Patho HESI
Therapeutic lithium level
0.4 to 1.3 mEq/L (0.4 to 1.3 mmol/L)
Grey syndrome
can be caused by Chloramphenicol (antibiotic)
Indomethacin
pauses preterm labor
Dinoprostone
uterine stimulant
Which condition is contraindicated for St. John's wort herbal therapy? 1 Anxiety 2 Seizures 3 Dementia 4 Pregnancy
Dementia is contraindicated for St. John's wort herbal therapy; this herbal therapy is used to treat anxiety. Seizures are contraindicated for bupropion therapy. Pregnancy is contraindicated for ginseng herbal therapy.
Which drug is safe to administer to a lactating woman but may cause teratogenic effects when administered to pregnant clients? 1 Tetracycline 2 Methotrexate 3 Carbamazepine 4 Cyclophosphamide
Carbamazepine is safe to administer in a lactating woman but may cause neural tube defects as a teratogenic effect. Tetracycline may cause tooth and bone abnormalities as a teratogenic effect. Methotrexate may cause limb malformations as a teratogenic effect. Cyclophosphamide may cause secondary cancer as a teratogenic effect. Tetracycline, methotrexate, and cyclophosphamide should not be administered to breast-feeding women.
The nurse is teaching a client who is receiving a monoamine oxidase inhibitor about dietary restrictions. The nurse plans to caution the client to avoid which foods? 1 Pork, spinach, and fresh oysters 2 Milk, grapes, and meat tenderizers 3 Cheese, beer, and products with chocolate
Cheese, beer, and products with chocolate are high in tyramine, which in the presence of a monoamine oxidase inhibitor can cause an excessive epinephrine-type response that can result in a hypertensive crisis. There is no relationship between monoamine oxidase inhibitors and pork, spinach, oysters, milk, grapes, meat tenderizers, leafy green vegetables, apples, or ice cream.
Donepezil is prescribed for a senior client who has mild dementia of the Alzheimer type. What information does the nurse include when discussing this medication with the client and family? 1 Fluids should be limited to four large glasses per day. 2 Constipation should be reported to the primary healthcare provider immediately. 3 Blood tests that reflect liver function will be performed routinely. 4 The client's medication dosage may be self-adjusted according to the client's response.
Donepezil may affect the liver, because alanine aminotransferase (ALT) is found predominantly in the liver; most ALT increases indicate hepatocellular disease. Clients taking this medication should have regular liver function tests and report light stools and jaundice to the primary healthcare provider. Fluids should not be limited, because one of the side effects of donepezil is constipation. A side effect of constipation is expected; therefore fluids, high-fiber foods, and exercise should be recommended to help keep the stools soft. The client should not abruptly increase or decrease the dosage; donepezil should be taken exactly as prescribed.
Which statement about psychotherapeutic drugs in elderly clients requires correction? Tricyclic antidepressants may increase anxiety in elderly clients. Normal dosage of lithium may result in lithium toxicity in elderly clients. Elderly clients on antipsychotic drugs are susceptible to orthostatic hypotension. Low serum levels of the drug are reported in elderly clients on psychotherapeutic drugs.
Low serum levels of the drug are reported in elderly clients on psychotherapeutic drugs.
Clomiphene
increases estrogen and leutenizing hormone and ovarian stimulation by stimulating the hypothalamus
Which client condition is contraindicated for prescribing clozapine? 1 Seizures 2 Glaucoma 3 Dysrhythmias 4 Bone marrow depression
Clozapine is an atypical antipsychotic drug that is contraindicated in clients with bone marrow depression. Clozapine should be used with caution in clients with seizures. First-generation antipsychotics should be used with caution in clients with glaucoma. Ziprasidone is contraindicated in clients with a history of dysrhythmias.
Which drug is used to prevent preterm labor? 1 Oxytocin 2 Nifedipine 3 Raloxifene 4 Clomiphene
Nifedipine is used to prevent preterm labor because it inhibits myometrial activity by blocking the influx of calcium. Oxytocin may be used to induce labor. Raloxifene is used to prevent postmenopausal osteoporosis. Clomiphene is used to cause ovulation.
