HESI Pharmacology Exam Practice, Pharmacology Hesi, HESI: Pharmacology, Pharmacology HESI, Pharmacology hesi, Pharmacology HESI, Pharmacology HESI

Lioresal (Baclofen)

-muscle relaxant and CNS depressant -advise the patient to move carefully and to rise and walk slowly -assess the LOC -given intrathcally by pump (use test dose 1st) -SE: CNS depression, drowsiness, dizziness, hypotension

teaching for glucagon emergency kit

-once injection is given, patient should be placed on their left sides, as it is not uncommon for the patient to vomit -patient should become conscious within 15 minutes; if not 2nd injection can be given -go to ER

Esomeprazole (Nexium)

-proton pump inhibitor (PPI) for GERD, erosive esophagitis, Zollinger-Ellison syndrome -decrease risk of gastric ulcer during continuous NSAID therapy

Atropine

-this is the antidote for cholinergic crisis (OD) and drug-induced bradycardia -also the antidote for nerve gas poisoning and organophosphate poisoning found in insecticides

Ergotamine (Ergomar) , Dihydroergotamine (D.H.E 45, migranal)

-treatment of vascular headaches, including migraines with or without aura, cluster headaches -produces vasoconstriction of dilated blood vessels -used for migraine relief

Flu vaccine

-typically given IM in the deltoid (upper arm) muscle -recommended for everyone 6 months and older -does not contain the flu virus -SE: soreness, redness, and swelling at the site of injection; low grade fever; aches

Adderall (amphetamine/dextroamphetamine)

-used for the treatment of ADHD ***-time of dosage is once in the morning and then about 5 hours later*** -do NOT give at bedtime (insomnia) -XR is given once daily in the morning (half dose is released immediately and the remainder 4 hours later)

3

A client is started on tetracycline antibiotic therapy. What should the nurse do when administering this drug? 1 Administer the medication with meals or a snack. 2 Provide orange or other citrus fruit juice with the medication. 3 Give the medication an hour before milk products are ingested. 4 Offer antacids 30 minutes after administration if gastrointestinal side effects occur

1

A client newly diagnosed with type 2 diabetes is receiving glyburide and asks the nurse how this drug works. What mechanism of action does the nurse provide? 1 Stimulates the pancreas to produce insulin 2 Accelerates the liver's release of stored glycogen 3 Increases glucose transport across the cell membrane 4 Lowers blood glucose in the absence of pancreatic function

3

A client receiving intravenous vancomycin reports ringing in both ears. Which initial action should the nurse take? 1 Notify the primary healthcare provider. 2 Consult an audiologist. 3 Stop the infusion. 4 Document the finding and continue to monitor the client

1

A client who has been prescribed tetracycline continues the course of treatment during the first trimester of pregnancy. Which teratogenic effect may occur in the fetus? 1 Bone anomalies 2 Central nervous system malformations 3 Facial malformations 4 Internal organ defects

1

A client will be taking nitrofurantoin 50 mg orally every evening at home to manage recurrent urinary tract infections. What instructions should the nurse give to the client? 1 Increase the intake of fluids. 2 Strain the urine for crystals and stones. 3 Stop the drug if urinary output increases. 4 Maintain the exact time schedule for taking the drug

2

A client with a history of malabsorption syndrome is admitted to the hospital for medical management. Total parenteral nutrition (TPN) has been prescribed. What action will the nurse take to prevent a major reaction to the TPN infusion? 1 Record the intake and output. 2 Administer the infusion slowly. 3 Change the site every 24 hours. 4 Check the vital signs every 4 hours

1,2,3

A client with gastroesophageal reflux disease (GERD) receives a prescription for an H2 receptor antagonist. Which medications are within the classification of an H2 receptor antagonist? Select all that apply 1 Nizatidine 2 Ranitidine 3 Famotidine 4 Lansoprazole 5 Metoclopramide

3

A healthcare provider prescribes ampicillin for a client with an infection. What information should the nurse include in the teaching plan about this medication? 1 Take the ampicillin with meals. 2 Store the ampicillin in a light-resistant container. 3 Notify the healthcare provider if diarrhea develops. 4 Continue the drug until a negative culture is obtained

1

A healthcare provider prescribes an antibiotic intravenous piggyback twice a day for a client with an infection. The healthcare provider prescribes peak and trough levels 48 and 72 hours after initiation of the therapy. The client asks the nurse why there is a need for so many blood tests. What reason does the nurse provide? 1 "They determine adequate dosage levels of the drug." 2 "They detect if you are having an allergic reaction to the drug." 3 "The tests permit blood culture specimens to be obtained when the drug is at its lowest level." 4 "These allow comparison of your fever to when the blood level of the antibiotic is at its highest."

3

A nurse is administering a histamine H2 antagonist to a client who has extensive burns. The nurse explains to the client that this drug is given prophylactically during the first few weeks after extensive burns. What complication of burns will it prevent? 1 Colitis 2 Gastritis 3 Stress ulcer 4 Metabolic acidosis

What is right about cephalosporins?

"Cannot administer if patient has a past history of penicillin allergy"

The nurse is preparing to administer morning meds to a pt who has been newly diagnosed with tuberculosis. The patient ask, "Why do I have to take so many different drugs?" Which response by the nurse is correct?

"Taking multiple drugs reduces the chance that tuberculosis will become drug resistant."

Which OTC form or something would be absorbed the fastest-

"powders"

Celecoxib (Celebrex)

-COX-2 inhibitor (NSAID) for decreasing inflammation, reducing pain and fever -has a cross sensitivity reaction if someone is allergic to sulfa drugs -there is a increased risk of MI and stroke

Sulfonylureas names

-Glipizide (Glucotrol) -Glimepiride (Amaryl)

Discharge instructions for taking MDI?

-Rinse mouth after use of LABA -Consistently use a spacer with inhaler

ticarcilline/clavulanic acid (Timentin)

-broad spectrum (extended spectrum penicillin) -do NOT administer in same infusion with aminoglycosides

miotics

-cause pupil contriction (glaucoma) -reducing night vision; risk for injury

Antihistamines

-ex: diphenhydramine (Benadryl) -dcreases nasopharyngeal secretions by blocking H1 receptors -use cautiously with elderly, COPD, asthma, pneumonia -A major SE is sedation

SE of second generation Sulfonylureas

-hypoglycemia -weight gain -skin rash -nausea -vomiting -diarrhea

Cyclosporine (Gengraf, Neoral, Sandimmune)

-immunosupressant drugs indicated for the prevention of organ rejection (kidney, liver, heart transplant) -can cause nephrotoxicity and post-transplant diabetes millitus -avoid grapefruit juice

antidiuretic hormone (ADH)

-prevents excess fluid loss -patients with diabetes have insufficient amounts of this and produce large amounts of very dilute urine -***should have decreases urine output*** -watch for fluid overload; renal assessment

How likely is a person allergic to a penicillin to have cross-sensitivity to second-and third-generation cephalosporins?

0.05% or less

What is the acceptable dose range of morphine sulfate IV?

0.1-0.2 mg/kg

Therapeutic range digoxin:

0.5-2

Normal digoxin level

0.5-2 ng/mL

179.) A nurse provides medication instructions to a client who had a kidney transplant about therapy with cyclosporine (Sandimmune). Which statement by the client indicates a need for further instruction? 1. "I need to obtain a yearly influenza vaccine." 2. "I need to have dental checkups every 3 months." 3. "I need to self-monitor my blood pressure at home." 4. "I need to call the health care provider (HCP) if my urine volume decreases or my urine becomes cloudy."

1. "I need to obtain a yearly influenza vaccine." Rationale: Cyclosporine is an immunosuppressant medication. Because of the medication's effects, the client should not receive any vaccinations without first consulting the HCP. The client should report decreased urine output or cloudy urine, which could indicate kidney rejection or infection, respectively. The client must be able to self-monitor blood pressure to check for the side effect of hypertension. The client needs meticulous oral care and dental cleaning every 3 months to help prevent gingival hyperplasia.

32.) Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response? 1. Decreased urinary output 2. Decreased blood pressure 3. Decreased peripheral edema 4. Decreased blood glucose level

1. Decreased urinary output Rationale: Desmopressin promotes renal conservation of water. The hormone carries out this action by acting on the collecting ducts of the kidney to increase their permeability to water, which results in increased water reabsorption. The therapeutic effect of this medication would be manifested by a decreased urine output. Options 2, 3, and 4 are unrelated to the effects of this medication.

171.) A nurse is preparing to administer furosemide (Lasix) to a client with a diagnosis of heart failure. The most important laboratory test result for the nurse to check before administering this medication is: 1. Potassium level 2. Creatinine level 3. Cholesterol level 4. Blood urea nitrogen

1. Potassium level Rationale: Furosemide is a loop diuretic. The medication causes a decrease in the client's electrolytes, especially potassium, sodium, and chloride. Administering furosemide to a client with low electrolyte levels could precipitate ventricular dysrhythmias. Options 2 and 4 reflect renal function. The cholesterol level is unrelated to the administration of this medication.

3.) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which of the following would indicate the presence of systemic toxicity from this medication? 1. Tinnitus 2. Diarrhea 3. Constipation 4. Decreased respirations

1. Tinnitus Rationale: Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with salicylism.

79.) Ibuprofen (Advil) is prescribed for a client. The nurse tells the client to take the medication: 1. With 8 oz of milk 2. In the morning after arising 3. 60 minutes before breakfast 4. At bedtime on an empty stomach

1. With 8 oz of milk Rationale: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs should be given with milk or food to prevent gastrointestinal irritation. Options 2, 3, and 4 are incorrect.

What is the therapeutic range of theophylline (theo-dur)?

10-20 mcg/mL--monitor levels to prevent toxicity

29.) A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions for the client and tells the client that the most likely time for a hypoglycemic reaction to occur is: 1. 2 to 4 hours after administration 2. 4 to 12 hours after administration 3. 16 to 18 hours after administration 4. 18 to 24 hours after administration

2. 4 to 12 hours after administration Rationale: Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.

146.) A client has begun therapy with theophylline (Theo-24). The nurse tells the client to limit the intake of which of the following while taking this medication? 1. Oranges and pineapple 2. Coffee, cola, and chocolate 3. Oysters, lobster, and shrimp 4. Cottage cheese, cream cheese, and dairy creamers

2. Coffee, cola, and chocolate Rationale: Theophylline is a xanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These include coffee, cola, and chocolate.

169.) Insulin glargine (Lantus) is prescribed for a client with diabetes mellitus. The nurse tells the client that it is best to take the insulin: 1. 1 hour after each meal 2. Once daily, at the same time each day 3. 15 minutes before breakfast, lunch, and dinner 4. Before each meal, on the basis of the blood glucose level

2. Once daily, at the same time each day Rationale: Insulin glargine is a long-acting recombinant DNA human insulin used to treat type 1 and type 2 diabetes mellitus. It has a 24-hour duration of action and is administered once a day, at the same time each day.

82.) A client is receiving meperidine hydrochloride (Demerol) for pain. Which of the following are side effects of this medication. Select all that apply. 1. Diarrhea 2. Tremors 3. Drowsiness 4. Hypotension 5. Urinary frequency 6. Increased respiratory rate

2. Tremors 3. Drowsiness 4. Hypotension Rationale: Meperidine hydrochloride is an opioid analgesic. Side effects include respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors.

139.) Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin neutral protamine Hagedorn (NPH) insulin daily. Which of the following prescription changes does the nurse anticipate during therapy with the prednisone? 1. An additional dose of prednisone daily 2. A decreased amount of daily Humulin NPH insulin 3. An increased amount of daily Humulin NPH insulin 4. The addition of an oral hypoglycemic medication daily

3. An increased amount of daily Humulin NPH insulin Rationale: Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus may need their dosages of insulin or oral hypoglycemic medications increased during glucocorticoid therapy. Therefore the other options are incorrect.

71.) After kidney transplantation, cyclosporine (Sand immune) is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1. Decreased creatinine level 2. Decreased hemoglobin level 3. Elevated blood urea nitrogen level 4. Decreased white blood cell count

3. Elevated blood urea nitrogen level Rationale: Nephrotoxicity can occur from the use of cyclosporine (Sandimmune). Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen (BUN) and serum creatinine levels. Cyclosporine is an immunosuppressant but does not depress the bone marrow.

154.) A nurse is reinforcing dietary instructions to a client who has been prescribed cyclosporine (Sandimmune). Which food item would the nurse instruct the client to avoid? 1. Red meats 2. Orange juice 3. Grapefruit juice 4. Green, leafy vegetables

3. Grapefruit juice Rationale: A compound present in grapefruit juice inhibits metabolism of cyclosporine. As a result, the consumption of grapefruit juice can raise cyclosporine levels by 50% to 100%, thereby greatly increasing the risk of toxicity. Grapefruit juice needs to be avoided. Red meats, orange juice, and green leafy vegetables are acceptable to consume.

129.) Megestrol acetate (Megace), an antineoplastic medication, is prescribed for the client with metastatic endometrial carcinoma. The nurse reviews the client's history and contacts the registered nurse if which diagnosis is documented in the client's history? 1. Gout 2. Asthma 3. Thrombophlebitis 4. Myocardial infarction

3. Thrombophlebitis Rationale: Megestrol acetate (Megace) suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. Megestrol is used with caution if the client has a history of thrombophlebitis. **megestrol acetate is a hormonal antagonist enzyme and that a side effect is thrombotic disorders**

27.) Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. A nurse reviews the client's medical record and would question the prescription if which of the following is noted in the client's history? 1. Neuralgia 2. Insomnia 3. Use of nitroglycerin 4. Use of multivitamins

3. Use of nitroglycerin Rationale: Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide in the corpus cavernosum of the penis, thus sustaining an erection. Because of the effect of the medication, it is contraindicated with concurrent use of organic nitrates and nitroglycerin. Sildenafil is not contraindicated with the use of vitamins. Neuralgia and insomnia are side effects of the medication.

56.) Heparin sodium is prescribed for the client. The nurse expects that the health care provider will prescribe which of the following to monitor for a therapeutic effect of the medication? 1. Hematocrit level 2. Hemoglobin level 3. Prothrombin time (PT) 4. Activated partial thromboplastin time (aPTT)

4. Activated partial thromboplastin time (aPTT) Rationale: The PT will assess for the therapeutic effect of warfarin sodium (Coumadin) and the aPTT will assess the therapeutic effect of heparin sodium. Heparin sodium doses are determined based on these laboratory results. The hemoglobin and hematocrit values assess red blood cell concentrations.

94.) The client with acquired immunodeficiency syndrome has begun therapy with zidovudine (Retrovir, Azidothymidine, AZT, ZDV). The nurse carefully monitors which of the following laboratory results during treatment with this medication? 1. Blood culture 2. Blood glucose level 3. Blood urea nitrogen 4. Complete blood count

4. Complete blood count Rationale: A common side effect of therapy with zidovudine is leukopenia and anemia. The nurse monitors the complete blood count results for these changes. Options 1, 2, and 3 are unrelated to the use of this medication.

144.) A client is taking docusate sodium (Colace). The nurse monitors which of the following to determine whether the client is having a therapeutic effect from this medication? 1. Abdominal pain 2. Reduction in steatorrhea 3. Hematest-negative stools 4. Regular bowel movements

4. Regular bowel movements Rationale: Docusate sodium is a stool softener that promotes the absorption of water into the stool, producing a softer consistency of stool. The intended effect is relief or prevention of constipation. The medication does not relieve abdominal pain, stop gastrointestinal (GI) bleeding, or decrease the amount of fat in the stools.

99.) The client with acquired immunodeficiency syndrome and Pneumocystis jiroveci infection has been receiving pentamidine isethionate (Pentam 300). The client develops a temperature of 101° F. The nurse does further monitoring of the client, knowing that this sign would most likely indicate: 1. The dose of the medication is too low. 2. The client is experiencing toxic effects of the medication. 3. The client has developed inadequacy of thermoregulation. 4. The result of another infection caused by leukopenic effects of the medication.

4. The result of another infection caused by leukopenic effects of the medication. Rationale: Frequent side effects of this medication include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of infection. Options 1, 2, and 3 are inaccurate interpretations.

140.) The client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition? 1. Intestinal obstruction 2. Peptic ulcer with melena 3. Diverticulitis with perforation 4. Vomiting following cancer chemotherapy

4. Vomiting following cancer chemotherapy Rationale: Metoclopramide is a gastrointestinal (GI) stimulant and antiemetic. Because it is a GI stimulant, it is contraindicated with GI obstruction, hemorrhage, or perforation. It is used in the treatment of emesis after surgery, chemotherapy, and radiation.

An HDL of ____ or higher reduces heart disease risk

60mg/dL

Cholinergic effects

A anticholinesterase drug has what kind of effects?

1

A client is receiving antibiotics and antifungal medications for the treatment of a recurring vaginal infection. What should the nurse encourage the client to do to compensate for the effect of these medications? 1 Eat yogurt with active cultures daily. 2 Avoid spicy foods. 3 Drink more fruit juices. 4 Take a multivitamin every day

Carbonic Anhydrase Inhibitors CAI

A diuretic that can induce metabolic/respiratory acidosis Elevate blood glucose

What should a nurse teach to a patient who will begin taking enapril malteat (vasotec)?

ACE INHIBITOR that causes antihypertensive efffect--Change positions slowly for orthostatic hypotension

Bismuth

Adsorbant Use in caution with children, chickenpox/flu Avoid Aspirin (potentiates effects)

How to counteract the side effects of Niacin?

Advise pt to take Asa or NSAID 30 mins prior

Clozapine (clozaril) is known to cause what adverse reaction?

Agranulocytosis--monitor WBC count

Individuals taking metronidazole (Flagyl) must avoid which of the following substances or suffer severe headache with nausea and vomiting?

Alcohol

Drug Interactions of Opioids

Alcohol, antihistamines, barbiturates, benzodiazepines, phenothiazine, and other central nervous system depressants can result in additive respiratory-depressant effects. Monoamine oxidase inhibitors can result in respiratory depression and hypotension.

Potassium Sparing Diuretic

Aldalactone (spironolactone)

-azosin

Alpha blockers ex: doxazosin, prazosin major complication: first-dose effect, reflex tachycardia

Tricyclic (TCAs)

Amitriptyline (Elavil) adverse effects: dry mouth, tachycardia, constipation, retention, reflux, orthostatic hypotension Administer at night Contraindicated with cardiac disease

Gabapentin (Neurontin)

An anti epileptic also used to treat neuropathic pain

Atropine

An anticholinergic drug given preoperatively to dry secretions

Antidiarrheal drug that acts by decreasing peristalsis and muscular tone of the intestine, thus slowing the movement of substances through the GI tract

Anticholenergics (severe)

Adverse effects of fibric acid derivatives

Antilipemic: Gemfibrozil (Lopid): Diarrhea, HA, blurred vision

rifa-

Antituberculars ex: rifampin consideration: noncomplicance is an issue

What antiplatelet is recommended for stroke prevention?

Aspirin

Valproic Acid and Derivative

Aspirin may increase amount of free drug and result in hepatotoxicity

Calan (verapamil) is used for

Atrial fibrillation and flutter, SVT

What drug should be given after a noticed bradycardia r/t digitalis toxicity?

Atropine which blocks vagus nerve stimulation to allow increased sinus node conduction to increase heart rate from bradycardia

What are the side effects of Viagra?

Back pain Dizziness Flushing Headache Indigestion Muscle aches Nausea Stuffy or runny nose

An antibiotic that inhibits protein synthesis in a microorganism but does not kill the organism is known as what type of agent?

Bacteriostatic

Which of the following is a characteristic of tetracycline?

Bacteriostatic

MOA of Metoclopramide HCl (Reglan)

Blocks dopamine--risk for EPS

What color is dobutamine?

Brown

-calci-

Calcium & Vitamin D supplements ex: calciferol, ergocalciferol

First line anti epileptics

Carbamazepin (tergetrol) Pehnobarbital Phenytoin Valproic acid

A client is receiving pyridostigmine bromide (Mestinon) to control the symptoms of myasthenia gravis. Which client behavior would indicate that the drug therapy is effective?

Clear speech--this shows increased muscle strength

Sedative-Hypnotic Benzodiazepines

Clonazepam (Klonopin) Diazepam (Valium) Alprazolam (Xanax) Lorazepam (Ativan) Temazepam (Restoril) Midazolam (Versed) Triazolam (Halcion)

Adenosine

Converts to sinus rhythm

What is the antidote for digoxin toxicity?

Digibind

What is the DOC for heart failure?

Digoxin (lanoxin)

Other antidyrhythmic drugs:

Digoxin, Adenosine

Antagonist

Drug binds to a receptor to prevent a response

2

During a teaching session about insulin injections, a client asks the nurse, "Why can't I take the insulin in pills instead of taking shots?" What is the nurse's best response? 1 "Insulin cannot be manufactured in pill form." 2 "Insulin is destroyed by gastric juices, rendering it ineffective." 3 "Your health care provider decides the route of administration." 4 "Your health care provider will prescribe pills when you are ready."

3

During the administration of total parenteral nutrition (TPN), an assessment of the client reveals a bounding pulse, distended jugular veins, dyspnea, and cough. What is the priority nursing intervention? 1 Restart the client's infusion at another site. 2 Slow the rate of the client's infusion of the TPN. 3 Interrupt the client's infusion and notify the healthcare provider. 4 Obtain the vital signs and continue monitoring the client's status

Tricyclic Antidepressants

Effective, but used judiciously due to side effects and lethal overdose

A type of laxative that softens the stool

Emollient

Thirty minutes after administering trimethobenzamide (tigan) to a client with nausea, the nurse observes that the client is sedated, but arouses, easily and denies further nausea. Which action should the nurse implement?

Encourage the client to rest until feeling more alert.

A male client reveives a scopolamine transdermal patch 2 hours prior to surgery. Four hours after surgery, the client tells the nurse that he is experiencing pain and asks why the patch is not working. What action should the nurse take?

Explain that the medication is not given to prevent pain.

during a home visit, the nurse assesses a client with Alzheimer's Disease who recently started a new prescription for rivastigmine (exelon). The caregiver reports that the client seems to be thinking more clearly, but is not sleeping well at night. Which action should the nurse take?

Explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started.

Pilocarpine hydrochloride (pilocar) for chronic glaucoma eye drops. How does this drug work?

Facilitate the outflow of aqueous humor

Cyclobenzaprine (Flexeril) increases the patients risk for

Falls: r/t altered sensorium

What is an indication for haloperidol (haldol)

For agitation, violence, and bizarre thoughts associated w/ dementia

-tidine

H2 blockers

A pt with migraines is being evaluated. One potential tx is ergotamine tabs. What medical condition is a contraindication?

HTN Glaucoma Coronary Heart Disease Peripheral Vascular Disease

What activity contraindicated for a patient on antihypertensive medications?

Hot baths--too much vasodilation

take apical pulse for one full minute

How do you assess for the positive inotrope and negative chronotrope of digoxin?

take the first puff then wait 1 to 2 minutes and take the next (2nd) puff

How do you take 2 puffs of inhalers with the same med?

Vasodilators

Hydralazine, diazoxide, and nitroprusside *first line for hypertensive emergency*

What is the DOC for pain for a patient with pancreatitis?

Hydromorphone (dilaudid) or demerol (meperidine)

Adverse affect of Venofer (Iron sucrose)

Hypotension

Something with patient taking some kind med and has been getting watery diarrhea for the past 10

I chose the answer with something that said "may be developing superinfection"

Where is the DPT injection done in infants younger than 2 yrs?

IM--vastus lateralis

Thiazide Diuretics

Inhibit water/sodium reabsorption (HCTZ)

How does allopurinol (zyloprim) act on gout?

Inhibits uric acid formation

Which nursing action has the highest priority when administering a dose of codeine with acetaminophen to a client?

Instruct the client to request assistance when ambulating to the bathroom.

MAOIS

Isocarboxazid (Marplan) *do not take with SSRIs May cause hypertensive crisis if people eat foods containing tyramine

Sodium Polystyrene Sulfonate-results

It is very important that PN report 1-2 watery stools to the physician

A patient with rheumatoid arthritis is placed on methotrexate. What lab studies should be monitored regularly?

Liver enzymes (AST and ALT)

What type of diuretic is useful when rapid diuresis is desired?

Loop (furosemide)

Treatment resistant depression may recieve

MAOIs or methylphenidate

What type of antacid causes diarrhea

Magnesium: milk of magnesia

Osmotic Diuretics

Mannitol (rapid diuresis)

What drug is used for conscious sedation?

Midalozam (versed)

Feverfew is used for

Migraine Headache

What will decrease the absorption of tetracycline?

Milk

Valsartan ( Diovan) angiotensin II receptor antagonist which parameter should the PN monitor to evaluate therapeutic response to this drug?

Monitor the BP

Somatic Pain

Muscle or tissues

-profen

NSAIDs

The physician has ordered orlistat (Xenical). What condition is this used to treat?

Obesity

Ambien

PN should decrease any external stimuli to provide a quiet restful environment

What is the nurse's main priority when a medication error has occurred?

Patient safety

What is a secondary use of anticonvulsants

Peripheral Neuropathy pain

Beta Blockers

Peripherally acting propanolol, metoprolol, atenolol

Generic name of a first line antiepileptic drug which can cause gingival hyperplasia with long term use

Phenytoin

Another word for intestinal flora modifier

Probiotic

Parietal Cells

Produce HCL

What is the antidote for heparin?

Protamine sulfate

What is the antidote for heparin

Protamine sulfate IV

How should the PN administer the ear drops for the child?

Pull the ear down and back

Chemotherapy--daunorubicin HCl (Cerubidine) sign of effective treatment

Red urine

Missed dose of Amphetamine

Resume the medication dosing schedule with the noon dose

Chloramphenicol (Chloromycetin)

Risk for irreversible, fatal bone marrow depression The nurse should monitor the client's platelet count

What is the first line treatment for depression?

SSRIs

Treatment for anxiety disorders include

SSRIs and benzodiazipine (increased risk for falls in elderly)

What drug would be ordered for treating mild to moderate Crohn's disease without systemic manifestations?

STEROIDS--Budesonide (entocort) PO

Laxative that increases osmotic pressure

Saline

What is the therapeutic response of Keratolytic properties to a client with psoriasis?

Scaley areas of the skin appear softer with less peeling

Side effect of linezolid (Zyvox)

Severely watery diarrhea

respiratory conditions

Since a beta blocker is cardio- selective you want to also assess what prior to administering?

Superficial Pain

Skin and mucous membranes

A highly soluble antacid form with a quick onset but short duration of action

Sodium bicarbonate

Potassium Sparing diuretics

Spironolactone

sulf-

Sulfonamides (antibiotics) ex: sulfadiazine s/e: crystalluria (maintain adequate hydration)

Mr. Jones, age 37, is HIV-positive, and ciprofloxacin (a quinolone) has been ordered for him. In addition to making sure he drinks 8 full glasses of water a day to prevent crystalluria, you are aware that you need to be observant for the possible development of:

TSS Quinolones can cause a toxic shock-like syndrome with a diffuse, nonpuritic rash, fever, and hypotension in patients who are HIV positive.

Which antibiotic should be avoided in children because it causes permanent staining of the teeth?

Tetracycline

Dronabinol (Marinol)

Tetrahydrocannabionoid derived from marijuana

Haloperidol (Haldol) controls...

Tics and vocalizations

The nurse is reviewing a pts medication administration record. What is a common use for doxapram (Dopram)?

To treat drug-induced respiratory depression (COPD)

Serotonin Antagonists and Reuptake inhibitors

Trazodone (Desyrel) for sedation

Urine culture vs urine analysis....which one is more specific?

Urine culture

What test is done to check for UTI?

Urine culture test--do this before administering abx

Serotonin Receptor Agonists

Used to treat migraines (sumatriptan: Imitrex)

Lidocaine is used for

Ventricular dysrhythmias

What is the antidote for warfarin

Vitamin K (phytonadione)

4-12 mcg/mL

WHat is carbamazepine (Tegretol) serum level?

Sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra)

What are the drugs that are used for erectile dysfunction?

-pam -lam

What do benzodiazepine drugs end with?

chronic pain

What is morphine sulfate continued release used for?

an insulin syringe (measured in units)

What is the ONLY type of syringe that can be used when giving insulin?

get a medication history because many drugs can interact with antidepressants

When giving antidepressants what do you ALWAYS want to do?

Atomoxetine (Strattera)

Which drug is linked with increased suicidal thinking and behaviors in adolescents?

2

Which information should be included in the teaching plan for the elderly client with peptic ulcer disease who is taking an antacid and sucralfate? 1 Antacids should be taken 30 minutes before a meal. 2 Sucralfate should be taken on an empty stomach one hour before meals. 3 Sucralfate is prescribed for the long-term maintenance of peptic ulcer disease. 4 Sodium bicarbonate is an inexpensive over-the-counter antacid with few adverse effects

A client receiving the urinary antispasmodic oxybutynin CL (Ditropan XL) reports having an extremely dry mouth. How should the nurse respond?

You can suck on hard candy to help relieve the mouth dryness, which is a common side effect.

When a second drug is given with a primary analgesic to enhance the analgesic effect it is being used as an

adjuvant

Mydriatics

agents used to produce dilation of pupils for eye exams and ocular surgery

A patient taking phenobarbital must not ingest

alcohol

-micin

aminoglycosides (antibiotics) complications: ototoxicity, nephrotoxicity considerations: parental, topical admin only

-mycin

aminoglycosides/Macrolides (antibiotic) macrolide complications: QT prolongation, thrombophlebitis when admin IV (dilute and admin slowly)

-triptan

anti-migranes

-ciclovir

antivirals

-cyclovir

antivirals

-barbital

barbituates (sedative-hypnotics) ex: amobarbital, pentobarbital

-lam

benzodiazepines

-lol

beta blockers

Tiotropium (Spiriva)

bronchodilator used in LT maintenance of COPD; given by inhaler; rinse mouth after inhaler use

-terol

bronchodilators s/e: tremor and tachycardia

-dipine

calcium channel blockers major adverse effect(s): acts on blood vessels which can trigger baroreceptor refelx thus increasing BP

Beta Blockers are used with caution in diabetics due to

causing hyper/hypoglycemia

Cyclobenzaprine (Flexeril)

centrally acting muscle relaxant

Cef- or Ceph-

cephalosporins (antibiotics) ex: cefadroxil, cephalexin

-stigmine

cholingerics

Anticholinerics, Antihistamins, and benzodiazepines can all cause

confusion

The major reason neuroleptics such as haloperidol (haldol) may be used for treating patients w/ severe psychiatric disorder is to...

decrease psychotic symptoms

Side effects of Anti-parkinson drugs

delirium, orthostatic hypotension

Thiazide diuretics interact with

digitalis, hypoglycemics, and corticosteroids

Milrinone (Primacor) is used in HF, but can cause

dysrhythmias

-ergot-

ergotamines (anti-migraine)

Benztropine (Cogentin)

for Parkinson's disease and treatment of extrapyramidal symptoms (EPS) also called parkinsonism -anticholinergic -common SE include blurred vision, urinary retention (Parkinson's meds).

