ELSEVIER - Antibiotics/Immunologics & GI & Opioids

n adolescent with leukemia is to be given a chemotherapeutic agent that is known to cause nausea and vomiting. When is the best time for the nurse to administer the prescribed antiemetic? a. Before each dose of chemotherapy b. As nausea occurs c. 1 hour before meals d. Just before each meal is eaten

A: Before each dose of chemotherapy The purpose of an antiemetic before chemotherapy is to prevent the child from experiencing nausea during and after the administration of the medication. Waiting until nausea has occurred is too late; the medication should be given before nausea occurs. The meals are not causing the nausea; the nausea is caused by the chemotherapy, and if nausea is not prevented, the child will not eat.

Pyridoxine (vitamin B6) and isoniazid (INH) are prescribed as part of the chemotherapy protocol for a client with tuberculosis. Which response indicates to the nurse that vitamin B6 is effective? a. Weight gain b. Absence of stomatitis c. Absence of numbness and tingling in extremities d. Acceleration of dormant tubercular bacilli destruction

C: Absence of numbness and tingling in extremities One of the most common side effects of INH is peripheral neuritis, and vitamin B6 will counteract this problem. Although it does help nutrition, this may not result in weight gain. B6 does not affect stomatitis. It does not speed the destruction of the causative organism.

A client receiving combination chemotherapy for treatment of metastatic carcinoma asks the nurse in the clinic why more than one type of drug is necessary. Which concept is most important to teach the client in relation to why drug cocktails are more effective than a single drug in cancer therapy? a. Drug resistance b. Tumor doubling time c. Cellular growth cycle d. Retained radioactive particles

C: Cellular growth cycle Different drugs destroy cells at different stages of their replication; rapidly dividing cells not destroyed by one drug may be destroyed by another drug during a different stage of cell replication. Although certain tumors are drug resistant, it is not the reason for multiple chemotherapeutic drugs; drug-resistant tumors may be treated with surgery, radiation therapy, or other methods. Doubling time of the tumor is a factor that influences the length of time chemotherapy will be given, but it is not the reason multiple drugs are given. Retained radioactive particles can occur with internal radiation therapy, not chemotherapy.

The nurse is caring for a client with deep partial-thickness burns who is receiving an opioid for pain management. What is the preferred mode of medication administration for this client? a. Oral b. Rectal c. Intravenous d. Intramuscular

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

A client reports frequently taking calcium carbonate. What effect should the nurse advise the client that this can have? a. Diarrhea b. Water retention c. Rebound hyperacidity d. Bone demineralization

C: Rebound hyperacidity The antacid action of calcium carbonate adds alkalinity, neutralizing gastric pH; this in turn stimulates renewed secretion of acid by the gastric mucosa. This medication causes constipation, not diarrhea. Calcium carbonate does not contain sodium, as do some antacids; thus it does not promote fluid retention. This antacid provides a source of calcium, which helps prevent bone demineralization.

A nurse is planning to screen a school-aged child for impaired hearing because the child is receiving an antibiotic that affects hearing. Which medication does the nurse suspect may have caused hearing impairment? a. Amoxicillin b. Ciprofloxacin c. Clindamycin d. Gentamicin

D: Gentamicin Gentamicin can be ototoxic because of its effects on the eighth cranial nerve. Reactions to amoxicillin are usually allergic in nature. Impaired hearing does not occur with ciprofloxacin or with clindamycin.

A nurse is interviewing an adolescent who is to start a chemotherapeutic drug regimen that includes vincristine. Which side effect is it most important for the nurse to prepare the adolescent to expect? a. Alopecia b. Constipation c. Loss of appetite d. Peripheral neuropathy

A: Alopecia A side effect of vincristine is alopecia. To adolescents, who are very concerned with identity, hair loss represents a tremendous threat to self-image. Constipation, although very serious, is not as important to the adolescent as a side effect that affects appearance. Although anorexia will be a concern while the adolescent is undergoing chemotherapy, it is not as important before the start of the regimen. Although neurologic side effects are serious, they are not as important to the adolescent before the start of chemotherapy.

A nurse is caring for a child with acute lymphoid leukemia who is undergoing chemotherapy. The parents ask why the child needs prednisone. How will the nurse respond? a. It decreases inflammation. b. Production of lymphocytes is suppressed. c. It increases appetite and a sense of well-being. d. Irradiation skin irritation and edema are reduced.

A: It decreases inflammation Prednisone is a synthetic glucocorticoid that exerts an active antiinflammatory effect by stabilizing lysosomal membranes, thereby inhibiting proteolytic enzyme release. Prednisone does not affect the lymphocytes. Although prednisone increases the appetite and creates a sense of well-being, these are not the reasons it is administered. There is no indication the child is receiving radiation.

After a client on the mental health unit with a known history of opioid addiction has a visit from several friends, a nurse finds the client in a deep sleep and unresponsive to attempts at arousal. The nurse assesses the client's vital signs and determines that an overdose of an opioid has occurred. Which findings support this conclusion? a. Blood pressure of 70/40 mm Hg, weak pulse, and respiratory rate of 10 breaths/min b. Blood pressure of 180/100 mm Hg, tachycardia, and respiratory rate of 18 breaths/min c. Blood pressure of 120/80 mm Hg, regular pulse, and respiratory rate of 20 breaths/min d. Blood pressure of 140/90 mm Hg, irregular pulse, and respiratory rate of 28 breaths/min

A:Blood pressure of 70/40 mm Hg, weak pulse, and respiratory rate of 10 breaths/min Opioids cause central nervous system depression, resulting in severe respiratory depression, hypotension, tachycardia, and unconsciousness. The other findings, particularly the respirations, are not indicative of an overdose of an opioid.

