Unit 5- Pharmacological and Parenteral Therapies

A client develops hepatic encephalopathy 1 week after portal caval shunt surgery. The client's physician orders neomycin, 4 g by mouth daily in four divided doses. The client's partner asks how neomycin decreases the serum ammonia concentration. How should the nurse respond?

Neomycin decreases the amount of ammonia-producing bacteria in the GI tract. Neomycin lowers the blood ammonia level by reducing the quantity of ammonia-producing bacteria in the GI tract. The drug also exerts its antibacterial activity directly on the ribosomes of susceptible organisms, among them E. coli, by inhibiting protein synthesis via direct action on ribosomal subunits. When present, these bacteria convert urea to ammonia. Neomycin is bactericidal in high concentrations and bacteriostatic in low concentrations. Thus, it doesn't trap or bind with ammonia in the GI tract.

The nurse is caring for a 10-week gestation client. The healthcare provider orders new medications for the client. What would be the most appropriate principles for the nurse to apply to these new medications? Select all that apply.

ategory C is contraindicated for women who are pregnant. Category X is contraindicated for women who are pregnant. Category D is contraindicated for women who are pregnant. Category X: Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits. Category D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks: and Category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Categories B and A are classified as no risk or no adverse effects for women who are pregnant.

A client has obtained levonorgestrel as emergency contraception. After unprotected intercourse, the client calls the clinic to ask questions about taking the contraceptives. The nurse realizes the client needs further explanation when she makes which statement?

"I can wait up to 4 days after intercourse to start taking these to prevent pregnancy." Levonorgestrel can reduce the chance of pregnancy if taken within 72 hours of unprotected intercourse, but pills are most effective if taken immediately after unprotected intercourse and then again 12 hours later,. Males can purchase this contraceptive as long as they are over 18 years of age. Levonorgestrel works by preventing ovulation or fertilization depending on where a client is the menstrual cycle. Common side effects include nausea, breast tenderness, vertigo, and stomach pain.

The client was recently diagnosed with a musculoskeletal disorder and ordered carisoprodol. The nurse completes teaching about the medication. Which statement by the client indicates a need for more teaching about carisoprodol?

"I will stop the medication as soon as the muscle spasticity goes away." The nurse must clarify that muscle spasticity will return when medication is suspended. Carisoprodol is to be taken with food and fluid, should not be used with alcohol, and activities such as driving should be avoided only if drowsy/dizzy.

The health care provider (HCP) prescribes ampicillin 100 mg/kg/dose for a newly admitted neonate. The neonate weighs 1,350 g. How many milligrams should the nurse administer? Record your answer using a whole number.

135 The recommended dose of ampicillin for a neonate is 100 mg/kg per dose. First, determine the neonate's weight in kilograms, and then multiply the kilograms by 100 mg. The nurse should use this formula: 1,000 g = 1 kg 1,350 g = 1.35 kg 100 mg × 1.35 kg = 135 mg/kg

A client who is 1 day postoperative is using a morphine patient-controlled analgesia (PCA) pump. The client is confused and disoriented. What is the priority intervention by the nurse?

Check respiratory rate and depth as well as oxygen saturation levels. Morphine depresses respiration, so the nurse should assess the client's respiratory rate and depth. If the rate is below 12 breaths/min, morphine can be withheld. Checking oxygen saturation levels will also indicate whether there is effective oxygenation of the blood. Morphine's effect is not usually significant on the cardiovascular system. The calculation of effective morphine dose includes that administered via the bolus. Pulmonary embolism is not a problem in the initial postoperative period.

After extensive cardiac bypass surgery, a client returns to the intensive care unit on dobutamine, 5 mcg/kg/minute I.V. Which classification best describes dobutamine?

Direct-acting beta-active agent Adrenergic agents are classified according to their method of action and the type of receptor on which they act. Direct-acting agents act on the sympathetically innervated organ or tissue, whereas indirect-acting agents trigger the release of a neurotransmitter, usually norepinephrine. Dual-acting agents combine direct and indirect actions. Adrenergic agents act on alpha, beta, and dopamine receptors. Dobutamine acts directly on beta receptors. Thus, the drug can be described as a direct-acting beta-active agent.

To prevent development of peripheral neuropathies associated with isoniazid administration, what should the nurse teach the client to do?

Supplement the diet with pyridoxine (vitamin B6). Isoniazid competes for the available vitamin B6 in the body and leaves the client at risk for developing neuropathies related to vitamin deficiency. Supplemental vitamin B6 is routinely prescribed to address this issue. Avoiding sun exposure is a preventive measure to lower the risk of skin cancer. Following a low-cholesterol diet lowers the individual's risk of developing atherosclerotic plaque. Rest is important in maintaining homeostasis but has no real impact on neuropathies.

A nurse is assessing a client who is receiving clozapine. The nurse reviews the medical record. What should the nurse do next?

Withhold the clozapine, and notify the health care provider (HCP). Because clozapine can cause tachycardia, the nurse should withhold the medication if the pulse rate is greater than 140 bpm and notify the HCP. Giving the drug or telling the client to exercise could be detrimental to the client.

A client takes hydrochlorothiazide (HCTZ) for treatment of hypertension. The nurse should instruct the client to report which effects? Select all that apply.

abdominal cramping lethargy muscle weakness HCTZ is a thiazide diuretic used in the management of mild to moderate hypertension and in the treatment of edema associated with heart failure, renal dysfunction, cirrhosis, corticosteroid therapy, and estrogen therapy. It increases the excretion of sodium and water by inhibiting sodium reabsorption in the distal tubule of the kidneys. It promotes the excretion of chloride, potassium, magnesium, and bicarbonate. Side effects include drowsiness, lethargy, and muscle weakness but not muscle twitching. Although there may be abdominal cramping, there is no diarrhea. The client does not become confused as a result of taking this drug.

A 6-year-old child is admitted to a pediatric unit for the treatment of osteomyelitis. Which essential medication classification would the nurse anticipate as documented on the medication report?

antibiotic Staphylococcus. aureus is the most common causative pathogen of osteomyelitis; the usual source of the infection is an upper respiratory infection (URI) or skin lesion. The nurse anticipates an intravenous antibiotic as the essential medication. The nurse may have an anti-inflammatory medication as adjunct therapy. By decreasing the infection, the client may experience decreased pain; thus, not needing an analgesic. The nurse would administer an antipyretic if the child was febrile.

A client admitted for alcohol detoxification is taking disulfiram. The nurse should instruct the client to avoid ingestion of which foods and/or liquids? Select all that apply.

beer communal wine at church cough syrup The client who is taking disulfiram is advised to avoid all forms of alcohol including beer, communal wine at church, and cough syrup; these can trigger a serious physical reaction. Aged cheeses and chocolate are to be avoided by the client taking monoamine oxidase inhibitors.

A client is receiving opioid epidural analgesia. The nurse should notify the health care provider (HCP) if the client has which findings? Select all that apply.

blood pressure of 80/40 mm Hg and baseline blood pressure of 110/60 mm Hg report of crushing headache minimal clear drainage on the dressing A drop in blood pressure to 80/40 mm Hg is significant and should be reported to the HCP. Hypotension and vasodilation may occur as a result of sympathetic nerve blockage along with the pain nerve blockage. A report of a crushing headache suggests that the epidural catheter may be dislodged in the subarachnoid space rather than the epidural space. Epidural dressings should remain dry and intact. The presence of clear fluid on the dressing could indicate a cerebral spinal fluid leak or the leakage of medication. A respiratory rate of 14 breaths/min, although somewhat decreased from baseline, is within acceptable parameters. However, if the rate drops to 10 breaths/min or less, the HCP should be notified. A pain rating of 3 out of 10 suggests that pain is being relieved with the epidural analgesia.

A nurse should evaluate a school-age child for signs and symptoms of adverse effects from morphine. The nurse should assess for which ones? Select all that apply.

constipation nausea and vomiting pruritus Constipation, nausea and vomiting, and pruritus are all treatable adverse effects of morphine. Anemia and hyperglycemia are not adverse effects of morphine.

A client begins taking haloperidol. After a few days, the client experiences severe tonic contractures of muscles in the neck, mouth, and tongue. The nurse should recognize this as

dystonia. These symptoms describe dystonia, which commonly occurs after a few days of treatment with haloperidol. Mistaking the symptoms for psychotic symptoms can lead to misdiagnosis. Parkinsonism results in muscle rigidity, shuffling gait, stooped posture, flat-faced affect, tremors, and drooling. Signs and symptoms of akathisia are restlessness, pacing, and inability to sit still.

The charge nurse is transcribing an order into the electronic medical record (EMR). The order is written atorvastatin 20mg PO QOD x 3. How should the order be written to prevent a medication error?

every other day x 3 Every other day x 3 comprises of 5 days total, and every other day the medication is given. Every other day times (x) 3 days comprises of only 3 days, administering the medication every other day for a total of 2 doses. Every other day times 3 the client would be administered the drug every other day for 3 doses. Every other day has no definite stop date.