Penicillin is ineffective for the treatment of primary atypical pneumonia because the causative organism (Mycoplasma pneumoniae):

has no peptidoglycan layer. Penicillins (and cephalosporins) kill bacteria by altering the peptidogylcan layer in the cell wall. Mycoplasma pneumoniae will not respond to penicillin because the organism does not have a cell wall.

take the bronchodilator first then wait 2 to 5 minutes before you take the other one

how do you take 2 puffs of inhalers with two different meds?

Rifampin is known to stimulate the hepatic metabolism of many other drugs. This is called enzyme

induction

Which drug does the CDC now recommend for the treatment of Clostridium difficile infection?

metronidazole (Flagyl)

-zoline

nasal decongestants s/e: rebound congestion

-curium

neuromuscular blockers

-curonium

neuromuscular blockers

In giving patients an antibiotic, the nurse must:

observe the patient for 15 to 20 minutes after administration of the drug.

A superinfection is an infection that:

occurs when normal body flora are altered by an antibiotic.

Aminoglycosides such as gentamycin may cause:

ototoxicity and nephrotoxicity

What labs must be monitored with a pt newly taking an ACE Inhibitor

potassium (hyperkalemia)

-actone

potassium-sparing diuretic ex: spironolactone, aldactone major complication: hyperkalemia

Warfarin is used for

prevention

One patient has cancer of the bone; another has cancer in the connective tissues of the thigh muscles; a third patient has cancer in the vascular tissues. These patients have a type of tumor referred to as a-

sarcoma

A hypnotic causes

sleep

Referred Paine

spinal cord

-ine

stimulants

Trimethoprim is given most commonly in combination with which other drug to increase the bacteriocidal potential?

sulfamethoxazole

-cycline

tetracyclines (antibiotic) adverse effects: permanent discoloration of teeth, photosensitivity. Notify HCP if diarrhea occurs

Mabel G., age 61, started taking calcium carbonate (Tums) as a calcium supplement last year. Yesterday, enteric-coated erythromycin tablets were prescribed for the treatment of Mycoplasma pneumoniae. You tell her not to take Tums within 2 hours of the erythromycin because:

the Tums will dissolve the enteric coating on the erythromycin in the stomach, and she will experience gastric distress.

N/V, amenorrhea, spotting, edema, weight gain or loss, rash fever, insomnia, depression ***most serious is liver dysfunction and thromboembolic disorders such as PE***

what are the adverse effects of Medroxyprogesterone (Depo-Provera)?

can cause addiction, patients experience withdrawal symptoms

what can happen with long term use of antidepressants?

219.) A health care provider instructs a client with rheumatoid arthritis to take ibuprofen (Motrin). The nurse reinforces the instructions, knowing that the normal adult dose for this client is which of the following? 1. 100 mg orally twice a day 2. 200 mg orally twice a day 3. 400 mg orally three times a day 4. 1000 mg orally four times a day

3. 400 mg orally three times a day Rationale: For acute or chronic rheumatoid arthritis or osteoarthritis, the normal oral adult dose is 400 to 800 mg three or four times daily.

A patient is receiving a third session of chemotherapy with daunorubicin (Cerubidine). The nurse will assess the patient for which signs of a potential severe toxic effect of this drug?

"A weight gain of 2 pounds or more in 24 hours"

Patient education on theophylline (theo-dur)

-Maintain adequate fluid intake -Report signs of toxicity: N/V, tremors, nervousness, and seizures

Verapamil (Calan) and Diltiazem (Cardizem)

-These 2 calcium channel blocker also affect the heart. So you wnat to monitor BP and for a decrease in HR. -SE: constipation -Avoid grapefruit juice

Heparin

-a high alert medication -requires another nurse to check the dosage -a potential SE would be bleeding

Flucanazole (Diflucan)

-antifungal for vaginal candidiasis (yeast infection) -many antifungals can cause liver injury (hepatotoxicity) -monitor LFTs

Acyclovir (Zovirax)

-antiviral for treatment of HSV-1 and HSV-2, varicella zoster virus (shingles) & chickenpox. -Patient's with HSV-2 (genital herpes) should avoid sexual intercourse.

Labetalol

-beat blocker for hypertension -notify prescriber for a low pulse rate and do NOT give the med -SE: weight gain (fluid retention) -monitor weight is the best thing you can do to know if there has been a fluid gain or loss

Nitrofurantoin (Macrodantin)

-broad spectrum antibiotics for treating UTIs -SE: heaptotoxicity, skin reactions, neuropathy -Nursing consideration: give with milk or meals -check LFTs ***watch for numbness and tingling of extremities (irreversible peripheral neuropathy)***

laxative use

-bulk forming need to be given with plenty of fluid--> can produce esophogeal and/or intestinal obstruction -ASSESS: last BM and characteristics, abdominal pain, fever, obstruction -ASSESS: dietary and fluid intake -encourage fluids, fiber and exercise

Cefepime (Maxipime)

-cephalosporin antibiotic -GI SE such as nausea

SE of opioids

-constipation -pruritis -urinary retention -decreased BP and heart rate

drugs for erectile dysfunction

-contraindicated with nitrates/nitroglycerin (potent vasodilator) to include isosorbide dinitrate (Isodil) and isosorbide mononitrate (Imdur)

Succinycholine (Anectine)

-depolarizing nerumuscular blocker (NMB) and used during surgery (produces paralysis) -may cause v-tach/dysrhythmias -check respiratory status

Dantolene (Dantrium)

-direct acting muscle relaxant -does not produce CNS depression -used to also treat malignant hyperthermia (severe genetic SE from general anesthesia)

SE of furosemide (Lasix)

-dizziness, -headache -tinnitus -Nausea, vomiting, diarrhea -decreased potassium -hyperglycemia -ototoxicity with aminoglycosides (-mycin drugs)

Topical/inhaled adrenergics (decongestants)

-do not want to use longer than 3-5 days -can produce rebound congestion -taper by alternating nostrils

9.) The nurse is applying a topical corticosteroid to a client with eczema. The nurse would monitor for the potential for increased systemic absorption of the medication if the medication were being applied to which of the following body areas? 1. Back 2. Axilla 3. Soles of the feet 4. Palms of the hands

2. Axilla Rationale: Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions in which permeability is poor (back, palms, soles).

199.) A nurse is applying a topical glucocorticoid to a client with eczema. The nurse monitors for systemic absorption of the medication if the medication is being applied to which of the following body areas? 1. Back 2. Axilla 3. Soles of the feet 4. Palms of the hands

2. Axilla Rationale: Topical glucocorticoids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axillae, face, eyelids, neck, perineum, genitalia), and lower from regions where penetrability is poor (back, palms, soles). **Eliminate options 3 and 4 because these body areas are similar in terms of skin characteristics**

45.) A client has a prescription to take guaifenesin (Humibid) every 4 hours, as needed. The nurse determines that the client understands the most effective use of this medication if the client states that he or she will: 1. Watch for irritability as a side effect. 2. Take the tablet with a full glass of water. 3. Take an extra dose if the cough is accompanied by fever. 4. Crush the sustained-release tablet if immediate relief is needed.

2. Take the tablet with a full glass of water. Rationale: Guaifenesin is an expectorant. It should be taken with a full glass of water to decrease viscosity of secretions. Sustained-release preparations should not be broken open, crushed, or chewed. The medication may occasionally cause dizziness, headache, or drowsiness as side effects. The client should contact the health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache.

214.) A health care provider initiates carbidopa/levodopa (Sinemet) therapy for the client with Parkinson's disease. A few days after the client starts the medication, the client complains of nausea and vomiting. The nurse tells the client that: 1. Taking an antiemetic is the best measure to prevent the nausea. 2. Taking the medication with food will help to prevent the nausea. 3. This is an expected side effect of the medication and will decrease over time. 4. The nausea and vomiting will decrease when the dose of levodopa is stabilized.

2. Taking the medication with food will help to prevent the nausea. Rationale: If carbidopa/levodopa is causing nausea and vomiting, the nurse would tell the client that taking the medication with food will prevent the nausea. Additionally, the client should be instructed not to take the medication with a high-protein meal because the high-protein will affect absorption. Antiemetics from the phenothiazine class should not be used because they block the therapeutic action of dopamine. **eliminate options 3 and 4 because they are comparable or alike**

83.) The client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept (Enbrel), it is most important for the nurse to check: 1. The injection site for itching and edema 2. The white blood cell counts and platelet counts 3. Whether the client is experiencing fatigue and joint pain 4. A metallic taste in the mouth, with a loss of appetite

2. The white blood cell counts and platelet counts Rationale: Infection and pancytopenia are side effects of etanercept (Enbrel). Laboratory studies are performed before and during drug treatment. The appearance of abnormal white blood cell counts and abnormal platelet counts can alert the nurse to a potentially life-threatening infection. Injection site itching is a common occurrence following administration. A metallic taste with loss of appetite are not common signs of side effects of this medication.

14.) The client with acute myelocytic leukemia is being treated with busulfan (Myleran). Which laboratory value would the nurse specifically monitor during treatment with this medication? 1. Clotting time 2. Uric acid level 3. Potassium level 4. Blood glucose level

2. Uric acid level Rationale: Busulfan (Myleran) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute renal failure. Options 1, 3, and 4 are not specifically related to this medication.

106.) Fluoxetine (Prozac) is prescribed for the client. The nurse reinforces instructions to the client regarding the administration of the medication. Which statement by the client indicates an understanding about administration of the medication? 1. "I should take the medication with my evening meal." 2. "I should take the medication at noon with an antacid." 3. "I should take the medication in the morning when I first arise." 4. "I should take the medication right before bedtime with a snack."

3. "I should take the medication in the morning when I first arise." Rationale: Fluoxetine hydrochloride is administered in the early morning without consideration to meals. **Eliminate options 1, 2, and 4 because they are comparable or alike and indicate taking the medication with an antacid or food.**

11.) The health care provider has prescribed silver sulfadiazine (Silvadene) for the client with a partial-thickness burn, which has cultured positive for gram-negative bacteria. The nurse is reinforcing information to the client about the medication. Which statement made by the client indicates a lack of understanding about the treatments? 1. "The medication is an antibacterial." 2. "The medication will help heal the burn." 3. "The medication will permanently stain my skin." 4. "The medication should be applied directly to the wound."

3. "The medication will permanently stain my skin." Rationale: Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not stain the skin.

163.) A client with trigeminal neuralgia tells the nurse that acetaminophen (Tylenol) is taken on a frequent daily basis for relief of generalized discomfort. The nurse reviews the client's laboratory results and determines that which of the following indicates toxicity associated with the medication? 1. Sodium of 140 mEq/L 2. Prothrombin time of 12 seconds 3. Platelet count of 400,000 cells/mm3 4. A direct bilirubin level of 2 mg/dL

4. A direct bilirubin level of 2 mg/dL Rationale: In adults, overdose of acetaminophen (Tylenol) causes liver damage. Option 4 is an indicator of liver function and is the only option that indicates an abnormal laboratory value. The normal direct bilirubin is 0 to 0.4 mg/dL. The normal platelet count is 150,000 to 400,000 cells/mm3. The normal prothrombin time is 10 to 13 seconds. The normal sodium level is 135 to 145 mEq/L.

4

A client who has a gastric ulcer asks what to do if epigastric pain occurs. The nurse evaluates that teaching is effective when the client makes which statement? 1 "Eliminating fluids with meals will prevent pain." 2 "I will increase my food intake to avoid an empty stomach." 3 "Taking an aspirin with milk will relieve my pain and coat my ulcer." 4 "Taking an antacid preparation will decrease pain due to gastric acid."

Autoinduction

A metabolic process in which a drug stimulates the production of enzymes that enhance its own metabolism over time, which leads to a reduction in therapeutic drug concentrations

What antihypertensive is known for its benefits in protecting kidneys and preventing diabetic neuropathy

ACE Inhibitor

Expectorant

Acetylcysteine (Mucomyst) Increase fluid intake and watch for GI upset

Loop Diuretics

Act on loop of henle: Furosemide

Class II antidysrhythmic drugs

Beta blockers

Agonist

Binds to a receptor and causes a response

Norepinephrine Dopamine Reuptake Inhibitor (NDRIs)

Bupropion (Wellbutrin/Zyban)

A male patient taking antihypertensive dry methyldopa (aldomet). This drug is known to cause what adverse reaction?

Decreased erectile ability

Which intervention is most important for a nurse to implement prior to administering atropine PO?

Determine the presence of 5 to 35 bowel sounds/min.

Hypnotic

Drugs that, when given at low to moderate dosages, calm the CNS. Can cause sleep at high doses and are much more potent than sedatives

Eye GTTS- Glaucoma

Eye drops are used to decrease eye pressure, but it does not restart it.

What happens when antabuse is taken with alcohol?

Flushing, headache, nausea, vomiting, and sweating

-navir

HIV/AIDS antiviral

Give epinephrine to open airway

If a patient id wheezing after the first dose of penicillin what do you want to do to treat it?

The nurse is administering a combination of three different antineoplastic drugs to a patient who has metastatic breast cancer. Which statement best describes the rationale for combination therapy?

Increased cancer-cell killing will occur

Class I antidysrhythmic drugs

Membrane stabilizaing (sodium channel blocker) quinidine, procainaminie, phenytoin, lidocaine

What is the nursing measures for Mannitol ( Osmitol )

Monitor the urinary output

A barbiturate used primarily to control tonic-clonic and partial seizures

Phenobarbital

Pseudomonas can change urine to what color?

Purple

Neuropathic pain

Results from damage to peripheral or CNS nerve fibers

Chief Cells

Secrete Pepsinogen (enzyme)

How should the nurse explain how a sulfonyura drug works for a newly diagnosed type 2 DM patient?

Stimulate pancreatic cells to produce insulin

Proton Pump Inhibitors (PPIs)

What are the only drugs that can be taken with antacids?

restless leg syndrome (RLS)

What is caused by iron deficiency and vitamin D deficiency?

decreases heart rate

What is the negative chronotrope for Digoxin do?

increases force of contraction

What is the positive inotrope for Digoxin do?

-stine

anti-tumor major complication: cardiotoxicity

-pam

benzodiazepines

Heparin is used for

treatment and prevention (hospital prophylaxis)

Methadone (Dolophine)

treatment of breakthrough pain. Half-life is longer than duration of action. With repeated doses drug accumulates in the tissues, which is then slowly released. Allows for 24-hour dosing.

-triptyline

tricyclics (antidepressants)

-take in the morning (diuretics in morning if possible) -avoid salt substitutes, ACE inhibitors, ARBs -often take with other (thiazide) diuretics to treat edema, hypertension, heart failure -can be taken with other meds that lower potassium

what do you want to teach a patient who is on a potassium sparing diuretic?

Nursing Implications of Opioids

¬ Assess vital signs (blood pressure, pulse, respirations, and pain level) prior to administration. ¬ Withhold medication if respiratory rate is <12 breaths/minute or systolic blood pressure is <90. ¬ Administer oral medications with food to decrease nausea and vomiting. ¬ Monitor urinary output and bowel status. ¬ Institute safety precautions (i.e., side rail up, call bell in place).

A patient is receiving her third course of 5-fluorouracil therapy and knows that stomatitis is a potential adverse effect of antineoplastic therapy. What will the nurse teach her about managing this problem?

"Be sure to examine your mouth daily for bleeding, painful areas, and ulcerations."

.A female client is being treated for tuberculosis with rifampin (rifadin). Which statement indicates that further teaching is needed?

"I'll take my usual oral contraceptives for birth control."

The nurse is providing education regarding chemotherapy to a patient who is about to receive the first course of treatment. Which statement by the nurse is appropriate?

"Report black, tarry stools if they occur."

Avoid drug that interacts with tetracyclines-

"antacids"

Patient has painful mouth sores, what should the patient do?

"avoid acidic juices"

Something else with what to avoid while on tetracycline-

"avoid sunlight exposure" something like that

Doxorubicin-

"cardiomyopathy"

Nonspecific cell cycle-

"cytoxic cells...at any phase"

ARBs

(Cozaar) Losartan, valsartan, less symptoms than ACE

Pregabalin (Lyrica)

-Nonopioid analgesic for peripheral neuropathy, postherpetic (shingles) neuralgia, fibromyalgia. -SE: suicidal thoughts, dizziness, drowsiness, edema, dry mouth, abdominal pain, constipation.

Misoprostol (Cytotec)

-Prostaglandin analog -prevents ulcers in those with LT NSAID use -produces uterine contractions -pregnancy category X -used after delivery to expel products of conception

Duloxetine (Cymbalta)

-S/NRI antidepressant -treatment of depression, anxiety, panic disorder, anorexia, nervosa, OCD, etc. -also used to treat diabetic neuropathic pain -DO NOT USE WITH MAOIs

Zaleplon (Sonata)

-Sedative/Hypnotic -very short half-life -can be repeated at night

Potassium sparing diuretics

-Spironolactone (Aldactone) -amiloride (Midamor) -triamterene (Dyrenium) -can cause increased potassium -blocks receptors for aldosterone -inhibits sodium and water reabsorption

matronidazole (flagyl)

-drug of choice for treating C-Diff ***take with food, take around the clock, avoid alcohol and products contain alcohol***

Calcitriol (Rocaltrol, vitamin d3)

-management of hypocalcemia in pts. on chronic renal dialysis or pts. with moderate to severe renal insufficiency with secondary hyperparathyroidism; -improved calcium and phosphorous homeostasis in these pts.

Sucrlfate (Carafate)

-may delay absorption of PPIs -should be taken on empty stomach; take other drugs 2 hours before sucrlfate -typically taken before meals and at bedtime -needs a pH of 4 or less to bind to the ulcer

Common opioids

-morphine -hydrocodone -oxycodone -hydromorphone [dilaudid] -codine

Levedopa - Carbidopa (Sinemet)

-stimulates dopamine production or increases sensitivity of dopamine receptors; to treat parkinson's -toxicity includes involuntary muscle twitching, facial grimacing, spasmodic eye winking, exaggerated protrusion of tongue, etc. -notify prescriber -do not consume high protein meals because it can impair effects

93.) The client who is human immunodeficiency virus seropositive has been taking stavudine (d4t, Zerit). The nurse monitors which of the following most closely while the client is taking this medication? 1. Gait 2. Appetite 3. Level of consciousness 4. Hemoglobin and hematocrit blood levels

1. Gait Rationale: Stavudine (d4t, Zerit) is an antiretroviral used to manage human immunodeficiency virus infection in clients who do not respond to or who cannot tolerate conventional therapy. The medication can cause peripheral neuropathy, and the nurse should monitor the client's gait closely and ask the client about paresthesia. Options 2, 3, and 4 are unrelated to the use of the medication.

125.) A nurse is preparing to administer digoxin (Lanoxin), 0.125 mg orally, to a client with heart failure. Which vital sign is most important for the nurse to check before administering the medication? 1. Heart rate 2. Temperature 3. Respirations 4. Blood pressure

1. Heart rate Rationale: Digoxin is a cardiac glycoside that is used to treat heart failure and acts by increasing the force of myocardial contraction. Because bradycardia may be a clinical sign of toxicity, the nurse counts the apical heart rate for 1 full minute before administering the medication. If the pulse rate is less than 60 beats/minute in an adult client, the nurse would withhold the medication and report the pulse rate to the registered nurse, who would then contact the health care provider.

109.) A client taking buspirone (BuSpar) for 1 month returns to the clinic for a follow-up visit. Which of the following would indicate medication effectiveness? 1. No rapid heartbeats or anxiety 2. No paranoid thought processes 3. No thought broadcasting or delusions 4. No reports of alcohol withdrawal symptoms

1. No rapid heartbeats or anxiety Rationale: Buspirone hydrochloride is not recommended for the treatment of drug or alcohol withdrawal, paranoid thought disorders, or schizophrenia (thought broadcasting or delusions). Buspirone hydrochloride is most often indicated for the treatment of anxiety and aggression.

12.) A nurse is caring for a client who is receiving an intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. During an inspection of the site, the nurse notes redness and swelling and that the rate of infusion of the medication has slowed. The nurse should take which appropriate action? 1. Notify the registered nurse. 2. Administer pain medication to reduce the discomfort. 3. Apply ice and maintain the infusion rate, as prescribed. 4. Elevate the extremity of the IV site, and slow the infusion.

1. Notify the registered nurse. Rationale: When antineoplastic medications (Chemotheraputic Agents) are administered via IV, great care must be taken to prevent the medication from escaping into the tissues surrounding the injection site, because pain, tissue damage, and necrosis can result. The nurse monitors for signs of extravasation, such as redness or swelling at the insertion site and a decreased infusion rate. If extravasation occurs, the registered nurse needs to be notified; he or she will then contact the health care provider.

8.) A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the (HCP) if the client is taking which medication? 1. Vitamin A 2. Digoxin (Lanoxin) 3. Furosemide (Lasix) 4. Phenytoin (Dilantin)

1. Vitamin A Rationale: Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. Options 2, 3, and 4 are not contraindicated with the use of isotretinoin.

88.) Dantrolene sodium (Dantrium) is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds, knowing that the therapeutic action of this medication is which of the following? 1. Depresses spinal reflexes 2. Acts directly on the skeletal muscle to relieve spasticity 3. Acts within the spinal cord to suppress hyperactive reflexes 4. Acts on the central nervous system (CNS) to suppress spasms

2. Acts directly on the skeletal muscle to relieve spasticity Rationale: Dantrium acts directly on skeletal muscle to relieve muscle spasticity. The primary action is the suppression of calcium release from the sarcoplasmic reticulum. This in turn decreases the ability of the skeletal muscle to contract. **Options 1, 3, and 4 are all comparable or alike in that they address CNS suppression and the depression of reflexes. Therefore, eliminate these options.**

25.) A home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse tells the client to: 1. Freeze the insulin. 2. Refrigerate the insulin. 3. Store the insulin in a dark, dry place. 4. Keep the insulin at room temperature.

2. Refrigerate the insulin. Rationale: Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.

191.) A child is brought to the emergency department for treatment of an acute asthma attack. The nurse prepares to administer which of the following medications first? 1. Oral corticosteroids 2. A leukotriene modifier 3. A β2 agonist 4. A nonsteroidal anti-inflammatory

3. A β2 agonist Rationale: In treating an acute asthma attack, a short acting β2 agonist such as albuterol (Proventil HFA) will be given to produce bronchodilation. Options 1, 2, and 4 are long-term control (preventive) medications.

148.) A client is taking cetirizine hydrochloride (Zyrtec). The nurse checks for which of the following side effects of this medication? 1. Diarrhea 2. Excitability 3. Drowsiness 4. Excess salivation

3. Drowsiness Rationale: A frequent side effect of cetirizine hydrochloride (Zyrtec), an antihistamine, is drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating.

138.) A daily dose of prednisone is prescribed for a client. A nurse reinforces instructions to the client regarding administration of the medication and instructs the client that the best time to take this medication is: 1. At noon 2. At bedtime 3. Early morning 4. Anytime, at the same time, each day

3. Early morning Rationale: Corticosteroids (glucocorticoids) should be administered before 9:00 AM. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning. **Note the suffix "-sone," and recall that medication names that end with these letters are corticosteroids.**

203.) A nurse is preparing to give the postcraniotomy client medication for incisional pain. The family asks the nurse why the client is receiving codeine sulfate and not "something stronger." In formulating a response, the nurse incorporates the understanding that codeine: 1. Is one of the strongest opioid analgesics available 2. Cannot lead to physical or psychological dependence 3. Does not cause gastrointestinal upset or constipation as do other opioids 4. Does not alter respirations or mask neurological signs as do other opioids

4. Does not alter respirations or mask neurological signs as do other opioids Rationale: Codeine sulfate is the opioid analgesic often used for clients after craniotomy. It is frequently combined with a nonopioid analgesic such as acetaminophen for added effect. It does not alter the respiratory rate or mask neurological signs as do other opioids. Side effects of codeine include gastrointestinal upset and constipation. The medication can lead to physical and psychological dependence with chronic use. It is not the strongest opioid analgesic available.

223.) A client with a psychotic disorder is being treated with haloperidol (Haldol). Which of the following would indicate the presence of a toxic effect of this medication? 1. Nausea 2. Hypotension 3. Blurred vision 4. Excessive salivation

4. Excessive salivation Rationale: Toxic effects include extrapyramidal symptoms (EPS) noted as marked drowsiness and lethargy, excessive salivation, and a fixed stare. Akathisia, acute dystonias, and tardive dyskinesia are also signs of toxicity. Hypotension, nausea, and blurred vision are occasional side effects.

15.) The client with small cell lung cancer is being treated with etoposide (VePesid). The nurse who is assisting in caring for the client during its administration understands that which side effect is specifically associated with this medication? 1. Alopecia 2. Chest pain 3. Pulmonary fibrosis 4. Orthostatic hypotension

4. Orthostatic hypotension Rationale: A side effect specific to etoposide is orthostatic hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all the antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication.

3

A client is diagnosed with diabetic ketoacidosis. Which insulin should the nurse expect the health care provider to prescribe? 1 NPH insulin 2 Inhaled insulin 3 Regular insulin 4 Insulin glargine

2

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? 1 Halfway between two doses of the drug 2 Between 30 and 60 minutes after a dose 3 Immediately before the medication is administered 4 Anytime it is convenient for the client and the laboratory

-pril

ACE Inhibitor major complications: first dose effect, dry cough, angioedema

ACE Inhibitors Mechanism/Therapeutic Effects

ACE inhibitors prevent vasoconstriction and the retention of sodium and water. Preload and afterload are decreased. The therapeutic effects of ACE inhibitors are decreased blood pressure and diuresis.

What type of antacid causes constipation

Aluminum (Maalox, Amphojel)/Calcium containing (Tums)

Both calcium and magnesium based antacids are more likely to accumulate to toxic levels in patients with renal disease, an alternative would be

Aluminum containing antacids (Mylanta/Maalox/Amphojel)

Class III antidysrhythmic drugs

Amiodarone

What drug is given when there are PVCs?

Amiodarone for antidysrhythmias

What type of drugs can be given to relieve neuropathic pain?

Anticonvulsants

-azole

Antifungals ex: fluconazole s/e: dry mouth, rash consideration: no alcohol, lots of drug-drug interactions, risk for liver injury

A pt on haloperiodol (Haldol) reports dizziness when changing from supine to sitting position. What should the first intervention be for the nurse?

Because haloperidol (Haldol) causes CNS effects of sedation and decreased thirst, the nurse should assess for signs of dehydration

Laxative that absorb water into the intestine, increasing the volume and distending the bowel

Bulk-Forming

A 26-year-old primigravida client is experiencing increasing discomfort and anxiety during the active phase of labor. She requests something for pain. Which analgesic should the nurse anticipate administering?

Butorphanol (Stadol)--is a mixed agonist-antagonist analgesic resulting in good analgesia but with less respiratory depression, nausea, and vomiting compared with opioid agonist analgesics

Common SSRIs

Celexa (citalopram) Escitalopram (lexapro) Fluoxetine (Prozac) Fluvoxamine (Luvox) Paraxetine (Paxil) Sertaline (Zoloft)

The nurse suspects that a client has experienced an adverse reaction to a prescribed medication. Which action should the nurse take first?

Complete a focuses system assessment of the client.

Smoking has been shown to ____ the effectiveness of H2 antagonists like Cimetidine, famotidine, rantitidine)

Decrease

The health care provider prescribes the anticonvulsant carbamazepine (Tegretol) for an adolescent client with a seizure disorder. The nurse should instruct the client to notify the health care provider if which condition occurs?

Develops a sore throat--Blood dyscrasias (aplastic anemia, leukopenia, anemia, and thrombocytopenia) can be an adverse effect of carbamazepine (Tegretol). Flulike symptoms, such as pallor, fatigue, sore throat, and fever, are indications of such dyscrasias.

First choice for status epilepticus

Diazepam (valium)

A patient recovering from intracerebral hemorrhage is expected to take what drug to reduce ICP?

Docusate sodium (colace) to minimize strain and increase in ICP

Anesthetics

Drugs that depress the CNS

Which meds interact with sumatriptan (imitrex) for migraines?

Ergot Alkaloids MAOIs SSRIs must wait 2 weeks after

Hypokalemia

Furosemide (lasix) can cause _______ which can lead to dig toxicity.

What lab should the nurse monitor for a client with the Chronic Kidney Disease?

Hemoglobin

Epoetin alfa (epogen) is used to elevate what lab levels?

Hemoglobin and hematocrit

Drugs known as H2 Blockers that reduce acid secretion in the stomach

Histamine type 2 receptor antagonists: Cimetidine (tagamet) Ranitidine (Zantac) and Famotidine (Pepcid)

SSRI Contraindications

Hypersensitivity, renal dysfunction, hepatic dysfunction, and pregnancy and lactation

A rapid increase (more than 1 g/dL in a 2-week period) may lead to...

Hypertension

During a procedure, the nurse is monitoring a patient who has received Dexmedetomidine (Precedex) for moderate sedation. the nurse will observe for which potential adverse effect?

Hypotension Bradycardia Nausea

SSRI Drug Interactions

Increased drug effects occur when SSRIs are given with other strongly protein-bound drugs (warfarin and phenytoin). SSRIs prolong the actions of drugs metabolized by the cytochrome P-450 system (carbamazepine). There is increased risk for toxicity with monoamine oxidase inhibitors and tricyclic antidepressants.

Guaifenesin (Mucinex)

Mucolytic

When a child receives medication for ADHD, what will the nurse instruct the caregivers to closely monitor?

Physical Growth and weight

-prazole

Proton pump inhibitors N/consideration: not indicated for preventing aspiration in surgical patients

Muscle relaxants are most effective when combined with

Rest and Physical Therapy Dantrolen (Dantrium) Baclofen Cyclobenzaprine (Flexeril)

A pregnant patient goes into premature labor and is admitted to the high-risk labor and delivery unit. Which med would the RN anticipate administering to the patient?

Ritodrine (yutopar)--indicated to halt early labor by relaxing uterine muscles and supressing uterine contractions

During the initial nursing assessment history, a client tells the nurse that he is taking tetracycline hydrochloride (Sumycin) for urethritis. Which medication taken concurrently with Sumycin could interfere with its absorption?

Sucralfate (Carafate) (A) is used to treat duodenal ulcers and will bind with tetracycline hydrochloride (Sumycin), inhibiting this antibiotic's absorption.

Cinchonism

Symptoms: tinnitus, hearing loss, blurred vision, GI upset Adverse effect of class 1a antidystrrhythmic Quinidine

Patient Teaching for ACE Inhibitors

Take medication exactly as prescribed. Do not stop taking it abruptly. Do not use with potassium supplements or increased dietary intake of potassium. Move and change positions slowly to prevent postural hypotension. This medication may cause an irritating dry cough. Impaired taste may be an adverse effect that may last up to 2 to 3 months after the drug has been discontinued. Monitor blood pressure and understand which parameters to report.

Nitroglycerin Patch

The Priority action is to ensure removal of patch for resting hours

A client asks the PN to crush an enteric coated medication so that it will be easier to swallow. What is the action of the enteric coating?

The coating delays dissolution until the medication is exposed to intestinal secretions

If a patient taking nitroglycerin starts to have a headache, what should the nurse tell them?

The headache will last 5-20 minutes ...don't stop taking it

When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs?

