pharmacological & parenteral therapies 3/13/23
After abdominal surgery 3 days ago the client continues to have pain every 4 to 6 hours ranging from 3 to 7 on a 10-point scale. The client has prescriptions for morphine 10 mg IM every 3 to 4 hours and acetaminophen with codeine 30 mg every 3 to 4 hours as needed for pain. The client has been taking the morphine every 4 hours for the past 3 days but tells the nurse that the morphine is no longer lasting 4 hours and wants to receive pain medication every 3 hours. The nurse reviews the progress notes that indicate the client has obtained pain relief for 5 to 6 hours after receiving the morphine. What should the nurse do to help the client manage the pain? Continue to administer the morphine every 4 hours. Encourage the client to ambulate more frequently. Administer the morphine every 3 hours. Suggest that the client take the acetaminophen with codeine every 3 hours.
Suggest that the client take the acetaminophen with codeine every 3 hours. Explanation: Evidence indicates that acetaminophen with codeine provides pain relief for most clients with moderate pain. Because the progress notes indicate that the client is obtaining relief from the morphine for more than 4 hours and has moderate pain, the nurse can suggest that the client try taking the acetaminophen with codeine every 3 hours. The goal for this client is to gradually use less pain medication. The client can be encouraged to ambulate, but that will not be sufficient to manage the postoperative pain at this point.
A 10-year-old child is taking high doses of aspirin. Which finding indicates the child is experiencing early salicylate toxicity? slowed pulse rate pink-colored urine dizziness chest pain
dizziness Explanation: Signs and symptoms of early salicylate toxicity include tinnitus, disturbances in hearing and vision, and dizziness. Salicylate toxicity may cause nausea, vomiting, diarrhea, and bleeding from mucous membranes from long-term use.Pink-colored urine, a slowed pulse rate, and chest pain, rarely occurring in children, are not associated with salicylate toxicity.
A nurse would question administration of which medication through a midline intravenous catheter? furosemide dopamine cefazolin morphine sulfate
dopamine Explanation: Vesicant medications such as dopamine should not be administered through a midline catheter, as extravasation of the medication can cause tissue damage. The other medications will not cause tissue damage if extravasation occurs.
The client is seen in the clinic for acute gouty arthritis. The healthcare provider orders indomethacin. What should the nurse include in the client's teaching concerning the administration of indomethacin? Select all that apply. "You should consider a replacement for indomethacin." "You should have periodic eye exams." "You should take muscle relaxers for pain." "You should eat high-fiber foods." "Do not use aspirin with indomethacin."
"You should have periodic eye exams." "Do not use aspirin with indomethacin." Explanation: Indomethacin can cause problems with vision or balance, so the client should have periodic eye exams. Aspirin/NSAIDs should not be used with indomethacin, as it can cause bleeding or perforation. Teaching about intake of high-fiber foods, taking NSAIDs for pain, and replacing certain medications used for depression/seizures is directed at opioid administration.
A nurse is assigned to four clients. Which client should the nurse see first? A client with acquired immunodeficiency syndrome receiving emtricitabine A client who is being prepared for a major surgery receiving clopidogrel A client with a low white blood cell count receiving pegfilgrastim A client who had open reduction internal fixation (ORIF) receiving fondaparinux
A client who is being prepared for a major surgery receiving clopidogrel Explanation: Clopidogrel is an anti-platelet drug that should be stopped seven days prior to surgery because it can increase the risk of bleeding. All the other options are correct. Fondaparinux can be given to a client who had ORIF to prevent blood clot formation. Pegfilgrastim is given to a client with low white blood cell (WBC). Emtricitabine is a nucleoside-nucleotide reverse transcriptase inhibitor (NNRTI) drug used for clients with HIV/AIDS.
The health care provider prescribes fluoxetine orally every morning for a 72-year-old client with depression. Which transient adverse effect of this drug requires immediate action by the nurse? nausea dizziness sedation dry mouth
Explanation: The presence of dizziness could indicate orthostatic hypotension, which may cause injury to the client from falling. Nausea, sedation, and dry mouth do not require immediate intervention by the nurse.
Which is the correct technique when the nurse is instilling eye drops for an adult who is alert? Select all that apply. Instruct the client to apply pressure to the eyes after instillation of the eyedrops. Blot excess drops from the client's face. Have the client look down, and instill the medication onto the client's cornea. Have the client tilt the head back and look up. Hold the dropper over the eye, and instill the drops into the lower lid.
Hold the dropper over the eye, and instill the drops into the lower lid. Have the client tilt the head back and look up. Blot excess drops from the client's face.
A client will receive IV midazolam hydrochloride during surgery. Which finding indicates a therapeutic effect? mild agitation amnesia blurred vision nausea
amnesia Explanation: Midazolam hydrochloride causes antegrade amnesia or decreased ability to remember events that occurred around the time of sedation. Nausea, mild agitation, and blurred vision are adverse effects of midazolam.
A nurse discovers that an I.V. site in a client's hand has infiltrated, causing localized pain and swelling. Which intervention would relieve the client's discomfort most effectively? administering an as-needed analgesic wrapping the arm in an elastic bandage from wrist to elbow placing an ice pack on the hand elevating the hand and wrapping it in a warm towel
elevating the hand and wrapping it in a warm towel Explanation: Elevating the arm promotes venous drainage and reduces edema; applying warmth increases circulation and eases pain and edema. Ice application would relieve pain but not edema. An analgesic wouldn't correct the primary cause of the discomfort. Wrapping the arm above the hand would slow venous return and is contraindicated.
A client is receiving a blood transfusion, and 1 hour after starting the transfusion the client reports dyspnea and has crackles on lung auscultation. Which medication would be most important for the nurse to give? diphenhydramine 50 mg PO methylprednisolone 250 mg I.V. bolus acetaminophen 600 mg PO furosemide 40 mg I.V.
furosemide 40 mg I.V. Explanation: This client is experiencing fluid overload usually noted after the first 15 minutes. The treatment of choice would be a diuretic. Acetaminophen would used to treat a febrile reaction; methylprednisolone and diphenhydramine would be indicated in an allergic reaction, which does not normally cause crackles.
