Pathopharm Practice Final Exam

A client has a prescription for a sublingual nitroglycerin tablet. Which technique will the nurse teach the client to use?

Place the pill under the tongue and let it dissolve.

A total parenteral nutrition (TPN) solution is prescribed to infuse at 1 liter every 12 hours. Which clinical findings are important for the nurse to monitor? Select all that apply. One, some, or all responses may be correct.

Intake and output Glucose levels Serum electrolytes

The nurse is caring for a child receiving prednisone. Which consideration is most important for the nurse to remember when administering adrenocorticosteroid therapy?

It suppresses inflammation. Because of suppression of the inflammatory manifestations of infection, such as increase in body temperature, the nurse must be alert to the subtle signs and symptoms of infection (e.g., changes in appetite, sleep patterns, and behavior). Adrenocorticosteroid therapy may cause hypokalemia, not hyperkalemia, because of the retention of sodium and fluid. Adrenocorticosteroid therapy delays, not accelerates, wound healing. Adrenocorticosteroid therapy decreases, not increases, the production of antibodies.

Which pharmacokinetic condition would result in a high intensity and long duration of response?

When absorption is rapid but elimination is delayed Pharmacokinetic factors determine the concentration of a medication at its sites of action. When the medication's absorption is rapid and elimination is delayed, the concentration of the medication at the site of action is high. This action increases the intensity and duration of the medication response. When both the absorption and elimination rates are rapid, the concentration of medication at the site of action is lesser. This in turn decreases the duration of the medication response. In contrast, when both the absorption and elimination of the medication are delayed, the intensity of the medication's effect is also decreased. When absorption is delayed but elimination is rapid, the duration and intensity of the medication are decreased because the concentration of the medication at the site of action is low.

A health care provider prescribes psyllium 3.5 g twice a day for constipation. Which statement is important for the nurse to teach this client?

"Each dose should be taken with a full glass of water." Because this medication has a strong affinity for fluids, it will swell in the intestine. The large bulk stimulates peristalsis. A full glass of fluid taken at the same time will help minimize the risk of esophageal obstruction or fecal impaction. Senna, a stimulant laxative, may discolor urine, not psyllium. Psyllium, a bulk-forming laxative, is among the safest laxatives on the market. It is useful with prolonged therapy because it is not systemically absorbed and is not potent in its action. Prolonged use of lubricant or saline/osmotic laxatives, not bulk-forming laxatives, can inhibit the absorption of some fat-soluble vitamins.

The nurse administers acetaminophen to a child who complains of pain after abdominal surgery. The mother asks the nurse why her child isn't being given ibuprofen. Which response by the nurse is most appropriate?

"It could prolong bleeding time." Acetaminophen is not associated with bleeding complications like ibuprofen is, but if used long term, it can result in liver toxicity. Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID) prolongs bleeding time; in the postoperative period, medications that interfere with clotting and prolong bleeding are contraindicated. Ibuprofen is safe for young children when administered in appropriate doses. Ibuprofen exerts an anti-inflammatory action; it does not interfere with the healing process. Tolerance for ibuprofen does not develop.

A client with an infection is receiving vancomycin. Which laboratory blood test result would the nurse report?

Blood urea nitrogen (BUN): 30 mg/dL (10.2 mmol/L) Vancomycin is a nephrotoxic medication. An elevated BUN can be an early sign of toxicity. The BUN of a healthy adult is 10 to 20 mg/dL (3.6-7.1 mmol/L). This hematocrit is expected in a healthy adult; the range is from 40 to 52. The expected range of the white blood cell (WBC) count is 5000 to 10,000 mm 3 (5 to 10 × 10 9/L) for a healthy adult. This calcium level is within the expected range of 9.0 to 10.5 (2.25-2.75 mmol/L) for a healthy adult.

A client with systemic lupus erythematosus is taking prednisone. Which foods would the nurse encourage the client to eat while receiving treatment to prevent hypokalemia?

Broccoli Potassium is plentiful in green leafy vegetables; broccoli provides 207 mg of potassium per half cup. Oatmeal provides 73 mg of potassium per half cup. Rice provides 29 mg of potassium per half cup. Cooked fresh carrots provide 172 mg of potassium per half cup; canned carrots provide only 93 mg of potassium per half cup.

