GI, Pain, Renal, Musculoskeletal, and CNS PrepU

The nurse is caring for an 8-year-old client who takes imipramine. The nurse should assess this client for a history of which health problem?

Enuresis Explanation: One of the indications for use of the drug imipramine is enuresis in children older than 6 years. Imipramine is not indicated for the treatment of OCD, oppositional defiant disorder, or psoriasis.

What type of diet should a patient taking diuretics have?

Eat potassium-rich or low-potassium diet as appropriate Explanation: Provide potassium-rich or low-potassium diet as appropriate to maintain electrolyte balance and replace lost potassium or prevent hyperkalemia.

A client asks the nurse about herbal therapies for osteoarthritis. What is the nurse's best response?

"Glucosamine and chondroitin are generally well tolerated and not considered harmful. Explanation: Glucosamine and chondroitin are recommended and are generally safe for use. The absorption of oral glucosamine is 90%-98% so injection is not necessary. The nurse should not recommend taking any herbal supplement outside of the usual dosage range before checking with the health care provider.

Which statement best indicates that a client knows how much fluid to drink each day to prevent urinary tract infections?

"I try to drink enough fluid so that my urine is pale yellow in color and clear." Explanation:The client is encouraged to drink at least 2,000 mL of fluid daily. The client should gauge the amount of fluid to drink by the color of the urine. It should be pale yellow during the day. The other statements don't indicate an understanding to base fluid intake on the appearance of the urine.

A male client has been ordered spironolactone (Aldactone) for hypertension. Which statement by the client indicates a need for further education?

"I will take the medication when my blood pressure is elevated." Explanation: Spironolactone (Aldactone) should be taken daily to decrease blood pressure, not only when blood pressure is elevated. Spironolactone (Aldactone) is a potassium-sparing diuretic; therefore, no additional potassium is needed. Adverse reactions include gynecomastia, headache, diarrhea, and cramping. It is important that the client weigh himself daily.

A client has been taking Prozac for the past two months for depression. She is seeing her gynecologist for premenopausal symptoms and during the interview with the nurse she says, "I'm interested in trying Sarafem because my friend is taking it and she says it works great." What is the best response by the nurse?

"Sarafem and Prozac are different brand names for the same generic medication." Explanation: Prozac and Sarafem are different brand names for fluoxetine, so there is no benefit in changing the client's medication regimen and, if taken together, would result in a drug overdose. The other three responses are incorrect or inappropriate because they do not reflect the fact that both drugs are the same.

A patient is receiving acetazolamide in a sustained release form. The nurse would anticipate the onset of drug action in approximately which time frame?

2 Hours Explanation: Acetazolamide in sustained release form has an onset of action of 2 hours.

A nurse demonstrates understanding of diuretics when identifying which medication as exerting its effect by inhibiting the enzyme carbonic anhydrase?

Acetazolamide Explanation:Acetazolamide is a carbonic anhydrase inhibitor that exerts its effect by inhibiting the enzyme carbonic anhydrase. Furosemide is a loop diuretic. Hydrochlorothiazide is a thiazide diuretic. Spironolactone is a potassium-sparing diuretic.

What would be a contraindication to the use of carbonic anhydrase inhibitors?

Allergy to Sulfonamides Explanation: Carbonic anhydrase inhibitors are sulfonamides, and as such are contraindicated in patients with an allergy to sulfonamides. Carbonic anhydrase inhibitors are used cautiously in patients with adrenocortical insufficiency, respiratory acidosis, and COPD because these conditions could be exacerbated by the use of the drug.

A common drug regimen for eradication of H. pylori includes a proton pump inhibitor (PPI) and two antibiotics. What is one of the preferred antibiotics?

Amoxicillin Explanation: The treatment of choice for H. pylori infection is a PPI and clarithromycin plus either amoxicillin or metronidazole.

A client has called the clinic with complaints of constipation despite taking a laxative. The nurse asks what OTC medication the client is taking because the nurse knows that what drugs may decrease the effects of laxatives?

Antihistamines Explanation: These drugs slow intestinal mobility. Patients receiving these agents are at risk for development of constipation. Aspirin, decongestants, and fungicides do not decrease the effects of laxatives.

A client with dementia has been very agitated lately. What type of medication might the provider prescribe to help with the agitation?