A child with leukemia has just completed a course of methotrexate therapy. How soon should the nurse expect to see signs of bone marrow depression in this client? within 1 month within 2 weeks within hours after induction therapy is completed
within 2 weeks Explanation: Bone marrow depression is most likely to occur 10 days after methotrexate is administered.
A child with leukemia has just completed a course of methotrexate therapy. How soon should the nurse expect to see signs of bone marrow depression in this client? within hours within 1 month within 2 weeks after induction therapy is completed
within 2 weeks Explanation: Bone marrow depression is most likely to occur 10 days after methotrexate is administered.
The nurse needs to administer heparin 10,000 units subcutaneously twice a day on a client who had a colon resection prophylactically for deep vein thrombosis. The dose on hand is 20,000 units per mL. How many milliliters will the nurse give?
0.5 Explanation: Dimensional analysis Given quantity = 10,000 units Wanted quantity = mL Dose on hand = 20,000 units 10,000 units mL = 10 = 0.5 mL 20,000 units 20 The zeros are dropped from the 10,000 units and the 20,000 units. End up with 10 as the numerator and 20 as the denominator. Divide the 10 by 20 and get 0.5 mL.
In preparing for insertion of a peripheral I.V. catheter, the nurse must select an appropriate site. Which area should the nurse try first if an appropriate vein is found? Inner aspect of the elbow. Outer aspect of the forearm. Inner aspect of the forearm. Back of the hand.
Back of the hand. Explanation: When inserting an I.V. catheter needle, the nurse initially uses veins low on the hand or arm if available, unless contraindicated. Should the I.V. fluid infiltrate or the vein become irritated at this insertion site, veins higher on the arm are still available for use. After a vein higher up on the arm has been damaged, veins below it cannot be used.
The nurse is reviewing the physician's order written for a postmenopausal client: "calcitonin salmon nasal spray 200 IU, one spray every day." What is the appropriate action to be taken by the nurse regarding this order? Inform the physician that the medication is not a nasally applied medication. Clarify with the physician that the spray should be given in only one nostril per day. Remind the physician that this medication can be purchased over-the-counter. Ask the physician why this medication was ordered for a postmenopausal client.
Clarify with the physician that the spray should be given in only one nostril per day. Explanation: Calcitonin salmon nasal spray should be administered in only one nostril per day. Many preprinted order sheets automatically print "administer in both nostrils" when a nasal spray is ordered. Nurses must be familiar with the directions for each medication they give before administering medications. The other options are incorrect because calcitonin salmon nasal spray is prescribed to postmenopausal clients for the treatment of osteoporosis and requires a physician's order.
A client is taking iron supplements. What information should the nurse give the client? Do not use a bulk laxative. The stools will become darker. Liquid iron supplements will not discolor teeth. Iron supplements should be taken on an empty stomach.
The stools will become darker. Explanation: Iron supplements will darken the stools. Iron supplements should not be taken on an empty stomach because they can cause gastric irritation. Iron is constipating, and a daily bulk-forming laxative should be started prophylactically. A straw should be used when taking liquid iron to avoid discoloring the teeth.
A client is admitted to the oncology unit with an infection. It is suspected that the infection may be related to the vascular access device (VAD). The nurse should draw the blood cultures from which site? the proximal lumen of the VAD only a peripheral site only a peripheral site and all lumens of the VAD all lumens of the VAD
a peripheral site and all lumens of the VAD Explanation: When an infection is suspected from a VAD, blood cultures should be drawn peripherally and from all lumens of the VAD to determine the source of the infection. If the number of organisms is greater from the VAD than in the peripheral culture, the source is determined to be the VAD.
A nurse is caring for a 3-year-old child admitted to the pediatric unit with acetaminophen poisoning. The nurse administers acetylcysteine every 4 hours for 72 hours. Which laboratory findings confirm the effectiveness of the drug therapy? creatine kinase-MB blood urea nitrogen and serum creatinine complete blood count alanine aminotransferase and aspartate aminotransferase
alanine aminotransferase and aspartate aminotransferase Explanation: Acetaminophen poisoning causes liver damage, raising the liver enzymes alanine aminotransferase and aspartate aminotransferase. Creatine kinase-MB levels are elevated with heart muscle damage and aren't associated with acetaminophen poisoning. Blood urea nitrogen and serum creatinine levels provide information on renal function and aren't indicators of effectiveness of drug therapy in acetaminophen poisoning. A complete blood count won't give the nurse information on the effectiveness of therapy.
A client is taking finasteride. The nurse is most concerned when this client manifests breast enlargement. decreased prostate size. flushing. azotemia.
azotemia. Explanation: Azotemia, a buildup of nitrogenous waste products in the blood, indicates impaired renal function. Finasteride, an antiandrogenic agent, is prescribed for chronic urinary retention secondary to benign prostatic hypertrophy (BPH). Azotemia in a client on finasteride therapy can indicate that the drug is not effective in relieving the urinary symptoms associated with BPH, or that an unrelated renal problem has occurred. Breast enlargement, decrease in prostate size, and flushing are expected effects of finasteride.
A client with newly diagnosed type 1 diabetes is scheduled to receive regular insulin 10 units and NPH insulin 20 units every morning. When should the nurse schedule the administration of these medications? NPH 1 hour before and regular 0.5 hours before breakfast regular insulin with breakfast; NPH after breakfast in two separate syringes with breakfast both insulins 0.5 hours before breakfast
both insulins 0.5 hours before breakfast Explanation: Regular and NPH insulins are scheduled together one-half hour before breakfast. They do not need to be given separately or in different syringes.
