the herbal supplement St. John's wort will enhance the stimulation of serotonergic receptors to cause hyperpyrexia and death. Dextromethorphan can produce the same reaction but is not an herbal supplement. Ginger and garlic are herbal supplements but will not produce hyperpyrexia and death.

Ribavirin would be used for

hemorrhagic fever

A nurse is administering a prescribed dose of chlordiazepoxide to a client. The nurse should closely assess the client for what adverse reaction?

respiratory depression Chlordiazepoxide may have profound central nervous system (CNS) effects, including respiratory depression, and the nurse must assess accordingly. Urinary retention, ITP, and esophageal bleeding have not been noted.

The nurse is preparing a teaching tool on the action of calcium preparations. The nurse will identify that calcium is absorbed through which body area?

small intestine The absorption of calcium occurs in the small intestines. Approximately one third of the amount of calcium consumed is actually absorbed. Calcium is not absorbed through the mouth, the stomach, or the large intestines.

Humoral and cell-mediated immunity involve

the action by B lymphocytes and T lymphocytes.

Hepatitis A is a

viral vaccine.

What question is important for the nurse to ask a client who is scheduled to receive a first dose of radioactive iodine for hyperthyroidism?

"Do you have any trouble swallowing?" Radioactive iodine is given orally, either as a solution or in a gelatin capsule. Since it is not given intravenously, any questions regarding needles or veins is not necessary. Radioactive iodine is given for the treatment of hyperthyroidism or cancer of the thyroid. The question states this client is taking radioactive iodine for hyperthyroidism.

A client is prescribed calcitriol. Which instruction would be most important for the nurse to include in the teaching plan?

"Have your calcium levels checked periodically." Calcitriol increases serum calcium levels; therefore, periodic monitoring is important to ensure effectiveness of therapy without causing hypercalcemia. Antacids containing magnesium should be avoided due to the increased risk for hypermagnesemia. Calcitriol is often combined with dietary supplementation of calcium. Dairy products are a good source of calcium and should not be limited. The drug can cause nausea, vomiting, and dry mouth. Taking the drug with food may help alleviate these effects.

An older adult client has experienced recent declines in bone density and has consequently been deemed a candidate for treatment with alendronate. During health education, what teaching point should the nurse emphasize?

"It's important that you not lie down for half an hour after taking your alendronate." The person must remain upright (with head elevated 90 degrees if in bed, sitting upright in a chair, or standing) for at least 30 minutes after administration of alendronate. It is always necessary to take the drug with a full glass of water, not juice or coffee, at least 30 minutes before breakfast and before taking other drugs. Bone pain is a possible adverse effect, but prevention of esophageal ulceration is a priority. Increased dairy consumption is not vital.

The nurse is teaching parents of a pediatric client diagnosed with ADHD. Teaching has been about the disorder and its treatment. The nurse determines that teaching has been effective when the parents state which?

"We need to remember that our son is not a bad kid; he just has difficulty with impulse control and attention." Teaching patients and families about the biological basis of ADHD helps parents understand that these children are not "bad" kids but that they have problems with impulse control and attention. It may be helpful to review the purposes of the medications and assure the parents that there is evidence that medications help most children. Studies show that treatment of ADHD is not associated with a risk of substance disorders. The physician, not the parents, would determine when it would be appropriate to take a drug holiday to evaluate the need for continued medication therapy. Regular routines are important but so are clear limits with clear consequences when these limits are violated.

The nurse is working in a clinic which is providing the annual influenza A vaccine for staff and residents of a large long-term care facility. Which client poses the greatest concern associated with being vaccinated?

A resident who received four units of packed red blood cells for a gastrointestinal bleed three weeks ago Recent blood transfusions contraindicate the use of vaccines because there is an associated risk of an unpredictable immune response. The influenza vaccine, like most vaccines, is not contraindicated during breastfeeding. Old age, COPD and recent hepatitis vaccinations are not contraindications.

A health care worker has received an annual influenza vaccination and has remained at the clinic after administration so that the nurse may observe for adverse reactions. The worker reports pain at the site of IM injection. What should the nurse recommend?

Acetaminophen Most vaccines can cause fever and soreness at the site of injection. Acetaminophen can be taken two to three times daily for 24 to 48 hours if needed to decrease fever and discomfort. Aspirin and heat are not explicitly recommended; opioids are not necessary.

A client is diagnosed with both hypothyroidism and adrenal insufficiency. If the adrenal insufficiency is not treated first, what may occur with the administration of thyroid hormone?

Acute adrenocortical insufficiency When hypothyroidism and adrenal insufficiency coexist, the adrenal insufficiency should be treated with a corticosteroid drug before starting thyroid replacement. Thyroid hormones increase tissue metabolism and tissue demands for adrenocortical hormones. If adrenal insufficiency is not treated first, administration of thyroid hormone may cause acute adrenocortical insufficiency, a life-threatening condition.

Which is an example of artificially acquired active immunity? (Select all that apply.)

Administration of the varicella vaccine to an individual who has no immunity to the disease. Administration of the influenza vaccine to an individual who has no immunity to the disease. Administration of the rubella vaccine to an individual who has no immunity to the disease. Administration of the varicella, influenza, and rubella vaccine to an individual who has no immunity to the disease are examples of artificially acquired active immunity.

The client has been prescribed an MAO inhibitor. As the nurse teaches the client about this medication, what foods will the client be instructed to avoid?

Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans MAO inhibitors are rarely used in clinical practice today, mainly because they may interact with some foods and drugs to produce severe hypertension and possible heart attack or stroke. Foods that interact contain tyramine, a monoamine precursor of norepinephrine. Normally, tyramine is deactivated in the GI tract and liver so that large amounts do not reach the systemic circulation. When deactivation is blocked by MAO inhibitors, tyramine is absorbed systemically and transported to adrenergic nerve terminals, where it causes a sudden release of large amounts of norepinephrine. Foods that should be avoided include aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans.

The nurse should assess for an enlarged thyroid by palpating which area?

Anterior neck The thyroid gland is located in the neck in front of the trachea. It is not located in the submandibular, midsternal, or supraclavicular areas.

A client who has been taking medication for a seizure disorder is asking the nurse about getting pregnant. Why is pregnancy discouraged in women who are being treated for seizure disorders?

Antiepilepsy drugs are teratogenic. Antiepileptic drugs must be used cautiously during pregnancy because they are teratogenic. Seizure disorders are not genetic or familial. Antiepilepsy medications do not decrease fertility.

A health care provider has prescribed thyroid drugs to a client with euthyroid goiter. Which should the nurse include in the nursing diagnosis checklist?

Anxiety related to symptoms, adverse reactions, and treatment regimen The nurse should include anxiety related to symptoms, adverse reactions, and treatment regimen in the nursing diagnosis checklist on administering thyroid drugs to the client with euthyroid goiter. In the nursing diagnosis checklist for this client, the nurse need not include disturbed thought processes related to adverse drug reactions, risk for infection, or risk for impaired skin integrity related to adverse drug reactions. Risk for infection related to adverse drug reactions and risk for impaired skin integrity related to adverse reactions must be included in the nursing diagnosis checklist of a patient who is administered antithyroid drugs. The nursing diagnosis checklist of a client receiving ACTH must include disturbed thought processes related to adverse drug reactions.

A client taking methimazole develops a rash. What is the nurse's best recommendation to treat the rash?

Apply a soothing cream until the rash subsides. If a client experiences a rash while taking methimazole, either soothing creams or lubricants may be applied; soap is used sparingly, if at all, until the rash subsides. Drug dosing may need to be changed, so the next step is to notify the health care provider. Wearing gloves does not address how to care for the rash.

Which instruction should the nurse specifically stress when administering drugs used for muscle spasm and cramping?

Avoid alcohol or other CNS depressants. The nurse should instruct the patient to avoid alcohol or other CNS depressants when taking a drug for muscle spasms and cramping. The nurse should instruct patients taking drugs for osteoporosis to take them with 6 to 8 oz of water and to stay upright for 30 minutes after taking drugs. The nurse should instruct patients with gout to take drugs for treating gout with food.

The nurse is preparing to administer a client's prescribed dose of immune sera. How should the nurse describe this treatment to the client?

Bacterial antibodies in serum Immune sera refer to sera that contain antibodies to specific bacteria or viruses. A viral protein coat, weakened bacterial cell membrane, and chemically weakened actual virus can be components of an immunization.

A patient has hypocalcemia secondary to hypoparathyroidism. Which would the nurse expect to be ordered?

Calcitriol Calcitriol is an antithypocalcemic agent used to treat hypoparathyroidism. Levothyroxine would be used to treat a deficiency of thyroid hormone or hypothyroidism. Methimazole is an antithyroid agent used to treat hyperthyroidism. Propylthiouracil is an antithyroid agent used to treat hyperthyroidism.

A group of nursing students are preparing for a class presentation to discuss drugs used to treat Parkinson disease. Which drug would the group include when discussing dopaminergic agents?

Carbidopa Carbidopa (Lodosyn) is classified as a dopaminergic agent that treats parkinsonism by supplementing the amount of dopamine in the brain. Benztropine is classified as a cholinergic blocking drug. Biperiden is classified as a cholinergic blocking drug. Pramipexole is classified as a non-ergot dopamine receptor agonist.

Rapid administration of IV calcium may result in which of the following conditions? Select all that apply.

Cardiac arrhythmias Tissue irritation Hypotension Give intravenous (IV) preparations slowly (0.5-2 mL/min), check pulse and blood pressure closely, and monitor the electrocardiogram (ECG) if possible. These solutions may cause arrhythmias and hypotension if injected rapidly. They are also irritating to tissues.

A nursing instructor is describing Parkinsonism to a group of nursing students. When discussing the underlying cause of the symptoms, the instructor explains the depletion of dopamine in which of the following?

Central nervous system The symptoms of parkinsonism are caused by the depletion of dopamine in the central nervous system. Peripheral nervous system disorders can result from damage to or dysfunction of the cell body, myelin sheath, axons, or neuromuscular junction such as seen in neuropathy. Disorders of the smooth muscle seen affecting the esophagus is a condition called achalasia causing a failure to relax, usually referring to the smooth muscle fibers of the gastrointestinal (GI) tract; causing difficulty swallowing; and a feeling of fullness in the sternal region. Disorders of the skeletal muscle can cause twitching, spasms, and even slow movement called bradykinesia.

