PassPoint MS Pharmacology ML6
The label of a drug package reads "meperidine hydrochloride, 50 mg/ml." How many milliliters should a nurse give a client for a 30-mg dose? A. 0.6 ml B. 1.6 ml C. 0.5 ml D. 1 ml
A 30mg/50mg = 0.6*1mL = 0.6mL
The nurse is caring for a client taking risperidone 2 mg daily. It is most important for the nurse to follow up on which client statement? A. "I'm constantly sick and feel like I always have a fever." B. "I take my medication every morning before breakfast." C. "I've been exercising regularly and lost 5 pounds." D. "Sometimes I get dizzy if I stand up quickly."
A A major adverse reaction of risperidone is agranulocytosis. Therefore, it is a priority for the nurse to follow up if the client reports constantly being sick. Risperidone can be given without regard to meals; taking it at the same time every day is encouraged. Clients are encouraged to exercise regularly; the nurse should monitor the client taking risperidone for weight gain. Orthostatic hypotension is a common side effect of risperidone, and the nurse should follow up; however, the priority concern is agranulocytosis. Additionally, the client indicates experiencing dizziness "sometimes" but the feeling sick "constantly."
A client is admitted to the emergency department with anxiety and restlessness. The nurse observes the client exhibiting uncontrolled blinking, tremors, and facial stiffness. The client reports taking thioridazine, amitriptyline, and escitalopram at home. What is the priority action by the nurse? A. Obtain vital signs, and encourage the client to drink 20 ounces of water immediately. B. Assess vital signs, and administer oxygen per nasal cannula to maintain a saturation of 95%. C. Insert an intravenous catheter, and administer 1 mg benztropine intravenously as prescribed. D. Use therapeutic communication to get the client to sit still so an assessment can be performed.
C The client is currently taking antipsychotic and antidepressant medications. These place the client at risk for extrapyramidal effects, including a feeling of restlessness, tremors, and facial stiffness. The priority nursing action is to recognize these signs and administer benztropine, an anticholinergic that will block cholinergic activity in the central nervous system to decrease the extrapyramidal side effects. The extrapyramidal side effects are physically preventing the client from sitting still; therefore, using therapeutic communication will be ineffective. Obtaining vital signs is an appropriate intervention, but there is no indication that the client requires supplemental oxygen. and drinking water will not impact the extrapyramidal side effects.
The health care provider has ordered ondansetron 0.15 mg/kg IV to a pediatric client who weighs 40 lb (18.1 kg). The dose on hand is 2 mg/mL. How many milliliters will the nurse administer to the client? Round the answer to the nearest tenth.
1.4 0.15mg/kg*18.1kg = 2.715mg/2mg = 1.3575*1ml = 1.4mL
The student nurse asks why a client is receiving an I.V. of lactated Ringer's with potassium following an episode of diabetic ketoacidosis. What is the best response by the nurse? A. With acidosis, the intracellular potassium switches places with the plasma hydrogen ions to buffer the acidosis; the lactated Ringer's helps restore the bicarbonate reserves. B. In acidosis, the sodium moves into the cells to buffer the acid and displaces the potassium. The lactated Ringer's helps restore the alkaline pH. C. Lactated Ringer's will help lower the blood pH when hypokalemia is related to ketoacidosis. D. Hypokalemia is associated with uncontrolled diabetes, and the lactated Ringer's is isotonic fluid replacement.
A In diabetic ketoacidosis, the cellular buffers will be activated. Potassium will move out of the cell and hydrogen will move inside the cells to lessen the impact on the plasma pH. Once the acidosis is corrected by bicarbonate injections and I.V. lactated Ringer's, potassium will move back into the cells, resulting in hypokalemia. Potassium levels will be monitored closely, and replacement will be initiated. Lactated Ringer's helps increase the blood pH and provides a source of bicarbonate replacement to replenish the base portion of the 1:20 acid-to-base relationship that helps maintain the blood at the pH of 7.35 to 7.45. Sodium does not switch with potassium in an acidotic state.
