Lesson 6-B: Medications
The provider orders 500 mg erythromycin suspension per gastrostomy tube every six hours for a client with pneumonia. The supplied suspension contains 250 mg/5 mL. How many mL should the nurse administer for each dose? (Report your answer as a whole number.)
Correct Answer: 10mL
A client is prescribed acetaminophen, 325 mg two tabs orally, every 4 to 6 hours as needed for minor pain. What is the total, maximum dose of acetaminophen that the client would receive in a 24-hour period? Report your answer as a whole number.
Correct Answer: 3,900mg
A client has an order for ibuprofen oral drops, 10 mg/kg of body weight. The client weighs 62 lbs. The medication is supplied in a bottle containing 40 mg/mL. How many mL will the nurse administer? (Round your answer to the nearest whole number.)
Correct Answer: 7mL
The nurse in an ambulatory clinic is speaking with the parents of a 2-year-old child diagnosed with acute otitis media. Which information is most important for the nurse to include in the instructions to the parents? A. The child must complete the entire course of the prescribed antibiotic. B. The child may be given acetaminophen or ibuprofen drops for pain. C. The child may be given a decongestant to relieve pressure on the tympanic membrane. D. The child should return to the clinic to evaluate effectiveness of the treatment.
Correct Answer: A Rationale: Acute otitis media (AOM) is an inflammation of the middle ear space with a rapid onset of the signs and symptoms of acute infection, namely, fever and otalgia (ear pain). It is one of the most prevalent early childhood illnesses. Treatment for AOM is one of the most common reasons for antibiotic use in the ambulatory setting. When antibiotics are necessary, it is most important to complete the entire course to prevent antibiotic resistance. The child should be seen after antibiotic therapy is complete to ensure that the infection has resolved. Supportive care of AOM includes treating the fever and pain. Decongestants or antihistamines are not recommended for children with ear infections.
A nurse administers cimetidine to a 75-year-old client diagnosed with a gastric ulcer. The nurse should monitor the client for which adverse reaction? A. Mental status change B. Constipation C. Hearing loss D. Increased liver enzymes
Correct Answer: A Rationale: Cimetidine is a histamine H2-receptor antagonist used to treat gastric ulcers. It has been found to cause confusion in susceptible clients, such as the elderly and debilitated clients. Clients over age 50 or who are severely ill may become temporarily confused while taking H2 blockers, especially cimetidine.
The client is discharged from the hospital with a new prescription for furosemide. During a follow-up visit one week later, the nurse notes the following findings. Which finding is most important to report to the health care provider? A. Muscle cramps B. Constipation C. Occasional lightheadedness D. Increased urine production
Correct Answer: A Rationale: Furosemide is a loop (potassium-wasting) diuretic. It can cause dehydration and hypokalemia, which can result in muscle cramps. This is the most important finding. Dizziness or lightheadedness may occur as the body adjusts to the medication. The nurse should reinforce to the client that they should get up slowly when rising from a sitting or lying position. The client should tell the HCP if these findings persist or become worse. Increased urine production is an expected action of the medication. Some people experience constipation when taking this medication, but it is not as important to report that finding as the possibility of hypokalemia.
A client received hydromorphone orally one hour ago. When the nurse enters the client's room, the client is unresponsive to verbal stimuli and has a respiratory rate of six. Which action should the nurse take next? A. Prepare to administer naloxone. B. Administer supplemental oxygen. C. Begin cardiopulmonary resuscitation. D. Prepare for endotracheal intubation.
Correct Answer: A Rationale: Hydromorphone is an opioid analgesic. The client seems to be experiencing central nervous system and respiratory depression related to the medication. The antidote for opioids is naloxone. The nurse should first administer naloxone to reverse the effects of the hydromorphone. The other actions are not appropriate for the client at this time.
The nurse is preparing a client with rheumatoid arthritis (RA) for discharge to an assisted living facility. Which statement about the prescribed oral glucocorticoid is correct? A. "The medication will be gradually tapered off over 5 to 7 days." B. "It is normal to experience some memory loss or hallucinations." C. "The medication will reverse the joint deterioration of RA." D. "You will be taking the medication for several years."