A new resident who has Parkinson's disease has been admitted to long term care. The client's admission orders include "levodopa-carbidopa 100/25 mg PO daily." What is the nurse's best action when processing this prescription?

Contact the provider to question the frequency of administration Levodopa has a brief half life of one to three hours, necessitating t.i.d. dosing in most cases. The dose is appropriate. Confirming the frequency of administration is a priority over education and swallowing assessment, even though these are both relevant to the client's care.

A client diagnosed with hypothyroidism admits knowing the term "thyroid gland" but not knowing its function. The nurse should explain the fact that thyroid hormone is responsible for which action?

Controlling the rate of cell metabolism throughout the body Thyroid hormones control the rate of cellular metabolism and thus influence the functioning of virtually every cell in the body. The heart, skeletal muscle, liver, and kidneys are especially responsive to the stimulating effects of thyroid hormones. The brain, spleen, and gonads are less responsive. Thyroid hormone does not primarily influence glucose levels or the function of the endocrine system.

A client has been admitted to the unit for treatment of a multiple sclerosis exacerbation. The admission order indicates that the client is taking baclofen. Which outcome would the nurse expect to be associated with use of this medication?

Decreased muscle spasms Baclofen, a GABA agonist, is used in the treatment of spasms. It can be administered orally or by intrathecal injection. Avonex and Betaseron reduce the appearance of new lesions in MRI studies. Corticosteroids limit the severity and duration of exacerbations. Anticholinesterase agents increase muscle strength in the upper extremities.

Dexmethylphenidate has been prescribed to Scott, a 7-year-old boy who was diagnosed with ADHD. The mother asks how this medication will help her son. Which would be the most accurate description of the purpose of this medication?

Dexmethylphenidate will improve Scott's attention span so that he will be able to complete a task. Dexmethylphenidate is thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space. This activity results in improved attention spans, decreased distractibility, and increased ability to follow directions or complete tasks, and decreased impulsivity and aggression in patients with ADHD. Although dexmethylphenidate does not produce a physical dependence, it may induce tolerance or psychic dependence.

One of the neurotransmitters can become decreased in the area of the corpus striatum. This results in the manifestations of Parkinson's disease. Which neurotransmitter will cause this?

Dopamine When dopamine is decreased in the area of the corpus striatum there is a chemical imbalance that allows the cholinergic or excitatory cells to dominate. This affects the functioning of the basal ganglia and cortical and cerebella components of the extrapyramidal motor system. This system provides coordination for unconscious muscle movements, including those that control position, posture, and movement. The result of the imbalance produces the signs and symptoms of Parkinson's disease. The corpus striatum in the brain is connected to the substantia nigra by a series of neurons that utilize the inhibitory neurotransmitter GABA. Higher neurons from the cerebral cortex secrete acetylcholine in the area of the corpus stratum as an excitatory neurotransmitter to coordinate movements of the body. Serotonin is not involved in these functions.

When developing a teaching plan for a client who is to receive carisoprodol, which sign or symptom would the nurse include as the most common adverse reaction?

Drowsiness Drowsiness is the most common adverse reaction to skeletal muscle relaxants like carisoprodol (Soma) that the nurse should discuss with the client. No correlation is found with skeletal muscle relaxants causing dyspnea. The Disease-modifying antirheumatic medication of leflunomide has the adverse reaction of hypertension. Tachycardia can be seen in the use of skeletal muscle relaxants but is not the most common and is seen in the use of dantrolene and diazepam.

Which factor should the clinician reassess when combination therapy is ineffective?

Drug-drug interactions If combination therapy is ineffective, the clinician may need to reassess the patient for type of seizure, medical conditions or drug-drug interactions that aggravate the seizure disorder or decrease the effectiveness of antiseizure drugs, and compliance with the prescribed drug therapy regimen.

A primary health care provider has prescribed levothyroxine to a client with hypothyroidism. Which information would the nurse include in the teaching plan to promote an optimal response to the drug therapy?

False Hypothyroidism is the most common type of thyroid dysfunction.

More patients experience hyperthyroidism than hypothyroidism. True or false

False Hypothyroidism is the most common type of thyroid dysfunction.

Parents bring a 15-year-old male into the clinic. The parents tell the nurse that there is a family history of schizophrenia and they fear their son has developed the disease. What is an appropriate question to ask the parents?

How long has your son been exhibiting symptoms? Characteristics of schizophrenia include hallucinations, paranoia, delusions, speech abnormalities, and affective problems. This disorder, which seems to have a very strong genetic association, may reflect a fundamental biochemical abnormality.

The nurse is providing education to a client who has been prescribed tizanidine. What adverse effect should the nurse mention during teaching?

Hypotension Hypotension is the most significant adverse effect of tizanidine. Dark black urine, excessive salivation, and eczema are not adverse effects of tizanidine.

An elderly client has been given a tetanus-diphtheria (Td) booster after stepping on a rusty nail. Which statements indicate an understanding of vaccine schedules?

I know that this booster is good for 10 years. Recommended immunizations for older adults have usually consisted of a tetanus-diphtheria (Td) booster every 10 years, annual influenza vaccine, and a one-time administration of pneumococcal vaccine at 65 years of age.

The nurse administers teriparatide (Forteo) and evaluates the drug as effective in achieving desired effects when what is assessed?

Increase in serum calcium and decrease in serum phosphorous With once-daily administration, teriparatide stimulates new bone formation, leading to an increase in skeletal mass. It increases serum calcium and decreases serum phosphorous.

A nurse is caring for a patient who is prescribed flurazepam. Which is an effect of flurazepam?

Induces sleep Flurazepam induces sleep. Adrenergic drugs help to relieve stress. Analgesics are used to ease pain. Circulation can be improved by exercising.

The nurse is caring for a client whose current medication regimen includes baclofen 60 mg PO daily. What assessment should the nurse prioritize when assessing for therapeutic effects?

Inspection for muscle spasticity and range of motion assessment Baclofen is prescribed to treat muscle spasticity and/or acute musculoskeletal discomfort. It is not an anticonvulsant and does not affect fine motor versus gross motor skills. An absence of spasticity may increase muscle strength but this is not the most direct effect of the medication.

A client is to receive a typhoid vaccine. The nurse would prepare to administer this vaccine in which site?

Into the fatty tissue of the upper arm The typhoid vaccine is administered subcutaneously, often into the fatty tissue of the upper arm.

A nurse is performing patient education for a woman who has just been prescribed a bisphosphonate. Which diagnostic and history findings would have prompted the woman's care provider to prescribe a bisphosphonate?

Low bone density and a family history of osteoporosis Bisphosphonate drugs are recommended for long-term management of hypercalcemia to increase bone resorption of calcium, in treating and preventing osteoporosis in postmenopausal women, and in managing Paget disease. Low bone density and a family history of osteoporosis would consequently indicate a potential benefit. Impaired growth, cold intolerance, and cognitive deficits are not indications for the use of bisphosphonates.

A client with a history of cardiovascular disease, who is taking a thyroid hormone, reports chest pain. What is the nurse's best action?

Notify the health care provider. The development of chest pain or worsening of cardiovascular disease should be reported to the primary health care provider immediately because the client may require a reduction in the dosage of the thyroid hormone.

A patient comes to the clinic for a botox injection around her eyes. While making an assessment, the nurse finds that the patient is taking polymyxin for an infection. What would the nurse do first?

Notify the physician. If the botulinum toxins are used with other drugs that interfere with neuromuscular transmission—neuromuscular junction (NMJ) blockers, lincosamides, quinidine, magnesium sulfate, anticholinesterases, succinylcholine, or polymyxin—or with aminoglycosides, there is a risk of additive effects. If any of these must be given in combination, extreme caution should be used.

When educating a group of nursing students on immunologic agents, the nurse explains about a particular kind of immunity that develops by injecting ready-made antibodies found in the serum of immune individuals or animals. The nurse is referring to what kind of immunity?

Passive immunity The nurse is referring to passive immunity. The injection of ready-made antibodies found in the serum of immune individuals or animals is called passive immunity.

For what group of adults is pre-exposure immunization against hepatitis B recommended?

People who receive hemodialysis Pre-exposure immunization against hepatitis B is recommended for high-risk groups. These may include health care workers; clients with cancer, organ transplants, hemodialysis, immunosuppression drug therapy, or multiple infusions of blood products;sexually active gay and bisexual males; IV drug users; household contacts of HBV carriers; and residents and staff of institutions for people with intellectual disability.

An older adult resident of a long-term care facility has been prescribed calcium citrate to address decreasing bone density. The nurse should review the resident's medication administration record knowing that what medication may decrease the effects of calcium?

Prednisone Corticosteroids reduce the effects of calcium by various mechanisms. Thiazide diuretics have the opposite effect. NSAIDs, calcium channel blockers, and beta-blockers do not appreciably affect the pharmacokinetics of calcium supplements.

A patient admitted to the health care facility for insomnia related to stress is prescribed a sedative. What intervention should the nurse perform to promote the effects of the sedative?

Provide back rubs The nurse must provide back rubs to the patient to promote the effects of the sedative. Providing plenty of fluids and fiber-rich foods are measures taken to prevent constipation. Providing beverages does not help to promote the effect of the sedatives.

A patient undergoing treatment with barbiturates is showing symptoms of barbiturate toxicity. Which intervention should the nurse perform?

Provide respiratory assistance The nurse must provide respiratory assistance to the patient showing symptoms of barbiturate toxicity. Providing assistance with movement, supportive care, and a safe environment are suggested for patients at risk for injury due to drowsiness or impaired memory.

A client is receiving levodopa as treatment for Parkinson disease. The nurse would instruct the client to avoid foods high in which vitamin to prevent a reduction in the effect of levodopa?

Pyridoxine (vitamin B6) A nurse should counsel clients receiving levodopa to avoid foods high in pyridoxine (vitamin B6) as it reduces the effect of levodopa. Cyanocobalamin is used to treat pernicious anemia, however, if it is taken with Prilosec, the Prilosec can interfere with the absorption of B12. Phylloquinone (vitamin K1) is well known for being crucial for proper blood clotting and is contraindicated if the client is on anticoagulation therapy. When taking ascorbic acid (vitamin C), the client should tell the health care provider as side effects may be increased.

The nurse has taught a client who is receiving lamotrigine about possible adverse effects. The nurse determines that the client has understood the teaching when the client identifies a need to promptly report what adverse effect?