A nurse is caring for a school-age client who is in the second percentile of height and weight for age as a result of an endocrine disorder. Which pharmacological intervention should the nurse anticipate? A. replacement with biosynthetic growth hormone B. replacement with antidiuretic hormone (ADH) C. treatment with testosterone or estrogen D. treatment with desmopressin acetate (DDAVP)
A The definitive treatment of growth hormone deficiency is the replacement of growth hormone (somatotropin) with biosynthetic somatotropin. This treatment is successful in 80% of affected children. Desmopressin acetate is used to treat diabetes insipidus. A deficiency of antidiuretic hormone causes diabetes insipidus, and isn't related to hypopituitarism. Testosterone or estrogen may be given during adolescence for normal sexual maturation, but neither is the definitive treatment for hypopituitarism.
The client who is just starting to wake up from a moderate sedation procedure repeatedly asks the nurse, "Where am I? What happened to me?" What action does the nurse take in response to the client's condition? A. Assess the client for signs of an acute head injury. B. Assess the client for evidence of acute stroke. C. No action is required based on the client's condition. D. Request a reversal agent for the medications administered.
C Confusion, repeated questions, and amnesia of the procedure and events are normal behaviors in a client who is just beginning to wake up from moderate sedation due to the amnesic, sedating, and hypnotic effects of the medications used. While repetitive questioning and confusion could be signs of a head injury or stroke, in this scenario they are an expected side effect of the medications given and should resolve as the client metabolizes the medications. Confusion during the initial recovery phase is not a severe adverse reaction to the procedure or medications, but an expected temporary state of altered mental status.
The nurse is caring for a 62-year-old female client receiving an intravenous (IV) heparin infusion for a deep vein thrombosis (DVT) in the left calf, using a smart infusion pump and bar code technology. Select the actions the nurse will take to provide for safe IV medication administration. Note: Each category must have at least 1 option selected. Infusion Pump: A. Verify the order with another nurse. B. Check infusion pump settings with two nurses. C. Silence infusion pump alarms at night. Patient Identification A. Check the client's room and bed number. B. Use two client identifiers prior to administering the medication. C. Scan the bar code on the client's identification (ID) band and IV medication bag. Laboratory Testing A. Monitor the platelet count. B. Monitor the activated partial thromboplastin time (aPTT). C. Monitor the international normalized ratio (INR).
Infusion Pump: A, B Patient Identification: B, C Laboratory Testing: A, B Because heparin is a high-alert medication that carries a risk of causing significant harm, the nurse verifies the heparin order with another nurse before administering the IV infusion. This includes a double-check of the client's identity, medication, dose, indication, route, and pump settings to ensure accuracy.The nurse uses two client identifiers before administering all medications. These identifiers may include the client's name, full date of birth, and medical record number. The nurse also scans the bar code on the client's ID band and on the label on the IV bag. When infusing IV heparin, the nurse monitors aPTT levels and titrates the heparin infusion, per orders, to maintain the aPTT within therapeutic levels. The platelet count is also monitored to detect heparin-induced thrombocytopenia, which requires prompt action to reduce the risk of venous and arterial thrombosis. The infusion pump alarms should be turned on, even at night, to alert the nurse of events, such as air in the tubing, occlusion of tubing, or completion of the infusion. The nurse uses two client identifiers: administer the right medication to the right client. These identifiers may include the client's name, full date of birth, and medical record number. The client's room number and bed number are not acceptable unique identifiers. The nurse monitors the INR when the client is switched to oral warfarin to titrate the warfarin to a therapeutic level.
A child is receiving I.V. gamma globulin for treatment of Kawasaki disease. The order is for 8 g over 12 hours. The concentration is 8 g in 300 ml of normal saline. How many milliliters per hour will this child receive? Record your answer using a whole number.
25 300 ml/12 hr = 25 ml/hr
The nurse is caring for a 12 kg child diagnosed with epiglottitis. Vancomycin 50 mg/kg/day in three divided doses is prescribed. The medication is supplied as 500 mg/100 ml. How many milliliters per dose will the nurse administer? Record your answer using a whole number.