The penicillin will cause an enhanced anticoagulant effect of the warfarin.

How do immunizations work?

They enhance the immunological defenses of the host by stimulating the production of protective antibodies (active immunization)

How does Humibid (guaifenesin) primarily work?

Thin and loosen respiratory tract secretions--it is an expectorant.

coffee-ground emesis or black stool

What may indicate a GI bleed?

A patient will be receiving the barbituarate phenobarbital as a part of treatment for seizures. the nurse assesses the pts current list of medications, which are known to cause interactions?

alcohol antihistamines benzodiazepines, opioids tranquilizers anticoagulants MAOIs TCAs Oral Contraceptives Glucocorticoids

-statin

anti-cholesterol s/e: heartburn, muscle or joint pain

-quine

antiparasitics

The nurse is teaching a class about the various chemotherapy drugs and explains that alkylating drugs are also called "cell cycle-nonspecific drugs" because they are-

cytotoxic in any phase of the cell cycle

-ane

general anesthetics ex: cyclohexane, flourane

HMG- CoA cause

muscle pain that can lead to rhabdomyelysis

Naloxone (Narcan)

What do you want to give as the antidote for opioids (like to reverse respiratory depression and analgesia)? -may need to be titrated

use a soft tooth brush, use electric razors, do not got without shoes

What do you want to teach those on warfarin (Coumadin) to do to avoid bleeding?

Dopamine

What drug is the only drug that can activate dopamine in the body?

SE of bisphosphonates

-headache -GI upset -joint pain -risk of esophogeal burns if me becomes lodged in esophegus -ostenecrosis of the jaw

243.) A hospitalized client is having the dosage of clonazepam (Klonopin) adjusted. The nurse should plan to: 1. Weigh the client daily. 2. Observe for ecchymosis. 3. Institute seizure precautions. 4. Monitor blood glucose levels.

3. Institute seizure precautions. Rationale: Clonazepam is a benzodiazepine used as an anticonvulsant. During initial therapy and during periods of dosage adjustment, the nurse should initiate seizure precautions for the client. Options 1, 2, and 4 are not associated with the use of this medication.

vasoconstriction

What is the stimulation of alpha 1?

2

What should a nurse teach the client to do to avoid lipodystrophy when self-administering insulin therapy? 1 Exercise regularly. 2 Rotate injection sites. 3 Use the Z-track technique. 4 Avoid massaging the injection site

2

Which Food and Drug Administration pregnancy risk category do drugs that have not undergone any studies in animal and pregnant women belong to? 1 Category B 2 Category C 3 Category D 4 Category X

The nurse is monitoring a patient who has severe bone marrow suppression following antineoplastic drug therapy. Which is considered the principal early sign of infection?

Fever

Fluphenazine (Prolixin) an antipsychotic for schizophrenics is often seen in pts that...

Noncompliant with medications Fluphenazine (prolixin) has a rapid onset (1 to 2 hours) and a long duration of action (up to 3 or 4 weeks)

2,3,4

What interventions are needed to help prevent accidental poisoning of children? Select all that apply 1 Medicines should be referred to as candy. 2 Potent poisons should be kept out of reach of children. 3 Containers of the poisonous substances should be tightly closed. 4 Old unused and unnecessary medications should be safely disposed. 5 Medications should be transferred from their original containers to alternate ones

Acetylcysteine (Mucomyst)

What is the antidote for acetaminophen (tylenol)?

Fluazenil (Romazicon)

What is the antidote for benzodiazepines?

protamine sulfate

What is the antidote/reversal agent for Heparin?

4

The nurse is preparing to administer an intravenous piggyback antibiotic that has been newly prescribed. Shortly after initiation, the client becomes restless and flushed and begins to wheeze. The nurse determines the that appropriate priority action will be to stop the antibiotic infusion and then do what? 1 Notify the physician immediately about the client's condition. 2 Take the client's blood pressure. 3 Obtain the client's pulse oximetry. 4 Assess the client's respiratory status

SSRI Adverse Effects

They are generally well tolerated. The most common adverse effects include insomnia, weight gain, and sexual dysfunction. The most potentially serious adverse effect is the occurrence of serotonin syndrome (elevated or diminished blood pressure, palpitations, fever, confusion, mania, and [in the most severe cases] seizures and coma). Serotonin syndrome is usually self-limited with discontinuation of medication.

you always want to check the apical pulse, hold if less than 60

What do you want to always check when giving a beta blocker (-lol)

Acetominophen (Tylenol)

-nonopioid analgesic -not an NSAID -MAX daily dose 4,000 mg; 3,000 mg for the elderly and those with liver disease -long term use can produce nephrotoxicity -overdonse/frequent use can produce hepatotoxicity

teaching for those on warfarin (coumadin)

-maintain vitamin K foods (greens, mustard greens,) in diet; do not increase or decrease them -PT/INR moitoring -avoid activities that may cause bleeding

Donepezil (Aricept)

-may slow progression of alzhemiers disease over next year (12 months) -improvement may be seen in quality of life and cognitive function; these improvements are only modest and short-lasting -no evidence of marked improvement or significant delay of disease progression

anabolic steroids

-oxymetholone (Anadrol-50), oxandrolone (Oxandrin), nandrolone (Deca-Durabolin) -stimulates growth and development of male sex organs and secondary sex characteristics; stimulates production of erythropoientin by the kidney -Administration of exogenous adrogens inhibits the release of endogenous androgens, which suppresses sperm production as well as can cause shrinking of testicles and gynecomastia

Metoclopramide (Reglan)

-prevention of chemotherapy-induced emesis -diabetic gastroparesis -SE: drowsiness, EPS such as tremors (notify MD if tremors are present

Zolipidem (Ambien)

-sedative/hypnotic -can produce somnambulism

6.) The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. The nurse monitors the client, knowing that which of the following indicates that a systemic effect has occurred? 1.Hyperventilation 2.Elevated blood pressure 3.Local pain at the burn site 4.Local rash at the burn site

1.Hyperventilation Rationale: Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing acidosis. Clients receiving this treatment should be monitored for signs of an acid-base imbalance (hyperventilation). If this occurs, the medication should be discontinued for 1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs with a burn injury.

84.) Baclofen (Lioresal) is prescribed for the client with multiple sclerosis. The nurse assists in planning care, knowing that the primary therapeutic effect of this medication is which of the following? 1. Increased muscle tone 2. Decreased muscle spasms 3. Increased range of motion 4. Decreased local pain and tenderness

2. Decreased muscle spasms Rationale: Baclofen is a skeletal muscle relaxant and central nervous system depressant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases and in clients with multiple sclerosis. Options 1, 3, and 4 are incorrect.

240.) A client with Parkinson's disease has been prescribed benztropine (Cogentin). The nurse monitors for which gastrointestinal (GI) side effect of this medication? 1. Diarrhea 2. Dry mouth 3. Increased appetite 4. Hyperactive bowel sounds

2. Dry mouth Rationale: Common GI side effects of benztropine therapy include constipation and dry mouth. Other GI side effects include nausea and ileus. These effects are the result of the anticholinergic properties of the medication. **Eliminate options 1 and 4 because they are comparable or alike. Recall that the medication is an anticholinergic, which causes dry mouth**

161.) A nurse is caring for a client with severe back pain, and codeine sulfate has been prescribed for the client. Which of the following would the nurse include in the plan of care while the client is taking this medication? 1. Restrict fluid intake. 2. Monitor bowel activity. 3. Monitor for hypertension. 4. Monitor peripheral pulses.

2. Monitor bowel activity. Rationale: While the client is taking codeine sulfate, an opioid analgesic, the nurse would monitor vital signs and monitor for hypotension. The nurse should also increase fluid intake, palpate the bladder for urinary retention, auscultate bowel sounds, and monitor the pattern of daily bowel activity and stool consistency (codeine can cause constipation). The nurse should monitor respiratory status and initiate breathing and coughing exercises. In addition, the nurse monitors the effectiveness of the pain medication.

75.) A client with myasthenia gravis becomes increasingly weak. The health care provider prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or increasing severity of the disease (myasthenic crisis). An injection of edrophonium (Enlon) is administered. Which of the following indicates that the client is in cholinergic crisis? 1. No change in the condition 2. Complaints of muscle spasms 3. An improvement of the weakness 4. A temporary worsening of the condition

4. A temporary worsening of the condition Rationale: An edrophonium (Enlon) injection, a cholinergic drug, makes the client in cholinergic crisis temporarily worse. This is known as a negative test. An improvement of weakness would occur if the client were experiencing myasthenia gravis. Options 1 and 2 would not occur in either crisis.

181.) A client is taking ticlopidine hydrochloride (Ticlid). The nurse tells the client to avoid which of the following while taking this medication? 1. Vitamin C 2. Vitamin D 3. Acetaminophen (Tylenol) 4. Acetylsalicylic acid (aspirin)

4. Acetylsalicylic acid (aspirin) Rationale: Ticlopidine hydrochloride is a platelet aggregation inhibitor. It is used to decrease the risk of thrombotic strokes in clients with precursor symptoms. Because it is an antiplatelet agent, other medications that precipitate or aggravate bleeding should be avoided during its use. Therefore, aspirin or any aspirin-containing product should be avoided.

Adverse Effects of Opioids

Effects include central nervous system depression, respiratory depression, hypotension, flushing, palpitations, constipation, nausea and vomiting, urinary retention, itching, rash, and biliary tract spasm.

3

Naltrexone is used to treat clients with substance abuse problems. In which situation does the nurse anticipate that naltrexone will be administered? 1 To treat opioid overdose 2 To block the systemic effects of cocaine 3 To decrease the recovering alcoholic's desire to drink alcohol 4 To prevent severe withdrawal symptoms from antianxiety agents

Carbamazepine

The PN should monitor the temp

Clopidogrel (Plavix)

-Antiplatelet -you want to hold 7-10 days before the surgery (may not have to hold aspirin, contact MD)

Haloperidol (Haldol)

-Antipsychotic -produces severe extrapyramidal symptoms (EPS) or reactions to include tardive dyskinesia

Nurse is about start on patient's first chemotherapy session, patient says something where she needs further teaching on-

"I plan on getting pregnant soon"

Patient asks why she's getting meds through IV, what should nurse respond?

"IV meds are faster"

Olanzapine (Zyprexa)

-Antipsychotic -affects the chemicals in the brain -used to treat the symptoms of psychotic conditions such as schizophrenia and bipolar disorder (manic depression) in adults and children who are at least 13 years old -common SE: asthenia, dizziness, drowsiness, extrapyramidal reaction, hyperkinesia, akinesia, cogwheel rigidity, drug-induced parkinson's disease, dyspepsia, mask-like face, xerostomia -other SE: abnormal gait, back pain, constipation, fever orthostatic hypotension, WEIGHT GAIN, myoclonus, and personality disorders

What is the therapeutic range of digoxin?

0.5-2.0 ng/mL

Gentamicin, patient asks to repeat questions, imbalanced-

"Patient is experiencing ototoxicity from the gentamicin."

Something about giving chemotherapy, it included "500 neutrophils"-

"administer the prescription as ordered"

Main adverse effect of clindamycin-

"diarrhea" c diff

Doctor prescribed to give a certain med STAT but pharmacy sent it an hour late, what should the nurse do?

"hold the medication and call doctor"

Immunosuppressant-

"should not be stopped abruptly"

Oral vs sublingual-

"sublingual absorbs faster"

Something about transdermal patches and I put:

"they are usually via adhesive patches"

Antiepileptic Drugs used to treat status epilepticus

*Diazepam* Lorazepam Phenobarbital Phenytoin

Alzehimer's Conex

- The PN should monitor the mental status exam Vaginal Cream - The pt need to remain supine for a short period (5-10) mins

Clonazepam (Klonopin)

-Anticonvulsant, benzodiazepine to treat panic disorder -SE: drowsiness, CNS depression, dizziness, nightmares, dry mouth, constipation, weight gain -can produce withdrawl phenomenon and hangover effects

Ondansetron (Zofran)

-Antiemetic -prevention of nausea and vomiting associated with chemotherapy and radiation therapy -use cautiously with liver failure

Aspirin (ASA)

-Antiplatelet -cautions with peptic ulcer disease (PUD) -cautions with children younger than the age of 18 with recent viral illness (Reyes syndrome) -interacts with other antiplatelets, anticoagulants, NSAIDs (etc) ***WATCH FOR BLEEDING!!!!***

Rifampin

-Antitubercular (treatment of TB) -may turn soft contacts orange -advise the patient that the discoloration is a normal response to the drugs -hepatotoxic--> check LFTs ***turns all body fluids red/orange/brown*** *** drug has a teratogenic properties that may decrease effectiveness of oral contraceptives; counsel patient to use a nonhormonal form of contraception throughout therapy***

Important interventions for a pt taking methotrexate for rheumatoid arthritis?

-Confirm with another nurse that it is not intended as chemo -Assess LFTs -Monitor I&Os -Expected side effect: stomatitis

Side effects of patient-controlled analgesia (PCA) with morphine sulfate?

-Constipation and pruritus -Decreased resp rate -Sedation and lightheadedness

Glargine (Lantus) insulin

-NO peak -flat effect (last 24 hours) -once a day dosing at bed time

Diclofenac (Zipsor)

-NSAID -can increase LFTs (hepatotoxicity) -like other NSAIDs may increase the risk of MI and stroke -SE are the same as NSAIDs, including GI bleeding -S/S of anemia

Ketorolac (Toradol)

-NSAID (causes gastric irritation) -should e]be given with meals or snacks -has pain relief like morphine but is not a opioid -it is used for post-op pain not chronic pain -do not give this med for more than 5 days

Methimazole (Tapazole) or Propylthiouracil (PTU)

-These are for the treatment of hyperthyroidism (Graves disease). -May be referred to as "antithyroid" medication. -Take at same time every day with meal or snack. -Avoid foods high in iodine (iodized salt; seafood). -May take 2 weeks to be effective. -SE: hypothyroidism symptoms (sluggish, tired, weight gain, cold intolerance, constipation). -Take one hour apart from Lugol's solution (potassium iodide) for treatment of severe hyperthyroidism (thyroid storm/thyroid crisis).

Montelukast (Singulair)

-This is a anti-inflammatory that can be given to children greater than 2 years of age -take PO once daily in the evening -SE: headache and dizziness -check LFTs

Filgrastim (Neupogen)

-administered to increase WBC count in neutropenic patients -white blood cells increase from 2500/mm3 to 5500/mm3--- meaninf the desired effect is reached -give before infection develops ***-SE: include fever, muscle aches, bone pain, and flushing*** -give nonopioid or opioid analgesics; stops when med is D/C

Tamsulosin (Flomax)

-alpha 1 adrenergic blocker -decreases smooth muscle contraction of prostate capsules and bladder neck - used to treat BPH ***Alpha one blockers -zosin - antihypertensives***

Edrophonium (Tensilon)

-an anticholinesterase -enhances the effects of acetylcholine at the skeletal muscle receptors -used in patients with myasthenia gravis -effective if improvement in pt. muscle strength (e.g. opening of eyes, improved swallowing, etc.). -NOTE: An anticholinesterase drug has cholinergic effects!

S/S of dig toxicity

-anorexia -bradycardia -headache -dizziness -confusion -nausea -visual distrubances (blurred, yellow, halo vision)

Azithromycin (Zithromax)

-antibiotic for treatment of STDs such as gonorrhea and chlamydia -usually requires one(1g or 2g) dose -male partner should be treated if woman has trichomonas (any STI), even if asymptomatic ***Hepatotoxicity--> elevated liver enzymes***

Terbinafine (Lamisil)

-antifungal -for treatment of superficial dermatologic infections (athletes foot) and onychomycosis (nail fungus) -avoid alcohol -monitor LFTs -report nausea, upper stomach pain, itching, loss of appitite, dakr urine, clay-colored stools, jaundice

Methylphenidate (Ritalin)

-best if taken on empty stomach 30-45 minutes before eating -stimulant which produces insomnia (don't take at bedtime) -schedule 2 drug

Vancomycin

-drug of choice for MRSA -acute care may require frequent monitoring of serum drug levels for dose adjustment -peak and trough schedule (trough usually just before the next dose) -monitor BUN/creatinine -Red man syndrome if infused to rapidly -IV infusion should be greater than 60 minutes

Glucagon Emergency Kit

-elevates blood sugar; used when a diabetic patient becomes hypoglycemic and becomes unconscious -it is a powder that is mixed with the liquid given and then administered as an injection by someone else

Isoniazid (INH)

-for TB -interacts with food containing tyramine -can produce life-threatening hypertensive crisis; know foods to avoid -use a second for of birth control

Lactulose (Chronulac)

-for constipation and to LOWER serum ammonia levels in patients with liver disease (cirrhosis)-hepatic encephalopathy (monitor ammonia levels 15-45 mg) - this medication is effective if the patient is having mroe frequent BM's or has more improved mentation (less confusion) and DECREASED serum ammonia levels

Pentoxifylline (Trental)

-for intermittent claudication -treats ischemic pain

epoetin alfa (Epogen, Procrit)

-for patients with chronic kidney disease (CKD), increases RBC production -treats anemia in patients with ESRD(CKD) or from HIV or chemotherapy -need the normal iron levels -monitor H & H, monitor for signs of bleeding and clotting as a dvt -teach a diet high in iron

Androgen block

-for prostate and testicular cancer (Lupron); decreases production of testosterone; -SE include decreased libido and gynecomastia. -Work on the premise that tumors arising from tissue influenced by the hormones estrogen and progesterone/androgen show regression (tumors shrink) when treated with a drug which produces the opposite hormonal effect/environment. -In men with prostate cancer, estrogens act on the pituitary to suppress secretion of luteinizing hormone, which in turn decreases testicular androgen secretion. -Estrogen therapy causes feminization in men, manifested by gynecomastia and impotence. -Women may experience decreased libido and breast tenderness.

Aminoglycosides

-gentamincin (garamycin), neomycin, tobramycin (Nebcin) -given IV for several days -adverse effects: decreased hearing (ototoxicity) and nephrotoxicity (check BUN and creatinine)

What solution is the intial fluid for the situation of significant blood loss?

0.9% NS

radioactive iodine

-given for thyroid gland ablation -given as large capsules that are odorless and tasteless -can dry up salivary glands -excreted in urine, so FORCE FLUIDS!!! -patient is radioactive until this is removed from the body -Isolation, -you want to double flush toilets, etc. -administered by the nuclear medicine physician

Ginkgo biloba

-given to enhance mental alertness and improve memory -may increase the risk of bleeding with anticoagulants, antiplatelets, and NSAIDs -SE: allergic skin reactions and irritated mucous membranes

oral contraceptive pills (OCPs)

-have decreased efficacy while on antibiotics -use a second method of birth control

Estrogen (Premarin)

-hormone necessary to development and maintenance of female reproductive system and 2ndary sex characteristics -hormone replacement therapy (HRT) for treating postmenopausal symptoms -adverse effects: HTN, thromboembolic events (most serious), edema, N (most common) /V/D, constipation, amenorrhea, breakthrough uterine bleeding, chloasma, hirsutism, alopecia, tender breasts, fluid retention, HA.

theophylline (methylxanthine bronchodilator)

-indicted for treatment of COPD -IV form (aminophylline) for status asthmaticus -avoid caffeinated beverages, as caffeine is a methylxanthine -Monitor plasma drug levels -Toxicity can produce life threatening dysrhythmias

Symptoms of hepatotoxicity

-jaundice -abdominal pain -clay-colored stools -dark urine

Cevemiline (Evoxac)

-like bethanechol but used to relieve xerostomia (Dry mouth) in patients with Sjogren syndrome

Rapid acting insulin

-lispro, aspart, glulisine -onset: 5-10 minutes, peak: 1 hr, duration: 2-4 hrs -take immediately before eating

Furosemide (Lasix)

-loop diuretic -rapid acting -used foe rapid diuresis in emergencies (Pulmonary embolism) -may produce hypokalemia (assess for muscle craps or weakness) -Hypotension, F/E abnormalities, dehydration,

Lithium (Lithobid, lithotabs)

-mood stabilizing drug used to treat bipolar disorder -low therapeutic index -toxicity can occur at blood levels that are slightly greater than therapeutic levels -monitor lithium levels -this is the drug of choice for treating manic phase of patients with BPD. -lithium levels must be kept below 1.5 mEq/L; levels greater can produce toxicity -initial therapy levels= 0.8 to 1.4 mEq/L; maintenance levels= 0.5 to 1.5 mEq/L -draw the levels in the morning, 12 hours after the evening dose, during maintenance therapy levels should be checked every 3 to 6 months

Calcitonin (Miacalcin)

-nasal spray to decrease bone loss from osteoporosis -instruct pt. to alternate nostrils each day when administering the nasal spray to decrease rhinitis

Lansoprazole (Prevacid)

-proton pump inhibitor (PPI) -antacid for erosive esophagitis, PUD, ST treatment for GERD -healing and risk reduction in NSAID-associated gastric ulcers

patients with Alzheimer's

-safety is a potential problem -confusion -wandering -cognition -Sundowning

Sumtriptan (Imitrex)

-serotonin receptor agonist (triptan) for relief of migraine headaches -contraindications: don' take within 24 hours of ergot alkaloids -can cause coronary vasospasms -contraindicated in stroke (CVA)

Regular insulin

-short acting insulin -given IV for emergencies -peak: 2-3 hours -give 30-60 minutes before meals -when giving this make sure patients breakfast is on the way

drugs for PUD

-take at least one hour apart from other drugs and antacids,

-dipine ending drugs (like amlodipine)

-these calcium channel blockers affect vessels only (vasodilation) -SE: dizziness, facial flushing, edema, hypotension

Lorazepam (Ativan)

-this is the drug of choice for treating alcoholic delirium tremors (DT) -after the IV administration, keep the patient supine for 8 hours and observe closely -used for anxiety and withdrawal symptoms

H2 antagonists (blockers)

-tidine drug endings (Cimetidine [Tagamet], and ranitidine [Zantac[) -prevents irritation of stomach from too much acid (PUD, GERD) -this is the first choice drug for gastric and duodenal ulcers -take 30 to 60 minutes before meals Take at least 1 to 2 hours before antacids (antacids decrease absorption)

Bethanechol (Urecholine)

-to treat urinary retention in postop and postpartum pts -relaxes the trigone and sphincter muscles and increases voiding pressure (by contracting the detrusor muscle, which composes the bladder wall)

Pilocarpine (Pilocar, Isopto)

-topical muscarinic agonist (choinergic) for glaucoma -produces miosis (constriction of pupil) and contraction of ciliary muscle -SE: decreased visual activity, local irritation, eye pain, brow ache\ -may produce bradycardia, bronchospasm, hypotension, urinary urgency, dirrhea, hypersalivation, and sweating

Xenical (Orlistat, Alli)

-use for long term weight control -BMI of 30 or more -patient has oily stool and flatulence -ask patient to describe their dietary intake (SE are increased if greater than 30% of fat in the diet) -fiber laxatives (like metamucil) help to decrease SE (binds to fat)

Feverfew

-used for antiinflammatory properties -treatment of migraines, menstural cramps, inflammation and fever

Isotretinoin (Accutane)

-used for treatment of several nodulocystic acne -severe photosensitivity (avoid sun) -teratogenesis (preg. category X)

St. John's Wort

-used to treat depression and anxiety -decrease benifits of immunosuppressant drugs for patients with kidney transplants

Phenytoin (Dilantin)

-used to treat seizures (anticoagulant) -at plasma levels above 20mcg/mL, toxicity can occur -toxicity: nystagmus, ataxia, diplopia, and cognitive impairment -suicidal thoughts and extrpyramidal symptoms (EPS) ***-A common side effect is gingival hyperplasia (teach good oral hygiene)*** -other SE: measles like rash, hirsutism, steven-johnsons, toxic epidermal necrolysis

Hypnotics (CNS Depressants)

-zaleplon (sonata) -zolpidem (ambien) -eszopiclone (lunesta)

Diuretics

Decrease the plasma and extracellular fluid volumes results in reduced preload (HCTZ)

173.) A nurse reviews the medication history of a client admitted to the hospital and notes that the client is taking leflunomide (Arava). During data collection, the nurse asks which question to determine medication effectiveness? 1. "Do you have any joint pain?" 2. "Are you having any diarrhea?" 3. "Do you have frequent headaches?" 4. "Are you experiencing heartburn?"

1. "Do you have any joint pain?" Rationale: Leflunomide is an immunosuppressive agent and has an anti-inflammatory action. The medication provides symptomatic relief of rheumatoid arthritis. Diarrhea can occur as a side effect of the medication. The other options are unrelated to medication effectiveness.

91.) Cyclobenzaprine (Flexeril) is prescribed for a client to treat muscle spasms, and the nurse is reviewing the client's record. Which of the following disorders, if noted in the client's record, would indicate a need to contact the health care provider regarding the administration of this medication? 1. Glaucoma 2. Emphysema 3. Hyperthyroidism 4. Diabetes mellitus

1. Glaucoma Rationale: Because this medication has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. Cyclobenzaprine hydrochloride should be used only for short-term 2- to 3-week therapy.

127.) The nurse provides medication instructions to an older hypertensive client who is taking 20 mg of lisinopril (Prinivil, Zestril) orally daily. The nurse evaluates the need for further teaching when the client states which of the following? 1. "I can skip a dose once a week." 2. "I need to change my position slowly." 3. "I take the pill after breakfast each day." 4. "If I get a bad headache, I should call my doctor immediately."

1. "I can skip a dose once a week." Rationale: Lisinopril is an antihypertensive angiotensin-converting enzyme (ACE) inhibitor. The usual dosage range is 20 to 40 mg per day. Adverse effects include headache, dizziness, fatigue, orthostatic hypotension, tachycardia, and angioedema. Specific client teaching points include taking one pill a day, not stopping the medication without consulting the health care provider (HCP), and monitoring for side effects and adverse reactions. The client should notify the HCP if side effects occur.

31.) A community health nurse visits a client at home. Prednisone 10 mg orally daily has been prescribed for the client and the nurse reinforces teaching for the client about the medication. Which statement, if made by the client, indicates that further teaching is necessary? 1. "I can take aspirin or my antihistamine if I need it." 2. "I need to take the medication every day at the same time." 3. "I need to avoid coffee, tea, cola, and chocolate in my diet." 4. "If I gain more than 5 pounds a week, I will call my doctor."

1. "I can take aspirin or my antihistamine if I need it." Rationale: Aspirin and other over-the-counter medications should not be taken unless the client consults with the health care provider (HCP). The client needs to take the medication at the same time every day and should be instructed not to stop the medication. A slight weight gain as a result of an improved appetite is expected, but after the dosage is stabilized, a weight gain of 5 lb or more weekly should be reported to the HCP. Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development.

77.) Phenytoin (Dilantin), 100 mg orally three times daily, has been prescribed for a client for seizure control. The nurse reinforces instructions regarding the medication to the client. Which statement by the client indicates an understanding of the instructions? 1. "I will use a soft toothbrush to brush my teeth." 2. "It's all right to break the capsules to make it easier for me to swallow them." 3. "If I forget to take my medication, I can wait until the next dose and eliminate that dose." 4. "If my throat becomes sore, it's a normal effect of the medication and it's nothing to be concerned about."

1. "I will use a soft toothbrush to brush my teeth." Rationale: Phenytoin (Dilantin) is an anticonvulsant. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. The client should not skip medication doses, because this could precipitate a seizure. Capsules should not be chewed or broken and they must be swallowed. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction, because this indicates hematological toxicity.

220.) A adult client with muscle spasms is taking an oral maintenance dose of baclofen (Lioresal). The nurse reviews the medication record, expecting that which dose should be prescribed? 1. 15 mg four times a day 2. 25 mg four times a day 3. 30 mg four times a day 4. 40 mg four times a day

1. 15 mg four times a day Rationale: Baclofen is dispensed in 10- and 20-mg tablets for oral use. Dosages are low initially and then gradually increased. Maintenance doses range from 15 to 20 mg administered three or four times a day.

115.) A client received 20 units of NPH insulin subcutaneously at 8:00 AM. The nurse should check the client for a potential hypoglycemic reaction at what time? 1. 5:00 PM 2. 10:00 AM 3. 11:00 AM 4. 11:00 PM

1. 5:00 PM Rationale: NPH is intermediate-acting insulin. Its onset of action is 1 to 2½ hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.

10.) The clinic nurse is performing an admission assessment on a client. The nurse notes that the client is taking azelaic acid (Azelex). Because of the medication prescription, the nurse would suspect that the client is being treated for: 1. Acne 2. Eczema 3. Hair loss 4. Herpes simplex

1. Acne Rationale: Azelaic acid is a topical medication used to treat mild to moderate acne. The acid appears to work by suppressing the growth of Propionibacterium acnes and decreasing the proliferation of keratinocytes. Options 2, 3, and 4 are incorrect.

145.) A nurse has a prescription to give a client albuterol (Proventil HFA) (two puffs) and beclomethasone dipropionate (Qvar) (nasal inhalation, two puffs), by metered-dose inhaler. The nurse administers the medication by giving the: 1. Albuterol first and then the beclomethasone dipropionate 2. Beclomethasone dipropionate first and then the albuterol 3. Alternating a single puff of each, beginning with the albuterol 4. Alternating a single puff of each, beginning with the beclomethasone dipropionate

1. Albuterol first and then the beclomethasone dipropionate Rationale: Albuterol is a bronchodilator. Beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

26.) Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. A nurse reinforces instructions for the client and tells the client to avoid which of the following while taking this medication? 1. Alcohol 2. Organ meats 3. Whole-grain cereals 4. Carbonated beverages

1. Alcohol Rationale: When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. The items in options 2, 3, and 4 do not need to be avoided.

142.) A health care provider has written a prescription for ranitidine (Zantac), once daily. The nurse should schedule the medication for which of the following times? 1. At bedtime 2. After lunch 3. With supper 4. Before breakfast

1. At bedtime Rationale: A single daily dose of ranitidine is usually scheduled to be given at bedtime. This allows for a prolonged effect, and the greatest protection of the gastric mucosa. **recall that ranitidine suppresses secretions of gastric acids**

What is the therapeutic range of theophylline (theo-dur)

10-20 mcg Caution for toxicity

100.) Saquinavir (Invirase) is prescribed for the client who is human immunodeficiency virus seropositive. The nurse reinforces medication instructions and tells the client to: 1. Avoid sun exposure. 2. Eat low-calorie foods. 3. Eat foods that are low in fat. 4. Take the medication on an empty stomach.

1. Avoid sun exposure. Rationale: Saquinavir (Invirase) is an antiretroviral (protease inhibitor) used with other antiretroviral medications to manage human immunodeficiency virus infection. Saquinavir is administered with meals and is best absorbed if the client consumes high-calorie, high-fat meals. Saquinavir can cause photosensitivity, and the nurse should instruct the client to avoid sun exposure.

