Medical-Surgical Drugs Level 1 & 2

A client presents with extensive lesions due to psoriasis. Which intervention does the nurse anticipate from the healthcare provider? 1 Advising sunscreen and special clothing 2 Topical application of steroids 3 Potassium permanganate baths 4 Debridement of necrotic plaques

2 Steroids are applied locally, and the lesions usually are covered with plastic wrap at night to reverse the inflammatory process. Solar rays may be used for treatment, but other forms of ultraviolet light are preferred. Potassium permanganate is an antiseptic astringent used on infected, draining, or vesicular lesions. The plaques are not necrotic and therefore do not require débriding.

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

1 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.

A client is taking furosemide and digoxin for heart failure. Why does the nurse advise the client to drink a glass of orange juice every day?1 Maintaining potassium levels 2 Preventing increased sodium levels 3 Limiting the drugs' synergistic effects 4 Correcting the associated dehydration

1 Orange juice is an excellent source of potassium. Furosemide promotes excretion of potassium, which can result in hypokalemia. Digoxin toxicity can occur in the presence of hypokalemia. Neither drug increases sodium levels. Digoxin does not potentiate the action of furosemide; therefore, the client should not experience dehydration. Orange juice will not prevent an interaction between digoxin and furosemide.

The healthcare provider prescribes nitroglycerin ointment for a client who was admitted for chest pain and a myocardial infarction (MI). Which statement, if made by the client, would indicate understanding of the side effects of nitroglycerin ointment? 1 "I may experience a headache." 2 "Confusion is a common adverse effect." 3 "A slow pulse rate in an expected side effect." 4 "Increased blood pressure readings may occur initially."

1 The most common side effect of nitroglycerin is a headache. Additional cardiovascular side effects are hypotension, not hypertension; tachycardia, not bradycardia; and dizziness, not confusion.

A client with myasthenia gravis has been receiving neostigmine and asks about its action. What information about its action should the nurse consider when formulating a response? 2

1 Stimulates the cerebral cortex 2 Blocks the action of cholinesterase 3 Replaces deficient neurotransmitters 4 Accelerates transmission along neural sheaths Neostigmine, an anticholinesterase, inhibits the breakdown of acetylcholine, thus prolonging neurotransmission. Neostigmine's action is at the myoneural junction, not the cerebral cortex. Neostigmine prevents neurotransmitter breakdown, but it is not a neurotransmitter. Neostigmine's action is at the myoneural junction, not the sheath.

What should a nurse teach the client to do to avoid lipodystrophy when self-administering insulin therapy? 1 Exercise regularly. 2 Rotate injection sites. 3 Use the Z-track technique. 4 Avoid massaging the injection site.

2 Fibrous scar tissue can result from the trauma of repeated injections at the same site. Exercise is unrelated to lipodystrophy, but it reduces blood glucose, which decreases insulin requirements. Insulin is given subcutaneously; the Z-track technique is used with some intramuscular injections. Gentle pressure over the injection site after insulin administration promotes absorption.

A client is rescued from a house fire and arrives at the emergency department 1 hour after the rescue. The client weighs 132 pounds (60 kilograms) and is burned over 35% of the body. The nurse expects that the amount of lactated Ringer solution that will be prescribed to be infused in the next 8 hours is what? 1 2100 mL 2 4200 mL 3 6300 mL 4 8400 mL

2 In the first 8 hours 4200 mL should be infused. According to the Parkland (Baxter) formula, one half of the total daily amount of fluid should be administered in the first 8 hours. Because the client weighs 60 kg (132 pounds ÷ 2.2 kg = 60 kg), the calculation is 60 kg × 4 mL/kg × 35% burns = 8400 mL per day; half of this amount should be infused within the first 8 hours. 2100 mL, 6300 mL, and 8400 mL are incorrect calculations.

A nurse is providing discharge instructions about digoxin. Which response should a nurse include as a reason for a client to withhold the digoxin? 1 Chest pain 2 Blurred vision 3 Persistent hiccups 4 Increased urinary output

2 Visual disturbances, such as blurred or yellow vision, may be evidence of digoxin toxicity. Chest pain is not a toxic effect of digoxin. Persistent hiccups are not related to digoxin toxicity. An increased urinary output is not a sign of digoxin toxicity; it may be a sign of a therapeutic response to the drug and an improved cardiac output.