A client is experiencing both tingling of the extremities and tetany. The nurse will review the client's laboratory report to check for which electrolyte abnormality?

Hypocalcemia

A client who had an organ transplant is receiving cyclosporine. The nurse would monitor for which serious adverse effect of cyclosporine?

Increased creatinine level

A client on prolonged cortisone therapy for adrenal insufficiency is being discharged. Which side effects would the nurse teach the client and family to expect? Select all that apply. One, some, or all responses may be correct.

Weakness Moon face Weight gain

When caring for a client on isoniazid therapy for tuberculosis, the nurse would focus on which diagnostic testing for this client?

Liver function tests

Prednisone is prescribed for a client with an exacerbation of colitis. When administering the first dose of the medication, which information would the nurse provide to the client?

"Prednisone is not curative but does cause a suppression of the inflammatory process." Prednisone inhibits phagocytosis and suppresses other clinical phenomena of inflammation; this is a symptomatic treatment that is not curative. Prednisone suppresses the immune response, which increases the potential for infection. The appetite is increased with prednisone; weight gain may result from the increased appetite or from fluid retention. Generally, the response to prednisone is rapid.

Which response by the nurse is appropriate when a client asks what to expect when beginning treatment for tuberculosis?

"Therapy will occur over two phases."

The health care provider prescribes finasteride for a client with benign prostatic hyperplasia. Which information would the nurse provide to the client?

A condom should be worn during intercourse with a pregnant female. Contact with the semen of a client taking finasteride can adversely affect a developing male fetus in a pregnant woman. Finasteride helps prevent male pattern baldness. Results may take 6 to 12 months. Finasteride is used to shrink an enlarged prostate. Other medications, such as tamsulosin, relax the muscles in the prostate and bladder neck, making it easier to urinate.

A 9-month-old infant with iron-deficiency anemia has been getting supplements but shows no improvement. The nurse recognizes which action by the parents as the reason for the lack of improvement?

Administering iron supplements with whole cow's milk Whole cow's milk binds with free iron and reduces medication absorption. The infant has developed medication insufficiency for maximum therapeutic action. Administering iron supplements through a straw does not reduce medication absorption; it prevents the iron from staining the infant's teeth. Orange juice increases the absorption of iron supplements. Administering iron supplements at the back of the mouth does not reduce medication absorption; it prevents the iron from staining the infant's teeth.

A client is admitted to the emergency department with crushing chest pain. A diagnosis of acute coronary syndrome is suspected. Which medication is indicated to prevent progression to a myocardial infarction?

Aspirin

During a procedure, the client's heart rate drops to 38 beats/min. Which medication is indicated to treat bradycardia?

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 medication used for ventricular tachycardia; it will not stimulate the heart rate.

The nurse administers a parenteral preparation of potassium slowly to avoid which complication?

Cardiac arrest

A client with arthritis takes large doses of aspirin. Which symptom would the nurse include when teaching the client about the clinical manifestations of aspirin toxicity?

Disturbances in hearing Ringing in the ears occurs because of aspirin's effect on the eighth cranial nerve and is a classic symptom of aspirin toxicity. Feelings of drowsiness are not side effects of aspirin; aspirin promotes comfort, which may permit rest. Aspirin may cause diarrhea, nausea, and vomiting, not intermittent constipation. A metallic taste in the mouth is not a side effect of salicylates such as aspirin.

A health care provider prescribes mannitol for a client with a head injury. Which mechanism of action is responsible for therapeutic effects of this medication?

Drawing fluid from brain cells into the bloodstream Mannitol, an osmotic diuretic, pulls fluid from the brain to relieve cerebral edema. Mannitol's diuretic action does not decrease the production of cerebrospinal fluid. Mannitol does not affect brain metabolism; rest and lowered body temperature reduce brain metabolism. Preventing uncontrolled electrical discharges in the brain is the action of phenytoin sodium, not mannitol.

The nurse provided teaching to a client prescribed a proton pump inhibitor (PPI). The nurse determines that teaching is effective when the client identifies that the medication is used to treat which condition?

Gastroesophageal reflux disease (GERD) PPIs are effective in decreasing the secretion of gastric acid, helping alleviate the symptoms of GERD. PPIs are not used for the treatment of diarrhea, vomiting, or cardiac dysrhythmias.