40 12kg*50mg/kg/day = 600mg/500mg = 1.2*100mL = 120mL/3 = 40mL three times a day
The health care provider prescribes ampicillin 100 mg/kg per dose for a newly admitted neonate. The neonate weighs 1350 g (2.97 lb). How many milligrams should the nurse administer? Record your answer using one decimal place.
135 1350g/1000 = 1.35kg 100mg/kg*1.35kg = 135mg
What adverse reaction might the nurse observe after administering enteric-coated erythromycin to a client? A. constipation B. nausea and vomiting C. increased appetite D. weight gain
B Erythromycin is an antibiotic. Common adverse effects include nausea, vomiting, diarrhea, abdominal pain, and anorexia. It should be given with a full glass of water and after meals, or with food, to lessen gastrointestinal symptoms.
A client with rheumatoid arthritis reports gastrointestinal irritation after taking piroxicam. To prevent gastrointestinal upset, the nurse should provide which instruction? A. "Space the administration every 4 hours." B. "Take piroxicam with food or an antacid." C. "Decrease the piroxicam dosage." D. "Take piroxicam with a full glass of water."
B Taking piroxicam with food or an antacid decreases the risk of gastrointestinal upset. The client may take the full piroxicam dosage once daily or may divide it in half and take a smaller dose every 12 hours; dosing every 4 hours is not recommended. Taking the medication with water will not reduce gastrointestinal upset as significantly as taking with food will. The client should not adjust the dosage of piroxicam or any medication unless directed to do so by a health care provider.
The client has been admitted to the hospital with generalized seizures and the healthcare provider ordered pentobarbital sodium. What discharge teaching will the nurse include about pentobarbital sodium? A. "Pentobarbital sodium is available without a prescription." B. "In the initial period of dosage regulation, you may experience visual problems." C. "Smoking decreases the absorption of pentobarbital sodium." D. "Alcohol can cause drug toxicity with pentobarbital sodium."
D Discharge teaching for pentobarbital sodium includes reporting jaundice, abrupt withdrawal can cause seizures, withdrawal should be done gradually, avoid potentially dangerous activities, alcohol can cause drug toxicity, and receiving a flu shot during therapy can increase seizure occurrence. The potential to experience visual problems during the initial period of regulation, smoking leading to decreased absorption, and the availability of the drug without a prescription are included in discharge teaching for insulin, not pentobarbital sodium.
The nurse is caring for a client prescribed IV heparin for treatment of thromboembolism. The client is prescribed 18 units/kg/hr. The client weighs 145 lb (66 kg). The heparin comes from the pharmacy as 25,000 units in 250 mL of D5W. How many mL/hr should this client receive? Round to the nearest whole number.
18u/kg/hr*66kg = 1188u/hr/25000u = 0.04752hr*250mL = 11.88 = 12mL/hr
A nurse is caring for an infant who weighs 8 kg and is ordered to receive ampicillin 25 mg/kg intravenously every 6 hours. How many milligrams would a nurse administer per dose? Record the answer as a whole number.
200 25mg/kg*8kg = 200mg
The nurse is preparing to administer 0.1 mg of digoxin intravenously. Digoxin comes in a concentration of 0.5 mg/2 ml. How many milliliters should the nurse administer? Record your answer using one decimal place.
0.4 (0.1mg/0.5mg) = 0.2*2mL = 0.4mL
A nurse is to administer 10 mg of morphine sulfate to a client with three fractured ribs. The available concentration for this drug is 15 mg/mL. How many milliliters should the nurse administer? Record your answer using one decimal place.
0.7 10mg/5mg = 0.67*1mL = 0.7mL
The healthcare provider orders carbamazepine 200 mg orally three times a day for a client who has epilepsy. The dose on hand is 100 mg/5 mL. How many teaspoons will the nurse give the client at each dose? Record your answer as a whole number.