Rash Lamotrigine has been associated with very serious to life-threatening rashes and the drug should be discontinued at the first sign of any rash. Anorexia is a common adverse GI effect. Fatigue is a common adverse CNS effect. Upper respiratory infection is an adverse effect of the drug, but it is not life threatening and does not need to be reported immediately.

Laboratory values indicate that a client has a serum calcium level of 6.0 mg/dL. When reviewing the client history, the nurse might expect to see what condition associated with this calcium level?

Renal failure Conditions in which hypercalcemia is likely are cancer, prolonged mobilization, and vitamin D overdose.

The nurse is providing client education prior to administering propylthiouracil. During teaching, the nurse should inform the client about the need for what form of follow-up?

Routine liver function testing The FDA has issued a black box warning for propylthiouracil stating that severe liver injury resulting in death or acute liver failure may occur within 6 months of treatment. All clients should receive instructions about the signs and symptoms of acute liver failure. Routine liver function testing to assess for liver failure is important. There is no specific need for chest radiographs, CBCs, or glucose monitoring.

A client who is receiving an antiseizure agent reports feeling sleepy and tired and reports dizziness when standing up. Which intervention would the nurse most likely implement as the priority?

Safety precautions The client is experiencing CNS effects that could lead to injury. Therefore, the nurse would need to implement safety precautions as the priority. Hydration may be needed if the client were experiencing vomiting or diarrhea. Skin-care measures would be appropriate for the development of a rash. Emotional support would be appropriate if the client had verbalized difficulty coping with the condition or drug therapy.

After teaching a group of nursing students about antidepressants, the instructor determines that the teaching was successful when the students identify which as inhibiting the reuptake of serotonin?

Selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors exert their effects by inhibiting reuptake of serotonin. Tricyclic antidepressants exert their effects by inhibiting reuptake of norepinephrine and serotonin. Monoamine oxidase inhibitors, classified as MAOIs inhibit the activity of monoamine oxidase, a complex enzyme system responsible for inactivating certain neurotransmitters. Lithium is not a true antidepressant drug, it is grouped with the antidepressants because of its use in regulating the severe fluctuations of the manic phase of bipolar disorder.

A 25-year-old female client is diagnosed with hypothyroidism. The client is prescribed levothyroxine. Which instruction about the administration of this medication would be important?

She should take the medication in the morning before breakfast. Levothyroxine interacts with many drugs. Many drugs interfere with its absorption, resulting in decreased serum concentration. Coadministration with levothyroxine should be separated by several hours. Levothyroxine is best taken as a single daily dose before breakfast. Assist the patient to establish a routine for taking the medication. Assess the patient's intake of grapefruit juice; excessive grapefruit juice may delay the absorption of levothyroxine.

A patient is receiving teriparatide. The nurse would expect to administer this drug by which route?

Subcutaneous Teriparatide is administered by subcutaneous injection.

A group of students demonstrate understanding of thyroid hormone secretion when they state:

T3 is much more active in the circulation than T4. T3 is approximately 4 times more active than T4. More T4 is released into circulation than T3. Most of T4 is converted into T3. T3 and T4 are carried on plasma proteins.

The nurse is assessing a 13-year-old client who has symptoms of depression and recognizes that what class of antidepressant medication would not be a drug of choice for an adolescent?

TCAs A TCA probably is not a drug of first choice for adolescents, because TCAs are more toxic in overdose than other antidepressants, and suicide is a leading cause of death in adolescents.

The nurse should monitor a client for which effect of a drug interaction in a client taking thyroid hormones and a beta blocker?

Tachycardia Beta blockers and thyroid hormones interact, leading to decreased effectiveness of the beta blocker (i.e., cardiac drug, adrenergic blocker). Hypoglycemia may occur when thyroid hormones are taken with oral antidiabetic agents and insulin. Prolonged bleeding can occur when thyroid hormones and oral anticoagulants are taken together. Visual changes do not occur when beta blockers are taken with thyroid hormones.

A client is receiving a thyroid hormone to treat hypothyroidism. Which would indicate to the nurse that the client needs a reduced dosage of the drug?

Tachycardia Tachycardia suggests hyperthyroidism due to excessive thyroid hormone; this would require a reduction in dosage. The other responses suggest hypothyroidism and drug ineffectiveness.

A nurse is caring for a patient with thyrotoxicosis. The physician prescribes liotrix to the patient. Which adverse reaction to the drug should the nurse monitor for in the patient?

Tachycardia The nurse should monitor for tachycardia, palpitations, headache, nervousness, insomnia, diarrhea, vomiting, weight loss, fatigue, sweating, and flushing as adverse reactions after administering liotrix to the patient with thyrotoxicosis. Agranulocytosis, loss of hair, and skin rash are not the adverse reactions to liotrix. Agranulocytosis, loss of hair, and skin rash are adverse reactions found in a patient receiving a methimazole drug.

A patient with partial seizures has bn prescribed succinimides at a health care facility. The patient experiences GI upset after succinimides administration. What should the nurse instruct the patient to do?

Take the drug with food or milk. If the patient experiences GI upset after succinimides administration, the nurse should instruct the patient to take the drug with food or milk. The nurse need not instruct the patient to take the drug once only at bedtime, before meals, nor avoid taking fruit juice.

A 65-year-old client has come to the clinic after receiving the shingles vaccine two weeks ago. The client asks the nurse how long the immunity will last. The nurse would include which information in the explanation?

The varicella virus (shingles) vaccine protects the recipient for several years or for life. The varicella virus (shingles) vaccine protects the recipient for several years or, in some cases, for life. There is no recommended booster vaccine available.

The college health nurse is providing health education for freshmen. Which piece of information about immunizations is applicable to individuals of this age group?

The yearly administration of flu vaccine is recommended. An annual flu vaccine is recommended for all adults. The administration of oral polio will not need to be updated in this population. The administration of tetanus toxoid should be every 10 years. HAV vaccination is not mandatory.

A female client is diagnosed with Parkinson's disease and is having difficulty performing her activities of daily living. Her health care provider orders pramipexole. Pramipexole may be used alone for which purpose?

To improve motor performance and improve ability to participate in usual activities of daily living Pramipexole (Mirapex), ropinirole (Requip), and rotigotine-transdermal (Neupro) stimulate dopamine receptors in the brain. They are approved for both beginning and advanced stages of Parkinson's disease. In early stages, one of these drugs can be used alone to improve motor performance, improve ability to participate in usual activities of daily living, and delay levodopa therapy.

The nurse is discussing medication therapy with a family whose infant was born with congenital hypothyroidism and informs them that drug therapy will continue for life to prevent what condition?

To prevent intellectual disability For congenital hypothyroidism (cretinism), drug therapy should be started within 6 weeks of birth and continued for life, or intellectual disability may result.

To prevent meningococcal infections, the nurse would administer:

Vaccine Meningococcal infections would be prevented by a vaccine. A toxoid is a type of vaccine made from the toxins produced by the organism. Immune globulins and antivenin are examples of immune sera.

When describing the use of vaccines to a local community group, what would the nurse include?

Vaccines are used to provide active immunity. Immunization is the process of using vaccines to artificially stimulate active immunity. They promote the formation of antibodies against a specific disease. The person experiences an immune response without having to suffer the full course of the disease. Severe reactions are rare.

When is calcitonin released by the body?

When serum calcium levels rise The release of calcitonin is not controlled by the hypothalamic-pituitary axis, but is regulated locally at the cellular level. Calcitonin is released when serum calcium levels rise.

Which statement reflects the relationship between calcium and phosphate?

When there is an increase in calcium, the phosphate is decreased. An inverse relationship exists between calcium and phosphate. When serum calcium levels increase, serum phosphate levels decrease. When the serum calcium level decreases, serum phosphate levels increase. Calcium and phosphorus are learned together as they are closely related. These mineral nutrients occur in the same food, and absorbed together.

The nurse is providing education to a client who has been newly diagnosed with osteoporosis. How should the nurse describe the role of the parathyroid on the development of the disorder?

When there is too much parathyroid hormone, the bones release their calcium into the blood at a rate that is too high, resulting in bones which have too little calcium. Osteoporosis associated with hyperparathyroidism is caused by the high parathyroid hormone that is secreted by the overactive parathyroid gland(s). This excess parathyroid hormone acts directly on the bones to remove calcium from the bones.

A client is receiving a barbiturate intravenously. The nurse would monitor the client for:

bradycardia When given intravenously, barbiturates can result in bradycardia, hypotension, hypoventilation, respiratory depression, and laryngospasm. Bleeding is not associated with barbiturate therapy.

A 30-year-old client is taking phenelzine 30mg PO tid. The nurse knows that at that dosage, the client will need to be carefully monitored for which?

dizziness The nurse will closely monitor for the adverse effects of phenelzine related to the anticholinergic effect of the drug, such as dizziness that tends to be more pronounced at dosages above 45 mg/day. Dizziness is also a sign of a phenelzine drug overdose. Constipation and dry mouth are also adverse effects, not diarrhea and increased secretions. Facial flushing is not an identified adverse effect of phenelzine.

Common side effects of anticholinergics include:

dry mouth, urinary retention, constipation, and increased pulse rate. Anticholinergic drugs may cause blurred vision, dry mouth, tachycardia, and urinary retention. They also decrease sweating and may cause fever or heatstroke. Fever may occur in any age group, but heatstroke is more likely to occur in older adults, especially with cardiovascular disease, strenuous activity, and high environmental temperatures. When centrally active anticholinergics are given for Parkinson's disease, agitation, mental confusion, hallucinations, and psychosis may occur.

A client has developed symptoms of rigidity and bradykinesia. Which medication has been linked to the development of such symptomology?

haloperidol Drugs that deplete dopamine stores or block dopamine receptors, including the older antipsychotic drugs (phenothiazines and haloperidol), reserpine, and metoclopramide, can produce movement disorders such as secondary parkinsonism. Neither furosemide, psyllium, nor valproic acid depletes dopamine stores.

