Pharmacology version 4 HESI

Which question should the nurse ask a client prior to the initiation of treatment with IV infusions of gentamicin sulfate?

"Are you having difficulty hearing?" Rationale: Complications of gentamicin sulfate therapy include ototoxicity, nephrotoxicity, and neurotoxicity. Determining if the client is hard of hearing prior to initiation of this aminoglycoside will be helpful as the treatment progresses and ototoxicity is identified as a possible complication.

Which statement indicatesthat client teaching regarding the administration of the chemotherapeutic agent daunorubicin HCl has been effective?

"I expect my urine to be red for the next few days." Rationale: Daunorubicin HCl causes the urine to turn red in color.

A client is taking famotidine. Which client statement should the nurse further assess because it may indicate that the client is experiencing a side effect of this drug?

"I seem to be having difficulty thinking clearly." Rationale: A common side effect of of famotidine is confusion.

The nurse is evaluating a client's understanding of the prescribed antilipemic drug lovastatin. Which client statement indicates that further teaching is needed?

"I will take the medication every day before breakfast." Rationale: The enzyme that helps metabolize cholesterol is activated at night, so this medication should be taken with the evening meal. Options A, B, and C"My bowel habits should not be affected by this drug." , "This medication should be taken once a day only." And "I will still need to follow a low-cholesterol diet." reflect correct information about lovastatin.

A client is receiving oral griseofulvin for a persistent tinea corporis infection. Which response by the client indicates an accurate understanding of the drug teaching conducted by the nurse?

"I'll wear sunscreen whenever I mow the lawn." Rationale: Photosensitivity is a side effect of griseofulvin, so clients should be cautioned to wear protective sunscreen during sun exposure.

A client is receiving anti-infective drug therapy for a postoperative infection. Which complaint should alert the nurse to the possibility that the client has contracted a superinfection?

"My mouth feels sore." Rationale: Stomatitis caused by a thrush infection, which can cause mouth pain, is a sign of superinfection. Headache, ears feeling plugged up and constipation are more typical side effects, rather than symptoms, of a superinfection.

The nurse is preparing a teaching plan for a client who has received a new prescription for levothyroxine sodium. Which instruction should be included?

"Take your pulse daily, and if it exceeds 100 beats/min, contact the health care provider." Rationale: Levothyroxine sodium should be withheld if the pulse is over 100 beats/min. To prevent insomnia, the daily dose should be taken early in the morning before breakfast, not at bedtime. Product brands should not be changed without consulting the health care provider because the intended effects and side effects of different formulations of the medication can vary.

The nurse has completed diabetic teaching for a client who has been newly diagnosed with diabetes mellitus. Which statement by this client would indicate to the nurse that further teaching is needed?

"When I exercise, I should plan to increase my insulin dosage." Rationale: Exercise helps facilitate the entry of glucose into the cell,so increasing insulin doses with exercise would place the client at high risk for a hypoglycemic reaction. "Regular insulin can be stored at room temperature for 30 days.", "My legs, arms, and abdomen are all good sites to inject my insulin." And "I will always carry hard candies to treat hypoglycemic reactions." reflect accurate statements about the use of insulin and management of hypoglycemic reactions.

A client is ordered 22 mg of gentamicin by IM injection. The drug is available in 20 mg/2 mL. How many milliliters should be administered?

2.2 mL Rationale: (22 mg/20 mg) × (x mL/2 mL) = 22x = 40 x = 2.2 mL

Amoxicillin, 500 mg PO every 8 hours, is prescribed for a client with an infection. The drug is available in a suspension of 125 mg/5 mL. How many milliliters should the nurse administer with each dose?

20 mL Rationale: 500 mg/x mL = 125 mg/5 mL 125x = 2500 x = 20 mL

Dopamine, 5 mcg/kg/min, is prescribed for a client who weighs 105 kg. The nurse mixes 400 mg of dopamine in 250 mL D5W for IV administration via an infusion pump. What is the hourly rate that the nurse should set on the pump?

20 mL/hr Rationale: 400 mg/250 mL equals 1.6 mg/mL, or 1600 mcg/mL. The prescription for 5 mcg/kg/min would result in 31,500 mcg/hr. Delivery of that dose would be achieved by administering 20 mL/hr, which would deliver 5.07 mcg/kg/min. Options A, B, and C are not accurate hourly rates for this infusion.

The nurse is administering the early morning dose of insulin as part, 5 units subcutaneously, to a client with diabetes mellitus type 1. The client's fingerstick serum glucose level is 140 mg/dL. Considering the onset of insulin as part, when should the nurse ensure that the client's breakfast be given?

5 minutes after subcutaneous administration Rationale: Insulin aspart is a very rapidly acting insulin, with an onset of 5 to 15 minutes. Insulin aspart should be administered when the client's tray is available. Insulin aspart peaks in 45 minutes to 1½ hours and has a duration of 3 to 4 hours. The client should have eaten to ensure absorption of the meal so that serum glucose levels will coincide with the peak. Insulin glargine has a flat peak of action and is usually given at bedtime.

The charge nurse isreviewing the admission history and physical data for four clients newly admitted to the unit. Which client is at greatest risk for adverse reactions to medications?

75-year-old woman with liver disease Rationale: Impaired hepatic metabolic pathways for drug and chemical degradation place option an elderly pt at greatest risk for adverse reactions to medications based on advancing age and liver disease.

