Pharmacology and Medication Management

A nurse is preparing to instill ear drops in a 28-year-old client with otitis externa. What is the correct procedure for instillation? a. pull the pinna down and back b. pull the pinna up and back c. pull the tragus up and back d. separate the palpebral fissures with a clean gauze pad

To straighten the ear canal of an adult, the pinna is pulled up and back. Options 1 and 3 aren't appropriate methods for preparing the ear to receive eardrops. The palpebral fissures are in the eye. Explanation: b. pull the pinna up and back

The nurse is planning care for a client receiving I.V. magnesium sulfate for hypertension. Which medication should the nurse have available for an emergency? a. calcium gluconate b. hydralazine c. naloxone d. Rho(D) immune globulin

a. calcium gluconate Explanation: Calcium gluconate is the antidote for magnesium toxicity. Ten milliliters of 10% calcium gluconate is given I.V. push over 3 to 5 minutes to correct the effects of toxicity. Hydralazine is given for sustained elevated blood pressures in preeclamptic clients. Naloxone is used to correct narcotic toxicity. Rho(D) immune globulin is given to women with Rh-negative blood to prevent antibody formation from Rh-positive conceptions.

Which medication is routinely given to the neonate within 1 hour of birth? a. erythromycin ophthalmic ointment b. hepatitis B vaccine c. glucose d. vitamin A

a. erythromycin ophthalmic ointment Explanation: Erythromycin ophthalmic ointment is given for prophylactic treatment of ophthalmic neonatorum. It is given within 1 hour of birth. Glucose would be given if the neonate is exhibiting signs of hypoglycemia. Many hospitals give the neonate the first dose of Hepatitis B vaccine prior to discharge.

A client with a large cerebral intracranial hemorrhage was given mannitol to decrease intracranial pressure (ICP). What therapeutic effect should the nurse anticipate from mannitol? a. increased urine output b. pupils that are bilaterally 7mm and nonreactive c. evidence of rebound cerebral hypertension d. normal blood urea nitrogen (BUN) and creatinine levels

a. increased urine output Explanation: Mannitol promotes osmotic diuresis by increasing the pressure gradient in the renal tubules, thus increasing urine output. Fixed and dilated pupils are symptoms of increased ICP or cranial nerve damage, seen in herniation associated with a deteriorating cerebellar hemorrhage. No information is given about abnormal BUN and creatinine levels, or that mannitol is being given for renal dysfunction. Rebound cerebral hypertension is an adverse and undesired complication from ongoing mannitol use.

A client is experiencing status asthmaticus. For which would the nurse anticipate an immediate order? a. inhaled Beta-2 adrenergic agonist b. inhaled corticosteroids c. I.V. beta-adrenergic agents d. oral corticosteroids

a. inhaled Beta-2 adrenergic agonist Explanation: Inhaled beta-adrenergic agonists agents are the first line of therapy in status asthmaticus, as they help promote bronchodilation, which improves oxygenation. I.V. beta-adrenergic agents can be used, but must be carefully monitored because of their systemic effects. They are typically used when the inhaled beta-adrenergic agents do not work. Inhaled and oral corticosteroids are slow-acting, and their use won't reduce hypoxia in the acute phase.

A child with diabetic ketoacidosis is being treated for a blood glucose level of 738 mg/dl (41.0 mmol/L). The nurse should anticipate an order for: a. normal saline with regular insulin. b. normal saline with ultralente insulin. c. 5% dextrose in water with NPH insulin. d. 5% dextrose in water with PZI insulin.

a. normal saline with regular insulin. Explanation: Short-acting regular insulin is the only insulin used for insulin infusions. Initially, normal saline is used until blood glucose levels are reduced, then a dextrose solution may be used to prevent hypoglycemia. Ultralente, NPH, and PZI insulins have a longer duration of action and shouldn't be used for continuous infusions.

A client who is receiving acetaminophen for osteoarthritis reports continuing pain. The healthcare provider prescribes celecoxib. What important information regarding this medication, should the nurse share with this client? a. report black and tarry stools to the health care provider b. use a stool softener or fiber laxative daily to prevent constipation c. if you miss a dose, take a double dose the next day d. don't take the medication with dairy products

a. report black and tarry stools to the health care provider Explanation: Black and tarry stools are a sign of gastrointestinal (GI) bleeding, and may necessitate a medication change. Dairy products can help reduce GI irritation. The celecoxib dose should never be doubled. Constipation isn't an adverse effect of this medication.

The family of a client in rehabilitation following heroin withdrawal asks a nurse why the client is receiving naltrexone. What is the nurse's best response? a. to help reverse withdrawal symptoms b. to keep the client sedated during withdrawal c. to take the place of detoxification with methadone d. to decrease the client's memory of the withdrawal experience

a. to help reverse withdrawal symptoms Explanation: Naltrexone is an opioid antagonist and helps the client stay drug free. Keeping the client sedated during withdrawal isn't the reason for giving this drug. The drug doesn't decrease the client's memory of the withdrawal experience, and isn't used in place of detoxification with methadone.

The nurse is caring for a client being treated for pedophilia. The client discloses that the dose of medroxyprogesterone is not helping to reduce sexual impulses. What is the nurse's mostappropriate response? a. "That is an off-label use for that medication." b. "I will review your lab results and medication dosage." c. "How are you tolerating that hormone therapy?" d. "Have you registered yet as a sex offender?

b. "I will review your lab results and medication dosage." Explanation: The nurse should reinforce that testosterone suppression can take from 3 to 10 months to realize symptom relief. It is important to understand serum levels as well as dosage before contacting the prescriber about a change in dosage. It is also helpful to learn how the client is tolerating the hormone, but this is not of primary importance. Hormone replacement therapy, as a treatment for this disorder, is not done universally. It is inappropriate to overreact about the disorder, or the provider's chosen treatment for this client.