A client with cirrhosis begins to develop ascites. Spironolactone is prescribed to treat the ascites. The nurse should monitor the client closely for which drug-related adverse effect?

hyperkalemia Spironolactone is a potassium-sparing diuretic; therefore, clients should be monitored closely for hyperkalemia. Other common adverse effects include abdominal cramping, diarrhea, dizziness, headache, and rash. Constipation and dysuria are not common adverse effects of spironolactone. An irregular pulse is not an adverse effect of spironolactone but could develop if serum potassium levels are not closely monitored.

A client with Parkinson's disease is prescribed levodopa (L-dopa) therapy. Improvement in which area indicates effective therapy?

muscle rigidity Levodopa is prescribed to decrease severe muscle rigidity. Levodopa does not improve mood, appetite, or alertness in a client with Parkinson's disease.

A client admitted to the alcohol detoxification program asks the nurse if there is a medication to "stop me from wanting a drink so badly." The nurse should teach the client about:

naltrexone Naltrexone is a drug that can decrease alcoholic cravings. Chlordiazepoxide and other sedatives help reduce the symptoms of alcohol withdrawal but don't decrease cravings. Haloperidol may be given to treat clients with psychosis, severe agitation, or delirium. Magnesium sulfate and other anticonvulsant medications are only administered to treat seizures if they occur during withdrawal.

Which action is a priority when a nurse is preparing to administer a transfusion of platelets?

obtaining a written informed consent Special transfusion sets should be used when administering platelets. A written consent should be obtained and this is the priority before obtaining equipment. Vital signs should be taken before administration and may be delegated. Platelets are stored at room temperature and a blood-warming device should not be used.

The nurse is assessing a client with bipolar disorder during a follow-up appointment after initiating treatment with lithium carbonate. Which symptom would cause the nurse to suspect lithium toxicity?

persistent GI upset Persistent GI upset indicates a mild to moderate toxic reaction that should be reported. Black tongue is an adverse reaction to mirtazapine (Remeron), not lithium. Increased tearing is not an adverse reaction to lithium. Diarrhea is more common with lithium than constipation.

An older adult client with heart failure and 2+ pitting edema is prescribed furosemide. Due to the effects of furosemide, which additional medication should the nurse recommend to the client to supplement when taking furosemide?

potassium Furosemide inhibits reabsorption of sodium and chloride, so the nurse should explain that a potassium replacement is needed. Calcium, phosphates, and magnesium should be unaffected when taking furosemide.

After returning home, a client who has had cataract surgery will need to continue to instill eye drops in the affected eye. The client is instructed to apply slight pressure against the nose at the inner canthus of the eye after instilling the eye drops. What is the expected outcome of applying pressure? Pressure:

prevents the medication from entering the tear duct. Applying pressure against the nose at the inner canthus of the closed eye after administering eye drops prevents the medication from entering the lacrimal (tear) duct. If the medication enters the tear duct, it can enter the nose and pharynx, where it may be absorbed and cause toxic symptoms. Eye drops should be placed in the eye's lower conjunctival sac. Applying pressure will not prevent the drug from running down the face as long as the drops are instilled in the eye. Pressure does not affect the cornea or facilitate distribution of the medication over the eye surface.

Which laboratory test should the nurse monitor when the client is receiving warfarin sodium therapy?

prothrombin time (PT) Warfarin sodium interferes with clotting. The nurse should monitor the PT and evaluate for the therapeutic effects of coumadin. A therapeutic PT is between 1.5 and 2.5 times the control value; the PT should be established by the health care provider (HCP). It may also be reported as an International Normalized Ratio, a standardized system that provides a common basis for communicating and interpreting PT results. The PTT is monitored in clients who are receiving heparin therapy. Serum potassium levels and ABG values are not affected by coumadin.

An RN preceptor is assisting a new graduate to access a port-a-cath with a Huber needle. Which action by the new graduate would require intervention by the RN preceptor?

rotating the needle immediately after access Accessing a port-a-cath is a sterile procedure which requires a mask and sterile gloves. The needle should be placed at a 90 degree angle and should NOT be rotated as this may damage the port.

The client is to receive digoxin 0.25 mg. Available are 0.125-mg scored tablets. How many tablets should the nurse administer?

2 tablets 0.25 mg/x tablets = 0.125 mg/1 tablet.x = 2 tablets.

The nurse is caring for a 12 kg child diagnosed with epiglottitis. Vancomycin 50 mg/kg/day in three divided doses is prescribed. The medication is supplied as 500 mg/100 ml. How many milliliters per dose will the nurse administer? Record your answer using a whole number.

40 The child should receive 40 ml per dose. Here are the calculations: 50 mg/kg/day x 12 kg = 600 mg/day 600 mg/day ÷ 3 doses/day = 200 mg/dose 200 mg/dose ÷ 5 mg/ml = 40 ml/dose

The healthcare provider orders digoxin for the client with congestive heart failure. What should the nurse include in the client's teaching concerning the administration of digoxin? Select all that apply.

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

A client who has suffered a stroke is brought to the emergency department. The physician has ordered t-PA 0.9mg/kg for a client who weighs 198 lbs (90 kg). Directions for administration are to mix the 100 mg vial of t-PA with 100 ml of sterile water to yield 1 mg/ml. How many ml of t-PA should be removed from the vial and discarded before administration? Record your answer using a whole number.

19 Each ml = 1 mg 100 mg 0.9 x 90 = 81 ml needed 100 - 81 = 19 ml discarded. For safety and to reduce errors of overdosing, only the amount of the t-PA required should remain in the vial.

The nurse has a prescription to administer an IM injection to a neonate. Which injection site should the nurse select?

vastus lateralis The vastus lateralis muscle of the thigh is preferred for administering IM injections to infants because there is less danger of injuring nerves, blood vessels, or bony structures at this site.The deltoid muscle is used for IM injections only when other areas are unavailable.The dorsogluteal site has long been contraindicated for use in children who have not been walking for at least 1 year and is seldom used in other clients because of the risk of sciatic nerve.The ventrogluteal site is relatively free of major nerves and blood vessels, but the vastus lateralis remains the preferred IM injection site in infants.

After the nurse has administered droperidol, care is taken to move the client slowly based on the knowledge of droperidol's effect on the:

cardiovascular system. Because droperidol causes tachycardia and orthostatic hypotension, the client should be moved slowly after receiving this medication. Droperidol produces a tranquilizing effect and does affect the central nervous, respiratory, or psychoneurologic system, but the primary reason for moving the client slowly is the potential cardiovascular effects of hypotension.

A nurse is preparing to administer intravenous cefazolin 1 gram in 50 mL of normal saline over 30 minutes. How many mLs per hour will the client receive? Record your answer using a whole number.

100 50 mL should be administered over 30 minutes. The I.V. pump is set at mL/hr, so the pump should be set at 100 mL/hr.

The nurse is preparing to administer propranolol to a client for control of migraine headaches. The client also has a prescription for sumatriptan as needed for a headache. The client's pulse rate is 56 bpm. What should the nurse do next?

Assess blood pressure. One of the actions of propranolol, a drug used in the treatment of migraine headaches, is to inhibit arterial vasodilation. The nurse should assess the client's blood pressure to evaluate overall circulatory response to the medication. Until the nurse determines the client's blood pressure, there is no immediate need to contact the HCP. There is no immediate need to administer oxygen. The client has not indicated pain; it is not necessary to administer the sumatropin at this time.

A client receiving an intravenous infusion states that, "My arm is feeling cool." Which priority action should be taken?

Assess the intravenous site. The statment that the client's arm is "feeling cool" could be an indication of infiltration; therefore, assessment of the I.V. site is indicated and should be completed first, as this poses a potential risk to the client. The other actions should be acted on but are not the highest priority.

A physician orders an I.V. bolus injection of diltiazem hydrochloride for a client with uncontrolled atrial fibrillation. What should the nurse do before administering an I.V. bolus?

Gently aspirate the I.V. catheter to check for a blood return. Before administering an I.V. bolus, the nurse should gently aspirate the I.V. catheter for a small amount of blood to ensure correct placement of the I.V. catheter. Then the nurse may inject the medication over the recommended time interval. The nurse doesn't need to insert another I.V. line unless the ordered medication is incompatible with the medication in the I.V. solution. Warming the medication could alter the drug's action. Placing a tourniquet on the arm would close off the venous system and prevent drug injection.

A child diagnosed with tinea is being treated with griseofulvin. What instructions should the nurse give the parents?

Have the child avoid intense sunlight. Griseofulvin is associated with photosensitivity reactions. Therefore, the nurse should instruct the parents to have the child avoid intense sunlight. Griseofulvin is best absorbed when administered after a high-fat meal. Treatment with griseofulvin typically lasts for at least 1 month. There are no indications that increased fluid intake affects absorption.

