HESI Medical-Surgical Drugs

A client has an IV of D5W 250 mL to which 100 mg of morphine is added. The healthcare provider prescribes 14 mg of morphine per hour for end of life palliative treatment of a client . At how many mL per hour should the nurse set the intravenous pump? Record your answer using a whole number. ___mL/hr

35 100mg/250ml=14mg/x 100x=3500 x=35 mL/hr

A nurse is reviewing the history and physicals of several clients from the clinic who are taking rifampin for the treatment of tuberculosis. Which client presents a specific concern for the nurse? 1 45-year-old taking a loop diuretic 2 26-year-old taking oral contraceptives 3 32-year-old taking a proton pump inhibitor 4 72-year-old taking intermediate-acting insulin

26-year-old taking oral contraceptives Rifampin increases metabolism of oral contraceptives, which may result in an unplanned pregnancy. Rifampin does not interact with a loop diuretic, a proton pump inhibitor, or intermediate-acting insulin.

A client has acute tubulointerstitial renal disease and is experiencing fluid and electrolyte imbalances. The client is confused and complains of nausea and muscle weakness. What does the nurse anticipate will be prescribed to help correct the electrolyte imbalance associated with this diagnosis? 1 Infuse normal saline intravenously. 2 Administer a cation-exchange resin. 3 Increase the intake of dairy products. 4 Restrict the intake of foods high in fiber

Administer a cation-exchange resin Kayexalate, a potassium-exchange resin, permits sodium to be exchanged for potassium in the intestine, reducing the serum potassium level. Intravenous normal saline will cause fluid retention in the oliguric phase of acute tubular necrosis and is contraindicated. Dairy products will increase calcium levels, not reduce potassium levels. Foods high in fiber will not alter the electrolyte imbalance

After cataract surgery, a client reports feeling nauseated. How can the nurse help relieve the nausea? 1 Administer the prescribed antiemetic drug. 2 Provide some dry crackers for the client to eat. 3 Explain that this is expected following surgery. 4 Teach how to breathe deeply until the nausea subsides.

Administer the prescribed antiemetic drug. An antiemetic will prevent vomiting; vomiting increases intraocular pressure and should be avoided. Providing some dry crackers for the client to eat, explaining that this is expected following surgery, and teaching how to breathe deeply until the nausea subsides. are unsafe; vomiting increases intraocular pressure, and aggressive intervention is required.

While a pacemaker catheter is being inserted, the client's heart rate drops to 38 beats/min. What medication should the nurse expect the healthcare provider to prescribe? 1 Digoxin 2 Lidocaine 3 Amiodarone 4 Atropine sulfate

Atropine sulfate Atropine blocks vagal stimulation of the sinoatrial (SA) node, resulting in an increased heart rate. Digoxin slows the heart rate; hence it would not be indicated in this situation. Lidocaine decreases myocardial sensitivity and will not increase the heart rate. Amiodarone is an antidysrhythmic drug used for ventricular tachycardia; it will not stimulate the heart rate.

A client with acquired immunodeficiency syndrome (AIDS) is receiving zidovudine. Which laboratory values are most important for the nurse to monitor in this client? 1 Cardiac enzymes 2 Serum electrolytes 3 Complete blood counts (CBCs) 4 Human immunodeficiency virus (HIV) antibody levels

Complete blood counts (CBCs) Zidovudine can cause anemia, leukopenia, and granulocytopenia; these blood dyscrasias can be life threatening and therefore the CBC should be monitored. Cardiac enzymes are not affected directly by zidovudine. Serum electrolytes are not affected directly by zidovudine. Once infected, the client will continue to test positive for the antibody.

A client is admitted with head trauma after a fall. The client is being prepared for a supratentorial craniotomy with burr holes, and an intravenous infusion of mannitol is instituted. The nurse concludes that this medication primarily is given to do what? 1 Lower blood pressure 2 Prevent hypoglycemia 3 Increase cardiac output 4 Decrease fluid in the brain

Decrease fluid in the brain Osmotic diuretics remove excessive cerebrospinal fluid (CSF), reducing intracranial pressure. Osmotic diuretics increase, not decrease, the blood pressure by increasing the fluid in the intravascular compartment. Osmotic diuretics do not directly influence blood glucose levels. Although there is an increase in cardiac output when the vascular bed expands as CSF is removed, it is not the primary purpose for administering the medication.

