pharm and parental therapy EAQ

A client has been receiving fluphenazine for several months. The nurse will assess the client for which side effects? Tremors Excess salivation Rambling speech Reluctance to converse Uncoordinated movement of extremities

Tremors Uncoordinated movement of extremities Acute dystonic reactions such as tremors, dyskinesia, and akathisia are observable side effects of fluphenazine therapy. There is a decrease, not an increase, in salivation with fluphenazine therapy. Rambling speech is not a side effect of this drug; nor is reluctance to converse.

The nurse is caring for a client undergoing chemotherapy for cancer treatment. The client's laboratory results indicate bone marrow suppression. What will the nurse encourage the client to do? Use an electric razor when shaving Drink citrus juices frequently for nourishment Increase activity level by ambulating frequently Sleep with the head of the bed slightly elevated

Use an electric razor when shaving Suppression of bone marrow increases bleeding susceptibility associated with decreased platelets. Drinking citrus juices frequently for nourishment does not offer an advantage. The client receiving chemotherapy because of the side effects of stomatitis should avoid citrus juices. With bone marrow suppression there is a decrease in red blood cells to meet cellular oxygen needs; rest should be encouraged, if needed. Sleeping with the head of the bed slightly elevated does not offer any specific advantage; the client should sleep in the position of comfort.

Which drug is safe to administer to a lactating woman but may cause teratogenic effects when administered to pregnant clients? Tetracycline Methotrexate Carbamazepine Cyclophosphamide

Carbamazepine is safe to administer in a lactating woman but may cause neural tube defects as a teratogenic effect. Tetracycline may cause tooth and bone abnormalities as a teratogenic effect. Methotrexate may cause limb malformations as a teratogenic effect. Cyclophosphamide may cause secondary cancer as a teratogenic effect. Tetracycline, methotrexate, and cyclophosphamide should not be administered to breast-feeding women.

A client who is receiving phenytoin asks why folic acid (Folate) was prescribed. What is the best explanation by the nurse? Absorption of folate from foods is inhibited. The action of phenytoin is potentiated. Absorption of iron from foods is improved. Neuropathy caused by phenytoin is prevented.

Absorption of folate from foods is inhibited. Phenytoin inhibits folic acid absorption and potentiates the effects of folic acid antagonists. Folic acid is helpful in correcting certain anemias that can result from administration of phenytoin. The dosage must be carefully adjusted because folic acid diminishes the effects of phenytoin. Absorption of iron from foods and prevention of neuropathy caused by phenytoin are not effects of folic acid.

While caring for a client on phenelzine, the nurse finds an excess elevation of the client's temperature. Which other medication currently being taken by the client may be responsible for this condition? Meperidine Desipramine Amitriptyline Amphetamine

Meperidine Phenelzine is a monoamine oxidase inhibitor (MAOI) used to treat depression. Meperidine is a strong analgesic that when taken concurrently with MAOIs may result in excessive elevation of the temperature. Desipramine and amitriptyline are tricyclic antidepressants that may cause hypertensive episodes or hypertensive crisis when taken concurrently with MAOIs. Amphetamine is an indirectly acting sympathomimetic that causes a hypertensive crisis when taken concurrently with MAOIs.

A pregnant woman who is past her due date is hospitalized for a labor induction. Which drug should be administered to the client? Clomiphene Menotropins Dinoprostone Choriogonadotropin alfa

Dinoprostone Dinoprostone is a prostaglandin that stimulates uterine contractions to promote the progression of labor. Clomiphene, menotropins, and choriogonadotropin alfa are fertility drugs that are used to increase the likelihood of conception in an infertile woman.

A client has colorectal cancer and is receiving cetuximab. Which process does cetuximab inhibit? Proteasome activity BCR-ABL tyrosine kinase (TK) Anaplastic lymphoma kinase Epidermal growth factor receptors (EGFRs)

Epidermal growth factor receptors (EGFRs) Cetuximab is an EGFR-tyrosine TK inhibitor that acts by inhibiting EGFRs in clients with colorectal cancer. Bortezomib inhibits proteasome activity in clients with multiple myeloma. Dasatinib acts by inhibiting BCR-ABL TK in clients with chronic myeloid leukemia. Crizotinib acts by inhibiting anaplastic lymphoma kinase (ALK) in clients with locally advanced or metastatic non-small cell lung cancer that is ALK positive.

