Medical-Surgical Drugs Level 1

A male client who is receiving prolonged steroid therapy complains of always being thirsty and urinating frequently. What is the nurse's best initial action? a. Have the client assessed for an enlarged prostate. b. Obtain a urine specimen from the client to test for ketonuria. c. Perform a finger stick to test the client's blood glucose level. d. Assess the client's lower extremities for the presence of pitting edema.

c. Perform a finger stick to test the client's blood glucose level. The client has signs of an increased serum glucose level, which may result from steroid therapy; testing the blood glucose level is a method of gathering more data. The symptoms are not those of benign prostatic hyperplasia. The blood glucose level, not the amount of ketones in the urine, should be assessed. The symptoms presented are not those of fluid retention, but of hyperglycemia.

Cyanocobalamin (vitamin B12) 0.2 mg intramuscularly (IM) is prescribed for a client with pernicious anemia. A vial of the drug labeled "1 mL = 100 mcg" is available. How many milliliters should the nurse administer? Record your answer using a whole number. ___mL

2

Colchicine 1200 mcg orally is prescribed for client with gout. Each tablet contains 0.6 mg. How many tablets should the nurse administer? Record your answer using a whole number. _____

2 0.6 X 1000 = 600 1200/600 = 2

Filgrastim 5 mcg/kg/day by injection is prescribed for a client who weighs 132 lb (60 kg). The vial label reads filgrastim 300 mcg/mL. How many milliliters should the nurse administer? Record your answer using a whole number. ___mL

1

A nurse must administer streptomycin 1 g intramuscularly (IM) to a client with tuberculosis. The vial contains 500 mg/mL. How much solution must the nurse administer? Record your answer using a whole number. ___ mL

2

Atenolol 150 mg by mouth is prescribed for a client with hypertension. Each tablet contains 50 mg. How many tablets should the nurse administer? Record your answer using a whole number. ____________tablet(s)

3

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

35 100/14 X250= 35

A client is admitted to the intensive care unit with acute pulmonary edema. Which diuretic does the nurse anticipate will be prescribed? A. Furosemide B. Chlorothiazide C. Spironolactone D.Acetazolamide

A. Furosemide Furosemide acts on the loop of Henle by increasing the excretion of chloride and sodium, is available for intravenous administration, and is more effective than chlorothiazide, spironolactone, and acetazolamide. Although used in the treatment of edema and hypertension, chlorothiazide is not as efficacious as furosemide. Spironolactone is a potassium-sparing diuretic; it is less efficacious than thiazide diuretics. Acetazolamide is used in the treatment of glaucoma to lower intraocular pressure

A client is scheduled for an adrenalectomy. What does the nurse expect that the plan of care will include? A. Low-protein diet B. Parenteral corticosteroids C. Preoperative 24-hour urine specimen D. Withholding all medications 48 hours before surgery

B. Parenteral corticosteroids Steroid therapy usually is given intravenously or intramuscularly preoperatively and continued intraoperatively to prepare for the acute adrenal insufficiency that follows surgery. The diet must supply ample protein and potassium. A 24-hour urine specimen is unnecessary. Corticosteroids must be administered preoperatively to prevent adrenal insufficiency during surgery, so withholding all medications for 48 hours before surgery is contraindicated.

A nurse reviews a list of medications that have been prescribed for a client. The nurse is aware that it is unsafe to administer which medication as an intravenous (IV) bolus? A. Saline flush B. Potassium chloride C. Naloxone D. Adenosine

B. Potassium chloride Potassium chloride given as an IV bolus can cause cardiac arrest. It should never be administered intravenously without being diluted and infused slowly through an IV infusion pump. Saline flush, naloxone, and adenosine are appropriate to be given as an IV bolus undiluted.

The spouse of a client with an intracranial hemorrhage asks the nurse, "Why aren't they administering an anticoagulant?" How will the nurse respond? A. "It is not advisable because bleeding will increase." B. "If necessary it will be started to enhance circulation." C. "If necessary it will be started to prevent pulmonary thrombosis." D. "It is inadvisable because it masks the effects of the hemorrhage."

A. "It is not advisable because bleeding will increase." An anticoagulant should not be administered to a client who is bleeding because it will interfere with clotting and will increase hemorrhage. Anticoagulants are unsafe and will not be used to enhance the circulation or prevent pulmonary thrombosis. The response "It is inadvisable because it masks the effects of the hemorrhage" is not the reason why it is contraindicated; if given, it will increase, not mask, the effects of the hemorrhage.