The nurse is assessing the newborn of a known opioid user for signs of withdrawal. What clinical manifestations does the nurse expect to identify? Select all that apply. a. Sneezing b. Hyperactivity c. High-pitched cry d. Exaggerated Moro reflex e. Reduced deep tendon reflexes

ABC: Sneezing, Hyperactivity, & High-pitched cry Neurologic signs of withdrawal in the neonate of an opioid-addicted mother are manifested by sneezing, hyperactivity, jitteriness, and a shrill, high-pitched cry. The Moro reflex usually becomes exaggerated as the signs of withdrawal become apparent. The deep tendon reflexes are exaggerated during opioid withdrawal.

What is a nurse's responsibility when administering prescribed opioid analgesics? Select all that apply. a. Count the client's respirations. b. Document the intensity of the client's pain. c. Withhold the medication if the client reports pruritus. d. Verify the number of doses in the locked cabinet before administering the prescribed dose. e.Discard the medication in the client's toilet before leaving the room if the medication is refused.

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

A client who is addicted to opioids undergoes emergency surgery. During the postoperative period the healthcare provider decreases the previously prescribed methadone dosage. For what clinical manifestations will the nurse monitor the client? a. Constipation and lack of interest in surroundings b. Agitation and attempts to escape from the hospital c. Skin dryness and scratching under the incision dressing d. Lethargy and refusal to participate in therapeutic exercises

B: Agitation and attempts to escape from the hospital When the methadone dosage is reduced, a craving for opioids may occur, anxiety will increase, and the client will become agitated and may try to leave the hospital to secure drugs. Constipation and lack of interest in surroundings and skin dryness and itching under the incision dressing are not related to methadone dosage reduction. Lethargy and refusal to participate in therapeutic exercises may occur with methadone overdose.

A health care provider prescribes vancomycin peak and trough levels for a client who is receiving vancomycin intravenous piggyback (IVPB). When should the nurse have the laboratory obtain a blood sample to determine a peak level of the antibiotic? a. Halfway between two doses of the drug b. Between 30 and 60 minutes after a dose c. Immediately before the medication is administered d. Anytime it is convenient for the client and the laboratory

B: Between 30 and 60 minutes after a dose Because the drug was administered IV, the blood level of the drug will be at its highest shortly after administration. A drug blood level measured halfway between two doses will not obtain the peak level. Immediately before the medication is administered is done for a trough level, when the drug level is at its lowest. Anytime it is convenient for the client and the laboratory will produce inaccurate results; peak and trough levels are measured in relation to the time a drug is administered.

A client is receiving doxorubicin as part of a chemotherapy protocol. The nurse should assess the client for which major life-threatening side effect of doxorubicin? a. Anemia b. Cardiotoxicity c. Pulmonary fibrosis d. Ulcerative stomatitis

B: Cardiotoxicity Ceart failure and dysrhythmias are the primary life-threatening toxic effects unique to doxorubicin. When bone marrow is depressed to precarious levels, the dose is altered or blood components administered. Pulmonary fibrosis is not an adverse effect of doxorubicin or of any of the other antineoplastic agents. Ulcerative stomatitis is an uncomfortable side effect of doxorubicin, but it is not life threatening as are the primary life-threatening toxic effects unique to doxorubicin.

A client is to receive doxorubicin as part of a chemotherapy protocol. The nurse should assess for which major life-threatening adverse effect? a. Infiltration b. Cardiotoxicity c. Pulmonary fibrosis d. Ulcerative stomatitis

B: Cardiotoxicity Congestive heart failure and dysrhythmias are life-threatening toxic effects unique to doxorubicin. Infiltration can cause severe tissue damage; however, this is not typically life threatening. Pulmonary fibrosis is not a side effect of doxorubicin or of any of the other antineoplastic agents. Ulcerative stomatitis is a very uncomfortable side effect, but is not life threatening.

A client has been taking methadone 40 mg/day for treatment of an opioid addiction. During a methadone clinic visit she tells the counselor that she is 3 months pregnant and receiving prenatal care. The counselor notifies the nurse in the prenatal clinic about the client's addiction history. What should the nurse in the prenatal clinic recommend that the client do? a. Withdraw the methadone slowly over the next several weeks. b. Continue the prescribed methadone to prevent withdrawal symptoms. c. Temporarily discontinue the methadone to improve maternal and neonatal outcome. d. Leave the methadone maintenance program during the pregnancy and reenter it after the birth.

B: Continue the prescribed methadone to prevent withdrawal symptoms. Methadone is the only medication approved for the treatment of pregnant women with opioid addiction. Although methadone crosses the placenta, it is considered safer for the newborn than the acute opioid detoxification that would result if the methadone was not administered. Withdrawing the methadone slowly over the next several weeks is not recommended. Detoxification from methadone, a long-acting opioid, takes longer than several weeks. Discontinuing methadone treatment can lead to withdrawal problems and put the client at risk for a return to opioid abuse. If methadone is discontinued during the pregnancy, both client and fetus will be at risk.

