(PrepU) Pharmacology: Nursing Concepts

After teaching the parents of a child with central precocious puberty about medication therapy, which statement by the parents indicates successful teaching?

"Our child will start puberty again when the medication stops." Treatment for central precocious puberty involves administering a gonadotropin-releasing hormone (GnRH) analog. When it is stopped, puberty resumes according to the appropriate developmental stages. This analog can be given by depot injection every 3 to 4 weeks, a daily subcutaneous injection, or an intranasal spray two or three times per day. With GnRH analog treatment, secondary sexual development stabilizes or regresses. Surgery is indicated only if there is a tumor. The goal of the medication is to delay the progression of puberty and not to reverse it.

A physician orders an infusion of 2,400 ml of I.V. fluid over 24 hours, with half this amount to be infused over the first 10 hours. During the first 10 hours, a client should receive how many milliliters of I.V. fluid per hour?

120 ml/hour First, the nurse determines how many milliliters (half of the total) to administer over the first 10 hours: 2,400 ml ÷ 2 = 1,200 ml. Then the nurse determines how many of these milliliters to deliver per hour: 1,200 ml ÷ 10 hours = 120 ml/hour.

A client with a feeding tube is to receive medication. The medication supplied is an enteric-coated tablet. Which of the following would be most appropriate?

Check with the pharmacist to see of a liquid form is available. Enteric-coated tablets due to their formulation cannot be crushed. Rather the nurse would need to contact the pharmacist to see if there is a liquid form available. Some time-released tablet forms can be opened but cannot be crushed because doing so may release too much of the drug too quickly Giving the tablet as is in its original form would be inappropriate because it would not pass through the tube, thus not reaching its intended site for absorption.

A client with kidney failure has been admitted to the hospital for severe anemia. The client has refused a blood transfusion. The nurse anticipates administering which drug to stimulate the production of red blood cells?

Erythropoietin (EPO) The genes for most hematopoietic growth factors have been cloned and their recombinant proteins have been generated for use in a wide range of clinical problems. EPO is used to treat the anemia of kidney failure and cancer, hematopoietic neoplasms, infectious diseases, and congenital and myeloproliferative disorders.

A client with fibrocystic breast disease has been receiving treatment with danazol (Danocrine) therapy for the past 6 months. In anticipation of the drug being discontinued, the nurse instructs the client to inform the health care provider about which of the following?

Lack of return of regular menses within 90 days after discontinuing the drug. The nurse should tell the client to inform the healthcare provider if regular menses do not resume within 90 days after discontinuing the drug. Nausea, constipation, and sleep are not associated with danazol or its discontinuation.

Which drug has been effective in treating aggressive clients diagnosed with bipolar disorders?

Lithium Lithium, an antimanic medication, has been effective in treating aggressive clients with bipolar disorder.

A nurse is reviewing the medication history of a client. The nurse understands that a PDE5 inhibitor would be inappropriate for a client taking:

Nitroglycerin The PDE5 inhibitors cannot be taken in combination with any organic nitrates or alpha-adrenergic blockers because serious cardiovascular effects may occur, including death. Increased PDE5 inhibitor levels and effects may be seen with ketoconazole, indinavir, and erythromycin; the dosage of the inhibitor would need to be reduced.

Upon admission, a client tells the nurse that he takes aspirin every 4 hours every day. The nurse determines that this client is at risk for:

Peptic ulcer Peptic ulcers occur in the areas of the upper gastrointestinal tract and are caused by Helicobacter pylori infection and aspirin or nonsteroidal anti-inflammatory drug use. Therefore, the nurse determines that a client taking aspirin every 4 hours daily is at risk for a peptic ulcer.

A nurse is caring for a client who recently received GPIIb/IIIa inhibitors and is concerned that the client has developed thrombocytopenia as demonstrated by:

Platelet count less than 50,000/μL Thrombocytopenia is defined as a platelet count below the normal level of 150,000/μL and the GPIIb/IIIa medications are indicated in causing acute and delayed thrombocytopenia.