After being hospitalized for a transient ischemic attack (TIA) related to hypertension, a client is discharged with a prescription of hydrochlorothiazide. What should the nurse instruct the client to do when taking this medication? A. Increase the intake of potassium-rich foods. B. Drink a protein supplement daily. D. Avoid eating foods high in insoluble fiber. C.Resume regular eating habits.

A. Increase the intake of potassium-rich foods. The client must increase the dietary intake of potassium because of potassium loss associated with hydrochlorothiazide. Protein supplements are not necessary and may be obtained from meat, fish, and dairy products in the diet or complementary vegetable and grain proteins. Foods high in insoluble fiber are part of the food pyramid and should be included in the diet. The client should be taught about medication-induced deficiencies, which may necessitate a change in diet, and not just return to regular eating habits once home.

What should the nurse teach a client who is taking warfarin? A. Report episodes of spontaneous bleeding. B.Increase the dose with prolonged inactivity. C. Take antibiotics, if injured, to prevent infection. D.Eat a diet with an increased quantity of green vegetables.

A. Report episodes of spontaneous bleeding. Warfarin is an anticoagulant; therefore, excessive bleeding, especially that which occurs spontaneously and unrelated to injury, may require a dosage adjustment for safety reasons. Activity or inactivity is unrelated to the need to alter the dose of warfarin. The dose should not be altered without healthcare supervision. The problem of bleeding is more significant than infection when a client is taking warfarin. Green vegetables that contain vitamin K, which is necessary for the synthesis of clotting factors VII, IX, and X, should be kept consistent in the diet from week to week; increased consumption will decrease the action of warfarin, and a decreased consumption will increase the action of warfarin.

A client who takes four 325-mg tablets of buffered aspirin four times a day for severe arthritis complains of dizziness and ringing in the ears. Which complication does the nurse conclude that the client probably is experiencing? A. Salicylate toxicity B. Anaphylactic reaction C. Withdrawal symptoms D. Acetaminophen overdose

A. Salicylate toxicity Excessive aspirin ingestion can influence the vestibulocochlear nerve (cranial nerve VIII), causing tinnitus and dizziness. The client is experiencing symptoms of toxicity, not an anaphylactic response. Withdrawal symptoms occur when a medication is no longer being administered. The chemical name of aspirin is acetylsalicylic acid, not acetaminophen.

Immediately after a bilateral adrenalectomy a client is receiving corticosteroids that are to be continued after discharge from the hospital. Which statement by the client indicates to the nurse that additional education is needed? A "I need to have periodic tests of my blood for glucose." B. "I am glad that I only have to take the medication once a day." C. "I must take the medicine with meals while I have food in my stomach." D. "I should tell the doctor if I am overly restless or have trouble sleeping."

B. "I am glad that I only have to take the medication once a day." Usually a larger dose is given at 8 am and the second dose is given before 4 pm to mimic expected hormonal secretion and prevent insomnia. Having periodic blood tests for glucose is necessary because long-term administration of steroids leads to elevated blood glucose levels and possible steroid-induced diabetes. Oral corticosteroids should be taken with food or antacids to prevent gastric irritation and gastric hemorrhage. Neurological and emotional side effects, such as euphoria, mood swings, and sleeplessness, are expected.

A nurse assesses a client's intravenous site. What clinical finding, unique to infiltration, leads the nurse to conclude that the intravenous (IV) site has infiltrated, rather than become inflamed? A. Pain B. Coolness C. Localized swelling D. Cessation in flow of solution

B. Coolness When an IV infiltrates, the IV solution entering the interstitial space is at room temperature (approximately 75° F [23.9° C]), whereas body temperature is approximately 98.6° F (37° C); therefore, the client's skin will feel cool to the touch at the site of an IV infiltration. The site of an inflammation will feel warm to the touch because of vasodilation and hyperemia. Pain may occur with both an inflammation and an infiltration. The pain of an inflammation is related to the pressure of edema on nerve endings. The pain of an infiltration is related to the IV solution in the interstitial compartment pressing on nerve endings. An increase in interstitial fluid occurs with both an inflammation and an infiltration. With an inflammation there is increased vascular permeability at the site; fluid, proteins, and leukocytes then move from the intravascular compartment into the interstitial compartment. With an infiltration the IV solution enters the interstitial compartment rather than the intravascular compartment. A cessation in flow of solution occurs with both an inflammation and an infiltration. An inflammation in the vein at the insertion site may close the lumen of the vessel, interfering with the flow of solution. An infiltration will cause excess fluid in the interstitial compartment to the extent that it will not accommodate more solution, interfering with the flow of the solution.