A nurse is administering erythropoietin three times a week to a client receiving chemotherapy for cancer. Which client response is considered most significant? a. Elevated liver enzymes b. Elevated hematocrit level c. Increase in Kaposi sarcoma lesions d. Increase in the white blood cell (WBC) count

B: Elevated hematocrit level Erythropoietin stimulates red blood cell production, thereby increasing the hematocrit and hemoglobin level. An elevated liver panel is not related to erythropoietin because erythropoietin is not hepatotoxic. Erythropoietin increases red blood cells (RBCs), not WBCs. Increased Kaposi sarcoma lesions are a sign of acquired immunodeficiency syndrome (AIDS) progression and are not affected by erythropoietin.

A healthcare provider prescribes bed rest, loperamide, and esomeprazole for a client who just had major surgery. After several days of this regimen, the client complains of diarrhea. Which treatment strategy does the nurse conclude is the most likely cause of the diarrhea? a. Loperamide b. Esomeprazole c. Bed rest d. Diet alteration

B: Esomeprazole Esomeprazole, a proton pump inhibitor, may cause diarrhea related to a higher risk for Clostridium difficile intestinal infection. Loperamide, an antidiarrheal, may cause constipation, not diarrhea. Immobility causes constipation, not diarrhea. Although diet can affect elimination, no data are presented to support this conclusion.

A client with tuberculosis is started on a chemotherapy protocol that includes rifampin. The nurse evaluates that the teaching about rifampin is effective when the client makes which statement? a. "I need to drink a lot of fluid while I take this medication." b. "I can expect my urine to turn orange from this medication." c. "I should have my hearing tested while I take this medication." d. "I might get a skin rash because it is an expected side effect of this medication."

B: I can expect my urine to turn orange from this medication." Rifampin causes body fluids, such as sweat, tears, and urine, to turn orange. It is not necessary to drink large amounts of fluid with this drug; it is not nephrotoxic. Damage to the eighth cranial nerve is not a side effect of rifampin; it is a side effect of streptomycin sulfate, sometimes used to treat tuberculosis. A skin rash is not a side effect of rifampin.

A nurse working on a substance abuse unit knows that the individual uses opioids most commonly for what reason? a. Desires independence b. Is trying to reduce stress c. Wants to fit in with the peer group d. Enjoys the social interrelationships that occur

B: Is trying to reduce stress Individuals often take drugs because they cannot deal with the pain of reality; the drug blurs the pain and reduces anxiety. Drugs increase dependency rather than foster independence. Although the individual wanting to fit in with the peer encourages initial use by some adolescents, it is not the most common reason for opioid use. The use of drugs fosters social isolation.

The client receives dosages of sedative and opioid drugs during the postoperative period following surgical correction of a small bowel obstruction. What is the most critical assessment to be performed as a nursing safety priority? a. Urinary assessment b. Respiratory assessment c. Cardiovascular assessment d. Neuromuscular assessment

B: Respiratory assessment Respiratory assessment is the most important assessment that should be performed on the client who has undergone surgery after receiving dosages of sedative and opioid drugs. Urinary assessment, cardiovascular assessment, and neuromuscular assessment are assessments that are performed after the nurse is done with the respiratory assessment.

A toddler with cystic fibrosis has been hospitalized with bacterial pneumonia. The nurse determines that the child has no known allergies. What does the nurse conclude is the reason that the healthcare provider selected a specific antibiotic? a. Tolerance of the child b. Sensitivity of the bacteria c. Selectivity of the bacteria d. Preference of the healthcare provider

B: Sensitivity of the bacteria When the causative organism is isolated, it is tested for antimicrobial susceptibility (sensitivity) to various antimicrobial agents. When a microorganism is sensitive to a medication, the medication is capable of destroying the microorganism. The tolerance of the child of the particular antibiotic is unknown because up to this time the child has not exhibited any allergies. Bacteria are not selective. Although the healthcare provider may have a preference for a particular antibiotic, it first must be determined whether the bacteria are sensitive to it.

A primary healthcare provider instructs a nurse to administer opioids to a child. During an assessment, the nurse finds that the infant is showing symptoms of lightheadedness, drowsiness, and hallucinations. Which is the first nursing action in this situation? a. Monitor the child closely. b. Stop administration of the drug. c. Inform the primary healthcare provider. d. Check the level of consciousness of the child

B: Stop administration of the drug. Lightheadedness, drowsiness, and hallucinations indicate that the opioid is having an adverse effect on the central nervous system. Therefore the nurse should stop further administration of the drug. All other interventions should be conducted once the drug is discontinued.

A nurse is caring for a client who is addicted to opioids and who has undergone major surgery. The client is receiving methadone. What is the purpose of this medication? a. Allows symptom-free termination of opioid addiction b. Switches the user from illicit opioid use to use of a legal drug c. Provides postoperative pain control without causing opioid dependence d. Counteracts the depressive effects of long-term opioid use on thoracic muscles

B: Switches the user from illicit opioid use to use of a legal drug Methadone may be dispensed legally; the strength of this drug is controlled and remains constant from dose to dose, unlike illicit drugs. Methadone is used in the medically supervised withdrawal period to treat physical dependence on opiates; methadone therapy substitutes a legal for an illegal drug. Methadone may be administered over the long term to replace illegal opioid use. If methadone treatment is abruptly stopped, there will be withdrawal symptoms. Methadone is a synthetic opioid and can cause dependence; it is used in the treatment of heroin addiction, but may be prescribed for people who have chronic pain syndromes. It is not used for acute postoperative pain. Methadone is not known to counteract the depressive effects of long-term opioid use on thoracic muscles.