Five days after running out of medication, a client taking clonazepam tells the nurse, "I know I shouldn't have just stopped the drug like that, but I'm OK." What is the nurse's most appropriate response? a. "Let's monitor you for problems, in case something else happens." b. "You could go through withdrawal symptoms for up to two weeks." c. "You have handled your anxiety, and now you know how to cope with stress." d. "If you're fine now, chances are you won't experience withdrawal symptoms."

b. "You could go through withdrawal symptoms for up to two weeks." Explanation: Withdrawal symptoms can appear after one or two weeks because the benzodiazepine has a long half-life. Looking for another problem unrelated to withdrawal isn't the nurse's best strategy. The act of discontinuing an antianxiety medication doesn't indicate that a client has learned to cope with stress. Every client taking medication needs to be monitored for withdrawal symptoms when the medication is abruptly stopped.

The nurse is checking the blood sugar level of a pregnant client who is at 33 weeks' gestation. This client has had type 1 diabetes since she was 12 years old. Which fasting glucose value would indicate to the nurse that this client's disease is controlled? a. 45 mg/dl (2.5 mmol/L) b. 85 mg/dl (4.7 mmol/L) c. 120 mg/dl (6.7 mmol/L) d. 136 mg/dl (7.6 mmol/L)

b. 85 mg/dl (4.7 mmol/L) Explanation: The recommended fasting blood sugar level in a pregnant client with diabetes is 60 to 90 mg/dl (3.3 to 5.0 mmol/L). A fasting blood sugar level of 45 mg/dl (2.5 mmol/L) is low, and may result in symptoms of hypoglycemia. A blood sugar level below 120 mg/dl (6.7 mmol/L) is a recommended one-hour postprandial value. A blood sugar level above 136 mg/dl (7.6 mmol/L) in a pregnant client indicates hyperglycemia.

A toddler taking penicillin for acute otitis media developed a maculopapular rash 24 hours ago after 3 days of therapy. The parents report no other abnormal symptoms. The nurse takes what initial action? a. Administer epinephrine intramuscularly. b. Assess chest sounds and oxygen saturation. c. Administer albuterol (salbutamol) nebulizer. d. Reassure the parents that this is a mild reaction.

b. Assess chest sounds and oxygen saturation. Explanation: It is relatively common for children to experience delayed hypersensitivity reactions to penicillin that are isolated to cutaneous eruptions. Often, it is safe for these children to receive penicillins in the future. However, the nurse must ensure this current reaction is not more serious than it appears. Because a toddler cannot adequately communicate symptoms, the nurse assesses the client's respiratory status to ensure there is no evidence of bronchoconstriction that could suggest anaphylaxis. Once a full assessment has been completed, the nurse can then request the appropriate treatments be initiated.

A 20-month-old toddler has been treated with permethrin for scabies. The toddler's parent asks, "Is this medication working? My child is still itching." Which response by the nurse is mostappropriate? a. Stop treatment because the drug isn't safe for children under age 2. b. Pruritus can be present for weeks after treatment. c. Apply the drug every day until the rash and itching disappear. d. Pruritus is common in children under age 5 treated with permethrin.

b. Pruritus can be present for weeks after treatment. Explanation: Pruritus may be present for weeks following treatment with permethrin. The drug is safe for use in infants as young as age 2 months. Treatment with permethrin can be safely repeated in 2 weeks. Pruritus is caused by secondary reactions of the mites.

A client with a subarachnoid hemorrhage is prescribed a 1,000 mg loading dose of I.V. phenytoin. What information is most important when administering this dose? a. Therapeutic drug levels should be maintained between 20 and 30 mg/ml. b. Rapid phenytoin administration can cause cardiac arrhythmias. c. Phenytoin should be mixed in dextrose in water before administration. d. Phenytoin should be administered through an I.V. catheter in the client's hand.

b. Rapid phenytoin administration can cause cardiac arrhythmias. Explanation: Intravenous phenytoin should not exceed 50 mg/min, as rapid administration can depress the myocardium, causing lethal dysrhythmias. Therapeutic drug levels range from 10 to 20 mg/ml. Phenytoin is only compatible with normal saline, not dextrose in water. Phenytoin is very irritating to the blood vessels, and may cause purple glove syndrome when administered I.V. into a hand.

A client, diagnosed with asthma, is experiencing an anaphylactic reaction to a medication. After administering initial emergency care, the nurse would a. administer beta-adrenergic blockers. b. administer bronchodilators. c. obtain serum electrolyte levels. d. have the client lie flat in the bed.

b. administer bronchodilators. Explanation: Bronchodilators will open the client's airway and improve oxygenation status. Beta-adrenergic blockers aren't indicated in the management of asthma because they may cause bronchospasm. Obtaining laboratory values wouldn't be done during an emergency, and having the client lie flat in bed could impede their ability to breathe.