A nurse is caring for a client who has been diagnosed with hypothyroidism. Levothyroxine (Synthroid) has been prescribed. Before the drug therapy is started, the nurse will assess for:

history of taking anticoagulant drugs. If the client is taking anticoagulant drugs, there is a risk of a drug-drug interaction with levothyroxine that can result in an increased risk of bleeding. Therefore, the nurse should assess the client's medical record and drug history. Bleeding times such as INR, PR, and PTT should be closely monitored if it is necessary for the two drugs to be given together. There is no evidence that an allergy to seafood, the client's age, or hirsutism, which is excessive hair growth, would need to be assessed in this case.

With regard to the functioning of the thyroid gland, which is an essential element for the manufacturing of thyroxine and triiodothyronine?

iodine Iodine is the essential element for the manufacturing of thyroxine and triiodothyronine. Sodium plays a key role in muscle contraction, nerve conduction, and water balance in the body. Hydrogen in the body is mostly found attached to oxygen to form water, and acts as a proton or positive ion in chemical reactions. Potassium is crucial to heart function and plays a key role in skeletal and smooth muscle contraction.

What drug type is most likely to cause respiratory depression and myxedema coma in clients with thyroid disorders?

opioid analgesics Clients with hypothyroidism are especially likely to experience respiratory depression and myxedema coma with opioid analgesics and other sedating drugs. These drugs should be avoided when possible. None of the other options present with this contraindication.

A decrease in dosage of a prescribed benzodiazepine most likely would be necessary if a client was also taking:

oral contraceptive. The effects of benzodiazepines are increased when taken with oral contraceptives, necessitating a change in dosage of the benzodiazepine. The effects of benzodiazepines are decreased when taken with theophylline and ranitidine, which might result in the need for an increased dosage of the benzodiazepine. Alcohol should not be used with benzodiazepines because the combination increases the risk of CNS depression.

When methimazole and propylthiouracil are administered to the client, the nurse should recommend that the client

record the pulse rates and bring the record to the primary health care provider.

An adolescent taking oral contraceptives has been prescribed an anticonvulsant medication. The nurse should tell the client to do which?

use another form of birth control, such as condoms. Anticonvulsants and oral contraceptives interact, leading to decreased effectiveness of birth control. This can result in breakthrough bleeding or unintended pregnancy. Anticonvulsants and antidiabetic medications interact, resulting in increased blood glucose levels. Anticonvulsants and antiseizure medications taken together may increase seizure activity. Anticonvulsants interact with analgesics and alcohol, not oral contraceptives, to cause increased depressant effects.

A client with an acute onset of disorganized thinking and hallucinations is prescribed an intramuscular dose of chlorpromazine. How soon after administration can the nurse assess for therapeutic effect?

within 20 minutes Chlorpromazine is well absorbed and distributed to most body tissues, and it reaches high concentrations in the brain. After intramuscular administration, the onset of action is 10 to 15 minutes, with a peak at 15 to 20 minutes. An intramuscular dose of the medication has a duration of 4 to 6 hours. An oral dose of the medication has an onset of action of 30 to 60 minutes and will peak between 2 and 4 hours.

A nurse has been invited to speak to a support group for Parkinson's disease clients and families. Which statement addresses the chronic nature of the disease and the relevant drug therapies?

"Drugs do not cure these disorders; they instead enhance quality of life." It is most important that clients and their families know that Parkinson's disease as with other movement disorders are chronic, that there is no cure, and that drug therapy only serves to help decrease the severity of the symptoms. Symptoms are not normally eliminated completely. Culture must be considered because of catecholamine-O-methyltransferase (COMT), which affects the absorption of levodopa in the body. Some of the drugs used to treat movement disorders can pose a risk of causing renal or hepatic dysfunction, but not all.

When the client prescribed entacapone asks the nurse to describe exactly how this medication works, what response is most appropriate?

"Entacapone inhibits COMT so that dopamine is active for a longer time." Entacapone is a COMT inhibitor. COMT plays a role in brain metabolism of dopamine. Entacapone is administered orally, not parenterally. Entacapone does not increase the metabolism of dopamine in the bloodstream, but it inhibits the metabolism of levodopa in the bloodstream. Entacapone is 90% excreted in the biliary tract and feces and 10% in the urine.

A client is prescribed transdermal selegiline. What health education should the nurse provide?

"Place the patch on dry skin on your torso that has no cuts or openings." Transdermal selegiline should be applied to dry intact skin on the upper torso, upper thigh, or upper arm. The old patch should be removed before placing the new one and there is no need to massage the area.

A 75-year-old client is brought to the emergency department by the family. The family relates that the client has confusion, seizures, and abnormal perception of movement. When the nurse looks at the medication that the family has brought to the ED, the nurse discovers that twice the number of tablets are missing from the vial as there should be if the prescription orders were being followed. What should the nurse suspect is wrong with this client?

Benzodiazepine toxicity Common manifestations include increased anxiety, psychomotor agitation, insomnia, irritability, headache, tremor, and palpitations. Less common but more serious manifestations include confusion, abnormal perception of movement, depersonalization, psychosis, and seizures.

Thyroid hormones are principally concerned with the increase in metabolic rate of tissues that can result in certain effects. What are some of these effects? Select all that apply.

Increased cardiac output Increased heart rate Increased body temperature Thyroid hormones are principally concerned with the increase in metabolic rate of tissues, which results in increased heart and respiratory rate, body temperature, cardiac output, oxygen consumption, and the metabolism of fats, proteins, and carbohydrates.

What organ provides the control over the amount of calcium in the blood?

parathyroid glands Parathyroid chief cells are cells in the parathyroid glands that produce parathyroid hormone. The end result of increased secretion by the chief cells of a parathyroid gland is an increase in the serum level of calcium. Parathyroid chief cells constitute one of the few cell types of the body that regulate intracellular calcium levels as a consequence of extracellular (or serum) changes in calcium concentration. The thyroid controls how quickly the body burns energy and makes proteins, and how sensitive the body should be to other hormones. The pituitary releases ACTH (adrenocorticotropic hormone), which in turn tells the adrenal cortex to release cortisol and aldosterone into the blood. The kidneys are complicated organs that have numerous biological roles. Their primary role is to maintain the homeostatic balance of bodily fluids by filtering and secreting metabolites (such as urea) and minerals from the blood and excreting them, along with water, as urine.

A client's medication regimen for treatment of anxiety has been changed from a benzodiazepine. The client asks the nurse what likely prompted the health care provider to change the medication. What is the nurse's best response?

"Long-term use of benzodiazepines can result in dependency." Although benzodiazepines are effective anxiolytics, long-term use is associated with concerns over tolerance, dependency, withdrawal, lack of efficacy for treating the depression that often accompanies anxiety disorders, and the need for multiple daily dosing with some agents. They do not cause insomnia, convulsions, or depression.

A client with depression has been taking citalopram for several months and has presented for a follow-up assessment. The client tells the nurse, "I've been reading a lot online about the benefits of St. John's wort for depression, so I've started taking it once per day." In addition to referring the client to the provider, what is the nurse's best response?

"There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged." The nurse should explain why this combination is not recommended rather than simply telling the client to comply without providing a rationale. It is true that many herbal remedies contain inconsistent doses, but this is not the primary risk of combining SSRIs with St. John's wort. Taking them at different times of day does not mitigate the risks of an unsafe reaction.

A new mother asks her nurse about the safety of taking St. John's wort for postpartum depression. What would be the nurse's best response?

"There is insufficient evidence to support the use of St. John's wort, and drug interactions may be extensive." Most experts agree that there is insufficient evidence to establish that St. John's wort is effective in treating depression. The herb has some side effects (such as photosensitivity, dizziness, and nausea), though they are usually infrequent and mild. Drug interactions, however, may be extensive. St. John's wort may decrease the effectiveness of some drugs, and combining it with others, such as cold and flu medications, may result in severe hypertension.

A female client's seizure disorder has been successfully controlled by AEDs for years. She and her husband decide that it is time to start a family. She asks the nurse if it is safe for the fetus for her to continue her AEDs as prescribed. What is the nurse's best response?

"They are considered teratogenic." Sexually active adolescent girls and women of childbearing potential who require an AED must be evaluated and monitored very closely, because all of the AEDs are considered teratogenic. In general, infants exposed to one AED have a significantly higher risk of birth defects than those who are not exposed, and infants exposed to two or more AEDs have a significantly higher risk than those exposed to one AED.

A client with a lower back injury was recently prescribed chlorzoxazone 250 mg PO t.i.d. The client has phoned the clinic, telling the nurse, "My pain's better, but I'm worried that my bladder is bleeding because there's been blood in my urine." What is the nurse's best response"

"This drug causes your urine to change color, so it's not likely blood that you're seeing." Chlorzoxazone causes discoloration of the urine that can mimic hematuria. This is not due to a drug-drug interaction. Telling the client to monitor this for the next day without giving any explanation will not alleviate the client's concern.

An adult client diagnosed with narcolepsy admits being embarrassed to receive this diagnosis and is adamant that no one find out about it. The nurse should respond to the client by explaining what aspect of the etiology?

"This is the result of neurologic factors over which you have no direct control." Narcolepsy is a neurologic sleep disorder, not the result of mental illness or psychological problems. It is most likely due to several genetic abnormalities, but family history is not noted to be highly significant. Learning that improvement of sleeping habits is important, but it will not address embarrassment.

A hospitalized client asks the nurse why the health care provider prescribed an anxiolytic medication. What is the nurse's best response?

"This type of medication is typically prescribed to treat excess anxiety that interferes with daily activities." Drugs used to treat anxiety are called antianxiety, or anxiolytic, drugs. Long-term use of benzodiazepines, such as Xanax, can result in physical or psychological dependence. Due to the risk of dependence, benzodiazepines are used for short-term anxiety relief. Due to the risk of dependence, anxiolytics are classified as schedule IV controlled substances. Therefore, anxiolytics require a prescription. Anxiolytic drugs exert their tranquilizing effect by blocking certain neurotransmitter sites.

A black, male client routinely takes haloperidol to manage his psychosis. Recently, he presented to the health care provider's (HCP's) office with signs of tardive dyskinesia, and his HCP modified the drug regimen over time. The client will now take the drug olanzapine and discontinue the haloperidol. What will the nurse tell the client to help decrease his anxiety about the new drug regimen?

"When compared with haloperidol, olanzapine has been associated with fewer extrapyramidal reactions in black clients." Black clients tend to respond more rapidly; experience a higher incidence of adverse effects, including tardive dyskinesia; and metabolize antipsychotic drugs more slowly than white clients. When compared with haloperidol, olanzapine has been associated with fewer extrapyramidal reactions in black clients.