The nurse is caring for a client with deep partial-thickness burns who is receiving an opioid for pain management. Which mode of medication administration is preferred for this client?

Intravenous The intravenous route provides for the quickest onset of action of the opioid; pain relief occurs almost immediately. Nausea, vomiting, and paralytic ileus may occur postburn, making oral medications impractical. The rectal route does not provide uniform absorption; also, relief of pain will be delayed. With the intramuscular route, medication may be sequestered in the tissues, and with fluid shifts it takes time for the medication to take effect.

A client who receives morphine by patient-controlled analgesia has a respiratory rate of 6 breaths/minute. Which intervention is needed?

Naloxone administration Naloxone is an opioid antagonist and will reverse respiratory depression caused by opioids. Nasotracheal suction, mechanical ventilation, and cardiopulmonary resuscitation are not needed; naloxone will correct the respiratory depression.

A client is receiving furosemide. For which sign of hypokalemia will the nurse monitor the client?

Muscle weakness

The nurse is caring for a client who is receiving azathioprine, cyclosporine, and prednisone before receiving a kidney transplant. Which medication action would the nurse identify as the purpose of these medications?

Reduce antibody production These drugs suppress the immune system, decreasing the body's production of antibodies in response to the new organ, which acts as an antigen. These medications decrease the risk of rejection. These medications inhibit leukocytosis. These medications do not provide immunity; they interfere with natural immune responses. Because these medications suppress the immune system, they increase the risk of infection.

A client develops a maculopapular rash on the upper extremities and audible wheezing during the administration of intravenous vancomycin. Which action would the nurse take next?

Stop the infusion. The first action the nurse would take is to stop the infusion immediately. The client may be experiencing an allergic reaction. The nurse would stop the medication infusion and then notify the health care provider. Decreasing the flow rate is not an appropriate action. Infusions must be stopped if an allergic reaction is suspected. This could be an emergent situation, so reassessing in 15 minutes is not the most appropriate action.

Naloxone effectively reverses a client's respiratory depression from an overdose of heroin. Why will the nurse continue to closely monitor this client's status?

Symptoms of the heroin overdose may return after the naloxone is metabolized. The duration of action of naloxone is shorter than that of heroin. After naloxone is metabolized and its effects are diminished, the respiratory distress caused by the heroin overdose will return, necessitating readministration of naloxone. A combination of these medications does not cause cardiac depression. There are no reports of peripheral neuropathy or hyperexcitability and amnesia with naloxone.

A client is admitted to the hospital with a diagnosis of acute pancreatitis. The health care provider's prescriptions include nothing by mouth and total parenteral nutrition (TPN). The nurse explains that the TPN therapy provides which benefit?

Will meet the client's nutritional needs without causing the discomfort precipitated by eating Providing nutrients by the intravenous route eliminates pancreatic stimulation, reducing the pain experienced with pancreatitis. TPN is used to meet the client's needs, not the nurse's needs. TPN creates many safety risks for the client. Hunger can be experienced with TPN therapy.

A client who takes rifampin tells the nurse, "My urine looks orange." Which action would the nurse take?

Explain that this is expected. Rifampin causes a reddish-orange discoloration of secretions such as urine, sweat, and tears. Although liver enzymes should be monitored because of the risk of hepatitis, this action is not addressing the client's statement. A urinalysis is not indicated for an anticipated finding. The medication, not food, is responsible for the urine color.

A parent of three young children has contracted tuberculosis. Which medication would the nurse anticipate being prescribed for members of the family who have been exposed?

Isoniazid

A client has a prescription for nitrofurantoin 50 mg orally every evening to manage recurrent urinary tract infections. Which instruction would the nurse give to the client?

"Increase your intake of fluids." To prevent crystal formation, the client should have sufficient intake to produce 1000 to 1500 mL of urine daily while taking this medication. Straining urine is not indicated when the client is taking a urinary anti-infective. If fluids are encouraged, the client's output should increase. Nitrofurantoin turns urine dark yellow to brown, not green.

A client takes morphine sulfate for severe metastatic bone pain. The nurse will assess the client for which adverse effect?