Which medication should a nurse expect the physician to order to reverse a dystonic reaction? haloperidol midazolam prochlorperazine diphenhydramine
diphenhydramine Explanation: Diphenhydramine, 25 to 50 mg I.M. or I.V., would quickly reverse this condition. Prochlorperazine and haloperidol are both capable of causing dystonia, not reversing it. Midazolam would make this client drowsy.
A client with a retroperitoneal abscess is receiving gentamicin. Which signs should the nurse monitor? Select all that apply. hematocrit (HCT) blood urea nitrogen (BUN) and creatinine levels hearing urine output serum calcium level
hearing urine output blood urea nitrogen (BUN) and creatinine levels Explanation: Adverse reactions to gentamicin include ototoxicity and nephrotoxicity. The nurse must monitor the client's hearing and instruct them to report any hearing loss or tinnitus. Signs of nephrotoxicity include decreased urine output and elevated BUN and creatinine levels. Gentamicin doesn't affect the serum calcium level or HCT.
The nurse should assess older adults for which serious adverse effects of ibuprofen? hypoglycemia rebound headaches impaired renal function neuropathy
impaired renal function Explanation: Renal function may already be compromised in the elderly, and ibuprofen can further impair renal or liver function. Nonsteroidal anti-inflammatory drugs can also cause nephrosis, cirrhosis, and heart failure in elderly persons.Rebound headaches are not a serious adverse effect of ibuprofen.Neuropathy and hypoglycemia are not adverse effects of ibuprofen.
A client with heart failure is allergic to sulfa-based medications. Which diuretic would the nurse anticipate ordered as an alternate? potassium-sparing diuretics carbonic anhydrase inhibitors loop diuretics thiazide and thiazide-like diuretics
potassium-sparing diuretics Explanation: The only diuretics that are not sulfonamide derivatives are the potassium-sparing diuretics (triamterene, spironolactone, and amiloride) and ethacrynic acid. Thiazide and thiazide-like diuretics, loop, and carbonic anhydrase inhibitor diuretics should be used in caution with clients with a sulfa allergy.
The client was found not breathing and was transported to the hospital. A family member states the client may have taken too much pain medication because the client frequently forgets if the medication was taken. Which observation(s) by the nurse indicates therapeutic effect of naloxone hydrochloride in the client? Select all that apply. Reverses decreased respiratory rate of 10. Reverses decreased level of consciousness. Increases nerve pain. Reverses blood pressure of 90/58. Increases inflammation.
Reverses decreased respiratory rate of 10. Reverses decreased level of consciousness. Reverses blood pressure of 90/58. Explanation: Therapeutic effect includes reversal of respiratory depression, sedation, and hypotension. Therapeutic effect does not include increasing nerve pain or increasing inflammation.
The nurse reviews a client's medication administration record and notes the scheduled medications (see chart). When planning to administer the medications, the nurse must administer which medication within 30 minutes of its scheduled administration time?
ampicillin Explanation: Time-critical medications are those medications that can cause client harm or subtherapeutic blood levels and should be administered within 30 minutes of the scheduled time. These include antibiotics, anticoagulants, immunosuppressants, insulin, and antiseizure medications. Non-time-critical medications, such as lisinopril, metoprolol, and the pneumococcal vaccine should generally be administered within 1 to 2 hours of the scheduled time. However, agency policy dictates the window of time to administer non-time-critical medications and may vary by institution.
What information should the nurse give the client about mydriatic agents? "Your pupils will be small and your night vision will be diminished." "Compress the lacrimal sac for one minute after instillation." "Eye pain is common after administration." "Blurred vision is an adverse effect, and you should report it to the provider immediately."
"Compress the lacrimal sac for one minute after instillation." Explanation: To prevent systemic absorption, the client should compress the lacrimal sac for one minute after instilling a mydriatic agent. The drug dilates the pupils and causes light sensitivity. Blurred vision is an expected effect of mydriatics, and do not need not be reported immediately. The client should discontinue the drug if eye pain occurs.
The label of a drug package reads "meperidine hydrochloride, 50 mg/mL." How many milliliters should a nurse give a client for a 30-mg dose? Round the answer to the nearest tenth of a milliliter.
0.6 Explanation: There are 50 mg in each mL, and the objective is to deliver 30 mg to the client. Set up a ratio and solve: 50 mg / 1 mL = 30 mg / x Cross multiply: 50x = 30 mL Divide to isolate x: x = 30/50 mL = 0.6 mL
Griseofulvin was ordered to treat a child's ringworm of the scalp. The nurse instructs the parents to use the medication for several weeks for which reason? Fewer side effects occur as the body slowly adjusts to a new substance over time. Fewer allergic reactions occur if the drug is maintained at the same level long-term. The growth of the causative organism into new cells is prevented with long-term use. A sensitivity to the drug is less likely if it is used over a period of time.
The growth of the causative organism into new cells is prevented with long-term use. Explanation: Griseofulvin is an antifungal agent that acts by binding to the keratin that is deposited in the skin, hair, and nails as they grow. This keratin is then resistant to the fungus. But as the keratin is normally shed, the fungus enters new, uninfected cells unless drug therapy continues. Long-term administration of griseofulvin does not prevent sensitivity or allergic reactions. As the body adjusts to a new substance over time, side effects are variable and do not necessarily decrease.
To prevent development of peripheral neuropathies associated with isoniazid administration, what should the nurse teach the client to do? Follow a low-cholesterol diet. Supplement the diet with pyridoxine (vitamin B6). Avoid excessive sun exposure. Obtain extra rest.
Supplement the diet with pyridoxine (vitamin B6). Explanation: Isoniazid competes for the available vitamin B6 in the body and leaves the client at risk for developing neuropathies related to vitamin deficiency. Supplemental vitamin B6 is routinely prescribed to address this issue. Avoiding sun exposure is a preventive measure to lower the risk of skin cancer. Following a low-cholesterol diet lowers the individual's risk of developing atherosclerotic plaque. Rest is important in maintaining homeostasis but has no real impact on neuropathies.