202.) A nurse is collecting data from a client about medications being taken, and the client tells the nurse that he is taking herbal supplements for the treatment of varicose veins. The nurse understands that the client is most likely taking which of the following? 1. Bilberry 2. Ginseng 3. Feverfew 4. Evening primrose

1. Bilberry Rationale: Bilberry is an herbal supplement that has been used to treat varicose veins. This supplement has also been used to treat cataracts, retinopathy, diabetes mellitus, and peripheral vascular disease. Ginseng has been used to improve memory performance and decrease blood glucose levels in type 2 diabetes mellitus. Feverfew is used to prevent migraine headaches and to treat rheumatoid arthritis. Evening primrose is used to treat eczema and skin irritation.

156.) A nurse is reviewing the laboratory results for a client receiving tacrolimus (Prograf). Which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medication? 1. Blood glucose of 200 mg/dL 2. Potassium level of 3.8 mEq/L 3. Platelet count of 300,000 cells/mm3 4. White blood cell count of 6000 cells/mm3

1. Blood glucose of 200 mg/dL Rationale: A blood glucose level of 200 mg/dL is elevated above the normal range of 70 to 110 mg/dL and suggests an adverse effect. Other adverse effects include neurotoxicity evidenced by headache, tremor, insomnia; gastrointestinal (GI) effects such as diarrhea, nausea, and vomiting; hypertension; and hyperkalemia.

105.) A nurse is collecting data from a client and the client's spouse reports that the client is taking donepezil hydrochloride (Aricept). Which disorder would the nurse suspect that this client may have based on the use of this medication? 1. Dementia 2. Schizophrenia 3. Seizure disorder 4. Obsessive-compulsive disorder

1. Dementia Rationale: Donepezil hydrochloride is a cholinergic agent used in the treatment of mild to moderate dementia of the Alzheimer type. It enhances cholinergic functions by increasing the concentration of acetylcholine. It slows the progression of Alzheimer's disease. Options 2, 3, and 4 are incorrect.

33.) The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these medications. The nurse should reinforce which instructions to the client? Select all that apply. 1. Diarrhea can occur secondary to the metformin. 2. The repaglinide is not taken if a meal is skipped. 3. The repaglinide is taken 30 minutes before eating. 4. Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes. 5. Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide. 6. Muscle pain is an expected side effect of metformin and may be treated with acetaminophen (Tylenol).

1. Diarrhea can occur secondary to the metformin. 2. The repaglinide is not taken if a meal is skipped. 3. The repaglinide is taken 30 minutes before eating. 4. Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes. Rationale: Repaglinide is a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion that should be taken before meals, and that should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide and the client should always be prepared by carrying a simple sugar with her or him at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect from metformin but it might signify a more serious condition that warrants health care provider notification, not the use of acetaminophen.

116.) A nurse administers a dose of scopolamine (Transderm-Scop) to a postoperative client. The nurse tells the client to expect which of the following side effects of this medication? 1. Dry mouth 2. Diaphoresis 3. Excessive urination 4. Pupillary constriction

1. Dry mouth Rationale: Scopolamine is an anticholinergic medication for the prevention of nausea and vomiting that causes the frequent side effects of dry mouth, urinary retention, decreased sweating, and dilation of the pupils. The other options describe the opposite effects of cholinergic-blocking agents and therefore are incorrect.

193.) Sodium hypochlorite (Dakin's solution) is prescribed for a client with a leg wound containing purulent drainage. The nurse is assisting in developing a plan of care for the client and includes which of the following in the plan? 1. Ensure that the solution is freshly prepared before use. 2. Soak a sterile dressing with solution and pack into the wound. 3. Allow the solution to remain in the wound following irrigation. 4. Apply the solution to the wound and on normal skin tissue surrounding the wound.

1. Ensure that the solution is freshly prepared before use. Rationale: Dakin solution is a chloride solution that is used for irrigating and cleaning necrotic or purulent wounds. It can be used for packing necrotic wounds. It cannot be used to pack purulent wounds because the solution is inactivated by copious pus. It should not come into contact with healing or normal tissue, and it should be rinsed off immediately if used for irrigation. Solutions are unstable and the nurse must ensure that the solution has been prepared fresh before use. **Eliminate options 2 and 3 first because they are comparable or alike. It makes sense to ensure that the solution is freshly prepared; therefore, select option 1**

112.) A hospitalized client is started on phenelzine sulfate (Nardil) for the treatment of depression. The nurse instructs the client to avoid consuming which foods while taking this medication? Select all that apply. 1. Figs 2. Yogurt 3. Crackers 4. Aged cheese 5 Tossed salad 6. Oatmeal cookies

1. Figs 2. Yogurt 4. Aged cheese Rationale: Phenelzine sulfate (Nardil) is a monoamine oxidase inhibitor(MAOI). The client should avoid taking in foods that are high in tyramine. Use of these foods could trigger a potentially fatal hypertensive crisis. Some foods to avoid include yogurt, aged cheeses, smoked or processed meats, red wines, and fruits such as avocados, raisins, and figs.

158.) A client with chronic renal failure is receiving epoetin alfa (Epogen, Procrit). Which laboratory result would indicate a therapeutic effect of the medication? 1. Hematocrit of 32% 2. Platelet count of 400,000 cells/mm3 3. White blood cell count of 6000 cells/mm3 4. Blood urea nitrogen (BUN) level of 15 mg/dL

1. Hematocrit of 32% Rationale: Epoetin alfa is used to reverse anemia associated with chronic renal failure. A therapeutic effect is seen when the hematocrit is between 30% and 33%. The laboratory tests noted in the other options are unrelated to the use of this medication.

167.) A nurse prepares to reinforce instructions to a client who is taking allopurinol (Zyloprim). The nurse plans to include which of the following in the instructions? 1. Instruct the client to drink 3000 mL of fluid per day. 2. Instruct the client to take the medication on an empty stomach. 3. Inform the client that the effect of the medication will occur immediately. 4. Instruct the client that, if swelling of the lips occurs, this is a normal expected response.

1. Instruct the client to drink 3000 mL of fluid per day. Rationale: Allopurinol (Zyloprim) is an antigout medication used to decrease uric acid levels. Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day. A full therapeutic effect may take 1 week or longer. Allopurinol is to be given with or immediately following meals or milk to prevent gastrointestinal irritation. If the client develops a rash, irritation of the eyes, or swelling of the lips or mouth, he or she should contact the health care provider because this may indicate hypersensitivity.

113.) A nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. Which of the following would be included in the plan of care for instructions? 1. Maintain a high fluid intake. 2. Discontinue the medication when feeling better. 3. If the urine turns dark brown, call the health care provider immediately. 4. Decrease the dosage when symptoms are improving to prevent an allergic response.

1. Maintain a high fluid intake. Rationale: Each dose of sulfisoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfisoxazole cause the urine to turn dark brown or red. This does not indicate the need to notify the health care provider.

43.) A histamine (H2)-receptor antagonist will be prescribed for a client. The nurse understands that which medications are H2-receptor antagonists? Select all that apply. 1. Nizatidine (Axid) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Cimetidine (Tagamet) 5. Esomeprazole (Nexium) 6. Lansoprazole (Prevacid)

1. Nizatidine (Axid) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Cimetidine (Tagamet) Rationale: H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist in preventing complications of peptic ulcer disease. These medications also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions. The other medications listed are proton pump inhibitors. H2-receptor antagonists medication names end with -dine. Proton pump inhibitors medication names end with -zole.

235.) A tricyclic antidepressant is administered to a client daily. The nurse plans to monitor for the common side effects of the medication and includes which of the following in the plan of care? 1. Offer hard candy or gum periodically. 2. Offer a nutritious snack between meals. 3. Monitor the blood pressure every 2 hours. 4. Review the white blood cell (WBC) count results daily.

1. Offer hard candy or gum periodically. Rationale: Dry mouth is a common side effect of tricyclic antidepressants. Frequent mouth rinsing with water, sucking on hard candy, and chewing gum will alleviate this common side effect. It is not necessary to monitor the blood pressure every 2 hours. In addition, it is not necessary to check the WBC daily. Weight gain is a common side effect and frequent snacks will aggravate this problem.

18.) The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which of the following is documented in the client's history? 1. Pancreatitis 2. Diabetes mellitus 3. Myocardial infarction 4. Chronic obstructive pulmonary disease

1. Pancreatitis Rationale: Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between administration of the doses. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are not contraindicated with this medication.

30.) A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? 1. Prednisone 2. Phenelzine (Nardil) 3. Atenolol (Tenormin) 4. Allopurinol (Zyloprim)

1. Prednisone Rationale: Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 2, a monoamine oxidase inhibitor, and option 3, a β-blocker, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

152.) Intravenous heparin therapy is prescribed for a client. While implementing this prescription, a nurse ensures that which of the following medications is available on the nursing unit? 1. Protamine sulfate 2. Potassium chloride 3. Phytonadione (vitamin K ) 4. Aminocaproic acid (Amicar)

1. Protamine sulfate Rationale: The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage occurs. Potassium chloride is administered for a potassium deficit. Vitamin K is an antidote for warfarin sodium. Aminocaproic acid is the antidote for thrombolytic therapy.

102.) A client with human immunodeficiency virus is taking nevirapine (Viramune). The nurse should monitor for which adverse effects of the medication? Select all that apply. 1. Rash 2. Hepatotoxicity 3. Hyperglycemia 4. Peripheral neuropathy 5. Reduced bone mineral density

1. Rash 2. Hepatotoxicity Rationale: Nevirapine (Viramune) is a non-nucleoside reverse transcriptase inhibitors (NRTI) that is used to treat HIV infection. It is used in combination with other antiretroviral medications to treat HIV. Adverse effects include rash, Stevens-Johnson syndrome, hepatitis, and increased transaminase levels. Hyperglycemia, peripheral neuropathy, and reduced bone density are not adverse effects of this medication.

72.) Cinoxacin (Cinobac), a urinary antiseptic, is prescribed for the client. The nurse reviews the client's medical record and should contact the health care provider (HCP) regarding which documented finding to verify the prescription? Refer to chart. 1. Renal insufficiency 2. Chest x-ray: normal 3. Blood glucose, 102 mg/dL 4. Folic acid (vitamin B6) 0.5 mg, orally daily

1. Renal insufficiency Rationale: Cinoxacin should be administered with caution in clients with renal impairment. The dosage should be reduced, and failure to do so could result in accumulation of cinoxacin to toxic levels. Therefore the nurse would verify the prescription if the client had a documented history of renal insufficiency. The laboratory and diagnostic test results are normal findings. Folic acid (vitamin B6) may be prescribed for a client with renal insufficiency to prevent anemia.

90.) A nurse is reviewing the record of a client who has been prescribed baclofen (Lioresal). Which of the following disorders, if noted in the client's history, would alert the nurse to contact the health care provider? 1. Seizure disorders 2. Hyperthyroidism 3. Diabetes mellitus 4. Coronary artery disease

1. Seizure disorders Rationale: Clients with seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsive medication. The disorders in options 2, 3, and 4 are not a concern when the client is taking baclofen.

53.) Rifabutin (Mycobutin) is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. The nurse monitors for which side effects of the medication? Select all that apply. 1. Signs of hepatitis 2. Flu-like syndrome 3. Low neutrophil count 4. Vitamin B6 deficiency 5. Ocular pain or blurred vision 6. Tingling and numbness of the fingers

1. Signs of hepatitis 2. Flu-like syndrome 3. Low neutrophil count 5. Ocular pain or blurred vision Rationale: Rifabutin (Mycobutin) may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count), red-orange body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flu-like syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid (INH). Ethambutol (Myambutol) also causes peripheral neuritis.

92.) In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which findings would the nurse interpret as acceptable responses? Select all that apply. 1. Symptom control during periods of emotional stress 2. Normal white blood cell counts, platelet, and neutrophil counts 3. Radiological findings that show nonprogression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy 5. Inflammation and irritation at the injection site 3 days after injection is given 6. A low-grade temperature upon rising in the morning that remains throughout the day

1. Symptom control during periods of emotional stress 2. Normal white blood cell counts, platelet, and neutrophil counts 3. Radiological findings that show nonprogression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy Rationale: Because emotional stress frequently exacerbates the symptoms of rheumatoid arthritis, the absence of symptoms is a positive finding. DMARDs are given to slow progression of joint degeneration. In addition, the improvement in the range of motion after 3 months of therapy with normal blood work is a positive finding. Temperature elevation and inflammation and irritation at the medication injection site could indicate signs of infection.

149.) A client taking fexofenadine (Allegra) is scheduled for allergy skin testing and tells the nurse in the health care provider's office that a dose was taken this morning. The nurse determines that: 1. The client should reschedule the appointment. 2. A lower dose of allergen will need to be injected. 3. A higher dose of allergen will need to be injected. 4. The client should have the skin test read a day later than usual.

1. The client should reschedule the appointment. Rationale: Fexofenadine is an antihistamine, which provides relief of symptoms caused by allergy. Antihistamines should be discontinued for at least 3 days (72 hours) before allergy skin testing to avoid false-negative readings. This client should have the appointment rescheduled for 3 days after discontinuing the medication.

221.) A nurse is reviewing the health care provider's prescriptions for an adult client who has been admitted to the hospital following a back injury. Carisoprodol (Soma) is prescribed for the client to relieve the muscle spasms; the health care provider has prescribed 350 mg to be administered four times a day. When preparing to give this medication, the nurse determines that this dosage is: 1. The normal adult dosage 2. A lower than normal dosage 3. A higher than normal dosage 4. A dosage requiring further clarification

1. The normal adult dosage Rationale: The normal adult dosage for carisoprodol is 350 mg orally three or four times daily.

21.) A nurse is assisting with caring for a client with cancer who is receiving cisplatin. Select the adverse effects that the nurse monitors for that are associated with this medication. Select all that apply. 1. Tinnitus 2. Ototoxicity 3. Hyperkalemia 4. Hypercalcemia 5. Nephrotoxicity 6. Hypomagnesemia

1. Tinnitus 2. Ototoxicity 5. Nephrotoxicity 6. Hypomagnesemia Rationale: Cisplatin is an alkylating medication. Alkylating medications are cell cycle phase-nonspecific medications that affect the synthesis of DNA by causing the cross-linking of DNA to inhibit cell reproduction. Cisplatin may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity. Amifostine (Ethyol) may be administered before cisplatin to reduce the potential for renal toxicity.

213.) A client is admitted to the hospital with complaints of back spasms. The client states, "I have been taking two or three aspirin every 4 hours for the past week and it hasn't helped my back." Aspirin intoxication is suspected. Which of the following complaints would indicate aspirin intoxication? 1. Tinnitus 2. Constipation 3. Photosensitivity 4. Abdominal cramps

1. Tinnitus Rationale: Mild intoxication with acetylsalicylic acid (aspirin) is called salicylism and is commonly experienced when the daily dosage is higher than 4 g. Tinnitus (ringing in the ears) is the most frequently occurring effect noted with intoxication. Hyperventilation may occur because salicylate stimulates the respiratory center. Fever may result because salicylate interferes with the metabolic pathways involved with oxygen consumption and heat production. Options 2, 3, and 4 are incorrect.

110.) A client taking lithium carbonate (Lithobid) reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is checked as a part of the routine follow-up and the level is 3.0 mEq/L. The nurse knows that this level is: 1. Toxic 2. Normal 3. Slightly above normal 4. Excessively below normal

1. Toxic Rationale: The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. A level of 3 mEq/L indicates toxicity.

239.) Which of the following precautions will the nurse specifically take during the administration of ribavirin (Virazole) to a child with respiratory syncytial virus (RSV)? 1. Wearing goggles 2. Wearing a gown 3. Wearing a gown and a mask 4. Handwashing before administration

1. Wearing goggles Rationale: Some caregivers experience headaches, burning nasal passages and eyes, and crystallization of soft contact lenses as a result of administration of ribavirin. Specific to this medication is the use of goggles. A gown is not necessary. A mask may be worn. Handwashing is to be performed before and after any child contact.

24.) A nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH insulin in the same syringe. Which of the following actions, if performed by the client, indicates the need for further teaching? 1. Withdraws the NPH insulin first 2. Withdraws the regular insulin first 3. Injects air into NPH insulin vial first 4. Injects an amount of air equal to the desired dose of insulin into the vial

1. Withdraws the NPH insulin first Rationale: When preparing a mixture of regular insulin with another insulin preparation, the regular insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of regular insulin with insulin of another type. Options 2, 3, and 4 identify the correct actions for preparing NPH and regular insulin.

195.) A nurse is caring for a client who is taking metoprolol (Lopressor). The nurse measures the client's blood pressure (BP) and apical pulse (AP) immediately before administration. The client's BP is 122/78 mm/Hg and the AP is 58 beats/min. Based on this data, which of the following is the appropriate action? 1. Withhold the medication. 2. Notify the registered nurse immediately. 3. Administer the medication as prescribed. 4. Administer half of the prescribed medication.

1. Withhold the medication. Rationale: Metoprolol (Lopressor) is classified as a beta-adrenergic blocker and is used in the treatment of hypertension, angina, and myocardial infarction. Baseline nursing assessments include measurement of BP and AP immediately before administration. If the systolic BP is below 90 mm/Hg and the AP is below 60 beats/min, the nurse should withhold the medication and document this action. Although the registered nurse should be informed of the client's vital signs, it is not necessary to do so immediately. The medication should not be administered because the data is outside of the prescribed parameters for this medication. The nurse should not administer half of the medication, or alter any dosages at any point in time.

234.) A hospitalized client is started on phenelzine sulfate (Nardil) for the treatment of depression. At lunchtime, a tray is delivered to the client. Which food item on the tray will the nurse remove? 1. Yogurt 2. Crackers 3. Tossed salad 4. Oatmeal cookies

1. Yogurt Rationale: Phenelzine sulfate is a monoamine oxidase inhibitor (MAOI). The client should avoid taking in foods that are high in tyramine. These foods could trigger a potentially fatal hypertensive crisis. Foods to avoid include yogurt, aged cheeses, smoked or processed meats, red wines, and fruits such as avocados, raisins, or figs.

How long does antabuse stay in the system?

2 weeks after last dose--don't have any alcohol within this timeframe

Why should a patient with pancreatitis not take morphine?

It causes spasms of the sphincter of Oddi and could increase pain

What is Prednisone ( Deltasone)

It is a corticoid steroid

74.) A client with myasthenia gravis is receiving pyridostigmine (Mestinon). The nurse monitors for signs and symptoms of cholinergic crisis caused by overdose of the medication. The nurse checks the medication supply to ensure that which medication is available for administration if a cholinergic crisis occurs? 1. Vitamin K 2. Atropine sulfate 3. Protamine sulfate 4. Acetylcysteine (Mucomyst)

2. Atropine sulfate Rationale: The antidote for cholinergic crisis is atropine sulfate. Vitamin K is the antidote for warfarin (Coumadin). Protamine sulfate is the antidote for heparin, and acetylcysteine (Mucomyst) is the antidote for acetaminophen (Tylenol).

86.) A nurse is reinforcing discharge instructions to a client receiving baclofen (Lioresal). Which of the following would the nurse include in the instructions? 1. Restrict fluid intake. 2. Avoid the use of alcohol. 3. Stop the medication if diarrhea occurs. 4. Notify the health care provider if fatigue occurs.

2. Avoid the use of alcohol. Rationale: Baclofen is a central nervous system (CNS) depressant. The client should be cautioned against the use of alcohol and other CNS depressants, because baclofen potentiates the depressant activity of these agents. Constipation rather than diarrhea is an adverse effect of baclofen. It is not necessary to restrict fluids, but the client should be warned that urinary retention can occur. Fatigue is related to a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary that the client notify the health care provider if fatigue occurs.

123.) A nurse is planning to administer amlodipine (Norvasc) to a client. The nurse plans to check which of the following before giving the medication? 1. Respiratory rate 2. Blood pressure and heart rate 3. Heart rate and respiratory rate 4. Level of consciousness and blood pressure

2. Blood pressure and heart rate Rationale: Amlodipine is a calcium channel blocker. This medication decreases the rate and force of cardiac contraction. Before administering a calcium channel blocking agent, the nurse should check the blood pressure and heart rate, which could both decrease in response to the action of this medication. This action will help to prevent or identify early problems related to decreased cardiac contractility, heart rate, and conduction. **amlodipine is a calcium channel blocker, and this group of medications decreases the rate and force of cardiac contraction. This in turn lowers the pulse rate and blood pressure.**

224.) Neuroleptic malignant syndrome is suspected in a client who is taking chlorpromazine. Which medication would the nurse prepare in anticipation of being prescribed to treat this adverse effect related to the use of chlorpromazine? 1. Protamine sulfate 2. Bromocriptine (Parlodel) 3. Phytonadione (vitamin K) 4. Enalapril maleate (Vasotec)

2. Bromocriptine (Parlodel) Rationale: Bromocriptine is an antiparkinsonian prolactin inhibitor used in the treatment of neuroleptic malignant syndrome. Vitamin K is the antidote for warfarin (Coumadin) overdose. Protamine sulfate is the antidote for heparin overdose. Enalapril maleate is an antihypertensive used in the treatment of hypertension.

68.) Bethanechol chloride (Urecholine) is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this medication? 1. Gastric atony 2. Urinary strictures 3. Neurogenic atony 4. Gastroesophageal reflux

2. Urinary strictures Rationale: Bethanechol chloride (Urecholine) can be harmful to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions.

20.) The client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? 1. Glucose level 2. Calcium level 3. Potassium level 4. Prothrombin time

2. Calcium level Rationale: Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.

176.) A nurse notes that a client is taking lansoprazole (Prevacid). On data collection, the nurse asks which question to determine medication effectiveness? 1. "Has your appetite increased?" 2. "Are you experiencing any heartburn?" 3. "Do you have any problems with vision?" 4. "Do you experience any leg pain when walking?"

2. "Are you experiencing any heartburn?" Rationale: Lansoprazole is a gastric acid pump inhibitor used to treat gastric and duodenal ulcers, erosive esophagitis, and hypersecretory conditions. It also is used to treat gastroesophageal reflux disease (GERD). It is not used to treat visual problems, problems with appetite, or leg pain. **NOTE: "-zole" refers to gastric acid pump inhibitors**

183.) A client who received a kidney transplant is taking azathioprine (Imuran), and the nurse provides instructions about the medication. Which statement by the client indicates a need for further instructions? 1. "I need to watch for signs of infection." 2. "I need to discontinue the medication after 14 days of use." 3. "I can take the medication with meals to minimize nausea." 4. "I need to call the health care provider (HCP) if more than one dose is missed."

2. "I need to discontinue the medication after 14 days of use." Rationale: Azathioprine is an immunosuppressant medication that is taken for life. Because of the effects of the medication, the client must watch for signs of infection, which are reported immediately to the HCP. The client should also call the HCP if more than one dose is missed. The medication may be taken with meals to minimize nausea.

194.) A nurse provides instructions to a client regarding the use of tretinoin (Retin-A). Which statement by the client indicates the need for further instructions? 1. "Optimal results will be seen after 6 weeks." 2. "I should apply a very thin layer to my skin." 3. "I should wash my hands thoroughly after applying the medication." 4. "I should cleanse my skin thoroughly before applying the medication."

2. "I should apply a very thin layer to my skin." Rationale: Tretinoin is applied liberally to the skin. The hands are washed thoroughly immediately after applying. Therapeutic results should be seen after 2 to 3 weeks but may not be optimal until after 6 weeks. The skin needs to be cleansed thoroughly before applying the medication.

78.) A client is taking phenytoin (Dilantin) for seizure control and a sample for a serum drug level is drawn. Which of the following indicates a therapeutic serum drug range? 1. 5 to 10 mcg/mL 2. 10 to 20 mcg/mL 3. 20 to 30 mcg/mL 4. 30 to 40 mcg/mL

2. 10 to 20 mcg/mL Rationale: The therapeutic serum drug level range for phenytoin (Dilantin) is 10 to 20 mcg/mL. ** A helpful hint may be to remember that the theophylline therapeutic range and the acetaminophen (Tylenol) therapeutic range are the same as the phenytoin (Dilantin) therapeutic range.**

215.) A client with rheumatoid arthritis is taking acetylsalicylic acid (aspirin) on a daily basis. Which medication dose should the nurse expect the client to be taking? 1. 1 g daily 2. 4 g daily 3. 325 mg daily 4. 1000 mg daily

2. 4 g daily Rationale: Aspirin may be used to treat the client with rheumatoid arthritis. It may also be used to reduce the risk of recurrent transient ischemic attack (TIA) or brain attack (stroke) or reduce the risk of myocardial infarction (MI) in clients with unstable angina or a history of a previous MI. The normal dose for clients being treated with aspirin to decrease thrombosis and MI is 300 to 325 mg/day. Clients being treated to prevent TIAs are usually prescribed 1.3 g/day in two to four divided doses. Clients with rheumatoid arthritis are treated with 3.6 to 5.4 g/day in divided doses. **Eliminate options 1 and 4 because they are alike**

64.) Nalidixic acid (NegGram) is prescribed for a client with a urinary tract infection. On review of the client's record, the nurse notes that the client is taking warfarin sodium (Coumadin) daily. Which prescription should the nurse anticipate for this client? 1. Discontinuation of warfarin sodium (Coumadin) 2. A decrease in the warfarin sodium (Coumadin) dosage 3. An increase in the warfarin sodium (Coumadin) dosage 4. A decrease in the usual dose of nalidixic acid (NegGram)

2. A decrease in the warfarin sodium (Coumadin) dosage Rationale: Nalidixic acid can intensify the effects of oral anticoagulants by displacing these agents from binding sites on plasma protein. When an oral anticoagulant is combined with nalidixic acid, a decrease in the anticoagulant dosage may be needed.

170.) Atenolol hydrochloride (Tenormin) is prescribed for a hospitalized client. The nurse should perform which of the following as a priority action before administering the medication? 1. Listen to the client's lung sounds. 2. Check the client's blood pressure. 3. Check the recent electrolyte levels. 4. Assess the client for muscle weakness.

2. Check the client's blood pressure. Rationale: Atenolol hydrochloride is a beta-blocker used to treat hypertension. Therefore the priority nursing action before administration of the medication is to check the client's blood pressure. The nurse also checks the client's apical heart rate. If the systolic blood pressure is below 90 mm Hg or the apical pulse is 60 beats per minute or lower, the medication is withheld and the registered nurse and/or health care provider is notified. The nurse would check baseline renal and liver function tests. The medication may cause weakness, and the nurse would assist the client with activities if weakness occurs. **Beta-blockers have "-lol" at the end of the medication name**

34.) A client with Crohn's disease is scheduled to receive an infusion of infliximab (Remicade). The nurse assisting in caring for the client should take which action to monitor the effectiveness of treatment? 1. Monitoring the leukocyte count for 2 days after the infusion 2. Checking the frequency and consistency of bowel movements 3. Checking serum liver enzyme levels before and after the infusion 4. Carrying out a Hematest on gastric fluids after the infusion is completed

2. Checking the frequency and consistency of bowel movements Rationale: The principal manifestations of Crohn's disease are diarrhea and abdominal pain. Infliximab (Remicade) is an immunomodulator that reduces the degree of inflammation in the colon, thereby reducing the diarrhea. Options 1, 3, and 4 are unrelated to this medication.

63.) A client with coronary artery disease complains of substernal chest pain. After checking the client's heart rate and blood pressure, a nurse administers nitroglycerin, 0.4 mg, sublingually. After 5 minutes, the client states, "My chest still hurts." Select the appropriate actions that the nurse should take. Select all that apply. 1. Call a code blue. 2. Contact the registered nurse. 3. Contact the client's family. 4. Assess the client's pain level. 5. Check the client's blood pressure. 6. Administer a second nitroglycerin, 0.4 mg, sublingually.

2. Contact the registered nurse. 4. Assess the client's pain level. 5. Check the client's blood pressure. 6. Administer a second nitroglycerin, 0.4 mg, sublingually. Rationale: The usual guideline for administering nitroglycerin tablets for a hospitalized client with chest pain is to administer one tablet every 5 minutes PRN for chest pain, for a total dose of three tablets. The registered nurse should be notified of the client's condition, who will then notify the health care provider as appropriate. Because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would assess the client's pain level and check the client's blood pressure before administering each nitroglycerin dose. There are no data in the question that indicate the need to call a code blue. In addition, it is not necessary to contact the client's family unless the client has requested this.

209.) A client with multiple sclerosis is receiving diazepam (Valium), a centrally acting skeletal muscle relaxant. Which of the following would indicate that the client is experiencing a side effect related to this medication? 1. Headache 2. Drowsiness 3. Urinary retention 4. Increased salivation

2. Drowsiness Rationale: Incoordination and drowsiness are common side effects resulting from this medication. Options 1, 3, and 4 are incorrect.

133.) A nurse is monitoring a client receiving desmopressin acetate (DDAVP) for adverse effects to the medication. Which of the following indicates the presence of an adverse effect? 1. Insomnia 2. Drowsiness 3. Weight loss 4. Increased urination

2. Drowsiness Rationale: Water intoxication (overhydration) or hyponatremia is an adverse effect to desmopressin. Early signs include drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma also may occur in overhydration. **Recall that this medication is used to treat diabetes insipidus to eliminate weight loss and increased urination.**

108.) A nurse is performing a follow-up teaching session with a client discharged 1 month ago who is taking fluoxetine (Prozac). What information would be important for the nurse to gather regarding the adverse effects related to the medication? 1. Cardiovascular symptoms 2. Gastrointestinal dysfunctions 3. Problems with mouth dryness 4. Problems with excessive sweating

2. Gastrointestinal dysfunctions Rationale: The most common adverse effects related to fluoxetine include central nervous system (CNS) and gastrointestinal (GI) system dysfunction. This medication affects the GI system by causing nausea and vomiting, cramping, and diarrhea. Options 1, 3, and 4 are not adverse effects of this medication.

136.) A nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of: 1. Myxedema 2. Graves' disease 3. Addison's disease 4. Cushing's syndrome

2. Graves' disease Rationale: PTU inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves' disease. Myxedema indicates hypothyroidism. Cushing's syndrome and Addison's disease are disorders related to adrenal function.

41.) The client has been taking omeprazole (Prilosec) for 4 weeks. The ambulatory care nurse evaluates that the client is receiving optimal intended effect of the medication if the client reports the absence of which symptom? 1. Diarrhea 2. Heartburn 3. Flatulence 4. Constipation

2. Heartburn Rationale: Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4.

131.) The nurse is reinforcing medication instructions to a client with breast cancer who is receiving cyclophosphamide (Neosar). The nurse tells the client to: 1. Take the medication with food. 2. Increase fluid intake to 2000 to 3000 mL daily. 3. Decrease sodium intake while taking the medication. 4. Increase potassium intake while taking the medication.

2. Increase fluid intake to 2000 to 3000 mL daily. Rationale: Hemorrhagic cystitis is a toxic effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal (GI) upset occurs. Hyperkalemia can result from the use of the medication; therefore the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake.

101.) Ketoconazole is prescribed for a client with a diagnosis of candidiasis. Select the interventions that the nurse includes when administering this medication. Select all that apply. 1. Restrict fluid intake. 2. Instruct the client to avoid alcohol. 3. Monitor hepatic and liver function studies. 4. Administer the medication with an antacid. 5. Instruct the client to avoid exposure to the sun. 6. Administer the medication on an empty stomach.