Respiratory depression 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. Urinary retention, not diuresis, is a common side effect of morphine.

A continuous insulin infusion is started on an adolescent with a blood glucose level of 700 mg/dL (38.9 mmol/L). Which complication would the nurse make a priority of detecting while the adolescent is receiving the infusion?

Hypokalemia

In which category of fluids would the nurse classify an intravenous solution of 0.45% sodium chloride?

Hypotonic

A client who has been taking the prescribed dose of zolpidem for 5 days returns to the clinic for a follow-up visit. When interviewing the client, the nurse identifies that the medication has been effective when the client makes which statement?

"I have been sleeping better."

A client with tuberculosis asks the nurse why vitamin B 6 (pyridoxine) is given with isoniazid. Which explanation would the nurse provide?

"Isoniazid interferes with the synthesis of this vitamin."

A client begins escitalopram for treatment of a depressive episode. On the fifth day, the client refuses the medication, stating, "It doesn't help, so what's the use of taking it?" Which is the best response by the nurse?

"It can take 1 to 4 weeks to see an improvement."

The client with chronic arterial insufficiency of the legs refuses the prescribed dose of aspirin (ASA). The client states, "My legs are not painful." Which action will the nurse take?

Explain the reason for the medication and encourage the client to take it. Aspirin is given to the client to prevent platelet aggregation and possible deep vein thrombosis. The client needs information to make an educated decision. Aspirin is not prescribed to relieve pain. The client should receive information and support before making the decision to refuse the medication. Clients should never be pressured to take medication, especially when they do not have an understanding of the risks and benefits of the medication.

A 6-year-old child is receiving an intravenous solution of 10% glucose and mannitol to reduce cerebral edema. Which complication would the nurse monitor the child for?

Hypovolemic shock

Which mechanism of action explains how hydrochlorothiazide increases urine output?

Increases the excretion of sodium Hydrochlorothiazide inhibits sodium reabsorption in the nephrons, causing increased excretion of sodium, which increases urine excretion. The glomerular filtration rate is not affected. The loss of potassium is a side effect, not the mechanism of action. Renal perfusion is not affected.

During the administration of total parenteral nutrition (TPN), an assessment of the client reveals a bounding pulse, distended jugular veins, dyspnea, and cough. Which nursing intervention is the priority?

Slowing the infusion rate

In addition to hydration, parenteral lorazepam is prescribed for a client during alcohol withdrawal delirium. The nurse knows that this medication is given during detoxification primarily for which purpose?

To reduce the anxiety tremor state and prevent more serious withdrawal symptoms

How would the nurse prepare an intravenous piggyback (IVPB) medication for administration to a client who has an established IV infusion? Select all that apply. One, some, or all responses may be correct.

Wear clean gloves to assess the IV site. Use a sterile technique when preparing the medication. Establish the flow rate for infusion. Clean gloves should be worn to check the IV site because there is a risk of coming into contact with the client's blood. Because IV solutions enter the body's internal environment, all solutions and medications using this route must be sterile to prevent the introduction of microbes, and sterile technique should be used to avoid introducing microbes into the infusion system. It is important to establish the flow rate so that medications do not infuse too rapidly or too slowly. The insertion site does not have to be flushed with an infusing IV. The IVPB should be hung higher, not lower, than the existing bag.

According to the Food and Drug Administration (FDA) pregnancy risk categories, the nurse identifies which category of drugs may cause slight risks to the fetus?

B The FDA classified pregnancy risk categories based on animal studies and controlled studies in women. Category B drugs cause slight risks to the fetus. Category A drugs do not cause any harm. Category C drugs cause greater risks to the fetus. Category D drugs have proven risks of fetal harm.

A client develops hyponatremia. Which factors are likely causes of hyponatremia? Select all that apply. One, some, or all responses may be correct.

Profuse diaphoresis Rapid intravenous (IV) infusion of 5% dextrose in water (D 5W) Common causes of hyponatremia from loss of sodium-rich body fluids include draining wounds, diarrhea, vomiting, and primary adrenal insufficiency. Inappropriate use of sodium-free or hypotonic IV fluids (like D 5W) causes hyponatremia from water excess. Because perspiration contains high levels of sodium, this is a cause of hyponatremia. Diabetes insipidus results in inadequate antidiuretic hormone (ADH), causing water loss and hypernatremia. Excess sodium intake can lead to hypernatremia. Removal of the parathyroid glands can lead to hypocalcemia.