A client is typed and cross-matched for three units of packed cells. What are important precautions for the nurse to take before initiating the transfusion? Select all that apply.

Have two nurses check the blood type and identity. Initiate an IV with normal saline. Take baseline vital signs. Prior to administering blood, the unit must be checked by two registered nurses. Baseline vital signs are obtained before the transfusion is started so any changes would be identified. Blood is always transfused with normal saline as other IV fluids are incompatible with blood. Warming to room temperature is not necessary.

Which step should a nurse take first when administering a liquid medication to an infant?

Verify the physician order. The nurse should first verify the physician's order. Next, the nurse should verify the drug, dose, route, and time. The nurse should then verify the client by checking the infant's armband. After these steps, the nurse should hold the infant securely in the crook of the arm and raise the infant's head to about a 45-degree angle. Then, the nurse should place the dropper at the corner of the infant's mouth so the drug runs into the pocket between the infant's cheek and gum. Doing this keeps the infant from spitting out the drug and reduces the risk of aspiration.

A client is admitted to an acute care facility after an episode of status epilepticus. After the client is stabilized, which factor is most beneficial in determining the potential cause of the episode?

compliance with the prescribed medication regimen The most common cause of status epilepticus is sudden withdraw of anticonvulsant therapy. The type of medication prescribed, the client's stress level, and weight change don't contribute to this condition.

The nurse administers theophylline to a client. When evaluating the effectiveness of this medication, what is an expected outcome?

less difficulty breathing Theophylline is a bronchodilator that is administered to relax airways and decrease dyspnea. Theophylline is not used to treat infections and does not decrease or thin secretions.

A hospitalized 5-year-old is pulseless, and after verifying the child is not breathing, the nurse begins chest compressions. Where should the nurse apply pressure?

on the lower sternum with the heel of one hand The chest is compressed with the heel of one hand positioned on the lower sternum, two fingerbreadths above the sternal notch (at the nipple line). Fingertips are used to compress the sternum in infants, and the heels of both hands are used in adult cardiopulmonary resuscitation.

A client who is receiving acetaminophen for osteoarthritis reports continuing pain. The healthcare provider prescribes celecoxib. What important information regarding this medication, should the nurse share with this client?

report black and tarry stools to the health care provider Black and tarry stools are a sign of gastrointestinal (GI) bleeding, and may necessitate a medication change. Dairy products can help reduce GI irritation. The celecoxib dose should never be doubled. Constipation isn't an adverse effect of this medication.

When positioned properly, the tip of a central venous catheter should lie in the

superior vena cava. When positioned correctly, the tip of a central venous catheter lies in the superior vena cava, inferior vena cava, or right atrium — that is, in the central venous circulation. Blood flows unimpeded around the tip, allowing the rapid infusion of large amounts of fluid directly into circulation. The basilic, jugular, and subclavian veins are common insertion sites for central venous catheters.

A client is diagnosed with diabetes mellitus. The physician orders 15 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. The nurse checks the medication order, assembles equipment, washes their hands, rotates the NPH insulin vial, puts on disposable gloves, and cleans the stoppers. To draw the two insulin doses into the single U-100 insulin syringe, which sequence should the nurse use?

Inject 35 units air into NPH vial; inject 15 units air into regular insulin vial, withdraw 15 units regular insulin; withdraw 35 units NPH. To avoid creating a vacuum, the nurse must inject exactly the same amount of air into a multidose vial to replace the amount of medication to be withdrawn. The nurse should follow these steps: (1) Inject air into the vial from which the second insulin dose will be withdrawn (isophane insulin). (2) Inject air into the vial from which insulin will be withdrawn first (regular insulin). (3) With the needle inserted into the regular insulin vial, withdraw the correct amount. (4) With 15 units of regular insulin in the syringe, carefully withdraw 35 units of NPH, for a total of 50 units in the syringe. Options 2 and 4 are incorrect because regular insulin must be withdrawn first. Option 3 is incorrect because the nurse must not insert air into a multiple-dose vial with a syringe containing medication.

The health care provider prescribes clomiphene citrate for a woman who has been having difficulty getting pregnant. When teaching the client about this drug, the nurse should discuss what potential adverse effects?

chance of multiple gestation. Clomiphene citrate is a fertility drug that induces ovulation in women desiring pregnancy. One of the drug's most common adverse effects is multiple gestation (twins or triplets).An increase in spontaneous abortions is not associated with clomiphene citrate.Evidence does not support an association between the use of clomiphene citrate and an increase in fibrocystic breast disease.An increase in congenital anomalies is not associated with clomiphene citrate.

The administration of medications during infancy is often necessary. The nurse needs to be concerned about the metabolism of these drugs. What concern regarding metabolism should the nurse consider when administering medications to an infant?

inefficient liver function Inefficient liver function will most likely decrease drug metabolism during infancy. As the liver matures during the first year of life, drug metabolism improves. Decreased glomerular filtration and increased tubular secretion may affect drug excretion rather than metabolism; reduced protein-binding ability may affect drug distribution but not metabolism.

The nurse is caring for a client with a history of kidney cysts. The client is having right-sided flank pain and is scheduled to have an intravenous pyelogram with iodine contrast solution. The client states that a test was performed before but the name is unknown to the client. The client also tells the nurse that after "something" was injected into the I.V., the client's throat "started closing." What should the nurse do? Select all that apply.

Call the healthcare provider to discuss the previous reaction. Verify the test order with the healthcare provider. The nurse should notify the healthcare provider of the patient's previous reaction to I.V.P. dye and clarify if the test should still be completed. The healthcare provider will decide if another test is to be ordered after notification of previous reaction. The nurse should not have the client go for the test until it is known whether the client had a reaction before; do not cancel the test, the client may be able to use another medication. Wait until the reaction is known before having the healthcare provider order another test.

After teaching a client how to instill nose drops, the nurse evaluates that the client's technique is correct when the client:

lies supine for several minutes after instilling the drops. The client should be instructed to lie supine with the head tilted back for several minutes after instillation of the nose drops to ensure adequate absorption of the medication by the nasal mucosa.Because the nose is not sterile, sterile technique is not necessary.The client should blow the nose gently before, not after, administering the medication.The dropper should be cleaned after each use; a new dropper is not necessary for each instillation.

A client with heart failure will take oral furosemide at home. To help the client evaluate the effectiveness of furosemide therapy, the nurse should teach the client to:

weigh daily. Monitoring daily weight will help determine the effectiveness of diuretic therapy. A client who gains weight without diet changes most probably is retaining fluids, so the diuretic therapy should be adjusted. Blood pressure monitoring is useful when diuretics are prescribed to control blood pressure. However, in clients with heart failure, the primary indication is to promote sodium and water excretion by the kidneys. While it may be useful to monitor intake and urinary output in the hospital, daily weights are a sensitive indicator of fluid status and more practical for home management. The client may be told to eat a potassium-rich diet; however, serum potassium levels are not used to determine the effectiveness of diuretic therapy.

What is the main advantage of using a floor stock system?

A nurse can implement medication orders quickly. A floor stock system enables a nurse to implement medication orders quickly. It doesn't allow for pharmacist input, nor does it minimize transcription errors or reinforce accurate calculations.

A client is receiving total parenteral nutrition (TPN). The nurse notices that the bag of TPN solution has been infusing for 24 hours but has 300 mL of solution left. What should the nurse do?

Discontinue the current solution, change the tubing, and hang a new bag of TPN solution. IV fluids should not be infused for longer than 24 hours because of the risk of bacterial growth in the solution. The appropriate action for the nurse to take is to discontinue the current TPN solution, change the tubing, and hang a new bag of solution. Changing the filter does not decrease the risk of contamination. Notifying the HCP for a change in flow rate is not an acceptable solution.

The nurse is teaching a client how to self-administer insulin. Which statement by the client indicates a need for further teaching?

"As long as I use the safety syringe, disposal is not a problem." Regardless of safety devices on a syringe, the syringe should be disposed of in a sharp- or puncture-proof container. Swollen, inflamed, or scarred tissue will negatively impact absorption. Aspiration is not required when administered in the subcutaneous tissue.

The student nurse is learning how to administer medications. The nurse instructor asks, "What are the client's rights when administering medication?" What are the most appropriate response(s) by the student? Select all that apply.

"Right to refuse." "Right time or frequency." "Right assessment." The Ten Rights of Medication Administration include the right medication, dose, time/frequency, client, route, education, documentations, refuse, assessment, and evaluation. The right to interpretation and right to authentication are not included in the Ten Rights of Medication Administration.

A nurse is providing in-home management instructions to the parents of a child who is receiving desmopressin acetate (DDAVP). What is the most important instruction for the nurse to include?

Call the healthcare provider if the child has an upper respiratory infection or allergic rhinitis. Excessive nasal mucus, associated with upper respiratory infection or allergic rhinitis, may interfere with DDAVP absorption because it is given intranasally. Parents should be instructed to contact the health care provider for advice in altering the hormone dose during times when nasal mucus may be increased. The DDAVP dose should remain unchanged, even if the child is experiencing polyuria just before the next dose to avoid over medicating the child.