What is the most appropriate time for the nurse to administer an intravenous opioid analgesic to a client in active labor? a. Between contractions b. When a contraction starts c. At the peak of a contraction d. Just before the end of a contraction

B: When a contraction starts When an analgesic is administered at the beginning of a contraction, uterine muscle tension increases resistance to the absorption of the medication, thereby slowing its passage through the placenta to the fetus. Between contractions is when the uterine muscle is at its most relaxed, and giving the analgesic at this time thereby increases the rate of the opioid's passage through the placenta to the fetus. Although giving the analgesic at the peak of a contraction will decrease the rate of the opioid's passage through the placenta, it is not the time of maximum resistance. There will be minimum resistance to the opioid's passage through the placenta just before the end of a contraction.

A client with a diagnosis of tuberculosis is receiving isoniazid (INH) as part of a chemotherapy protocol. The nurse assesses the client for adverse responses to the medication. The nurse determines that prompt intervention is needed for which client response? a. Orange feces b. Yellow sclera c. Temperature of 96.8° F (36° C) d. Weight gain of 5 pounds (2.3 kilograms)

B: Yellow sclera An adverse reaction to isoniazid (INH) is hepatitis, resulting in jaundice. Rifampin, an antitubercular medication, can color excretions orange, which is not harmful. A temperature of 96.8° F (36° C) is within expected limits. Weight gain indicates improvement in the client's health status.

A child with Wilms tumor is undergoing chemotherapy in a protocol that includes vincristine and doxorubicin hydrochloride. Which common side effect unique to doxorubicin will the nurse expect to observe in the child? a. Hair loss b. Vomiting c. Red urine d. Stomatitis

C: Red urine Red urine is a common side effect of doxorubicin administration. The drug is not metabolized and is excreted in the urine. The genitourinary responses to vincristine are nocturia, oliguria, urine retention, and gonadal suppression. Hair loss, vomiting, and stomatitis occur with both medications.

A client had surgery for a ruptured appendix. Postoperatively, the health care provider prescribes an antibiotic to be administered intravenously twice a day. The nurse administers the prescribed antibiotic via a secondary line into the primary infusion of 0.9% sodium chloride. During the administration of the antibiotic, the client becomes restless and flushed, and begins to wheeze. What should the nurse do after stopping the antibiotic infusion? a. Check the client's temperature. b. Take the client's blood pressure. c. Obtain the client's pulse oximetry. d. Assess the client's respiratory status.

D: Assess the client's respiratory status. The client is experiencing an allergic reaction that may progress to anaphylaxis. Anaphylactic shock can lead to respiratory distress as a result of laryngeal edema or severe bronchospasm. Assessing and maintaining the client's airway is the priority. Checking the client's temperature and taking the client's blood pressure are not the priority; vital signs should be obtained after airway patency is ensured and maintained. Pulse oximetry is only one portion of the needed respiratory status assessment.

A health care provider prescribes famotidine for a client with dyspepsia. What is important to include about this medication in a teaching program for this client? a. Lowers the stress level b. Neutralizes gastric acidity c. Reduces gastrointestinal peristalsis d. Decreases secretions in the stomach

D: Decreases secretions in the stomach Famotidine inhibits histamine at H2 receptor sites in the stomach, inhibiting gastric acid secretion. Famotidine does not affect stress levels. Famotidine inhibits, rather than neutralizes, gastric secretion. Famotidine inhibits gastric secretion, not peristalsis.

Famotidine (Pepcid) is prescribed for a client with peptic ulcer disease. The client asks the nurse what this medication does. Which action does the nurse mention when replying? a. Increases gastric motility b. Neutralizes gastric acidity c. Facilitates histamine release d. Inhibits gastric acid secretion

D: Inhibits gastric acid secretion Famotidine decreases gastric secretion by inhibiting histamine at H2 receptors. Increases gastric motility, neutralizes gastric acidity, and facilitates histamine release are not actions of famotidine.

What signs and symptoms of withdrawal does the nurse identify in a postpartum client who has a history of opioid abuse? a. Paranoia and evasiveness b. Extreme hunger and thirst c. Depression and tearfulness d. Irritability and muscle tremors

D: Irritability and muscle tremors The earliest sign of opioid withdrawal is central nervous system overstimulation. Paranoia and evasiveness are related to opioid drug abuse, not opioid withdrawal. Extreme hunger and thirst have no relation to opioid withdrawal; most postpartum women are hungry and thirsty. Depression and tearfulness are not specific to people who abuse opioids.