Antipsychotic Explanation: Antipsychotic medications are used to treat agitation in clients with dementia. Antidepressant, antibiotic, and narcotic medications are not used to treat agitation in clients with dementia.

A client has been prescribed chlorpromazine hydrochloride for nausea. What assessment should the nurse perform before the drug is administered to the client?

Assess signs of fluid and electrolyte imbalances Explanation: Before chlorpromazine hydrochloride is administered to the client, the nurse should assess for signs of fluid and electrolyte imbalances. When antacids are given, the nurse keeps a record of the client's bowel movements because these drugs may cause constipation or diarrhea. The nurse should monitor continuous spitting of blood and measure oral fluid intake after chlorpromazine hydrochloride is administered. While the client is undergoing chlorpromazine hydrochloride therapy, the nurse needs to provide the client mouthwash or frequent oral rinses to remove the disagreeable taste that accompanies vomiting.

The nurse is working with a client who has been prescribed tizanidine (Zanaflex) for the treatment of muscle spasticity. When monitoring the client's risk for injury, what assessment should the nurse prioritize?

Assessment of the client's blood pressure following administration Explanation: Tizanidine has been associated with hypotension, which could be a safety risk especially if the client is also taking an antihypertensive drug. Constipation and headaches are common adverse effects that do not pose as direct a safety risk. Creatinine levels are not normally affected, and these do not pose a safety risk.

A truck driver has been diagnosed with a generalized anxiety disorder (GAD) and lorazepam has been prescribed. The client asked the nurse how this medication will affect his job. The nurse would advise him how?

Avoid driving until he's aware of the adverse side effects Explanation:Drowsiness, sedation, and ataxia may occur when the drug is started, but these effects should disappear once the client becomes accustomed to the drug. The nurse must advise the client to avoid driving or performing any other tasks that require mental alertness and concentration until the effects of the drug are known. Lorazepam does not have prolonged effects after cessation of therapy, so the nurse would not advise the client to change his profession. The client should avoid driving until the drug effects are known, instead of avoiding driving only at night or for 2 hours after drug consumption.

A client with spinal cord injury is experiencing muscle spasticity. Which agent would most likely be ordered?

Baclofen Explanation: Baclofen is used for the treatment of muscle spasticity associated with spinal cord injuries. Carisoprodol is used for the relief of discomfort of acute musculoskeletal conditions. Chlorzoxazone is used for the relief of discomfort of acute musculoskeletal conditions. Cyclobenzaprine is used for the relief of discomfort of acute musculoskeletal conditions.

A 17-year-old client has just been diagnosed with schizophrenia. When educating the family about the cause of this disease, the nurse should address what factors? Select all that apply.

Biochemical Disruptions Explanation: This disorder, which seems to have a very strong genetic association, may reflect a fundamental biochemical abnormality. Mental disorders are now thought to be caused by some inherent dysfunction within the brain that leads to abnormal thought processes and responses. Schizophrenia is not caused by poor coping, childhood trauma, or seizure activity.

A client experiencing diarrhea asks the nurse about over-the-counter (OTC) antidiarrheals. Which OTC should not be taken with aspirin?

Bismuth subsalicylate Explanation: Bismuth subsalicylate is a commonly used OTC medication for diarrhea. It has a salicylate, which is in the family of aspirin. A nurse should teach the client that use of the medication with aspirin can cause an overdose. Octreotide acetate is a synthetic form of somatostatin and is used for diarrhea as it decreases GI secretion and motility. Polycarbophil is a bulk-forming laxative. Loperamide is a synthetic derivative of meperidine that decreases GI motility by its effect on intestinal muscles.

The client in the ER has increased intracranial pressure. The nurse has just administered 150 g of mannitol IV . What assessment should the nurse prioritize when monitoring the client?

Blood Pressure Explanation: The most common and potentially dangerous adverse effect related to an osmotic diuretic is the sudden drop in fluid levels, which could result in dangerous hypotension. Weight and abdominal girth may change over time as fluid balance changes, but effects would not be observed as quickly as a drop in blood pressure. The nurse should monitor the client's respiratory status and heart rate because of the client's acute illness, but these are less likely to affected my mannitol.

What sign is most indicative of dehydration in a patient taking diuretics?