A male client with prostatic carcinoma has arrived for his scheduled dose of docetaxel chemotherapy. What symptom would indicate a need for an immediate response by the nurse prior to implementing another dose of this chemotherapeutic agent?

A cough that is new and persistent Rationale: A cough that is new and persistent is an adverse effect that is immediately life threatening. Severe fluid retention can cause pleural effusion (requiring urgent drainage), dyspnea at rest, cardiac tamponade, or pronounced abdominal distention (caused by ascites). Persistent nausea and vomiting, Fingernail and toenail changes and Increasing weakness and neuropathy are all adverse effects from chemotherapy and need to be monitored consistently.

The nurse is preparing to administer a secondary infusion of a dobutamine solution to a client. The nurse notes that the solution is brown in color. Which action should the nurse implement?

Administer the drug if the solution's reconstitution time is <24 hours. Rationale: The color of the dobutamine solution is normal, and the solution should be administered within 24 hours after reconstitution, so the time of reconstitution should be verified before administering the solution of medication.

Methylphenidate is prescribed for daily administration to a 10-year-old child with attentiondeficit/hyperactivity disorder (ADHD). In preparing a teaching plan for the parents of this child newly diagnosed with ADHD, which instruction is most important for the nurse to provide to the parents?

Administer the medication in the morning before the child goes to school. Rationale: Methylphenidate is a central nervoussystem (CNS) stimulant. To be most effective in affecting the child's behavior, the dose of the drug should be administered in the morning before the child goes to school. Drug holidays are often prescribed to assess the child's degree of recovery; however, such interruptions are not conducted in the early phase of treatment and are usually implemented when side effects occur over a period of time.

The nurse performs a client assessment prior to the administration of a prescribed dose of dipyridamole and aspirin PO. The nurse notes that the client's carotid bruit is louder than previously assessed. Which action should the nurse implement?

Administer the prescribed dose as scheduled. Rationale: A carotid bruit reflects the degree of blood vessel turbulence, which is typically the result of atherosclerosis. Aspirin is prescribed to reduce platelet aggregation and should be administered to this client, who is at high risk for thrombus occlusion.

Which nursing intervention has the highest priority during IV administration of mechlorethamine HCl and actinomycin?

Assess for extravasation at the IV site during infusion. Rationale: Mechlorethamine HCl and actinomycin are vesicants; therefore, assessment for blister formation and/or tissue sloughing that can occur with leakage of these agents into surrounding subcutaneous tissues is essential to ensure client safety during the IV infusion.

A client with Tourette syndrome takes haloperidol to control tics and vocalizations. The client has become increasingly drowsy over the past 2 days and reports becoming dizzy when changing from a supine to sitting position. Which action should the nurse take?

Assess for poor skin turgor, sunken eyeballs, and concentrated urine output. Rationale: Because haloperidol causes CNS effects of sedation and decreased thirst, the nurse should assess for signs of dehydration. Sedation may occur with haloperidol administration, this side effect may signal an adverse CNS reaction. urine pink or reddish brown is expected.

When providing nursing care for a client receiving pyridostigmine bromide for myasthenia gravis, which nursing intervention has the highest priority?

Assess respiratory status and breath sounds often. Rationale: The client should be assessed often for signs of respiratory complications. The client with myasthenia gravis is at greatest risk for life-threatening respiratory complications because of the weakness of the diaphragm and ancillary respiratory muscles caused by the disease process. Cholinergic agents used to reduce muscle weakness can also cause hypersalivation, increased respiratory secretions, and possible bronchoconstriction.

The nurse is preparing to apply a surface anesthetic agent for a client. Which action should the nurse implement to reduce the risk of systemic absorption?

Avoid abraded skin areas when applying the anesthetic. Rationale: To minimize systemic absorption of topical anesthetics, the anesthetic agent should be applied to the smallest surface area of intact skin. Application to the mucous membranes poses the greatest risk of systemic absorption because absorption occurs more readily through mucous membranesthan through the skin. Inflamed areas generally have an increased blood supply, which increases the risk of systemic absorption. A large surface area increases the amount of topical drug that is available for transdermal absorption, so the smallest area should be covered not the largest.

A female client with trichomoniasis(Trichomonas vaginalis) receives a prescription for metronidazole. Which instruction is most important for the nurse to include in this client's teaching plan?

Avoid alcohol consumption. Rationale: Clients should be instructed to avoid alcohol and products containing alcohol while taking metronidazole because of the possibility of a disulfiram-like reaction.

The nurse is providing discharge instructions to a client who has received a prescription for an antibiotic that is hepatotoxic. Which information should the nurse include in the instructions?

Avoid ingesting any alcohol or acetaminophen. Rationale: Combining hepatotoxic drugs, such as acetaminophen and alcohol, increases the risk of liver damage. A client who is receiving a hepatotoxic drug should report any hepatotoxic symptoms, such as jaundice, dark urine, or light-colored stools.

Which instruction should the nurse include in the teaching plan for a client who is receiving phenytoin for seizure control?

Brush and floss teeth daily. Rationale: Brushing and flossing the teeth daily prevents gingival hyperplasia (gum disease) that is common with long-term phenytoin therapy.

A client is receiving pyridostigmine bromide to control the symptoms of myasthenia gravis. Which client behavior would indicate that the drug therapy is effective?

