Chapter 6: Challenges to Effective Drug Therapy

A client seeks medical attention for skin reactions to mosquito bites. The client refuses to use prescription medication for the reactions. Which herbal supplement could the nurse suggest to treat the mosquito bites?

tea tree oil

When describing the characteristics of the client who comes into the health care system today, which would most likely apply?

the use of a complex array of OTC and alternative therapies

A client with chronic headaches wants to stop using prescribed analgesics. Which herbal supplement does the nurse know is used for this client's condition?

topical peppermint

In the past 20 years, the marketing power for prescription drugs has grown. Because of this, the health care provider must be aware of:

what clients are seeing about these drugs.

The nurse is admitting a client who has been on a three-day binge of methamphetamine. The nurse should anticipate what sign or symptom?

tachycardia

A client denies using alternative therapies but makes an appointment to have acupuncture later in the day. Which information would the nurse share with the client?

"Alternative therapies include health-inducing practices such as acupuncture."

A client plans to use valerian to help with insomnia. Which teaching would the nurse provide about this herbal supplement?

"Do not take with alcohol."

A client reports taking an over-the-counter (OTC) antacid to relieve acid indigestion daily for several months. This is the first time the client has ever reported this medication use to a health care provider. What health education should the nurse provide to the client?

"Ensure that you keep your provider up to date on your mediation use so there aren't any unanticipated interactions."

A client denies taking nutritional supplements but asks if a probiotic supplement can still be taken for a gastrointestinal condition. Which response would the nurse make?

"Probiotics are considered nutritional supplements."

The nurse is providing education to the family of a client recently admitted for treatment of a substance use disorder. How should the nurse best explain the etiology of this disorder?

"Substance abuse is multifactorial and involves genetics, personality, and culture."

A client plans to used herbal therapy to treat a health problem. Which information would the nurse emphasize with the client about this therapy? Select all that apply.

"The doses are not precise." "The ingredients are not precise." "A disclaimer must be on the container." "They are not strictly regulated by the Food and Drug Administration."

The nurse is assessing a client and is asking about the client's current medication regimen. The client states, "I'm not taking anything that you need a prescription to get." What is the nurse's best response?

"Which drugs do you take that don't require a prescription?"

Which website extension represents a professional group?

.org

A 22-year-old client calls the clinic and tells the nurse that they are depressed and have been taking St. John's wort. The client wants to know whether this is a safe herbal remedy to take. What medications will the nurse ask specifically about?

Oral contraceptives

What patient populations are more commonly prescribed off-label drugs?

Pediatrics and geriatrics

A client reports that, "The alcohol treatment programs I've tried in the past have only helped for a little and then I start drinking again." This statement best describes which type of alcohol-related behavior?

Psychological dependence

A nurse is preparing a drug for administration to a patient. The drug does not have an indicated use for the patient's medical diagnosis. What should the nurse do?

Question the prescriber concerning the ordered drug

A 70-year-old with a history of atrial fibrillation has been admitted with a lower gastrointestinal bleed. During the nurse's admission assessment, the nurse realizes that the client has been taking ginkgo biloba supplements in addition to prescribed warfarin, a combination that has resulted in bleeding. What nursing diagnosis should the nurse identify when planning this client's care?

Risk for Injury related to drug interactions of vitamins, herbs, or food intake with prescribed drug therapy

A client, admitted for the treatment of a fracture, has a history of heavy alcohol use. What event should suggest the implementation of pharmacologic treatment for alcohol withdrawal?

Signs/symptoms of withdrawal are noted.

A client has been prescribed a selective serotonin reuptake inhibitor (SSRI) to treat depression. The regular use of which herbal supplement requires intervention by the nurse?

St. John's wort

With the increasing number of clients who go to their physician and request a drug they have seen advertised on television or in a magazine, a continuing challenge to health care providers to do what has emerged?

Stay knowledgeable about drug therapy.

The nurse is assessing a client who is brought to the emergency department by some friends who admit that the client used cocaine. What should the nurse expect to assess?

Tachycardia

Which entity or act classifies herbal products, vitamins, and minerals as "dietary supplements"?

The Dietary Supplement Health and Education Act of 1994

A client asks for a nonpharmacologic approach to treat sunburn. Which substance would the nurse suggest to the client?

aloe vera

A patient tells the clinic nurse that they have been taking OTC Pepcid to relieve acid indigestion for several years. This is the first time the patient has ever reported this problem to a health care provider. Why should the patient share their use of Pepcid with their health care provider?