2. Instruct the client to avoid alcohol. 3. Monitor hepatic and liver function studies. 5. Instruct the client to avoid exposure to the sun. Rationale: Ketoconazole is an antifungal medication. It is administered with food (not on an empty stomach) and antacids are avoided for 2 hours after taking the medication to ensure absorption. The medication is hepatotoxic and the nurse monitors liver function studies. The client is instructed to avoid exposure to the sun because the medication increases photosensitivity. The client is also instructed to avoid alcohol. There is no reason for the client to restrict fluid intake. In fact, this could be harmful to the client.

162.) Carbamazepine (Tegretol) is prescribed for a client with a diagnosis of psychomotor seizures. The nurse reviews the client's health history, knowing that this medication is contraindicated if which of the following disorders is present? 1. Headaches 2. Liver disease 3. Hypothyroidism 4. Diabetes mellitus

2. Liver disease Rationale: Carbamazepine (Tegretol) is contraindicated in liver disease, and liver function tests are routinely prescribed for baseline purposes and are monitored during therapy. It is also contraindicated if the client has a history of blood dyscrasias. It is not contraindicated in the conditions noted in the incorrect options.

89.) A nurse is reviewing the laboratory studies on a client receiving dantrolene sodium (Dantrium). Which laboratory test would identify an adverse effect associated with the administration of this medication? 1. Creatinine 2. Liver function tests 3. Blood urea nitrogen 4. Hematological function tests

2. Liver function tests Rationale: Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests should be performed before treatment and periodically throughout the treatment course. It is administered in the lowest effective dosage for the shortest time necessary. **Eliminate options 1 and 3 because these tests both assess kidney function.**

65.) A nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. Which of the following should be included in the list of instructions? 1. Restrict fluid intake. 2. Maintain a high fluid intake. 3. If the urine turns dark brown, call the health care provider (HCP) immediately. 4. Decrease the dosage when symptoms are improving to prevent an allergic response.

2. Maintain a high fluid intake. Rationale: Each dose of sulfisoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfisoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the HCP.

204.) A client receives a dose of edrophonium (Enlon). The client shows improvement in muscle strength for a period of time following the injection. The nurse interprets that this finding is compatible with: 1. Multiple sclerosis 2. Myasthenia gravis 3. Muscular dystrophy 4. Amyotrophic lateral sclerosis

2. Myasthenia gravis Rationale: Myasthenia gravis can often be diagnosed based on clinical signs and symptoms. The diagnosis can be confirmed by injecting the client with a dose of edrophonium . This medication inhibits the breakdown of an enzyme in the neuromuscular junction, so more acetylcholine binds to receptors. If the muscle is strengthened for 3 to 5 minutes after this injection, it confirms a diagnosis of myasthenia gravis. Another medication, neostigmine (Prostigmin), also may be used because its effect lasts for 1 to 2 hours, providing a better analysis. For either medication, atropine sulfate should be available as the antidote.

227.) When teaching a client who is being started on imipramine hydrochloride (Tofranil), the nurse would inform the client that the desired effects of the medication may: 1. Start during the first week of administration 2. Not occur for 2 to 3 weeks of administration 3. Start during the second week of administration 4. Not occur until after a month of administration

2. Not occur for 2 to 3 weeks of administration Rationale: The therapeutic effects of administration of imipramine hydrochloride may not occur for 2 to 3 weeks after the antidepressant therapy has been initiated. Therefore options 1, 3, and 4 are incorrect.

47.) A client has been taking isoniazid (INH) for 2 months. The client complains to a nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing: 1. Hypercalcemia 2. Peripheral neuritis 3. Small blood vessel spasm 4. Impaired peripheral circulation

2. Peripheral neuritis Rationale: A common side effect of the TB drug INH is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This side effect can be minimized by pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are incorrect.

228.) A client receiving an anxiolytic medication complains that he feels very "faint" when he tries to get out of bed in the morning. The nurse recognizes this complaint as a symptom of: 1. Cardiac dysrhythmias 2. Postural hypotension 3. Psychosomatic symptoms 4. Respiratory insufficiency

2. Postural hypotension Rationale: Anxiolytic medications can cause postural hypotension. The client needs to be taught to rise to a sitting position and get out of bed slowly because of this adverse effect related to the medication. Options 1, 3, and 4 are unrelated to the use of this medication.

50.) A nurse has given a client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client states that he or she will immediately report: 1. Impaired sense of hearing 2. Problems with visual acuity 3. Gastrointestinal (GI) side effects 4. Orange-red discoloration of body secretions

2. Problems with visual acuity Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client is also taught to take the medication with food if GI upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin (Rifadin).

186.) A nurse prepares to administer sodium polystyrene sulfonate (Kayexalate) to a client. Before administering the medication, the nurse reviews the action of the medication and understands that it: 1. Releases bicarbonate in exchange for primarily sodium ions 2. Releases sodium ions in exchange for primarily potassium ions 3. Releases potassium ions in exchange for primarily sodium ions 4. Releases sodium ions in exchange for primarily bicarbonate ions

2. Releases sodium ions in exchange for primarily potassium ions Rationale: Sodium polystyrene sulfonate is a cation exchange resin used in the treatment of hyperkalemia. The resin either passes through the intestine or is retained in the colon. It releases sodium ions in exchange for primarily potassium ions. The therapeutic effect occurs 2 to 12 hours after oral administration and longer after rectal administration.

40.) The client who chronically uses nonsteroidal anti-inflammatory drugs has been taking misoprostol (Cytotec). The nurse determines that the medication is having the intended therapeutic effect if which of the following is noted? 1. Resolved diarrhea 2. Relief of epigastric pain 3. Decreased platelet count 4. Decreased white blood cell count

2. Relief of epigastric pain Rationale: The client who chronically uses nonsteroidal anti-inflammatory drugs (NSAIDs) is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence. Diarrhea can be a side effect of the medication, but is not an intended effect. Options 3 and 4 are incorrect.

168.) Colcrys (colchicine) is prescribed for a client with a diagnosis of gout. The nurse reviews the client's medical history in the health record, knowing that the medication would be contraindicated in which disorder? 1. Myxedema 2. Renal failure 3. Hypothyroidism 4. Diabetes mellitus

2. Renal failure Rationale: Colchicine is contraindicated in clients with severe gastrointestinal, renal, hepatic or cardiac disorders, or with blood dyscrasias. Clients with impaired renal function may exhibit myopathy and neuropathy manifested as generalized weakness. This medication should be used with caution in clients with impaired hepatic function, older clients, and debilitated clients. **Note that options 1, 3, and 4 are all endocrine-related disorders: Myxedema=Hypothyroidism**

48.) A client is to begin a 6-month course of therapy with isoniazid (INH). A nurse plans to teach the client to: 1. Drink alcohol in small amounts only. 2. Report yellow eyes or skin immediately. 3. Increase intake of Swiss or aged cheeses. 4. Avoid vitamin supplements during therapy.

2. Report yellow eyes or skin immediately. Rationale: INH is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately (which include yellow skin and sclera). For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of INH therapy for TB.

23.) A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which information should the nurse teach when carrying out plans for discharge? 1. Keep insulin vials refrigerated at all times. 2. Rotate the insulin injection sites systematically. 3. Increase the amount of insulin before unusual exercise. 4. Monitor the urine acetone level to determine the insulin dosage.

2. Rotate the insulin injection sites systematically. Rationale: Insulin dosages should not be adjusted or increased before unusual exercise. If acetone is found in the urine, it may possibly indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, the insulin should be administered at room temperature. Injection sites should be systematically rotated from one area to another. The client should be instructed to give injections in one area, about 1 inch apart, until the whole area has been used and then to change to another site. This prevents dramatic changes in daily insulin absorption.

216.) A nurse is caring for a client with gout who is taking Colcrys (colchicine). The client has been instructed to restrict the diet to low-purine foods. Which of the following foods should the nurse instruct the client to avoid while taking this medication? 1. Spinach 2. Scallops 3. Potatoes 4. Ice cream

2. Scallops Rationale: Colchicine is a medication used for clients with gout to inhibit the reabsorption of uric acid by the kidney and promote excretion of uric acid in the urine. Uric acid is produced when purine is catabolized. Clients are instructed to modify their diet and limit excessive purine intake. High-purine foods to avoid or limit include organ meats, roe, sardines, scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, and yeast.

114.) A postoperative client requests medication for flatulence (gas pains). Which medication from the following PRN list should the nurse administer to this client? 1. Ondansetron (Zofran) 2. Simethicone (Mylicon) 3. Acetaminophen (Tylenol) 4. Magnesium hydroxide (milk of magnesia, MOM)

2. Simethicone (Mylicon) Rationale: Simethicone is an antiflatulent used in the relief of pain caused by excessive gas in the gastrointestinal tract. Ondansetron is used to treat postoperative nausea and vomiting. Acetaminophen is a nonopioid analgesic. Magnesium hydroxide is an antacid and laxative.

172.) A nurse provides dietary instructions to a client who will be taking warfarin sodium (Coumadin). The nurse tells the client to avoid which food item? 1. Grapes 2. Spinach 3. Watermelon 4. Cottage cheese

2. Spinach Rationale: Warfarin sodium is an anticoagulant. Anticoagulant medications act by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K often are omitted from the diet. Vitamin K-rich foods include green, leafy vegetables, fish, liver, coffee, and tea.

188.) The nurse should anticipate that the most likely medication to be prescribed prophylactically for a child with spina bifida (myelomeningocele) who has a neurogenic bladder would be: 1. Prednisone 2. Sulfisoxazole 3. Furosemide (Lasix) 4. Intravenous immune globulin (IVIG)

2. Sulfisoxazole Rationale: A neurogenic bladder prevents the bladder from completely emptying because of the decrease in muscle tone. The most likely medication to be prescribed to prevent urinary tract infection would be an antibiotic. A common prescribed medication is sulfisoxazole. Prednisone relieves allergic reactions and inflammation rather than preventing infection. Furosemide promotes diuresis and decreases edema caused by congestive heart failure. IVIG assists with antibody production in immunocompromised clients.

Indication of venlafaxine (Effexor XR)

Depression

147.) A client with a prescription to take theophylline (Theo-24) daily has been given medication instructions by the nurse. The nurse determines that the client needs further information about the medication if the client states that he or she will: 1. Drink at least 2 L of fluid per day. 2. Take the daily dose at bedtime. 3. Avoid changing brands of the medication without health care provider (HCP) approval. 4. Avoid over-the-counter (OTC) cough and cold medications unless approved by the HCP.

2. Take the daily dose at bedtime. Rationale: The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. In addition, this medication causes insomnia. The client should take in at least 2 L of fluid per day to decrease viscosity of secretions. The client should check with the physician before changing brands of the medication. The client also checks with the HCP before taking OTC cough, cold, or other respiratory preparations because they could cause interactive effects, increasing the side effects of theophylline and causing dysrhythmias.

57.) A nurse is monitoring a client who is taking propranolol (Inderal LA). Which data collection finding would indicate a potential serious complication associated with propranolol? 1. The development of complaints of insomnia 2. The development of audible expiratory wheezes 3. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication 4. A baseline resting heart rate of 88 beats/min followed by a resting heart rate of 72 beats/min after two doses of the medication

2. The development of audible expiratory wheezes Rationale: Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. β-Blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.

28.) The health care provider (HCP) prescribes exenatide (Byetta) for a client with type 1 diabetes mellitus who takes insulin. The nurse knows that which of the following is the appropriate intervention? 1. The medication is administered within 60 minutes before the morning and evening meal. 2. The medication is withheld and the HCP is called to question the prescription for the client. 3. The client is monitored for gastrointestinal side effects after administration of the medication. 4. The insulin is withdrawn from the Penlet into an insulin syringe to prepare for administration.

2. The medication is withheld and the HCP is called to question the prescription for the client. Rationale: Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It is not recommended for clients taking insulin. Hence, the nurse should hold the medication and question the HCP regarding this prescription. Although options 1 and 3 are correct statements about the medication, in this situation the medication should not be administered. The medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.

165.) The client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept (Enbrel), it is most important for the nurse to assess: 1. The injection site for itching and edema 2. The white blood cell counts and platelet counts 3. Whether the client is experiencing fatigue and joint pain 4. A metallic taste in the mouth and a loss of appetite

2. The white blood cell counts and platelet counts Rationale: Infection and pancytopenia are adverse effects of etanercept (Enbrel). Laboratory studies are performed before and during treatment. The appearance of abnormal white blood cell counts and abnormal platelet counts can alert the nurse to a potential life-threatening infection. Injection site itching is a common occurrence following administration of the medication. In early treatment, residual fatigue and joint pain may still be apparent. A metallic taste and loss of appetite are not common signs of side effects of this medication.

126.) A nurse is caring for a client who has been prescribed furosemide (Lasix) and is monitoring for adverse effects associated with this medication. Which of the following should the nurse recognize as a potential adverse effect Select all that apply. 1. Nausea 2. Tinnitus 3. Hypotension 4. Hypokalemia 5. Photosensitivity 6. Increased urinary frequency

2. Tinnitus 3. Hypotension 4. Hypokalemia Rationale: Furosemide is a loop diuretic; therefore, an expected effect is increased urinary frequency. Nausea is a frequent side effect, not an adverse effect. Photosensitivity is an occasional side effect. Adverse effects include tinnitus (ototoxicity), hypotension, and hypokalemia and occur as a result of sudden volume depletion.

51.) Cycloserine (Seromycin) is added to the medication regimen for a client with tuberculosis. Which of the following would the nurse include in the client-teaching plan regarding this medication? 1. To take the medication before meals 2. To return to the clinic weekly for serum drug-level testing 3. It is not necessary to call the health care provider (HCP) if a skin rash occurs. 4. It is not necessary to restrict alcohol intake with this medication.

2. To return to the clinic weekly for serum drug-level testing Rationale: Cycloserine (Seromycin) is an antitubercular medication that requires weekly serum drug level determinations to monitor for the potential of neurotoxicity. Serum drug levels lower than 30 mcg/mL reduce the incidence of neurotoxicity. The medication must be taken after meals to prevent gastrointestinal irritation. The client must be instructed to notify the HCP if a skin rash or signs of central nervous system toxicity are noted. Alcohol must be avoided because it increases the risk of seizure activity.

135.) A nurse reinforces medication instructions to a client who is taking levothyroxine (Synthroid). The nurse instructs the client to notify the health care provider (HCP) if which of the following occurs? 1. Fatigue 2. Tremors 3. Cold intolerance 4. Excessively dry skin

2. Tremors Rationale: Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, heat intolerance, and sweating. The client should be instructed to notify the HCP if these occur. Options 1, 3, and 4 are signs of hypothyroidism.

7.) Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed? 1. Platelet count 2. Triglyceride level 3. Complete blood count 4. White blood cell count

2. Triglyceride level Rationale: Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been evaluated. Options 1, 3, and 4 do not need to be monitored specifically during this treatment.

238.) Ribavirin (Virazole) is prescribed for the hospitalized child with respiratory syncytial virus (RSV). The nurse prepares to administer this medication via which of the following routes? 1. Orally 2. Via face mask 3. Intravenously 4. Intramuscularly

2. Via face mask Rationale: Ribavirin is an antiviral respiratory medication used mainly in hospitalized children with severe RSV and in high-risk children. Administration is via hood, face mask, or oxygen tent. The medication is most effective if administered within the first 3 days of the infection.

55.) A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3.0 mEq/L and is complaining of anorexia. A health care provider prescribes a digoxin level to rule out digoxin toxicity. A nurse checks the results, knowing that which of the following is the therapeutic serum level (range) for digoxin? 1. 3 to 5 ng/mL 2. 0.5 to 2 ng/mL 3. 1.2 to 2.8 ng/mL 4. 3.5 to 5.5 ng/mL

2.) 0.5 to 2 ng/mL Rationale: Therapeutic levels for digoxin range from 0.5 to 2 ng/mL. Therefore, options 1, 3, and 4 are incorrect.

How does aluminum hydroxide (amphojel) work?

It is an antacid that decreases acidity in the stomach--it neutralizes acidic gastric secretions

5.) Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying the medication, the client complains of local discomfort and burning. Which of the following is the most appropriate nursing action? 1. Notifying the registered nurse 2. Discontinuing the medication 3. Informing the client that this is normal 4. Applying a thinner film than prescribed to the burn site

3. Informing the client that this is normal Rationale: Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and is used to treat burns to reduce bacteria present in avascular tissues. The client should be informed that the medication will cause local discomfort and burning and that this is a normal reaction; therefore options 1, 2, and 4 are incorrect

111.) A client arrives at the health care clinic and tells the nurse that he has been doubling his daily dosage of bupropion hydrochloride (Wellbutrin) to help him get better faster. The nurse understands that the client is now at risk for which of the following? 1. Insomnia 2. Weight gain 3. Seizure activity 4. Orthostatic hypotension

3. Seizure activity Rationale: Bupropion does not cause significant orthostatic blood pressure changes. Seizure activity is common in dosages greater than 450 mg daily. Bupropion frequently causes a drop in body weight. Insomnia is a side effect, but seizure activity causes a greater client risk.

128.) A nurse is providing instructions to an adolescent who has a history of seizures and is taking an anticonvulsant medication. Which of the following statements indicates that the client understands the instructions? 1. "I will never be able to drive a car." 2. "My anticonvulsant medication will clear up my skin." 3. "I can't drink alcohol while I am taking my medication." 4. "If I forget my morning medication, I can take two pills at bedtime."

3. "I can't drink alcohol while I am taking my medication." Rationale: Alcohol will lower the seizure threshold and should be avoided. Adolescents can obtain a driver's license in most states when they have been seizure free for 1 year. Anticonvulsants cause acne and oily skin; therefore a dermatologist may need to be consulted. If an anticonvulsant medication is missed, the health care provider should be notified.

197.) Collagenase (Santyl) is prescribed for a client with a severe burn to the hand. The nurse provides instructions to the client regarding the use of the medication. Which statement by the client indicates an accurate understanding of the use of this medication? 1. "I will apply the ointment once a day and leave it open to the air." 2. "I will apply the ointment twice a day and leave it open to the air." 3. "I will apply the ointment once a day and cover it with a sterile dressing." 4. "I will apply the ointment at bedtime and in the morning and cover it with a sterile dressing."

3. "I will apply the ointment once a day and cover it with a sterile dressing." Rationale: Collagenase is used to promote debridement of dermal lesions and severe burns. It is usually applied once daily and covered with a sterile dressing.

164.) A client receives a prescription for methocarbamol (Robaxin), and the nurse reinforces instructions to the client regarding the medication. Which client statement would indicate a need for further instructions? 1. "My urine may turn brown or green." 2. "This medication is prescribed to help relieve my muscle spasms." 3. "If my vision becomes blurred, I don't need to be concerned about it." 4. "I need to call my doctor if I experience nasal congestion from this medication."

3. "If my vision becomes blurred, I don't need to be concerned about it." Rationale: The client needs to be told that the urine may turn brown, black, or green. Other adverse effects include blurred vision, nasal congestion, urticaria, and rash. The client needs to be instructed that, if these adverse effects occur, the health care provider needs to be notified. The medication is used to relieve muscle spasms.

42.) A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is reinforcing teaching for the client about the medications prescribed, including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin (Amoxil). Which statement by the client indicates the best understanding of the medication regimen? 1. "My ulcer will heal because these medications will kill the bacteria." 2. "These medications are only taken when I have pain from my ulcer." 3. "The medications will kill the bacteria and stop the acid production." 4. "These medications will coat the ulcer and decrease the acid production in my stomach."

3. "The medications will kill the bacteria and stop the acid production." Rationale: Triple therapy for Helicobacter pylori infection usually includes two antibacterial drugs and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production.

141.) The nurse has reinforced instructions to a client who has been prescribed cholestyramine (Questran). Which statement by the client indicates a need for further instructions? 1. "I will continue taking vitamin supplements." 2. "This medication will help lower my cholesterol." 3. "This medication should only be taken with water." 4. "A high-fiber diet is important while taking this medication."

3. "This medication should only be taken with water." Rationale: Cholestyramine (Questran) is a bile acid sequestrant used to lower the cholesterol level, and client compliance is a problem because of its taste and palatability. The use of flavored products or fruit juices can improve the taste. Some side effects of bile acid sequestrants include constipation and decreased vitamin absorption. **Note the closed-ended word "only" in option 3**

120.) A client is taking lansoprazole (Prevacid) for the chronic management of Zollinger-Ellison syndrome. The nurse advises the client to take which of the following products if needed for a headache? 1. Naprosyn (Aleve) 2. Ibuprofen (Advil) 3. Acetaminophen (Tylenol) 4. Acetylsalicylic acid (aspirin)

3. Acetaminophen (Tylenol) Rationale: Zollinger-Ellison syndrome is a hypersecretory condition of the stomach. The client should avoid taking medications that are irritating to the stomach lining. Irritants would include aspirin and nonsteroidal antiinflammatory drugs (ibuprofen). The client should be advised to take acetaminophen for headache. **Remember that options that are comparable or alike are not likely to be correct. With this in mind, eliminate options 1 and 2 first.**

233.) Diphenhydramine hydrochloride (Benadryl) is used in the treatment of allergic rhinitis for a hospitalized client with a chronic psychotic disorder. The client asks the nurse why the medication is being discontinued before hospital discharge. The nurse responds, knowing that: 1. Allergic symptoms are short in duration. 2. This medication promotes long-term extrapyramidal symptoms. 3. Addictive properties are enhanced in the presence of psychotropic medications. 4. Poor compliance causes this medication to fail to reach its therapeutic blood level.

3. Addictive properties are enhanced in the presence of psychotropic medications. Rationale: The addictive properties of diphenhydramine hydrochloride are enhanced when used with psychotropic medications. Allergic symptoms may not be short term and will occur if allergens are present in the environment. Poor compliance may be a problem with psychotic clients but is not the subject of the question. Diphenhydramine hydrochloride may be used for extrapyramidal symptoms and mild medication-induced movement disorders.

35.) The client has a PRN prescription for loperamide hydrochloride (Imodium). The nurse understands that this medication is used for which condition? 1. Constipation 2. Abdominal pain 3. An episode of diarrhea 4. Hematest-positive nasogastric tube drainage

3. An episode of diarrhea Rationale: Loperamide is an antidiarrheal agent. It is used to manage acute and also chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy. It is not used for the conditions in options 1, 2, and 4.

207.) A client is suspected of having myasthenia gravis, and the health care provider administers edrophonium (Enlon) to determine the diagnosis. After administration of this medication, which of the following would indicate the presence of myasthenia gravis? 1. Joint pain 2. A decrease in muscle strength 3. An increase in muscle strength 4. Feelings of faintness, dizziness, hypotension, and signs of flushing in the client

3. An increase in muscle strength Rationale: Edrophonium is a short-acting acetylcholinesterase inhibitor used as a diagnostic agent. When a client with suspected myasthenia gravis is given the medication intravenously, an increase in muscle strength would be seen in 1 to 3 minutes. If no response occurs, another dose is given over the next 2 minutes, and muscle strength is again tested. If no increase in muscle strength occurs with this higher dose, the muscle weakness is not caused by myasthenia gravis. Clients receiving injections of this medication commonly demonstrate a drop of blood pressure, feel faint and dizzy, and are flushed.

107.) A client receiving a tricyclic antidepressant arrives at the mental health clinic. Which observation indicates that the client is correctly following the medication plan? 1. Reports not going to work for this past week 2. Complains of not being able to "do anything" anymore 3. Arrives at the clinic neat and appropriate in appearance 4. Reports sleeping 12 hours per night and 3 to 4 hours during the day

3. Arrives at the clinic neat and appropriate in appearance Rationale: Depressed individuals will sleep for long periods, are not able to go to work, and feel as if they cannot "do anything." Once they have had some therapeutic effect from their medication, they will report resolution of many of these complaints as well as demonstrate an improvement in their appearance.

174.) A client with portosystemic encephalopathy is receiving oral lactulose (Chronulac) daily. The nurse assesses which of the following to determine medication effectiveness? 1. Lung sounds 2. Blood pressure 3. Blood ammonia level 4. Serum potassium level

3. Blood ammonia level Rationale: Lactulose is a hyperosmotic laxative and ammonia detoxicant. It is used to prevent or treat portosystemic encephalopathy, including hepatic precoma and coma. It also is used to treat constipation. The medication retains ammonia in the colon (decreases the blood ammonia concentration), producing an osmotic effect. It promotes increased peristalsis and bowel evacuation, expelling ammonia from the colon.

96.) The nurse is caring for a postrenal transplant client taking cyclosporine (Sandimmune, Gengraf, Neoral). The nurse notes an increase in one of the client's vital signs, and the client is complaining of a headache. What is the vital sign that is most likely increased? 1. Pulse 2. Respirations 3. Blood pressure 4. Pulse oximetry

3. Blood pressure Rationale: Hypertension can occur in a client taking cyclosporine (Sandimmune, Gengraf, Neoral), and because this client is also complaining of a headache, the blood pressure is the vital sign to be monitoring most closely. Other adverse effects include infection, nephrotoxicity, and hirsutism. Options 1, 2, and 4 are unrelated to the use of this medication.

153.) A client is diagnosed with pulmonary embolism and is to be treated with streptokinase (Streptase). A nurse would report which priority data collection finding to the registered nurse before initiating this therapy? 1. Adventitious breath sounds 2. Temperature of 99.4° F orally 3. Blood pressure of 198/110 mm Hg 4. Respiratory rate of 28 breaths/min

3. Blood pressure of 198/110 mm Hg Rationale: Thrombolytic therapy is contraindicated in a number of preexisting conditions in which there is a risk of uncontrolled bleeding, similar to the case in anticoagulant therapy. Thrombolytic therapy also is contraindicated in severe uncontrolled hypertension because of the risk of cerebral hemorrhage. Therefore the nurse would report the results of the blood pressure to the registered nurse before initiating therapy. The findings in options 1, 2, and 4 may be present in the client with pulmonary embolism.

69.) A nurse who is administering bethanechol chloride (Urecholine) is monitoring for acute toxicity associated with the medication. The nurse checks the client for which sign of toxicity? 1. Dry skin 2. Dry mouth 3. Bradycardia 4. Signs of dehydration

3. Bradycardia Rationale: Toxicity (overdose) produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Treatment includes supportive measures and the administration of atropine sulfate subcutaneously or intravenously.

1) A nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as prescribed to the client? 1. Calcium chloride 2. Calcium gluconate 3. Calcitonin (Miacalcin) 4. Large doses of vitamin D

3. Calcitonin (Miacalcin) Rationale: The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration.

49.) A client has been started on long-term therapy with rifampin (Rifadin). A nurse teaches the client that the medication: 1. Should always be taken with food or antacids 2. Should be double-dosed if one dose is forgotten 3. Causes orange discoloration of sweat, tears, urine, and feces 4. May be discontinued independently if symptoms are gone in 3 months

3. Causes orange discoloration of sweat, tears, urine, and feces Rationale: Rifampin should be taken exactly as directed as part of TB therapy. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider. The medication should be administered on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin causes orange-red discoloration of body secretions and will permanently stain soft contact lenses.

38.) An older client recently has been taking cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system side effect of this medication? 1. Tremors 2. Dizziness 3. Confusion 4. Hallucinations

3. Confusion Rationale: Cimetidine is a histamine 2 (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.

16.) The clinic nurse is reviewing a teaching plan for the client receiving an antineoplastic medication. When implementing the plan, the nurse tells the client: 1. To take aspirin (acetylsalicylic acid) as needed for headache 2. Drink beverages containing alcohol in moderate amounts each evening 3. Consult with health care providers (HCPs) before receiving immunizations 4. That it is not necessary to consult HCPs before receiving a flu vaccine at the local health fair

3. Consult with health care providers (HCPs) before receiving immunizations Rationale: Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without a HCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side effects.

150.) A client complaining of not feeling well is seen in a clinic. The client is taking several medications for the control of heart disease and hypertension. These medications include a β-blocker, digoxin (Lanoxin), and a diuretic. A tentative diagnosis of digoxin toxicity is made. Which of the following assessment data would support this diagnosis? 1. Dyspnea, edema, and palpitations 2. Chest pain, hypotension, and paresthesia 3. Double vision, loss of appetite, and nausea 4. Constipation, dry mouth, and sleep disorder

3. Double vision, loss of appetite, and nausea Rationale: Double vision, loss of appetite, and nausea are signs of digoxin toxicity. Additional signs of digoxin toxicity include bradycardia, difficulty reading, visual alterations such as green and yellow vision or seeing spots or halos, confusion, vomiting, diarrhea, decreased libido, and impotence. **gastrointestinal (GI) and visual disturbances occur with digoxin toxicity**

85.) A nurse is monitoring a client receiving baclofen (Lioresal) for side effects related to the medication. Which of the following would indicate that the client is experiencing a side effect? 1. Polyuria 2. Diarrhea 3. Drowsiness 4. Muscular excitability

3. Drowsiness Rationale: Baclofen is a central nervous system (CNS) depressant and frequently causes drowsiness, dizziness, weakness, and fatigue. It can also cause nausea, constipation, and urinary retention. Clients should be warned about the possible reactions. Options 1, 2, and 4 are not side effects.

244.) A client has a prescription for valproic acid (Depakene) orally once daily. The nurse plans to: 1. Administer the medication with an antacid. 2. Administer the medication with a carbonated beverage. 3. Ensure that the medication is administered at the same time each day. 4. Ensure that the medication is administered 2 hours before breakfast only, when the client's stomach is empty.

3. Ensure that the medication is administered at the same time each day. Rationale: Valproic acid is an anticonvulsant, antimanic, and antimigraine medication. It may be administered with or without food. It should not be taken with an antacid or carbonated beverage because these products will affect medication absorption. The medication is administered at the same time each day to maintain therapeutic serum levels. **Use general pharmacology guidelines to assist in eliminating options 1 and 2. Eliminate option 4 because of the closed-ended word "only."**

97.) Amikacin (Amikin) is prescribed for a client with a bacterial infection. The client is instructed to contact the health care provider (HCP) immediately if which of the following occurs? 1. Nausea 2. Lethargy 3. Hearing loss 4. Muscle aches

3. Hearing loss Rationale: Amikacin (Amikin) is an aminoglycoside. Adverse effects of aminoglycosides include ototoxicity (hearing problems), confusion, disorientation, gastrointestinal irritation, palpitations, blood pressure changes, nephrotoxicity, and hypersensitivity. The nurse instructs the client to report hearing loss to the HCP immediately. Lethargy and muscle aches are not associated with the use of this medication. It is not necessary to contact the HCP immediately if nausea occurs. If nausea persists or results in vomiting, the HCP should be notified. **(most aminoglycoside medication names end in the letters -cin)**

60.) A nurse is planning to administer hydrochlorothiazide (HydroDIURIL) to a client. The nurse understands that which of the following are concerns related to the administration of this medication? 1. Hypouricemia, hyperkalemia 2. Increased risk of osteoporosis 3. Hypokalemia, hyperglycemia, sulfa allergy 4. Hyperkalemia, hypoglycemia, penicillin allergy

3. Hypokalemia, hyperglycemia, sulfa allergy Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

130.) The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? 1. Anemia 2. Decreased platelets 3. Increased uric acid level 4. Decreased leukocyte count

3. Increased uric acid level Rationale: Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in a massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is related specifically to cell destruction.