A client who is taking an oral hypoglycemic daily for type 2 diabetes develops the flu and is concerned about the need for special care. What should the nurse advise the client? Select all that apply. 1 Avoid solid food. 2 Take the oral medication. 3 Drink fluids throughout the day. 4 Monitor capillary glucose levels. 5 Do not take medication until tolerating food.

2, 3, 4 Physiologic stress increases gluconeogenesis, requiring continued pharmacologic therapy despite an inability to eat; fluids prevent dehydration; monitoring of glucose levels permits early intervention if necessary. Skipping the oral hypoglycemic agent may precipitate hyperglycemia. Food intake should be attempted to prevent acidosis. Delaying an oral hypoglycemic agent may precipitate hyperglycemia.

A client with lymphosarcoma is receiving allopurinol and methotrexate. The nurse can help the client prevent complications related to uric acid nephropathy by administering which drug in relation to fluid intake? 1 Allopurinol and restricting the fluid intake 2 Methotrexate and restricting fluid intake 3 Allopurinol and encouraging increased fluid intake 4 Methotrexate and encouraging increased fluid intake

3 Allopurinol decreases serum uric acid levels before and during chemotherapy; increased fluid intake aids in the increased excretion of uric acid. Allopurinol and increased fluids help prevent renal tubular impairment and kidney failure because of hyperuricemia. The client should be encouraged to follow a diet that promotes urine alkalinity. If the oral route is used, administering the methotrexate after providing an antacid will limit gastric irritation, not uric acid nephropathy. Fluid intake should be increased to 2 to 3 liters per day to prevent urate deposits and calculus formation.

A nurse is caring for a client who is receiving aspirin therapy. Which clinical indicator would be related to this therapy? 1 Urinary calculi 2 Atrophy of the liver 3 Prolonged bleeding time 4 Premature erythrocyte destruction

3 Aspirin interferes with platelet aggregation, thereby lengthening bleeding time. Urate excretion is enhanced by high doses of aspirin. Aspirin does not cause atrophy of the liver; it is readily broken down in the gastrointestinal tract and liver. Aspirin does not destroy erythrocytes.

What should the nurse include when teaching a client with severe Parkinson disease about carbidopa-levodopa? 1 Multivitamins should be taken daily. 2 Alcohol consumption should be in moderation. 3 The medication should be taken with meals. 4 A high-protein diet should be followed.

3 Carbidopa-levodopa should be taken with meals to reduce the nausea and vomiting that commonly are caused by this drug. Multivitamins are contraindicated; vitamins may contain pyridoxine (vitamin B6), which diminishes the effects of levodopa. Moderate amounts of alcohol will antagonize the drug's effects; a rare, occasional drink is not harmful. A high-protein diet is contraindicated. Sinemet contains levodopa, an amino acid that may increase blood urea nitrogen levels. Also, some proteins contain pyridoxine, which increases peripheral metabolism of levodopa, decreasing the amount of levodopa crossing the blood-brain barrier.

A client is diagnosed with Parkinson disease and receives a prescription for levodopa therapy. What does the nurse identify as the drug's mechanism of action? 1 Blocks the effects of acetylcholine 2 Increases the production of dopamine 3 Restores the dopamine levels in the brain 4 Promotes the production of acetylcholine

3 Levodopa is a precursor of dopamine, a catecholamine neurotransmitter; it increases dopamine levels in the brain that are depleted in Parkinson disease. Blocking the effects of acetylcholine is accomplished by anticholinergic drugs. Increasing the production of dopamine is ineffective because it is believed that the cells that produce dopamine have degenerated in Parkinson disease. Levodopa does not affect acetylcholine production.

Aspirin is prescribed on a regular schedule for a client with rheumatoid arthritis. The nurse understands that the drug is being used primarily for which of its properties? 1 Analgesic 2 Antipyretic 3 Antiinflammatory 4 Antiplatelet

3 The antiinflammatory action of aspirin reduces joint inflammation. Aspirin reduces fever, but this is not the rationale for prescribing it for clients with rheumatoid arthritis. Aspirin does not preserve bone integrity. Flexion contractures are prevented by exercise, not aspirin.