The drug could mask symptoms of a serious problem that is undiagnosed.

The nurse is caring for a client who has strong beliefs about the effectiveness of a specific alternative therapy. The nurse recognizes the effectiveness of this therapy is increased by what effect?

placebo effect

The nurse is discharging a client with atrial fibrillation who has been prescribed "Warfarin 4 mg PO daily DAW." What should the nurse teach the client about this prescription?

The pharmacy cannot dispense a generic equivalent.

Which teaching points about herbal therapies is inaccurate?

The results of available testing involve large groups of people.

What should the nurse include when teaching a client about herbal therapies?

The results of available testing often involve only a small number of people.

A client reporting to the emergency department reports possible ingestion of "that date rape drug." The nurse suspects that the client is referring to what drug?

rohypnol

How should the nurse best assess the client for physical dependence on alcohol?

Assess the client for signs and symptoms of alcohol withdrawal.

The emergency department nurse is admitting a young adult client who denies the use of prescription or over-the-counter medications, but who admits to using cocaine and ecstasy. How should the nurse best follow up this assessment finding?

Assess the frequency of use and document the findings.

A client is agitated due to withdrawing from alcohol. Which group of drugs would assist the client?

Benzodiazepines

Biological assaults are a concern across the health care industry. In order to cope effectively with any biological assault, which group needs to be well-educated?

Health care providers

What is a drawback to HMO insurance?

Health care providers in the organization are the only ones who can be consulted.

Access to information has become so broad over the last decade that consumers are often overwhelmed with details, facts, and choices that affect their health care. What factors have influenced how a client approaches the health care provider when it comes to prescriptions? Select all that apply.

Internet alternative therapy media

Ipecac, once used as the drug of choice by parents for treatment of suspected poisoning in children, was tested by the FDA in 2003. What was the finding of this testing?

Ipecac is ineffective for its intended use

The nurse admitted a client who overdosed on an unknown drug. The fact that the client appears to be experiencing psychosis should suggest what possible drug to the nurse?

LSD

The nurse is preparing a presentation for a local community group about the health care system and drug therapy. What principle should guide the nurse's preparation?

Most consumers are open to a wide range of over-the-counter and alternative therapies.

What action should the nurse take when identifying that a client regularly self-medicates with herbal supplements?

Notify the healthcare provider of the client's use of herbs.

It is common practice for a pharmacy to provide written information with each drug that is dispensed. However, it is not always within the consumer's ability to sort through this information and understand it. Whose task does this become?

Nurse

A client was prescribed an oral antibiotic but was unable to tolerate the medication due to adverse effects. The client asks the nurse what to do with the remaining medication. What is the nurse's best recommendation?

Bring the medication to a pharmacy that accepts unused medications.

What assessment should the nurse perform prior to administering pharmacologic treatments prescribed for a client diagnosed with cocaine-induced psychosis?

Cardiovascular assessment

A group of students asks an instructor about where to find the most up-to-date information on biological weapons. What would the instructor recommend?

Centers for Disease Control

Off-label use refers to uses of a drug that are not part of the stated therapeutic indications for which the drug was approved by the FDA. When a nurse is using a medication for its off label use, the nurse should be very cognizant of certain factors in order to ensure patient safety. Select all that apply.

Clear about the intended use Why the drug is being given Its potential for problems

Clients often do not mention the use of alternative therapies to the health care provider. Which is a likely reason they do not discuss alternative therapies? Select all that apply.

Clients fear that the health care provider will not approve of any alternative therapies. Clients think that if a product is "natural," including it in a list of medications does not make sense.

What are accurate regarding herbal remedies? (Select all that apply.)

Clients often do not mention their use to health care providers. Herbal remedies produce unexpected effects. Herbal remedies can interact with prescription drugs.

The nurse is unfamiliar with a drug ordered for the client and looks it up in a drug handbook. The client is not diagnosed with any of the problems the drug is identified as being useful in treating. What will the nurse do before administering the drug?

Consult the prescriber.

Which of the following statements about today's health care consumers would the nurse recognize as false?

Consumers are reluctant to use over-the-counter and alternative therapies.

The nurse is caring for a 64-year-old single client who lives in an inner city rooming house. What variable is most likely to affect the client's adherence to prescribed treatment?