During an emergency, a physician has asked for I.V. calcium to treat a client with hypocalcemia. The nurse should:

Check with the physician for his complete order. The nurse should first check with the physician for the complete order of calcium because calcium chloride has a concentration of 13.6 mEq (3.4 mmol/l) of calcium per gram and calcium gluconate has 4.65 mEq (1.2 mmol/l) of calcium per gram. The nurse can always offer the doctor the type of calcium available after the conversion in calcium has been made; otherwise, the error could be fatal.

When administering an oral medication to an infant, the nurse should take which action to decrease the risk of aspiration?

Use an oral syringe to place the medication beside the tongue, and administer the medication slowly. Using an oral syringe is the best way to prevent aspiration because it allows controlled administration of a small amount of medication. Administering the medication too quickly may cause aspiration. Putting the drug in a bottle of formula isn't preferred because the infant may not take the entire dose of medication and the contents of the bottle could interfere with drug absorption or action. Blocking the nasal passages could cause aspiration.

In the acute phase of burn injury, which pain medication would most likely be given to the client to decrease the perception of the pain?

intravenous opioids The severe pain experienced by burn clients requires opioid analgesics. In addition, opioids such as morphine sedate and alleviate apprehension. Oral analgesics such as ibuprofen or acetaminophen are unlikely to be strong enough to effectively manage the intense pain experienced by the client who is severely burned. Because of the altered tissue perfusion from the burn injury, intravenous medications are preferred. Antianxiety agents are not effective against pain.

A client with idiopathic seizure disorder is being discharged with a prescription for phenytoin. Client teaching about this drug should include which instruction?

"Schedule follow-up visits with your physician for blood tests." A client taking phenytoin to control seizures must undergo routine blood testing to monitor for therapeutic serum phenytoin levels. Typically, the client takes the medication for 1 year after the original seizure, then is reevaluated for continued therapy. During phenytoin therapy, the client may drive and operate machinery. This drug may cause a decreased heart rate and hypotension.

A nurse is to give a client heparin 8,000 units subcutaneously. The available vial is 10,000 units/mL. How many milliliters should the nurse draw up into the syringe? Record your answer using one decimal place.

0.8 8,000 units/X mL = 10,000 units/mLX = 0.8 mL.

When assessing a client's I.V. insertion site, a nurse notes normal color and temperature at the site and no swelling. However, the I.V. solutions haven't infused at the ordered rate; the flow rate is slow even with the roller clamp wide open. When the nurse lowers the I.V. fluid bag, no blood returns to the tubing. What should the nurse do first?

Check the tubing for kinks and reposition the client's wrist and elbow. The nurse should check for common causes of a decreased I.V. flow rate, such as kinks in the tubing and poor positioning of the affected arm. The nurse should discontinue the I.V. infusion only if other measures fail to solve the problem. Irrigating I.V. tubing may dislodge any clots that are present. Elevating the I.V. fluid bag may help if the nurse finds no kinks and if repositioning doesn't resolve the problem.

When teaching a client when to take glipizide in order to maximize the effectiveness of the drug, the nurse should instruct the client to:

take glipizide 30 minutes before breakfast. Glipizide is most effective when taken 30 minutes before breakfast. The duration of action is 10 to 24 hours.If the drug needs to be taken more than once a day, the dosage may be divided and taken twice a day before meals.It is not as effective to take the drug after meals.Although blood glucose levels will be monitored, the values do not dictate when the drug should be taken.

The nurse is collaborating with the health care provider (HCP) to develop a care plan to help control chronic pain in a client with cancer who is receiving hospice home care. Which plan is most appropriate for preventing and reducing the client's pain?

Administer analgesics on a regular basis with administration of additional analgesics for breakthrough pain. Maintaining a steady blood level of analgesics is beneficial for the client with chronic cancer pain. Administering analgesics on a regular basis helps to control pain more efficiently. It may also be necessary for the client to have additional doses of medication ordered to be administered for breakthrough pain. Keeping the client overly sedated may not help to control pain, and intravenous analgesics are more effective at controlling pain as they are more predictable in their distribution than many oral medications. Vital signs are not a reliable indicator of how much pain the client is experiencing.

Pancreatic enzyme replacements are prescribed for the client with chronic pancreatitis. When should the nurse instruct the client to take them to obtain the most therapeutic effect?

with each meal and snack

A child with sickle cell anemia is being treated for sickle cell crisis. The physician orders morphine sulfate 2 mg intravenously. The concentration of the vial is 10 mg/1 ml of solution. How many milliliters of solution would the nurse administer? Record your answer using one decimal place.

0.2 The nurse would calculate the volume to be given using this equation:2 mg/X = 10 mg/1 ml.10X = 2 ml.X = 0.2 ml.

The nurse needs to administer heparin 10,000 units subcutaneously twice a day on a client who had a colon resection prophylactically for deep vein thrombosis. The dose on hand is 20,000 units per mL. How many milliliters will the nurse give?

0.5 Dimensional analysis Given quantity = 10,000 units Wanted quantity = mL Dose on hand = 20,000 units 10,000 units mL = 10 = 0.5 mL 20,000 units 20 The zeros are dropped from the 10,000 units and the 20,000 units. End up with 10 as the numerator and 20 as the denominator. Divide the 10 by 20 and get 0.5 mL.

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

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

A client has a heart rate of 170 beats/minute. The physician diagnoses ventricular tachycardia and orders lidocaine hydrochloride, an initial I.V. bolus of 50 mg followed in 5 minutes by a second 50-mg bolus, then continuous I.V. infusion at 2 mg/minute. The nurse can expect the client to begin experiencing an antiarrhythmic effect within

1 to 2 minutes after I.V. bolus administration. Lidocaine exerts its antiarrhythmic effect in 1 to 2 minutes after I.V. bolus administration. A continuous I.V. infusion will maintain lidocaine's antiarrhythmic effect for as long as the drip is used. Lidocaine provides antiarrhythmic effects for only 15 minutes after the I.V. infusion is stopped.

The nurse is preparing a client's preoperative medication. The prescription reads atropine 0.6 mg and meperidine hydrochloride 50 mg IM. The dosage of available atropine is 0.8 mg/mL, and the dosage of available meperidine is 100 mg/mL. What will be the total volume of medication the nurse will administer? Record your answer using two decimal places.

1.25 he atropine dosage is calculated as follows:0.6 mg/x mL = 0.8 mg/mL.x = 0.75 mL.The meperidine dosage is calculated as follows:50 mg/x mL = 100 mg/mL.x = 0.5 mL.The total volume to be administered is 1.25 mL.

The physician has placed a client who has suffered the loss of a child on a selective serotonin reuptake inhibitor (SSRI) for depression. The nurse is aware that the greatest risk for suicide would be:

10 to 14 days after the initial medication regime is implemented. Ten to fourteen days is the normal response time for antidepressant medications to take effect and subsequent return of energy levels to perform the suicide act. There is no information about problems with the family that would precipitate suicide. The 1-year anniversary could be a stimulus, but a lower priority. Visiting with other clients is a positive interaction with elevation of mood.

The nurse receives a physician's order to administer 1,000 mL of intravenous (I.V.) normal saline solution over 8 hours to a client who recently had a stroke. What should the drip rate be if the drop factor of the tubing is 15 gtt/mL? Record your answer using a whole number.

31 The drip rate is calculated using the following formula: Volume of infusion (in milliliters)/Time of infusion (in minutes) × drip factor (in drops/milliliter) = drops/minute. Therefore, 1,000 mL/480 minutes × 15 drops/mL = 31 gtt/minute.

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

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

A 10-year-old client with asthma is prescribed 2 mg of albuterol syrup four times per day. The syrup comes in a dosage strength of 2 mg/5 mL. How many milliliters of syrup should the nurse administer? Record your answer using a whole number.

5 Set up the following proportion to obtain the prescribed dose: 2 mg/X = 2 mg/5 mL X = 5 mL.

A preterm neonate who has been stabilized is placed in a radiant warmer and is receiving oxygen via an oxygen hood. Which action should the nurse take while administering oxygen in this manner?

Humidify the air being delivered. Whenever oxygen is administered, it should be humidified to prevent drying of the nasal passages and mucous membranes. Because the neonate is under a radiant warmer, a stocking cap is not necessary. Temperature, continuously monitored by a skin probe attached to the radiant warmer, is recorded every 30 to 60 minutes initially. Although the oxygen concentration in the hood requires close monitoring and measurement of blood gases, checking the blood glucose level is not necessary.

Why are antacids administered regularly, rather than as needed, in peptic ulcer disease?