Which instruction should a nurse give a client with prostatitis who is receiving co-trimoxazole double strength? "Drink 6 to 8 glasses of fluid daily while taking this medication." "Don't expect improvement of symptoms for 7 to 10 days." "If your mouth or throat becomes sore, take the medication with milk or an antacid." "To protect against drug-induced photosensitivity, use a sunscreen of at least SPF-15 with PABA."
"Drink 6 to 8 glasses of fluid daily while taking this medication." Explanation: The client must drink 6 to 8 glasses of fluid daily to prevent renal problems, such as crystalluria and stone formation. If the drug is effective, symptoms should improve within a few days. Sore throat and sore mouth are adverse effects; the client should report them to a physician right away. The drug causes photosensitivity, but the client should use a PABA-free sunscreen; PABA can interfere with the drug's action.
The nurse must administer a unit of packed red blood cells to a 4-year-old child. The child's blood type is Type B Rh factor positive. When the unit of blood arrives, it is labeled as Type O Rh factor negative. What is the appropriate action for the nurse to take? Have the child's blood retested for blood type. Begin the administration of the blood as ordered. Return the blood and order a new unit of Type B. Document the error with an incident report.
Begin the administration of the blood as ordered. Explanation: Type O Rh negative blood is the universal donor and can be administered to a child who is Type B. As long as the crossmatch report confirms "OK to transfuse," there would be no need to return this unit to the blood bank. This should not be considered an error and would not be documented as such. There is no indication for retesting the child's blood type.
The nurse ascertains that there is a discrepancy in the records of use of a controlled substance for a client who is taking large doses of narcotic pain medication. What should the nurse do next? Notify the police. Notify the nursing supervisor of the clinical unit. Contact the hospital's administration or legal department. Notify the pharmacy technician who delivered the controlled substance.
Notify the nursing supervisor of the clinical unit. Explanation: All health care facilities in which controlled medications are stored for dispensing and/or administration to clients are required to follow procedures for the proper maintenance of narcotic inventory. Narcotic inventory maintenance includes, but is not limited to, thorough and appropriate documentation of any discrepancy with accompanying reasons (i.e., tablet/amp/vial breakage, additional medication volume), timely resolution of inventory discrepancies, and timely notification of persons in oversight areas (i.e., Pharmacy, Security, Nursing House Supervisor). In the event of a significant incident, the proper external authorities will be notified by the Quality and Risk Management/Legal Department.
A nurse is teaching a client to use a metered-dose inhaler (MDI) to administer bronchodilator medication. Indicate the correct order of the steps from first to last the client should take to use the MDI appropriately. All options must be used. 1 Activate the MDI on inhalation. 2 Hold the breath for 5 to 10 seconds and then exhale. 3 Shake the inhaler immediately before use. 4 Breathe out through the mouth. SUBMIT ANSWER
Shake the inhaler immediately before use. Breathe out through the mouth. Activate the MDI on inhalation. Hold the breath for 5 to 10 seconds and then exhale. Explanation: When using inhalers, clients should first shake the inhaler to activate the MDI, and then breathe out through the mouth. Next, the client should activate the MDI while inhaling, hold the breath for 5 to 10 seconds, and then exhale normally.
A nurse is to administer several oral medications to a client at the same time. Which nursing instruction or action is appropriate in this situation? Tell the client to take all the medications at once. Tell the client the name and action or use of each medication before administering it. Advise the client to take each medication with 8 oz (240 mL) of water. Leave the medications at the bedside for the client to take as the client wishes.
Tell the client the name and action or use of each medication before administering it. Explanation: When administering several oral medications at the same time, the nurse should tell the client the name of each medication and its action or use before administering it. The client may take the medications all at once or one at a time with any amount of fluid. Leaving medications at the bedside may lead to errors such as the client not taking them. To ensure that the client takes the medication, the nurse should always observe the client taking it.
A client is receiving total parenteral nutrition (TPN), and the nurse is concerned about the complication of fluid volume overload. Which nursing action is most appropriate in the administration of TPN to prevent this complication? Use an infusion pump to administer the TPN solution. Reduce the ordered flow rate by half. Weigh the client every day. Continuously monitor the infusion rate.
Use an infusion pump to administer the TPN solution. Explanation: Complications of TPN include fluid overload, electrolyte imbalances, infection, hyperglycemia and hypoglycemia, air embolism, and pneumothorax. A nurse should use an infusion pump to administer TPN to help prevent fluid overload. Although weighing the client every day would alert the nurse to possible fluid overload, it is more appropriate for the nurse to prevent fluid overload by using an infusion pump. The nurse does not need to continuously monitor the infusion rate once the pump is set. The nurse should not decrease the prescribed flow rate, thus preventing the administration of the ordered nutrition.
For which medication(s) will the nurse ask another nurse to witness the disposal of a partial dose in the pharmaceutical waste container? Select all that apply. meperidine alprazolam losartan hydrocodone amlodipine
alprazolam hydrocodone meperidine Explanation: Federal law requires two nurses to witness and document the waste of all controlled substances in order to prevent diversion and misuse of these substances. Alprazolam, hydrocodone, and meperidine are controlled substances. These medications require the nurse to have another nurse witness the waste in a pharmaceutical waste container. Losartan and amlodipine are not controlled substances and do not require special procedures for the waste of a partial dose.
A client rates the pain level of a migraine an 8 on a scale of 1-10. How would the nurse administer the medication to give the client the quickest relief? sublingual intramuscular (IM) intravenous (IV) buccal
intravenous (IV) Explanation: The nurse would want the client to receive the benefit of the medication as quickly a possible to help alleviate the migraine. A drug placed directly into intravenous system enters the client's bloodstream more quickly than oral, IM, or buccal, thereby avoiding the barriers of food and the destructive effects of stomach acid. With oral, IM, and buccal administration, the client's response to the drug is slower.