Clear speech Rationale: Clear speech is the result of increased muscle strength. Muscle weakness characteristic of myasthenia gravis often first appears in the muscles of the neck and face. Decreased oral secretions and increased ptosis are symptoms of multiple sclerosis that would persist if the medication was ineffective. Hand tremors are not typical symptoms of the disease.

Which factor is most important to ensure compliance when planning to teach a client about a drug regimen?

Client education Rationale: The client's educational level is the most important factor when planning teaching to ensure a client's compliance with taking a prescribed drug. Genetics and absorption rate are physiologic responses that do not relate to a client's compliance. Although maturity level and age contribute to compliance, the client's basic understanding of instructions, which is best indicated by educational level, is more significant.

To evaluate whether the administration of an antihypertensive medication has caused a therapeutic effect, which action should the nurse implement?

Compare the client's blood pressure before and after the client takes the medication. Rationale: Therapeutic effects are the expected or predictable physiologic responses to a medication. An antihypertensive medication is administered to lower blood pressure, so to determine if the therapeutic effect has been achieved, the nurse should compare the client's blood pressure before and after the client takes the medication. Ask the client about the onset of any dizziness since taking the medication and Measure the client's blood pressure while the client is lying, sitting, and then standing provide data related to the side effect of hypotension, which may occur following the administration of an antihypertensive medication. Interviewing the client about any past or recent history of high blood pressure provides useful data but does not evaluate the medication's effectiveness.

A client who has trouble swallowing pills intermittently has been prescribed venlafaxine (XR) for depression. The medication comes in capsule form. What should the nurse include in the discharge teaching plan for this client?

Contact the health care provider for another form of medication. Rationale: Venlafaxine is administered PO in capsule form. Capsules that are extended-release (XR) or continuous release (CR) contain delayed-release, enteric-coated granules to prevent decomposition of the drug in the acidic pH of the stomach. The client should notify the health care provider about the inability to swallow the capsule. This medication should not be chewed or opened so that the delayed-release, enteric-coated granules can remain intact. Water or juice will not affect the medication.

When developing a written nursing care plan for a client receiving chemotherapy for treatment of cancer, the nurse writes, "Assess each voiding for hematuria." The administration of which type of chemotherapeutic agent would prompt the nurse to add this intervention?

Cyclophosphamide Rationale: Hemorrhagic cystitis is the characteristic adverse reaction of cyclophosphamide.

Following the administration ofsublingual nitroglycerin, which assessment finding indicatesthat the medication was effective?

Decrease in level of chest pain Rationale: Nitroglycerin reduces myocardial oxygen consumption, which decreasesischemia and reduces chest pain.

A client with viral influenza is receiving vitamin C, 1000 mg PO daily, and acetaminophen elixir, 650 mg PO every 4 hours PRN. The nurse calls the health care provider to report that the client has developed diarrhea. Which change in prescriptions should the nurse anticipate?

Decrease the dose of vitamin C. Rationale: Diarrhea is an adverse effect of high doses of vitamin C, so the nurse should anticipate a reduction in the dose of vitamin C. Acetaminophen does not cause diarrhea and is not available in an injectable form. Because the client has a viral infection Tx with abx will not be beneficial.

The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate, IM STAT. What isthe primary purpose for administering this drug to the child at this time?

Decrease the oral secretions. Rationale: Atropine sulfate, an anticholinergic agent, is given to decrease oral secretions during a surgical procedure.

A client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCl. Which assessment finding would require immediate intervention by the nurse?

Demonstrates Parkinson-like symptoms, such as cogwheel rigidity. Rationale: Metoclopramide HCl blocks dopamine receptors in the brain, which can cause the extrapyramidal symptoms associated with Parkinson disease. Reglan has been associated with hypertension. An unpleasant metallic taste in the mouth is often associated with metronidazole, not metoclopramide HCl.

A female client with myasthenia gravis is taking a cholinesterase inhibitor and asks the nurse what can be done to remedy her fatigue and difficulty swallowing. What action should the nurse implement?

Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms. Rationale: Maintaining optimal dosage for cholinesterase inhibitors can be challenging for clients with myasthenia gravis. Clientsshould be taught to recognize signs of over-medication and under-medication so that they can modify the dosage themselves based on a prescribed sliding scale.

The health care provider prescribes the anticonvulsant carbamazepine for an adolescent client with a seizure disorder. The nurse should instruct the client to notify the health care provider if which condition occurs?

Develops a sore throat. Rationale: Blood dyscrasias(aplastic anemia, leukopenia, anemia, and thrombocytopenia) can be an adverse effect of carbamazepine. Flu-ike symptoms, such as pallor, fatigue, sore throat, and fever, are indications of such dyscrasias. Options A and B are expected reactions. Option D is a side effect of phenytoin, not carbamazepine.

A client experiencing dysrhythmias is given quinidine, 300 mg PO every 6 hours. The nurse plans to observe this client for which common side effect associated with the use of this medication?

Diarrhea Rationale: The most common side effects associated with quinidine therapy are gastrointestinal complaints, such as diarrhea.

A 6-year-old child is admitted to the emergency department with status epilepticus. His parents report that his seizure disorder has been managed with phenytoin, 50 mg PO bid, for the past year. Which drug should the nurse plan to administer in the emergency department?

Diazepam Rationale: Diazepam is the drug of choice for treatment of status epilepticus. Phenytoin, Phenobarbital and Carbamazepine are used for the long-term management of seizure disorders but are not as useful in the emergency management of status epilepticus.

Which medication is useful in treating digoxin toxicity?