Body Weight Explanation: Obtain an accurate body weight, to provide a baseline to monitor fluid balance. The other options would not indicate dehydration.

A nurse is reviewing information about anxiolytics. Which anxiolytics would the nurse identify as the safest to use in older adult clients?

Buspirone Explanation: Buspirone is a safe choice for the older adult client with anxiety because it does not cause excessive sedation and the risk of falling is not as great. Lorazepam is a benzodiapine used for short-term anxiety and has increased risk for falls due to dizziness and lightheadedness. Doxepin is a nonbenzodiapine much like buspirone, however, it is used for those severely ill. Hydroxyzine is also a nonbenzodiapine causing drowsiness and involuntary motor activity increasing the risk for falls.

Which condition will place the client prescribed a benzodiazepine at risk for toxicity?

Decreased albumin Explanation: Clients with liver disease are at risk for adverse effects with drugs that are highly bound to plasma proteins. Neither increased calcium nor decreased potassium will have a direct impact on benzodiazepine toxicity. The normal bicarbonate will not contribute to benzodiazepine toxicity.

A nurse is caring for a client who has developed diarrhea after antibiotic administration. The client has a BUN of 35 and creatinine of 1.8. The provider has ordered diphenoxylate with atropine for the client. What action should the nurse implement?

Call the prescriber about the laboratory tests. Explanation: The nurse knows that the use of diphenoxylate with atropine requires caution with clients that have renal or hepatic compromise. The nurse should call the provider and make sure the provider is aware of the laboratory values before administering the medication. Discussion with other nurses is not warranted. The medication does not need to be held at this time as diphenoxylate with atropine is not contraindicated with renal or hepatic compromise but can be administered with caution.

An 73-year-old client with intractable back pain is scheduled to begin taking a centrally acting skeletal muscle relaxant. What medication is most likely to balance risks and benefits to the client?

Carisoprodol Explanation: Carisoprodol is the centrally acting skeletal muscle relaxant of choice for older clients and for those with hepatic or renal impairment. Although the other options may be prescribed, older adults are more likely to experience the adverse effects associated with the drug.

In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill client?

Decreased cardiac workload Explanation: Antianxiety and sedative-hypnotic drugs are often useful in critically ill clients to relieve stress, anxiety, and agitation. Their calming effects decrease cardiac workload (e.g., heart rate, blood pressure, force of myocardial contraction, myocardial oxygen consumption) and respiratory effort. They do not decrease blood pH, increase diffusion and perfusion, or increase level of

The nurse is caring for an 89-year-old client with frequent liquid stools. When preparing a plan of care for this client, what nursing diagnosis is a priority?

Deficient Fluid Volume Explanation: Fluid volume deficits may develop rapidly in older adults with diarrhea. Older adults are more likely to develop adverse effects associated with the use of these drugs, including sedation, confusion, dizziness, electrolyte disturbances, fluid imbalance, and cardiovascular effects.

A nurse has admitted two patients to the unit and is are developing care plans for both of them. One of the patients is having a pump placed to deliver intrathecal baclofen. The other patient will be receiving dantrolene as a muscle relaxant. What nursing diagnosis would be appropriate for both care plans?

Deficient knowledge regarding drug therapy Explanation: Appropriate nursing diagnoses for both patients include: Deficient knowledge regarding drug therapy; Acute pain related to GI and CNS effects; Disturbed thought processes related to CNS effects; and Risk for injury related to CNS effects.

A client who experiences frequent constipation is using psyllium (Metamucil). The nurse knows what contraindications to using psyllium? Select all that apply.

Difficulty swallowing Gastrointestinal obstruction Fecal impaction Undiagnosed abdominal pain Explanation: Difficulty swallowing and gastrointestinal obstruction contraindicates psyllium. Fecal impaction and undiagnosed abdominal pain are contraindications to all orally administered laxatives. Use of herbal preparations is not a contraindication. There are no interactions reported with psyllium.

Administering an antacid to a client taking which medications will decrease the absorption of the medication and result in a decreased drug effect?

Digoxin Explanation: Administering an antacid to a client taking digoxin will decrease the absorption of digoxin and result in a decreased digoxin effect. Quinidine, dextroamphetamine, and simvastatin are not affected by the use of antacids.