The client has second- and third-degree burns. The family asks if there is anything that can be given to the client for pain. Which analgesic would the nurse anticipate to manage the client's pain? meperidine administered by IM codeine administered by PO heparin administered by IV morphine administered by IV
morphine administered by IV Explanation: The best and most effective medication for second- and third-degree burns would be IV morphine. IM medications may not be absorbed, and codeine may not provide sufficient analgesia.
The client has second- and third-degree burns. The family asks if there is anything that can be given to the client for pain. Which analgesic would the nurse anticipate to manage the client's pain? codeine administered by PO morphine administered by IV heparin administered by IV meperidine administered by IM
morphine administered by IV Explanation: The best and most effective medication for second- and third-degree burns would be IV morphine. IM medications may not be absorbed, and codeine may not provide sufficient analgesia.
The nurse is admitting a school-age child for suspected nephrotic syndrome. The nurse notifies the healthcare provider immediately that the child is on what medication? ampicillin phenytoin diphenhydramine prednisone
phenytoin Explanation: Nephrotic syndrome is a condition that occurs in children for a variety of reasons. This inflammatory disease results in protein loss in the urine leading to rapid reduction in plasma albumin levels. Phenytoin is highly protein bound. The low albumin levels from nephrotic syndrome will increase the risk for phenytoin toxicity as more of the drug becomes unbound and exerts an effect on tissues. The nurse will need to request phenytoin levels, which will be corrected for current albumin levels. Ampicillin is a relevant finding because it could indicate a recent Streptococcus infection that can lead to a form of nephrotic syndrome, poststreptococcal glomerulonephritis. However, this is not as important as the risk for phenytoin toxicity. Corticosteroids can be used to treat nephrotic syndrome, so there is no need to notify the healthcare provider regarding them. Diphenhydramine is not related to the disorder or its effects.
The health care provider (HCP) has prescribed pseudoephedrine. The nurse should instruct the client about which possible adverse effect of this drug? diplopia constipation bradycardia restlessness
restlessness Explanation: Adverse effects of pseudoephedrine are experienced primarily in the cardiovascular system and through sympathetic effects on the central nervous system (CNS). The most common CNS adverse effects include restlessness, dizziness, tension, anxiety, insomnia, and weakness. Common cardiovascular adverse effects include tachycardia, hypertension, palpitations, and arrhythmias. Constipation and diplopia are not adverse effects of pseudoephedrine. Tachycardia, not bradycardia, is an adverse effect of pseudoephedrine.
Which statement by the mother of a child who is receiving pancreatic enzymes for the treatment of cystic fibrosis indicates that the mother understands the teaching? "I can sprinkle the enzymes on food." "I should give the medicine about 1 hour before meals." "I will give the enzymes when my child is sick." "I will give the medication when my child has diarrhea."
"I can sprinkle the enzymes on food." Explanation: One problem associated with cystic fibrosis is poor digestion and absorption of foods, especially fats. Pancreatic enzymes can help improve digestion and absorption of nutrients. Therefore, they are given with meals and can be sprinkled on food.They must be taken regularly, not just when the child is sick.
A female client is treated for trichomoniasis with metronidazole. What should the nurse tell the client about this medication? She should discontinue oral contraceptive use during this treatment. The medication should not alter the color of the urine. She should avoid alcohol during treatment and for 24 hours after completion of the drug. Her partner does not need treatment.
She should avoid alcohol during treatment and for 24 hours after completion of the drug. Explanation: Metronidazole can cause a disulfiram-like reaction if it is taken with alcohol. Tachycardia, nausea, vomiting, and other serious interaction effects can occur. Flagyl will make the urine a darker color. Oral contraceptives should never be discontinued with trichomoniasis. The partner also requires treatment to prevent retransmission of infection
The health care provider's (HCP's) prescription for an intravenous infusion is 3% normal saline to infuse at 125 mL/h. The client's most recent sodium level is 132 mEq/L (132 mmol/L). What should the nurse do next? Hang the IV solution prescribed at 62 mL/h. Start the IV solution as prescribed. Hang 0.9% normal saline at 125 mL/h. Consult the prescriber about the prescription.
Consult the prescriber about the prescription. Explanation: Three percent saline is a hypertonic solution, which will pull fluid from the interstitial and intracellular spaces into the bloodstream. Its use is usually reserved for severe hyponatremia (sodium <115 mEq/L). If this client were experiencing a fluid volume deficit, this IV solution could worsen the condition. The nurse should consult with the HCP about this prescription. The nurse does not have prescribing rights and cannot change the prescription. The IV rate of 62 mL/h may still be dangerous for this client, and the rate was prescribed at 125 mL/h.
When a central venous catheter dressing becomes moist or loose, what should a nurse do first? Remove the dressing, clean the site, and apply a new dressing. Notify the physician. Remove the catheter, check for catheter integrity, and send the tip for culture. Draw a circle around the moist spot and note the date and time.
Remove the dressing, clean the site, and apply a new dressing. Explanation: A nurse maintaining a central venous catheter should change the dressing every 72 hours or when it becomes soiled, moist, or loose. After removing the soiled dressing, the nurse should use sterile technique to clean around the site in accordance with facility policy. After the cleaning solution has dried, the nurse should cover the site with a transparent semipermeable dressing. A nurse who notes drainage on a wound dressing should draw a circle around the moist spot and note the date and time. The nurse should notify the physician if any catheter-related complications are observed. Only a nurse with the appropriate qualifications may remove a central venous catheter, and a moist or loose dressing isn't a reason to remove the catheter.
Which statement by a client who has been taking buspirone as prescribed for 2 days indicates the need for further teaching? "The drug does not cause physical dependence." "This medication will help my tight, aching muscles." "I can take the medication with food." "I may not feel better for 7 to 10 days."