One hour after receiving pyridostigmine bromide for myasthenia gravis, a client reports difficulty swallowing and excessive respiratory secretions. What medication would the nurse anticipate to reverse the effects of pyridostigmine bromide? a. additional pyridostigmine bromide b. atropine c. edrophonium d. acyclovir

b. atropine Explanation: These symptoms suggest cholinergic crisis or excessive acetylcholinesterase medication, typically appearing 45 to 60 minutes after the last dose of acetylcholinesterase inhibitor. Atropine, an anticholinergic drug, is used to antagonize acetylcholinesterase inhibitors. The other drugs are acetylcholinesterase inhibitors. Edrophonium is used for diagnosis, and pyridostigmine bromide is used to treat myasthenia gravis and would worsen these symptoms. Acyclovir is an antiviral and would not be used to treat these symptoms.

The nurse is teaching the family of a client with a psychiatric disorder about traditional antipsychotic drugs and their effect on symptoms. Which symptom would be most responsive to these types of drugs? a. apathy b. delusions c. social withdrawal d. attention impairment

b. delusions Explanation: Positive symptoms such as delusions, hallucinations, thought disorder, and disorganized speech respond to traditional antipsychotic drugs. The other options belong in a category of negative symptoms, including affective flattening, restricted thought and speech, apathy, anhedonia, asociality, and attention impairment. Negative symptoms are more responsive to the new atypical antipsychotics, such as clozapine, risperidone, and olanzapine.

Which instruction should the nurse give to a client with prostatitis who is receiving double strength co-trimoxazole? a. don't expect improvement of symptoms for 7 to 10 days b. drink six to eight glasses of fluid daily while taking this medication c. if a sore mouth or throat develops, take the medication with milk or an antacid d. use a sunscreen of at least SPF-15 with para-aminobenzoic acid (PABA)

b. drink six to eight glasses of fluid daily while taking this medication Explanation: Six to eight glasses of fluid daily are needed to prevent renal problems, such as crystalluria and stone formation. The symptoms should improve in a few days if the drug is effective. Sore throat and sore mouth are adverse effects that should be reported right away. The drug causes photosensitivity, but a PABA-free sunscreen should be used because PABA can interfere with the drug's action.

Which antiparkinsonian drug can cause drug tolerance or toxicity if taken for too long? a. amantadine b. levodopa-carbidopa c. pergolide d. selegiline

b. levodopa-carbidopa Explanation: Long-term therapy with levodopa-carbidopa can result in drug tolerance or toxicity manifested by confusion, hallucinations, or decreased drug effectiveness. The other drugs listed don't require the client to take a drug holiday.

A client with joint pain, tenderness and swelling has been admitted to the hospital. A disease modifying anti-rheumatic drug (DMARD) is prescribed by the healthcare provider. Which medication should the nurse expect to administer? a. aspirin b. methotrexate c. ferrous sulfate d. prednisone

b. methotrexate Explanation: Methotrexate is considered a first-line DMARD for most clients with rheumatoid arthritis (RA). NSAIDs, such as aspirin, cannot be tolerated. Ferrous sulfate is not used to treat RA. Prednisone may be used to control inflammation when NSAIDs cannot be used.

The nurse makes initial rounds for the clients. Five medications are scheduled for administration at the same time to five different clients. Which medication should the nurse administer first after initial rounds? a. a maintenance dose of digoxin to the client with congestive heart failure b. morphine sulfate to a client with a myocardial infarction reporting chest pain c. naproxen to the client with rheumatoid arthritis d. ondansetron to a diabetic client reporting nausea

b. morphine sulfate to a client with a myocardial infarction reporting chest pain Explanation: Morphine sulfate relieves pain which immediately decreases myocardial oxygen demand and decreases preload and afterload pressure. The digoxin is a maintenance dose and does not elicit an immediate reaction. Though administration of naproxen and ondansetron are next in the order of urgency, they are not the priority.

A client is newly prescribed ramipril. What information should the nurse provide the client about taking this medication at home? a. "Monitor your blood pressure, and do not take the medication if your blood pressure is under 100/60 mmHg." b. "This medication can affect your heart rate. Do not take it if your pulse is under 60 beats per minute." c. "Change positions slowly, and notify your healthcare provider if dizziness becomes problematic." d. "If you feel lightheaded while taking this medication, notify your healthcare provider immediately."

c. "Change positions slowly, and notify your healthcare provider if dizziness becomes problematic." Explanation: The nurse should only advise the client to take reasonable actions related to medication management. When first starting on an angiotensin-converting enzyme inhibitor (ACE-I), orthostatic hypotension is an expected side effect that will diminish as the client adjusts to the dose. The nurse should not advise the client to hold the medication if blood pressure is under a certain value unless this was specifically prescribed by the healthcare provider. This advice could result in the client skipping doses unnecessarily. ACE-Is do not lower heart rate. The nurse should also not advise the client to notify the healthcare provider immediately for an expected side effect (e.g., lightheadedness) but does tell the client what to expect, how to reduce this symptom (e.g., changing positions slowly), and what to do if the symptom is problematic.

What is the most important information for the nurse to include when teaching a client about metronidazole? a. Breathlessness and cough are common adverse effects. b. Urine may develop a greenish tinge while the client is taking this drug. c. Mixing this drug with alcohol causes severe nausea and vomiting. d. Heart palpitations may occur and should be immediately reported.

c. Mixing this drug with alcohol causes severe nausea and vomiting. Explanation: When mixed with alcohol, metronidazole causes a disulfiram-like effect involving nausea, vomiting, and other unpleasant symptoms. Urine may turn reddish brown, not greenish, from the drug. Cardiovascular or respiratory effects are not associated with this drug.