Digoxin immune Fab Rationale: Digibind is useful in treating this type of drug toxicity because it is an antibody that binds antigenically to unbound serum digoxin or digitoxin, resulting in renal excretion of the bound complex.

A client is being discharged with a prescription for sulfasalazine to treat ulcerative colitis. Which instruction should the nurse provide to this client prior to discharge?

Drink at least eight glasses of fluid a day Rationale: Adequate hydration is important for all sulfa drugs because they can crystallize in the urine. If possible, the drug should be taken after eating to provide longer intestinal transit time. Maintaining good oral hygiene is important for other medications, such as phenytoin, because of the incidence of gingival hyperplasia, Discontinue use of the drug gradually is important for steroid administration.

A chemotherapeutic regimen with doxorubicin HCl is being planned for a client recently diagnosed with cancer. What diagnostic test results should the nurse review prior to initiating this treatment?

Electrocardiogram (ECG) Rationale: Baseline cardiac function studies are required to monitor the irreversible cardiotoxic effects of doxorubicin HCl.

A client who is hypertensive receives a prescription for hydrochlorothiazide. When teaching about the side effects of this drug, which symptoms are most important for the nurse to instruct the client to report?

Fatigue and muscle weakness Rationale: Thiazide diuretics, such as HCTZ, cause potassium wasting in the urine, so the client should be instructed to report fatigue and muscle weakness, which are characteristic of hypokalemia. which is a side effect of thiazides that can cause cardiac dysrhythmias.

A 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous hospitalizations have occurred since the diagnosis because of noncompliance with the prescribed medication regimen. Which drug might work best for this particular client?

Fluphenazine decanoate Rationale: Fluphenazine, an antipsychotic drug that can be given IM, has a rapid onset (1 to 2 hours) and a long duration of action (up to 3 or 4 weeks), so it would be the drug of choice for a noncompliant psychotic client. Chlorpromazine HCl is an antipsychotic drug used to treat schizophrenia and is usually administered PO (IM doses are short-acting). The client must be compliant in taking this drug for it to be effective. Lithium carbonate is most effective with manic and depressive bipolar affective disorders. Diazepam is an anti-anxiety drug and would not be effective for a psychotic disorder.

In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, the nurse writes a nursing diagnosis of alteration in nutrition: less than body requirements, related to inadequate digestion of nutrients. Which intervention would best meet this child's needs?

Give pancrelipase capsule mixed with applesauce before each meal. Rationale: Pancreatic enzyme replacement with pancrelipase is a major component of cystic fibrosis nutritional management. Aluminum hydroxide and magnesium hydroxide may be given before meals with enzymes to reduce gastric acidity and prevent enzyme destruction but are ineffective when used alone to promote enzyme replacement. Administering cholestyramine resin before each meal and at bedtime and administering omeprazole for gastroesophageal reflux are used to treat steatorrhea in cystic fibrosis.

Prior to administering a scheduled dose of digoxin, the nurse reviews the client's current serum digoxin level, which is 1.3 ng/dL. Which action should the nurse implement?

Give the dose of digoxin if the client's heart rate is within a safe range. Rationale: The client's digoxin level of 1.3 ng/dL is not above the upper range of its therapeutic index (toxic level is >2.0 ng/dL), so the dose should be administered after the client's heart rate is evaluated. Digibind is administered for toxic levels of digoxin

A child is being treated with mebendazole for pinworms. Which type of diet should the mother be instructed to feed the child while the child is receiving this medication?

High-fat diet Rationale: A high-fat diet increases the absorption of mebendazole, which boosts the effectiveness of the medication in eliminating the pinworms.

A client receives a prescription for theophylline PO to be initiated in the morning after the dose of theophylline IV is complete. The nurse determines that a theophylline level drawn yesterday was 22 mcg/mL. Based on this information, which action should the nurse implement?

Hold the theophylline dose and notify the health care provider Rationale: The therapeutic range for theophylline is 10 to 20 mcg/mL, so the theophylline dose should be held for fear of causing toxicity.

A primigravida at 34 weeks of gestation is admitted to labor and delivery in preterm labor. She isstarted on a terbutaline sulfate continuous IV infusion via pump. This therapy is ineffective, and the baby is delivered vaginally. For which complication should the nurse monitor in this infant during the first few hours after delivery?

Hypoglycemia Rationale: Hypoglycemia may occur in the neonate because a side effect of terbutaline sulfate isincreased maternal serum glucose levels. Monitoring for hypoglycemia is the priority following the maternal administration of terbutaline sulfate.

The nurse is reviewing a client's laboratory results before a procedure in which a neuromuscular blocking agent is prescribed. Which finding should the nurse report to the health care provider?

Hypokalemia Rationale: Low potassium levels enhance the effects of neuromuscular blocking agents,so the health care provider should be informed of the client's hypokalemia. Hyponatremia, Hypercalcemia and Hypomagnesemia are of concern but do not enhance the effects of neuromuscular blocking agents.

In addition to nitrate therapy, a client is receiving nifedipine, 10 mg PO every 6 hours. The nurse should plan to observe for which common side effect of this treatment regimen?

Hypotension Rationale: Nifedipine reduces peripheral vascular resistance and nitrates produce vasodilation,so concurrent use of nitrates with nifedipine can cause hypotension with the initial administration of these agents.

A client is prescribed a cholinesterase inhibitor, and a family member asks the nurse how this medication works. Which pharmacophysiologic explanation should the nurse use to describe this class of drug?