A health care provider prescribes daily docusate sodium for a client. The nurse explains to the client that this drug has what action? a. Lubricates the feces b. Creates an osmotic effect c. Stimulates motor activity d. Lowers the surface tension of feces

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

The postoperative prescriptions for a client who had repair of an inguinal hernia include docusate sodium daily. Before discharge, the nurse instructs the client about what potential side effect? a. Rectal bleeding b. Fecal impaction c. Nausea and vomiting d. Mild abdominal cramping

D: Mild abdominal cramping Mild abdominal cramping is the only side effect of docusate sodium; this emollient laxative permits water and fatty substances to penetrate and mix with fecal material. Rectal bleeding is more likely to occur with a saline-osmotic laxative. Docusate sodium promotes defecation, not constipation. Nausea and vomiting are more likely to occur with a saline-osmotic laxative.

A healthcare provider prescribes famotidine and magnesium hydroxide/aluminum hydroxide antacid for a client with a peptic ulcer. The nurse should teach the client to take the antacid at what time? a. Only at bedtime, when famotidine is not taken b. Only if famotidine is ineffective c. At the same time as famotidine, with a full glass of water d. One hour before or 2 hours after famotidine

D: One hour before or 2 hours after famotidine Antacids interfere with complete absorption of famotidine; therefore antacids should be administered at least 1 hour before or 2 hours after famotidine. Magnesium hydroxide/aluminum hydroxide usually is taken 1 hour after meals and at bedtime. Famotidine usually is prescribed once a day at bedtime. The client has received a prescription for both medications; the client should not be instructed to omit one of the medications without checking with the healthcare provider first.

A client with leukemia who is receiving a chemotherapeutic regimen that includes vincristine reports numbness and loss of feeling in the legs below the knees. The client asks the nurse about what is causing these problems. What fact forms the basis for the nurse's response? a. Enlarged lymph nodes in the groin related to the cancer may cause these symptoms. b. Most chemotherapeutic regimens do not affect the nervous or peripheral vascular system. c. Vascular occlusion may be the cause, and immediate medical evaluation is indicated. d. Peripheral neuropathies can result from chemotherapy and usually are reversible if promptly treated.

D: Peripheral neuropathies can result from chemotherapy and usually are reversible if promptly treated. Muscle weakness, tingling, and numbness are related to drugs like vincristine; neuropathies usually are transient if the drug is stopped or reduced. Nodal enlargement produces vascular rather than neural side effects. Most chemotherapeutic regimens do affect the nervous or peripheral vascular system; neuropathies and peripheral vascular adaptations are potential side effects of chemotherapy. Tingling and numbness are characteristic of neuropathy, not vascular occlusion.

A health care provider prescribes bisacodyl for a client with cardiac disease. The nurse explains to the client that this drug acts by what mechanism? a. Producing bulk b. Softening feces c. Lubricating feces d. Stimulating peristalsis.

D: Stimulating peristalsis. Bisacodyl stimulates nerve endings in the intestinal mucosa, precipitating a bowel movement. Bisacodyl is not a bulk cathartic. Bulk-forming laxatives, such as psyllium hydrophilic mucilloid, form soft, pliant bulk that promotes physiologic peristalsis. Bisacodyl is not a stool softener. Stool softeners, such as docusate sodium, permit fat and water to penetrate feces, which softens and delays the drying of the feces. Bisacodyl is not an emollient. Emollient laxatives, such as mineral oil, lubricate the feces and decrease absorption of water from the intestinal tract.

A nurse is caring for a 3-month-old infant with severe diarrhea following antibiotic therapy. After the effects of dehydration are stabilized, the healthcare provider prescribes Lactobacillus granules. What explanation does the nurse give to the infant's parents about the reason for giving lactobacilli? a. They diminish the inflammatory mucosal edema. b. The discomfort caused by gastric hyperacidity is lessened. c. They relieve the pain caused by gas in the gastrointestinal tract. d. The flora that inhabit a healthy gastrointestinal tract must be recolonized.

D: The flora that inhabit a healthy gastrointestinal tract must be recolonized. Lactobacilli are part of the flora in the healthy gastrointestinal tract. The purpose of administering lactobacilli granules is to help recolonize the normal gastrointestinal flora that were destroyed with antibiotic therapy. The other options are not the actions of lactobacilli granules.

A client with small-cell lung cancer is receiving chemotherapy. A complete blood count is prescribed before each round of chemotherapy. Which component of the complete blood count is of greatest concern to the nurse? a. Platelets b. Hematocrit c. Red blood cells (RBCs) d. White blood cells (WBCs)

D: WBCs Antineoplastic drugs depress bone marrow, which causes leukopenia; the client must be protected from infection, which can be life threatening. RBCs diminish slowly and can be replaced with a transfusion of packed red blood cells. Platelets decrease as rapidly as WBCs, but complications can be limited with infusions of platelets.

A nurse who is assessing a recently hospitalized client with a diagnosis of opioid addiction should look for signs of withdrawal. What are these signs? Select all that apply. a. Seizures b. Yawning c. Drowsiness d. Constipation e. Muscle aches

ABE: Seizures, yawning, and muscle aches Seizures, yawning, and muscle aches are all clinical manifestations of opioid withdrawal, which occurs after cessation or reduction of prolonged moderate or heavy use of opioids. Insomnia, not drowsiness occurs with opioid withdrawal. Diarrhea, not constipation, occurs with opioid withdrawal..