To keep gastric pH at 3.0 to 3.5 To maintain a gastric pH of 3.0 to 3.5 throughout each 24-hour period, regular (not as needed) doses of an antacid are needed to treat peptic ulcer disease. Frequent administration of an antacid tends to decrease client compliance rather than promote it. Antacids don't regulate bowel patterns, and they decrease pepsin activity.

The nurse is preparing a client for an ileostomy. Two weeks before the surgery, what should the nurse instruct the client to do?

Stop taking drugs that will interfere with clotting. The nurse should instruct the client to stop taking drugs that would interfere with clotting, such as aspirin or ibuprofen. The client should follow a high-fiber diet with increased fluids during the 2-week preoperative period. It is not necessary to limit fluids. The client does not need to report having a temperature above 99° F (37.2° C) to the health care provider (HCP) as this is within normal limits; however, if the temperature is higher, this could indicate an infection, and the client should notify the HCP.

Which assessment findings indicates that epoetin alfa is having a therapeutic effect?

hemoglobin 12 g/dL Epoetin alfa is a colony-stimulating factor used help boost red blood cell count. Indications for use are a hemoglobin level < 10 g/dL. It will not improve white blood cells or components (neutrophils) or platelet counts.

The nurse should suspect that the client taking disulfiram has ingested alcohol when the client exhibits which symptom?

nausea and flushing of the face and neck The client who drinks alcohol while taking disulfiram experiences sweating, flushing of the neck and face, tachycardia, hypotension, a throbbing headache, nausea and vomiting, palpitations, dyspnea, tremor, and weakness.

The nurse has completed teaching a client about alprazolam. Which statement by the client will the nurse document as evidence of successful teaching?

"This medication carries a risk of dependence." Alprazolam can be addictive even when taken as prescribed. Driving or operating machinery should be avoided because alprazolam can cause drowsiness and dizziness. Alprazolam is short-acting, so it will not help morning anxiety if taken at bedtime.

A client has a nasogastric (NG) tube. How should the nurse administer oral medication to this client?

Crush the tablets and prepare a liquid form; then insert the liquid into the NG tube. To administer oral medication through an NG tube, the nurse must reproduce the disintegration and dissolution processes by crushing the tablets and preparing a liquid form. Making sure not to crush sustained-release tablets or empty capsules, the nurse then inserts the liquid into the NG tube. Heating the tablets may destroy or alter the drug's action. Washing cut tablets or crushed powder down the tube may cause the medication to stick to the sides of the tube, possibly providing inaccurate dosing and clogging the tube.

Which performance improvement strategy helps prevent adverse reactions to blood products?

confirming client identification with two qualified health professionals The client must be correctly identified to prevent a life-threatening adverse blood reaction. Obtaining vital signs, instructing the client about the signs and symptoms of a blood reaction, and priming the blood administration tubing with normal saline solution are key steps in the blood administration procedure; however, they don't prevent adverse reactions.

A 2-month-old infant is seen in the emergency department for symptoms of infection. The healthcare provider has prescribed an antibiotic via the IM route. In which location should the nurse administer the injection?

vastus lateralis The recommended injection site for an infant is the vastus lateralis muscle. The maximum volume that can be injected in each site is 0.5ml. The deltoid or dorsogluteal muscles are not used in infants. The ventrogluteal site can be used only after 7 months of age.

Which instruction should a nurse give a client with prostatitis who is receiving co-trimoxazole double strength?

"Drink 6 to 8 glasses of fluid daily while taking this medication." The client must drink 6 to 8 glasses of fluid daily to prevent renal problems, such as crystalluria and stone formation. If the drug is effective, symptoms should improve within a few days. Sore throat and sore mouth are adverse effects; the client should report them to a physician right away. The drug causes photosensitivity, but the client should use a PABA-free sunscreen; PABA can interfere with the drug's action.

Which client statement indicates to the nurse that the client needs further teaching about disulfiram?

"I can drink one or two beers and not get sick while on disulfiram." Any amount of alcohol consumed while taking disulfiram can cause an alcohol-disulfiram reaction. The reaction experienced is in proportion to the amount of alcohol ingested. The alcohol-disulfiram reaction can begin 5 to 10 minutes after alcohol is ingested. Symptoms can be mild, as in flushing, throbbing in the head and neck, nausea, and diaphoresis. Other symptoms include vomiting, respiratory difficulty, hypotension, vertigo, syncope, and confusion. Severe reactions involve respiratory depression, convulsions, coma, and even death. Disulfiram can be taken at bedtime if the client feels sleepy from the medication. Some clients experience a metallic or garlic taste when initiating disulfiram treatment. Anything containing alcohol, such as cough medicine, aftershave lotion, and mouthwash, can cause a reaction. Therefore, the client needs to check the labels of these items for their alcohol content.

Which statement indicates that the client needs further teaching about taking medication to control cancer pain?

"I should skip doses periodically so I don't get hooked on my drugs." The client should not skip his dosages of pain medication to prevent addiction. Clients with cancer pain do not become psychologically dependent on the medication and should not fear becoming addicted. The nurse should allow the client and family members to verbalize their concerns about drug addiction.

The nurse is preparing a client for a cardiac catheterization. Which client statement would the nurse need to report to the healthcare provider immediately?

"I took my metformin this morning." The priority would be to notify the healthcare provider of the metformin because it cannot be taken 48 hours before or after contrast, as there is an increased risk of lactic acidosis and acute renal failure with iodinated contrast material. It would be appropriate for the client to take nothing by mouth. It is important to determine the client's allergies; however, it is not the priority. Claustrophobia would not be an issue during a cardiac catheterization.

A physician prescribes intravenous heparin 25,000 units in 250 ml of normal saline solution to infuse at 600 units/hour for a client who suffered an acute myocardial infarction (MI). After 6 hours of heparin therapy, the client's partial thromboplastin time is subtherapeutic. The healthcare provider orders the infusion to be increased to 800 units/hour. The nurse would set the infusion pump to deliver how many milliliters per hour? Record your answer using a whole number.

8 The nurse would calculate the infusion rate using the formula:Dose on hand/Quantity on hand = Dose desired/X25,000 units/250 ml = 800 units/hour ÷ X25,000 units x X = 250 ml x 800 units/hour25,000 x X = 200,000 ml/hourX = 8 ml/hour

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving

A-positive blood to an A-negative client. An acute hemolytic reaction occurs when there is an ABO or Rh incompatibility. For example, giving A blood to a B client would cause a hemolytic reaction. Likewise, giving Rh-positive blood to an Rh-negative client would cause a hemolytic reaction. It's safe to give Rh-negative blood to an Rh-positive client if there is a blood type compatibility. O-negative blood is the universal donor and can be given to all other blood types. AB clients can receive either A or B blood as long as there isn't an Rh incompatibility.

A client is taking spironolactone. Which change in the diet should the nurse teach the client to make when taking this drug?

Avoid eating foods high in potassium. Spironolactone is a potassium-sparing diuretic that causes excretion of sodium. When taking this drug, it is important that the client not eat foods high in potassium to avoid elevating serum potassium levels.The client does not need to restrict sodium intake as the drug promotes sodium excretion.Unless contraindicated, the client needs to maintain an adequate fluid intake; however, the client does not need to increase fluid intake to 3,000 mL/day.Spironolactone does not affect iron levels.

When administering a thrombolytic drug to the client who is experiencing a myocardial infarction (MI) and who has premature ventricular contractions, which is the expected outcome of the drug?

Dissolve clots. Thrombolytic drugs are administered within the first 6 hours after onset of an MI to lyse clots and reduce the extent of myocardial damage.

The client with a major burn injury receives total parenteral nutrition (TPN). What is the expected outcome of TPN?

Ensure adequate caloric and protein intake. Nutritional support with sufficient calories and protein is extremely important for a client with severe burns because of the loss of plasma protein through injured capillaries and an increased metabolic rate. Gastric dilation and paralytic ileus commonly occur in clients with severe burns, making oral fluids and foods contraindicated. Water and electrolyte imbalances can be corrected by administration of IV fluids with electrolyte additives, although TPN typically includes all necessary electrolytes. Resting the gastrointestinal tract may help prevent paralytic ileus, and TPN provides vitamins and minerals; however, the primary reason for starting TPN is to provide the protein necessary for tissue healing.

A client has a patient a controlled analgesia (PCA) infusion to manage postoperative pain. In spite of receiving a dose of pain medication, the client rates the pain at 8 on a 0 to 10 pain scale. What should the nurse do first?

Inspect the infusion site. The nurse should first check the infusion site to be sure the site has not infiltrated. Next, the nurse should check the PCA pump to determine if it is functioning properly. Assessing vital signs would be important to provide additional data about the possible cause of pain, but is not the first action at this time. It is not necessary to notify the health care provider (HCP) unless the infusion site or pump is malfunctioning and other methods of managing the pain are required.

The nurse is changing a peripheral venous access dressing. Place the steps in the order that the nurse should perform them. All options must be used.