2tsp 200mg/100mg = 2*5mL = 10mL 5ml = 1tsp 10mL = 2tsp
A client who weighs 187 lb (85 kg) has an order to receive enoxaparin 1 mg/kg. This drug is available in a concentration of 30 mg/0.3 mL. What dose would the nurse administer in milliliters? Record your answer to two decimal places.
0.85 1mg/kg*85kg = 85mg/30mg = 2.83*0.3mL = 0.85mL
The nurse needs to administer verapamil 0.3 mg/kg I.V. once a day to a pediatric client who weighs 20 lb (9.07 kg). The dose on hand is 5 mg/2 ml. How many milliliters will the nurse administer to the pediatric client? Round to the nearest tenth.
1.1 9.07kg*0.3mg/kg = 2.721mg/5mg = 0.5442*2mL = 1.0884 = 1.1mL
A client who weighs 207 lb (94.1 kg) is to receive 1.5 mg/kg of gentamicin sulfate intravenously three times each day. How many milligrams of medication should the nurse administer for each dose? Round to the nearest whole number.
141 1.5mg/kg*94.1kg = 141.15mg = 141mg
Because of a shortage of IV infusion pumps, a nurse must regulate a client's IV by gravity flow. The client has a prescription for 1000 mL of 0.9 normal saline to infuse at 100 mL/hr. The tubing drop factor is 10 drops/mL. At what drip rate should the nurse set the infusion? A. 6 drops per minute B. 10 drops per minute C. 60 drops per minute D. 17 drops per minute
17 10gtt/ml*100ml/hr = 1000gtt/hr/60 = 16.67 = 17gtt/min
A woman who has preeclampsia is receiving magnesium sulfate 20 g per 500 mL of lactated Ringer's solution via an infusion pump. The prescribed rate of infusion is 2 g per hour. How many milliliters per hour should the nurse set the infusion pump for? Record your answer using a whole number.
50 20g/2g/hr = 10hr 500mL/10hr = 50mL/hr
The nurse will administer a dosage of captopril at 1.5 mg/kg/day, in divided doses, q12h, to an infant who weighs 10 kg. How much would the nurse give per dose? Record your answer using one decimal place.
7.5 1.5*10 = 15mg/day/2 = 7.5mg twice a day
A client diagnosed with idiopathic thrombocytopenia purpura needs a peripherally inserted central catheter (PICC) placed. When explaining the catheter to the client, the nurse explains that one advantage of a catheter is that it can be used A. in clients with infections in the blood. B. to provide long-term access to central veins. C. for 2 weeks without being replaced. D. to administer only blood products and I.V. fluids.
B A PICC provides long-term access (longer than 2 weeks) to central veins. It can be used to administer blood products, medications, I.V. fluids, and total parenteral nutrition. Moreover, the PICC can be used to obtain blood specimens. As with any other central venous catheter, this catheter shouldn't be inserted when systemic infection (infection in the blood) is present.
Which physical assessment data would alert the nurse to a possible mild toxic reaction in a client receiving lithium? A. increased appetite B. seizures C. vomiting and diarrhea D. hypotension
C Vomiting and diarrhea are signs of mild to moderate lithium toxicity. Hypotension and seizures occur with moderate to severe toxic reactions. Anorexia occurs with mild toxic reactions.
A client has been diagnosed with hypothyroidism and started on synthetic levothyroxine for thyroid replacement therapy. Which effect is the most important to report to the physician? A. increased energy level and reduction of edema B. increased temperature and metabolic rate C. palpitations and chest pain on exertion D. insomnia and loss of weight
C Assessment of the effects of severe hypothyroidism on the circulatory system is important. Serum cholesterol levels are also elevated in clients with hypothyroidism. As the metabolic rate increases with the thyroid replacement therapy, there is more demand on the heart, and angina and palpitations may occur. All of the choices are expected effects once the replacement hormone is started. There is an increase in temperature, a loss in weight, and increased energy levels.