A client with metastatic melanoma is being treated with interferon gamma 1b. The nurse concludes that the teaching about this drug is understood when the client makes which statement? "I will increase my fluid intake to several quarts (liters) every day." "I need to discard any reconstituted solution at the end of the week." "I can continue driving my car as before as long as I have the stamina." "I should be able to continue my usual activity while taking this medication."

"I will increase my fluid intake to several quarts (liters) every day." Increasing fluid intake to several quarts (liters) every day helps flush the kidneys and prevent nephrotoxicity, especially during the early phase of treatment. Reconstituted solution can be stored in the refrigerator for one month. Confusion, dizziness, and hallucinations are side effects of this drug; the client should avoid hazardous tasks, such as driving or using machinery. Activity may have to be altered because fatigue and other flulike symptoms are common with this drug.

A client with tuberculosis is prescribed isoniazid. What statements should the nurse tell the client? "Take the drug on an empty stomach." "Report any changes in vision to your primary healthcare physician." "Take daily multiple vitamins that contain B-complex." "Wear protective clothing when going outdoors during the day." "Report darkening of the urine or a yellowish skin discoloration."

"Take the drug on an empty stomach." "Take daily multiple vitamins that contain B-complex." "Report darkening of the urine or a yellowish skin discoloration." Isoniazid should be taken on an empty stomach because food prevents absorption of the drug. Multiple vitamins that contain the vitamin B-complex should be taken along with isoniazid because the drug depletes vitamin B. A client on isoniazid should report darkening of the urine and yellowish skin discoloration because these conditions are signs of liver toxicity. A client on ethambutol should be taught to report changes in vision. A client on pyrazinamide is instructed to wear protective clothing if he or she will be exposed to sunlight.

A client is prescribed sertraline, an antidepressant. What does the nurse include when preparing a teaching plan about the side effects of this drug? Seizures Agitation Tachycardia Agranulocytosis

Agitation Sertraline, a selective serotonin reuptake inhibitor (SSRI), inhibits neuronal uptake of serotonin in the central nervous system, thus potentiating the activity of serotonin. Central nervous system side effects of this drug include agitation, anxiety, confusion, dizziness, drowsiness, and headache. Seizures are a side effect of clozapine, an antipsychotic, not sertraline, which is an antidepressant. Tachycardia is a side effect of tricyclic antidepressants, not sertraline, which is an SSRI antidepressant. A decrease in the production of granulocytes (agranulocytosis) causing a pronounced neutropenia is a side effect of clozapine, not sertraline.

A nurse prepares to administer extended-release metformin to an older adult who has asked that it be crushed because it is difficult to swallow. What will prompt the nurse to ask the provider for a different form of metformin? This drug has a wax matrix frame that is difficult to crush. The drug has an unpleasant taste, which most clients find intolerable if crushed. If crushed, this drug irritates mucosal tissue and can cause oral and esophageal ulcer formation. Extended-release formulations are designed to be released slowly, and crushing the tablet will prevent this from occurring.

Extended-release formulations are designed to be released slowly, and crushing the tablet will prevent this from occurring. The slow-release formulary will be compromised and the client will not receive the entire dose if it is chewed or crushed. The capsules are not difficult to crush. Irritation of the mucosal tissue is not the reason the medication should not be crushed; however, this drug should be given with meals to prevent gastrointestinal irritation. Although taste could be a factor, it is not the priority issue.

When administering albumin intravenously, what fluid shifts does the nurse anticipate? Interstitial compartment to the intracellular compartment Intravascular compartment to the interstitial compartment Interstitial compartment to the intravascular compartment Extracellular compartment to the intracellular compartment

Interstitial compartment to the intravascular compartment Intravenous albumin increases colloid osmotic pressure, resulting in a pull of fluid from the interstitial compartments to the intravascular compartment. Intravascular compartment to the interstitial compartment and extracellular compartment to the intracellular compartment are opposite to the actual shift of fluids when albumin is administered.