Put on gloves. Hold the catheter in place with nondominant hand. Carefully remove old dressing and discard. Inspect intravenous site for phlebitis, infection, or infiltration. Place sterile transparent dressing over venipuncture site. Label the intravenous dressing with date, time of change, and initials. The first step is to put on gloves to prevent contact with a client's body fluids. The second step is to hold the catheter in place with nondominant hand to stabilize the catheter and prevent it from displacing. The third step is to carefully remove the old dressing and discard to prevent spread of microorganisms. The fourth step is to inspect the intravenous site for phlebitis, infection, or infiltration. If any of these are present, the catheter would need to be removed because there is tissue trauma. The fifth step is to place a sterile transparent dressing over the venipuncture site so the site can be visually assessed and the catheter is stabilized. The sixth step is to label the intravenous dressing with date, time of change, and initials so other healthcare professionals providing care and utilizing the catheter will know when it was inserted and when the dressing was changed.

The nurse is administering packed red blood cells (PRBCs) to a client. What should the nurse do first?

Stay with the client during the first 15 minutes of infusion. The most likely time for a blood transfusion reaction to occur is during the first 15 minutes or first 50 ml of the infusion. If a blood transfusion reaction does occur, it is imperative to keep an established I.V. line so that medication can be administered to prevent or treat cardiovascular collapse in case of anaphylaxis. PRBCs should be administered through a 19-gauge or larger needle; a peripherally inserted central catheter line is not recommended, in order to avoid a slow flow. RBCs will hemolyze in dextrose or lactated Ringer's solution and should be infused with only normal saline solution.

Griseofulvin was ordered to treat a child's ringworm of the scalp. The nurse instructs the parents to use the medication for several weeks for which reason?

The growth of the causative organism into new cells is prevented with long-term use. Griseofulvin is an antifungal agent that acts by binding to the keratin that is deposited in the skin, hair, and nails as they grow. This keratin is then resistant to the fungus. But as the keratin is normally shed, the fungus enters new, uninfected cells unless drug therapy continues. Long-term administration of griseofulvin does not prevent sensitivity or allergic reactions. As the body adjusts to a new substance over time, side effects are variable and do not necessarily decrease.

The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a corticosteroid. Which observations indicates that the client is using the MDI correctly? Select all that apply.

The inhaler is held upright. The client rinses the mouth with water following administration. The client should shake the inhaler and hold it upright when administering the drug. The head should be tilted back slightly. The client should wait about 30 seconds between puffs. The mouth should be rinsed following the use of a corticosteroid MDI to decrease the likelihood of developing an oral infection. The client does not need to lie supine; instead, the client will likely to be able to breathe more freely if sitting upright.

Small air bubbles adhering to the interior surface of the syringe might have which effect on parenteral administration?

altered drug dose Although not harmful to the client when injected, small air bubbles can actually change the dose of medication administered; therefore, the nurse should remove the air bubbles. Small air bubbles won't affect the drug's onset of action, duration, or absorption. Air bubbles may be helpful in some situations but should be added only after the dose of the drug has been withdrawn accurately. For example, with iron dextran, an air bubble and the Z-track method of injection help prevent permanent staining of the client's skin if the solution leaks into the subcutaneous tissue.

A nurse in a psychiatric inpatient unit is caring for a client with generalized anxiety disorder. As part of the client's treatment, the psychiatrist orders lorazepam, 1 mg by mouth three times per day. During lorazepam therapy, the nurse should remind the client to:

avoid caffeine. Ingesting 500 mg or more of caffeine can significantly alter the anxiolytic effects of lorazepam. Other dietary restrictions are unnecessary. Staying out of the sun or using sunscreens is required when taking phenothiazines. An adequate salt intake is necessary for clients receiving lithium.

Clients who are receiving parenteral nutrition (PN) are at risk for development of which complication?

fluid imbalances Clients receiving TPN are at risk for a number of complications, including fluid imbalances such as fluid overload and hyperosmolar diuresis. Other common complications include hyperglycemia, sepsis, pneumothorax, and air embolism. Hypostatic pneumonia, pulmonary hypertension, and orthostatic hypotension are not complications of TPN.

An elderly client's lithium level is 1.4 mEq/L. The client complains of diarrhea, tremors, and nausea. The nurse should:

hold the lithium and notify the physician. The client exhibits symptoms of lithium toxicity. Therefore, the lithium should be held and the physician notified immediately. These aren't normal adverse effects, and administering another dose would increase the toxic effects. A nurse can't discontinue a medication without a physician's order.

Metoclopramide is prescribed as a premedication for a client about to undergo a gastroduodenoscopy. What expected therapeutic effect of this drug should the nurse assess in this client?

increased gastric emptying Metoclopramide is an antiemetic given because of its gastric emptying ability, which is necessary in gastrointestinal procedures. It does not increase gastric pH, reduce anxiety, or inhibit respiratory secretions.

After an eye examination, a client is diagnosed with open-angle glaucoma. The physician orders pilocarpine ophthalmic solution, 0.25% gtt i, OU q.i.d. Based on this prescription, the nurse should teach the client or a family member to administer the drug by

instilling one drop of pilocarpine 0.25% into both eyes four times daily. The abbreviation "gtt" stands for drop, "i" is the apothecary symbol for the number 1, "OU" signifies both eyes, and "q.i.d." means four times per day. Therefore, one drop of pilocarpine 0.25% should be instilled into both eyes four times daily.

A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption?

intrinsic factor Vitamin B12 absorption depends on intrinsic factor, which is secreted by parietal cells in the stomach. The vitamin binds with intrinsic factor and is absorbed in the ileum. Hydrochloric acid, histamine, and liver enzymes don't influence vitamin B12 absorption.

A client's diagnosis of pneumonia requires treatment with antibiotics. The corresponding order in the client's chart should be written as

moxifloxacin 400 mg daily Among the Joint Commission's list of "do not use" abbreviations are Q.D., qd, and OD when denoting a once-per-day drug administration. Because of the potential for misinterpretation and consequent drug errors, the Joint Commission recommends writing "daily" in the order.

Gentamicin IV has been prescribed to treat a client's infection. The nurse should monitor the client for:

ototoxicity. Ototoxicity is a serious side effect of gentamicin. Tinnitus and dizziness are common; irreversible deafness can develop if the onset of ototoxicity is not detected early. Gentamicin is also known to be nephrotoxic and hepatotoxic.Ascites, arrhythmias, and confusion are not common side effects.

The client is in preterm labor and is ordered magnesium sulfate to help stop labor. The nurse asks the student, "What adverse effects should we be watching for?" What is the most appropriate response made by the student nurse? Select all that apply.

respiratory depression loss of deep tendon reflexes (DTR) slurred speech. Signs of magnesium sulfate toxicity include deep tendon reflexes, paralysis, respiratory depression, drowsiness, lethargy, blurred vision, slurred speech, and confusion. Headache is a side effect of calcium channel blockers, which are sometimes used to stop preterm labor. Palpitations are a side effect of terbutaline, which is sometimes used to stop preterm labor.

The nurse is assessing the client's understanding of the use of medications. Which medication may cause a complication with the treatment plan of a client with diabetes?

steroids Steroids can cause hyperglycemia because of their effects on carbohydrate metabolism, making diabetic control more difficult. Aspirin is not known to affect glucose metabolism. Sulfonylureas are oral hypoglycemic agents used in the treatment of diabetes mellitus. ACE inhibitors are not known to affect glucose metabolism.

To determine the I.V. drip rate, a nurse must know the drip factor, which is

the number of drops in one milliliter. The drip factor is the number of drops in one milliliter, not the number of milliliters in one drop. The drip rate refers to the number of drops infused per minute. The flow rate is the number of milliliters, not the number of drops, infused per hour.

The nurse is working in an internal medicine office. A child brings a parent to the health care provider's appointment. Upon reviewing the medication list, the daughter states, "Which medication is prescribed to prevent a stroke?" The nurse is correct to answer which medication?

ticlopidine Ticlopidine inhibits platelet aggregation by interfering with adenosine diphosphate release in the coagulation cascade and, therefore, is used to prevent thromboembolic stroke. Allopurinol is an antigout medication used to reduce uric acid. Loratadine is an over-the-counter allergy medication. Methylprednisolone, a steroid with anticoagulant properties, is not used to treat thromboembolic stroke.

After receiving an oral dose of codeine for an intractable cough, a client asks the nurse, "How long will it take for this drug to work?" How should the nurse respond?

30 minutes Codeine's onset of action is 30 minutes. Its peak concentration occurs in about 1 hour; its half-life, in 2.5 hours; and its duration of action is 4 to 6 hours.

A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution administered via an infusion pump set at 10 ml/hour. The nurse determines that the client is receiving how many units of insulin each hour? Record your answer using a whole number.

5 To determine the number of insulin units the client is receiving per hour, the nurse must first determine the number of units in each milliliter of fluid (50 units ÷ 100 ml = 0.5 units/ml). Next, multiply the units per milliliter by the rate of milliliters per hour (0.5 units × 10 ml/hr = 5 units).