The nurse is instructing a client who will be discharged on anticoagulant therapy. What is the most important instruction for this nurse to include? a. Do not shave with an electric razor. b. Take ibuprofen or aspirin for pain. c. Take the anticoagulant at the same time each day. d. Eat green, leafy vegetables and salad daily.

c. Take the anticoagulant at the same time each day. Explanation: It is important to take the anticoagulant at the same time each day to maintain an adequate blood level. An electric razor reduces the risk of cutting the skin. Avoid the use of standard razors. Avoid taking aspirin or ibuprofen because these drugs decrease clotting time. Eating a large amount of green, leafy vegetables that contain vitamin K will increase clotting time, thus requiring more anticoagulants.

The nurse is caring for a client prescribed a tocolytic agent. The nurse takes immediate action based on what assessment finding? a. blood glucose of 170 mg/dL (9.4 mmol/L) b. maternal heart rate of 114 beats/min c. bilateral crackles on lung auscultation d. peripheral pulse strength of +2

c. bilateral crackles on lung auscultation Explanation: Tocolytics are used to stop labor contractions. The most common adverse effect associated with the use of these drugs is pulmonary edema. Bilateral crackles on lung auscultation is a sign of pulmonary edema, and prompt action would be required. A serum glucose level of 170 mg/dL (9.4 mmol/L) is elevated and should be reported, but it is not life-threatening. Tocolytics may cause tachycardia and increased cardiac output with bounding arterial pulsations. A peripheral pulse strength of +2 indicates a slightly lower than normal level that is not an immediate cause for concern.

A client diagnosed with uncomplicated rheumatoid arthritis is receiving naproxen. Which medication would require further intervention by the nurse prior to administration? a. cimetidine b. gabapentin c. dabigatran d. etanercept

c. dabigatran Explanation: Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) used for clients with rheumatoid arthritis. NSAIDs are aspirin and aspirin-like medications that may increase the risk of bleeding when taken with an anticoagulant like dabigatran. Histamine H2 receptor antagonist drug used for peptic ulcer disease such as cimetidine, anticonvulsant drug gabapentin, and a tumor necrosis factor (TNF) blocker like etanercept will not cause serious drug interaction when taken with naproxen.

A client is prescribed a tricyclic antidepressant after other medications were ineffective. The nurse assesses for what outcome as evidence the new medication has been effective? a. reduction in purposeless movements b. decreased daytime sleepiness c. improved cognitive functioning d. moderate weight gain

c. improved cognitive functioning Explanation: Tricyclic antidepressants (TCAs) are not recommended as first-line treatment for depression, because they carry more side effects than other classes such as selective serotonin reuptake inhibitors (SSRIs). If treatment with an SSRI is ineffective, the client may take a TCA to improve the symptoms of depression, such as increased energy level and interest in enjoyable activities, improved memory and cognitive functioning, and improved sleep. Weight gain is a side effect of TCAs but is not an indication of improvement of depressive symptoms. Drowsiness is also a side effect, so it is possible daytime sleepiness will increase, not decrease. Purposeless movements are not a symptom of depression.

A laboring client in the latent stage of labor begins reporting pain in the epigastric area, blurred vision, and a headache. Which medication would the nurse anticipate for these symptoms? a. terbutaline b. oxytocin c. magnesium sulfate d. calcium gluconate

c. magnesium sulfate Explanation: Magnesium sulfate is the drug of choice to treat hypertension of pregnancy because it reduces edema by causing a shift from the extracellular spaces into the intestines. It also depresses the central nervous system, which decreases the incidence of seizures. Terbutaline is a smooth muscle relaxant used to relax the uterus. Oxytocin is the synthetic form of the pituitary hormone used to stimulate uterine contractions. Calcium gluconate is the antagonist for magnesium toxicity.

The nurse reviews information about how to take the prescribed tetracycline. Which statement by the client allows the nurse to determine that the client understands the information? a. "I can take tetracycline with or without meals." b. "I can take tetracycline with milk and milk products." c. "I can take tetracycline on an empty stomach with small amounts of water." d. "I can take tetracycline 1 hour before or 2 hours after meals with plenty of water."

d. "I can take tetracycline 1 hour before or 2 hours after meals with plenty of water." Explanation: Tetracycline must be taken on an empty stomach to increase absorption, and with ample water to avoid esophageal irritation. Milk products impede absorption.

A client is receiving spironolactone to treat hypertension. Which instruction should the nurse provide? a. eat foods high in potassium b. take daily potassium supplements c. discontinue sodium restrictions d. avoid salt substitutes

d. avoid salt substitutes Explanation: Because spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content. The client should also avoid potassium-rich foods and potassium supplements. To reduce fluid volume overload, sodium restrictions should continue.

Which assessment finding is expected in a client receiving bicalutamide and leuprolide for advanced prostate cancer? a. abdominal distention b. acromegaly c. colicky pain d. hot flashes

d. hot flashes Explanation: Bicalutamide, a nonsteroidal antiandrogen, and leuprolide, a gonadotropin-releasing hormone agonist, decrease the production of testosterone. This helps decrease the production of cancer cells involved in prostate cancer. Because androgens are responsible for the development of male genitalia and secondary male sex characteristics, low androgen levels can cause genital atrophy, breast enlargement, and hot flashes. Abdominal distention, acromegaly, and colicky pain aren't caused by bicalutamide and leuprolide therapy.

The nurse is providing discharge instructions for a client who is receiving chemotherapeutic medications. Which intervention is most important to prevent hemorrhagic cystitis? a. administering antacids b. administering antibiotics c. increasing calcium intake d. increasing fluid intake

d. increasing fluid intake Explanation: Sterile hemorrhagic cystitis is an adverse effect of chemical irritation of the bladder from cyclophosphamide. It can be prevented by liberal fluid intake (at least one-and-a-half times the recommended daily fluid requirement). Antibiotics do not aid in the prevention of sterile hemorrhagic cystitis. Increasing calcium intake does not alter the risk of developing cystitis. Antacids would not be indicated for treatment.