"This medication will help my tight, aching muscles." Explanation: Buspirone, a nonbenzodiazepine anxiolytic, is particularly effective in treating the cognitive symptoms of anxiety, such as worry, apprehension, difficulty with concentration, and irritability. Buspirone is not effective for the somatic symptoms of anxiety (muscle tension). Therapeutic effects may be experienced in 7 to 10 days, with full effects occurring in 3 to 4 weeks. This drug is not known to cause physical or psychological dependence. It can be taken with food or small meals to reduce gastrointestinal upset.
After laparoscopic cholecystectomy, a 43-year-old client reports pain and nausea. The nurse is preparing meperidine hydrochloride 75 mg and promethazine hydrochloride 12.5 mg to be administered I.M. in the same syringe. If the label on the meperidine reads 50 mg/ml and the label on the promethazine reads 25 mg/ml, how many milliliters should the nurse have in the syringe after the correct doses are drawn up? Record your answer using a whole number.
2 Explanation: This formula is used to calculate drug dosages: dose on hand/quantity on hand = dose desired/X. In this example, the formula for calculating the amount of meperidine is: 50 mg/ml = 75 mg/X; X = 1.5 ml. The formula for calculating the amount of promethazine is: 25 mg/ml = 12.5 mg/X; X = 0.5 ml. To calculate the total milliliters that should be drawn up in the syringe, the nurse adds the quantity of meperidine and the quantity of promethazine as follows: 1.5 ml + 0.5 ml = 2 ml total drawn up in the syringe.
The clinic nurse is caring for an 8-month-old female client with congenital heart disease in the pediatric clinic. Parent reports that the infant takes dioxin twice a day, and furosemide daily as prescribed for congestive heart failure. The infant also takes ferrous sulfate drops daily. This morning, the infant seemed more tired than usual, and had a poor appetite. The client vomited 30 minutes after taking their morning medication. Client has also had 4 loose stools in last 24 hours. VS T 97.8 °F (36.6°C), P 88, RR 30, B/P 80/56 mm Hg, pulse oximetry 95% on room air. Last weight at 6 months was 15 lbs 3oz (6.9 kg). Weight today is 16 lb 14 oz (7.6 kg). Point-of-care testing shows electrolytes are within normal limits. The nurse reviews the assessment data to begin the plan of care. Complete the diagram by dragging from the choices below to specify the condition the client is most likely experiencing, 2 actions to take, and 2 parameters to monitor to assess the client's progress.
Actions to take: Obtain digitalis levels, obtain ECG Potential complication: Digitalis toxicity Monitor: heart rate and input & output Explanation: The infant's bradycardia, lethargy, diarrhea, and vomiting most suggest the infant has digitalis toxicity. The findings of a stable respiratory status and typical 2- month weight gain suggest that the infant does not have fluid overload. The weight, vital signs, and electrolytes do not indicate the infant is dehydrated as would be expected with gastroenteritis. Tachycardia or poor growth would be expected if the infant had anemia. The nurse should obtain a digitalis level and an electrocardiogram to check for arrhythmias. Stool cultures are not needed unless the diarrhea persists. Obtaining a hemoglobin and hematocrit is not critical because the infant's respiratory because the infant is on iron and gaining weight. A chest X-ray is not needed because the respiratory status is stable. The nurse will monitor the heart rate and hold digitalis for rates less than 90. The nurse will also monitor intake and output for resolution of the diarrhea. The nurse would continue with routine monitoring of breath sounds, color, and pulse oximetry. Since these parameters are normal, they are not the best indicators of the infant's progress.
The nurse just started an infusion of blood on a client. A few minutes pass and the client develops a sudden fever. What are the priority interventions by the nurse? Select all that apply. Stop the blood infusion. Continue to monitor vital signs. Notify the health care provider. Start the normal saline infusion. Force oral fluids.
Start the normal saline infusion. Continue to monitor vital signs. Stop the blood infusion. Notify the health care provider. Explanation: Development of fever during blood transfusion can indicate a transfusion reaction. The appropriate nursing action is to discontinue the blood transfusion, infuse normal saline to prevent a more severe reaction, continue to monitor vital signs, and call the healthcare provider. Other interventions include serum analysis of BUN and creatinine, and returning the blood and tubing to the laboratory to be analyzed. Forcing oral fluids is not part of transfusion reaction care.
A client is diagnosed with rheumatoid arthritis and is ordered oral indomethacin. What should the nurse include in the client's teaching concerning the administration of indomethacin? Select all that apply. "Take the drug with a glass of water only." "Tell your health care provider immediately about changes in your hearing." "Avoid any hazardous activity until you know how you react to this drug." "Do not use aspirin while taking this drug." "It is OK to continue to consume alcohol at dinner."
"Avoid any hazardous activity until you know how you react to this drug." "Tell your health care provider immediately about changes in your hearing." "Do not use aspirin while taking this drug." Explanation: Client teaching regarding indomethacin includes advising against the use of aspirin or other NSAIDs; the client should notify the health care provider if pain relief is needed. The client should take the drug with milk, food, or an antacid to lessen the risk for GI upset. The consumption of alcohol while taking indomethacin may cause GI reactions and should be discouraged. The client should notify the health care provider of visual disturbances, hearing loss or tinnitus, weight gain, or edema. The client should also be instructed to avoid hazardous activities until the extent of CNS reactions (e.g., dizziness, syncope, vertigo) are known.
A client with acute psychosis has been taking haloperidol for 3 days. When evaluating the client's response to the medication, which comment reflects the greatest improvement? "I'm feeling so restless, and I can't sit still." "I know these voices aren't real, but I'm still scared of them." "I'm ready to talk about my discharge medications." "Boy, do I need a shower. I think it's been days since I've had one."