A healthcare provider prescribes a vitamin tablet that contains vitamin B complex. What should the nurse teach the client? It may turn the urine bright yellow. The daily fluid intake should be increased. The drug should be taken on an empty stomach. It may accumulate in the body if an excessive amount is taken.

It may turn the urine bright yellow. Bright yellow urine is an expected, insignificant side effect of vitamin B complex. There is no need to increase oral fluids; the client may consume the usual daily intake of fluid. Taking the drug on an empty stomach may precipitate nausea; therefore, it should be taken with food. Vitamin B complex is a water-soluble vitamin, and excess amounts are excreted in urine.

A nurse in the surgical intensive care unit is caring for a client with a large surgical incision. The nurse reviews a list of vitamins and expects that which medication may be prescribed because of its major role in wound healing? Vitamin A (retinol) Vitamin K (phytonadione) Vitamin C (ascorbic acid) Vitamin B 12 (cyanocobalamin)

Vitamin C (ascorbic acid) plays a major role in wound healing. It is necessary for the maintenance and formation of collagen, the major protein of most connective tissues. Vitamin A is important for the healing process; however, vitamin C is the priority because it cements the ground substance of supportive tissue. Cyanocobalamin is a vitamin B 12 preparation needed for red blood cell synthesis and a healthy nervous system. Phytonadione is vitamin K, which plays a major role in blood coagulation.

A preterm infant is started on digoxin and furosemide for persistent patent ductus arteriosus. Which nursing assessment provides the best indication of the effectiveness of the furosemide? Pedal edema is reduced. Digoxin toxicity is prevented. Fontanels appear depressed. Urine output exceeds fluid intake.

Urine output exceeds fluid intake. Urine output exceeding fluid intake is the expected outcome. Output exceeding intake indicates that furosemide is causing diuresis. Although it is important to determine whether pedal edema is reduced, this could be influenced by other factors. Furosemide can cause hypokalemia, which may precipitate digoxin toxicity; it is not given to prevent digoxin toxicity. Depressed fontanels are not the desired outcome; this finding indicates dehydration, which may occur with excessive diuresis.

Which type of drugs readily crosses the placenta? Polar drugs Ionized drugs Lipid-soluble drugs Protein-bound drugs

Drugs that are lipid soluble penetrate the placenta in higher concentrations. Polar drugs are not transferred in higher concentrations through the placenta. Nonionized drugs are more likely to be transferred through the placenta than ionized drugs. Protein-bound drugs remain in the maternal plasma because the molecules are too large to cross the placenta.

What is the priority nursing intervention for a school-aged child with lead poisoning who is undergoing chelation therapy? Scrupulous skin care Provision of a high-protein diet Careful monitoring of intake and output Daily blood sampling for liver function tests

Careful monitoring of intake and output Kidney function must be adequate to excrete the lead; if it is not adequate, nephrotoxicity or kidney damage may result. Skin breakdown is not associated with chelation therapy. A high-protein diet is not necessary. Liver damage does not occur with chelation therapy.

A nurse is evaluating the results of treatment with erythropoietin. Which assessment finding indicates an improvement in the underlying condition being treated? 2+ pedal pulses Decreased pallor Decreased jaundice 2+ deep tendon reflexes

Decreased pallor Erythropoietin stimulates red blood cell production, thereby decreasing the pallor that accompanies anemia. It would not have a role in alleviating jaundice. It would not have an appreciable effect on pulses or deep tendon reflexes.

A client has been taking clomiphene citrate for 3 months to treat anovulatory cycles. Which finding should be reported to the primary healthcare provider immediately? Missed period Blurred vision Weight gain Hot flashes

Missed period Clomiphene is classified in pregnancy category X, and it should be discontinued if the client is pregnant. The client should notify her primary healthcare provider of the presumptive signs of pregnancy. Weight gain, blurred vision, and hot flashes are all common side effects of this ovulation inducer.