A client has been prescribed rabeprazole (Aciphex). It will be important for the nurse to assess the client's drug history to determine if the client is taking which drug?

Digoxin Explanation: The nurse should assess for the use of digoxin. Rabeprazole interacts with digoxin and increases its serum concentration. It is necessary to monitor for signs of digoxin toxicity when these drugs are given together. Morphine, levodopa, and dicyclomine hydrochloride can cause adverse interactions with metoclopramide.

The nurse is working in post-op and the client has just come out of surgery. The nurse notes that the clients respiratory rate is 4 breaths per minute. The nurse has a standing order to give doxapram 0.5 mg/kg IV for respiratory depression. What should the nurse do next?

Draw up the medication, have it checked by a second provider, have suction close by, and give the medication. Explanation: Doxapram is given for postanesthesia respiratory depression. All medications should be double-checked by a second provider prior to administration. Clients often vomit after being given doxapram so suction should be close by. Narcan is not recommended because the client would be in severe pain if the narcotic was counteracted by the Narcan. Continually shaking and talking loudly to the client may stimulate the client for that moment, but will not help continual respiratory depression.

When developing a teaching plan for a client who is to receive carisoprodol, which sign or symptom would the nurse include as the most common adverse reaction?

Drowsiness Explanation: Drowsiness is the most common adverse reaction to skeletal muscle relaxants like carisoprodol (Soma) that the nurse should discuss with the client. No correlation is found with skeletal muscle relaxants causing dyspnea. The Disease-modifying antirheumatic medication of leflunomide has the adverse reaction of hypertension. Tachycardia can be seen in the use of skeletal muscle relaxants but is not the most common and is seen in the use of dantrolene and diazepam.

A nurse administers carisoprodol to a client for the treatment of an acute musculoskeletal condition. The nurse would be alert for which adverse effect after administering the drug?

Drowsiness Explanation: The nurse should monitor for drowsiness in the client as the adverse reaction of carisoprodol administration. Depression is not an adverse reaction of carisoprodol administration. Insomnia and anxiety are adverse reactions associated with bisphosphonate drugs.

What instruction should be included in the plan of care as nonpharmacologic interventions for an older adult client experiencing diarrhea? Select all that apply.

Eat a diet of bland foods such as rice, soup, and crackers. Increase fluid intake to 2-3 liters per day. Explanation: Diarrhea is less common than constipation in older adults but it may occur from laxative abuse and bowel-cleansing procedures before GI surgery or diagnostic tests. General principles of fluid and electrolyte replacement, measures to decrease GI irritants, and drug therapy apply as for younger adults. Acceptable replacement fluids during the first 24 hours include up to 3 liters of clear liquids. Also, a diet consisting of bland foods such as rice, soup, salted crackers, cooked cereals, baked potatoes, eggs, and applesauce is best. Clients do not need to call a dietitian or go to the ED or follow up with the primary care provider.

Which medication reduces the secretion of gastric acid by inhibition of the hydrogen-potassium adenosine triphosphate (ATPase) enzyme system of the gastric parietal cells? Select all that apply.

Esomeprazole Lansoprazole Explanation: The proton pump inhibitors, like esomeprazole and lansoprazole, reduce the secretion of gastric acid by inhibition of the hydrogen-potassium adenosine triphosphate enzyme system of the gastric parietal cells. Famotidine (Pepcid) and ranitidine are both histamine H2 antagonists decreasing stomach acid by inhibiting the action of H2 receptors in the stomach. Calcium carbonate is an acid neutralizer that reduces the pH of the acid in the stomach and duodenum.

The nurse understands that which DMARDs should not be used in clients with congestive heart failure?

Etanercept Explanation: Etanercept, adalimumab, and infliximab should not be used in clients with congestive heart failure. Hydroxychloroquine (Plaquenil) is contraindicated in clients with maculopathy of the eye. Anakinra should not be used in combination with etanercept, adalimumab, or infliximab. The adverse reactions to sulfa-based drugs, such as sulfasalazine, include ocular changes, gastrointestinal (GI) upset, and mild pancytopenia.

The physician requests that flumazenil (Romazicon) be administered to a client. The nurse knows that which statements regarding flumazenil (Romazicon) is correct?