Correct Answer: A Rationale: RA is an autoimmune, inflammatory disease that affects the joints. It is a progressive disease that causes joint deterioration and destruction, joint deformities and functional limitations for affected clients. The main goal of pharmacotherapy for RA is symptom relief. Glucocorticoids are anti-inflammatory drugs, which can relieve symptoms of RA and may also delay disease progression. For generalized symptoms related to RA, oral glucocorticoids are indicated. The most commonly employed oral glucocorticoids are prednisone and prednisolone. Glucocorticoids can slow disease progression, but will not reverse it. Treatment with glucocorticoids for RA is usually limited to short courses. Adverse psychological reactions such as hallucinations, memory loss or other psychoses must be reported to the provider and may require discontinuation of the glucocorticoid. To minimize adrenal insufficiency when glucocorticoids are discontinued, doses should be tapered very gradually.
A client has been diagnosed with hypothyroidism. Which medication should the nurse administer to treat the client's bradycardia? A. Levothyroxine B. Atropine C. Adenosine D. Epinephrine
Correct Answer: A Rationale: The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine sodium, a T4 replacement hormone. If the heart rate were so slow that it causes hemodynamic instability, then atropine or epinephrine might be an option for short-term management. Adenosine slows atrioventricular (AV) conduction in the heart and would be contraindicated for a client with bradycardia.
A client with diabetes is starting on insulin therapy. Which type of short-acting insulin will the nurse discuss using for mealtime coverage? A. Lispro B. Glargine C. NPH D. Detemir
Correct Answer: A Rationale: When classified according to time course, insulin preparations fall into three major groups: short duration, intermediate duration and long duration. Lispro is a rapid-acting insulin with an onset of 15 to 30 minutes, a peak of 0.5 to 2.5 hours and duration of 3 to 6 hours. Rapid- or short-acting insulin is commonly used for mealtime coverage for clients receiving insulin therapy. NPH insulin, glargine or detemir will be used as the basal insulin for intermediate- and long-duration blood sugar control.
The nurse is discharging a client who is at risk for venous thromboembolism (VTE). The client is prescribed enoxaparin. Which instruction should the nurse provide to this client? A. "Notify your health care provider if your stools appear tarry or black." B. "You should massage the injection site for better absorption." C. "You must have your partial thromboplastin time (PTT) checked weekly." D. "An intravenous (IV) catheter will be placed to administer the medication."
Correct Answer: A Rationale: As with any anticoagulant, enoxaparin carries the risk of bleeding. Clients should be instructed to report the presence of tarry stools, bleeding gums, hematuria, ecchymosis or petechiae to their HCP. PTT monitoring is not required for this medication. This type of heparin is administered subcutaneously, not intravenously. Massaging the site will cause bruising and decrease effectiveness of the drug.
A client has been admitted for the second time to treat tuberculosis (TB). Which referral does the nurse initiate as a priority? A. Psychiatric nurse liaison to assess reasons for noncompliance B. Visiting nurses to arrange for directly observed therapy (DOT) C. Social worker to see if the client can afford the medications D. Infection control nurse to arrange testing for drug resistance
Correct Answer: B Rationale: Clients with TB must take multiple drugs for six months or longer, making adherence a very real problem. Non-adherence is the most common cause of treatment failure and relapse. This client has a risk of non-adherence, as evidenced because this is their second admission to treat TB. When the client is discharged, they most likely will need to be placed on DOT to ensure compliance. This is the priority referral in order to prevent transmission of TB to others in the community. The other referrals may also be appropriate depending on the client's needs.
A client recovering from hip replacement surgery is taking acetaminophen with codeine every three hours for pain. For which side effect should the nurse monitor the client? A. Diffuse rash B. Constipation C. Hyperglycemia D. Wheezing
Correct Answer: B Rationale: Codeine is an opioid analgesic and antitussive (cough suppressant). For analgesic use, codeine is formulated alone and in combination with non-opioid analgesics (either aspirin or acetaminophen). Because codeine and non-opioid analgesics relieve pain by different mechanisms, the combination can produce greater pain relief than either agent alone. Opioids such as codeine slow down the function of the central nervous system. This can affect involuntary movements in the body, such as peristalsis. As the movement of food through the intestinal tract is slowed down, the walls of the intestine absorb more fluid. With less fluid in the intestines, stool becomes hard and constipation develops. The other side effects are not usually seen with codeine.