The health care provider prescribes sulfasalazine for the client with ulcerative colitis. Which instruction should the nurse give the client about taking this medication?

Take it with a full glass (240 mL) of water. Adequate fluid intake of at least eight glasses a day prevents crystalluria and stone formation during sulfasalazine therapy.Sulfasalazine can cause gastrointestinal distress and is best taken after meals and in equally divided doses.Sulfasalazine gives alkaline urine an orange-yellow color, but it is not necessary to stop the drug when this occurs.

A client is refusing to take the prescribed oral medication. Which measure by the nurse can be used to get the client to take the medication? Select all that apply.

suggesting a liquid form of the medication instead of a pill asking the client the reason for not taking the medication explaining the purpose of the medication to the client The correct answers provide an alternative solution for the client and provide the client an opportunity to consent to taking the medication in another form, neither of which would be considered abuse. Providing health education regarding the medications to ensure the client has all the information needed to make an informed consent would be appropriate. Hiding medication or disguising it in food knowing that the client has refused the medication would be considered abuse. The client has the right to refuse care, including medication, and a family member should not be placed in a position of having to give the medication.

Which instruction is most important for the nurse to include in the teaching plan for a client who is taking phenelzine?

Avoid foods high in tyramine. A client who is taking phenelzine, a monoamine oxidase inhibitor, needs to avoid foods that are rich in tyramine because this food-drug combination can cause hypertensive crisis. The client should be given a list of foods to avoid and should report headaches, palpitations, and a stiff neck to the health care provider (HCP) immediately. The client does not need to restrict or add salt to the diet. Drinking 10 to 12 glasses of water each day is important to teach the client who is receiving lithium therapy. Antidepressant drugs take 2 to 4 weeks to achieve therapeutic effects.

A client with diabetes has been diagnosed with hypertension, and the health care provider has prescribed atenolol, a beta-blocker. When teaching the client about the drug, what should the nurse tell the client about how it may interact with the client's diabetes? Atenol may cause:

an increase in the hypoglycemic effects of insulin. There is a direct interaction between the effects of insulin and those of beta blockers. The nurse must be aware that there is a potential for increased hypoglycemic effects of insulin when a beta blocker is added to the client's medication regimen. The client's blood sugar should be monitored. Ketoacidosis occurs in hyperglycemia. Although a decrease in the incidence of ketoacidosis could occur when a beta blocker is added, the direct result is an increase in the hypoglycemic effect of insulin.

The nurse is to administer midazolam 2.5 mg. The medication is available in a 5 mg/mL vial. How many mL should the nurse administer? Record your answer using one decimal point.

0.5 To obtain the answer, treat the volume to be administered as X.5 mg/1 mL = 2.5 mg/XX = 1 mL x (2.5/5) = 0.5 mL.

The client has been taking the monoamine oxidase inhibitor (MAOI) phenelzine, 10 mg twice a day. The healthcare provider prescribes a selective serotonin reuptake inhibitor (SSRI), paroxetine 20 mg to be given every morning. What action should the nurse take?

Question the health care provider about the prescription. The nurse should question the health care provider about the prescription because the client who has been taking an MAOI such as phenelzine must wait 14 days after stopping the MAOI before starting an SSRI such as paroxetine. Serotonin syndrome, a potentially lethal consequence, can occur when combining an MAOI and an SSRI. Serotonin syndrome is characterized by hyperreflexia, hyperthermia, myoclonus, and other symptoms similar to neuroleptic malignant syndrome. Giving the medication as prescribed can result in serious adverse consequences, as described previously. The dosage is accurate. Benztropine is not given with an SSRI; it is an antiparkinsonian agent usually prescribed for the adverse effects of antipsychotic medication.

A client was discharged from an alcohol rehabilitation program on clonazepam 0.5 mg three times a day. Several months later, the client reports having insomnia, shakiness, sweating, and one seizure. The nurse should first assess the client for which possible symptoms cause?

stopping the clonazepam suddenly The nurse should first confirm that the client has stopped taking the clonazepam because the client is reporting symptoms of benzodiazepine withdrawal from stopping the clonazepam abruptly. The client would report symptoms of being sedated if the client took alcohol with the clonazepam. Tolerance symptoms would be increased anxiety, not these physical symptoms. The client symptoms are consistent with clonazepam withdrawal, not excess; thus, asking about increased use is not relevant.

A 20-year-old client visiting the clinic requests the use of oral contraceptives. When reviewing the client's history, which finding would alert the nurse to a possible contraindication to using these agents?

thrombophlebitis Oral contraceptives are contraindicated for clients with a history of thrombophlebitis because a serious side effect of oral contraceptives is thrombus formation. Other contraindications include stroke and liver disease. Oral contraceptives are used cautiously in clients with hypertension or diabetes. Close follow-up of these clients is essential.Urinary tract infections (UTIs) do not contraindicate the use of oral contraceptives. If the client is suffering from UTIs, the nurse can instruct her to increase her fluid intake and wipe from front to back after urinating or defecating.Ulcerative colitis does not contraindicate using oral contraceptives.Menorrhagia is typically reduced through the use of oral contraceptives.

A client is receiving furosemide as part of the treatment for heart failure. Which assessment finding indicates that the medication is attaining a therapeutic effect?

trace peripheral edema, previously +2 The therapeutic effect of furosemide is to mobilize excess fluid. The client's peripheral edema should decrease, indicated by changing from +2 to trace. As furosemide decreases fluid in the lungs, the client's crackles should decrease, not continue to progress. If furosemide is attaining a therapeutic effect, the blood pressure should decrease into normal range and the oxygen level should increase to above 90%.

Which instruction would be most appropriate for the nurse to include in the teaching plan for the mother of a 1-year-old child who is to receive iron therapy with ferrous sulfate drops?

Put the drops in the child's mouth, then follow with juice. Absorption of iron is enhanced in an acid environment. Thus, iron drops are better absorbed when mixed with fruit juice or followed by fruit juice.Medications should not be mixed in a cup or bottle of fluids. If the child does not drink the entire cup or bottle, it is difficult to determine how much of the medication the child actually received. Also, even though the child may be learning to use a cup, it may spill, again making it difficult to determine the amount of medication that the child has received. In addition, milk tends to decrease iron absorption.Putting the drops in the child's mouth is appropriate. However, following administration with milk should be avoided because milk decreases iron absorption.Medications should not be diluted with water. If the child does not swallow the entire dose, it is difficult to determine how much of the medication the child actually received.

A client is receiving an I.V. infusion of mannitol after undergoing intracranial surgery to remove a brain tumor. To determine whether this drug is producing its therapeutic effect, the nurse should consider which finding most significant?

increased urine output The therapeutic effect of mannitol is diuresis, which is confirmed by an increased urine output. A decreased LOC and elevated blood pressure may indicate lack of therapeutic effectiveness. A decreased heart rate doesn't indicate that mannitol is effective.

A client who is incoherent and agitated comes to the emergency department. The client reports visual and auditory hallucinations. The healthcare provider orders haloperidol, 5 mg IM. When educating the client on this medication, which statement by the nurse is correct?

"This medication will help decrease your tension and agitation." By altering the effects of dopamine in the central nervous system, haloperidol, an antipsychotic drug, treats psychosis and decreases agitation. While this medication diminishes signs and symptoms of psychoses when taken regularly, it is incorrect for the nurse to state one dose will prevent future psychotic episodes. Drowsiness is a common side effect of haloperidol, but the purpose of this medication is to treat the psychosis and decrease agitation. Tardive dyskinesia may occur after prolonged haloperidol use; the client should be monitored for this adverse reaction.

A client has been taking 30 mg of duloxetine hydrochloride twice daily for 2 months because of depression and vague aches and pains. While interacting with the nurse, the client discloses a pattern of drinking a 6-pack of beer daily for the past 10 years to help with sleep. What should the nurse do first?

Report the client's beer consumption to the health care provider (HCP). The nurse should report the client's beer consumption to the HCP . Duloxetine should not be administered to a client with renal or hepatic insufficiency because the medication can elevate liver enzymes and, together with substantial alcohol use, can cause liver injury. Referring the client to the concurrent diagnosis program, sharing information at the next interdisciplinary treatment conference, and teaching the client relaxation exercises are helpful interventions for the nurse to implement. However, reporting the findings to the HCP is most important.

A client with psychosis is prescribed quetiapine 400 mg by mouth daily in two divided doses. The pharmacy dispenses 200-mg tablets. How many tablets should the nurse administer with each dose? Record your answer using a whole number.

1 The prescribed dosage is 400 mg by mouth daily in two divided doses. 400 mg divided by 2 doses equals 200 mg per dose. The nurse should give one tablet with each dose.

Which comment from a client indicates a need for further instruction after being taught about taking ciprofloxacin?