122.) A client who has begun taking fosinopril (Monopril) is very distressed, telling the nurse that he cannot taste food normally since beginning the medication 2 weeks ago. The nurse provides the best support to the client by: 1. Telling the client not to take the medication with food 2. Suggesting that the client taper the dose until taste returns to normal 3. Informing the client that impaired taste is expected and generally disappears in 2 to 3 months 4. Requesting that the health care provider (HCP) change the prescription to another brand of angiotensin-converting enzyme (ACE) inhibitor

3. Informing the client that impaired taste is expected and generally disappears in 2 to 3 months Rationale: ACE inhibitors, such as fosinopril, cause temporary impairment of taste (dysgeusia). The nurse can tell the client that this effect usually disappears in 2 to 3 months, even with continued therapy, and provide nutritional counseling if appropriate to avoid weight loss. Options 1, 2, and 4 are inappropriate actions. Taking this medication with or without food does not affect absorption and action. The dosage should never be tapered without HCP approval and the medication should never be stopped abruptly.

230.) A client is placed on chloral hydrate (Somnote) for short-term treatment. Which nursing action indicates an understanding of the major side effect of this medication? 1. Monitoring neurological signs every 2 hours 2. Monitoring the blood pressure every 4 hours 3. Instructing the client to call for ambulation assistance 4. Lowering the bed and clearing a path to the bathroom at bedtime

3. Instructing the client to call for ambulation assistance Rationale: Chloral hydrate (a sedative-hypnotic) causes sedation and impairment of motor coordination; therefore, safety measures need to be implemented. The client is instructed to call for assistance with ambulation. Options 1 and 2 are not specifically associated with the use of this medication. Although option 4 is an appropriate nursing intervention, it is most important to instruct the client to call for assistance with ambulation.

241.) A client with a history of simple partial seizures is taking clorazepate (Tranxene), and asks the nurse if there is a risk of addiction. The nurse's response is based on the understanding that clorazepate: 1. Is not habit forming, either physically or psychologically 2. Leads to physical tolerance, but only after 10 or more years of therapy 3. Leads to physical and psychological dependence with prolonged high-dose therapy 4. Can result in psychological dependence only, because of the nature of the medication

3. Leads to physical and psychological dependence with prolonged high-dose therapy Rationale: Clorazepate is classified as an anticonvulsant, antianxiety agent, and sedative-hypnotic (benzodiazepine). One of the concerns with clorazepate therapy is that the medication can lead to physical or psychological dependence with prolonged therapy at high doses. For this reason, the amount of medication that is readily available to the client at any one time is restricted. **Eliminate options 2 and 4 first because of the closed-ended word "only"**

52.) A client with tuberculosis is being started on antituberculosis therapy with isoniazid (INH). Before giving the client the first dose, a nurse ensures that which of the following baseline studies has been completed? 1. Electrolyte levels 2. Coagulation times 3. Liver enzyme levels 4. Serum creatinine level

3. Liver enzyme levels Rationale: INH therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is greater than age 50 or abuses alcohol.

210.) Dantrolene (Dantrium) is prescribed for a client with a spinal cord injury for discomfort resulting from spasticity. The nurse tells the client about the importance of follow-up and the need for which blood study? 1. Creatinine level 2. Sedimentation rate 3. Liver function studies 4. White blood cell count

3. Liver function studies Rationale: Dantrolene can cause liver damage, and the nurse should monitor liver function studies. Baseline liver function studies are done before therapy starts, and regular liver function studies are performed throughout therapy. Dantrolene is discontinued if no relief of spasticity is achieved in 6 weeks.

59.) A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention? 1. Monitor for renal failure. 2. Monitor psychosocial status. 3. Monitor for signs of bleeding. 4. Have heparin sodium available.

3. Monitor for signs of bleeding. Rationale: Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin is given after thrombolytic therapy, but the question is not asking about follow-up medications.

151.) A client is being treated for acute congestive heart failure with intravenously administered bumetanide. The vital signs are as follows: blood pressure, 100/60 mm Hg; pulse, 96 beats/min; and respirations, 24 breaths/min. After the initial dose, which of the following is the priority assessment? 1. Monitoring weight loss 2. Monitoring temperature 3. Monitoring blood pressure 4. Monitoring potassium level

3. Monitoring blood pressure Rationale: Bumetanide is a loop diuretic. Hypotension is a common side effect associated with the use of this medication. The other options also require assessment but are not the priority. **priority ABCs—airway, breathing, and circulation**

201.) A nurse is preparing to administer eardrops to an infant. The nurse plans to: 1. Pull up and back on the ear and direct the solution onto the eardrum. 2. Pull down and back on the ear and direct the solution onto the eardrum. 3. Pull down and back on the ear and direct the solution toward the wall of the canal. 4. Pull up and back on the ear lobe and direct the solution toward the wall of the canal.

3. Pull down and back on the ear and direct the solution toward the wall of the canal. Rationale: When administering eardrops to an infant, the nurse pulls the ear down and straight back. In the adult or a child older than 3 years, the ear is pulled up and back to straighten the auditory canal. The medication is administered by aiming it at the wall of the canal rather than directly onto the eardrum.

37.) The client has begun medication therapy with pancrelipase (Pancrease MT). The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed? 1. Weight loss 2. Relief of heartburn 3. Reduction of steatorrhea 4. Absence of abdominal pain

3. Reduction of steatorrhea Rationale: Pancrelipase (Pancrease MT) is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. Its use could result in weight gain but should not result in weight loss if it is aiding in digestion.

137.) A nurse is reinforcing instructions for a client regarding intranasal desmopressin acetate (DDAVP). The nurse tells the client that which of the following is a side effect of the medication? 1. Headache 2. Vulval pain 3. Runny nose 4. Flushed skin

3. Runny nose Rationale: Desmopressin administered by the intranasal route can cause a runny or stuffy nose. Headache, vulval pain, and flushed skin are side effects if the medication is administered by the intravenous (IV) route.

95.) The nurse is reviewing the results of serum laboratory studies drawn on a client with acquired immunodeficiency syndrome who is receiving didanosine (Videx). The nurse interprets that the client may have the medication discontinued by the health care provider if which of the following significantly elevated results is noted? 1. Serum protein 2. Blood glucose 3. Serum amylase 4. Serum creatinine

3. Serum amylase Rationale: Didanosine (Videx) can cause pancreatitis. A serum amylase level that is increased 1.5 to 2 times normal may signify pancreatitis in the client with acquired immunodeficiency syndrome and is potentially fatal. The medication may have to be discontinued. The medication is also hepatotoxic and can result in liver failure.

98.) The nurse is assigned to care for a client with cytomegalovirus retinitis and acquired immunodeficiency syndrome who is receiving foscarnet. The nurse should check the latest results of which of the following laboratory studies while the client is taking this medication? 1. CD4 cell count 2. Serum albumin 3. Serum creatinine 4. Lymphocyte count

3. Serum creatinine Rationale: Foscarnet is toxic to the kidneys. Serum creatinine is monitored before therapy, two to three times per week during induction therapy, and at least weekly during maintenance therapy. Foscarnet may also cause decreased levels of calcium, magnesium, phosphorus, and potassium. Thus these levels are also measured with the same frequency.

211.) A client with epilepsy is taking the prescribed dose of phenytoin (Dilantin) to control seizures. A phenytoin blood level is drawn, and the results reveal a level of 35 mcg/ml. Which of the following symptoms would be expected as a result of this laboratory result? 1. Nystagmus 2. Tachycardia 3. Slurred speech 4. No symptoms, because this is a normal therapeutic level

3. Slurred speech Rationale: The therapeutic phenytoin level is 10 to 20 mcg/mL. At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) appear. At a level higher than 30 mcg/mL, ataxia and slurred speech occur.

187.) A clinic nurse prepares to administer an MMR (measles, mumps, rubella) vaccine to a child. How is this vaccine best administered? 1. Intramuscularly in the deltoid muscle 2. Subcutaneously in the gluteal muscle 3. Subcutaneously in the outer aspect of the upper arm 4. Intramuscularly in the anterolateral aspect of the thigh

3. Subcutaneously in the outer aspect of the upper arm Rationale: The MMR vaccine is administered subcutaneously in the outer aspect of the upper arm. The gluteal muscle is most often used for intramuscular injections. The MMR vaccine is not administered by the intramuscular route.

46.) A postoperative client has received a dose of naloxone hydrochloride for respiratory depression shortly after transfer to the nursing unit from the postanesthesia care unit. After administration of the medication, the nurse checks the client for: 1. Pupillary changes 2. Scattered lung wheezes 3. Sudden increase in pain 4. Sudden episodes of diarrhea

3. Sudden increase in pain Rationale: Naloxone hydrochloride is an antidote to opioids and may also be given to the postoperative client to treat respiratory depression. When given to the postoperative client for respiratory depression, it may also reverse the effects of analgesics. Therefore, the nurse must check the client for a sudden increase in the level of pain experienced. Options 1, 2, and 4 are not associated with this medication.

58.) Isosorbide mononitrate (Imdur) is prescribed for a client with angina pectoris. The client tells the nurse that the medication is causing a chronic headache. The nurse appropriately suggests that the client: 1. Cut the dose in half. 2. Discontinue the medication. 3. Take the medication with food. 4. Contact the health care provider (HCP).

3. Take the medication with food. Rationale: Isosorbide mononitrate is an antianginal medication. Headache is a frequent side effect of isosorbide mononitrate and usually disappears during continued therapy. If a headache occurs during therapy, the client should be instructed to take the medication with food or meals. It is not necessary to contact the HCP unless the headaches persist with therapy. It is not appropriate to instruct the client to discontinue therapy or adjust the dosages.

245.) A client taking carbamazepine (Tegretol) asks the nurse what to do if he misses one dose. The nurse responds that the carbamazepine should be: 1. Withheld until the next scheduled dose 2. Withheld and the health care provider is notified immediately 3. Taken as long as it is not immediately before the next dose 4. Withheld until the next scheduled dose, which should then be doubled

3. Taken as long as it is not immediately before the next dose Rationale: Carbamazepine is an anticonvulsant that should be taken around the clock, precisely as directed. If a dose is omitted, the client should take the dose as soon as it is remembered, as long as it is not immediately before the next dose. The medication should not be double dosed. If more than one dose is omitted, the client should call the health care provider.

229.) A client who is taking lithium carbonate (Lithobid) is scheduled for surgery. The nurse informs the client that: 1. The medication will be discontinued a week before the surgery and resumed 1 week postoperatively. 2. The medication is to be taken until the day of surgery and resumed by injection immediately postoperatively. 3. The medication will be discontinued 1 to 2 days before the surgery and resumed as soon as full oral intake is allowed. 4. The medication will be discontinued several days before surgery and resumed by injection in the immediate postoperative period.

3. The medication will be discontinued 1 to 2 days before the surgery and resumed as soon as full oral intake is allowed. Rationale: The client who is on lithium carbonate must be off the medication for 1 to 2 days before a scheduled surgical procedure and can resume the medication when full oral intake is prescribed after the surgery. **lithium carbonate is an oral medication and is not given as an injection**

80.) A nurse is caring for a client who is taking phenytoin (Dilantin) for control of seizures. During data collection, the nurse notes that the client is taking birth control pills. Which of the following information should the nurse provide to the client? 1. Pregnancy should be avoided while taking phenytoin (Dilantin). 2. The client may stop taking the phenytoin (Dilantin) if it is causing severe gastrointestinal effects. 3. The potential for decreased effectiveness of the birth control pills exists while taking phenytoin (Dilantin). 4. The increased risk of thrombophlebitis exists while taking phenytoin (Dilantin) and birth control pills together.

3. The potential for decreased effectiveness of the birth control pills exists while taking phenytoin (Dilantin). Rationale: Phenytoin (Dilantin) enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, are 4 are not accurate.

22.) A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed to: 1. Treat thyroid storm. 2. Prevent cardiac irritability. 3. Treat hypocalcemic tetany. 4. Stimulate the release of parathyroid hormone.

3. Treat hypocalcemic tetany. Rationale: Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes or muscle spasms or twitching, the health care provider is notified immediately. Calcium gluconate should be kept at the bedside.

103.) A nurse is caring for a hospitalized client who has been taking clozapine (Clozaril) for the treatment of a schizophrenic disorder. Which laboratory study prescribed for the client will the nurse specifically review to monitor for an adverse effect associated with the use of this medication? 1. Platelet count 2. Cholesterol level 3. White blood cell count 4. Blood urea nitrogen level

3. White blood cell count Rationale: Hematological reactions can occur in the client taking clozapine and include agranulocytosis and mild leukopenia. The white blood cell count should be checked before initiating treatment and should be monitored closely during the use of this medication. The client should also be monitored for signs indicating agranulocytosis, which may include sore throat, malaise, and fever. Options 1, 2, and 4 are unrelated to this medication.

81.) A client with trigeminal neuralgia is being treated with carbamazepine (Tegretol). Which laboratory result would indicate that the client is experiencing an adverse reaction to the medication? 1. Sodium level, 140 mEq/L 2. Uric acid level, 5.0 mg/dL 3. White blood cell count, 3000 cells/mm3 4. Blood urea nitrogen (BUN) level, 15 mg/dL

3. White blood cell count, 3000 cells/mm3 Rationale: Adverse effects of carbamazepine (Tegretol) appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects. Options 1, 2, and 4 identify normal laboratory values.

Normal serum potassium (K+) level

3.5-5.0 mEq/L

How soon after administering regular insulin will it begin to have an effect. What should the nurse say?

30 minutes to an hour

4

A client with hepatitis B asks the nurse, "Are there any medications to help me get rid of this problem?" Which is the best response by the nurse? 1 "Sedatives can be given to help you relax." 2 "We can give you immune serum globulin." 3 "Vitamin supplements are frequently helpful and hasten recovery." 4 "There are medications to help reduce viral load and liver inflammation.

73.) A client with myasthenia gravis is suspected of having cholinergic crisis. Which of the following indicate that this crisis exists? 1. Ataxia 2. Mouth sores 3. Hypotension 4. Hypertension

4. Hypertension Rationale: Cholinergic crisis occurs as a result of an overdose of medication. Indications of cholinergic crisis include gastrointestinal disturbances, nausea, vomiting, diarrhea, abdominal cramps, increased salivation and tearing, miosis, hypertension, sweating, and increased bronchial secretions.

157.) A client receiving nitrofurantoin (Macrodantin) calls the health care provider's office complaining of side effects related to the medication. Which side effect indicates the need to stop treatment with this medication? 1. Nausea 2. Diarrhea 3. Anorexia 4. Cough and chest pain

4. Cough and chest pain Rationale: Gastrointestinal (GI) effects are the most frequent adverse reactions to this medication and can be minimized by administering the medication with milk or meals. Pulmonary reactions, manifested as dyspnea, chest pain, chills, fever, cough, and the presence of alveolar infiltrates on the x-ray, would indicate the need to stop the treatment. These symptoms resolve in 2 to 4 days following discontinuation of this medication. **Eliminate options 1, 2, and 3 because they are similar GI-related side effects. Also, use the ABCs— airway, breathing, and circulation**

118.) A nurse is caring for an older client with a diagnosis of myasthenia gravis and has reinforced self-care instructions. Which statement by the client indicates that further teaching is necessary? 1. "I rest each afternoon after my walk." 2. "I cough and deep breathe many times during the day." 3. "If I get abdominal cramps and diarrhea, I should call my doctor." 4. "I can change the time of my medication on the mornings that I feel strong."

4. "I can change the time of my medication on the mornings that I feel strong." Rationale: The client with myasthenia gravis should be taught that timing of anticholinesterase medication is critical. It is important to instruct the client to administer the medication on time to maintain a chemical balance at the neuromuscular junction. If not given on time, the client may become too weak to swallow. Options 1, 2, and 3 include the necessary information that the client needs to understand to maintain health with this neurological degenerative disease.

54.) A nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium (Coumadin). Which statement, if made by the client, reflects the need for further teaching? 1. "I will take my pills every day at the same time." 2. "I will be certain to avoid alcohol consumption." 3. "I have already called my family to pick up a Medic-Alert bracelet." 4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."

4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated." Rationale: Ecotrin is an aspirin-containing product and should be avoided. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information.

61.) A home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which of the following statements, if made by the client, indicates the need for further education? 1. "Constipation and bloating might be a problem." 2. "I'll continue to watch my diet and reduce my fats." 3. "Walking a mile each day will help the whole process." 4. "I'll continue my nicotinic acid from the health food store."

4. "I'll continue my nicotinic acid from the health food store." Rationale: Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin is to be avoided. Constipation and bloating are the two most common side effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

62.) A client is on nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client would indicate an understanding of the instructions? 1. "It is not necessary to avoid the use of alcohol." 2. "The medication should be taken with meals to decrease flushing." 3. "Clay-colored stools are a common side effect and should not be of concern." 4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."

4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing." Rationale: Flushing is a side effect of this medication. Aspirin or a nonsteroidal anti-inflammatory drug can be taken 30 minutes before taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this side effect. The medication should be taken with meals, this will decrease gastrointestinal upset. Taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be immediately reported to the health care provider (HCP).

218.) A film-coated form of diflunisal has been prescribed for a client for the treatment of chronic rheumatoid arthritis. The client calls the clinic nurse because of difficulty swallowing the tablets. Which initial instruction should the nurse provide to the client? 1. "Crush the tablets and mix them with food." 2. "Notify the health care provider for a medication change." 3. "Open the tablet and mix the contents with food." 4. "Swallow the tablets with large amounts of water or milk."

4. "Swallow the tablets with large amounts of water or milk." Rationale: Diflunisal may be given with water, milk, or meals. The tablets should not be crushed or broken open. Taking the medication with a large amount of water or milk should be tried before contacting the health care provider.

198.) Coal tar has been prescribed for a client with a diagnosis of psoriasis, and the nurse provides instructions to the client about the medication. Which statement by the client indicates a need for further instructions? 1. "The medication can cause phototoxicity." 2. "The medication has an unpleasant odor." 3. "The medication can stain the skin and hair." 4. "The medication can cause systemic effects."

4. "The medication can cause systemic effects." Rationale: Coal tar is used to treat psoriasis and other chronic disorders of the skin. It suppresses DNA synthesis, mitotic activity, and cell proliferation. It has an unpleasant odor, can frequently stain the skin and hair, and can cause phototoxicity. Systemic toxicity does not occur. **The name of the medication will assist in eliminating options 2 and 3**

87.) A client with acute muscle spasms has been taking baclofen (Lioresal). The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse should make which appropriate response to the client? 1. "You should never stop the medication." 2. "It is best that you taper the dose if you intend to stop the medication." 3. "It is okay to stop the medication if you think that you can tolerate the muscle spasms." 4. "Weakness and fatigue commonly occur and will diminish with continued medication use."

4. "Weakness and fatigue commonly occur and will diminish with continued medication use." Rationale: The client should be instructed that symptoms such as drowsiness, weakness, and fatigue are more intense in the early phase of therapy and diminish with continued medication use. The client should be instructed never to withdraw or stop the medication abruptly, because abrupt withdrawal can cause visual hallucinations, paranoid ideation, and seizures. It is best for the nurse to inform the client that these symptoms will subside and encourage the client to continue the use of the medication.

226.) A client receiving lithium carbonate (Lithobid) complains of loose, watery stools and difficulty walking. The nurse would expect the serum lithium level to be which of the following? 1. 0.7 mEq/L 2. 1.0 mEq/L 3. 1.2 mEq/L 4. 1.7 mEq/L

4. 1.7 mEq/L Rationale: The therapeutic serum level of lithium ranges from 0.6 to 1.2 mEq/L. Serum lithium levels above the therapeutic level will produce signs of toxicity.

242.) A client who was started on anticonvulsant therapy with clonazepam (Klonopin) tells the nurse of increasing clumsiness and unsteadiness since starting the medication. The client is visibly upset by these manifestations and asks the nurse what to do. The nurse's response is based on the understanding that these symptoms: 1. Usually occur if the client takes the medication with food 2. Are probably the result of an interaction with another medication 3. Indicate that the client is experiencing a severe untoward reaction to the medication 4. Are worse during initial therapy and decrease or disappear with long-term use

4. Are worse during initial therapy and decrease or disappear with long-term use Rationale: Drowsiness, unsteadiness, and clumsiness are expected effects of the medication during early therapy. They are dose related and usually diminish or disappear altogether with continued use of the medication. It does not indicate that a severe side effect is occurring. It is also unrelated to interaction with another medication. The client is encouraged to take this medication with food to minimize gastrointestinal upset. **Eliminate options 2 and 3 first because they are comparable or alike and because of the word "severe" in option 3**

4.) The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied: 1. Immediately before swimming 2. 15 minutes before exposure to the sun 3. Immediately before exposure to the sun 4. At least 30 minutes before exposure to the sun

4. At least 30 minutes before exposure to the sun Rationale: Sunscreens are most effective when applied at least 30 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming or sweating.

178.) Methylergonovine (Methergine) is prescribed for a client with postpartum hemorrhage caused by uterine atony. Before administering the medication, the nurse checks which of the following as the important client parameter? 1. Temperature 2. Lochial flow 3. Urine output 4. Blood pressure

4. Blood pressure Rationale: Methylergonovine is an ergot alkaloid used for postpartum hemorrhage. It stimulates contraction of the uterus and causes arterial vasoconstriction. Ergot alkaloids are avoided in clients with significant cardiovascular disease, peripheral disease, hypertension, eclampsia, or preeclampsia. These conditions are worsened by the vasoconstrictive effects of the ergot alkaloids. The nurse would check the client's blood pressure before administering the medication and would follow agency protocols regarding withholding of the medication. Options 1, 2, and 3 are items that are checked in the postpartum period, but they are unrelated to the use of this medication.

237.) A client who is on lithium carbonate (Lithobid) will be discharged at the end of the week. In formulating a discharge teaching plan, the nurse will instruct the client that it is most important to: 1. Avoid soy sauce, wine, and aged cheese. 2. Have the lithium level checked every week. 3. Take medication only as prescribed because it can become addicting. 4. Check with the psychiatrist before using any over-the-counter (OTC) medications or prescription medications.

4. Check with the psychiatrist before using any over-the-counter (OTC) medications or prescription medications. Rationale: Lithium is the medication of choice to treat manic-depressive illness. Many OTC medications interact with lithium, and the client is instructed to avoid OTC medications while taking lithium. Lithium is not addicting, and, although serum lithium levels need to be monitored, it is not necessary to check these levels every week. A tyramine-free diet is associated with monoamine oxidase inhibitors.

19.) Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that the primary action of this medication is to: 1. Increase DNA and RNA synthesis. 2. Promote the biosynthesis of nucleic acids. 3. Increase estrogen concentration and estrogen response. 4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.

4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Rationale: Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy. Tamoxifen reduces DNA synthesis and estrogen response.

217.) A health care provider prescribes auranofin (Ridaura) for a client with rheumatoid arthritis. Which of the following would indicate to the nurse that the client is experiencing toxicity related to the medication? 1. Joint pain 2. Constipation 3. Ringing in the ears 4. Complaints of a metallic taste in the mouth

4. Complaints of a metallic taste in the mouth Rationale: Ridaura is the one gold preparation that is given orally rather than by injection. Gastrointestinal reactions including diarrhea, abdominal pain, nausea, and loss of appetite are common early in therapy, but these usually subside in the first 3 months of therapy. Early symptoms of toxicity include a rash, purple blotches, pruritus, mouth lesions, and a metallic taste in the mouth.

124.) A client with chronic renal failure is receiving ferrous sulfate (Feosol). The nurse monitors the client for which common side effect associated with this medication? 1. Diarrhea 2. Weakness 3. Headache 4. Constipation

4. Constipation Rationale: Feosol is an iron supplement used to treat anemia. Constipation is a frequent and uncomfortable side effect associated with the administration of oral iron supplements. Stool softeners are often prescribed to prevent constipation. **Focus on the name of the medication. Recalling that oral iron can cause constipation will easily direct you to the correct option.**

155.) Mycophenolate mofetil (CellCept) is prescribed for a client as prophylaxis for organ rejection following an allogeneic renal transplant. Which of the following instructions does the nurse reinforce regarding administration of this medication? 1. Administer following meals. 2. Take the medication with a magnesium-type antacid. 3. Open the capsule and mix with food for administration. 4. Contact the health care provider (HCP) if a sore throat occurs.

4. Contact the health care provider (HCP) if a sore throat occurs. Rationale: Mycophenolate mofetil should be administered on an empty stomach. The capsules should not be opened or crushed. The client should contact the HCP if unusual bleeding or bruising, sore throat, mouth sores, abdominal pain, or fever occurs because these are adverse effects of the medication. Antacids containing magnesium and aluminum may decrease the absorption of the medication and therefore should not be taken with the medication. The medication may be given in combination with corticosteroids and cyclosporine. **neutropenia can occur with this medication**

132.) The client with non-Hodgkin's lymphoma is receiving daunorubicin (DaunoXome). Which of the following would indicate to the nurse that the client is experiencing a toxic effect related to the medication? 1. Fever 2. Diarrhea 3. Complaints of nausea and vomiting 4. Crackles on auscultation of the lungs

4. Crackles on auscultation of the lungs Rationale: Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as congestive heart failure is a toxic effect of daunorubicin. Bone marrow depression is also a toxic effect. Nausea and vomiting are frequent side effects associated with the medication that begins a few hours after administration and lasts 24 to 48 hours. Fever is a frequent side effect, and diarrhea can occur occasionally. The other options, however, are not toxic effects. **keep in mind that the question is asking about a toxic effect and think: ABCs—airway, breathing, and circulation**

117.) A nurse has given the client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client immediately reports: 1. Impaired sense of hearing 2. Distressing gastrointestinal side effects 3. Orange-red discoloration of body secretions 4. Difficulty discriminating the color red from green

4. Difficulty discriminating the color red from green Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when driving a motor vehicle. The client is taught to report this symptom immediately. The client is also taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin (Rifadin).

190.) A child is hospitalized with a diagnosis of lead poisoning. The nurse assisting in caring for the child would prepare to assist in administering which of the following medications? 1. Activated charcoal 2. Sodium bicarbonate 3. Syrup of ipecac syrup 4. Dimercaprol (BAL in Oil)

4. Dimercaprol (BAL in Oil) Rationale: Dimercaprol is a chelating agent that is administered to remove lead from the circulating blood and from some tissues and organs for excretion in the urine. Sodium bicarbonate may be used in salicylate poisoning. Syrup of ipecac is used in the hospital setting in poisonings to induce vomiting. Activated charcoal is used to decrease absorption in certain poisoning situations. Note that dimercaprol is prepared with peanut oil, and hence should be avoided by clients with known or suspected peanut allergy.

159.) A nurse is caring for a client receiving morphine sulfate subcutaneously for pain. Because morphine sulfate has been prescribed for this client, which nursing action would be included in the plan of care? 1. Encourage fluid intake. 2. Monitor the client's temperature. 3. Maintain the client in a supine position. 4. Encourage the client to cough and deep breathe.

4. Encourage the client to cough and deep breathe. Rationale: Morphine sulfate suppresses the cough reflex. Clients need to be encouraged to cough and deep breathe to prevent pneumonia. **ABCs—airway, breathing, and circulation**

231.) A client admitted to the hospital gives the nurse a bottle of clomipramine (Anafranil). The nurse notes that the medication has not been taken by the client in 2 months. What behaviors observed in the client would validate noncompliance with this medication? 1. Complaints of hunger 2. Complaints of insomnia 3. A pulse rate less than 60 beats per minute 4. Frequent handwashing with hot, soapy water

4. Frequent handwashing with hot, soapy water Rationale: Clomipramine is commonly used in the treatment of obsessive-compulsive disorder. Handwashing is a common obsessive-compulsive behavior. Weight gain is a common side effect of this medication. Tachycardia and sedation are side effects. Insomnia may occur but is seldom a side effect.

236.) A client is being treated for depression with amitriptyline hydrochloride. During the initial phases of treatment, the most important nursing intervention is: 1. Prescribing the client a tyramine-free diet 2. Checking the client for anticholinergic effects 3. Monitoring blood levels frequently because there is a narrow range between therapeutic and toxic blood levels of this medication 4. Getting baseline postural blood pressures before administering the medication and each time the medication is administered

4. Getting baseline postural blood pressures before administering the medication and each time the medication is administered Rationale: Amitriptyline hydrochloride is a tricyclic antidepressant often used to treat depression. It causes orthostatic changes and can produce hypotension and tachycardia. This can be frightening to the client and dangerous because it can result in dizziness and client falls. The client must be instructed to move slowly from a lying to a sitting to a standing position to avoid injury if these effects are experienced. The client may also experience sedation, dry mouth, constipation, blurred vision, and other anticholinergic effects, but these are transient and will diminish with time.

196.) A client has been prescribed amikacin (Amikin). Which of the following priority baseline functions should be monitored? 1. Apical pulse 2. Liver function 3. Blood pressure 4. Hearing acuity

4. Hearing acuity Rationale: Amikacin (Amikin) is an antibiotic. This medication can cause ototoxicity and nephrotoxicity; therefore, hearing acuity tests and kidney function studies should be performed before the initiation of therapy. Apical pulse, liver function studies, and blood pressure are not specifically related to the use of this medication.

175.) A nurse notes that a client is receiving lamivudine (Epivir). The nurse determines that this medication has been prescribed to treat which of the following? 1. Pancreatitis 2. Pharyngitis 3. Tonic-clonic seizures 4. Human immunodeficiency virus (HIV) infection

4. Human immunodeficiency virus (HIV) infection Rationale: Lamivudine is a nucleoside reverse transcriptase inhibitor and antiviral medication. It slows HIV replication and reduces the progression of HIV infection. It also is used to treat chronic hepatitis B and is used for prophylaxis in health care workers at risk of acquiring HIV after occupational exposure to the virus. **Note the letters "-vir" in the trade name for this medication**

192.) A nurse is collecting medication information from a client, and the client states that she is taking garlic as an herbal supplement. The nurse understands that the client is most likely treating which of the following conditions? 1. Eczema 2. Insomnia 3. Migraines 4. Hyperlipidemia

4. Hyperlipidemia Rationale: Garlic is an herbal supplement that is used to treat hyperlipidemia and hypertension. An herbal supplement that may be used to treat eczema is evening primrose. Insomnia has been treated with both valerian root and chamomile. Migraines have been treated with feverfew.

76.) Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's disease, and the nurse monitors the client for adverse reactions to the medication. Which of the following indicates that the client is experiencing an adverse reaction? 1. Pruritus 2. Tachycardia 3. Hypertension 4. Impaired voluntary movements

4. Impaired voluntary movements Rationale: Dyskinesia and impaired voluntary movement may occur with high levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia (the temporary muscle weakness that lasts 1 minute to 1 hour, also known as the "on-off phenomenon") are frequent side effects of the medication.