A nurse is caring for a child who is receiving vincristine as part of a chemotherapy protocol. What body systems are most important for the nurse to assess after drug administration? Select all that apply. a. Respiratory b. Neurological c. Reproductive d. Hematologic e. Gastrointestinal

BDE: Neurological, Hematologic, &Gastrointestinal Vincristine is neurotoxic; therefore the child should be monitored for paresthesias, seizures, footdrop, bowel and bladder problems, and alterations in the function of cranial nerves. Hematologic problems such as anemia, thrombocytopenia, and leukopenia occur, although they are not as severe as with other chemotherapeutic agents, such as cyclophosphamide. Gastrointestinal adverse effects include severe constipation, intestinal necrosis, intestinal perforation, and paralytic ileus, in addition to nausea and vomiting. Respiratory problems are not associated with vincristine therapy. The reproductive system is not affected by vincristine therapy.

The nurse is caring for a child with a very low platelet count related to chemotherapy. The nurse will monitor this child's urine for the presence what component? a. Protein b. Glucose c. Erythrocytes d. Lymphocytes

C: Erythrocytes A low platelet count predisposes the child to bleeding, which may be evident in the urine. Red blood cells are seen microscopically in the sediment. Protein is not found in the urine when the platelet count is low. Glucose is not found in the urine when the platelet count is low. Lymphocytes usually are not found in the urine.

A client with burns develops a wound infection. The nurse plans to teach the client that local wound infections primarily are treated with what type of antibiotics? a. oral b. topical c. intravenous d. intramuscular

B: Topical Topical antibiotics are applied directly to the wound and are effective against many gram-positive and gram-negative organisms found on the skin. Although oral, intravenous, and intramuscular antibiotics may be administered, they are most effective for systemic rather than local infections; the vasculature in and around a burn is impaired, and the medication may not reach the organisms in the wound.

After an infant completes a week of antibiotic therapy, the nurse finds white, adherent patches on the tongue, palate, and inner aspects of the cheeks that the provider identifies as thrush. Which medication does the nurse expect to be prescribed? a. Acyclovir b. Vidarabine c. Nystatin d. Fluconazole

C: Nystatin White, adherent patches on the tongue, palate, and inner aspects of the infant's cheeks indicate oral candidiasis(thrush). Oral candidiasis is caused by a fungus called Candida albicans. Nystatin is an antifungal agent prescribed to treat oral thrush in an infant. Acyclovir and vidarabine are antiviral agents and are not used to treat oral candidiasis in the infant. Fluconazole can effectively treat oral thrush, but its use in infants is not approved by the Food and Drug Administration.

Which physical skin finding indicates opioid abuse? a. Diaphoresis b. Red, dry skin c. Needle marks d. Spider angiomas

C: Needle marks Needle marks of the skin indicate opioid abuse. Diaphoresis indicates sedative hypnotic abuse. Red, dry skin indicates phencyclidine abuse. Spider angiomas indicate alcohol abuse.

A client is diagnosed with acute lymphoid leukemia and is receiving chemotherapy. The nurse should monitor what thrombocytopenic side effects of chemotherapy? Select all that apply. a. Nausea b. Melena c. Purpura d. Diarrhea e. Hematuria

B, C, E: Melena, Purpura, & Diarrhea Black, tarry feces caused by the action of intestinal secretions on blood are associated with bleeding in the gastrointestinal tract; bleeding is related to a reduced number of thrombocytes, which are part of the coagulation process. Hemorrhages into the skin and mucous membranes (purpura) may occur with reduced numbers of thrombocytes, which are part of the coagulation process. Blood in the urine (hematuria) may occur with a reduced number of thrombocytes, which are part of the coagulation process. Nausea and vomiting are not related to thrombocytopenia; they occur because of the effect of chemotherapy on the rapidly dividing cells of the mucous membranes of the gastrointestinal system. Diarrhea may be a side effect of chemotherapy, but it is not a thrombocytopenic side effect.

Penicillin G and probenecid are prescribed for an adolescent who has syphilis. The adolescent asks the nurse why two medicines are needed. What should the nurse explain about the rationale for this combination therapy? a. "Penicillin treats the syphilis, and the probenecid relieves the inflammation in the urethra." b. "Probenecid delays excretion of penicillin so the blood level of penicillin stays stable longer." c. "Probenecid lowers the risk of an allergic reaction to the penicillin, which treats the syphilis." d. "Penicillin attacks the organism during one stage of cell multiplication, and the probenecid attacks it at another stage."

B: "Probenecid delays excretion of penicillin so the blood level of penicillin stays stable longer." Administration of probenecid results in better utilization of the penicillin G because it delays penicillin's excretion by the kidneys. Probenecid is not prescribed to treat urethritis or to prevent allergic reactions. Penicillin destroys Treponema during all stages of its development; the probenecid does not attack the organism during a stage of cell multiplication.

A nurse is caring for a client who has developed dysphagia and is unable to swallow. The client is receiving around-the-clock opioid pain medications for cancer pain, and hospice has recently begun caring for the client. What is the best nursing intervention in preparing for the client's discharge? a. Contact the client's healthcare provider to ask to substitute a liquid form of medications for the pill form. b.Teach the client and family members to crush the pills and administer them with applesauce. c. Contact the client's healthcare provider to discuss use of transdermal medications for pain control. d. Teach the client and family members about addiction that may occur as a result of regular opioid use.