"I must drink 1,000 to 1,500 mL of water a day." To reduce the risk of crystalluria, the client should drink 2,000 to 3,000 mL of water a day, not 1,000 to 1,500 mL. The client should not take an antacid before taking ciprofloxacin. An antacid decreases the absorption of the drug. The client should let the HCP know if vomiting occurs from the medication. The client may get light-headed from the ciprofloxacin. If so, the client should not drive a motor vehicle and should contact the HCP.

Which statement made by a client who is taking misoprostol indicates a therapeutic outcome of therapy?

"My stomach feels better." Misoprostol is used to protect the stomach's lining when a client has a peptic ulcer. Misoprostol does not affect the cardiac or respiratory systems.

A client is receiving parenteral nutrition through a central venous catheter. As the nurse is changing the dressing at the catheter site, the client asks why this type of catheter is being used instead of a regular peripheral I.V. Which is the best response by the nurse to explain the use of the central venous catheter?

"The nutrients that are being administered are too concentrated for a peripheral I.V." Parenteral nutrition solutions have five to six times the concentration of nutrients of blood. They would be very irritating to the vascular intima if delivered via a peripheral vein. When administered via a central venous catheter, concentrated solutions are rapidly diluted to isotonic levels. The other answers are incorrect because the principal reason for the central venous catheter is to provide concentrated nutrition; fluids and electrolytes can be restored via regular I.Vs. Parenteral nutrition is not hypotonic, but hypertonic, and therefore cannot be administered peripherally. Central venous catheters are not accessed if peripheral veins have been overused; a cut down and deeper peripheral veins are then used.

The client with breast cancer is prescribed tamoxifen 20 mg daily. The client states she does not like taking medicine and asks the nurse if the tamoxifen is really worth taking. What should the nurse tell the client?

"This drug has been found to decrease metastatic breast cancer." Tamoxifen is an antiestrogen drug that has been found to be effective against metastatic breast cancer and to improve the survival rate. The drug causes hot flashes as an adverse effect.

A client is scheduled to receive a blood transfusion. In addition to taking vital signs and verifying that the unit of blood cells is checked, what other assessments/actions would the nurse be responsible for? Select all that apply.

Assess the client for chills or low back pain. Stop the transfusion for reports of dyspnea or itching Checking for the possibility of transfusion reactions is an important responsibility. Chills can be associated with blood contamination, low back pain can be associated with incompatible blood, and dyspnea and skin itching can be associated with an allergic reaction. The transfusion would need to be stopped. Rapidly transfusing blood is incorrect because the transfusion is started slowly for the first 15 minutes to detect abnormal reactions. Transfusing blood over a prolonged period, e.g., 5 hours, increases the risk of blood contamination.

A client with acute mania is to receive lithium carbonate 600 mg PO three times daily and 2 mg of haloperidol PO at bedtime. Which action should the nurse take?

Give the medications as prescribed. Lithium commonly is combined with an antipsychotic agent, such as haloperidol, or a benzodiazepine such as lorazepam. Antipsychotic agents, such as haloperidol, are prescribed to produce a neuroleptic effect until the lithium, produces a clinical response. After a clinical response is achieved, the antipsychotic agent usually is discontinued. Additionally, the dosages of each drug listed are appropriate. Therefore, the nurse would administer the drugs as prescribed.

The health care provider prescribes continuous IV nitroglycerin infusion for the client with myocardial infarction. What should the nurse do to ensure safe administration of this drug?

Use an infusion pump for the medication. IV nitroglycerin infusion requires an infusion pump for precise control of the medication. Blood pressure monitoring would be done with a continuous system, and more frequently than every 4 hours. Hourly urine outputs are not always required. Obtaining serum potassium levels is not associated with nitroglycerin infusion.

A client receiving phenothiazine has become restless and fidgety and is anxiously pacing the hallway. What adverse effect of phenothiazine would the nurse suspect, based on this behavior?

akathisia Akathisia is an adverse effect of phenothiazines. Dystonia appears as excessive salivation, difficulty speaking, and involuntary movements of the face, neck, arms, and legs. Parkinsonian effects include a shuffling gait, hand tremors, drooling, rigidity, and loose arm movements. Tardive dyskinesia is characterized by odd facial and tongue movements.

A nurse working on a psychiatric unit is checking orders on a newly admitted client diagnosed with schizophrenia. An order reads, "thioridazine 200 mg PO qid and 100 mg PO prn." Before this drug is administered, which should be the nurse's priority action?

checking accuracy of the order The nurse must question this order immediately. Thioridazine has an absolute dosage ceiling of 800 mg/day. Any dosage about this level places the client at high risk for toxic pigmentary retinopathy, which cannot be reversed. As written, the order allows for administering more than the maximum 800 mg/day; it should be corrected immediately before the client's health is jeopardized. This is a higher priority than assessing a client's allergies or teaching about the possible side effects, which will be done prior to medication administration. Proper client identification is necessary prior to medication administration; however, the client should be identified by name and date of birth. Accuracy of the order takes priority.

Liquid oral iron supplements have been prescribed for a child. What is the most important information for the nurse to provide to this child's parents?

give the medicine via a dropper or through a straw Liquid iron preparations may temporarily stain the teeth. The drug should be given by dropper or through a straw. Iron supplements should be given between meals, when the presence of free hydrochloric acid is greatest. If vomiting occurs, supplementation should not be stopped, but it should be administered with food. Constipation can be decreased by increasing intake of fruits and vegetables.

Which sign should the nurse closely assess in a client who is reversing from general anesthesia and receiving clindamycin?

respiratory depression The client who has received general anesthesia with neuromuscular blocking agents must be carefully monitored when given clindamycin. A serious interaction could be enhanced, neuromuscular blockage, skeletal muscle weakness, or respiratory depression, if this combination is used during or immediately after surgery. Concurrent use should be avoided. The combined effect of the medications places the client at increased risk, and the nurse should assess the client closely for respiratory depression or paralysis. The nurse will be monitoring the client's heart rate, blood pressure, and urinary output but not specifically because of potential drug interactions and adverse effects of clindamycin.

A client with heart failure is given a prescription for torsemide. Two days after the drug therapy is started, which sign indicates the drug is having the intended outcome? The client:

weighs 7 lbs (3 kg) less than the client did 2 days ago. The primary reason to give a diuretic to a client with heart failure is to promote sodium and water excretion through the kidneys. As a result, the excessive body water that tends to accumulate in a client with heart failure is eliminated, which causes the client to lose weight. Monitoring the client's weight daily helps evaluate the effectiveness of diuretic therapy. Clients should be advised to weigh themselves daily. An increased appetite or decreased thirst does not establish the effectiveness of the diuretic therapy, nor does having clearer urine after starting torsemide.

A client has just begun treatment with busulfan, 4 mg by mouth daily, for chronic myelogenous leukemia. The client receives busulfan until their white blood cell (WBC) count falls to between 10,000/mm3 and 25,000/mm3. Then the drug is stopped. When should treatment resume?

when the WBC count rises to 50,000/mm3 Busulfan treatment should resume when the WBC count rises to 50,000/mm3. Hair growth and anemia aren't appropriate markers for resuming busulfan treatment.

A client taking paroxetine 40 mg PO every morning tells the nurse that her mouth "feels like cotton." Which statement by the client necessitates further assessment by the nurse?

"I'm drinking 12 glasses of water every day." Dry mouth is a common, temporary side effect of paroxetine. The nurse needs to further assess the client's water intake when the client states she is drinking lots of water. Excessive intake of water could be harmful to the client and could lead to electrolyte imbalance. Dry mouth is caused by the medication, and drinking a lot of water will not eliminate it. Sucking on ice chips or using sugarless gum or candy is appropriate to ease the discomfort of dry mouth associated with paroxetine.

The nurse is preparing to administer a controlled substance to a client who was admitted to an inpatient unit after being injured during a manic episode. The single-dose vial contains more than is needed for the prescribed dose. Which nursing action is appropriate?

Document wasting of the excess medication with a second witness. Wasting of all controlled substances requires an independent witness and documentation; at least one, but preferably both, of the witnesses should be licensed. For single-dose vials, the excess is not returned to the pharmacy or saved for a future dose of medication. Adding the excess to a second vial would necessitate breaking the seal on the second vial, increasing the volume in the vial and adding to the risk of controlled substance discrepancies.

A physician orders cefoxitin, 1 g in 100 ml of 5% dextrose in water, to be administered I.V. A nurse determines that the recommended infusion time is 15 to 30 minutes. The available infusion set has a calibration of 10 drops/ml. To infuse cefoxitin over 30 minutes, which drip rate should the nurse use?

33 drops/minute To calculate an I.V. flow rate, the nurse multiplies the number of milliliters to be infused (100 in this case) by the drop factor (10 drops/ml), and then divides by the number of minutes over which the solution is to be infused — 30 minutes. (100 × 10) ÷ 30 = 33 drops/minute