The nurse is preparing discharge instructions for a client with bipolar disorder who has been prescribed lithium. Which information is most important for the nurse to provide to this client? Select all that apply. - the potential for addiction - the signs and symptoms of drug toxicity - the risk for tardive dyskinesia - the restrictions of a low-tyramine diet - the need to consistently monitor blood levels - the expected time frame for improvements in mood

- the signs and symptoms of drug toxicity - the need to consistently monitor blood levels - the expected time frame for improvements in mood Explanation: Client education should cover the signs and symptoms of drug toxicity, as well as the need to report them to the healthcare provider. The importance of monitoring lithium levels on a regular basis to avoid toxicity should be included. The nurse should explain that seven to 21 days may pass before a change in mood is noticed. Lithium does not have addictive properties. Tardive dyskinesia is not associated with lithium. Tyramines in the diet are a potential concern for clients taking monoamine oxidase inhibitors.

An unemployed client without health insurance has not filled their prescription. Which assessment finding indicates that this client is not taking their levothyroxine as prescribed? a. diarrhea b. rapid heart rate c. warm, dry, flushed skin d. temperature of 94° F (34.4° C)

d. temperature of 94° F (34.4° C) Explanation: Levothyroxine is prescribed for hypothyroidism, which causes a hypodynamic state. Failure to maintain levothyroxine therapy can lead to a low body temperature as well as slowing all metabolic processes. The other assessments indicate a hypermetabolic state, which could be symptomatic of an increase in thyroid hormones

A nurse is teaching a parent how to administer amoxicillin to the 5-year-old son. The child cannot swallow pills. The child weighs 20.6 lb (9.36 kg). The order is for 80 mg/kg/day given in two doses every 12 hours. The medication comes prepared as 250 mg/5 ml. How many teaspoons should the nurse instruct the parent to give with each dose? Record your answer using one decimal place.

1.5 Explanation: Here are the calculations: 80 mg/(kg/day) x 9.36 kg = 748.8 mg/day 748.8 mg/day ÷ 2 doses/day = 374.4 mg/dose. Round to 374 mg/dose. (250 mg)/(5 ml) = 50 mg/ml 374 mg/dose ÷ 50 mg/ml = 7.48 ml/dose Round to 7.5 ml/dose. 5 ml = 1 tsp (7.5 ml/dose ÷ 5 ml/tsp) = 1.5 tsp/dose

A client calls the clinic worried about experiencing new symptoms after taking antipsychotic medicine. The client reports persistent, uncontrollable restlessness of the limbs and head despite improvement in psychotic symptoms. What is the most appropriate intervention by the nurse? a. Inform the client to ignore these symptoms because they will go away. b. Advise the client to experiment with different dosages to see how that feels. c. Tell the client to go to the emergency room if blurred vision or fever develops. d. Direct the client to see the provider for medication to address these side effects.

Explanation: Symptoms of tardive dyskinesia include tongue protrusion, lip smacking, chewing, blinking, grimacing, choreiform movements of limbs and trunk, and foot tapping. Primary prevention of tardive dyskinesia is achieved by using the lowest effective dose of a neuroleptic for the shortest time. However, with diseases of chronic psychosis such as schizophrenia, this strategy must be balanced with the fact that increased dosages are more beneficial in preventing recurrence of psychosis. If tardive dyskinesia is diagnosed, the causative drug should be discontinued. Blurred vision is a common adverse reaction of antipsychotic drugs and usually disappears after a few weeks of therapy. Restlessness is associated with akathisia. Sudden fever is a symptom of a malignant neurological disorder. The prescribing provider will make appropriate changes to meet the client's need. Clients should not ignore such symptoms, or adjust their own medication dosage.

Which physical assessment data would alert the nurse to a possible mild toxic reaction in a client receiving lithium? a. vomiting and diarrhea b. hypotension c. seizures d. increased appetite

a. vomiting and diarrhea Explanation: Vomiting and diarrhea are signs of mild to moderate lithium toxicity. Hypotension and seizures occur with moderate to severe toxic reactions. Anorexia occurs with mild toxic reactions.

A 24-year old female client with active tuberculosis is receiving rifampin 600 mg daily. Which should this client avoid because of the significant interaction with rifampin? a. gingko biloba b. pancreatic enzymes c. oral contraceptives d. arthritis medications

c. oral contraceptives Explanation: Oral contraceptives may have decreased effectiveness while taking rifampin, and may also cause breakthrough bleeding, spotting or pregnancy. Pancreatic enzymes and arthritis medications and supplements do not interfere with rifampin or cause adverse effects.

The laboratory has just notified the nurse that a client on the unit has a phenytoin level of 32 mg/dl. Which symptoms should the nurse anticipate from this client? a. ataxia and confusion b. sodium depletion c. tonic-clonic seizure d. urinary incontinence

a. ataxia and confusion Explanation: A level of 32 mg/dl indicates phenytoin toxicity. Symptoms of toxicity include confusion and ataxia. Phenytoin doesn't cause hyponatremia, seizure, or urinary incontinence. Incontinence may occur during or after a seizure.

The nurse understands that certain medications protect the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation. Which class of medications serve this function? a. beta-adrenergic blockers b. calcium channel blockers c. opioids d. nitrates

a. beta-adrenergic blockers Explanation: The nurse understands that certain medications protect the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation. Which class of medications serve this function?