The nurse is caring for a client who has been diagnosed with Meniere disease. The nurse expects which medication will be prescribed to manage the symptoms?

Promethazine Pharmacologic management includes suppressant drugs such as promethazine. The other medications are not used to treat Meniere disease.

The client visits the health care provider reporting a red, swollen, and painful right great toe and is subsequently diagnosed with gouty arthritis. Which drug does the nurse anticipate the healthcare provider to order?

allopurinol Allopurinol is used to manage and prevent gout attacks and is also used for the treatment of calcium oxalate kidney stones. Phenytoin is used to treat and prevent seizures. Zaroxolyn is used to treat blood pressure and edema. Furosemide treats fluid retention and swelling caused by congestive heart failure, liver disease, and kidney disease.

What is the major clinical use of dobutamine?

increase cardiac output. Dobutamine (Dobutrex) increases cardiac output for clients with acute heart failure and those undergoing cardiopulmonary bypass surgery. Physicians may use epinephrine hydrochloride, another catecholamine agent, to treat sinus bradycardia. Physicians use many of the catecholamine agents, including epinephrine, isoproterenol, and norepinephrine, to treat acute hypotension. They don't use catecholamine agents to treat hypertension because catecholamine agents may raise blood pressure.

The client was diagnosed with hypertension 7 years ago. In the last 6 months, after diet and exercise, the client's blood pressure has consistently ranged around 160/95. What should the nurse include in the client's teaching about the side effects of clonidine? Select all that apply.

"Clonidine may cause low blood pressure when you stand up." "Clonidine may cause fatigue." "Clonidine may cause dry mouth." The nurse should explain that side effects of clonidine include orthostatic hypotension, drowsiness, peripheral edema, fatigue, urinary retention, dry mouth, and constipation. Hematuria and arthralgia are not side effects of clonidine.

The pediatric nurse is preparing to administer ibuprofen to an 8-month-old infant. The infant's weight is listed in the computer as 15 kg (33 lb) and the medication is prescribed to be given 10 mg/kg. The nurse notices that the dose of 150 mg seems high for an infant. The nurse clarifies the prescription with the healthcare provider, who states that it is the correct dose. What should the nurse do?

Verify child's weight is accurate and, if it is correct, give the medication. Pediatric medication dosages are weight-based. In this scenario, the nurse has already verified the prescription is correct with the healthcare provider, and 10 mg/kg is a safe and standard dose for ibuprofen in pediatric clients. The nurse should verify the child's weight is accurate, because 15 kg (33 lb) for an 8-month-old infant is higher than the 99th percentile and, if it is accurate, the medication should be given as prescribed. The nurse should not just give the medication just because the healthcare provider said it is correct and should not notify a superior unless there is clearly an unsafe situation that cannot be resolved otherwise. The nurse should document the interaction but the priority is verifying the weight and accuracy of the prescription.

A nurse is to administer several drugs. A drug belonging to which class would the nurse interpret as being contraindicated for a pregnant woman?

category X A category X drug is one in which studies have demonstrated fetal abnormalities or adverse reactions with reported evidence of fetal risks. A drug in this category would be contraindicated for use in a pregnant woman. A drug identified as category A would be safest because studies of such a drug have not demonstrated a risk to the fetus in the first trimester of pregnancy, and no evidence of risk in later trimesters. A category B drug is one in which animal studies have not demonstrated a risk to the fetus, but there are no adequate studies in pregnant women, or animal studies have shown an adverse effect, but adequate studies in pregnant women have not demonstrated a risk to the fetus during the first trimester of pregnancy and there is no evidence of risk in later trimesters. Benefit would need to outweigh the risk. A category C drug is one in which animal studies have shown an adverse effect on the fetus, but there are no adequate studies in humans. Benefit would need to outweigh the risk.