A nurse is providing education to a client who will soon begin taking levothyroxine for the first time. Which teaching point should the nurse include in this education session?

"You'll most likely take this drug for the rest of your life." Levothyroxine is normally taken for the duration of the client's life. It is only administered by the IV route in cases of myxedema coma. It does not require a strict diet of high protein and low carbohydrates and it does not create a need for blood glucose monitoring. The medication should be taken on an empty stomach at least one hour before breakfast or two hours after a meal.

A client has a history of seizures of which the client takes phenytoin on a regular basis. What should the nurse teach the client in order to ensure safety?

Avoid ginkgo supplements Clients being treated with barbiturates or phenytoin should be advised not to use ginkgo, which could cause serious adverse effects. The nurse should collaborate with the care provider about other supplements and OTC medications, but antacids, ginger, garlic and brewer's yeast are not noted to be harmful.

The nurse in the newborn nursery is assessing an infant with suspected congenital hypothyroidism. What assessment findings support this diagnosis? (Select all that apply.)

Bradycardia Feeding difficulties Lethargy Symptoms that support a diagnosis of congenital hypothyroidism include subnormal temperature, low heart rate, feeding difficulties, lethargy, and constipation.

The nurse expects to monitor a client's white blood count weekly when the client is prescribed:

Clozapine Clozapine is associated with significant leukopenia. Subsequently, is it available only through the Clozaril Client Management System, which involves monitoring white blood cell count and compliance issues with only a 1-week supply being given at a time. Aripiprazole, olanzapine, and quetiapine are not associated with leukopenia.

In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill client?

Decreased cardiac workload Antianxiety and sedative-hypnotic drugs are often useful in critically ill clients to relieve stress, anxiety, and agitation. Their calming effects decrease cardiac workload (e.g., heart rate, blood pressure, force of myocardial contraction, myocardial oxygen consumption) and respiratory effort. They do not decrease blood pH, increase diffusion and perfusion, or increase level of consciousness.

Which class of antidepressants exerts their effects by inhibiting reuptake serotonin? (Select all that apply.)

Escitalopram Fluoxetine Selective serotonin reuptake inhibitors, like fluoxetine and escitalopram, exert their effects by inhibiting reuptake of serotonin.

A diabetic patient being treated for obesity tells the nurse that the patient is having adverse effects from the drug therapy. The patient has been taking dextroamphetamine for 2 weeks as adjunct therapy. Which adverse effects would need the nurse's immediate attention?

Increased blood glucose All of the patient's adverse effects should be addressed by the nurse. However, the most critical effect that needs immediate attention would be the increased blood glucose. Drug therapy for the increased blood glucose may need to be altered. The patient should monitor blood glucose levels carefully and report abnormal findings as soon as possible. Medication can help his dry eyes, and a dose adjustment with the dextroamphetamine may be necessary if the jitteriness is profound and does not subside. Sympathomimetic action of the dextroamphetamine may lead to an inability to ejaculate and either increased or decreased libido. The patient may need to seek counseling for this concern.

A male client's health care provider orders antipsychotic medications for him. He experiences little or no side effects from the medications and is able to function successfully in both his home and work environments. Six weeks later, he is diagnosed with hepatitis B. He begins to experience adverse reactions to his medications. A possible reason for the adverse reactions might be that, in the presence of liver disease, what may happen?

Metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Antipsychotic drugs undergo extensive hepatic metabolism and then elimination in urine. In the presence of liver disease (e.g., cirrhosis, hepatitis), metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Therefore, these drugs should be used cautiously in clients with hepatic impairment.

Which action would be a priority for a client receiving apomorphine?

Monitoring cardiac status Apomorphine is associated with a risk for hypotension and a prolonged QT interval. Therefore, the priority would be to monitor the client's cardiac status closely. The drug is given by subcutaneous injection, not oral administration. Checking for skin lesions would be appropriate for a client receiving levodopa due to its association with melanoma. Palpating the bladder would be appropriate for any dopaminergic agent because of the risk for urinary retention. However, this would not be the priority.

A client taking levothyroxine (Synthroid) is starting a new job and will be using a new health insurance and pharmacy formulary. What teaching should the nurse provide to this client regarding Synthroid?

Notify the primary care provider if Synthroid is not covered by insurance. Thyroid hormone replacement drugs are not equivalent to each other. Client should not change brands without first checking with the primary care provider. The provider needs to determine the equivalent dosages when changing medication brands. Thyroid hormones are usually taken once per day.

A client admitted to the hospital with hyperthyroidism treated with propylthiouracil suddenly develops a skin rash. Which action would the nurse implement first?

Notify the primary health care provider. Whenever a client develops a skin rash after taking propylthiouracil, the nurse must notify the primary health care provider immediately because it may be an adverse reaction. The other measures are important to protect the skin integrity: avoid soap and apply soothing cream to affected areas. Recording the weight and reporting weight gain or loss are also important.

A nurse is reviewing the laboratory values of a client being treated for a diagnosis of hypocalcemia. The current serum calcium level is 8.1 mg/dL. What intervention does the nurse expect the prescriber to order?

Order an additional calcium supplement. Normal serum calcium levels are in the range of 8.5 to 10.5 mg/dL. The nurse would anticipate that the level is below the therapeutic range and the prescriber should order another calcium supplement. Once the hypocalcemia is stabilized, finding the underlying cause of recurrence is priority. Measurement of serum magnesium levels should also be completed to correct the hypocalcemia. The potassium chloride infusion is not associated with calcium.

A client with Alzheimer's disease and Parkinson's disease has been receiving benztropine since experiencing worsened tremor activity. The client is not verbally communicative and has been experiencing adverse effects of the anticholinergic in recent days. The client is uncharacteristically agitated this morning, so the nurse should perform what assessment for anticholinergic effects?

Palpate the client's bladder and assess urine volume with a bladder scanner Urinary hesitancy and urinary retention can occur as a result of anticholinergic effects, causing agitation. Dry mouth is an anticholinergic effect as well, but would be less likely to cause the client to be agitated. Similarly, blood pressure changes would not likely cause the client to feel agitated. Pain can cause agitation, especially in clients who are cognitively impaired, but this is not an anticholinergic effect.

A nurse educating a client and their family about levothyroxine (Synthroid) for the treatment of hypothyroidism should advise the client to contact the health care provider if which occur? (Select all that apply.)

Palpitation Excessive diaphoresis Significant weight changes Chest pain A nurse educating a client and their family about levothyroxine (Synthroid) for the treatment of hypothyroidism should advise the client to contact the provider if any of the following occur: headache, nervousness, palpitations, diarrhea, excessive diaphoresis, heat intolerance, chest pain, increased pulse rate, significant weight changes, or any unusual physical change or event.

After 48 hours of thyroid hormone replacement therapy, a client reports still having no appetite. Which is the nurse's best action?

Reassure the client that more time is needed to see results. The full effects of thyroid hormone replacement therapy may not be apparent for several weeks or more, but early effects may be apparent in as little as 48 hours. A lack of appetite at this stage in treatment is not indicative of toxicity. The client should not be told to adjust the dose without the supervision of a health care provider. Although reducing sodium may be suggested, eliminating sodium is not usually recommended. More time is needed to see the full effects of treatment.

The nurse is teaching a client who has been started on antiseizure medications. The nurse should inform the client that abrupt withdrawal from the medications can cause which problem?

Status epilepticus In clients receiving drug treatment for seizure disorders, the most common cause of status epilepticus is abruptly stopping antiseizure drugs. Stopping antiseizure medications does not cause hypertensive crisis, respiratory arrest or cardiac arrhythmias.

The nurse is providing client education regarding the administration of levothyroxine (Synthroid). Which information should the nurse include?

Take with a full glass of water. The client should be instructed to take the medication with a full glass of water to help prevent difficulty swallowing. The medication does not need to be taken on a full stomach and the client does not have to remain in the upright position after taking the medication. The medication should be taken as a single daily dose before breakfast each day to ensure consistent therapeutic levels.

A client is prescribed topiramate. The nurse cautions the client to avoid the intake of alcohol for which reason?

The client is at risk for increased CNS depression. Combining alcohol with topiramate increases the client's risk for CNS depression. Topiramate combined with alcohol does not result in a disulfiram-like reaction. Drug dependency is not associated with the use of topiramate and alcohol. The combination of topiramate and alcohol is not associated with the development of a hypertensive crisis.

Which hormone regulates the production and release of thyroid hormone?

Thyroid-stimulating hormone (TSH) The anterior pituitary hormone called thyroid-stimulating hormone (TSH) regulates thyroid hormone production and release. The secretion of TSH is regulated by thyrotropin-releasing hormone (TRH), a hypothalamic regulating factor. Tetraiodothyronine and triiodothyronine are thyroid hormones produced by the thyroid gland using iodine that is found in the diet.

The nurse is providing education to a client who is taking calcium for the treatment of osteopenia. What is the rationale for the nurse suggesting that the client limit whole grains in the diet?

Whole grains are known to interfere with calcium absorption. Clients should be taught to avoid whole grain cereals in the meal before taking calcium because they interfere with calcium absorption. The restriction is not related to serum phosphate levels, adverse effects, or the nutritional content of the grain products.

A male client is diagnosed with chronic renal failure. He routinely takes amantadine for his Parkinson's disease with success. Why would his health care provider consider discontinuing the amantadine?

With amantadine, excretion is primarily via the kidneys. With amantadine, excretion is primarily via the kidneys, and the drug should be used with caution in clients with renal failure.

A 70-year-old patient has just started taking lorazepam 10 days ago for anxiety issues related the death of her husband. She is staying with her daughter for a couple of weeks. The patient's daughter has noticed that her mother is having difficulty walking and seems to be confused at times and calls the clinic to report this to the nurse. The nurse will inform the daughter that:

a dose adjustment should be made if these symptoms persist. If ataxia and confusion occur, especially in older adults or in a debilitated patient, dose adjustments should be made if the effects persist. If the drug is stopped immediately, withdrawal symptoms may occur. Intravenous administration or continuing the same dosage and medication would not help relieve ataxia or confusion in the patient.