C: Contact the client's HCP to discuss use of transdermal medications for pain control. The client will be discharged home with hospice and therefore there is no chance that dysphagia will be relieved by surgery or will improve by other measures. Considering that the client is approaching death and the client's condition is deteriorating, the transdermal route of administration of the pain medications is less invasive and provides comfort. The liquid form of pain medication or crushing the pills and administering them with applesauce is not possible because the client has dysphagia. The client is approaching the end of life and requires comfort measures; therefore opioid addiction is not a nursing concern for the dying client.

A client is started on tetracycline antibiotic therapy. What should the nurse do when administering this drug? a. Administer the medication with meals or a snack. b. Provide orange or other citrus fruit juice with the medication. c. Give the medication an hour before milk products are ingested. d. Offer antacids 30 minutes after administration if gastrointestinal side effects occur.

C: Give the medication an hour before milk products are ingested. Any product containing aluminum, magnesium, or calcium ions should not be taken in the hour before or after an oral dose of tetracyclines (with the exception of doxycycline) because it decreases absorption by as much as 25% to 50%. Food interferes with absorption; it should be given one hour before or two hours after meals. Citrus juice has no influence on this drug. Antacids will interfere with absorption.

A client in a group for people who abuse opiate drugs states, "I just got a prescription for an opioid for my back pain." What is the most appropriate response by the nurse leading the group? a. "That was the wrong thing to do. Why did you do that?" b. "You're going to get in trouble with your probation officer." c. "Has anybody else had back pain? If you did, how did you handle it?" d. "You may not attend the group anymore because this is considered a relapse."

C: Has anybody else had back pain? If you did, how did you handle it?" Using group members to explore other solutions that could change a client's behavior is an appropriate use of group therapy. Telling the client that it was the wrong thing to do and asking why he or she did it are nontherapeutic and will not elicit change from within the client. The question does not indicate that the client has a probation officer; that the client will get in trouble may or may not be true. Saying the client may not attend the group anymore is a punitive response. Opioid use may be medically indicated.

A nurse withholds a prescribed opioid medication from a client requesting to be treated for intractable pain because the nurse fears the client will become addicted. In this situation, the nurse is adhering to which ethical principle? a. Veracity b. Autonomy c. Paternalism d. Beneficence

C: Paternalism Paternalism occurs if the nurse interferes with the individual's autonomy by disregarding the client's choices; the client has requested to be treated with a medication that has been prescribed by the healthcare team and the nurse is refusing to give it because of unfounded personal beliefs. The client's priority is pain relief and the nurse should be working with other health team members to achieve this objective. Veracity is defined as telling the truth. Autonomy, as an ethical principle, means that the nurse respects the client and the choices that are made. Beneficence commonly is referred to as "doing good;" it is related to the nurse's duty to help clients further their legitimate interest within the boundaries of safety.

A client is brought by ambulance to the emergency department. The client's signs and symptoms are indicative of opioid overdose. What does the nurse expect the primary healthcare provider to prescribe? a. Naloxone b. Methadone c. Epinephrine d. Amphetamine

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

A client undergoing chemotherapy for cancer gave birth to a newborn with limb malformations. Which medication may have caused the limb malformations in this neonate? a. Methotrexate b. Nitrofurantoin c. Carbamazepine d. Dexamethasone

A: Methotrexate When taken during pregnancy, methotrexate (MTX) may cause limb malformations. Because MTX is a folate antagonist and folate is required for healthy DNA and protein synthesis, it can affect limb formation and other things in a developing fetus. MTX has Pregnancy Category D status. Nitrofurantoin is a wide-spectrum antibiotic commonly given for a urinary tract infection; it has Pregnancy Category B status. Carbamazepine is an antiepileptic drug that may cause neural tube defects but not limb malformations; it has Pregnancy Category D status. Dexamethasone is a glucocorticoid medication used to treat the adrenal suppression commonly caused by cancer chemotherapy and it can cause fetal masculinization but not limb malformations; it has a Pregnancy Category C status.

A pharmacy technician arrives on the nursing unit to deliver opioids and, following hospital protocol, asks the nurse to receive the medications. The nurse is assisting a confused and unsteady client back to the client's room. How should the nurse respond to the technician? a. "I can't receive them right now. Please wait a few minutes or come back." b. "Please leave the medications and sign-out sheet in a location where I can see them." c. "Please bring them to me and I will be sure to put them away in a couple of minutes." d. "I can't receive them right now. Please give them to the unlicensed healthcare worker."

A: "I can't receive them right now. Please wait a few minutes or come back." The transfer of controlled substances from one authorized person to another must occur according to protocol. In this situation the controlled substance must be returned to the pharmacy and delivered at a later time. The controlled substances cannot be left unattended. The nurse cannot delay the securing of controlled substances; if time is not available when the medications are delivered, they must be returned to the pharmacy. The unlicensed healthcare worker does not have the authority to receive controlled substances.

A client with phosphate-based urinary calculi asks why aluminum hydroxide gel has been prescribed. The nurse explains that the medication decreases serum phosphorus by which action? a. Binding with phosphorus in the intestine b. Preventing absorption of phosphorus in the stomach c. Promoting excretion of excessive urinary phosphorus d. Dissolving stones as they pass through the urinary tract

A: Binding with phosphorus in the intestine Aluminum hydroxide binds phosphorus in the intestine, preventing its absorption; this decreases serum phosphorus. Preventing absorption of phosphorus in the stomach, promoting excretion of excessive urinary phosphorus, and dissolving stones as they pass through the urinary tract are not actions of this drug.