Improves nerve impulse transmission Rationale: Cholinesterase inhibitors work to increase the availability of acetylcholine at cholinergic synapses, which aids in neuronal transmission and assists in memory formation.

A client is receiving acyclovir sodium IV for a severe herpes simplex infection. Which intervention should the nurse implement during this drug therapy?

Increase daily fluids to 2000 to 4000 mL/day. Rationale: Increasing fluid intake during treatment prevents precipitation of the drug in the renal tubules, which could lead to obstructive problems that impair kidney function. Acute glomerulonephritis is a possible complication of acyclovir sodium therapy.

Dopamine is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response?

Increase in urine output Rationale: Intropin activates dopamine receptors in the kidney and dilates blood vessels to improve renal perfusion, so an increase in urine output indicates an increase in glomerular filtration caused by increased arterial blood pressure. Dopamine increases cardiac output, which increases a client's blood pressure.

A female client isreceiving tamoxifen following surgery for breast cancer. She reportsthe onset of hot flashes to the nurse. Which intervention should the nurse implement?

Instruct the client that hot flashes are a side effect that often occurs with the use of this medication. Rationale: Tamoxifen is an estrogen receptor blocker used to treat breast carcinoma. Hot flashes are a common side effect. If the hot flashes become bothersome, the client can be instructed in measures to reduce the discomfort.

A client taking linezolid at home for an infected foot ulcer calls the home care nurse to report the onset of watery diarrhea. Which intervention should the nurse implement?

Instruct the client to obtain a stool specimen to be taken to the laboratory for analysis. Rationale: Antibiotics, such as linezolid, can cause pseudomembranous colitis, resulting in severe watery diarrhea. The prescriber should be notified, and a stool specimen should be obtained and analyzed for this complication. Severe diarrhea is not an indication of drug toxicity. Although gastrointestinal disturbance can be an adverse effect of linezolid, a stool specimen should be obtained because the client reports the diarrhea is severe. Antidiarrheal medications are contraindicated in the presence of this colitis and should not be started until this potential complication is ruled out.

The nurse is scheduling a client's antibiotic peak and trough levels with the laboratory personnel. What is the best schedule for drawing the trough level?

Instruct the laboratory to draw the trough immediately before the next scheduled dose. Rationale: The best time to draw a trough is the closest time to the next administration.

A client has a positive skin test for tuberculosis. Which prophylactic drug should the nurse expect to administer to this client?

Isoniazid Rationale: Isoniazid is the drug of choice for treatment of clients with positive skin tests for tuberculosis.

During therapy with isoniazid, it is most important for the nurse to monitor which laboratory value closely?

Liver enzyme levels Rationale: The client receiving isoniazid is at risk for the development of hepatitis; therefore, liver function test results should be monitored carefully during drug therapy.

When caring for a client on digoxin therapy, the nurse knows to be alert for digoxin toxicity. Which finding would predispose this client to developing digoxin toxicity?

Low serum potassium level Rationale: Hypokalemia predisposes the client on digoxin to digoxin toxicity, which usually presents as abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and atrioventricular (AV) dissociation. Assessment of serum potassium levels with prompt correction of hypokalemia is an important intervention for the client taking digoxin.

A pediatric client is discharged home with multiple prescriptions for medications. Which information should the nurse provide that is most helpful to the parents when managing the medication regimens?

Maintain a drug administration record. Rationale: A written drug administration record provides a consistent plan to ensure safe adherence to multiple medication dosages and times. The parents should be given a tool to enhance their confidence and provide a mechanism to ensure accurate and timely medication administration without duplicating or omitting a dose. Using a written record to record medication administration allows more than one person to share the responsibility of giving medications to the child. Although smaller volumes ensure that all the medication is taken, it is more important to maintain an accurate administration schedule.

The health care provider prescribes carbamazepine for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. The mother asks why so many blood tests are necessary. Which complication is assessed through frequent laboratory testing that the nurse should explain to this mother?

Myelosuppression Rationale: Myelosuppression isthe highest priority complication that can potentially affect clients managed with carbamazepine therapy. The client requires close monitoring for this condition by weekly laboratory testing. Hepatic function may be altered, but this complication does not have as great a potential for occurrence as Myelosupression

A 4-year-old child is receiving chemotherapy for acute lymphocytic leukemia. Which laboratory result should the nurse examine to assess the child's risk for infection?

Neutrophil count Rationale: During chemotherapy, granulocytes are significantly suppressed. Because neutrophils comprise 60% to 70% of the granulocyte count, these levels are the most useful laboratory results of the options presented to determine the child's risk for infection.

A male client asks the nurse why condoms should not be lubricated with the spermicide nonoxynol-9. Which response is best for the nurse to provide?

Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of HIV. Rationale: The use of condoms and a water-based spermicide is recommended because nonoxynol-9 can cause a rash that allows viruses a portal of entry if the condom breaks, which increases the risk of transmission of sexually transmitted diseases (STDs), such as human immunodeficiency virus (HIV), herpes, human papillomavirus (HPV), or hepatitis B virus (HBV). Nonoxynol-9 may cause vaginal irritation.

The nurse notes that the hemoglobin level of a client receiving darbepoetin alfa has increased from 6 to 10 g/dL over the first 2 weeks of treatment. Which action should the nurse take?