A client is admitted to the hospital for an adrenalectomy. The nurse is providing postoperative care before the client's replacement steroid therapy is regulated fully. The nurse should monitor the client for which complication? 1 Hypotension 2 Hypokalemia 3 Hypernatremia 4 Hyperglycemia

Hypotension Because of instability of the vascular system and the lability of circulating adrenal hormones after an adrenalectomy, hypotension frequently occurs until the hormonal level is controlled by replacement therapy. Hyperglycemia is a sign of excessive adrenal hormones; after an adrenalectomy, adrenal hormones are not secreted. Sodium retention is a sign of hyperadrenalism; it does not occur after the adrenals are removed. Potassium excretion is a response to excessive adrenal hormones; after an adrenalectomy, adrenal hormones are decreased until replacement therapy is regulated

A client is admitted to the hospital for an adrenalectomy. When teaching the client about the prescribed medications, what will the nurse emphasize? 1 Drug therapy will be given in conjunction with insulin. 2 Once regulated, the dosage will remain the same for life. 3 If taken late in the evening, the medications may cause insomnia. 4 Salt intake may have to be restricted while taking the medications.

Salt intake may have to be restricted while taking the medications. Administration of adrenocortical hormones causes sodium retention; dietary intake of salt should be limited. Because pancreatic function is unimpaired, insulin therapy is not indicated. Because there is an increased secretion of glucocorticoids under stressful situations, the dosage must be adjusted accordingly. Insomnia is not an adverse effect of adrenocortical hormones.

The provider prescribes one unit of packed red blood cells to be administered to a client. To ensure the client's safety, which measure should the nurse take during administration of blood products? 1 Stay with client during first 15 minutes of infusion. 2 Flush packed red blood cells with 5% dextrose and 0.45% normal saline. 3 Discontinue the intravenous catheter if a blood transfusion reaction occurs. 4 Administer the red blood cells through a percutaneously inserted central catheter line with a 20-gauge needle.

Stay with client during first 15 minutes of infusion. The nurse should remain with the client for the first 15 to 30 minutes. Any severe reaction usually occurs with the infusion of the first 50 mL of blood. Blood components are viscous, requiring a large needle to be used for venous access. A 20-gauge needle is not used to access a central catheter line. Normal saline is the solution to administer with blood productions. Lactated Ringer and dextrose in water are not used for infusion because of hemolysis.

Which information should be included in the teaching plan for the elderly client with peptic ulcer disease who is taking an antacid and sucralfate? 1 Antacids should be taken 30 minutes before a meal. 2 Sucralfate should be taken on an empty stomach one hour before meals. 3 Sucralfate is prescribed for the long-term maintenance of peptic ulcer disease. 4 Sodium bicarbonate is an inexpensive over-the-counter antacid with few adverse effects.

Sucralfate should be taken on an empty stomach one hour before meals. Sucralfate works best in a low pH environment; therefore it should be given on an empty stomach either one hour before or two hours after meals. Sucralfate also should be administered no sooner than 30 minutes before or after an antacid. The acid-neutralizing effects of antacids last approximately 30 minutes when taken on an empty stomach and 3 to 4 hours when taken after meals. When sucralfate and an antacid are both prescribed, they are each most effective when the sucralfate is scheduled an hour before meals and the antacid is scheduled after meals. Sucralfate is prescribed for the short-term treatment of peptic ulcers. Its use is limited to 4 to 8 weeks. The client should follow the recommendations of the primary health care provider with regard to antacid selection. Sodium bicarbonate can produce acid-base imbalances which could be harmful, especially in elderly clients.

A client with biliary cirrhosis receives serum albumin therapy. What is the most effective method for the nurse to evaluate the client's response to therapy? 1 Weight daily 2 Vital signs frequently 3 Urine output every half hour 4 Urine albumin level every shift

Weight daily The increased osmotic effect of therapy increases the intravascular volume and urinary output; weight loss reflects fluid loss. The vital signs will not change drastically; "frequently" is a nonspecific timeframe. The urinary output is measured hourly; half-hour outputs are insignificant in this instance. A serum, not urine, albumin level is significant; albumin in the urine indicates kidney dysfunction, not liver dysfunction.