A client is to receive metoclopramide intravenously 30 minutes before initiating chemotherapy for cancer of the colon. The nurse explains that metoclopramide is given for which purpose?

To stimulate peristalsis of the upper gastrointestinal (GI) tract Prokinetic medications such as metoclopramide stimulate peristalsis in the GI tract. This enhances the emptying of stomach contents into the duodenum to decrease gastroesophageal reflux and vomiting, all of which are precipitated by chemotherapeutic agents. Metoclopramide does not stimulate the production of gastrointestinal secretions. Metoclopramide has no effect on the excretion of chemotherapeutic medications. Metoclopramide has no effect on the absorption of chemotherapeutic medications.

The nurse is caring for a female client who is receiving rifampin for tuberculosis. Which statements indicate that the client understands the teaching about rifampin? Select all that apply. One, some, or all responses may be correct.

"This medication may be hard on my liver, so I must avoid alcoholic drinks while taking it." "This medication may reduce the effectiveness of the oral contraceptive I am taking." "My health care provider must be called immediately if my eyes and skin become yellow." Alcohol may increase the risk of hepatotoxicity. Rifampin has teratogenic properties and may reduce the effectiveness of oral contraceptives. Yellowing of the eyes and skin are signs of hepatitis and should be reported immediately. An antacid may be taken 1 hour before taking the medication. The capsule may be opened and the powder mixed with applesauce.

A client takes acetaminophen routinely. The nurse will advise the client to avoid which substance?

Alcohol Acetaminophen and alcohol are both hepatotoxic substances. Metabolites of acetaminophen, along with alcohol, can cause irreversible liver damage. Caffeine stimulates the cardiovascular system, not the liver. In addition, caffeine does not interact with acetaminophen. Diphenhydramine may be taken with acetaminophen. Ibuprofen may be taken with acetaminophen.

Ceftriaxone is prescribed for a client's infection. For which potential adverse effect would the nurse monitor the client?

Allergic reaction

Which manifestation is an adverse effect of intravenous lorazepam? Select all that apply. One, some, or all responses may be correct.

Amnesia Drowsiness Sleep driving Blurred vision Respiratory depression

Which would the nurse use to monitor for torsades de pointes in a client with schizophrenia being treated with chlorpromazine?

Electrocardiogram (ECG)

The nurse understands which are the pharmacokinetic reasons for medication sensitivity in infants? Select all that apply. One, some, or all responses may be correct.

Medication absorption Renal medication excretion Protein binding of drugs Hepatic medication metabolism Increased medication sensitivity in infants is a result of the immature state of pharmacokinetic processes such as medication absorption, renal medication excretion, protein binding of drugs, and hepatic medication metabolism. A small body is not a pharmacokinetic parameter.

A health care provider prescribes daily docusate sodium for a client. The nurse explains to the client that this medication has which action?

Softens the feces The detergent action of docusate sodium promotes the drawing of fluid into the stool, which softens the feces. Lubricating the feces in the gastrointestinal (GI) tract is the action of lubricant laxatives such as mineral oil. Creating an osmotic effect in the GI tract is the action of saline laxatives, such as magnesium hydroxide, or other osmotics, such as lactulose. Stimulating motor activity of the GI tract is the action of peristaltic stimulants, such as cascara.

A client is treated with lorazepam for status epilepticus. Which effect of lorazepam is the reason it is given?

Depresses the central nervous system (CNS)

Which side effect would the nurse assess for in a child receiving prednisone?

Mood swings Mood swings may result from steroid therapy. Alopecia does not result from steroid therapy. An increased appetite, not anorexia, results from steroid therapy. Weight gain, not weight loss, results from steroid therapy.

Which medication is safest to take for pain in the week before a surgical procedure?

Acetaminophen Acetaminophen is a nonopioid analgesic that inhibits prostaglandins, which serve as mediators for pain; it does not affect platelet function. Naproxen, aspirin, and ketorolac are nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) that are contraindicated for clients undergoing surgery; nonselective NSAIDs have an inhibitory effect on thromboxane, a strong aggregating agent, and can result in bleeding.