In a person being treated for a diagnosed seizure disorder, what is the most common cause of status epilepticus?

abruptly stopping the antiseizure medications In a person taking medications for a diagnosed seizure disorder, the most common cause of status epilepticus is abruptly stopping AEDs. In other clients, regardless of whether they have a diagnosed seizure disorder, causes of status epilepticus include brain trauma or tumors, systemic or central nervous system (CNS) infections, alcohol withdrawal, and overdoses of drugs (e.g., cocaine, theophylline).

While speaking with a client, the nurse notes that the client stares off, unblinking. The nurse notes that after several prompts, the client blinks rapidly and then resumes normal conversation. This behavior is consistent with what type of seizure?

absence A type of generalized seizure is the absence seizure, characterized by abrupt alterations in consciousness that last only a few seconds. Generalized seizures (tonic-clonic or major motor seizure) involve sustained contraction of skeletal muscles; abnormal postures, such as opisthotonos; and absence of respiration, during which the person becomes cyanotic. The clonic phase is characterized by rapid rhythmic and symmetric jerking movements of the body. Tonic-clonic seizures are sometimes preceded by an aura. Other types of generalized seizures include the myoclonic type (contraction of a muscle or group of muscles) and the akinetic type (absence of movement).

A client reports sensing an unusual smell just prior to experiencing a tonic-clonic seizure. What term is used to describe this event?

aura Tonic-clonic seizures are sometimes preceded by an aura—a brief warning, such as a flash of light or a specific sound or smell. None of the other options accurately describe this event.

A nurse is caring for a client with chronic lymphocytic thyroiditis. The health care provider has prescribed liothyronine. For which condition of the client should the nurse be cautious before administering the drug?

cardiac disease The nurse should be cautious about existing conditions such as cardiac disease and also cautious about lactating clients before administering liothyronine to clients with chronic lymphocytic thyroiditis. The nurse need not be cautious about administering liothyronine to those with upper respiratory tract infection, diabetes, or elevated body temperature. The nurse should observe for elevated body temperature while managing the needs of a client administered thyroid hormones.

The nurse is providing health education for a client who has been prescribed a benzodiazepine. What adverse effect should the nurse discuss in the teaching?

dependence Benzodiazepines carry a significant risk for dependence. They do not cause suicidality, personality changes, or insomnia.

The home care nurse is caring for an 80-year-old patient who is receiving carbidopa-levodopa, a dopaminergic drug used to treat Parkinson's disease. The nurse knows that this drug may place the patient at increased risk for:

falls Adverse effects of dopaminergic drugs such as carbidopa-levodopa include orthostatic hypotension. The dizziness and potential for fainting associated with this effect can increase the risk of falls.

The nurse is caring for a client taking fluoxetine for depression. Which assessment findings indicate that the medication is effective? Select all that apply.

improved sleep decreased anxiety interest in physical activity Selective serotonin reuptake inhibitors such as fluoxetine are the drugs of first choice in the treatment of depression. Assessment findings that indicate therapeutic effects include improved sleep, decreased anxiety, improved appetite, and interest in physical activity. Weight loss is an adverse effect from this medication.

A client diagnosed with Parkinson's disease is being treated with tolcapone. When reviewing the client's medication history, the nurse should confirm that the client is concurrently taking what other drug?

levodopa/carbidopa It is necessary to administer tolcapone in conjunction with levodopa/carbidopa and to monitor the client's response to the medication. Ipratropium, atropine, and benztropine are not indicated.

Antipsychotic drugs are contraindicated in clients with:

liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease. Because of their wide-ranging adverse effects, antipsychotic drugs may cause or aggravate a number of conditions. They are contraindicated in clients with liver damage, coronary artery disease, cerebrovascular disease, parkinsonism, bone marrow depression, severe hypotension or hypertension, coma, or severely depressed states. They should be used cautiously in people with seizure disorders, diabetes mellitus, glaucoma, prostatic hypertrophy, peptic ulcer disease, and chronic respiratory disorders.

The nurse is planning care for a client who has been prescribed a CNS stimulant. What should the nurse establish as the primary goal of therapy?

relieve the symptoms for which they were prescribed. The main goal of therapy with CNS stimulants is to relieve symptoms of the disorders for which they are given. A secondary goal is to have clients use the drugs appropriately. Stimulants are often misused and abused by people who want to combat fatigue and delay sleep, such as long-distance drivers, students, and athletes. College students reportedly use stimulants as study aids. Use of stimulants for these purposes is not justified.

The nurse is caring for a 26-year-old client with partial seizures and has been prescribed oxcarbazepine as monotherapy. It will be critical for the nurse to inform the client of which needed action?

since she is taking oral contraceptives, she will need to use an additional form of birth control. Oxcarbazepine causes the circulating levels of oral contraceptives to decrease by up to half. The nurse should teach the client that she will need to use an additional form of birth control. Fatigue may be a concern, and the client should allow for rest periods during the day. Diplopia and abnormal vision can be adverse effects of the drug and eye exams should be part of the client's treatment regimen but they are not needed every other month. Informing the client that GI problems are common adverse effects is important but not as critical as preventing an unplanned pregnancy.

Alendronate (Fosamax) is prescribed for a 67-year-old postmenopausal woman. In order to help prevent gastrointestinal distress, the nurse will advise the patient to:

stand or sit upright for at least 30 minutes after taking alendronate. To decrease gastrointestinal distress, the patient should stand or sit upright for at least 30 minutes after taking the drug. Drinking at least 6 to 8 oz of water with the drug helps maximize the therapeutic effect of the drug. The patient should also take calcium and vitamin D supplements along with lifting weights to improve the success of therapy, but these interventions would not directly serve to decrease gastrointestinal distress.

A health care provider has asked the nurse to educate a client with Parkinson disease regarding the client's medication regimen. Because the client is taking carbidopa-levodopa, the nurse will assess the client's existing medication regimen for:

tricyclic antidepressants. Carbidopa-levodopa can interact substantially with hydantoins, MAOIs, phenothiazines, or tricyclic antidepressants. It does not interact appreciably with NSAIDs, diuretics, or beta-blockers.

The parents of a two month-old infant have brought their child in to the clinic for the first scheduled immunizations. The parents appear anxious and the child's father says, "We keep hearing about the link between vaccinations and autism. Is there a risk that it could happen to our child?"

"There's been shown to be no genuine link between children receiving vaccinations and developing autism." The parent's question specifically focuses on a putative link between vaccines and autism. It has been shown that there is no link so the nurse should provide this information to the client. The statement about not believing everything you hear could be construed as condescending. The risks of autism as a direct result of vaccinations are not low; instead, they are absent. The nurse's general statement about the safety of vaccines does not address the client's specific question.

The client has been on a systemic corticosteroid for the last 3 weeks. How long should the client wait before receiving a live virus vaccine?

3 months Clients who have been on a systemic corticosteroid longer than 2 weeks should wait 3 months before receiving a live virus vaccine.

A 60-year-old male client received a dose of pneumococcal vaccine during a health care provider's visit. What would the nurse recommend?

A second dose when he turns 65 A second dose of pneumococcal vaccine may be given at age 65 years if the first dose was given 5 years previously.

Which statements best indicates the client understands recommended vaccines following the 65th birthday?

A tetanus-diphtheria booster every 10 years, annual influenza vaccine, and a one-time administration of pneumococcal vaccine at 65 years of age Recommended immunizations for older adults have usually consisted of a tetanus-diphtheria (Td) booster every 10 years, annual influenza vaccine, and a one-time administration of pneumococcal vaccine at 65 years of age. A second dose of pneumococcal vaccine may be given at 65 years if the first dose was given 5 years previously.

When assessing the medical record of an older adult to evaluate the status of his immunizations, the nurse would be looking for evidence of which immunizations? a. Yearly pneumococcal vaccination b. Yearly flu vaccination c. Tetanus booster every 10 years d. Tetanus booster every 5 years e. Measles, mumps, rubella vaccine if the patient was born after 1957 f. Varicella vaccine only if there is evidence that the patient had chickenpox as a child

b. Yearly flu vaccination c. Tetanus booster every 10 years

A nurse suffers a needlestick after injecting a patient with suspected hepatitis B. The nurse should a. have repeated titers to determine whether she was exposed to hepatitis B and if she was have hepatitis immune globulin. b. immediately receive hepatitis immune globulin and begin hepatitis B vaccines if she has not already received them. c. start antibiotic therapy immediately. d. go on sick leave until all screening tests are negative.

b. immediately receive hepatitis immune globulin and begin hepatitis B vaccines if she has not already received them.

It is now recommended that all people over the age of 6 months should receive a flu vaccine every fall based on the understanding that the vaccine is repeated because a. the immunity wears off after a year. b. the strains of virus predicted to cause the flu change every year. c. a booster shot will activate the immune system. d. flu shots do not produce good antibodies.

b. the strains of virus predicted to cause the flu change every year.

A mother brings her child to his 18-month well-baby visit. The nurse would not give the child his routine immunizations in which situations? a. He cried at his last immunization. b. He developed a fever or rash after his last immunization. c. He currently has a fever and symptoms of a cold. d. He is allergic to aspirin. e. He is currently taking oral corticosteroids. f. His siblings are all currently being treated for a viral infection.

c. He currently has a fever and symptoms of a cold. e. He is currently taking oral corticosteroids. f. His siblings are all currently being treated for a viral infection.

The nurse reviews a patient's record to make sure that tetanus booster shots have been given a. only with exposure to anaerobic bacteria. b. every 2 years. c. every 5 years. d. every 10 years.

d. every 10 years.

A client is scheduled to receive an immunization. In which client may the administration of a live vaccine be contraindicated?

Client taking steroid therapy Clients receiving a systemic corticosteroid in high doses (e.g., prednisone 20 mg or equivalent daily) or for longer than 2 weeks should wait at least 3 months before receiving a live-virus vaccine. No evidence supports withholding immunizations related to renal insufficiency or hepatic failure. Clients over the age of 65 should receive immunizations as needed to protect from infectious disease.

A 1-year-old child will receive a scheduled MMR vaccination shortly. The nurse should teach the child's parents that the child may develop what possible adverse effect related to the administration of this medication?

Cough and fever Adverse effects associated with MMR vaccine include fever and cough. Nausea and vomiting, pallor and listlessness, and serum sickness are not among the noted adverse effects of the MMR vaccine.

A client has presented to the emergency department with a puncture wound suffered a few hours ago while demolishing an old house. The nurse's assessment reveals that the client is not in acute distress. The client's immunization status is unknown. What intervention should the nurse prioritize?