The nurse is preparing to administer 0800 medications. Which prescribed medication(s) will the nurse expect to retrieve from the computerized automated dispensing cabinet? Select all that apply. - morphine extended-release tablet 15 mg by mouth at 0800 - lorazepam 2 mg by mouth at 0800 - lisinopril 10 mg by mouth at 0800 - furosemide 20 mg I.V. at 0800 - metoprolol 25 mg by mouth at 0800

- morphine extended-release tablet 15 mg by mouth at 0800 - lorazepam 2 mg by mouth at 0800 Explanation: Morphine extended-release tablets and lorazepam are controlled substances. It is required by federal law that controlled substances are stored in locked drawers for safety and that a record must be kept for each controlled substance administered. Many facilities utilize computerized automated dispensing cabinets to record the name of the client receiving the controlled substance, the amount of the controlled substance given, the prescribing healthcare provider, and the name of the nurse administering the medication. Lisinopril, furosemide, and metoprolol are not controlled substances and therefore do not require storage in a computerized automated dispensing cabinet.

A client with new-onset seizures of unknown cause is started on phenytoin. The healthcare provider has ordered a loading dose of 15 mg/kg I.V. to be given at a rate of 40 mg/min. What is the loading dose in milligrams if the client weighs 176 lb (80 kg)? Record your answer using a whole number.

1200 Explanation: 15 mg/kg x 80 kg=1,200 mg.

The health care provider has prescribed salicylates for an older adult client with osteoarthritis to relieve pain. The nurse knows to assess the client for what potential adverse reaction? a. hearing loss b. increased pain in joints c. decreased calcium absorption d. increased bone demineralization

a. hearing loss Explanation: Many older adults already have diminished hearing, and salicylate use can lead to further or total hearing loss. Salicylates do not increase pain in joints, decrease calcium absorption, or increase bone demineralization.

Which medication would the nurse anticipate as the provider's treatment of choice for scarlet fever? a. acyclovir b. amphotericin B c. prednisone d. penicillin

d. penicillin Explanation: The causative agent of scarlet fever is Group A beta-hemolytic streptococci, which is susceptible to penicillin. Erythromycin is used for penicillin-sensitive children. Anti-inflammatory drugs, such as prednisone, are not indicated for these clients. Acyclovir is used in the treatment of herpes infections. Amphotericin B is used to treat fungal infections.

The nurse is providing discharge teaching for a client who will be taking lithium. Which condition would necessitate a call to the client's healthcare provider? a. development of black tongue b. increased lacrimation c. periods of excitability d. persistent gastrointestinal upset

d. persistent gastrointestinal upset Explanation: Persistent gastrointestinal upset indicates a mild-to-moderate toxic reaction to lithium. Black tongue is an adverse reaction of mirtazapine, not lithium. Increased lacrimation and periods of excitability aren't adverse effects of lithium.

The nurse is caring for a newborn with unrepaired transposition of the great vessels. Which medication should the nurse anticipate giving first for treatment of this defect? a. digoxin b. furosemide c. enalapril d. prostaglandin E1

d. prostaglandin E1 Explanation: Prostaglandin E1 is necessary to maintain patency of the patent ductus arteriosus, and improve systemic arterial flow in children with inadequate intracardiac mixing. Digoxin, furosemide, and enalapril will treat heart failure when present.

A client with acute pulmonary edema has been taking an angiotensin-converting enzyme (ACE) inhibitor. The nurse explains that this medication has been ordered to a. promote diuresis. b. increase cardiac output. c. decrease contractility. d. reduce blood pressure.

d. reduce blood pressure. Explanation: ACE inhibitors are given to reduce blood pressure by inhibiting aldosterone production, which in turn decreases sodium and water reabsorption. ACE inhibitors also reduce production of angiotensin II, a potent vasoconstrictor. Diuretics are given to increase urine production. Vasodilators increase cardiac output. Negative inotropic agents decrease contractility.

A client has been receiving oxytocin to augment her labor. The nurse notes that contractions are lasting 100 seconds. Which immediate action should the nurse take? a. Stop the oxytocin infusion. b. Notify the provider. c. Monitor fetal heart tones as usual. d. Turn the client on her left side.

a. Stop the oxytocin infusion. Explanation: Oxytocin should be withheld immediately, as it stimulates contractions. A contraction that continues for more than 90 seconds signals tetany and could lead to decreased placental perfusion and possibly uterine rupture. The nurse should monitor the fetal heart tones, stop the oxytocin, and notify the provider. The client should be turned on her left side to increase blood flow to the fetus, which can be decreased with tetany. This decreased blood flow can potentially compromise the fetus.

The nurse is preparing to administer I.V. insulin to a client diagnosed with diabetic ketoacidosis (DKA). What will the nurse monitor while the client is receiving this intervention? a. hypokalemia and hypoglycemia b. hypocalcemia and hyperkalemia c. hyperkalemia and hyperglycemia d. hypernatremia and hypercalcemia

a. hypokalemia and hypoglycemia Explanation: The nurse should monitor for decreased potassium and decreased glucose. Hypoglycemia might occur if too much insulin is administered, or insulin is administered too quickly. Intravenous insulin forces potassium into cells, thereby lowering plasma levels of potassium. The client may have hyperkalemia prior to starting the insulin therapy, but hypokalemia will occur with insulin administration. Calcium and sodium levels should not be affected.