Flumazenil can provoke withdrawal symptoms in persons who are physically dependent on benzodiazepines. Explanation: Flumazenil is a specific benzodiazepine antagonist and will not reverse effects of any other drug group. It is administered only by the intravenous route, and must be administered cautiously to persons known or suspected to have physical dependence on benzodiazepines: a withdrawal syndrome can ensue. Adverse effects of flumazenil include agitation and seizures.

The client states that prior to exams at school, the client has abdominal cramping and diarrhea. What does the nurse suspect is the trigger for these signs and symptoms?

Functional Diarrhea Disorder Explanation: The client is describing functional diarrhea disorder where the diarrhea occurs as a result of stress or anxiety. The client does not have hyperthyroid, intestinal neoplasm, or colitis. While all of these conditions can lead to diarrhea, the client's description does not support any of these diagnoses.

A client comes to the clinic for a 1-month follow-up appointment. The client states taking chlorothiazide (Diruil) for the month it has been prescribed and now has leg cramps and "feels tired all the time." What will the nurse consider as the cause of the patient's symptoms?

Hypokalemia Explanation:Hypokalemia is caused by the loss of potassium in the distal tubule and causes muscle weakness, fatigue, and arrhythmias. Hyperkalemia presents with cardiac arrhythmias and occasionally muscle weakness. Hypercalcemia is characterized by fatigue, depression mental confusion, nausea, vomiting, and constipation. Hypocalcemia presents with muscle spasms, facial grimacing, possible convulsions, irritability, and depression.

Which adverse effect of muscle relaxants is most pronounced when a client is prescribed tizanidine therapy?

Hypotension Explanation:Hypotension is the most significant adverse effect of tizanidine. Dark black urine, excessive salivation, and eczema are not adverse effects of tizanidine.

While studying for an upcoming pharmacology test, a student asks peers what drug would be more effective against depression characterized by anxiety and sleep disturbances. Which drug would the students say would be most effective?

Imipramine (Tofranil) Explanation: Imipramine is a tricyclic antidepressant, which is more effective against depression characterized by anxiety and sleep disturbances. Fluvoxamine is a selective serotonin reuptake inhibitor, tranylcypromine is a monoamine oxidase inhibitor, and bupropion is an antidepressant agent that does not fit into the other categories of antidepressants. Although buproprion, fluvoxamine, and tranylcypromine are used to treat depression, none of them would be as effective as imipramine in treating anxiety and sleep disturbances.

A nurse notes that a newly admitted client is currently prescribed both a loop diuretic as well as a thiazide diuretic. The nurse understands what primary rationale for the concurrent use of these two drugs?

Increased diuretic effect Explanation: When an inadequate diuretic response occurs with one drug, people sometimes take two potassium-losing diuretics concurrently. The combination of a loop and a thiazide diuretic has synergistic effects because the drugs act in different segments of the renal tubule. Thus, the rationale for this particular combination is not rooted in prevention of potassium imbalances, increased adherence, or maintenance of a normal heart rate.

The nurse is caring for a client who has been taking an oral neuroleptic medication for several years. What assessment should the nurse prioritize to best address the risk for adverse effects?

Involuntary facial movements Explanation: The nurse would monitor for and teach the client and family about tardive dyskinesias because it is such a common adverse effect with continued use of the drug. Clients do not normally experience disruptions to bowel function, cranial nerve function or deep tendon reflexes.

A client is prescribed alosetron. What information in the client's history would warrant the nurse calling the prescriber about the medication? Select all that apply.

Male client Elevated liver values Daily dose of fluvoxamine Explanation: Alosetron is a selective 5-HT3 receptor antagonist indicated for treating women with chronic severe diarrhea-predominant with IBS not responding to conventional therapy. Clinical studies have not demonstrated safety and efficacy of alosetron in men. Contraindications include concurrent administration of fluvoxamine and severe hepatic impairment. A decreased hematocrit value and diarrhea history are not necessary to call the prescriber about the medication.

The nurse is teaching a client about diphenoxylate with atropine sulfate which has been prescribed for treatment of acute diarrhea. For which adverse effect should the nurse teach the client to anticipate?

Nausea Explanation: Adverse effects of diphenoxylate with atropine sulfate include nausea, vomiting, dizziness, headache, drowsiness, and tachycardia. The incidence and severity of most adverse effects are low when the medication is used appropriately.

What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline?