What should the nurse monitor when a client is receiving a platelet aggregation inhibitor such as clopidogrel? A. Nausea B. Epistaxis C. Chest pain D. Elevated temperature

B. Epistaxis The high vascularity of the nose, combined with its susceptibility to trauma (e.g., sneezing, nose blowing), makes it a frequent site of hemorrhage. Nausea, chest pain, and elevated temperature usually are not associated with anticoagulant therapy.

The healthcare provider prescribes 1 liter of intravenous (IV) fluid to infuse over 4 hours for a client admitted for a urinary tract infection and hyponatremia. The tubing drop factor is 10 drops/mL. At what rate will the nurse infuse the medications? A. 20 drops/minute B. 34 drops/minute C. 42 drops/minute D. 60 drops/minute

C. 42 drops/minute

A client is receiving morphine sulfate for severe metastatic bone pain. What will the nurse do to assess for complications from a common serious side effect of morphine? A. Monitor for diarrhea B. Observe for an opioid addiction C. Assess for altered breathing patterns D. Check for a decreased urinary output

C. Assess for altered breathing patterns Morphine sulfate is a central nervous system depressant that commonly decreases the respiratory rate, which can lead to respiratory arrest. Morphine, an opioid, will cause constipation, not diarrhea. Addiction is not a concern for a terminally ill client. Although morphine sulfate may cause urinary retention, it is not a common side effect and is not life threatening.

A client with a history of pulmonary emboli is taking warfarin daily. The nurse teaches the client about foods that are appropriate to consume when taking this medication. The nurse evaluates that the client needs further teaching when the client makes which statement? A."Eggs provide a good source of iron, which is needed to prevent anemia." B. "Yellow vegetables are high in vitamin A and should be included in the diet." C. "Milk and other high-calcium dairy products are necessary to counteract bone density loss." D. "Dark green leafy vegetables are high in vitamin K so I should eat them more often."

D. "Dark green leafy vegetables are high in vitamin K so I should eat them more often." Foods high in vitamin K should be limited to usual amounts eaten by the client when establishing the prothrombin time/international normalized ratio because vitamin K is part of the body's blood-clotting mechanism and will counter the effects of warfarin if eaten in excess. Foods containing protein and iron are permitted because they are unrelated to blood clotting. Foods containing vitamin A are permitted because vitamin A is unrelated to blood clotting. Foods containing calcium are permitted because calcium is unrelated to blood clotting.

The client who takes furosemide and digoxin reports that everything looks yellow. How will the nurse respond? A. "This is related to your heart problems, not to the medication." B. "It is a medication that is necessary, and that side effect is only temporary." C. "Take this dose, and when I see your healthcare provider I will ask about it." D. "I will hold the medication until I consult with your healthcare provider."

D. "I will hold the medication until I consult with your healthcare provider." The response "I will hold the medication until I consult with your healthcare provider" is a safe practice because yellow vision indicates digitalis toxicity. The response "This is related to your heart problems, not to the medication" is incorrect; yellow vision is not a symptom of heart disease. The response "It is a medication that is necessary, and that side effect is only temporary" is incorrect; yellow vision is not a temporary side effect. The response "Take this dose, and when I see your healthcare provider I will ask about it" is unsafe.

At 10 AM the nurse hangs a 1000-mL bag of D5W with 20 mEq of potassium chloride to be administered at 80 mL/hr. At noon the healthcare provider prescribes a stat infusion of an intravenous (IV) antibiotic of 100 mL to be administered via piggyback over 1 hour. How much longer than expected will it take the primary bag to empty if the nurse interrupts the primary infusion to use the circulatory access for the secondary infusion of the antibiotic? A. Quarter hour B. Half hour C. Three quarters of an hour D. 1 hour

D. 1 hour An infusion of 1000 mL at 80 mL should take 12.5 hours. Because the primary infusion is interrupted for an hour while the antibiotic is infused, the primary bag will run an hour longer than if it were running uninterrupted. One quarter, half, and three quarters of an hour are incorrect calculations.

At 4:30 pm, a client who is receiving NPH insulin every morning states, "I feel very nervous." The nurse observes that the client's skin is moist and cool. What is the nurse's most accurate interpretation of what the client is likely experiencing? A. Polydipsia B. Ketoacidosis C. Glycogenesis D. Hypoglycemia

D. Hypoglycemia The time of the client's response corresponds to the expected peak action (4 to 12 hours after administration) of the intermediate-acting insulin that was administered in the morning; this can result in hypoglycemia. Hypoglycemia triggers the sympathetic nervous system; epinephrine causes diaphoresis and nervousness. Osmotic diuresis causes thirst; this is related to hyperglycemia, not to hypoglycemia. Warm, dry, flushed skin and lethargy are associated with ketoacidosis. Glycogenesis, the formation of glycogen in the liver, is unrelated to nervousness and cool, moist skin.