Which ophthalmic solution is contraindicated for clients with glaucoma?

Atropine Atropine, a mydriatic ophthalmic solution, is contraindicated for clients with glaucoma because it dilates the pupil, increasing intraocular pressure. Timolol, a beta blocker, decreases aqueous humor production; beta blockers are the preferred initial medications given to reduce intraocular pressure. Pilocarpine, a cholinergic, constricts the pupil, thereby increasing aqueous humor outflow. Epinephrine, an adrenergic agent, enhances aqueous humor outflow, thereby reducing intraocular pressure.

Which medication acts as an antidote to benzodiazepine?

Flumazenil

The nurse is caring for a client who is receiving total parenteral nutrition (TPN). The nurse will assess for which complications? Select all that apply. One, some, or all responses may be correct.

Infection Hyperglycemia Electrolyte imbalance The concentration of glucose in the solution is an excellent culture medium that promotes the growth of microorganisms. Hyperglycemia is a common complication with TPN because of the high-glucose formulas used; blood glucose levels need to be monitored carefully during therapy. TPN formulas may need to be adjusted daily based on the client's daily electrolyte levels. ABO incompatibility is not associated with TPN. Cardiac dysrhythmias are not related to TPN.

A client has primary open-angle glaucoma. Which ophthalmic preparation is indicated to manage this condition?

Timolol maleate Timolol maleate is a beta-adrenergic antagonist that decreases aqueous humor production and increases outflow, thereby reducing intraocular pressure. Tetracaine is a topical anesthetic; it will not reduce the increased intraocular pressure associated with glaucoma. Fluorescein is a dye used to identify corneal abrasions and foreign bodies. Atropine sulfate, a mydriatic, is contraindicated because it dilates the pupil, obstructing drainage and increasing intraocular pressure.

To prevent excessive bruising when administering subcutaneous heparin, which technique will the nurse employ?

Avoid massaging the injection site after the injection. The site of the injection should not be massaged to avoid dispersion of the heparin around the site and subsequent bleeding into the area. The Z-track technique and the intramuscular route are not used with heparin; subcutaneous injection and intravenous administration are the routes appropriate for heparin administration. The medication should be injected into the subcutaneous tissue slowly, not quickly. Diluting heparin with normal saline is unnecessary. Generally, heparin is provided by the pharmacy department in single-dose syringes.

A client receiving intravenous vancomycin reports ringing in both ears. Which initial action would the nurse take?

Stop the infusion. The first action the nurse would take is to stop the infusion immediately. Vancomycin can cause temporary or permanent hearing loss. The nurse would stop the medication infusion and then notify the health care provider at once if a client reports any hearing problems or ringing in the ears. An audiologist may need to be consulted at a later date, but this is not the best first action. The nurse would document the findings; however, this is not the initial action.

Potassium supplements are prescribed for a client receiving diuretic therapy. Which client statement indicates that the teaching about potassium supplements is understood?

"I will report any abdominal distress." Potassium supplements can cause gastrointestinal ulceration and bleeding. Most salt substitutes contain potassium, and their use with potassium supplements can cause hyperkalemia. Because they can be irritating to the stomach, potassium supplements should not be taken on an empty stomach. An increase in urine output is the therapeutic effect of diuretic therapy, not potassium supplements. An adverse effect of potassium supplements is oliguria.

Trimethoprim-sulfamethoxazole is prescribed for a client with cystitis. Which instruction would the nurse include when providing medication teaching?

"Drink eight to ten glasses of water daily." A urinary output of at least 1500 mL daily should be maintained to prevent crystalluria (crystals in the urine). Taking the medication with orange juice provides no advantage. Also, orange juice produces an alkaline ash, which results in an alkaline urine that supports the growth of bacteria. Trimethoprim-sulfamethoxazole should be taken 1 hour before meals for maximum absorption. A prescribed course of antibiotics must be completed to eliminate the infection, which can exist on a subclinical level after symptoms subside.

A client with tuberculosis is started on rifampin. The nurse evaluates that the teaching about rifampin is effective when the client makes which statement?

"My sweat will turn orange from this medication."

Which would the nurse include in the client's medication teaching on the administration of aspirin 650 mg every 6 hours as needed for arthritic pain? Select all that apply. One, some, or all responses may be correct.