A client has been prescribed neomycin and polymyxin B sulfates and hydrocortisone otic suspension, two drops in the right ear. What action is most important for the nurse take when instilling the medication? a. Verify the proper client and route. b. Warm the solution to prevent dizziness. c. Hold an emesis basin under the client's ear. d. Position the client in the semi-Fowler's position.

a. Verify the proper client and route. Explanation: When giving medications, a nurse should follow the "rights" of medication administration, which include verification of right client and right route. The drops may be warmed to prevent pain or dizziness, but this action isn't essential. An emesis basin would be used for irrigation of the ear. The client should be placed in the lateral position for five minutes, not semi-Fowler's position, to prevent the drops from draining.

The serum calcium level remains low in a client with hypoparathyroidism despite taking calcium supplements. What should the nurse ask the client related to these findings? a. "Have you been taking vitamin D along with your calcium supplements?" b. "Have you been taking your levothyroxine as prescribed in addition to calcium?" c. "Are you eating a diet that contains calcium-rich foods such as dairy products?" d. "Are you prescribed a thiazide diuretic along with the calcium supplements?"

a. "Have you been taking vitamin D along with your calcium supplements?" Explanation: A client with hypoparathyroidism has a decreased serum calcium level. Vitamin D enhances the absorption of calcium from the gastrointestinal tract and is the most important factor in improving the client's response to the calcium supplements. Even if the client increased dietary intake of calcium, without adequate vitamin D, this calcium would also be poorly absorbed. Thiazide diuretic therapy is linked to hypercalcemia, not hypocalcemia. Levothyroxine is given to treat hypothyroidism, not hypoparathyroidism.

A client is taking fluphenazine. The nurse understands that teaching and discharge instructions are understood when the client states: a. "I need to stay out of the sun." b. "I need to double my fluids." c. "I can't eat cheese or eggs." d. "I need to plan frequent naps."

a. "I need to stay out of the sun." Explanation: Fluphenazine is an antipsychotic drug that can cause photosensitivity and sunburn. Clients taking this drug don't need to increase fluid intake, avoid cheese or eggs, or plan rest periods.

Which client would be most at risk for secondary Parkinson's disease caused by pharmacotherapy? a. 30-year-old client with schizophrenia who is taking chlorpromazine b. 50-year-old client taking nitroglycerin tablets for angina c. 60-year-old client who is taking prednisone for chronic obstructive pulmonary disease d. 75-year-old client using naproxen for rheumatoid arthritis

a. 30-year-old client with schizophrenia who is taking chlorpromazine Explanation: Phenothiazines such as chlorpromazine deplete dopamine, which may lead to extrapyramidal effects. The other drugs don't place the client at a greater risk for developing Parkinson's disease.

The nurse is planning discharge teaching for a client who will continue taking the prescribed warfarin at home. What early symptoms of occult blood loss should the nurse teach the client? a. Increasing fatigue and shortness of breath. b. Decrease in blood pressure. c. Decreased hemoglobin level. d. Decreased urine output and lightheadedness.

a. Increasing fatigue and shortness of breath. Explanation: Warfarin is an anticoagulant, so the priority teaching would include watching for signs of hemorrhage that can be occult (not visible). Early symptoms the nurse should focus on are ones the client will feel rather than signs that need to be measured by a laboratory such as hemoglobin levels. The earlier signs related to the reduction in oxygen carrying capacity include a feeling of fatigue and dyspnea. Later signs (not symptoms) include a drop in blood pressure (manifested by the symptom of lightheadedness) and decreased urine output which will only be obvious to the client once renal perfusion is significantly affected.

The nurse is caring for a client receiving digoxin. Which symptoms would the nurse anticipate with a digoxin level of 2.3 ng/dl (0.08 nmol/l)? Select all that apply. - nausea - drowsiness - photophobia - increased appetite - increased energy level - seeing halos around bright objects

- nausea - drowsiness - photophobia - seeing halos around bright objects Explanation: Digoxin is a cardiac glycoside used to manage and treat heart failure, control ventricular rate in clients with atrial fibrillation, and treat and prevent recurrent paroxysmal atrial tachycardia. The therapeutic range of digoxin is 0.8 to 2.0 ng/dl (0.03 to 0.07 nmol/l). Signs of toxicity include gastrointestinal disturbances, neurological abnormalities, facial pain, personality changes, and ocular disturbances such as photophobia.

A nurse is preparing a dose of amoxicillin for a 3-year-old with acute otitis media. The child weighs 33 lb (15 kg). The dosage prescribed is 50 mg/kg/day in divided doses every 8 hours. The concentration of the drug is 250 mg/5 ml. How many milliliters should the nurse administer? Record your answer using a whole number.

5 Explanation: To calculate the child's weight in kilograms, the nurse should use the following formula: 1 kg/2.2 lb = X k /33 lb X = 33/2.2 kg = 15 kg. Next, the nurse should calculate the daily dosage for the child: 50 mg/kg/day x 15 kg = 750 mg/day The medication is divided into 3 daily doses: 750 mg/day ÷ 3 doses/day = 250 mg. The drug's concentration is 250 mg/5 ml, so the nurse should administer 5 ml.

The nurse is teaching the parents of a child with growth hormone deficiency how to administer growth hormone to their child. At what time should the nurse suggest administration of this medication? a. at bedtime b. after dinner c. in the middle of the day d. first thing in the morning

a. at bedtime Explanation: Optimal therapeutic effect is typically achieved when the prescribed growth hormone is administered at bedtime. Pituitary release of growth hormone occurs during the first 45 to 90 minutes after the onset of sleep, so normal physiological release is mimicked with bedtime dosing.