Administering tetanus immune globulin as prescribed Puncture wounds are a common source of tetanus infection and the administration of tetanus immune globulin is recommended if the client's immunizations are out of date or unknown. Cytomegalovirus immune globulin is administered to transplant recipients. The client would benefit from education, but this intervention is not time dependent or an immediate priority. The client's injury is recent, so there would not yet be signs of infection.

The parents of an infant are skeptical of immunizing their child, stating, "I've heard a lot about the risks of autism, and I'm not comfortable with increasing that risk." What is the nurse's best response?

"Could we talk about some of the risks that you heard about?" The nurse should take an approach that is respectful and which fosters further dialogue without dismissing or downplaying the parents' concerns.

A primiparous woman tells the nurse that she and her partner are highly reluctant to have their infant vaccinated, stating, "We've read that vaccines can potentially cause a lot of harm, so we're not sure we want to take that risk." How should the nurse respond to this family's concerns?

"Vaccinations are not without some risks, but these are far exceeded by the potential benefits." Mild reactions to vaccinations are common, but serious reactions are rare. Consequently, the benefits of vaccinations exceed the risks. Parental choice is still respected in most instances.

The nurse is preparing to administer a dose of the human papillomavirus vaccine to a middle school student. What assessment question should the nurse prioritize when interacting with the student?

"What's your understanding of why you're getting this vaccination?" The nurse cannot make the assumption that the client knows about the rationale for the vaccination. The client may know nothing about HPV or its relationship to her future cancer risk. This assessment question can be used to introduce client teaching. A middle school student is unlikely to know whether her parents or caregivers have ensured that her immunizations match the recommended schedule. The HPV vaccine does not require a booster and minimal - if any - side effects are anticipated.

The nurse is working with an 18-year-old client who recently immigrated and who did not receive childhood immunizations. The client is "catching up" on immunizations and is scheduled to receive a measles, mumps and rubella (MMR) vaccine today. What should the nurse teach the client about potential adverse effects?

"You might feel a bit unwell or get a slight fever after receiving your immunization." In general, immunizations are well tolerated. However, there is a possibility of a mild immune or inflammation reaction that sometimes causes a mild fever or malaise. Chills can also occur, but this does not constitute an emergency unless it is accompanied by other symptoms that cause distress. Clients are often monitored briefly after receiving a vaccine, but this does not normally require multiple hours of direct observation.

For the first time, a 10 year-old female has received an IM injection of Gardasil. What follow-up education should the nurse provide?

"You'll have to get another shot in around 2 months." Gardasil requires a series, a with a second dose two months after the first. A fever is not expected, nor is stomach pain. Without the appropriate boosters, the client will not be protected later in life.

An adult client is scheduled to receive the inactivated hepatitis A vaccine. The nurse should provide what education to the client?

"You'll need another dose of the vaccine in six to 12 months from now." Hepatitis A vaccine requires a repeat dose in six to twelve months. There is no prohibition against drinking alcohol after receiving the vaccine. B cells take more than 48 hours to create the necessary immunoglobulins for conferring immunity. The hepatitis A vaccine does not require an annual booster.

When a person is exposed to antigens, the body begins to form antibodies. This is called

Active immunity

A hospitalized client is about to receive immunological therapy and asks the nurse to explain the difference between passive and active immunity. In order to provide complete information, the nurse knows to include which information during the teaching session?

Active immunity occurs when a client receives a killed or weakened antigen that stimulates antibodies. These antibodies fight the antigen (for example, chickenpox vaccine).

A 23-year-old client is prescribed a thyroid-hormone antagonistic drug. Which should a nurse determine during an ongoing assessment and evaluation of the drug therapy?

Administer the drug early in the morning before breakfast. The nurse should instruct the client to administer the drug early in the morning before breakfast to promote an optimal response to the drug therapy since an empty stomach increases the absorption of the oral preparation.

The nurse at the pediatric clinic gives the mother of an infant a written record of the infant's immune sera use. The nurse encourages the mother to keep the information. What is the rationale behind keeping a written record of immune sera use?

Avert future reactions Provide a written record of immune sera use and encourage the patient or family to keep that information to ensure proper medical treatment and to avert future reactions. Written records are not kept to keep track of where the immune sera was given or to identify who gave the immune sera or to identify the lot number of the immune sera used.

An adult client being treated for breast cancer inquired about required vaccinations. What information should the nurse provide to this client?

Avoid all live vaccines. Clients with active malignant disease should not receive live vaccines. A tetanus-diphtheria-pertussis booster is not likely necessary, and there is no indication for a pneumococcal immunization. When possible, clients should have needed immunizations 2 weeks before or 3 months after immunosuppressive radiation or chemotherapy treatments.

A patient with a history of chronic cough is suspected of having pulmonary tuberculosis. Which vaccination is used to prevent the condition?

BCG vaccine For the prevention of pulmonary tuberculosis (TB) in high-risk populations such as health care workers, infants, and children in endemic areas, a BCG vaccination is given. The MMR vaccine is used for preventing measles, mumps, and rubella. The DPT vaccine is used for the prevention of diphtheria, pertussis, and tetanus. IPV is an inactivated polio virus used to prevent polio.

The nursing students are learning about childhood vaccinations. What would they learn is the recommended childhood and adolescent immunization schedule for measles, mumps, and rubella (MMR)?

Between 12 and 15 months and between 4 and 6 years The recommended schedule for the MMR is the first dose between 12 and 15 months and the second dose between 4 and 6 years. The schedule for inactivated poliovirus is 2 and 4 months, between 6 and 18 months, and between 4 and 6 years. Immunization for Haemophilus influenzae is 2, 4, and 6 months and between 12 and 15 months. The schedule for hepatitis A is between 24 months and 18 years of age.

What is the best source of information for current recommendations regarding immunizations and immunization schedules?

Centers for Disease Control and Prevention Recommendations regarding immunizations change periodically as additional information and new immunizing agents become available. Consequently, health care providers need to update their knowledge at least annually. The best source of information for current recommendations is the Centers for Disease Control and Prevention (http://www.cdc.gov).

The nurse is preparing to administer a vaccine to a newborn. What action would the nurse take prior to administering the vaccine?

Check the infant's temperature. The nurse should check the infant's temperature before administering any vaccine. Three injection sites are not normally required, and vigorous massage is not indicated. Warming the vaccine is not normally necessary.

A nurse should warn a client about which adverse reactions that can occur after the administration of influenza vaccine ? (Select all that apply.)

Chills Fever Lethargy Muscle aches Adverse reactions from the administration of vaccines or toxoids are usually mild and include chills, fever, muscle aches and pains, rash, and lethargy

The nurse educator is teaching a class of community leaders about immunologic agents. To minimize the concern regarding adverse effects of vaccinations, the nurse should include which mild reactions in the teaching plan?

Chills and fever Chills and fever are mild adverse reactions observed after administration of vaccines. None of the other options are generally associated with mild adverse reactions to vaccines.

A group of students are role-playing scenarios involving biological weapon exposure. Which medication would the students identify as using for a client with cutaneous anthrax?

Ciprofloxacin For cutaneous anthrax, ciprofloxacin or doxycycline would be used.

Serum sickness occurs when

a host with circulating injected antibodies responds by producing its own antibodies to those injected

A nurse is administering a mumps vaccine to an adolescent. Which medication should be available when administering an immunization?

Epinephrine The administration of vaccines for immunization possesses the risk of an allergic reaction and anaphylaxis. The nurse should have aqueous epinephrine available in the event of an anaphylactic reaction. The administration of diphenhydramine or hydroxyzine will reduce the allergic reaction but will not be effective in the event of anaphylaxis. Physostigmine is not administered.

An adult client received the annual influenza vaccine yesterday afternoon and has now presented back to the clinic reporting malaise. The client's oral temperature is 37.4°C (99.3°F). What is the nurse's best action?

Explain that vaccines often cause a mild immune response and have the client self-monitor Vaccines often cause symptoms such as fever, malaise, chills or agitation due to their stimulation of the immune system and the inflammatory process. However, this does not mean the client has an active influenza infection. Anaphylaxis would occur much earlier and with more significant signs and symptoms. Monitoring at the clinic would consequently not be necessary. The client's temperature does not constitute a fever.

Serum sickness occurs more commonly with the use of vaccines than with immune sera. True or false

False Serum sickness occurs more often when immune sera are used.

An immunocompromised client is exposed to hepatitis A. The health care provider orders an injection of immunoglobulin as prophylaxis against the hepatitis A. What adverse effects would the nurse advise the client might occur? (Select all that apply.)

Fever Angiedema Urticaria Adverse effects: Tenderness, muscle stiffness at site of injection; urticaria, angiedema, nausea, vomiting, chills, fever, and chest tightness. An immunocompromised client would not be told to watch for rhinitis or severe abdominal pain.

Which would a nurse expect to administer to a client who has not been immunized and has sustained a bite from an animal with rabies?

Immune globulin An immune globulin, specifically rabies immune globulin, would be used to prevent rabies in nonimmunized clients who are exposed to rabies. An antitoxin is used to treat poisonous substances released by invading pathogens, for example, botulism. Antivenin would be used to treat snake bites. Immune sera is a general term that includes immune globulins, antitoxins, and antivenins.

A nurse is receiving post-exposure prophylaxis for hepatitis B. What would the nurse most likely receive?

Immune globulin Hepatitis B immune globulin would be used for post-exposure prophylaxis for hepatitis B. This vaccine would be used to prevent herpes zoster (shingles) in persons over the age of 60 years. Antivenin (crotalidae) would be used to neutralize the venom of pit vipers, rattlesnakes, and copperheads. BCG vaccine would be used to prevent tuberculosis in those with a high risk for exposure.

A group of nursing students are presenting information on the hepatitis B vaccine. What would the students prepare to tell others about the recommended population?

Infants and people at high risk for contracting the disease As recommended by the World Health Organization and the CDC, the hepatitis B vaccine should be given to infants and should be given to all children under the age of 18/19 that have not been previously recommended. The vaccine is also recommended in certain high-risk populations among adults. While this population includes children under the age of 15, the vaccine is recommended for all children under the age of 18 or 19. There are not indications to receive the vaccine for people with diabetes or renal disease or all people over the age of 65.

When providing client teaching to parents regarding measles, mumps, and rubella vaccine administration, which is most important regarding the schedule for administration?