212.) Mannitol (Osmitrol) is being administered to a client with increased intracranial pressure following a head injury. The nurse assisting in caring for the client knows that which of the following indicates the therapeutic action of this medication? 1. Prevents the filtration of sodium and water through the kidneys 2. Prevents the filtration of sodium and potassium through the kidneys 3. Decreases water loss by promoting the reabsorption of sodium and water in the loop of Henle 4. Induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes

4. Induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes Rationale: Mannitol is an osmotic diuretic that induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes. It is used to reduce intracranial pressure in the client with head trauma.

225.) A nursing student is assigned to care for a client with a diagnosis of schizophrenia. Haloperidol (Haldol) is prescribed for the client, and the nursing instructor asks the student to describe the action of the medication. Which statement by the nursing student indicates an understanding of the action of this medication? 1. It is a serotonin reuptake blocker. 2. It inhibits the breakdown of released acetylcholine. 3. It blocks the uptake of norepinephrine and serotonin. 4. It blocks the binding of dopamine to the postsynaptic dopamine receptors in the brain.

4. It blocks the binding of dopamine to the postsynaptic dopamine receptors in the brain. Rationale: Haloperidol acts by blocking the binding of dopamine to the postsynaptic dopamine receptors in the brain. Imipramine hydrochloride (Tofranil) blocks the reuptake of norepinephrine and serotonin. Donepezil hydrochloride (Aricept) inhibits the breakdown of released acetylcholine. Fluoxetine hydrochloride (Prozac) is a potent serotonin reuptake blocker.

200.) A client is seen in the clinic for complaints of skin itchiness that has been persistent over the past several weeks. Following data collection, it has been determined that the client has scabies. Lindane is prescribed, and the nurse is asked to provide instructions to the client regarding the use of the medication. The nurse tells the client to: 1. Apply a thick layer of cream to the entire body. 2. Apply the cream as prescribed for 2 days in a row. 3. Apply to the entire body and scalp, excluding the face. 4. Leave the cream on for 8 to 12 hours and then remove by washing.

4. Leave the cream on for 8 to 12 hours and then remove by washing. Rationale: Lindane is applied in a thin layer to the entire body below the head. No more than 30 g (1 oz) should be used. The medication is removed by washing 8 to 12 hours later. Usually, only one application is required.

119.) A client with diabetes mellitus who has been controlled with daily insulin has been placed on atenolol (Tenormin) for the control of angina pectoris. Because of the effects of atenolol, the nurse determines that which of the following is the most reliable indicator of hypoglycemia? 1. Sweating 2. Tachycardia 3. Nervousness 4. Low blood glucose level

4. Low blood glucose level Rationale: β-Adrenergic blocking agents, such as atenolol, inhibit the appearance of signs and symptoms of acute hypoglycemia, which would include nervousness, increased heart rate, and sweating. Therefore, the client receiving this medication should adhere to the therapeutic regimen and monitor blood glucose levels carefully. Option 4 is the most reliable indicator of hypoglycemia.

205.) A nurse is assisting in preparing to administer acetylcysteine (Mucomyst) to a client with an overdose of acetaminophen (Tylenol). The nurse prepares to administer the medication by: 1. Administering the medication subcutaneously in the deltoid muscle 2. Administering the medication by the intramuscular route in the gluteal muscle 3. Administering the medication by the intramuscular route, mixed in 10 mL of normal saline 4. Mixing the medication in a flavored ice drink and allowing the client to drink the medication through a straw

4. Mixing the medication in a flavored ice drink and allowing the client to drink the medication through a straw Rationale: Because acetylcysteine has a pervasive odor of rotten eggs, it must be disguised in a flavored ice drink. It is consumed preferably through a straw to minimize contact with the mouth. It is not administered by the intramuscular or subcutaneous route. **Knowing that the medication is a solution that is also used for nebulization treatments will assist you to select the option that indicates an oral route**

36.) The client has a PRN prescription for ondansetron (Zofran). For which condition should this medication be administered to the postoperative client? 1. Paralytic ileus 2. Incisional pain 3. Urinary retention 4. Nausea and vomiting

4. Nausea and vomiting Rationale: Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect.

143.) A client has just taken a dose of trimethobenzamide (Tigan). The nurse plans to monitor this client for relief of: 1. Heartburn 2. Constipation 3. Abdominal pain 4. Nausea and vomiting

4. Nausea and vomiting Rationale: Trimethobenzamide is an antiemetic agent used in the treatment of nausea and vomiting. The other options are incorrect.

17.) The client with ovarian cancer is being treated with vincristine (Oncovin). The nurse monitors the client, knowing that which of the following indicates a side effect specific to this medication? 1. Diarrhea 2. Hair loss 3. Chest pain 4. Numbness and tingling in the fingers and toes

4. Numbness and tingling in the fingers and toes Rationale: A side effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest pain is unrelated to this medication.

39.) The client with a gastric ulcer has a prescription for sucralfate (Carafate), 1 g by mouth four times daily. The nurse schedules the medication for which times? 1. With meals and at bedtime 2. Every 6 hours around the clock 3. One hour after meals and at bedtime 4. One hour before meals and at bedtime

4. One hour before meals and at bedtime Rationale: Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect.

2.) Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The nurse instructs the mother to administer the iron with which best food item? 1. Milk 2. Water 3. Apple juice 4. Orange juice

4. Orange juice Rationale: Vitamin C increases the absorption of iron by the body. The mother should be instructed to administer the medication with a citrus fruit or a juice that is high in vitamin C. Milk may affect absorption of the iron. Water will not assist in absorption. Orange juice contains a greater amount of vitamin C than apple juice.

222.) A nurse has administered a dose of diazepam (Valium) to a client. The nurse would take which important action before leaving the client's room? 1. Giving the client a bedpan 2. Drawing the shades or blinds closed 3. Turning down the volume on the television 4. Per agency policy, putting up the side rails on the bed

4. Per agency policy, putting up the side rails on the bed Rationale: Diazepam is a sedative-hypnotic with anticonvulsant and skeletal muscle relaxant properties. The nurse should institute safety measures before leaving the client's room to ensure that the client does not injure herself or himself. The most frequent side effects of this medication are dizziness, drowsiness, and lethargy. For this reason, the nurse puts the side rails up on the bed before leaving the room to prevent falls. Options 1, 2, and 3 may be helpful measures that provide a comfortable, restful environment, but option 4 is the one that provides for the client's safety needs.

184.) A nurse preparing a client for surgery reviews the client's medication record. The client is to be nothing per mouth (NPO) after midnight. Which of the following medications, if noted on the client's record, should the nurse question? 1. Cyclobenzaprine (Flexeril) 2. Alendronate (Fosamax) 3. Allopurinol (Zyloprim) 4. Prednisone

4. Prednisone Rationale: Prednisone is a corticosteroid that can cause adrenal atrophy, which reduces the body's ability to withstand stress. Before and during surgery, dosages may be temporarily increased. Cyclobenzaprine is a skeletal muscle relaxant. Alendronate is a bone-resorption inhibitor. Allopurinol is an antigout medication.

189.) Prostaglandin E1 is prescribed for a child with transposition of the great arteries. The mother of the child asks the nurse why the child needs the medication. The nurse tells the mother that the medication: 1. Prevents hypercyanotic (blue or tet) spells 2. Maintains an adequate hormone level 3. Maintains the position of the great arteries 4. Provides adequate oxygen saturation and maintains cardiac output

4. Provides adequate oxygen saturation and maintains cardiac output Rationale: A child with transposition of the great arteries may receive prostaglandin E1 temporarily to increase blood mixing if systemic and pulmonary mixing are inadequate to maintain adequate cardiac output. Options 1, 2, and 3 are incorrect. In addition, hypercyanotic spells occur in tetralogy of Fallot. **Use the ABCs—airway, breathing, and circulation—to answer the question. The correct option addresses circulation**

13.) The client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? 1. Echocardiography 2. Electrocardiography 3. Cervical radiography 4. Pulmonary function studies

4. Pulmonary function studies Rationale: Bleomycin is an antineoplastic medication (Chemotheraputic Agents) that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication.

70.) Oxybutynin chloride (Ditropan XL) is prescribed for a client with neurogenic bladder. Which sign would indicate a possible toxic effect related to this medication? 1. Pallor 2. Drowsiness 3. Bradycardia 4. Restlessness

4. Restlessness Rationale: Toxicity (overdosage) of this medication produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a frequent side effect of the medication but does not indicate overdosage.

66.) Trimethoprim-sulfamethoxazole (TMP-SMZ) is prescribed for a client. A nurse should instruct the client to report which symptom if it developed during the course of this medication therapy? 1. Nausea 2. Diarrhea 3. Headache 4. Sore throat

4. Sore throat Rationale: Clients taking trimethoprim-sulfamethoxazole (TMP-SMZ) should be informed about early signs of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client should be instructed to notify the health care provider if these symptoms occur. The other options do not require health care provider notification.

44.) A client is receiving acetylcysteine (Mucomyst), 20% solution diluted in 0.9% normal saline by nebulizer. The nurse should have which item available for possible use after giving this medication? 1. Ambu bag 2. Intubation tray 3. Nasogastric tube 4. Suction equipment

4. Suction equipment Rationale: Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose, or it may be given by inhalation for use as a mucolytic. The nurse administering this medication as a mucolytic should have suction equipment available in case the client cannot manage to clear the increased volume of liquefied secretions.

166.) Alendronate (Fosamax) is prescribed for a client with osteoporosis. The client taking this medication is instructed to: 1. Take the medication at bedtime. 2. Take the medication in the morning with breakfast. 3. Lie down for 30 minutes after taking the medication. 4. Take the medication with a full glass of water after rising in the morning.

4. Take the medication with a full glass of water after rising in the morning. Rationale: Precautions need to be taken with administration of alendronate to prevent gastrointestinal side effects (especially esophageal irritation) and to increase absorption of the medication. The medication needs to be taken with a full glass of water after rising in the morning. The client should not eat or drink anything for 30 minutes following administration and should not lie down after taking the medication.

67.) Phenazopyridine hydrochloride (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. The nurse reinforces to the client: 1. To take the medication at bedtime 2. To take the medication before meals 3. To discontinue the medication if a headache occurs 4. That a reddish orange discoloration of the urine may occur

4. That a reddish orange discoloration of the urine may occur Rationale: The nurse should instruct the client that a reddish-orange discoloration of urine may occur. The nurse also should instruct the client that this discoloration can stain fabric. The medication should be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication.

177.) A nurse is assisting in caring for a pregnant client who is receiving intravenous magnesium sulfate for the management of preeclampsia and notes that the client's deep tendon reflexes are absent. On the basis of this data, the nurse reports the finding and makes which determination? 1. The magnesium sulfate is effective. 2. The infusion rate needs to be increased. 3. The client is experiencing cerebral edema. 4. The client is experiencing magnesium toxicity.

4. The client is experiencing magnesium toxicity. Rationale: Magnesium toxicity can occur as a result of magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression; loss of deep tendon reflexes; sudden decrease in fetal heart rate or maternal heart rate, or both; and sudden drop in blood pressure. Hyperreflexia indicates increased cerebral edema. An absence of reflexes indicates magnesium toxicity. The therapeutic serum level of magnesium for a client receiving magnesium sulfate ranges from 4 to 7.5 mEq/L (5 to 8 mg/dL).

232.) A client in the mental health unit is administered haloperidol (Haldol). The nurse would check which of the following to determine medication effectiveness? 1. The client's vital signs 2. The client's nutritional intake 3. The physical safety of other unit clients 4. The client's orientation and delusional status

4. The client's orientation and delusional status Rationale: Haloperidol is used to treat clients exhibiting psychotic features. Therefore, to determine medication effectiveness, the nurse would check the client's orientation and delusional status. Vital signs are routine and not specific to this situation. The physical safety of other clients is not a direct assessment of this client. Monitoring nutritional intake is not related to this situation.

121.) A client who is taking hydrochlorothiazide (HydroDIURIL, HCTZ) has been started on triamterene (Dyrenium) as well. The client asks the nurse why both medications are required. The nurse formulates a response, based on the understanding that: 1. Both are weak potassium-losing diuretics. 2. The combination of these medications prevents renal toxicity. 3. Hydrochlorothiazide is an expensive medication, so using a combination of diuretics is cost-effective. 4. Triamterene is a potassium-sparing diuretic, whereas hydrochlorothiazide is a potassium-losing diuretic.

4. Triamterene is a potassium-sparing diuretic, whereas hydrochlorothiazide is a potassium-losing diuretic. Rationale: Potassium-sparing diuretics include amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium). They are weak diuretics that are used in combination with potassium-losing diuretics. This combination is useful when medication and dietary supplement of potassium is not appropriate. The use of two different diuretics does not prevent renal toxicity. Hydrochlorothiazide is an effective and inexpensive generic form of the thiazide classification of diuretics. **It is especially helpful to remember that hydrochlorothiazide is a potassium-losing diuretic and triamterene is a potassium-sparing diuretic**

160.) Meperidine hydrochloride (Demerol) is prescribed for the client with pain. Which of the following would the nurse monitor for as a side effect of this medication? 1. Diarrhea 2. Bradycardia 3. Hypertension 4. Urinary retention

4. Urinary retention Rationale: Meperidine hydrochloride (Demerol) is an opioid analgesic. Side effects of this medication include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

104.) Disulfiram (Antabuse) is prescribed for a client who is seen in the psychiatric health care clinic. The nurse is collecting data on the client and is providing instructions regarding the use of this medication. Which is most important for the nurse to determine before administration of this medication? 1. A history of hyperthyroidism 2. A history of diabetes insipidus 3. When the last full meal was consumed 4. When the last alcoholic drink was consumed

4. When the last alcoholic drink was consumed Rationale: Disulfiram is used as an adjunct treatment for selected clients with chronic alcoholism who want to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for at least 12 hours before the initial dose of the medication is administered. The most important data are to determine when the last alcoholic drink was consumed. The medication is used with caution in clients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and hepatic disease. It is also contraindicated in severe heart disease, psychosis, or hypersensitivity related to the medication.

-dronate

biphosphonates (used for prevention and treatment of osteoporosis) Nursing considerations: - take with full glass of water, on empty stomach, in the morning - remain upright for 30min

180.) A health care provider (HCP) writes a prescription for digoxin (Lanoxin), 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is important to: 1. Count the radial and carotid pulses every morning. 2. Check the blood pressure every morning and evening. 3. Stop taking the medication if the pulse is higher than 100 beats per minute. 4. Withhold the medication and call the HCP if the pulse is less than 60 beats per minute.

4. Withhold the medication and call the HCP if the pulse is less than 60 beats per minute. Rationale: An important component of taking this medication is monitoring the pulse rate; however, it is not necessary for the client to take both the radial and carotid pulses. It is not necessary for the client to check the blood pressure every morning and evening because the medication does not directly affect blood pressure. It is most important for the client to know the guidelines related to withholding the medication and calling the HCP. The client should not stop taking a medication.

185.) Which of the following herbal therapies would be prescribed for its use as an antispasmodic? Select all that apply. 1.Aloe 2.Kava 3.Ginger 4.Chamomile 5.Peppermint oil

4.Chamomile 5.Peppermint oil Rationale: Chamomile has a mild sedative effect and acts as an antispasmodic and anti-inflammatory. Peppermint oil acts as an antispasmodic and is used for irritable bowel syndrome. Topical aloe promotes wound healing. Aloe taken orally acts as a laxative. Kava has an anxiolytic, sedative, and analgesic effect. Ginger is effective in relieving nausea.

3

A client admitted to the hospital with a diagnosis of chronic obstructive pulmonary disease has received a prescription for a medication that is delivered via a nebulizer. When teaching about use of the nebulizer, the nurse should teach the client to do what? 1 Hold the breath while spraying the medication into the mouth. 2 Position the lips loosely around the mouthpiece and take rapid, shallow breaths. 3 Seal the lips around the mouthpiece and breathe in and out, taking slow, deep breaths. 4 Inhale the medication from the nebulizer, remove the mouthpiece from the mouth, and then exhale.

4

A client develops a fever after surgery. Ceftriaxone is prescribed. For which potential adverse effect should the nurse monitor the client? 1 Dehydration 2 Heart failure 3 Constipation 4 Allergic response

3

A client has an anaphylactic reaction after receiving intravenous penicillin. What does the nurse conclude is the cause of this reaction? 1 An acquired atopic sensitization occurred. 2 There was passive immunity to the penicillin allergen. 3 Antibodies to penicillin developed after a previous exposure. 4 Potent antibodies were produced when the infusion was instituted

3

A client has severe diarrhea, and the health care provider prescribes intravenous fluids, sodium bicarbonate, and an antidiarrheal medication. Which drug does the nurse expect the health care provider to prescribe? 1 Psyllium 2 Bisacodyl 3 Loperamide 4 Docusate sodium

4

A client is admitted to the hospital with a diagnosis of acute pancreatitis. The health care provider's prescriptions include nothing by mouth and total parenteral nutrition (TPN). The nurse explains that the TPN therapy provides what benefit? 1 Is the easiest method for administering needed nutrition 2 Is the safest method for meeting the client's nutritional requirements 3 Will satisfy the client's hunger without the discomfort associated with eating 4 Will meet the client's nutritional needs without causing the discomfort precipitated by eating

2

A client is admitted to the hospital with a diagnosis of an exacerbation of asthma. What should the nurse plan to do to best help this client? 1 Determine the client's emotional state. 2 Give prescribed drugs to promote bronchiolar dilation. 3 Provide education about the impact of a family history. 4 Encourage the client to use an incentive spirometer routinely

4

A client is diagnosed with pulmonary tuberculosis, and the healthcare provider prescribes a combination of rifampin and isoniazid. The nurse evaluates that the teaching regarding the drug is effective when the client reports which action as most important? 1 "Report any changes in vision." 2 "Take the medicine with my meals." 3 "Call my doctor if my urine or tears turn red-orange." 4 "Continue taking the medicine even after I feel better.

1

A client is diagnosed with tuberculosis associated with human immunodeficiency virus infection. What crucial laboratory test results should the nurse review before antitubercular pharmacotherapy is started? 1 Liver function studies 2 Pulmonary function studies 3 Electrocardiogram and echocardiogram 4 White blood cell (WBC) count and sedimentation rate

4

A client is diagnosed with type 2 diabetes, and the health care provider prescribes an oral hypoglycemic. For what side effect should the nurse teach this client to monitor? 1 Ketonuria 2 Weight loss 3 Ketoacidosis 4 Low blood sugar

4

A client is prescribed metformin extended release to control type 2 diabetes mellitus. Which statement made by this client indicates the need for further education? 1 "I will take the drug with food." 2 "I must swallow my medication whole and not crush or chew it." 3 "I will notify my doctor if I develop muscular or abdominal discomfort." 4 "I will stop taking metformin for 24 hours before and after having a test involving dye."

4

A client is receiving dexamethasone to treat acute exacerbation of asthma. For what side effect should the nurse monitor the client? 1 Hyperkalemia 2 Liver dysfunction 3 Orthostatic hypotension 4 Increased blood glucose

3

A client is receiving penicillin G and probenecid for syphilis. What rationale should the nurse give for the need to take these two drugs? 1 Each drug attacks the organism during different stages of cell multiplication. 2 The penicillin treats the syphilis, whereas the probenecid relieves the severe urethritis. 3 Probenecid delays excretion of penicillin, thus maintaining blood levels for longer periods. 4 Probenecid decreases the potential for an allergic reaction to penicillin, which treats the syphilis

3

A client newly diagnosed with diabetes arrives at the emergency department complaining of dizziness and weakness. The client's spouse reports that the client has been confused since this morning. The spouse reports that the client administered the morning dose of 10 units of regular insulin and 25 units of NPH insulin with difficulty and did not eat much breakfast. What does the nurse identify as the most likely cause of the client's signs and symptoms? 1 Hyperglycemia 2 Hyperlipidemia 3 Hypoglycemia 4 Hypocalcemia

1

A client with a new diagnosis of type 1 diabetes is told that lifelong insulin will be needed. The client becomes agitated and says, "I am scared of shots. If that is my only option, I'll just have to go into a coma and die!" What is the nurse's best response? 1 "Injections are not the only option available for insulin." 2 "It won't be so bad; you will get used to it if you will only try." 3 "This is one of those times when you need to act like an adult." 4 "Clients have the right to refuse treatment, but I need you to sign this form that removes us from liability for your decision."

1

A client with diabetes asks how exercise will affect insulin and dietary needs. What information does the nurse share about insulin and exercise? 1 "Exercise increases the need for carbohydrates and decreases the need for insulin." 2 "Exercise increases the need for insulin and increases the need for carbohydrates." 3 "Regular physical activity decreases the need for insulin and decreases the need for carbohydrates." 4 "Intensive physical activity decreases the need for carbohydrates but does not affect the need for insulin."

3

A client with diabetes experiences tremors, pallor, and diaphoresis. What should the nurse consider is a possible cause of these clinical manifestations? 1 Overeating 2 Intestinal virus 3 Aerobic exercise 4 Missed insulin dose

3

A client with gastric ulcer disease asks the nurse why the health care provider has prescribed metronidazole. What purpose does the nurse provide? 1 To augment the immune response 2 To potentiate the effect of antacids 3 To treat Helicobacter pylori infection 4 To reduce hydrochloric acid secretion

2

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? 1 "I need to drink a lot of fluid while I take this medication." 2 "I can expect my urine to turn orange from this medication." 3 "I should have my hearing tested while I take this medication." 4 "I might get a skin rash because it is an expected side effect of this medication.

1

A client with tuberculosis is to begin combination therapy with isoniazid, rifampin, pyrazinamide, and streptomycin. The client says, "I've never had to take so much medication for an infection before." How will the nurse respond? 1 "This type of organism is difficult to destroy." 2 "Streptomycin prevents side effects of the other drugs." 3 "You'll only need to take the medications for a couple of weeks." 4 "Aggressive therapy is needed because the infection is well advanced."

2

A client with type 1 diabetes requests information about the differences between penlike insulin delivery devices and syringes. What information does the nurse provide about the penlike devices? 1 The penlike devices have a shorter injection time 2 Penlike devices provide a more accurate dose delivery. 3 The penlike delivery system uses a smaller-gauge needle. 4 Penlike devices cost less by having reusable insulin cartridges

1

A client with type 1 diabetes self-administers NPH insulin every morning at 8 am. The nurse evaluates that the client understands the action of the insulin when the client identifies which time range as the highest risk for hypoglycemia? 1. 2 pm to 8 pm 2. 8 pm to noon 3. 9 am to 10 am 4. 10 am to 11 am

4

A client with type 1 diabetes tells the nurse, "I take guaifenesin cough syrup when I have a cold." What important instruction does the nurse include in client teaching about this medication? 1 Substitute an elixir for the cough syrup. 2 Increase fluid intake and use a humidifier to control the cough. 3 The small amounts of sugar in medications are not a concern with diabetes. 4 Include the glucose in the cough syrup when calculating daily carbohydrate allowance

4

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? 1 Producing bulk 2 Softening feces 3 Lubricating feces 4 Stimulating peristalsis

4

A health care provider prescribes daily docusate sodium for a client. The nurse explains to the client that this drug has what action? 1 Lubricates the feces 2 Creates an osmotic effect 3 Stimulates motor activity 4 Lowers the surface tension of feces

2

A health care provider prescribes psyllium 3.5 g twice a day for constipation. What is most important for the nurse to teach this client? 1 Urine may be discolored. 2 Each dose should be taken with a full glass of water. 3 Use only when necessary because it can cause dependence. 4 Daily use may inhibit the absorption of some fat-soluble vitamins

2

A health care provider prescribes ranitidine for a client with heartburn. During a teaching session, which information will the nurse share with the client about how this drug works? 1 Ranitidine increases gastrointestinal peristalsis. 2 Ranitidine reduces gastric acidity in the stomach. 3 Ranitidine neutralizes the acid that is present in the stomach. 4 Ranitidine stops production of hydrochloric acid in the stomach

1,3,2,4

A healthcare provider prescribes a medication to be administered via a metered-dose inhaler (MDI) for a young adult with asthma. List in order the steps the nurse teaches the client to follow when using the inhaler. 1. Shake the inhaler for 30 seconds. 2. Hold the inhaler upright in the mouth. 3. Exhale slowly and deeply to empty the air from the lungs. 4. Start breathing in and press down on the inhaler once

4

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? 1 Only at bedtime, when famotidine is not taken 2 Only if famotidine is ineffective 3 At the same time as famotidine, with a full glass of water 4 One hour before or 2 hours after famotidine

4

A healthcare provider prescribes ophthalmic drops for a client. What should a nurse include in the instructions for a client learning to self-administer eyedrops? 1 Lie on the unaffected side for administration. 2 Instill drops onto the pupil to promote absorption. 3 Close eyes tightly after administering the eyedrops. 4 Apply pressure to the nasolacrimal duct after instillation

Bioavailability

A measure of the extent of drug absorption for a given drug and route (from 0% to 100%).

2

A nurse administers a tube of glucose gel to a client who is hypoglycemic. What explanation does the nurse share regarding the reversal of hypoglycemia? 1 It liberates glucose from hepatic stores of glycogen. 2 It provides a glucose source that is rapidly absorbed. 3 Insulin action is blocked as it competes for tissue sites. 4 Glycogen is supplied to the brain as well as other vital organs

2

A nurse administers beclomethasone by inhalation to a client with asthma, and the client asks why this medication is necessary. What should the nurse explain is the purpose of this pharmacologic therapy? 1 Promotes comfort 2 Decreases inflammation 3 Stimulates smooth muscle relaxation 4 Reduces bacteria in the respiratory tract

2

A nurse administers the drug desmopressin acetate (DDAVP) to a client with diabetes insipidus. What should the nurse monitor to evaluate the effectiveness of the drug? 1 Arterial blood pH 2 Intake and output 3 Fasting serum glucose 4 Pulse and respiratory rates

1,4

A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? Select all that apply 1 Irritability 2 Glycosuria 3 Dry, hot skin 4 Heart palpitations 5 Fruity odor of breath

2

A nurse determines that the teaching about the side effects of azithromycin has been understood when the adolescent client identifies which problem as the most common side effect of this medication? 1 Tinnitus 2 Diarrhea 3 Dizziness 4 Headache

2

A nurse evaluates that a client understands appropriately how to take the antacids prescribed by the primary health care provider when the client makes which statement? 1 "I will take this antacid at the onset of pain." 2 "I will take this antacid 30 minutes after meals." 3 "I will take this antacid every 4 hours around the clock." 4 "I will take this antacid each time I have something to eat."

Which complication is assessed through frequent laboratory testing of carbamazepine (tegretol)?

Myelosuppression

4

A nurse has provided teaching to a client with a newly prescribed proton pump inhibitor (PPI). The nurse determines that the teaching is effective when the client states that the medication is used for the treatment of which condition? 1 Diarrhea 2 Vomiting 3 Cardiac dysrhythmias 4 Gastroesophageal reflux disease (GERD

3

A nurse identifies that an older adult has not achieved the desired outcome from a prescribed proprietary medication. When assessing the situation, the client shares that the medication is too expensive and that the prescription was never filled. What is an appropriate nursing response? 1 Ask the pharmacist to provide a generic form of the medication. 2 Encourage the client to acquire the medication over the Internet. 3 Inform the healthcare provider of the inability to afford the medication. 4 Suggest that the client purchase medical insurance that covers prescription medications

4

A nurse is caring for a client who has been taking several antibiotic medications for a prolonged time. Because long-term use of antibiotics interferes with the absorption of fat, what prescription does the nurse anticipate? 1 High-fat diet 2 Supplemental cod liver oil 3 Total parenteral nutrition (TPN) 4 Water-soluble forms of vitamins A and E

1,2,4

A nurse is caring for a female client who is receiving rifampin for tuberculosis. Which statements indicate that the client understands the teaching about rifampin? Select all that apply 1 "This drug may be hard on my liver so I must avoid alcoholic drinks while taking it." 2 "This drug may reduce the effectiveness of the oral contraceptive I am taking." 3 "I cannot take an antacid within 2 hours before taking my medicine." 4 "My healthcare provider must be called immediately if my eyes and skin become yellow.

2

A nurse is caring for several clients with type 1 diabetes, and they each have a prescription for a specific type of insulin. Which insulin does the nurse conclude has the fastest onset of action? 1 NPH insulin 2 Insulin lispro 3 Regular insulin 4 Insulin glargine

1,2,3,4,5

A nurse is preparing to administer insulin to a client with diabetes. In which order should the nurse perform the actions associated with insulin administration? Correct 2. Rotate the vial of insulin between the palms of the hands. 4 Instill air into the vial of insulin equal to the desired dose. 3. Wipe the top of the insulin vial with an alcohol swab. 5. Withdraw the correct amount of insulin from the inverted vial. 1. Wash hands with soap and water

2

A nurse is reviewing a newly admitted client's medication administration record (MAR). Which element, if missing, makes the record incomplete? 1 Height 2 Allergies 3 Vital signs 4 Body weight

2

A nurse plans an evening snack of milk, crackers, and cheese for a client who is receiving NPH insulin. What is the purpose of this snack? 1 Encouragement to stay on the diet 2 Food to counteract late insulin activity 3 Added calories to promote weight gain 4 High carbohydrates to provide nourishment for immediate use

2

A senior nurse teaches a nursing student about how to treat poisoning in young children. Which statement by the nursing student indicates the need for further teaching? 1 "An emergency team should be called if the victim stops breathing." 2 "Syrup of ipecac should be administered immediately after poisoning." 3 "The National Poison Control hotline should be called if a poison is ingested." 4 "The child should be removed from the hazardous environment if the poison has been inhaled."

A client with a history of asthma is experiencing an acute episode of wheezing and shortness of breath four hours after returning from surgery. Which prescription should the nurse administer at this time?

Pirbuterol (Maxair).

A pt that has been taking a benzodiazepine for 5 weeks has been instructed to stop the medication. Which instruction will the nurse provide?

Plan a gradual reduction in dosage. Abrupt cessation may cause rebound insomnia

Adverse effect of too much vitamin C

Diarrhea

Antidiarrheal drug that acts by coating the walls of the GI tract and binding to causative bacteria/toxin to allow elimination

Adsorbents: activated charcoal, bismuth

A female client with osteoporosis has been taking a weekly dose of oral risedronate for several weeks. The client calls the clinic nurse to report increasing "hearburn." How should the nurse respond?

Advise the client to go to the nearest emergency department.

The nurse is administering the muscle relaxant baclofen (lioresal) PO to a client diagnosed with multiple sclerosis. Which intervention should then nurse implement?

Advise the client to move slowly and cautiously when rising and walking.