Orthostatic Hypotension Explanation: Orthostatic hypotension, a common cause for falls, is an adverse effect related to tricyclic antidepressants like amitriptyline. Urinary retention (not frequency) is an adverse effect of amitriptyline but is not related to the falls. Visual disturbances are not a common adverse effect.

A group of nursing students are reviewing information about CNS stimulants. The students demonstrate understanding of the information when they identify which drug as being used to treat obesity?

Phentermine Explanation: This drug is a CNS stimulant used to treat obesity. This CNS stimulant is used to treat attention-deficit hyperactivity disorder. Modafinil is a CNS stimulant used to treat narcolepsy. Methylphenidate is a CNS stimulant used to treat attention-deficit hyperactivity disorder.

Misoprostol is contraindicated for clients with what condition?

Pregnancy Explanation:This drug is contraindicated during pregnancy because it is an abortifacient. The other options are incorrect.

When administering a prescribed analeptic, the nurse understands that this type of CNS stimulant stimulates which area? Select all that apply.

Respiratory center of the brain Cardiovascular system Explanation: Analeptics are CNS stimulant drugs that stimulate the respiratory center of the brain and cardiovascular system. Analeptics do not stimulate the limbic system, digestive, or endocrine systems.

A client diagnosed with multiple sclerosis-induced spasticity asks why deep tissue massages do not relieve the associated pain. What facts about spasticity should be the basis of the nurse's response?

Spasticity is caused by nerve damage in the brain and spinal cord, and it is a permanent condition. Explanation:Spasticity is caused by nerve damage in the brain and spinal cord. It is a permanent condition that may be painful and disabling. None of the other options accurately provide information regarding the treatment of this condition.

What type of laxative would be the first choice for a client diagnosed with hemorrhoids experiencing intense pain when straining to pass stools?

Stool Softener Explanation: For clients in whom straining is potentially harmful or painful, stool softeners (e.g., docusate sodium) are the agents of choice.

The nurse has learned that there is a high incidence of suicidal ideation in children and adolescents when using which of the following drugs?

Strattera Explanation: An increased risk of suicidal ideation in children and adolescents has been found when using the drug atomoxetine (strattera). The other drugs listed are analeptics and are not associated with the risk factor of suicide

A child with attention-deficit hyperactivity disorder is prescribed atomoxetine. The nurse would assess the child closely for which adverse reactions?

Suicidal ideation Explanation: Children and adolescents given atomoxetine (Strattera) should be monitored closely for suicidal ideations. Atomoxetine has not shown adverse effects of hypertension, dyspnea, or hyperglycemia.

The nurse is caring for a client who is vomiting and has a severe urinary tract infection. The nurse knows that which anti-infective can be given IV?

TMP/SMZ Explanation: Fosfomycin, nitrofurantoin and methenamine are all administered orally. TMP-SMZ can be administered both orally and IV.

The nurse is caring for a 27-year-old female client who has just been prescribed misoprostol. What is a priority teaching point for this client?

The need to use a barrier-type contraceptive Explanation: Women of childbearing age who use misoprostol should be advised to use barrier-type contraceptives. All other options are correct but are not the priority for this client.

The class of diuretics that act to block the chloride pump in the distal convoluted tubules and lead to a loss of sodium and potassium and a minor loss of water are the:

Thiazide Diuretics Explanation:Thiazide diuretics work to block the chloride pump, which leads to a loss of sodium and potassium and some water. They are considered mild diuretics. Carbonic anhydrase inhibitors work to block the formation of carbonic acid and bicarbonate in the renal tubules. Osmotic diuretics use hypertonic pull to remove fluid from the intravascular spaces and to deliver large amounts of water into the renal tubules. Potassium-sparing diuretics are mild and act to spare potassium in exchange for the loss of sodium and water.

The home health nurse is gathering a client's medication prior to going to see the physician. The nurse cannot find the bottle for the methylphenidate, Daytrana. What would be the reason for this

This is a transdermal patch medication Explanation: Daytrana is a transdermal patch, which delivers the medication slowly through the skin. Nurses do not normally misplace medications. Medications are kept in specific places with many safeguards in place for proper administration. Daytrana is not given IM or IV.

Which laboratory test should the nurse monitor to evaluate treatment effectiveness, when a client has been prescribed a medication to manage bladder spasms associated with a urinary tract infection?