A 4-month-old infant is diagnosed with congenital hypothyroidism and prescribed levothyroxine. When should the nurse teach the parents to administer the medication? A. 30 minutes after meals B. with the nighttime formula C. regardless of meals D. on an empty stomach
D Levothyroxine should be taken on an empty stomach to facilitate absorption. All the other responses could reduce absorption and cause subtherapeutic levels.
The nurse is caring for a client who was admitted to the labor and birth department in preterm labor at 30 weeks' gestation. The nurse anticipates which medication will be given to help manage preterm labor? A. betamethasone B. indomethacin C. prostaglandin D. terbutaline
D Terbutaline reduces the frequency and intensity of uterine contractions by stimulating B2 receptors in the uterine smooth muscle. It is the drug of choice to inhibit labor. Indomethacin is an anti-inflammatory. Prostaglandins would induce cramping. Betamethasone, a synthetic corticosteroid, is administered to the mother to stimulate fetal pulmonary surfactant.
The client was diagnosed with hypertension 7 years ago. In the last 6 months, after diet and exercise, the client's blood pressure has consistently ranged around 160/95. What should the nurse include in the client's teaching about the side effects of clonidine? Select all that apply. A. "Clonidine may cause pain in your joints." B. "Clonidine may cause low blood pressure when you stand up." C. "Clonidine may cause blood in your urine." D. "Clonidine may cause fatigue." E. "Clonidine may cause dry mouth."
B, D, E The nurse should explain that side effects of clonidine include orthostatic hypotension, drowsiness, peripheral edema, fatigue, urinary retention, dry mouth, and constipation. Hematuria and arthralgia are not side effects of clonidine.
A nurse is developing a drug therapy regimen that won't interfere with a client's lifestyle. When doing this, the nurse must consider the drug's A. steady-state duration of action. B. route of excretion. C. peak concentration time. D. adverse effects.
D When developing a drug therapy regimen that won't interfere with a client's lifestyle, the nurse must consider the drug's adverse effects because these may result in noncompliance. A drug's excretion route, peak concentration time, and steady-state duration of action are important considerations when developing a drug therapy regimen; however, they're related to the drug's physiologic effects and don't affect the client's lifestyle.
A two-month-old infant arrives with a heart rate of 180 bpm and a temperature of 103.1° F (39.5° C) rectally. What is the most appropriate initial nursing intervention? A. give acetaminophen B. encourage fluid intake C. apply carotid massage D. place the infant's hands in cold water
A Acetaminophen should be given to decrease the temperature. A heart rate of 180/bpm is normal in an infant with a fever. A tepid sponge bath may be given to help decrease the temperature and calm the infant. Carotid massage and placing the infant's hands in cold water are attempts to decrease the heart rate through vagal maneuvers. This will not work because the source of the increased heart rate is fever. Fluid intake is encouraged after the acetaminophen is given to help replace insensible fluid losses.
A child is to receive dexamethasone intravenously at the ordered dosage of 7.6 mg. The drug concentration in the vial is 4 mg/ml. How many milliliters should the nurse administer? Record the answer using one decimal place.
1.9 (7.6mg/4mg) = 1.9*1ml = 1.9mL
A child has been prescribed a 3-day treatment of gentamicin sulfate. Which manifestation would indicate that the child is developing toxicity? A. decreased renal output B. visual disturbances C. electrolyte disturbances D. joint discomfort
A Gentamicin sulfate is an antibiotic that can cause ototoxicity and nephrotoxicity. Therefore, a decrease in renal output would be concerning. Electrolyte and visual disturbances and joint discomfort would not be indicative of gentamicin toxicity.
neck, and slow involuntary contractions of the arms and neck. After review of the client's medication list, the nurse would be correct in associating these symptoms with which medication? A. haloperidol B. propranolol C. benztropine D. pantoprazole
A Slow, involuntary contractions of the arms and neck, arching of the back, and extension and rotation of the neck are signs of dystonia. Dystonia is a common adverse effect of antipsychotic medications such as haloperidol. Benztropine is an antiparkinsonian drug, pantoprazole is an antiulcer medication, and propranolol is an antihypertensive.
