HESI Pharmacological and Parenteral Therapies
A client has a prescription for an antibiotic in an intravenous piggyback (IVPB) of 50 mL of D5W to run for 30 minutes. The microdrip tubing has a drop factor of 60 gtt/mL. At what rate should the nurse set the IV infusion? Record your answer using a whole number. ___gtts/min
100 (50mL*60gtt/mL)/30 minutes=100gtt/min
Dysmenorrhea is suspected in a client with symptoms including backache, diarrhea, syncope, and headache. After reviewing the data, the primary healthcare provider decides not to prescribe diclofenac. Which of these statements made by the client support this decision? Select all that apply. 1 "I am allergic to aspirin." 2 "I am allergic to penicillin." 3 "I have a history of kidney stones." 4 "I have a history of bleeding ulcers." 5 "I have a history of deep vein thrombosis."
"I am allergic to aspirin." "I have a history of bleeding ulcers." "I have a history of deep vein thrombosis." Backache, diarrhea, syncope, and headache are symptoms of dysmenorrhea. A nonsteroidal antiinflammatory drug, such as diclofenac, is the primarily prescribed drug, but it should not be given to a client who is allergic to aspirin. The drug is also contraindicated in clients with a history of bleeding ulcers. Because anticoagulants may be prescribed to the client with deep vein thrombosis, diclofenac use is contraindicated in a client with such a history. Penicillin allergy may not contraindicate the use of diclofenac. Renal calculi also may not contraindicate the use of diclofenac. Therefore a client with a history of renal calculi can likely be safely prescribed diclofenac for dysmenorrhea.
Loratadine, 10 mg by mouth once a day in the morning, is prescribed for a 15-year-old girl with hay fever. The girl tells the school nurse that she is concerned that she will be sleepy for a quiz the next day. How should the nurse respond? 1 By explaining that this medication rarely causes drowsiness 2 By advising her to take half a tablet in the morning before school 3 By suggesting that she skip the next day's dose if she can tolerate the hay fever 4 By recommending that she call the allergist for a prescription containing a stimulant
By explaining that this medication rarely causes drowsiness Loratadine causes little or no drowsiness or anticholinergic side effects. Even if the medication did cause drowsiness, the nurse does not have the legal authority to alter the prescribed dose. It is not necessary to call the allergist because loratadine rarely causes drowsiness.
While awaiting surgery, a client with a long history of Crohn disease is receiving total parenteral nutrition (TPN) on an outpatient basis. The nurse teaches the client that TPN helps to prepare for surgery by which process? 1 Decreasing fecal bulk 2 Preventing bowel infection 3 Providing stimulation of secretions 4 Maintaining negative nitrogen balance
Decreasing fecal bulk By decreasing fecal bulk and bowel stimulation, TPN provides rest for the bowel while the client awaits surgery. TPN does not prevent a bowel infection. TPN does not stimulate gastrointestinal secretions. TPN promotes positive nitrogen balance.
A 12-month-old infant is to receive ferrous sulfate for iron-deficiency anemia. How will the nurse administer the medication? 1 Through a straw 2 Crushed in applesauce 3 In an intramuscular injection 4 In a syringe directed toward the back of the mouth
In a syringe directed toward the back of the mouth Very young children should receive ferrous sulfate elixir through a syringe or medicine dropper placed in the back of the mouth; this limits staining of teeth by the ferrous sulfate. A 12-month-old infant may not be able to suck on a straw. A 12-month-old infant cannot swallow a tablet, and ferrous sulfate should not be crushed. Ferrous sulfate is not available in an injectable form.
A primary healthcare provider prescribes carbamazepine for a client. The nurse teaches the client about effects of the drug that should be reported to the primary healthcare provider. Which effects does the nurse include? Select all that apply. 1 Nausea or vomiting 2 Dizziness or drowsiness 3 Unusual bleeding or bruising 4 Sensitivity to bright light or sun 5 Breast enlargement or sexual dysfunction
Nausea or vomiting Unusual bleeding or bruising Nausea and vomiting may be side effects, or they may be signs of toxicity. The client should be evaluated by the primary healthcare provider. Carbamazepine can cause severe bone marrow depression; the client should have weekly complete blood counts for the first 4 weeks of therapy and every 3 to 6 months thereafter. Dizziness and drowsiness are common side effects of carbamazepine that do not require primary healthcare provider notification. The client should be cautioned not to engage in hazardous activities such as driving a car. Sensitivity to bright light or sun is not a side effect of carbamazepine. Neither breast enlargement nor sexual dysfunction is associated with carbamazepine.