Which drug will the nurse administer to trigger ovulation? Tolvaptan Clomiphene Conivaptan Metyrapone

Clomiphene is used to trigger ovulation for women with gonadotropin deficiency. Tolvaptan and conivaptan are used to treat syndrome of inappropriate antidiuretic hormone. Metyrapone is used to treat Cushing's syndrome.

The nurse cares for a client diagnosed with bipolar disorder who was prescribed drug therapy. Laboratory reports reveal that the client's thyroxine levels are low. Which drug might have led to this condition? Lithium Fluoxetine Risperidone Carbamazepine

Lithium is used to treat bipolar disorder. Decreased levels of thyroxine and triiodothyronine may indicate hypothyroidism. Lithium may cause a goiter, which is associated with hypothyroidism. Fluoxetine is a serotonin reuptake inhibitor that may lead to hyponatremia. Risperidone is a second generation antipsychotic used to treat bipolar disorder that does not cause hypothyroidism. Carbamazepine is an antiepileptic drug used to treat bipolar disorder; this drug may cause leukopenia, anemia, and thrombocytopenia.

A client who has a long leg cast for a fractured bone is to be discharged from the emergency department. When discussing pain management, when does the nurse advise the client to take the prescribed as-needed oxycodone? Just as a last resort Before going to sleep As the pain becomes intense When the discomfort begins

When the discomfort begins Pain is most effectively relieved when an analgesic is administered at the onset of pain, before it becomes intense; this prevents a pain cycle from occurring. Analgesics are less effective if administered when pain is at its peak. Before going to sleep, it may or may not be necessary; the medication should be taken when the client begins to feel uncomfortable within the parameters specified by the healthcare provider's prescription. Analgesics are less effective if administered when pain is at its peak.

A 7-year-old boy with a diagnosis of attention deficit-hyperactivity disorder (ADHD) is receiving methylphenidate. His mother asks about its action and side effects. What is the nurse's initial response? "This medicine increases the appetite." "This medicine must be continued until adulthood." "It is a short-acting medicine that must be given with each meal." "It is a stimulant that has a calming effect on children with your son's disorder."

"It is a stimulant that has a calming effect on children with your son's disorder." Although the exact mechanism is unknown, clinical improvements have been reported with sympathomimetic amines such as methylphenidate. After the purpose and action of the drug are explained, the nurse should review side effects with the parent. The appetite of a child taking methylphenidate usually diminishes. The child should be medicated for as short a period as possible. Each child is evaluated individually. The duration of methylphenidate is 3 to 6 hours, or 8 hours with the extended-release form.

A client has been taking lithium carbonate for 3 days. The nurse has the client's lithium level checked before administering the medication and finds it to be 0.3 mEq/L (0.3 mmol/L). What action will the nurse take? Notify the primary healthcare provider. Administer the medication. Watch for adverse side effects. Withhold the next dose of the medication.

Administer the medication. A level 0.3 mEq/L (0.3 mmol/L) is below the therapeutic range of 0.5 to 1.5 mEq/L (0.5 to 1.5 mmol/L); therefore the medication should be administered as prescribed to increase the serum drug level. There is no need to notify the primary healthcare provider, because the level is still subtherapeutic. Adverse side effects are not expected until the level exceeds the therapeutic range of 0.5 to 1.5 mEq/L (0.5 to 1.5 mmol/L).

Which medication will the nurse administer that prevents cellular infection with human immunodeficiency virus (HIV)? Maraviroc Nelfinavir Delavirdine Emtricitabine

Maraviroc Maraviroc is a medication used to prevent an HIV infection by blocking the CCR5 receptors on the CD4+ T cells. It also prevents cellular HIV infections. Nelfinavir is a protease inhibitor that prevents viral replication and release of viral particles. Delavirdine is a non-nucleoside reverse transcriptase inhibitor that inhibits viral gene replication. Emtricitabine is a nucleoside reverse transcriptase inhibitor that suppresses viral replication.