The hospice nurse is visiting a client diagnosed with end-stage lung cancer and metastases to the bone. What should the nurse keep in mind when planning for effective pain management? A. Relief of pain will be achieved quickly. B. Pain therapy is based on the client's report of pain. C. High doses of opioid analgesics will be required. D. The client will most likely become addicted.
Correct Answer: B Rationale: Every person's pain experience is unique and should be treated based on the individual's goals for pain management. Therefore, the amount of medication needed is dependent on the client's needs and reports of pain relief. The nurse should not assume that high doses of analgesics will be needed to alleviate the client's pain. Immediate or quick pain relief might be difficult to achieve, especially in light of the client's type of cancer and bone metastases. Addiction is a psychological condition and not a concern for this client. However, the client may develop a physical dependence and tolerance to pain medications that may require an increase in dosage to manage pain effectively.
A client who has been diagnosed with Raynaud's disease and hypertension is prescribed nifedipine. For which side effect should the nurse monitor the client? A. Increased pain in fingers B. Facial flushing C. Decreased urine output D. Cyanosis of the lips
Correct Answer: B Rationale: Nifedipine is a calcium channel blocker (CCB) used in the treatment of Raynaud's disease and hypertension by producing vasodilation. As a result of this vasodilating effect, facial flushing can occur. Cyanosis of the lips and decreased urinary output are not expected findings with nifedipine. Raynaud's disease causes vasoconstriction, resulting in pain in the fingers that should decrease when nifedipine is taken.
Propranolol is prescribed for a client with coronary artery disease (CAD). The nurse should consult with the health care provider (HCP) before giving this medication when the client reports a history of which condition? A. Deep vein thrombosis B. Asthma C. Peptic ulcer disease D. Myocardial infarction
Correct Answer: B Rationale: Non-cardioselective beta-blockers such as propranolol block b1- and b2-adrenergic receptors and can cause bronchospasm, especially in clients with a history of asthma. Beta-blockers will have no effect on the client's peptic ulcer disease or risk for DVT. Beta-blocker therapy is recommended after an MI.
A client diagnosed with tuberculosis is prescribed rifampin and isoniazid. Which information should the nurse include when reinforcing information about these medications? A. "You can take the medication with food." B. "You may notice an orange-red color to your urine." C. "You may have occasional problems sleeping." D. "You may experience an increase in appetite."
Correct Answer: B Rationale: Rifampin can cause reddish-orange discoloration of the urine and other body fluids, including tears and sweat. This is harmless, but the client needs to be made aware of it. The nurse should caution the client not to wear soft contacts while taking this medication because they can become discolored. The other information does not apply to those two medications.
A client with major depression is prescribed the extended release form of venlafaxine. Which statement by the client indicates a need for additional teaching? A. "I will call my doctor if I experience impotence." B. "I can stop taking the drug when I start feeling better." C. "I should swallow the pill whole." D. "I may feel nauseated and anorexic."
Correct Answer: B Rationale: Venlafaxine is a serotonin/norepinephrine reuptake inhibitor (SNRI) used for major depression, panic disorders and social phobias. It blocks neuronal uptake of serotonin and norepinephrine with minimal effects on other transmitters or receptors. Pharmacologic effects are similar to those of SSRIs. The most common side effect is nausea (37% to 58%). Sexual dysfunction may occur and can cause the client to stop taking the medication. Therefore, the client should contact their provider for a possible alternate prescription. The client is prescribed the extended release form and should not chew or break the pill, but swallow the pill whole. The client is expected to feel less depressed and should not stop taking the medication. Abrupt discontinuation can cause an intense withdrawal syndrome. Symptoms include anxiety, agitation, tremors, headache, vertigo, nausea, tachycardia and tinnitus. Worsening of pretreatment symptoms may also occur.
The nurse is reinforcing medication interactions with a client who is taking warfarin. Which over-the-counter (OTC) medication should the nurse remind the client to avoid? A. Pantoprazole B. Naproxen C. Diphenhydramine D. Acetaminophen
Correct Answer: B Rationale: Warfarin is an anticoagulant. OTC medications that interact with warfarin should be avoided. Naproxen, a nonsteroidal anti-inflammatory drug (NSAID), is a commonly used OTC analgesic. Naproxen can prolong bleeding time and should therefore be avoided by clients who take anticoagulants. The other medications are not contraindicated when taking warfarin.