"I know these voices aren't real, but I'm still scared of them." Explanation: Knowing that the voices are not real is a reflection that the haloperidol is effective in decreasing psychosis. Restlessness may be a side effect of haloperidol, not an indication of improvement. Awareness of need for activities of daily living is an indicator of improvement. However, recognizing that the voices are not real demonstrates a greater awareness of the client's disorder than the need for hygiene does. Wanting to prepare for discharge before stabilization reflects denial of illness.
The health care provider (HCP) prescribes IV cefazolin 1 g for a client. In preparing to administer the cefazolin, the nurse notes that the client is allergic to penicillin. Based on this information, what is an appropriate action for the nurse to take? Call the pharmacist to verify that the cefazolin should be administered as prescribed. Continue to prepare to administer the cefazolin as prescribed. Notify the HCP of the client's allergy to penicillin. Administer the cefazolin, staying at the client's bedside during the infusion.
Notify the HCP of the client's allergy to penicillin. Explanation: The nurse should notify the HCP that the client is allergic to penicillin before giving the cefazolin. Cephalosporins are contraindicated in clients who are allergic to penicillin. Clients who are allergic to penicillin may have a cross-allergy to cephalosporins.
When administering a blood transfusion to a client with multiple traumatic injuries, the nurse monitors closely for evidence of a transfusion reaction. Shortly after the transfusion begins, the client complains of chest pain, nausea, and itching and there is a rise in the client's temperature. The nurse stops the transfusion and notifies the physician. The nurse suspects which type of hypersensitivity reaction with a blood transfusion?
type II (cytolytic, cytotoxic) hypersensitivity reaction Explanation: ABO (blood type) incompatibility, such as from an incompatible blood transfusion, is a type II hypersensitivity reaction. Transfusions of more than 100 ml of incompatible blood can cause severe and permanent renal damage, circulatory shock, and even death. Drug-induced hemolytic anemia is another example of a type II reaction. A type I hypersensitivity reaction occurs in anaphylaxis, atopic diseases, and skin reactions. A type III hypersensitivity reaction occurs in Arthus reaction, serum sickness, systemic lupus erythematosus, and acute glomerulonephritis. A type IV hypersensitivity reaction occurs in tuberculosis, contact dermatitis, and transplant rejection.
The nurse is caring for a client with peripheral artery disease who has recently been prescribed clopidogrel. Which statement by the client indicates that the nurse should continue giving information to the client about this medication? "The health care provider prescribed this medicine to make my platelets less likely to stick together and help prevent clots from forming." "I should not be surprised if I bruise easier or my gums bleed a little when brushing my teeth." "It does not really matter if I take this medicine with or without food, whatever works best for my stomach." "I should stop taking clopidogrel if it makes me feel weak and dizzy."
"I should stop taking clopidogrel if it makes me feel weak and dizzy." Explanation: Weakness, dizziness, and headache are common adverse effects of clopidogrel and the client should report these to the health care provider (HCP) if they are problematic; in order to decrease risk of clot formation, the drug must be taken regularly and should not be stopped or taken intermittently. The main adverse effect of clopidogrel is bleeding, which often occurs as increased bruising or bleeding when brushing teeth. Clopidogrel is well absorbed, and while food may help decrease potential gastrointestinal upset, the drug may be taken with or without food. Clopidogrel is an antiplatelet agent used to prevent clot formation in clients who have experienced or are at risk for myocardial infarction, ischemic stroke, peripheral artery disease, or acute coronary syndrome.
The client with breast cancer is prescribed tamoxifen 20 mg daily. The client states she does not like taking medicine and asks the nurse if the tamoxifen is really worth taking. What should the nurse tell the client? "This drug will act as an estrogen in your breast tissue." "This drug has been found to decrease metastatic breast cancer." "This drug will prevent hot flashes since you cannot take hormone replacement." "This drug is part of your chemotherapy program."
"This drug has been found to decrease metastatic breast cancer." Explanation: Tamoxifen is an antiestrogen drug that has been found to be effective against metastatic breast cancer and to improve the survival rate. The drug causes hot flashes as an adverse effect.
An 8-month-old infant is admitted with a febrile seizure. The infant weighs 17 lb (7.7 kg). The physician orders ceftriaxone, 270 mg I.M. every 12 hours. (The safe dosage range is 50 to 75 mg/kg daily.) The pharmacy sends a vial containing 500 mg, to which the nurse adds 2 ml of preservative-free normal saline solution. The nurse should administer how many milliliters? None, because this is not a safe dosage 1.08 ml 0.08 ml 1.8 ml
1.08 ml Explanation: Because the infant weighs 17 lb (7.7 kg), the safe dosage range is within 385 to 578 mg daily. The ordered dosage, 270 mg every 12 hours or 540 mg daily, is safe. To calculate the amount to administer, the nurse may set up the following proportion of ceftriaxone to solution: 500 mg / 2 ml = 270 mg / x ml Cross multiply: 500x = 540 Divide to isolate x: x = 540/500 = 1.08 ml Double-check: Because the 270 mg dose is slightly more than half the 500 mg in solution, giving slightly more than half the 2 ml solution makes sense.
Immediately after receiving an injection of bupivacaine, the client becomes restless and nervous and reports a feeling of impending doom. What should the nurse do next? Reassure the client that it is normal to feel restless before a procedure. Ask the client explain these feelings. Administer epinephrine. Assess the client's vital signs.
Assess the client's vital signs. Explanation: The nurse should assess the client's vital signs because there is a likelihood of having a reaction to the bupivacaine. If the client's vital signs are abnormal, immediate intervention may be necessary. Although the nurse may ask the client to continue to describe feelings, this is not likely to be a psychosocial reaction. Simple reassurance is inappropriate in most clinical situations and can be dangerous if physiologic causes of restlessness are overlooked. The nurse should not administer epinephrine until vital signs have been assessed.