Notify the health care provider of the change in the client's laboratory values. Rationale: Although an increase in the client's hemoglobin level is desired, a rapid increase (more than 1 g/dL in a 2-week period) may lead to hypertension, so the health care provider should be notified of this excessive increase.

A client with metastatic cancer who has been receiving fentanyl for several weeks reports to the nurse that the medication is not effectively controlling the pain. Which intervention should the nurse initiate?

Notify the health care provider of the need to increase the dose. Rationale: Clients can develop a tolerance to the analgesic effect of opioids and may require an increased dose for effective long-term pain relief. The client is not exhibiting indications of dependence, withdrawal, or toxicity.

The apical heart rate of an infant receiving digoxin for congestive heart failure is 80 beats/min. Which intervention should the nurse implement first?

Obtain a serum digoxin level. Rationale: Sinus bradycardia (rate <90 to 110 beats/min in an infant) is an indication of digoxin toxicity, so assessment of the client's digoxin level is the highest priority. Further doses of digoxin should be withheld until the serum level is obtained.

A client receives an antihypertensive agent daily. Which action is most important for the nurse to implement prior to administering the medication?

Obtain the client's blood pressure. Rationale: To determine the most accurate response to antihypertensive therapy, baseline blood pressures should be obtained before an antihypertensive drug is administered and should be compared with orthostatic vital signs to determine whether any side effects are occurring.

When providing client teaching about the administration of methylphenidate (Ritalin) to a parent of a child diagnosed with ADHD, which instruction should the nurse include in the teaching plan?

Offer the child the medication with breakfast and after the child eats lunch. Rationale: Administering the medication at breakfast and after lunch provides the correct spacing of the doses to maximize the child's attention span and helps prevent the appetite suppression associated with the drug. Doses should be spaced at 6-hour intervals. A dose given mid-afternoon is likely to increase insomnia. Doses should be discontinued only for brief intervals (with the health care provider's approval) when the client's condition is being evaluated or if the client is being weaned from the medication entirely.

A female client is receiving tetracycline for acne. Which client teaching should the nurse include?

Oral contraceptives may not be effective. Rationale: Certain antibiotics,such astetracycline, decrease the effectiveness of oral contraceptives.

The nurse is reviewing prescribed medications with a female client who is preparing for discharge. The client asks the nurse why the oral dose of an opioid analgesic is higher than the IV dose that she received during hospitalization. Which response is best for the nurse to provide?

Oral forms of drugs must pass through the liver first, where more of the dose is metabolized. Rationale: Oral doses of medication are usually larger than parenteral dosesto compensate for the first-pass effect in the liver after oral administration, which metabolizes more of the drug's dose before affecting its therapeutic response. Although recommended dose ranges for adultsshould be individualized, a client's pain should be controlled at discharge.

Alteration of which laboratory finding represents the achievement of a therapeutic goal for heparin administration?

Partial thromboplastin time (PTT) Rationale: Heparin therapy is guided by changes in the partial thromboplastin time (PTT).

A child with cystic fibrosis is receiving ticarcillin disodium for Pseudomonas pneumonia. For which adverse effect should the nurse assess and report promptly to the health care provider?

Petechiae Rationale: Adverse effects of ticarcillin disodium include hypothrombinemia and decreased platelet adhesion, which can result in the presence of petechiae.

In administering the antiinfective agent chloramphenicol IV to a client with bacterial meningitis, the nurse observes the client closely for signs of bone marrow depression. Which laboratory data would be most important for the nurse to monitor?

Platelet count Rationale: Chloramphenicol can cause irreversible, fatal bone marrow depression, so the nurse should monitor the client's platelet count.

Which response best supports the observations that the nurse identifies in a client who is experiencing a placebo effect?

Psychological response to inert medication Rationale: The placebo effect is a response in the client that is caused by the psychological impact of taking an inert drug that has no biochemical properties. A placebo effect can be therapeutic, negative, or ineffective but provides no cure or benefit to the client's progress. The placebo effect may evoke behavioral changes but does not affect neurochemical psychotropic changes. Malingering and drug seeking are behaviors that a client exhibits to obtain treatment for nonexistent disorders or obtain prescription medications.

A client with acute lymphocytic leukemia isto begin chemotherapy today. The health care provider's prescription specifies that ondansetron is to be administered IV 30 minutes prior to the infusion of cisplatin. What is the rationale for administering Zofran prior to the chemotherapy induction?

Reduction or elimination of nausea and vomiting Rationale: Ondansetron is a type 3 receptor (5-HT3) antagonist that isrecognized for improved control of acute nausea and vomiting associated with chemotherapy. 5-HT3 antagonists are most effective when administered IV prior to the induction of the chemotherapeutic agent(s).

A client receives pancuronium, a long-acting, nondepolarizing neuromuscular blocker, during surgical anesthesia. Which client situation should alert the nurse to evaluate the client for a prolonged muscle relaxation response to this medication?

Renal insufficiency Rationale: Pancuronium is eliminated via the kidneys, so a client with renal failure is at risk for prolonged muscle relaxation. Although hepatitis can interfere with this drug's metabolism, it does not place a client at increased risk for prolonged muscle relaxation.

A client who is experiencing an acute attack of gouty arthritis is prescribed colchicine USP, 1 mg PO daily. Which information is most important for the nurse to provide the client?