"Report persistent abdominal pain." "Do not chew enteric-coated tablets." "Take the aspirin with meals or a snack." Aspirin therapy may lead to gastrointestinal bleeding, which may be manifested by abdominal pain; if present, the prescriber must be notified immediately. Enteric-coated tablets must not be crushed or chewed. Aspirin is irritating to the stomach lining and can cause ulceration; the presence of food, fluid, or antacids decreases this response. Bleeding gums should be reported to the practitioner, not the dentist. Acetaminophen does not contain the anti-inflammatory properties present in aspirin; tinnitus should be reported to the practitioner.

A client with a history of severe diarrhea for the past 3 days is admitted for dehydration. The nurse anticipates administering which intravenous (IV) solution?

0.9% sodium chloride

Which intravenous fluid is a hypertonic solution?

5% dextrose in normal saline

A 28-lb toddler is prescribed amoxicillin 145 mg by mouth three times daily. Medication available is supplied as a suspension of 250 mg/5 mL. The safe dosage is 35 mg/kg/24 h. How many milligrams within the safe dosage limit is the dose? Record your answer using one decimal place.

9.5 Because there are 2.2 lb/kg, the child's weight of 28 lb is equal to 12.7 kg. The safe dose is determined by multiplying the child's weight in kilograms by 35 (12.7 × 35), which is 444.5 mg/24 h. To calculate the child's dose in 24 hours, multiply the prescribed dose (145 mg) by 3, which yields 435 mg in 24 hours. Subtracting 435 from 444.5 yields 9.5 mg. Because the daily dose is 9.5 mg less than the maximal safe daily dose of 444.5 mg, it is safe to administer this amount of medication.

Which medications increase the risk for upper gastrointestinal (GI) bleeding? Select all that apply. One, some, or all responses may be correct.

Aspirin Ibuprofen Methylprednisolone Nonsteroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid and ibuprofen, and corticosteroids such as methylprednisolone are known causes of medication-induced gastrointestinal (GI) bleeding by causing irritation and erosion of the gastric mucosal barrier. Acetaminophen is a safe alternative to NSAIDs to reduce the risk of GI bleeding. Ciprofloxacin, an antibiotic, has not been associated with GI bleeding.

Aspirin is prescribed for a client with rheumatoid arthritis. Which clinical indicators of aspirin toxicity will the nurse teach the client to report? Select all that apply. One, some, or all responses may be correct.

Blood in the stool Ringing in the ears Blood in the stool indicates gastrointestinal irritation and may have resulted from the anticoagulant effect of aspirin. Salicylates, such as aspirin, can cause ototoxicity (affects eighth cranial nerve), which may manifest as ringing in the ears (tinnitus) or muffled hearing and it should be reported. Joint pain is not a symptom of salicylate toxicity; however, it is related to the disease process and should be minimized by the administration of aspirin. Bradycardia and increased urine output (polyuria) do not indicate salicylate toxicity.

A child with juvenile idiopathic arthritis is prescribed nonsteroidal anti-inflammatory drug (NSAID) therapy at home. Which important toxic effect of NSAIDs would the nurse include in discharge instructions to the child and family?

Blood in the urine Hematuria may result from the use of NSAIDs because they may cause nephrotoxicity. Diarrhea can occur but is not a sign of toxicity. Hypothermia does not occur with NSAIDs. Drowsiness, not hyperactivity, may occur.

A client is receiving patient-controlled analgesia (PCA) after surgery. Which benefit would this type of therapy provide? Select all that apply. One, some, or all responses may be correct.

Client is able to self-administer pain-relieving medications as necessary Decreases client dependency Increases client sense of autonomy

Which action is the nurse's responsibility when administering prescribed opioid analgesics? Select all that apply. One, some, or all responses may be correct.

Count the client's respirations. Document the intensity of the client's pain. Verify the number of doses in the locked cabinet before administering the prescribed dose. Opioid analgesics can cause respiratory depression; the nurse must monitor respirations. The intensity of pain must be documented before and after administering an analgesic to evaluate its effectiveness. Because of the potential for abuse, the nurse is legally required to verify an accurate count of doses before taking a dose from the locked source and at the change of the shift. Pruritus is a common side effect of opioids that can be managed with antihistamines. It is not an allergic response, so it does not preclude administration. The nurse would not discard an opioid in a client's room. Any waste of an opioid must be witnessed by another nurse.