A school-aged child with a seizure disorder has been taking carbamazepine for three years. What nursing intervention is most important to undertake regularly? Assessing the mouth for gingivitis Checking the pupillary reaction to light Keeping an accurate intake and output record Monitoring the child's complete blood cell counts

Monitoring the child's complete blood cell counts The side effects of carbamazepine include blood dyscrasias (e.g., thrombocytopenia, aplastic anemia, leukopenia, agranulocytosis). A side effect of long-term phenytoin, not carbamazepine, therapy is hyperplasia of the gingiva. Carbamazepine does not influence pupillary response directly. Keeping an accurate intake and output is unnecessary.

A client develops a maculopapular rash on the upper extremities and audible wheezing during the administration of intravenous vancomycin. To ensure the client's safety, which action would the nurse carry out first? Notify healthcare provider Stop infusion Decrease flow rate Reassess in 15 minutes

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

Which drugs may cause an increase in the serum clozapine level? Rifampin Phenytoin Ketoconazole Erythromycin Bromocriptine

Ketoconazole Erythromycin Ketoconazole and erythromycin increase clozapine levels in the blood by inhibiting P450 isoenzymes. Rifampin and phenytoin reduce clozapine levels in the blood by inducing cytochrome P450 isoenzymes. Bromocriptine is a direct dopamine receptor agonist that activates dopamine receptors.

A healthcare provider prescribes doxorubicin for a client with acute myelogenous leukemia. Which specific interventions should the nurse implement? Monitor for jaundice Increase fluids by mouth Provide frequent oral care Increase physical activities Assess vital signs routinely Serve hot liquids with meals

Monitor for jaundice Increase fluids by mouth Provide frequent oral care Assess vital signs routinely

A client says, "I take baking soda in water when I get heartburn." The nurse suggests an antacid containing aluminum and magnesium hydroxide instead of baking soda. What is the advantage these antacids have over baking soda? They contain little, if any, sodium. Absorption by the stomach mucosa is markedly enhanced. There is no direct effect on the systemic acid-base balance when taken as directed. Fewer side effects, such as diarrhea or constipation, are experienced when they are used properly.

There is no direct effect on the systemic acid-base balance when taken as directed. Nonsystemic antacids are not readily absorbed, so they do not alter the acid-base balance. Sodium bicarbonate is absorbed and can alter the acid-base balance. These preparations do contain sodium. Nonsystemic antacids are insoluble and not readily absorbed. Diarrhea and constipation are side effects of nonsystemic antacids.

Which antimicrobial medication acts on susceptible pathogens by inhibiting nucleic acid synthesis? Penicillin Actinomycin Erythromycin Cephalosporin

Actinomycin is an antimicrobial medication that acts on susceptible pathogens by inhibiting nucleic acid synthesis. Penicillin acts on susceptible pathogens by inhibiting cell wall synthesis. Erythromycin acts on susceptible pathogens by inhibiting biosynthesis and reproduction. Cephalosporin acts on susceptible pathogens by inhibiting cell wall synthesis.

A nurse is providing discharge medication teaching to a client who will be taking furosemide and digoxin after discharge from the hospital. What information is most important for the nurse to include in the teaching plan? Maintenance of a low-potassium diet Avoidance of foods high in cholesterol Signs and symptoms of digoxin toxicity Importance of an adequate intake and output

The risk of digoxin toxicity increases when the client is receiving digoxin and furosemide, a loop diuretic; loop diuretics can cause hypokalemia, which potentiates the effects of digoxin, leading to toxicity. Digoxin toxicity can result in dysrhythmias and death. When a client is receiving a loop diuretic, the diet should be high in potassium. Although teaching the need to avoid foods high in cholesterol may be included in the teaching plan, it is not the priority. Although it is important to maintain adequate intake and output because potassium chloride should not be taken when there is a decreased urinary output, the priority is monitoring for signs of digoxin toxicity.