A client who is incoherent and agitated comes to the emergency department. The client reports visual and auditory hallucinations. The healthcare provider orders haloperidol, 5 mg IM. When educating the client on this medication, which statement by the nurse is correct? A. "This medication will prevent you from acting this way again." B. "This medication will help decrease your tension and agitation." C. "This medication will make you sleep, and then you will not see or hear things that are untrue." D. "This medication will prevent stiff jerky movements of your face and body that you can't control."
B By altering the effects of dopamine in the central nervous system, haloperidol, an antipsychotic drug, treats psychosis and decreases agitation. While this medication diminishes signs and symptoms of psychoses when taken regularly, it is incorrect for the nurse to state one dose will prevent future psychotic episodes. Drowsiness is a common side effect of haloperidol, but the purpose of this medication is to treat the psychosis and decrease agitation. Tardive dyskinesia may occur after prolonged haloperidol use; the client should be monitored for this adverse reaction.
A client with rheumatoid arthritis is taking high doses of nonsteroidal anti-inflammatory medications. What should the nurse teach the client about taking these medications? A. "Use mouthwash to rinse the mouth after taking this medication." B. "Do not drive or use heavy machinery if dizziness occurs." C. "Take prescribed medication with food to lessen the likelihood of an upset stomach." D. "Do not stop taking the medication suddenly; the dose needs to be decreased gradually."
C Gastric upset is a side effect of nonsteroidal antiinflammatory medications; taking medication with food minimizes this effect. Corticosteroids affect adrenal gland function and are discontinued by lowering the dose gradually, but this is not true of nonsteroidal antiinflammatory medications. It is not necessary to rinse the mouth, as stomatitis is not a usual side effect. Dizziness is not an effect of this drug.
Which assessment should a nurse do prior to administering disulfiram to a client with a history of alcohol abuse? A. Assess whether the client admits to a problem with alcohol. B. Assess the client's commitment to attend Alcoholics Anonymous (AA) meetings. C. Assess when the client's last alcoholic beverage was consumed. D. Assess the client's nutritional status.
C The client must be alcohol free for 12 hours before starting therapy with disulfiram. Assessing the client's commitment to attend AA meetings, the client's perception of the problem, and nutritional status are all important interventions, but they aren't necessary prior to starting disulfiram.
The nurse is caring for a client recovering from moderate sedation for a routine endoscopy without complications. The nurse applies which statement by the client as evidence of understanding the discharge planning? A. "I need to remain in the emergency department for at least 12 hours after the procedure to be monitored." B. "I can drive myself home now that I have finished the procedure." C. "I will be admitted to the hospital overnight to recover from these medications." D. "I will need a ride home within a few hours of the procedure."
D Moderate sedation procedures, such as a routine endoscopy, are usually performed in the outpatient setting and are procedures in which rapid recovery and discharge is expected. Longer procedures with more in-depth monitoring and postprocedure care may not be appropriate for moderate sedation. The client should understand that a ride home is needed within a few hours of the procedure; many facilities will not sedate the client unless the person providing a ride home is physically present or readily available. Assuming there are no complications with the procedure, the client would not need to be admitted to the hospital overnight or spend 12 hours in the emergency department being monitored after moderate sedation. Because the medications given can impact decision making, cause drowsiness, and slow reflexes, the client is advised not to drive for 24 hours, and is not allowed to drive home.
The nurse is performing an assessment on a 2-year-old with tonsillitis. Which assessment component should the nurse perform so that the healthcare provider can select the appropriate medication dose for the client? A. respiratory rate B. length C. pulse D. blood pressure E. weight
E The assessment component the nurse needs to obtain to help the healthcare provider with selection of the appropriate medication dose is weight. Respiratory rate, length, pulse, and blood pressure are not used to calculate a dose of medications for a client at this age.