Report any vomiting to the clinic. Rationale: The client should be instructed to report signs of colchicine toxicity, such as nausea, diarrhea, vomiting, and/or abdominal pain, to the health care provider. Food inhibits the absorption of colchicine when ingested concurrently. Limited fluid intake decreases the excretion of the uric acid crystals, which contributesto painful attacks. Typically, a clientshould remain on a daily dose of colchicine to decrease the number and severity of acute attacks, so stopping the medication after the pain resolves is not indicated.

Minocycline, 50 mg PO every 8 hours, is prescribed for an adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.)

Report vaginal itching or discharge. Protect skin from natural and artificial ultraviolet light. Avoid driving until response to medication is known. Use a nonhormonal method of contraception ifsexually active. Rationale: Adverse effects of tetracyclinesinclude superinfections, photosensitivity, and decreased efficacy of oral contraceptives. Therefore, the client should report vaginal itching or discharge, protect the skin from ultraviolet light and use a nonhormonal method of contraception while on the medication. Minocycline is known to cause dizziness and ataxia, so until the client's response to the medication is known, driving should be avoided. Tetracyclines should be taken around the clock. They exhibit decreased absorption when taken with antacid.

An older client who had a colon resection yesterday is receiving a constant dose of hydromorphone via a patient-controlled analgesia (PCA) pump. Which assessment finding is most significant and requires that the nurse intervene?

Respirations decrease to 14 breaths/min. Rationale: Hydromorphone is an opioid agonist-analgesic of opiate receptors that inhibits ascending pathways and can cause respiratory depression. Older adults are more sensitive to opioids so the "start low and go slow" approach should be taken. Drowsiness and pruritus are common side effects of opioids, particularly the opiates, which are usually harmless and often transient. The normal range of pupils is 2 to 6 cm. The suture site may be red and swollen as an inflammatory response, but no action is required if the skin around the incision is a normal color and temperature.

During administration of theophylline, the nurse should monitor for signs of toxicity. Which symptom would cause the nurse to suspect theophylline toxicity?

Restlessness Rationale: Restlessness is a sign of theophylline intoxication. Other signs of toxicity are anorexia, nausea, vomiting, insomnia, tachycardia, arrhythmias, and seizures. dry mouth, urinary retention and sedation are common side effects of antihistamines but do not indicate theophylline intoxication.

A client who is HIV-positive isreceiving combination therapy with the antiviral medication zidovudine. Which instruction should the nurse include in this client's teaching plan?

Return to the clinic every 2 weeks for blood counts. Rationale: Bone marrow depression with granulocytopenia is a severe but common adverse effect ofzidovudine. Careful monitoring of CBCs is indicated. Dizziness is an expected side effect. The client should be instructed to avoid driving until this reaction improves.

A client who arrivesin the postanesthesia care unit (PACU) after surgery is not awake from general anesthesia. Which action should the nurse implement first?

Review the medication administration record (MAR). Rationale: Most general anesthetics produce cardiovascular and respiratory depression,so a review of the client's MAR identifies all the medications received during surgery and helps the nurse anticipate the client's response and emergence from anesthesia. Assessing for deep tendon reflexes and observing urinary output are ongoing postoperative assessments. Based on the medications that the client has received, naloxone may need to be administered if indicated by the client's vital signs and delayed spontaneous reactivity.

The nurse is preparing a plan of care for a client receiving the glucocorticoid methylprednisolone. Which nursing diagnosis reflects a problem related to this medication that should be included in the care plan?

Risk for infection Rationale: Corticosteroids depress the immune system, placing the client at risk for infection.

The nurse is preparing to administer amphotericin B IV to a client. What laboratory data is most important for the nurse to assess before initiating an IV infusion of this medication?

Serum potassium level Rationale: The nurse should obtain baseline potassium levels prior to beginning drug therapy because amphotericin B changes cellular permeability, allowing potassium to escape from the cell, which could lead to a decrease in the serum potassium level and severe hypokalemia.

Two hours after taking the first dose of penicillin, a client arrives at the emergency department complaining of feeling ill, exhibiting hives, having difficulty breathing, and experiencing hypotension. These findings are consistent with which client response that requires immediate action?

Severe acute anaphylactic response Rationale: Anaphylaxis related to penicillin can cause a life-threatening allergic response characterized by bronchospasm, laryngeal edema, and a precipitous drop in blood pressure. This client's ingestion of penicillin and presenting clinical picture indicate the client is having an acute reaction with respiratory difficulty.

A 42-year-old client is admitted to the emergency department after taking an overdose of amitriptyline in a suicide attempt. Which drug should the nurse plan to administer to reverse the cardiac and central nervous system effects of amitriptyline?

Sodium bicarbonate Rationale: Sodium bicarbonate is an effective treatment for an overdose of tricyclic antidepressantssuch as amitriptyline to reverse QRS prolongation.

During the initial nursing assessment history, a client tells the nurse that he is taking tetracycline hydrochloride for urethritis. The nurse is most concerned if the client reportstaking which medication concurrently?

Sucralfate Rationale: Sucralfate is used to treat duodenal ulcers and will bind with tetracycline hydrochloride, inhibiting this antibiotic's absorption.

A 67-year-old client is discharged from the hospital with a prescription for digoxin, 0.25 mg daily. Which instruction should the nurse include in this client's discharge teaching plan?

Take and record radial pulse rate daily. Rationale: Monitoring pulse rate is very important when taking digoxin. The client should be further instructed to report pulse rates <60 or >110 beats/min and to withhold the dosage until consulting with the health care provider in such a case. Vision change is an indication of drug toxicity, and the client should be instructed to report this immediately.