Cost of the drug

The nursing instructor is discussing the off-label use of drugs. What group of drugs would the instructor tell the students are often used for off-label indications?

Drugs used to treat psychiatric problems

A client has been diagnosed with heart failure and has been prescribed a calcium channel blocker. The client tells that nurse that it will be a major challenge to afford the medication and states, "I might see if I can find the pills cheaper from an online pharmacy in another country." What is the nurse's most appropriate action?

Educate the client about the potential risks involved in buying medications online.

What recommendation concerning bioterrorism by the Center for Disease Control (CDC) provides the public with the best protection?

Education of health care providers and the public concerning recognition and treatment of infections caused by biological weapons

A client with newly diagnosed hypertension has received a prescription from the care provider reading "Vasotec 5 mg PO daily." The client has expressed concern to the nurse about the possible cost of the medication. What is the nurse's best action?

Encourage the client to inquire about purchasing a generic equivalent.

Off-label use refers to uses of a drug that are not part of the stated therapeutic indications for which the drug was approved by the Food and Drug Administration. With the liability issues surrounding many of these drugs, the nurse should be aware of certain factors in order to ensure patient safety. Select all that apply.

For what purpose is the drug being given Which potential problems may arise after taking this drug How long it will take the nurse to administer it

What is a nonpharmacologic measure that is effective in treating nausea and vomiting in pregnant clients?

Ginger

A client has been prescribed a diuretic and asked the health care provider to write a prescription for twice the daily dose so that the client could split each pill and reduce costs. The nurse should:

caution the client that this practice can lead to inconsistent doses.

With access to multiple avenues of information regarding prescription drugs, what are many clients now doing?

challenging the health care provider

A client is experiencing acute alcohol withdrawal. What medication does the nurse anticipate the prescriber to order?

chlordiazepoxide

The nurse is researching the benefits and risks associated with the herbal supplement ginseng. In which client would this supplement be contraindicated? Select all that apply.

client who is taking antidepressants client who is on hormonal contraceptives client who has diabetes client who is pregnant

A client with benign prostatic hyperplasia asks if there is a nonpharmacologic supplement to help the condition. Which herbal supplement would the nurse discuss with the health care provider about the client's condition?

saw palmetto

A client reports taking a supplement that is marketed as the "fountain of youth." Which supplement would the nurse suspect the client is referring to?

dehydroepiandrosterone

The nurse who is working in the emergency department admits a 14-year-old client who is exhibiting blurred vision, confusion, impaired breathing, muscle twitches, irregular heartbeat, and excessive sweating. The client's friends report that the client bought a lot of cough syrup and has been drinking it all day. The nurse understands that the client has overdosed on what over-the-counter medication?

dextromethorphan

The nurse is caring for a client who routinely takes herbal supplements, including betel palm. For which medication(s) would the nurse remind the client to avoid taking with betel palm? Select all that apply.

digoxin beta blocker antiglaucoma monoamine oxidase inhibitor

A nurse has admitted a client diagnosed with substance abuse intoxication to the unit. The nursing assessment will first be directed toward data regarding:

drug use.

The home care nurse is paying a scheduled visit to an older adult client who has a complex medication regimen. The nurse should prioritize what action related to the client's medications during this visit?

educating the client about the management of possible adverse effects

Which aspect of medical care is an overriding concern of a health maintenance organization (HMO)?

financial

A client with osteoarthritis plans to start taking chondroitin. With which additional herbal preparation will the nurse expect this supplement to be combined?

glucosamine

Cimetidine (Tagamet) is an OTC drug used to treat:

heartburn

A nurse is working in the emergency department and is assigned to a client brought in by family members. The family thinks that the client is on methamphetamine. The nurse should assess for:

hypertension

Clients who use garlic with co-administration of antidiabetic drugs may run into which serious problem?

hypoglycemia

The clinic nurse is assessing a client who reports taking ginseng recently. Which condition would the nurse take special care to check for in this client?

hypoglycemia

A client with a new development of symptoms reports taking bromelain. Which assessment finding(s) would indicate to the nurse that the client may be experiencing adverse effects from the supplement? Select all that apply.

nausea diarrhea vomiting menstrual disorders

Heroin is classified as which type of street drug?

opioid

The nurse is caring for a client with a history of urinary tract infections. Which herbal supplement could be helpful for this condition?

parsley seeds and leaves