The nurse is caring for a client receiving a nitroglycerin infusion for a myocardial infarction. When titrating this infusion, for which adverse effect should the nurse monitor? A. Hypotension B. Tachycardia C. Diaphoresis D. Confusion
A The nurse should monitor for hypotension, as nitroglycerin is a potent vasodilator. Often upward titration is limited by blood pressure. Tachycardia and diaphoresis may be present in this cardiac client, but these symptoms would not be caused by the medication. Confusion would not be an adverse reaction to nitroglycerin but would be an ominous finding of declining condition in this client.
A nurse is reviewing the medication list of a client who presents with slow, involuntary muscle spasms of the arms and legs and twisting of the neck. The nurse reviews the client's prescriptions for which medication that could correlate with these symptoms? A. clonazepam B. haloperidol C. diazepam D. amitriptyline hydrochloride
B Haloperidol is a phenothiazine and is capable of causing dystonic reactions. Dystonia involves slow, involuntary contractions of an isolated muscle or groups of muscles in the limbs, trunk, and neck. It may involve spasmodic torticollis (involuntary turning of the neck). Diazepam and clonazepam are benzodiazepines. Benzodiazepines don't cause dystonic reactions; however, they can cause drowsiness, lethargy, and hypotension. Tricyclic antidepressants, like amitriptyline, rarely cause severe dystonic reactions; however, they can cause a decreased level of consciousness, tachycardia, dry mouth, and dilated pupils.
A nurse is caring for a client admitted to the psychiatric unit with anxiety and depression. The client refused to take the prescribed fluoxetine and bupropion. Which statement by the nurse is best? A. "Have you taken fluoxetine and bupropion before?" B. "Can you tell me why you do not want to take these mediations? C. "I will contact your provider and request different medications." D. "These medications upset my stomach too, I will get you crackers first."
B The nurse is required to assess before acting. In this circumstance, the nurse is required to assess why the client is refusing to take the medications before acting. By asking an open-ended question the nurse will encourage the client to express concerns. Asking a yes or no question will not elicit a detailed response. Before the nurse contacts the health care provider, the nurse should first assess why the client is refusing the medications. A therapeutic response should focus on the client, not the nurse. Additionally, the nurse should not assume the client is refusing the medications because of abdominal discomfort.
A client has been prescribed neomycin and polymyxin B sulfates and hydrocortisone otic suspension, two drops in the right ear. What action is most important for the nurse take when instilling the medication? A. Hold an emesis basin under the client's ear. B. Warm the solution to prevent dizziness. C. Verify the proper client and route. D. Position the client in the semi-Fowler's position.
C When giving medications, a nurse should follow the "rights" of medication administration, which include verification of right client and right route. The drops may be warmed to prevent pain or dizziness, but this action isn't essential. An emesis basin would be used for irrigation of the ear. The client should be placed in the lateral position for five minutes, not semi-Fowler's position, to prevent the drops from draining.
A client is scheduled for a prostatectomy, and the anesthetist plans to use a spinal (subarachnoid) block during surgery. In the operating room, the nurse prepares the client according to the anesthetist's instructions. Which statement by the anesthetist would the nurse question? A. "Hold the client firmly in position while I administer the spinal block." B. "Obtain a set of vital signs, and connect the client to a continuous oxygen saturation monitor." C. "Review the client's current medications, and verify the last dose of anticoagulants." D. "Position the client supine on the operating table, and prepare the site for injection."
D The client receiving a subarachnoid block requires special positioning to prevent CSF leakage and to ensure proper anesthetic distribution. The nurse would assist the client in a sitting or lateral position; lying supine is inappropriate as it obstructs the site of injection. Reviewing and verifying the last dose of anticoagulants will alert the nurse to a risk for bleeding. Obtaining vital signs is important to get baseline readings for comparison during and after the procedure. Since respiratory paralysis is a complication of subarachnoid injections, continuously monitoring the client's oxygen saturation is an appropriate intervention. Asking the nurse to hold the client firmly during the procedure will prevent sudden client movement that may displace the needle and cause injury to the nerve root.