A client with a parotid tumor that involves the lymph glands in the neck is prescribed vincristine, cyclophosphamide, and prednisone. The nurse should monitor the client for what adverse effect? 1 Peripheral paresthesia 2 Anginal-type chest pain 3 Ophthalmic papilledema 4 Bilateral crackles in the lung
Peripheral paresthesia Peripheral paresthesia is an indication of toxicity from a plant alkaloid such as vincristine. Anginal-type chest pain, ophthalmic papilledema, and bilateral crackles in the lung are not side effects of any of the drugs listed.
A client with Addison disease is receiving cortisone therapy. What complications does the nurse expect if the client abruptly stops the medication? Select all that apply. 1 Diplopia 2 Dysphagia 3 Tachypnea 4 Bradycardia 5 Hypotension
Tachypnea Hypotension Tachypnea occurs with addisonian crisis because inadequate circulating corticosteroids cause hypotension, pallor, weakness, tachycardia, and tachypnea. Double vision does not occur with addisonian crisis. Difficulty swallowing does not occur with addisonian crisis. Tachycardia, not bradycardia, occurs with addisonian crisis.
A client who is immunosuppressed is receiving filgrastim. When monitoring effectiveness, the nurse will check for an increase in which blood component? 1 Platelets 2 Erythrocytes 3 Thrombocytes 4 White blood cells
White blood cells Filgrastim, a granulocyte colony-stimulating factor, increases the production of neutrophils with little effect on the production of other blood components. The production of platelets is not stimulated by filgrastim. The production of erythrocytes is not stimulated by filgrastim. The production of thrombocytes is not stimulated by filgrastim.
A client with chronic undifferentiated schizophrenia is receiving an antipsychotic medication. For which potentially irreversible extrapyramidal side effect does a nurse monitor the client? 1 Torticollis 2 Oculogyric crisis 3 Tardive dyskinesia 4 Pseudoparkinsonism
Tardive dyskinesia Tardive dyskinesia occurs as a late and persistent extrapyramidal complication of long-term antipsychotic therapy. It is most often manifested by abnormal movements of the lips, tongue, and mouth. Torticollis, oculogyric crisis, and pseudoparkinsonism are reversible with administration of an anticholinergic (e.g., benztropine) or an antihistamine (e.g., diphenhydramine) or cessation of the medication.
A client with depression is to be given fluoxetine(Prozac). What precaution will the nurse consider when initiating treatment with this drug? 1 It must be given with milk and crackers to prevent hyperacidity and discomfort. 2 Eating cheese or pickled herring or drinking wine may cause a hypertensive crisis. 3 The blood level may not be sufficient to cause noticeable improvement for 2 to 4 weeks. 4 The blood level should be checked weekly for 3 months to monitor for an appropriate level.
The blood level may not be sufficient to cause noticeable improvement for 2 to 4 weeks. Fluoxetine does not produce an immediate effect; nursing measures must be continued to reduce the risk for suicide. Consuming milk and crackers to help prevent hyperacidity and discomfort is not necessary. Avoiding cheese, pickled herring, and wine is a precaution taken with the monoamine oxidase inhibitors. Weekly blood level checks are not necessary with fluoxetine.
The nursing student analyzes drug information on a chart after being taught about uterine stimulant medications. Which statement by the nursing student would indicate an understanding of the teaching?
The elimination half-life and peak plasma concentration of uterine stimulants are proportional. The statement made by the student that the elimination half-life and peak plasma concentration of uterine stimulants are proportional indicates an understanding of the teaching. Elimination half-life of a drug is the plasma concentration remaining when 50 percent of the drug plasma concentration has been eliminated. The nursing student would notice from the chart that the elimination half-life of the intravenous (IV) medication (Oxytocin) is 3 to 5 minutes versus the oral medication (Methylergonovine) which is 2 hours. Oxytocin shows an immediate and not a delayed onset of action because it is given IV. Methylergonovine does not show an immediate peak plasma concentration because oral medications require time for absorption. The elimination half-life of uterine stimulants is dependent and not independent of the peak plasma concentration because, by definition, a half-life is one half of the peak plasma concentration.