The health care provider prescribes oral contraceptives for a client who wants to prevent pregnancy. Which information is the most important for the nurse to provide to this client?

Take one pill at the same time every day until all the pills are gone. Rationale: To maintain adequate hormonal levels for contraception and enhance compliance, oral contraceptives should be taken at the same time each day. There is no strong pharmacokinetic evidence that shows a relationship between the category of broad-spectrum antibiotic use and altered hormone levels in oral contraceptive users. Abstinence is the best method to prevent pregnancy during the first cycle. If a client misses two pills during the first week, the client should take two pills a day for 2 days and finish the package while using a backup method of birth control until her next menstrual cycle.

A client with angina pectoris is instructed to take sublingual nitroglycerin tablets PRN for chest pain. Which instruction should the nurse include in the client's teaching plan?

Take one tablet at the onset of angina and stop activity. Rationale: Nitroglycerin tablets should be taken at the onset of angina, and the client should stop activity and rest. One tablet can be taken every 5 minutes, up to three doses. Nitroglycerin should be replaced every 3 to 6 months. Nitroglycerin should provide relief in 5 minutes.

A 3-year-old boy is admitted to the emergency department after ingesting an unknown amount of phenobarbital elixir prescribed for his brother's seizure disorder. Which nursing intervention should the nurse implement first?

Take the child's vital signs. Rationale: Phenobarbital causes respiratory depression, so the priority intervention is assessment of vital signs. Administering syrup of ipecac, drawing a blood specimen for a phenobarbital level and teaching the mother safe medication storage practices are actions that may all be used in the treatment of this child, but they do not have the priority over taking the vital signs.

The nurse knows that certain antipsychotic drugs cause extrapyramidal symptoms. Which extrapyramidal symptom is a permanent and irreversible adverse effect of long-term phenothiazine administration?

Tardive dyskinesia Rationale: Tardive dyskinesia is a permanent irreversable effect of long-term phenothiazine administration. Dystonia, Akathisia and Pseudoparkinsonism are side effects of phenothiazines but do not have the characteristics of being permanent and irreversible.

A client who is receiving chlorpromazine HCl to control his psychotic behavior also has a prescription for benztropine. When teaching the client and/or significant others about these medications, what should the nurse explain about the use of benztropine in the treatment plan for this client?

The benztropine is used to control extrapyramidal symptoms. Rationale: Benztropine, an anticholinergic drug, is used to control extrapyramidal symptoms associated with chlorpromazine HCl (Thorazine) use.

Methenamine mandelate is prescribed for a client with a urinary tract infection and renal calculi. Which finding indicates to the nurse that the medication is effective?

The frequency of urinary tract infections decreases. Rationale: Mandelamine is prescribed to acidify the urine, decreasing the incidence of calcium phosphate calculi and urinary tract infections. The urine changing color and pain is diminishing is related to the administration of pyridine.

A 45-year-old female client isreceiving alprazolam for anxiety. Which client behavior would indicate that the drug is effective?

The staff observes the client sitting in the day room reading a book. Rationale: The ability to sit and concentrate on reading indicates decreased anxiety.

The nurse plans to draw blood samples for the determination of peak and trough levels of gentamicin sulfate in a client receiving IV doses of this medication. When should the nurse plan to obtain the peak level?

Thirty minutes after the dose is administered Rationale: Peak drug serum levels are achieved 30 minutes after the IV administration of aminoglycosides.

A client being treated for an acute myocardial infarction is to receive the tissue plasminogen activator alteplase. The nurse would be correct in providing which explanation to the client regarding the purpose of this drug?

This drug is a clot buster that dissolves clots within a coronary artery. Rationale: t-PA, or tissue plasminogen activator, is a coronary-specific fibrinolytic agent that dissolves clots within the coronary arteries. This drug is not a calcium channel blocker or nitrate, which would promote vasodilation of the coronary arteries. This medication is not an anticoagulant, such as warfarin or heparin, which would prevent new clot formation. Volume expansion is not provided by an infusion of tPA and would not necessarily improve myocardial perfusion caused by an increased cardiac output in a client with coronary artery disease.

A client with chronic gouty arthritis is talking allopurinol, 100 mg PO daily. Which laboratory serum level should the nurse report to the health care provider to determine the therapeutic outcome?

Uric acid level Rationale: The primary therapeutic outcome associated with allopurinol therapy is reduced serum uric acid levels with a lower frequency of acute gouty attacks, so uric acid level should be reported to the health care provider

The health care provider prescribes cisplatin to be administered in 5% dextrose and 0.45% normal saline with mannitol added. Which assessment parameters would be most helpful to the nurse in evaluating the effectiveness of the therapy?

Urine output Rationale: The effectiveness of the diuresis is best measured by urine output. Mannitol, an osmotic diuretic, is given during cisplatin therapy to promote diuresis and reduce the risk of nephrotoxicity and ototoxicity associated with this chemotherapeutic agent.

A psychiatric client is discharged from the hospital with a prescription for haloperidol. Which instruction should the nurse include in the discharge teaching plan for this client?

Use sunglasses and sunscreen when outdoors. Rationale: Photosensitivity is a common adverse effect of haloperidol (Haldol); therefore, the use ofsunglasses and sunscreen should be included in the discharge teaching for this client.

A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization?

Vastus lateralis Rationale: The preferred intramuscular site for children younger than 2 years is the vastus lateralis.