A 2-year-old child is prescribed cyclosporine. The parent says the child doesn't like taking the liquid medication. Which statement by the nurse is most appropriate? A. "Offer the medication diluted with chocolate milk or orange juice to make it more palatable." B. "Give your child some control over what time the medication is taken during the day." C. "Give the ordered dose in small amounts over 2 hours to make it less unpleasant." D. "We can inquire about inserting a nasogastric (NG) tube to administer the medication."
A Because liquid cyclosporine has a very unpleasant taste, diluting it with chocolate milk or orange juice will lessen the strong taste and help the child take the medication as ordered. It is not acceptable to miss a dose, because the drug's effectiveness is based on therapeutic blood levels, and skipping a dose could lower the level. It is also very important that the dosage be given at the same time every day. If it is given in the morning, it should always be given in the morning. Unfortunately, the child does not get to pick and choose when they will take the medication. Cyclosporine should not be given by NG tube, because it adheres to the plastic tube and, thus, some of the drug may not be administered. Taking the medication over a period of time could negatively affect the blood level. Cyclosporine comes in pill form, but a 2 year old is generally too young to swallow pills.
What instruction should the nurse include when developing a discharge teaching plan for a client who has been prescribed phenytoin? A. "You can take any phenytoin brand because all brands are the same." B. "Don't stop taking the drug except with medical supervision." C. "Take the drug on an empty stomach." D. "You can consume alcoholic beverages in moderation."
B Abrupt cessation of phenytoin may trigger status epilepticus, so the client should be warned not to stop the drug unless approved by the provider. Taking phenytoin with food minimizes GI distress. Alcoholic beverages can decrease the drug's effectiveness. Changing phenytoin brands may alter the therapeutic effect.
The client visits the health care provider reporting a red, swollen, and painful right great toe and is subsequently diagnosed with gouty arthritis. Which drug does the nurse anticipate the healthcare provider to order? A. allopurinol B. phenytoin C. furosemide D. metolazone
A. Allopurinol is used to manage and prevent gout attacks and is also used for the treatment of calcium oxalate kidney stones. Phenytoin is used to treat and prevent seizures. Zaroxolyn is used to treat blood pressure and edema. Furosemide treats fluid retention and swelling caused by congestive heart failure, liver disease, and kidney disease.
The client is admitted for a myocardial infarction and has a heparin drip infusing. Which signs and symptoms would prompt the nurse to stop the infusion and notify the prescribing health care provider? A. Pain and stiffness to left shoulder B. Unrelieved chest pain C. New onset bleeding from client's rectum D. Report of upset stomach and nausea
C Heparin is a medication used to help prevent blood clots, and can be used in the treatment of myocardial infarction to prevent more blood clots. When a client is receiving a heparin infusion, the nurse must be alert to signs and symptoms of bleeding, as the heparin may need to be discontinued. New onset of rectal bleeding would indicate that the nurse should stop the heparin infusion and notify the provider immediately. Unrelieved chest pain, upset stomach and nausea, and left shoulder pain/stiffness are common symptoms during a myocardial infarction, and may necessitate the nurse notify the attending health care provider, but would not be indications for stopping the heparin drip.
A client is receiving fluid replacement with lactated Ringer's solution after 40% of the body was burned 10 hours ago. The assessment reveals a temperature of 97.1°F (36.2°C), heart rate of 122 bpm, blood pressure of 84/42 mm Hg, central venous pressure (CVP) of 2 mm Hg, and urine output of 25 mL for the last 2 hours. The intravenous (IV) rate is currently at 375 mL per hour. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse should request which prescription from the health care provider? A. dextrose 5% B. fresh frozen plasma C. furosemide D. IV rate increase
D The decreased urine output, low blood pressure, low CVP, and high heart rate indicate hypovolemia and the need to increase fluid volume replacement. Furosemide is a diuretic that should not be given due to the existing fluid volume deficit. Fresh frozen plasma is not indicated. It is given for clients with deficient clotting factors who are bleeding. Fluid replacement used for burns is lactated Ringer's solution, normal saline, or albumin.