A pregnant client's history reveals opioid abuse. What is the nurse's initial plan for providing pain relief measures during labor? a. Scheduling pain medication at regular intervals b. Administering the medication only when the pain is severe c. Avoiding the administration of medication unless it is requested d. Recognizing that less pain medication will be needed by this client compared with other women in labor

A: Scheduling pain medication at regular intervals This client will have a lower tolerance for pain and a greater need for pain relief. Larger doses may be needed if pain medication is administered only when the pain is severe. Delays increase anxiety and discomfort, and larger doses will be necessary. Individuals who abuse drugs require more medication than do others because of tolerance to the addictive drug.

A client with a known history of opioid addiction is treated for multiple stab wounds to the abdomen. After surgical repair the nurse notes that the client's pain is not relieved by the prescribed morphine injections. The nurse realizes that the failure to achieve pain relief indicates that the client is probably experiencing what phenomenon? a. Tolerance b. Habituation c. Physical addiction d. Psychological dependence

A: Tolerance Tolerance is a phenomenon that occurs in addicted individuals in which increasing amounts of the drug of addiction are needed to satisfy need; the client should receive adequate analgesia after surgery. Drug habituation is a mild form of psychological dependence; the individual develops a habit of taking the substance. A physical addiction is related to biochemical changes in body tissues, especially the nervous system. The tissues come to require the substance for usual function. Psychological dependence is emotional reliance on the substance to maintain a sense of well-being.

A healthcare provider prescribes oral aluminum-magnesium hydroxide and intravenous ranitidine for a client with traumatic burns and crush injuries. The client asks how these medications work. What is the nurse's best response? a. "They decrease severe irritability of the bowel." b. "They limit acidity in the gastrointestinal tract." c. "They are effective in clients with multiple trauma." d. "They work the same way antidiarrhea medications do."

B: "They limit acidity in the gastrointestinal tract." Stress from burns and crush injuries increases gastric acid production and contributes to Curling ulcer formation. Ranitidine (an H2 receptor antagonist) reduces gastric acid formation, and aluminum-magnesium hydroxide (an antacid) neutralizes gastric acid once it is formed. These drugs reduce gastrointestinal acidity, but do not decrease bowel irritability. Stating that they "are effective in clients with multiple trauma" does not answer the client's question about how the medications work. These drugs do not work in the same way as antidiarrhea medications, which work to slow gastrointestinal motility.

A client admitted with a myocardial infarction is prescribed docusate and morphine and takes digoxin and fluoxetine at home. Which drug should the nurse recognize as a risk factor for straining due to constipation? a. Digoxin b. Morphine c. Docusate d. Fluoxetine

B: Morphine Morphine is an opioid. Opioids decrease intestinal peristalsis, which may precipitate constipation; straining at stool should be avoided to prevent the Valsalva maneuver, which increases demands on the heart. Digoxin is unrelated to intestinal peristalsis and the potential for constipation. Docusate sodium is a stool softener which would relieve, not cause, constipation. A side effect of fluoxetine is diarrhea, not constipation.

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

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

Ranitidine has been prescribed to help treat a client's gastric ulcer. The nurse expects this drug to act specifically by which mechanism? a. Lowering the gastric pH b. Promoting the release of gastrin c. Regenerating the gastric mucosa d. Inhibiting the histamine at H2 receptors

D: Inhibiting the histamine at H2 receptors Ranitidine inhibits histamine at H2 receptor sites in parietal cells, which limits gastric secretion. Lowering the gastric pH is not the direct action of this drug. Promoting the release of gastrin is undesirable; gastric hormones increase gastric acid secretion. Ranitidine does not regenerate the gastric mucosa; the drug prevents its erosion by gastric secretions.

An intravenous (IV) antibiotic is prescribed for a child with fever of unknown origin. Within 10 minutes of the antibiotic infusion, the child's face and neck are flushed but the remainder of the body is unchanged. The nurse checks the child's record. In light of this information, what will the nurse do? a. Administer acetaminophen. b. Place the child on protective isolation. c. Increase the rate of the vancomycin infusion. d. Notify the primary healthcare provider after stopping the infusion.

D: Notify the primary healthcare provider after stopping the infusion. The child is exhibiting a common vancomycin reaction called red man syndrome or red neck syndrome. Flushing usually begins in the chest area and spreads upward to the neck and face, usually during the first 15 minutes of administration. This reaction is caused by a release of histamine, which results in vasodilation. If not treated, the syndrome can lead to circulatory collapse. The appropriate response is to stop the infusion and notify the primary healthcare provider. The provider will usually prescribe diphenhydramine hydrochloride (Benadryl) and then resume the vancomycin infusion. Diphenhydramine will be administered before each vancomycin dose, and the infusion will be set at a slower rate. Normal temperature is 98.6° F (37° C). It is not necessary to administer acetaminophen for a temperature below 100.4° F (38° C). The child's laboratory results indicate a bacterial infection. Protective (or reverse) isolation is not necessary. Increasing the vancomycin infusion rate will exacerbate the reaction and lead to circulatory collapse.