2

After an acute episode of gastrointestinal (GI) bleeding, a client is diagnosed with a gastric ulcer. The client receives a prescription for ranitidine 150 mg twice a day. What concern prompts the nurse to contact the health care provider about the prescription? 1 Ranitidine can increase bleeding risk. 2 An administration route is not specified. 3 Ranitidine is contraindicated for gastric ulcers. 4 The recommended dose is higher than prescribed

4

Ampicillin 250 mg by mouth every 6 hours is prescribed for a client who is to be discharged. Which statement indicates to the nurse that the client understands the teaching about ampicillin? 1 "I should drink a glass of milk with each pill." 2 "I should drink at least six glasses of water every day." 3 "The medicine should be taken with meals and at bedtime." 4 "The medicine should be taken one hour before or two hours after meals

Treatment for Acute Pain

Analgesics (opioids), NSAIDS, COX-2 inhibitors, and non-narcotic agents (tramadol)

-sartan

Angiotensin-II receptor antagonists (ARBs) s/e: hypotension

Anticholinergic antiparkinson agents

Anticholinergic antiparkinson agents or acetylcholine antagonists block the muscarinic acetylcholine receptors and cholinergic nerve activity. Activation of muscarinic receptors has an excitatory effect, opposite to that of dopaminergic activation, so suppression of the effects of acetylcholine compensates for a lack of dopamine in Parkinson Ex: Diphenhydramine

Anticholinergic bronchodilators

Anticholinergic bronchodilators (or muscarinic receptor antagonists) block the parasympathetic nerve reflexes that cause the airways to constrict, so allow the air passages to remain open. Muscarinic receptor antagonists bind to muscarinic receptors and inhibit acetylcholine mediated bronchospasm. Anticholinergic bronchodilators are used more to treat chronic obstructive pulmonary disease than to treat asthma. Ex: Atrovent, Spiriva

Nursing Implications of ACE Inhibitors

Assess blood pressure, apical pulse, and respiratory status prior to administration. Withhold medication if serum potassium >5 mEq/L and notify the health care provider. Monitor for angioedema and notify the health care provider immediately if it occurs. Monitor sodium and fluid volume status. Monitor dietary and fluid intake because ACE inhibitors can cause anorexia secondary to impaired taste.

During infusion of Mechlorethamine HCl (nitrogen mustard) and actinomycin (Actinomycin D), what should the nurse do first?

Assess for extravasation--they are vesicants Watch for blisters and tissue sloughing

Patient Teaching for AEDs

Avoid tasks requiring alertness until a steady state of the drug has been achieved (which takes 4 to 5 half-lives) to help prevent injury. ⎫ Avoid drinking alcohol and smoking. ⎫ Do not abruptly withdraw from an AED; rebound seizure activity could occur. ⎫ Phenytoin may turn urine to pink or red-brown. This color change commonly diminishes over time. ⎫ Drowsiness commonly decreases after several weeks because tolerance to this particular adverse effect occurs. ⎫ Frequent oral care and dental visits are necessary so as to prevent the adverse effect of gingival hyperplasia. ⎫ Avoid any form of stimulant (e.g., caffeine) because there is a higher risk for seizure. ⎫ Therapy is usually lifelong. Resources available include national and local support groups. ⎫ Contact the physician if any unusual reactions occur, such as glandular swelling, fever, sore throat, tarry stools, back pain, hematuria, easy bruising, lethargy, or mouth ulcers.

A patient is admitted with a fever of 102.8 F (39.3 ° C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain urine and blood cultures and to administer an antibiotic intravenously stat (now). The nurse will complete these orders in which sequence?

Blood and urine cultures, ampicillin dose I found this question online but I know for a fact that you have to get cultures FIRST and then administer medications. The answers choices included all meds first and then cultures except for one that said something with cultures FIRST and then administer medications.

Your patient calls after taking an antibiotic for 8 days. He reports that his sinus infection is much better, but now he has bruises on his arms and legs and a sore throat. You suspect:

Bone Marrow Toxicity

Symptoms of digoxin toxicity

Bradycardia, HA, dizziness, confusion, nausea, blurred vision (Yellow)

Nephrotoxic drug

It provides data about the effectiveness of the antibiotic, but not about compromised renal function, which is priority concern

Class IV antidysrhythmic drugs

CCBs: Verapamil, diltaizim

What drug is indicated in vasospastic angina?

CCBs: Verapamil, diltiazem, amlodipine

What type of antacid causes kidney stones

Calcium (tums)

What is the antagonist to magnesium sulfate for preeclampsia?

Calcium gluconate

What patient need to avoid caffeine?

Cardiac Dysrhythmias

A1 blockers

Cardura, Minipress, Flomax, and Hytrin used for HTN, BPH, and concurrently with digoxin in HF

A2 blocker

Catapress (clonidine) decrease blood pressure, given after other drugs fail due to sedation

Extravasation

Catecholamines (epinepherine, norepinepherine, dopamine, doubutamine, ect.) must be watched carefully for what?

A female client with myasthenia gravis is taking a cholinesterase inhibitor and asks the nurse what can be done to remedy her fatigue and difficulty swallowing. What action should the nurse implement?

Clients should be taught to recognize signs of overmedication and undermedication so that they can modify the dosage themselves

An adolescent receives a new prescription for isotretinoin (claravis) for cystic acne. Which information is most important for the nurse to provide?

Consider an alternative summer job, other than life-guarding.

A male client with prostatic carcinoma has arrived for his scheduled dose of docetaxel (Taxotere) chemotherapy. What symptom would indicate a need for an immediate response by the nurse prior to implementing another dose of this chemotherapeutic agent?

Cough that is new and persistent--fluid retention --> pleural effusion, dyspnea, cardiac tamponade, and abdominal distention

Antitussives

Dextromethorphan Reduces nonproductive cough Adverse Effects: GI upset, Drowsiness, consitpation

2

Daily regular insulin has been prescribed for a client with type 1 diabetes. The nurse administers the insulin at 8 am. When should the nurse monitor the client for a potential hypoglycemic reaction? 1 At breakfast 2 Before lunch 3 Before dinner 4 In the early afternoon

A pt has been taking alosteron (Lotonex) for 3 weeks for IBS, today she reports constipation. What is the priority action?

Discontinue the drug immediately.

What actions is appropriate with the administration of acetylcysteine as part of treatment for an acetaminophen overdose?

Disguise the flavor with soda or flavored water

Expected reaction to carbamazepine/tegretol

Dizziness and dry mouth

Doxorubicin HCl (Adriamycin)

Do ECG for risk for cardiotoxicity

YES

Do low potassium or magnesium levels increase the risk for dig toxicity?

Iron administration- Orange Juice preference

Drink such as orange juice which is high in ascorbic acid enhance the reabsorption of orally administered iron

ACE Inhibitors Contraindications

Drug allergy, hyperkalemia, bilateral renal stenosis, pregnancy, and lactation

Contraindications of Opioids

Drug allergy, severe asthma or other respiratory insufficiency, increased intracranial pressure, myasthenia gravis, paralytic ileus, acute abdominal conditions, and pregnancy and lactation

Adjunct anesthetis

Drugs used in combination with anesthetic drugs to control the adverse effects of anethetics or to help maintain

SNRIs

Duloxetine (Cymbalta) Venlafaxine (Effexor) reduces pain: fibromyalgia, diabetic neuropathy

ACE Inhibitors Adverse Effects

Effects may include fatigue; dizziness; mood changes; headache; dry, nonproductive cough; first-dose hypotension; loss of taste; proteinuria; hyperkalemia; rash; pruritus; anemia; neutropenia; thrombocytosis; and agranulocytosis.

Carbonic Anhydrase Inhibitors (CAIs)

Enzyme inhibiting Diuretic: Acetazolamide, for glaucoma

4

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? 1 Increases gastric motility 2 Neutralizes gastric acidity 3 Facilitates histamine release 4 Inhibits gastric acid secretion

Mechanism/Therapeutic Effects Hydantoins (Antiepileptic)

First, they increase the threshold of activity in the area of the brain called the motor cortex, making it more difficult for a nerve to be excited. Second, they act to depress or limit the spread of a seizure discharge from its origin. Third, they can decrease the speed of nerve impulse conduction within a given neuron. The major therapeutic indication for AEDs is the prevention or control of seizure activity.

Antidote for Benzodiazepine

Flumazenil

-floxacin

Fluoroquinolones (antibiotics) s/e: CNS effects, phototoxicity

3

For a client with difficulty swallowing, the nurse should crush which medication? 1 Metoprolol extended release 2 Felodipine sustained release 3 Acetaminophen extra strength 4 Potassium chloride extended release

use cautiously in elderly

For all hypnotics what do you want to do?

What is the indication of allopurinol (zyloprim)?

For gout

Treatment for chronic pain

Gabapentin, SNRIs, TCAs

Midazolam

Generic name for the drug that is most often used for moderate sedation procedures

In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, the nurse writes a nursing diagnosis of Alteration in nutrition: less than body requirements, related to inadequate digestion of nutrients. Which intervention would best meet this child's needs?

Give pancrelipase (Cotazym-S) capsule mixed with applesauce before each meal.

When administering chemotherapy for treatment of cancer, the nurse implements which intervention that treats or even prevents chemotherapy-induced nausea and vomiting?

Giving an antiemetic 30 to 60 minutes before the chemotherapy is started.

PEG-3350

Go-Lytely for bowel preperations: onset: 30-60 mins duration 4 hours

Darbepoetin (Arnesp), a erythropoiesis stimulating agent, is contraindicated when?

HTN, Hbg >10

When giving chemotherapy as cancer treatment, the nurse recognizes that toxicity to rapidly growing normal cells also occurs. Which rapidly growing normal cells are also harmed by chemotherapy? (Select all that apply.)

Hair follicle cells, Gastrointestinal (GI) mucous membrane cells, Bone marrow cells

The nurse is administering IV fluconazole (Diflucan) to a client who has systemic candidiasis. After reviewing the client's diagnostic studies, then nurse identifies a rising trend in the liver enzyme levels for aspartate aminotransferase (AST, also called SGOT). What action should the nurse implement?

Hold the dose and notify the healthcare provider of the changes in the laboratory studies.

How to make sure you're giving the medication to the right patient-

I put something with "2 identifiers (that included) last name, MRN, and room #) or something like that

Correct administration of Adenosine (adenocard)

IV 6mg bolus over 1-2 sec; second rapid bolus of 12 mg as needed *very fast*

dig toxicity

If a client has had a long history of digoxin and furosemide (lasix) use it could creates a high risk for what?

1,2,5

In what ways can a nurse prevent medication errors? Select all that apply 1 Avoid using abbreviations and acronyms 2 Minimize the use of verbal and telephone orders 3 Try to guess what the client is saying if the language is not understood 4 Document each dose of the drug using trailing zeros when recording the dose 5 Check three times before giving a drug by comparing the drug order and medication profile

How does acyclovir (zovirax) work?

Inactivate the virus

What is important to include in pt education in a patient taking sulfasalazine (Azulfidine)?

Increase fluid intake 8 glasses and take after a meal If not enough fluid is taken, sulfa drugs can crystallize urine

ACE Inhibitors Drug Interactions

Increased effects occur with other antihypertensive drugs and diuretics. Decreased effects occur with aspirin and NSAIDs. Risk for hyperkalemia occurs if given with potassium supplements or potassium-sparing diuretics. Risk for lithium toxicity occurs if administered concurrently with lithium.

Drug Interactions of AEDs

Increased hydantoin levels occur with disulfiram, isoniazid, and valproic acid. Increased risk for seizures occurs with tricyclic antidepressants.

Male patient reports that his mother took diethylstillbestrol (DES) dring pregnancy/ Which concern of the patient requires attention?

Increased risk of testicular cancer

Hypothyroid treatment monitoring pulse & weight

It provides data regarding metabolic responses to levothyroxine and abnormalities or changes in measurements. They can interfere with absorption of levothyroxine

Primacor (Milrinone)

Is a phosphodiesterase inhibitor used in HF. (positive inotropic effects) Monitor for ventricular dysrhythmias, hypotension, angina, hypokalemia, tremor, and thrombocytopenia do not administer in same IV line as lasix

Why should phenytoin (dilantin) only be primed with NS and not be infused with any other IV solutions?

It causes a crystallization of the drug

Ciprofloxacin (Cipro) is a quinolone, which acts by inhibiting DNA gyrase. Which of the following statements about ciprofloxacin is true?

It should not be used in children. Ciprofloxacin is teratogenic and is not approved for pregnant women or children. Antacids and other agents that contain divalent minerals can prevent ciprofloxacin from being absorbed. First-generation quinolones have little efficacy against the Gram-positive organisms that cause community-acquired pneumonia.

A client with hear failure (HF) develops hyperaldosteronism and spironolactone is prescribed. Which instruction should the nurse include in this client's plan of care?

Limit intake of high-potassium foods.

The nurse is preparing medications for a client with bipolar disorder and notices that the antipsychotic medication was discontinued several days ago. Which medication should also be discontinued?

Lithium

1

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

Anticoagulant therapy is appropriate for which conditions

MI, unstable angina, atrial fibrillation, mechanical heart valve, surgery or prolonged immobilization

Macrolides

Macrolides can cause hepatoxicity which is manifested by jaundice.

Third-generation cephalosporins are similar to first-generation cephalosporins with regard to:

Mechanism of antimicrobial action All cephalosporins, regardless of generation, are bacteriocidal, because they alter the bacterial peptidoglycan layer (cell wall). Efficacy against Gram-positive bacteria and gram-negative bacteria varies among third-generation cephalosporins. Third-generation, but not first-generation, cephalosporins have good penetration into the CNS.

Phophorated carbohydrate solution (Emetrol)

Mint-flavored oral solution to relive nausea

What should the nurse monitor for a client who is taking Neupogen-Filgrastin

Monitor the WBC's

SSRI Nursing Implications

Monitor the patient's mental status. ¬ Monitor for postural hypotension. ¬ Administer with meals to minimize gastrointestinal upset.

Hypokalemia with Digoxin

Monitoring the potassium and heart rate is very important

Long-term corticosteroids should be taken at what time of the day?

Morning since the drug should be given around the time of the natural release of cortisol--day time.

What is often the first sign of myasthenia gravis?

Muscle weakness in the head and neck

What is administered to reverse respiratory depression

Naloxone (narcan): an opioid reversal agent

A patient is present with a head injury. What drugs are automatically ruled out?

Narcotics and sedatives

A 19-year-old male client who has sustained a severe head injury is intubated and placed on assisted mechanical ventilation. To facilitate optimal ventilation and prevent the client from "fighting" the ventilator, the health care provider administers pancuronium bromide (Pavulon) IV, with adjunctive opioid analgesia. What medication should the nurse maintain at the client's bedside?

Neostigmine bromide (Prostigmin) and atropine sulfate (Atropine), both anticholinergic drugs, reverse the respiratory muscle paralysis caused by pancuronium bromide.

What are the 3 classes of meds used to treat angina

Nitrates, Beta Blockers, and CCBs

The nurse is teaching a male client with type 1 diabetes mellitus about the onset, peak, and duration of a new prescription for glargine (lantus) insulin. The the insulin is self-administered at 0800, when is the client most likely to experience hypoglycemia?

No peak occurs

An 18 year old basketball player fell and twisted his ankle during a game. Which type of analgesic is he likely to receive?

Non opioid analgesic such as indomethacin

The nurse notes that the hemoglobin level of a client receiving darbepoetin alfa (Aranesp) has increased from 6 to 10 g/dL over the first 2 weeks of treatment. Which action should the nurse take?

Notify the health care provider of the change in the client's laboratory values.

Opioid Mechanism/Therapeutic Effects

Opioid analgesics bind to opioid receptors in the brain, blocking the transmission of pain messages and causing a reduction in pain sensation. They also cause euphoria and sedation. Full agonists cause the strongest analgesic effect but also have the strongest adverse reactions. Partial or mixed agonists are weaker analgesics but also cause fewer adverse effects.

Pt education on tetracycline (Vibramycin)

Oral contraceptives may not be effective

Vascular Pain

Originate from vascular or peripheral tissue (migraines)

Visceral Pain

Originates from organs and smooth muscle

What type of diuretic can be used to reduce ICP and early renal failure?

Osmotic :mannitol (filter needle)

First line therapy for GERD that has not responded to medical treatment?

PPI

Sucralfate (carafate)

PPI used for mucosal protectant for ulcers and PUD

Drugs that block all acid secretion in the stomach

PPI: Proton Pump Inhibitor Omeprazole (Prilosec) Lansoprazole (Prevacid) Pantoprazole (Protonix)

SNRIs are used for

Pain, diabetic neuropathy

A child with cystic fibrosis is receiving ticarcillin disodium (Ticar) for Pseudomonas pneumonia. For which adverse effect should the nurse assess and report promptly to the health care provider?

Petichiae

What is a side effect to consider informing the pt on antifungals?

Phototoxicity

The nurse is preparing to administer amphotericin B (Fungizone) IV to a client. What laboratory data is most important for the nurse to assess before initiating an IV infusion of this medication?

Potassium levels---amphotericin B changes cellular permeability. This will allow potassium to leave the cell. Watch for hypokalemia.

Contraindications of AEDs

Pregnancy and Drug Allergy

Neuromuscular Blocking Drugs NMBDs

Prevent nerve transmission in skeletal and smooth muscle, leading to paralysis: First sensation is muscle weakness, followed by total flaccid paralysis, then the intercostal muscles and diaphram are paralyzed leading to respiratory arrest. *Succinylcholine: depolarizing, *Pancuronium: non depolarizing

A client receiving tetracycline (Azithromycin) for chlamydia urethritis. The PN should reinforce which instruction

Protect the client from sun exposure

Phenytoin interacts with

Proton Pump inhibitors Anti coagulants Benzodiazepans Amioderone Sulfonamide antibiotics SSRIs

What are symptoms of ineffective drug management of multiple sclerosis?

Ptosis and decreased oral secretions

3

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? 1 Weight gain 2 Absence of stomatitis 3 Absence of numbness and tingling in extremities 4 Acceleration of dormant tubercular bacilli destruction

The physician has an order for lovenox IV 0.3 mg/ml. What should the nurse do?

Question the route of administration. Lovenox is given SC, not IV

Your patient has been hospitalized after a seizure in which she fell and hit her head on a coffee table. On admission, she was also found to have a UTI. Which antibiotic class is known to reduce seizure threshold and should not be used to treat the UTI in your patient?

Quinolones

Which classes of drugs are used as adjunctive drugs with anesthesia?

Sedative Hypnotics/Anxiolytics (Propofol) Benzodiazepines (Diazepam, midazolam) Barbituates (tiopental) Opioid Analgesics ( Fentanyl, morphine) Anticholinergics (Atropine) Antiemetics (Ondansteron)

182.) A client with angina pectoris is experiencing chest pain that radiates down the left arm. The nurse administers a sublingual nitroglycerin tablet to the client. The client's pain is unrelieved, and the nurse determines that the client needs another nitroglycerin tablet. Which of the following vital signs is most important for the nurse to check before administering the medication? 1. Temperature 2. Respirations 3. Blood pressure 4. Radial pulse rate

Rationale: Nitroglycerin acts directly on the smooth muscle of the blood vessels, causing relaxation and dilation. As a result, hypotension can occur. The nurse would check the client's blood pressure before administering the second nitroglycerin tablet. Although the respirations and apical pulse may be checked, these vital signs are not affected as a result of this medication. The temperature also is not associated with the administration of this medication.

134.) A nurse reinforces instructions to a client who is taking levothyroxine (Synthroid). The nurse tells the client to take the medication: 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack

Rationale: Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast. **Note that options 1, 2, and 4 are comparable or alike in that these options address administering the medication with food.**

206.) A client is receiving baclofen (Lioresal) for muscle spasms caused by a spinal cord injury. The nurse monitors the client, knowing that which of the following is a side effect of this medication? 1. Muscle pain 2. Hypertension 3. Slurred speech 4. Photosensitivity

Rationale: Side effects of baclofen include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesia of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Paradoxical central nervous system excitement and restlessness can occur, along with slurred speech, tremor, dry mouth, nocturia, and impotence. **Option 3 is most closely associated with a neurological disorder**

Cancer Pain

Results from pressure of the tumor against organs, nerves, or tissues or from radiation/chemotherapry

The nurse is administering phenobarbital (Luminal) and will monitor the patient for which adverse effect

Sedation

SSRI Mechanism/Therapeutic Effects

Selective serotonin reuptake inhibitors (SSRIs) inhibit the reuptake of serotonin into presynaptic terminals (nerve endings) and thus increase the levels of serotonin available for neurotransmission at the postsynaptic nerve endings. They also demonstrate weak inhibition of norepinephrine and dopamine reuptake. Increased levels of these neurotransmitters are responsible for the improvement of the symptoms of depression. SSRIs are the first-line treatment for major depression and are also indicated for the treatment of obsessive-compulsive disorder, anxiety disorders, panic disorders, and compulsive eating disorders such as bulimia nervosa.

Antiemetic Chemotherapy drugs

Serotonin Blockers Tetrahydrocannabinoids

3

Steroid therapy is prescribed for a client with an exacerbation of ulcerative colitis. The nurse evaluates that teaching is effective when the client identifies which times for the medication schedule? 1 At bedtime with a snack 2 Three times a day with meals 3 In the early morning with food 4 One hour before or two hours after eating

Are steroids best taken on an empty or full stomach?

Steroids can cause gastric irritation, so it is best to take it with food

What is the nurse's priority action if extravasation of an antineoplastic drug occurs during intravenous (IV) administration?

Stop the infusion immediately, but leave the IV catheter in place

Pulmonary Embolus- Heparin

The PN should check the heparin protocol for parameters to adjust the infusion rate based on the client current partial thromboplastin time.

A pt has been taking antiepileptic drugs for a year. The nurse is reviewing his recent history and will monitor for which condition that may develop during this time?

Suidical Thoughts or behavior

Urinary Antispasmodic

The goal of treatment for the client with an overactive bladder is to reduce unpleasant symptoms w/o reducing urinary output, so a decrease in urinary output should be reported.

Adverse Effects of AEDs

The most common effects are lethargy, abnormal movements, mental confusion, and cognitive changes. These drugs can also cause bone marrow suppression, exfoliative dermatitis, lupus erythematosus, Stevens-Johnson syndrome, and neuropathies. At toxic levels, they can cause nystagmus, ataxia, dysarthria, and encephalopathy. Long-term therapy can cause gingival hyperplasia, acne, hirsutism, osteoporosis, and hypertrophy of subcutaneous facial tissue resulting in an appearance known as Dilantin facies.

3

The nurse is preparing to discharge a client who presented to the emergency room for an acute asthma attack. The nurse notes that upon discharge the healthcare provider has prescribed theophylline 300 mg orally to be taken daily at 9:00 AM. The nurse will teach the client to take the medication on which schedule? 1 With a meal 2 Only at bedtime 3 At a specific time prescribed 4 Until symptoms are gone

4

What information should the nurse include when teaching a client about antacid tablets? 1 Take them at 4-hour intervals. 2 Take them 1 hour before meals. 3 They are as effective as the liquid forms. 4 They interfere with the absorption of other drugs

4

The nurse provides discharge teaching to a client with tuberculosis. Which treatment measure does the nurse reinforce as the highest priority? 1 Getting sufficient rest 2 Getting plenty of fresh air 3 Changing the current lifestyle 4 Consistently taking prescribed medication

2

The nurse provides teaching to a client who has received a prescription for oral pancreatic enzymes, pancrelipase. The nurse evaluates that teaching is understood when the client identifies which time for medication scheduling? 1 At bedtime 2 With meals 3 One hour before meals 4 On arising each morning

4

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? 1 Rectal bleeding 2 Fecal impaction 3 Nausea and vomiting 4 Mild abdominal cramping

Balanced Anesthesia

The practice of using combinations of different drug classes rather than a single drug

Why can't you give folic acid to treat anemia without determining the underlying cause?

The symptoms of pernicious anemia may be masked, delaying treatment

How do antibiotics work?

They block growth of essential components of the bacterial cell by inhibiting/interfering protein synthesis leading to cell death or dysfunction

A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He says that he feels tense and that the "least little thing" bother him now. The nurse should explain to him which of the following:

This drug causes deprivation of REM sleep and may cause the inability to cope with normal stress

Deep Pain

Tissues below skin level

A patient with AIDS is taking megestrol acetate (megace). What would be the reason why they are taking it?

To increase appetite

Analeptics

Used for specific respiratory depression syndromes Doxapram (Dopram) Methylxantines aminophylline, theophylline, caffeine

What is the DOC for status epilepticus? (short-term)

Valium

2,3,6

What are the desired outcomes that the nurse expects when administering a nonsteroidal antiinflammatory drug (NSAID)? Select all that apply 1 Diuresis 2 Pain relief 3 Antipyresis 4 Bronchodilation 5 Anticoagulation 6 Reduced inflammation

10 to 20 mcg/mL

What are the therapeutic plasma levels for Phenytoin (Dilantin)? - very narrow therapeutic index

produce CNS depression and respiratory depression

What can opioids do?

Vitamin A deficiency

What causes night blindness/visual changes (NUTRITION)?

Cephalosporins

What do penicillin's have a cross-sensitivity with?

grapefruit juice

What do you NOT want to give with carbamazepine (Tegretol)?

Glucosamine and Chondroitin

What drugs are used for osteoarthritis?

2

What is the priority goal for a client with asthma who is being discharged from the hospital with prescriptions for inhaled bronchodilators? 1 Is able to obtain pulse oximeter readings 2 Demonstrates use of a metered-dose inhaler 3 Knows the healthcare provider's office hours 4 Can identify the foods that may cause wheezing

produce ease of breathing and decrease wheezing

What should bronchodilators do?

if apical pulse is lower than 60 bpm

When do you want to hold digoxin?

1 hour before or 2 hours after meals

When taking medications on a empty stomach you want to take.......

take within 30-60 minutes after eating

When taking medications that are ordered after a meal....

4

Which statement made by a client recently diagnosed with type 1 diabetes indicates that further education is necessary regarding the teaching plan? 1 "I will need to have my eyes and vision examined once a year." 2 "I will need to check my blood sugar at home to evaluate my response to my treatment plan." 3 "I can improve metabolic and cardiac risk factors of this disease if I follow a low-calorie diet and lose weight." 4 "Once I reach my target weight there is a good chance that I will be able to switch from insulin to an oral medication."

1

Which statement regarding treatment with interferon indicates that the client understands the nurse's teaching? 1 "I will drink 2 to 3 quarts (2 to 3 liters) of fluid a day." 2 "Any reconstituted solution must be discarded in 1 week." 3 "I can continue driving my car as long as I have the stamina." 4 "While taking this medicine I should be able to continue my usual activity."

Your patient is about to be prescribed rifampin because she was exposed to Neisseria meningitides by a housemate. Your patient is undergoing methadone maintenance therapy for a heroin addition. You know that the rifampin may:

You know that the rifampin may: induce the metabolism of methadone and she may have symptoms of withdrawal.

Calcium Channel Blockers

antidysrhythmic, antianginal, antihypertensive *Norvasc decreased contracility = decreased workload of heart

-setron

antiemetics

208.) A client with myasthenia gravis verbalizes complaints of feeling much weaker than normal. The health care provider plans to implement a diagnostic test to determine if the client is experiencing a myasthenic crisis and administers edrophonium (Enlon). Which of the following would indicate that the client is experiencing a myasthenic crisis? 1. Increasing weakness 2. No change in the condition 3. An increase in muscle spasms 4. A temporary improvement in the condition

auto-define "A client with myasthen..." Rationale: Edrophonium (Enlon) is administered to determine whether the client is reacting to an overdose of a medication (cholinergic crisis) or to an increasing severity of the disease (myasthenic crisis). When the edrophonium (Enlon) injection is given and the condition improves temporarily, the client is in myasthenic crisis. This is known as a positive test. Increasing weakness would occur in cholinergic crisis. Options 2 and 3 would not occur in either crisis.

Patients taking sulfonamides should be advised to drink a lot of liquids because sulfonamides:

can crystallize in concentrated urine, causing renal damage.

steven-johnson syndrome

can happen with use of any antibiotic; hypersensitivity. manifests: skin rash, hypotension, tachycardia, CNS changes

Ace Inhibitors

captopril, enalapril, monopril, lisonopril, ramipril *First line* Used for HTN and HF: prevents sodium reabsorbtion and decreases vascular resistance Used in diabetes to reduce GFR and prevent progression of neuropathy Interacts with NSAIDS :( Beware of hyperkalemia Dry cough

-lone

corticosteroids

-sone

corticosteroids

-phylline

inhaled bronchodilators (methylxanthines) nursing considerations: narrow therapeutic range

Ezetimibe (Zetia) works by

inhibiting absorption of cholesterol in the small intestine *never give with statins

The nurse is giving IV phenytoin (Dilantin). Which guidelines will the nurse follow for administration?

it is very irritating to veins and must be administered slowly, diluted in NS, using a filter needle followed by a flush of NS to avoid local venous irritation, it must be given IV push not continuously.

Antilipimic drugs are contraindicated in patients that have

liver disease

-caine

local anesthetics ex: lidocaine

verapamil / diltiazem

nondihydropine CCBs (works on both arteriole + heart) s/e: constipation

Your patient is a sexually active 15-year-old girl who suffers from recurrent urinary tract infections. Which drug should NOT be given to this patient as prophylaxis for UTI?

norfloxacin Women should be informed that antibiotics can reduce the efficacy of contraceptive steroids. Norfloxacin and other quinolone antibiotics are teratogenic and should not be used by sexually active women who may become pregnant.

Central Pain

occurs with trauma, tumor, inflammation, or disease affecting CNS tissues

Tetracycline, 8 year old boy, mother says something like "I was fine I took it why can't my son?

or whatever- something with tooth decay/discoloration

-cillin

penicillins (antibiotics) major complication: allergic reaction. If allergic to penicillin, may also be allergic to cephalosporins

-thiazide

thiazide diuretics (potassium-losing diuretics) major complication: hypokalemia

Optimal antihypertensive drugs for african americans are

thiazides and Calcium Chanel Blockers

-ase

thrombolytics (clot-busters) ex: eminase, retavase

replacement therapy (levothyroxine)

what is the treatment of hyperthyroidism?

Nursing Implications of AEDs

¬ Assess complete blood count, serum chemistry, and drug levels prior to administration. Know that therapeutic drug levels are usually 10 to 20 mcg/mL. ¬ Know that 150 mg of fosphenytoin yield 100 mg of phenytoin and that the concentration and infusion rate of fosphenytoin would be expressed as a phenytoin equivalent (PE). ¬ Administer phenytoin no faster than 50 mg/min and fosphenytoin at 150 mg PE/min to avoid hypotension or cardiorespiratory depression. ¬ Dilute phenytoin only with normal saline solution. Flush intravenous lines with saline before and after administration. ¬ Monitor the patient for ataxia and dizziness after an infusion. ¬ Do not confuse fosphenytoin (Cerebyx) with Celebrex. ¬ Administer oral dosage forms of the drug with food. Instruct the patient not to open, chew, or break capsules; however, the non-sustained-release tablets may be chewed.

SSRI Patient Teaching

⎫ Possible adverse effects include gastrointestinal upset, sexual dysfunction, and weight gain. ⎫ Use caution when driving and performing other activities requiring mental alertness until tolerance to the adverse effect develops. ⎫ It is important to take SSRIs as ordered and not to discontinue them abruptly, because of possible discontinuation syndrome (dizziness, diarrhea, movement disorders, insomnia, irritability, visual disturbances, lethargy, anorexia, and lowered mood). ⎫ Notify your health care provider immediately if you experience diarrhea, nausea, abdominal cramping, mental status changes, restlessness, diaphoresis, shivering, tremors, ataxia, headaches, or hyperreflexia because they may signify serotonin syndrome. ⎫ Check with your health care provider before using any over-the-counter medications.