The home health nurse is visiting a client newly diagnosed with type 1 diabetes mellitus. The client reports nausea and abdominal pain. The nurse observes dehydration and dry skin. What question should the nurse ask the client? a. "What did you drink today?" b. "Are you taking your insulin daily?" c. "When is the last time you had a checkup?" d. "Did you weigh yourself today?"

b. "Are you taking your insulin daily?" Explanation: The nurse should ask if the client is taking their insulin, as a common cause of DKA is missed insulin. Classic symptoms of diabetic ketoacidosis (DKA) include polyuria, weight loss, nausea and vomiting, altered mental status, abdominal pain, and Kussmaul respirations. The nurse should also check a blood glucose level. Asking the client what they drank, if they weighed themselves, and when they had a check-up will not help identify the cause of the current symptoms.

A 2-year-old child has tested positive for tuberculosis (TB), and has been started on rifampin. The child's parents ask the nurse if there is any important information they should know about this medication. What important adverse effect should the nurse inform these parents about? a. hyperactivity b. orange body secretions c. decreased bilirubin levels d. decreased liver enzyme levels

b. orange body secretions Explanation: Rifampin and its metabolites will turn urine, feces, sputum, tears, and sweat an orange color. This is not a serious adverse effect. Rifampin may also cause GI upset, headache, drowsiness, dizziness, visual disturbances, and fever. Liver enzyme and bilirubin levels increase because of hepatic metabolism of the drug. Parents should be taught the signs and symptoms of hepatitis and hyperbilirubinemia such as jaundice of the sclera or skin.

A client with a history of schizophrenia presents to the emergency department accompanied by police officers after assaulting a neighbor. The client is agitated and combative and cannot be reoriented. What prescribed medication should the nurse prioritize administering to the client? a. diphenhydramine b. paroxetine c. haloperidol d. fluoxetine

c. haloperidol Explanation: Haloperidol is the drug of choice to treat symptoms of acute psychosis. Diphenhydramine may be indicated in conjunction with other medications for its sedating effect, but is not a primary drug of choice. Paroxetine and fluoxetine are antidepressant medications and not indicated to treat acute psychosis.

Which nifedipine-related side effect should the nurse be most concerned with when caring for a new stroke admission? a. dehydration b. hypocarbia c. hypotension d. weakness

c. hypotension Explanation: Nifedipine is a calcium channel blocker used to lower blood pressure. It is avoided in acute stroke due to the potential of hypotension. Hypotension in acute ischemic stroke reduces brain perfusion and is associated with poor stroke outcomes. Treatment for an acute stroke includes permissive hypertension. Hypocarbia, dehydration, and weakness are not common side effects of nifedipine.

A client with sickle cell disease is discussing his therapeutic regimen. Which statement by the client indicates further teaching is needed? a. "I should avoid vacationing or traveling in areas of high altitude." b. "Cigarette smoking can cause a sickle cell crisis." c. "I should drink 4 to 6 L of fluid each day." d. "I should take one baby aspirin daily to help prevent sickle cell crisis."

d. "I should take one baby aspirin daily to help prevent sickle cell crisis." Explanation: Aspirin inhibits platelet aggregation and won't help prevent sickle cell crisis. Hydroxyurea is prescribed for some people to help prevent sickle cell crisis. High altitude increases oxygen demand and therefore can also precipitate a crisis. Tobacco, alcohol, and dehydration can precipitate a sickle cell crisis and should be avoided.

The nurse is teaching a client with iron-deficiency anemia about ferrous gluconate therapy. Which statement, if made by the client, would indicate a correct understanding of the teaching? a. "I will take the medication with an antacid." b. "I will take the medication with a glass of milk." c. "I will take the medication with whole-grain cereal." d. "I will take the medication on an empty stomach with orange juice."

d. "I will take the medication on an empty stomach with orange juice." Explanation: Preferably, ferrous gluconate should be taken on an empty stomach with orange juice. Ferrous gluconate shouldn't be taken with antacids, milk, or whole-grain cereals because these foods reduce iron absorption.

A client with suspected myasthenia gravis is to undergo a test with edrophonium. The client asks if edrophonium can be used to treat myasthenia gravis. What is the nurse's best response? a. It isn't available in an oral form. b. With repeated edrophonium use, immunosuppression may occur. c. Dry mouth and abdominal cramps may be intolerable adverse effects. d. The short half-life of edrophonium makes it impractical for long-term use.

d. The short half-life of edrophonium makes it impractical for long-term use. Explanation: Edrophonium is not available in an oral form and the duration of action is 1 to 2 minutes, making it impractical for the long-term management of myasthenia gravis. Immunosuppression with repeated use is an adverse effect of steroid administration. Dry mouth and abdominal cramps are adverse effects of increased acetylcholine in the parasympathetic nervous system.

A client with type 2 diabetes mellitus is prescribed capsaicin cream 0.075%. Which instruction should the nurse include in a teaching plan for this medication? a. "Apply this cream daily to prevent dry skin." b. "Apply this cream to open sores to prevent infection." c. "Apply this cream to necrotic areas of ulcers to aid in debridement." d. "Apply this cream four times daily to decrease neuropathic pain sensations."

d. "Apply this cream four times daily to decrease neuropathic pain sensations." Explanation: This drug reduces amounts of substance P, which is involved in pain transmission. The nurse should teach the client to apply the cream four times daily for several weeks to help manage the pain of peripheral diabetic neuropathy. The cream does not prevent dry skin, debride, or prevent infection.