The nurse is evaluating a client post kidney transplant about the client's understanding of mycophenolate mofetil. Which statement by the client indicates a need for further teaching? A. "I will take Tylenol for minor aches and pains." B. "I will take milk of magnesia with it to prevent heartburn." C. "I will notify my doctor when I develop a sore throat and chills." D. "I will take the medication on an empty stomach."
Correct Answer: B Rationale: Mycophenolate mofetil is a medication used to prevent transplant organ rejection. Absorption of this medication can be decreased by antacids that contain magnesium and aluminum hydroxides such as milk of magnesia. Accordingly, mycophenolate mofetil should not be given simultaneously with these drugs. Taking acetaminophen (Tylenol) for minor pain is acceptable, as long as the client remains within the FDA-recommended maximum daily dose of 3,900 mg. A sore throat and chills can be early symptoms of an infection in immunosuppressed clients, so the client should notify their HCP. Taking the drug on an empty stomach will facilitate complete absorption and is recommended.
The nurse is observing a new graduate nurse preparing to administer bumetanide 4 mg orally to a client with heart failure. Which client finding requires the nurse to intervene immediately? A. The client has crackles in both lung bases. B. The client's most recent blood pressure is 96/60 mmHg C. The client's most recent serum potassium level is 2.9 mg/dL D. The client has 4+ pitting edema in both lower legs.
Correct Answer: C Rationale: Bumetanide is a powerful, potassium-wasting loop diuretic. It promotes diuresis in clients suffering from heart failure (HF) and fluid retention. Prior to administration, the nurse should verify that the client's potassium level is within normal range (3.5 to 5.0 mg/dL). A serum potassium level of 2.9 mg/dL is very low. The new graduate nurse should hold the bumetanide and notify the health care provider (HCP) immediately. Bibasilar crackles and pitting edema are expected findings for a client with HF and are indications for the use of diuretics. Although loop diuretics can cause hypotension related to diuresis, a BP of 96/60 is within acceptable limits for a client with HF.
The nurse is reviewing prescribed medications with a client. Which information should the nurse reinforce about captopril? A. Avoid green leafy vegetables. B. Take the medication with meals. C. Avoid using salt substitutes. D. Restrict fluids to 1000 mL/day.
Correct Answer: C Rationale: Captopril is an angiotensin converting enzyme (ACE) inhibitor. It reduces aldosterone secretion, thereby reducing sodium and water retention. Captopril is used to treat hypertension and heart failure. Because it can cause an accumulation of serum potassium (i.e., hyperkalemia), clients should avoid the use of salt substitutes, which often contain potassium instead of sodium chloride. The other information does not apply to captopril.
A client is prescribed furosemide and digoxin for heart failure. The nurse should monitor the client for which potential adverse drug effect? A. Acute kidney injury B. Pulmonary hypertension C. Cardiac dysrhythmias D. Acute arterial occlusion
Correct Answer: C Rationale: Digoxin is a cardiac glycoside, or positive inotrope that increases myocardial contractility. By increasing contractile force, digoxin can increase cardiac output in clients with heart failure (HF). Furosemide is a potassium-wasting (loop) diuretic, prescribed to prevent fluid overload in clients with HF. Clients who take furosemide are at risk for developing hypokalemia. Potassium ions compete with digoxin and a low potassium level can cause digoxin toxicity, leading to lethal cardiac dysrhythmias. Therefore, it is imperative that potassium levels be kept within normal range (3.5 to 5 mEq/L) while taking digoxin.
The daughter of a client with Alzheimer's disease asks the nurse, "Will the medication my mother is taking cure her dementia?" What is the best response by the nurse? A. "It is used to halt the progression of Alzheimer's disease." B. "It will help your mother live independently again." C. "It will not improve dementia but can help control emotional responses." D. "It will provide a steady improvement in memory."
Correct Answer: C Rationale: Drug therapy for Alzheimer's disease such as memantine and donepezil produce modest improvements in cognition, behavior, and function, and slightly delayed disease progression. They do not reverse the dementia or halt the progression of Alzheimer's disease. At best, drugs currently in use may slow loss of memory and improve cognitive functions (e.g., memory, thought, reasoning) and emotional lability. However, these improvements are modest and last a short time and for many clients, even these modest goals are elusive.