A nurse is giving an educational program to paramedics who have volunteered to give the smallpox vaccine in a community vaccination drive. Which type of needle and method of administration should the nurse teach the volunteers to use when administering the smallpox vaccine? Bifurcated needle for 15 injections within 5 mm Intradermal needle for 15 injections within 5 mm Bifurcated needle for 10 dermal injections within 5 mm Double-lumen needle for 10 dermal injections within 5 mm

Bifurcated needle for 15 injections within 5 mm is the correct needle and procedure for administering the smallpox vaccine. Intradermal needle for 15 injections within 5 mm is an incorrect needle to use when administering the smallpox vaccine. Although a bifurcated needle is used, there should be 15, not 10, injections within 5 mm. Double-lumen needle for 10 dermal injections within 5 mm is an incorrect needle and method to use when administering the smallpox vaccine.

A client will be taking nitrofurantoin 50 mg orally every evening at home to manage recurrent urinary tract infections. What instructions should the nurse give to the client? Increase the intake of fluids. Strain the urine for crystals and stones. Stop the drug if urinary output increases. Maintain the exact time schedule for taking the drug.

Increase the 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 drug. Straining urine is not indicated when the client is taking a urinary antiinfective. Urinary decrease is of concern because it may indicate renal failure. If fluids are encouraged, the client's output should increase. The drug need not be taken at a strict time daily.

A 1-year-old exhibits a runny nose and cough after being administered a vaccine via the intranasal route. Which vaccine may have been administered to the child? Rotavirus Inactivated influenza Live attenuated influenza Haemophilus influenzae type b

Live attenuated influenza vaccines administered intranasally may cause such mild side effects as a runny nose and cough. Rotavirus vaccines may cause a runny nose, but these vaccines are administered orally. Inactivated influenza vaccine is administered intramuscularly. Haemophilus influenzae type b vaccine is administered intramuscularly and may cause fever and local reactions.

A nurse is assessing the therapeutic action of drugs classified as tumor necrosis factor (TNF) inhibitors. What client response indicates to the nurse that a drug with this classification is effective? Continued remission in a client with ovarian cancer Increased insulin production in a client with diabetes mellitus Reduction of inflammatory joint pain in a client with rheumatoid arthritis Vasodilation of coronary arteries in a client with ischemic heart disease

Reduction of inflammatory joint pain in a client with rheumatoid arthritis TNF is produced mainly by macrophages in synovium; over time, through various mechanisms, the presence of TNF causes inflammation of synovium, destruction of bone and cartilage, joint stiffness, and pain. TNF inhibitors or blockers neutralize TNF, thereby interrupting the inflammatory cascade; this inhibits the inflammatory response and other mechanisms, thereby slowing tissue damage. TNF inhibitors are not prescribed for clients with ovarian cancer, diabetes mellitus, or ischemic heart disease.

A primary healthcare provider is reviewing the previous medical history of a client before prescribing danazol. Which conditions would cause a primary healthcare provider to not prescribe danazol to a client? The client is in her first trimester of pregnancy The client has rheumatic heart disease The client has a chronic kidney disease The client has a history of pyelonephritis The client is recently diagnosed with fatty liver

The client is in her first trimester of pregnancy The client is recently diagnosed with fatty liver Danazol is a mild-acting synthetic steroid that suppresses follicle stimulating hormone and luteinizing hormone. This drug should not be prescribed to pregnant women because it may produce pseudohermaphroditism in female fetuses. Danazol is also contraindicated in a client with liver diseases. Danazol may be used with caution in clients with cardiac and renal diseases.

A client's cells are deprived of oxygen during a cardiac arrest. What medication should the nurse be prepared to administer? Regular insulin Calcium gluconate Potassium chloride Sodium bicarbonate

As extravascular fluid decreases, the hematocrit will decrease. Serum albumin is administered to maintain blood volume and normal oncotic (osmotic) pressure; it does this by pulling fluid from the interstitial spaces into the intravascular compartment. Serum albumin does affect blood ammonia levels; fluid accumulated in the abdominal cavity is removed via a paracentesis. The administration of albumin results in a shift of fluid from the interstitial to the intravascular compartment, which probably will increase the blood pressure. Albumin administration does not affect venous stasis or the blood urea nitrogen level.