It is administered at 12 to 15 months. Measles, mumps, and rubella immunization is administered initially at 12 to 15 months of age. The vaccine is not administered under the age of 1 year.

A young mother asks the clinic nurse about the "chickenpox" vaccine. The mother states that she and her husband have both had chickenpox, but that she wants to protect her child if she can. What should the nurse tell the mother about the recommendation for the chickenpox vaccine?

It is recommended for all children who have not been exposed to the varicella virus. Measles, mumps, rubella, varicella virus vaccine 0.5 mL Sub-Q. Simultaneous immunization against measles, mumps, rubella, and varicella in children aged 12 months to 12 years.

An infant is being administered an immunization. Which statement provides an accurate description of an immunization?

It is the administration of an antigen for an antibody response. Immunization involves administration of an antigen to induce antibody formation. This protects the child against the actions of infectious agents; it does not prevent exposure to them. Immunization must be administered to the child following birth. There are limited adverse effects associated with immunization; autism is not among them.

A nurse should screen clients of child-bearing age for pregnancy as the administration of which vaccines is contraindicated during pregnancy? (Select all that apply.)

Measles Varicella Rubella Mumps The measles, mumps, rubella, and varicella vaccines are contraindicated during pregnancy, especially during the first trimester, because of the danger for birth defects.

A nursing instructor is discussing the intended populations for various vaccines. Which groups might the instructor mention when discussing the hepatitis B vaccine?

Paramedics and emergency medical technicians Pre-exposure immunization against hepatitis B is recommended for people at high risk for exposure to the disease. This can include health care workers (e.g., paramedics and EMTs); patients with cancer, organ transplants, hemodialysis, immunosuppression drug therapy, or multiple infusions of blood products; sexually active gay and bisexual males; IV drug users; household contacts of HBV carriers; and residents and staff of institutions for people with intellectual disability.

The nursing instructor is discussing immunity with the clinical group. What statement would the instructor make that would be an accurate statement concerning immunity?

Passive immunity is limited. Unlike active immunity, passive immunity is limited. It lasts only as long as the circulating antibodies last because the body does not produce its own antibodies as with active immunity. People are born with active immunity in which the body recognizes a foreign protein and begins producing antibodies to react with specific proteins or antigens.

Which statement should the nurse include in a discussion about passive immunity?

Passive immunity provides temporary protection from disease. Passive immunity results from parenteral administration of immune serum containing disease-specific antibodies to a nonimmune person. Passive immunity is only temporary, and the person still needs a vaccine against a specific disease to develop antibodies that provide long-term immunity. It is inaccurate to characterize passive immunity as being safer than active immunity. Administration of antigens results in active immunity.

A client develops fever and arthralgia 4 days after the administration of tetanus toxoid. What reaction to the vaccine is this?

Serum sickness Serum sickness presents several days after the administration of a vaccine with symptoms of urticaria, fever, arthralgia, and enlarged lymph nodes. The presence of fever and arthralgia after the administration of an immunization is not noted as an infectious process, anaphylaxis, or distress syndrome.

After teaching a parent about common adverse effects associated with routine immunizations, which of the following, if stated by the parent, would indicate the need for additional teaching? a. Difficulty breathing and fainting b. Fever and rash c. Drowsiness and fretfulness d. Swelling and nodule formation at the site of injection

a. Difficulty breathing and fainting

A client has received a rubella immunization. The client was unaware that she was pregnant. What risk is associated with the administration of the rubella immunization in this client?

Risk of birth defects Rubella during the first trimester of pregnancy is associated with a high incidence of birth defects in the newborn. Rubella is not associated with the development of disease. Rubella is not associated with low birth weight or preterm labor.

A 65-year-old client is being seen in the emergency department for exposure to rabies. The nurse checks the electronic health record and discovers the client has had no history of allergic reactions to immunization agents. The client's history guides the nurse to take which action?

Teach the client that the agent of choice is rabies immune globulin Exposure to rabies is treated with the immunization agent called rabies immune globulin. Administration is not contraindicated in senior citizens, and herbal remedies are not the recommended treatment of choice.

Middle aged adults and health care workers should receive which immunizations?

Tetanus-diphtheria-pertussis; hepatitis B vaccine once and influenza vaccine annually Middle-aged adults should maintain immunizations against tetanus-diphtheria-pertussis; high-risk groups (e.g., those with chronic illness) and health care providers should receive hepatitis B vaccine once (if not previously taken) and influenza vaccine annually at 50 years of age and older.

The nurse is providing wellness information to a 50-year-old client who is employed as a paramedic. The client asks what, if any, vaccines the client should get. What is the nurse's best response?

Tetanus-diphtheria-pertussis; hepatitis B vaccine once; influenza vaccine annually Middle-aged adults should maintain immunizations against tetanus-diphtheria-pertussis. Health care providers should receive hepatitis B vaccine once (if not previously taken). The influenza vaccine is recommended annually for everyone over the age of 6 months. An additional vaccine to prevent zoster infections (shingles) is available for adults aged 60 years and older. Middle-aged adults born after 1956 should get at least one dose of measles-mumps-rubella (MMR) vaccine unless they have had either the vaccine or each of the three diseases.

A male client is being assessed after consuming packaged salad that is known to have been contaminated with hepatitis A. The use of hepatitis A immune globulin is being considered by the care team. What assessment finding should the nurse prioritize for communicating to the client's provider?

The client received hepatitis A immune globulin under similar circumstances one year ago The chances of a hypersensitivity reaction increase with repeat administrations of immune globulins. The nurse should ensure the provider is aware of the fact that the client received this immune globulin last year. The client's alcohol use is on the threshold of being problematic but would not be the priority. Flu-like symptoms after the influenza vaccine do not preclude the use of hepatitis immune globulin. Similarly, allergies to NSAIDs or penicillins do not rule out the safe use of this immune globulin.

A client has come to the clinic requesting a hepatitis A and B vaccination before leaving on a tropical vacation. After assessing the client, the nurse should prioritize what finding to communicate to the provider?

The client takes corticosteroids to treat rheumatoid arthritis Corticosteroids decrease the normal immune response and could interfere with the intended stimulation of B cells. Recent influenza vaccination does not contraindicate the hepatitis vaccine, nor does type 2 diabetes. Occasional marijuana use would not contraindicate a hepatitis vaccination.

A 70-year-old client is seen in the family practice clinic. Which vaccine should be administered to prevent herpes zoster?

Zoster vaccine Zoster vaccine is administered to adults 60 years and older to prevent herpes zoster (shingles). The Haemophilus influenzae type B is not administered to prevent herpes zoster. HPV and pneumococcal vaccine do not address the risk factors for shingles.

A public education campaign to stress the importance of childhood immunizations should include which points? a. Prevention of potentially devastating diseases outweighs the discomfort and risks of immunization. b. Routine immunization is standard practice in the United States. c. The practice of routine immunizations has virtually wiped out many previously deadly or debilitating diseases. d. The risk of severe adverse reactions is on the rise and is not being addressed. e. If there is a family history of autism, that person should avoid immunizations. f. The temporary discomfort associated with the immunization can be treated with over-the-counter drugs.

a. Prevention of potentially devastating diseases outweighs the discomfort and risks of immunization. b. Routine immunization is standard practice in the United States. c. The practice of routine immunizations has virtually wiped out many previously deadly or debilitating diseases. f. The temporary discomfort associated with the immunization can be treated with over-the-counter drugs.

A patient is to receive immune globulin after exposure to hepatitis A. The patient has a previous history of allergies to various drugs. Before giving the immune globulin, the nurse should a. have emergency equipment readily available. b. premedicate the patient with aspirin. c. make sure all of the patient's vaccinations are up to date. d. make sure the patient has a ride home.

a. have emergency equipment readily available.

A client receives an immunization. The nurse interprets this as providing the client with which type of immunity?

artificially acquired active immunity Artificially acquired active immunity occurs when an individual is given a killed or weakened antigen, which stimulates the formation of antibodies against the antigen. The antigen does not cause the disease, but the individual still manufactures specific antibodies against the disease. Naturally acquired active immunity occurs when the person is exposed to and experiences a disease and the body manufactures antibodies to provide future immunity to the disease. Passive immunity occurs when immune globulins or antivenins are administered. This type of immunity provides the individual with ready-made antibodies from another human or an animal. When a person is exposed to certain infectious microorganisms (the source of antigens), the body actively builds an immunity (forms antibodies) to the invading microorganism. This is called active immunity.

A landscaper has sought care because of a puncture wound to her foot and the provider has prescribed 250 units of the tetanus immune globulin. In preparation for administration, the nurse should:

assess the skin integrity of potential intramuscular injection sites. The tetanus immune globulin is administered by the IM route. Education is likely necessary but the administration of the immune globulin is the priority. Tetany develops several days after tetanus infection.

A client diagnosed with excessive parathyroid production is prone to develop:

osteopenia Most of the symptoms of parathyroid disease are "neurological" in origin. The most common symptoms are fatigue and tiredness. Other very common symptoms are lack of energy, memory problems, depression, problems with concentration, and problems sleeping. However, these symptoms are improved after intervention.

The administration of immune globulins or antivenins to a client is a form of what type of immunity?

passive immunity Passive immunity occurs when immune globulins or antivenins are administered. This type of immunity provides the individual with ready-made antibodies from another human or an animal. When a person is exposed to certain infectious microorganisms (the source of antigens), the body actively builds an immunity (forms antibodies) to the invading microorganism. This is called active immunity. Artificially acquired active immunity occurs when an individual is given a killed or weakened antigen, which stimulates the formation of antibodies against the antigen. The antigen does not cause the disease, but the individual still manufactures specific antibodies against the disease. Naturally acquired active immunity occurs when the person is exposed to and experiences a disease and the body manufactures antibodies to provide future immunity to the disease.

A nurse prepares to administer antithymocyte immune globulin. The nurse understands that this is used to:

treat acute renal transplant rejection. Antithymocyte immune globulin is used to treat acute renal transplant rejection. The varicella virus vaccine would be used to prevent varicella (chickenpox). Hepatitis B immune globulin would be used for post exposure prophylaxis for hepatitis B. Respiratory syncytial virus (RSV) immune globulin would be used to prevent RSV in children younger than 2 years of age with bronchopulmonary dysplasia or premature birth.

streptomycin or gentamicin would be used for

tularemia.