A client has a new prescription for sertraline, a selective serotonin reuptake inhibitor (SSRI) antidepressant. After reviewing the client's medical record, which data is the nurse most concerned about? A. History of premenstrual dysphoric disorder B. History of an eating disorder C. Current prescription for phenelzine D. Current prescription for alprazolam
Correct Answer: C Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI) antidepressant. Combining MAOIs with SSRIs and other serotonergic drugs poses a risk of serotonin syndrome. Accordingly, these combinations should be avoided. The MAOI should be gradually discontinued before starting the SSRI. Alprazolam is a benzodiazepine and can be taken concurrently with MAOI or SSRI antidepressants. The other data in the client's history do not represent a contraindication for the use of a SSRI. The nurse should clarify the new prescription with the prescribing health care provider (HCP).
A 48-year-old male client who is being admitted to the emergency department with an acute myocardial infarction (MI) gives the following list of medications to the nurse. Which medication would the nurse recognize as having the most immediate implications for the client's care? A. Captopril B. Losartan C. Sildenafil D. Furosemide
Correct Answer: C Rationale: The nurse will need to avoid giving nitrates to the client because nitrate administration, commonly prescribed for clients experiencing an acute MI, is contraindicated in clients who are using sildenafil (a PDE5 inhibitor) because of the risk of severe hypotension caused by vasodilation. The other medications the client is taking should also be documented and reported to the health care provider (HCP) but do not have as immediate an impact on decisions about the client's treatment.
The nurse is reinforcing teaching about levothyroxine for a client newly-diagnosed with hypothyroidism. Which information should the nurse make sure to reinforce about this medication? A. The medication may decrease the client's energy level. B. The medication will decrease the client's heart rate. C. The medication must be stored in a dark container. D. The medication should be taken in the morning.
Correct Answer: D Rationale: A thyroid supplement, such as levothyroxine, should be taken on an empty stomach in the morning. Morning dosing minimizes the side effect of insomnia and an empty stomach facilitates absorption. The medication does not need to be stored in a dark container. Levothyroxine will cause an increase in the client's energy level and heart rate.
A client at risk for a stroke has been prescribed clopidogrel. Which information is most important for the nurse to reinforce with the client? A. "You must take the medication on an empty stomach." B. "You must have your lab tests checked weekly." C. "If you miss a dose, take a double dose the next day." D. "You must stop the medication a week before your surgery."
Correct Answer: D Rationale: Clopidogrel is an oral antiplatelet drug with similar effects to aspirin. The drug is taken for secondary prevention of myocardial infarction, ischemic stroke and other vascular events. Clopidogrel prevents platelet aggregation. Like all other antiplatelet drugs, clopidogrel poses a risk of serious bleeding. Clopidogrel should be discontinued 5 to 7 days before elective surgery. The drug's effects begin two hours after the first dose and plateau after 3 to 7 days of treatment. Platelet function and bleeding time return to baseline 7 to 10 days after the last dose. It can be taken with or without food. No weekly lab tests are required with clopidogrel. Clients should not be instructed to double up when missing a dose.
A postoperative client has a prescription for acetaminophen with codeine for pain relief. The nurse understands which action to be the primary purpose of this drug combination? A. Prevents tolerance B. Faster onset of action C. Minimized side effects D. Enhanced pain relief
Correct Answer: D Rationale: Codeine is an opioid analgesic. It is considered a moderate opioid, similar to morphine in most respects. It is used for relief of mild to moderate pain. Codeine is formulated alone and in combination with non-opioid analgesics such as aspirin or acetaminophen. Because codeine and non-opioid analgesics relieve pain by different mechanisms, the combinations can produce greater (enhanced) pain relief than either agent alone. The onset of action, risk of tolerance and side effects are the same as with other oral, opioid medications.