A client with cancer is receiving a multiple chemotherapy protocol. Included in the protocol is leucovorin. The nurse concludes that this drug is administered for what purpose? To potentiate the effect of alkylating agents Because it diminishes toxicity of folic acid antagonists To limit the occurrence of vomiting associated with chemotherapy Interference with cell division at a different stage of cell division than the other drugs

Because it diminishes toxicity of folic acid antagonists Leucovorin limits toxicity of folic acid antagonists, such as methotrexate sodium, by competing for transport into cells. Leucovorin does not potentiate the effect of alkylating agents; however, leucovorin promotes binding of fluorouracil (5-FU) to target tumor cells. Antiemetics such as prochlorperazine maleate and ondansetron minimize nausea and vomiting associated with chemotherapeutic agents. Leucovorin does not interfere with cell division; this is the purpose of a multiple-drug protocol.

A 65-year-old client is receiving amitriptyline. What is the most important recommendation for the nurse to make to this client concerning this medication? "Obtain a complete cholesterol and lipid profile." "Have an eye examination to check for glaucoma." "Check your temperature daily for nighttime increases." "Watch for excessive sweating and possible weight loss."

"Have an eye examination to check for glaucoma." In addition to baseline laboratory tests, an older adult should have an eye examination with glaucoma testing when taking amitriptyline. Amitriptyline causes dilation of the pupil (mydriasis), which interferes with drainage of aqueous humor through the canal of Schlemm. Interfering with the outflow of aqueous humor will increase intraocular pressure and may cause a progressive loss of vision in clients with glaucoma. Amitriptyline does not affect cholesterol production or temperature regulation. Amitriptyline does not cause excessive perspiration or weight loss, but it can increase appetite, especially for sweets, resulting in weight gain.

A client who is receiving phenytoin to control a seizure disorder questions the nurse regarding this medication after discharge. How will the nurse respond? "Antiseizure drugs will probably be continued for life." "Phenytoin prevents any further occurrence of seizures." "This drug needs to be taken during periods of emotional stress." "Your antiseizure drug usually can be stopped after a year's absence of seizures."

"Antiseizure drugs will probably be continued for life." Seizure disorders usually are associated with marked changes in the electrical activity of the cerebral cortex, requiring prolonged or lifelong therapy. Seizures may occur despite drug therapy; the dosage may need to be adjusted. A therapeutic blood level must be maintained through consistent administration of the drug irrespective of emotional stress. Absence of seizures will probably result from medication effectiveness rather than from correction of the pathophysiologic condition.

A client is scheduled to begin chemotherapy 2 weeks after surgery for colon cancer. What explanation does the nurse give to explain the delay following surgery? Chemotherapy interferes with cell growth and delays wound healing. Because chemotherapy causes vomiting, it endangers the integrity of the incisional area. Chemotherapy decreases red blood cell production, and the resultant anemia will add to postoperative fatigue. Chemotherapy increases edema in areas distal to the incision by blocking lymph channels with destroyed lymphocytes.

Chemotherapy interferes with cell growth and delays wound healing. Chemotherapeutic agents can attack healthy as well as malignant cells; they generally interfere with protein synthesis and cell division in all rapidly dividing cells, including those regenerating traumatized tissue (as in wound healing), bone marrow, and cutaneous and alimentary tract epithelial tissue. Vomiting should not disturb the integrity of the area. Decreased red blood cell levels caused by bone marrow depression can be corrected with transfusions. Chemotherapy should not cause a blockage of lymph channels, with destroyed lymphocytes increasing edema.

A child with beta-thalassemia is receiving therapy that includes multiple blood transfusions. This child is at risk for which most common complication? Serum hepatitis Allergic response Pulmonary edema Hemolytic reaction

Pulmonary edema The added cardiac workload of individuals with anemia who are receiving transfusions increases the risk for heart failure that leads to pulmonary edema. Although hepatitis, allergic responses, and hemolytic reactions may occur, a child with beta-thalassemia does not have an increased risk of these complications.