Urine C&S Explanation:Monitor the results of laboratory tests, such as urinalysis and urine culture and sensitivity, to evaluate the effectiveness if UTI is the problem,and renal and hepatic function tests to determine the need for possible dose adjustment and to evaluate for possible toxicity. CBC monitors for overall health.

A female client is prescribed fosfomycin for a urinary tract infection (UTI). Which reported condition suggests an adverse effect of the medication?

Vaginal Itching Explanation: Adverse effects associated with urinary tract anti-infectives medications like fosfomycin include nausea, vomiting, diarrhea, anorexia, bladder irritation, dysuria, and vaginitis. The medication is not associated with any of the other conditions.

A child was diagnosed with attention-deficit hyperactivity disorder and methylphenidate was prescribed for treatment to be taken once a day in a sustained release form. On future visits what is a priority nursing assessment for this child?

Weight and Height Explanation: The nurse needs to carefully track this child's weight and height because the drug can cause weight loss, anorexia, and nausea that could result in slowed or absent growth. There would be no need to monitor breath sounds, respiratory rate, urine output, and kidney function. Although arrhythmias may occur as an adverse effect necessitating an ECG, there is no need to perform echocardiograms.

A client should be educated concerning the effect of combining theophylline with what chemical substance?

caffeine Explanation: Caffeine increases the effects of theophylline. Neither methylphenidate, atomoxetine nor modafinil is noted to have this effect.

A nurse has administered the first dose of didrex to a client for weight loss. The nurse should be monitoring for which side effects? Select all that apply.

headache nervousness apprehension disorientation excessive CNS stimulation Explanation: Some adverse effects seen when taking a CNS stimulant include those associated with the neuromuscular system, such as excessive CNS stimulation, headache, dizziness, apprehension, disorientation, and hyperactivity. Elevated blood glucose level is not a known side effect.

A nurse is working with a 39-year-old client who is experiencing muscle spasms associated with multiple sclerosis. The client reports needing help with basic care The client's health care provider has prescribed baclofen (Lioresal). The nurse and the client agree that an appropriate goal related to helping to maintain self-worth would be to:

increase self-care in activities of daily living Explanation: All of the options are goals that the nurse would like the client to achieve. However, the goal related to self-worth would be to increase self-care in activities of daily living. Loss of ability to dress oneself puts the client at risk for decreased self-esteem and feelings of low self-worth.

The nurse is caring for a black resident in a long-term care facility with a history of an anxiety disorder. The client is receiving oral lorazepam (Ativan) 2 mg t.i.d. What assessment should the nurse prioritize?

level of consciousness Explanation: Special care should be taken when anxiolytic or hypnotic drugs are given to black clients. About 15% to 20% of black clients are genetically predisposed to delayed metabolism of benzodiazepines. As a result, they may develop high serum levels of these drugs, with increased sedation and an increased incidence of adverse effects. Nurses should assess all clients for suicidal ideation, but there is no particular reason why this client's risk would be especially high. The nurse should assess the client's sleep quality, but this does not affect the client's safety level, like decreased level of consciousness. There is no particular reason for assessing the client's mucous membranes.

The nurse is seeing a pregnant client who has a confirmed urinary tract infection that requires treatment. Which anti-infective medication should the nurse anticipate will be prescribed for this client?

nitrofurantoin Explanation: Anti-infectives are contraindicated in patients with a hypersensitivity to the drugs and during pregnancy (pregnancy category C) and lactation. One exception is nitrofurantoin, which is classified as a pregnancy category B drug and is used with caution during pregnancy. Tartrazine is not an anti-infective but a food dye that is added to the anti-infective medication methenamine.

A nurse is planning teaching with a client who has had an anti-anxiety medication prescribed. A priority action for would be to:

try to identify and avoid factors that cause nervousness or insomnia. Explanation: The nurse should try to help the client identify and avoid factors that cause nervousness or insomnia, such as caffeine-containing beverages and stimulant drugs. This may prevent or decrease the severity of nervousness or insomnia so sedative-type drugs are not needed. The nurse would not tell the client to take their anti-anxiety medications just prior to going to bed or within 30 minutes of going to bed. The nurse would not teach the client to avoid factors that make the nurse go to sleep.