The nurse is evaluating the plan of care for a client with benign prostatic hyperplasia (BPH). For which prescribed medication should the nurse notify the health care provider (HCP)? A. Metoprolol B. Terazosin C. Finasteride D. Diphenhydramine
Correct Answer: D Rationale: Diphenhydramine is a first generation histamine1 receptor antagonist or antihistamine, commonly used for relief from symptoms of mild to moderate allergic disorders. H1 blockers have anticholinergic effects or atropine-like responses and can cause urinary hesitancy or retention. A client with BPH is already at risk for urinary retention and should not receive an antihistamine such as diphenhydramine without clarification from the HCP first. Metoprolol is a beta blocker, which does not affect the bladder. Finasteride and terazosin are drugs commonly used to treat BPH.
The nurse is reviewing the medical history of a client who is receiving weekly erythropoietin injections. Which medical condition requires the use of this medication? A. Sickle-cell disease B. Hemorrhagic fever (Ebola) C. Iron-deficiency anemia D. End-stage kidney disease (ESKD)
Correct Answer: D Rationale: Erythropoietin is a hormone that stimulates production of red blood cells (RBCs) in the bone marrow. The hormone is produced by cells in the proximal tubules of the kidneys. Erythropoietin can partially reverse anemia associated with chronic or end-stage renal failure. Initial effects can be seen within 1 to 2 weeks. Hemoglobin usually reaches acceptable levels (10 to 11 gm/dL) in 2 to 3 months. Erythropoietin is not used for iron-deficiency anemia, sickle cell disease or Ebola.
The nurse is reinforcing the correct use of a metered-dose inhaler (MDI) for a client newly-diagnosed with asthma. The client asks, "how will I know the canister is empty?" What is the best response by the nurse? A. "Drop the canister in water to observe if it floats." B. "Shake the canister and listen for any fluid movement." C. "Contact your pharmacy to find out when to obtain a refill." D. "Count the number of doses as the inhaler is used."
Correct Answer: D Rationale: Floating an MDI in water, or shaking it to listen for fluid movement to determine how much medication is left, is not recommended. MDIs that count down the number of remaining doses are available, however, these mechanisms are not always accurate. Therefore, it is best to calculate how long the inhaler will last by dividing the number of doses in the container by the number of doses the client takes per day. For example, a client who needs to take two puffs of albuterol, four times a day, will take a total of eight puffs per day. The MDI contains a total of 200 puffs. Divide 200/8 = 25 days. The inhaler in this example will last 25 days. To ensure that the client does not run out of medication, the client should obtain a refill at least 7 to 10 days before it runs out. The pharmacy would not be able to determine if the canister is empty.
The nurse is reinforcing teaching for a client with chronic kidney disease about the prescribed aluminum hydroxide. Which is the best statement by the nurse about this medication? A. "It increases urine output." B. "It controls stomach acid secretions." C. "It reduces potassium levels." D. "It decreases phosphate levels."
Correct Answer: D Rationale: Phosphates tend to accumulate in the client with chronic kidney disease due to decreased filtration capacity of the kidneys. Antacids that contain aluminum such as aluminum hydroxide (Amphojel) are commonly used to lower phosphate levels. Aluminum binds phosphates in the gastrointestinal tract and prevents their absorption. Aluminum hydroxide neutralizes stomach acid already present, but does not control gastric acid production or secretion. It does not affect potassium absorption or levels.
The nurse is preparing to administer an antibiotic intramuscularly (IM) to a 2-year-old child. The total volume of the injection is 2 mL. What is the best approach for the nurse to take when administering this medication? A. Call the provider and request a smaller dose. B. Inject the medication in the deltoid muscle. C. Substitute an oral form of the medication. D. Split the medication into two separate injections.
Correct Answer: D Rationale: Recommendations for IM medication administration for an infant/toddler (1 month to 2 years) include using a 1 inch, 22 to 25 gauge needle. The vastus lateralis muscle is preferred. The deltoid muscle should only be used if the muscle mass is adequately developed. IM injections for small children should not exceed a volume of 1 mL. For medication doses that exceed this volume, it is best to split the dose into two separate injections of 1 mL each. The other actions are not appropriate in this situation.
The nurse is evaluating the effectiveness of therapy for a client who received albuterol via nebulizer during an acute episode of shortness of breath due to asthma. Which finding is the best indicator that the therapy was effective? A. Accessory muscle use has decreased. B. Respiratory rate is 16 breaths/minute. C. No wheezes are audible. D. Oxygen saturation is greater than 90%.