When caring for a client with a central venous line, which nursing actions should be implemented in the plan of care for chemotherapy administration? Select all that apply. If unable to aspirate blood, reposition the client and encourage the client to cough. Administer a cytotoxic agent to keep the regimen on schedule even if blood return is not present. Contact the health care provider about verifying placement if the status is questionable. Verify patency of the line by the presence of a blood return at regular intervals. Inspect the insertion site for swelling, erythema, or drainage.
Verify patency of the line by the presence of a blood return at regular intervals. Inspect the insertion site for swelling, erythema, or drainage. If unable to aspirate blood, reposition the client and encourage the client to cough. Contact the health care provider about verifying placement if the status is questionable. Explanation: A major concern with IV administration of cytotoxic agents is vessel irritation or extravasation. The Oncology Nursing Society and hospital guidelines require frequent reevaluation of blood return when administering vesicant or non-vesicant chemotherapy due to the risk of extravasation. These guidelines apply to peripheral and central venous lines. The nurse should also assess the insertion site for signs of infiltration, such as swelling and redness. In addition, central venous lines may be long-term venous access devices. Thus, difficulty drawing or aspirating blood may indicate the line is against the vessel wall or may indicate the line has occlusion. Having the client cough or move position may change the status of the line if it is temporarily against a vessel wall. Occlusion warrants more thorough evaluation via X-ray study to verify placement if the status is questionable and may require a declotting regimen. The nurse should not administer any drug if the IV line is not open or does not have an adequate blood return.
The nurse instructs a child's parents to administer the prescribed ferrous sulfate with a citrus juice. The parents ask why they need to do this. Which response by the nurse is the best? "The citrus juice prevents the ferrous sulfate from staining the teeth." "The citrus juice makes the ferrous sulfate elixir taste better." "The citrus juice provides the vitamin C needed for the production of red blood cells." "The citrus juice helps with the absorption of ferrous sulfate."
"The citrus juice helps with the absorption of ferrous sulfate." Explanation: The citrus juice contains the vitamin C that enhances the absorption of the ferrous sulfate elixir. Vitamin C is not needed for the production of red blood cells. The citrus juice may make the ferrous sulfate elixir taste better, but this is not the primary reason for use. The child should drink the ferrous sulfate elixir using a straw to prevent staining of the teeth.
The nurse is caring for a 35-year-old client with bipolar disorder who will be starting on a new dose of lithium in addition to fluoxetine. Which teaching will the nurse make a priority for this client? Select all that apply. Take lithium extended release tablet whole Reduce caloric intake by 250 calories per day Skip a dose of fluoxetine if insomnia develops Allow extra time for completing routine activities Limit physical activity Drink 64 to 98 ounces (2 liters to 3 liters) of water each day Add extra salt to foods
Add extra salt to foods Take lithium extended release tablet whole Allow extra time for completing routine activities Drink 64 to 98 ounces (2 liters to 3 liters) of water each day Explanation: Lithium is a medication commonly used to treat bipolar disorder. This medication needs to be closely monitored. The client developed toxicity from lithium and actions need to be taken to prevent this from occurring again. The client should be instructed to have an adequate intake of salt each day.Extended release medication is to be swallowed whole and not chewed or crushed. The client is in the phase of depression and may need extra time to complete routine tasks. This should be reinforced with the client. Because the client had an episode of lithium toxicity, they should be instructed to have a daily intake of water between 2 to 3 liters per day. The client was exhibiting the phase of depression in bipolar disorder. Physical activity should be encouraged. There is no reason for the client to reduce caloric intake since their weight has been stable. The client should be instructed to take the fluoxetine as prescribed. Insomnia is a common side effect of this medication and doses do not need to be skipped. Side effects will reduce as the medication is taken routinely.
To treat a child's atopic dermatitis, a physician orders a topical application of hydrocortisone cream twice daily. After medication instruction by the nurse, which statement by the parent indicates effective teaching? "I will gently scrape the skin before applying the cream to promote absorption." "I will avoid using soap and water on the affected area and will apply an emollient cream on this area frequently." "I will apply a moisturizing cream sparingly and will wash the affected area frequently." "I will spread a thick coat of hydrocortisone cream on the affected area and will wash this area once a week."
I will avoid using soap and water on the affected area and will apply an emollient cream on this area frequently." Explanation: Avoiding the use of soap and water reflects effective teaching because such washing removes moisture from the horny layer of the skin. Applied in a thin layer, emollient cream holds moisture in the skin, provides a barrier to environmental irritants, and helps prevent infection. Spreading a thick coat of hydrocortisone cream shows ineffective teaching because topical steroid creams such as hydrocortisone should be applied sparingly as a light film; the affected area should be cleaned gently with water before the cream is applied. Scraping or abrading the skin may actually increase the risk of infection and alter drug absorption. Excessive application of steroidal creams may result in systemic absorption and Cushing's syndrome. Frequent washing dries the skin, making it more susceptible to cracking and further breakdown.
A physician orders lithium for a client diagnosed with bipolar disorder. The nurse needs to provide appropriate education for the client receiving this drug. Which topics should the nurse cover? Select all that apply. signs and symptoms of drug toxicity the need to report for laboratory testing to monitor blood levels information regarding a low-tyramine diet the potential for tardive dyskinesia changes in mood may take 7 to 21 days the potential for addiction
signs and symptoms of drug toxicity the need to report for laboratory testing to monitor blood levels changes in mood may take 7 to 21 days Explanation: Client education should cover the signs and symptoms of drug toxicity as well as the need to report them to the physician. The client should be instructed to report for follow-up laboratory studies to monitor the client's lithium level to avoid toxicity. The nurse should explain that it may take 7 to 21 days before the client notes a change in the client's mood. Lithium doesn't have addictive properties. Tardive dyskinesia isn't an adverse effect of lithium. Tyramine is a potential concern for clients taking monoamine oxidase inhibitors.