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? 1 Have the client assessed for an enlarged prostate. 2 Obtain a urine specimen from the client to test for ketonuria. 3 Perform a finger stick to test the client's blood glucose level. 4 Assess the client's lower extremities for the presence of pitting edema.

3 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.

Sublingual nitroglycerin tablets are prescribed to control periodic episodes of chest pain in the patient with stable angina. Which instruction should the nurse include when teaching the client about sublingual nitroglycerin? 1 Once the tablet is dissolved, spit out the saliva. 2 Take tablets 3 minutes apart up to a maximum of five tablets. 3 Common side effects include headache and low blood pressure. 4 Once opened, the tablets should be refrigerated to prevent deterioration.

3 The primary side effects of nitroglycerin are headache and hypotension. It is not necessary to spit out saliva into which nitroglycerin has dissolved. For pain that is not relieved, additional tablets may be taken every 5 minutes up to a total of three tablets. It should be stored at room temperature.

A client is undergoing diagnostic testing to determine if the client has myasthenia gravis. The nurse understands that the test that is most specific for determining the presence of this disease is what? 1 Electromyography 2 Pyridostigmine test 3 History of physical deterioration 4 Edrophonium chloride test

4 Edrophonium chloride test uses a drug that is a cholinergic and an anticholinesterase; it blocks the action of cholinesterase at the myoneural junction and inhibits the destruction of acetylcholine. Its action of increasing muscle strength is immediate for a short time. The results of an electromyography will be added to the database, but they are nonspecific. Pyridostigmine is a slower-acting anticholinesterase drug that is prescribed commonly to treat myasthenia gravis; edrophonium chloride is used instead of pyridostigmine to diagnose myasthenia gravis because, when injected intravenously, it immediately increases muscle strength for a short time. The results of a history and physical are added to the database, but the data collected are not as definitive as another specific test for the diagnosis of myasthenia gravis.

The postoperative prescriptions for a client who had repair of an inguinal hernia include docusate sodium daily. Before discharge, the nurse instructs the client about what potential side effect? 1 Rectal bleeding 2 Fecal impaction 3 Nausea and vomiting 4 Mild abdominal cramping

4 Mild abdominal cramping is the only side effect of docusate sodium; this emollient laxative permits water and fatty substances to penetrate and mix with fecal material. Rectal bleeding is more likely to occur with a saline-osmotic laxative. Docusate sodium promotes defecation, not constipation. Nausea and vomiting are more likely to occur with a saline-osmotic laxative.

Ranitidine has been prescribed to help treat a client's gastric ulcer. The nurse expects this drug to act specifically by which mechanism? 1 Lowering the gastric pH 2 Promoting the release of gastrin 3 Regenerating the gastric mucosa 4 Inhibiting the histamine at H2 receptors

4 Ranitidine inhibits histamine at H2 receptor sites in parietal cells, which limits gastric secretion. Lowering the gastric pH is not the direct action of this drug. Promoting the release of gastrin is undesirable; gastric hormones increase gastric acid secretion. Ranitidine does not regenerate the gastric mucosa; the drug prevents its erosion by gastric secretions.

When preparing discharge teaching for a client who had a kidney transplant, in addition to a corticosteroid, the nurse expects what other medications to be prescribed to prevent kidney rejection? 1 Furosemide and sirolimus 2 Cefazolin and methotrexate 3 Methylprednisolone and phenytoin 4 Tacrolimus and mycophenolate mofetil

4 Standard triple therapy includes a corticosteroid prednisone (methylprednisolone), an antimetabolite (mycophenolate), and a calcineurin inhibitor (tacrolimus and cyclosporine). Although sirolimus is used for immunosuppression, furosemide is a diuretic. Neither of these medications are immunosupressives. Cefazolin is an antibiotic, and methotrexate is a folic acid antagonist used in cancer chemotherapy. Although methylprednisolone is used for immunosuppression, phenytoin is an antiseizure medication.