Correct Answer: D Rationale: The goal for treatment of an asthma attack is to relieve bronchospasms and keep the oxygen saturation greater than 90%. Albuterol is a short-acting inhaled beta2-adrenergic agonist and the treatment of choice for an acute asthma attack. Pulse oximetry is an objective data point that the nurse should use to determine oxygenation status of the client. The other client data may occur when the client is too fatigued to continue with the increased work of breathing required in an asthma attack and, therefore, should not be used to evaluate effectiveness of treatment.
A client is prescribed trimethoprim/sulfamethoxazole for recurrent urinary tract infections. Which statement by the nurse about this medication is correct? A. "You can stop the medication after five days." B. "It is safe to take with oral contraceptives." C. "Be sure to take the medication with food." D. "Drink at least eight glasses of water a day."
Correct Answer: D Rationale: Trimethoprim/sulfamethoxazole is a highly insoluble medication and should be taken with a large volume of fluid. This medication can be taken with or without food. The full prescribed amount should be taken at evenly-spaced intervals until the medication is finished. Unlike many other antibiotics, trimethoprim/sulfamethoxazole does not seem to affect hormonal birth control such as the pill, the patch or ring.
A client has been prescribed alendronate for osteoporosis. Which of the following statements indicate the client understands how to safely take this medication? (Select all that apply.) A. "I will notify my doctor if I experience worsening heartburn." B. "I will take the pill with an antacid to prevent stomach upset." C. "I will stand or sit quietly for 30 minutes after taking the pill." D. "I will swallow the pill with a full glass of water." E. "I will always eat breakfast before taking the pill."
Correct Answers: A, C, D Rationale: Alendronate is a bisphosphonate used to treat osteoporosis. It can cause esophagitis or esophageal ulcers unless precautions are followed. The client must sit upright or stand for at least 30 minutes after taking the medication. The client should take the medication with a full glass of water, at least 30 minutes before eating or drinking anything or taking any other medication. Antacids will interfere with absorption and should not be taken at the same time.
The home care nurse is admitting a new client with a history of chronic obstructive pulmonary disease, atrial fibrillation and gout. After reviewing the client's medication list, for which medications should the nurse arrange to monitor blood levels? (Select all that apply.) A. Montelukast B. Digoxin C. Theophylline D. Allopurinol E. Beclomethasone
Correct Answers: B, C Rationale: It is necessary to monitor blood levels for theophylline and digoxin to prevent toxicity. Both of those drugs can accumulate in the blood and reach toxic levels. The other medications are not known to accumulate and cause toxicity if taken as prescribed.
The nurse observes a new nurse administering a rectal suppository to a client. Which actions are appropriate for the new nurse to implement? (Select all that apply.) A. The nurse instructs clients to hold their breath and bear down. B. The nurse pushes the suppository in, up to the second knuckle. C. The nurse places the client on the left side during insertion. D. The nurse applies water-soluble lubricant to the suppository. E. After 10 minutes, the nurse turns the client to the right side.
Correct Answers: B, C, D, E Rationale: Left side-lying position is the optimal position for the client receiving rectal medications. Due to the position of the descending colon, placing the client on their left side allows the medication to be inserted and move along the natural curve of the intestine and facilitates retention of the medication. The suppository should be somewhat melted after 10 to 15 minutes and turning the client to the right side will aid in further absorption. The suppository should be lubricated to ease insertion and reduce discomfort for the client. Bearing down will place pressure on the anal sphincter and may cause the suppository to be expelled. The client should be instructed to breathe slowly and try to relax.
The nurse is caring for a client who is experiencing excessive bleeding after receiving unfractionated heparin sodium. Which orders should the nurse anticipate from the health care provider? (Select all that apply.) A. Obtain prothrombin time (PT)/international normalized ratio (INR). B. Administer vitamin K. C. Change prescription to enoxaparin. D. Obtain activated partial thromboplastin time (aPTT). E. Administer protamine sulfate.
Correct Answers: D, E Rationale: Protamine sulfate is the antidote used to reverse the anticoagulant effects of heparin. A serum aPTT or PTT lab test is used to evaluate the anticoagulation effect of heparin. Vitamin K is the antidote for warfarin. A serum PT/INR lab test is used to monitor the therapeutic effectiveness of warfarin. Enoxaparin is another type of heparin and would be contraindicated for this client.