A child with iron-deficiency anemia is prescribed oral iron therapy. Anticipatory guidance regarding which side effect would the nurse provide?

Greenish-black stool Iron is excreted in the feces, and the change in color results from the insoluble iron compound excreted in the stool. Blood in the stool is associated with lower intestinal bleeding, not supplemental iron ingestion. Orange urine is not associated with supplemental iron ingestion; it occurs with phenazopyridine hydrochloride or rifampin administration. Staining of the mucous membranes of the mouth should not occur with oral administration of iron if a straw is used and the teeth are brushed immediately after administration. The teeth, not the mucous membranes, may become stained if these precautions are not taken.

Famotidine is prescribed for a client with peptic ulcer disease. Which mechanism of action is a characteristic of this medication?

Inhibits gastric acid secretion Famotidine decreases gastric secretion by inhibiting histamine at H 2 receptors. Increasing gastric motility, neutralizing gastric acidity, and facilitating histamine release are not actions of famotidine.

The nurse is teaching the parents of a child prescribed a high dose of oral prednisone for asthma. Which information is critical for the nurse to include when teaching about this medication?

It should be stopped gradually. Gradual weaning from prednisone is necessary to prevent adrenal insufficiency or adrenal crisis. Prednisone depresses the immune system, thereby increasing susceptibility to infection. The medication usually suppresses growth. A moon face may occur, but it is not a critical, life-threatening side effect.

A client in the emergency department presents with signs and symptoms indicative of an opioid overdose. Which medication would the nurse anticipate administering?

Naloxone Naloxone is an opioid antagonist that displaces opioids from receptors in the brain, reversing respiratory depression. Methadone is a synthetic opioid that causes central nervous system depression; it will accelerate the effects of the overdose. Epinephrine will have no effect on respiratory depression stemming from of an overdose of a narcotic. Amphetamine is a stimulant, not an opioid antagonist.

A client with gastroesophageal reflux disease (GERD) receives a prescription for an H 2 receptor antagonist. Which medications are within the classification of an H 2 receptor antagonist? Select all that apply. One, some, or all responses may be correct.

Nizatidine Ranitidine Famotidine Nizatidine is an H 2 receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Ranitidine is an H 2 receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Famotidine is an H 2 receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Lansoprazole is a proton pump inhibitor that inhibits gastric secretion up to 90% with one dose daily and provides for symptomatic improvement in GERD. Metoclopramide is a prokinetic agent that increases the rate of gastric emptying; it has multiple side effects and is not appropriate for long-term treatment of GERD.

Which therapeutic outcomes are expected after administering ibuprofen? Select all that apply. One, some, or all responses may be correct.

Pain relief Temperature reduction Reduced inflammation Prostaglandins accumulate at the site of an injury, causing pain; nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen inhibit COX-1 and COX-2 (both are isoforms of the enzyme cyclooxygenase), which inhibit the production of prostaglandins, thereby contributing to analgesia. NSAIDs inhibit COX-2, which is associated with fever, thereby causing the temperature to decline. NSAIDs inhibit COX-2, which is associated with inflammation, thereby reducing inflammation. NSAIDs do not cause diuresis; reversible renal ischemia and renal insufficiency in clients with heart failure, cirrhosis, or hypovolemia can be potential adverse effects of NSAIDs. NSAIDs do not cause bronchodilation. Anticoagulation is an adverse effect, not a desired outcome; NSAIDs can impair platelet function by inhibiting thromboxane, an aggregating agent, resulting in bleeding.

When the nurse is administering a course of aminoglycoside treatment to a client with Klebsiella infection, which adverse effects prompt the nurse to hold treatment and contact the health care provider? Select all that apply. One, some, or all responses may be correct.

Vertigo Tinnitus Dizziness Persistent headache The nurse monitors the client administered aminoglycosides for signs of ototoxicity, which include vertigo, tinnitus, dizziness, and persistent headache. Any sign of ototoxicity should result in holding the treatment and contacting the health care provider. Heartburn is not associated with ototoxicity.