A client is receiving imipramine, a tricyclic antidepressant, for depression. The nurse assesses the client for side effects and adverse effects. Which adverse effect requires further assessment and possible medical intervention? 1 Dry mouth 2 Weight gain 3 Blurred vision 4 Urinary hesitancy
Urinary hesitancy and retention are adverse effects of imipramine that may require immediate medical intervention. Dry mouth, weight gain related to increased appetite, and blurred vision may occur as side effects of imipramine; they usually decrease over time or can be managed through nursing interventions.
Chlordiazepoxide
anti anxiety and alcohol withdrawal symptoms
Clozapine
atypical antipsychotic that can cause agranulocytosis (low WBC) so watch out for infection because the person will be more suceptible than usual
Leuprolide
decreases levels of LH and FSH side effect related to decrease in estrogen, hot flashes, vaginal dryness, bone loss, headache treat: endometriosis, prostate cancer, uterine fibroids, early puberty
Isoniazid
don't take with tyramine products (wine) treats TB
Bupropion
smoking cessation and antidepressant
How should you take iron supplements
with orange juice multivitamin liquid iron supplements need to be taken with straw to avoid staining of teeth
side effect of digoxin toxicity
yellow halos
A client was treated with sex hormones during pregnancy. Which teratogenic effects may be seen in the newborn if the client gave birth to a baby girl? Select all that apply. 1 Ebstein anomaly 2 Vaginal carcinoma 3 Facial malformations 4 Masculinization of the female fetus 5 Reproductive organ defects
2,4,5 Vaginal carcinoma, masculinization of the female fetus, and reproductive organ defects are teratogenic effects that may be seen in a female newborn if the mother has a medication history of sex hormones during pregnancy. Exposure to lithium may cause Ebstein anomaly in the newborn. HMG-CoA reductase inhibitors may cause facial malformations in the fetus.
Selegiline, Rasagiline
Mech: MAO B inhibitors Use: Parkinsons permits lower doses of L-Dopa ↓ on/off phenomenon Tox: Enhance adverse effects of L-DOPA
A client on antidepressant therapy develops hyponatremia. Which drug may be responsible for the client's electrolyte imbalance? 1 Phenelzine 2 Paroxetine 3 Imipramine 4 Amitriptyline
Paroxetine is a selective serotonin reuptake inhibitor; side effects include hyponatremia. Phenelzine is a monoamine oxidase inhibitor; side effects include orthostatic hypotension. Imipramine and amitriptyline are tricyclic antidepressants; side effects associated with these drugs include dry mouth and blurred vision.
Which drug should be excluded from the prescription of a lactating mother being treated for heart problems? 1 Tenormin 2 Labetalol 3 Metoprolol 4 Propranolol
Tenormin is contraindicated for lactating mothers because this drug highly concentrates in breast milk. Labetalol, metoprolol, and propranolol are safe to prescribe to lactating mothers.
A young adult being treated for substance abuse asks the nurse about methadone. The nurse responds that methadone is useful in the treatment of opioid addiction because it has what characteristic? 1 Is a nonaddictive drug 2 Has an effect of longer duration 3 Does not produce a cumulative effect 4 Carries little risk of psychological dependence
The duration of effect of methadone is 12 to 24 hours, compared with other opioids, which have a 3- to 6-hour duration of effect. It is just as addictive but controls the addiction and keeps the client out of the illicit drug market. Methadone does produce a cumulative effect. Physical as well as psychological dependence is possible, just as with other opioids.
teratogenic effect of methotrexate
limb malformation
how severe are antiseizure drugs on the fetus during pregnancy
not very. malformations can be corrected by surgery or later in childhood
Which teratogen causes masculinization of the female fetus? 1 Danazol 2 Vitamin A 3 Topiramate 4 Tetracycline
Danazol is an androgen that may cause masculinization of the female fetus as a teratogenic effect. Vitamin A may cause fetal cardiac defects. Topiramate may cause fetal growth delays. Tetracycline may cause tooth and bone abnormalities as teratogenic effects.
A woman receiving treatment with topiramate gives birth to a newborn with a cleft lip and cleft palate. Which Food Drug Administration (FDA) Pregnancy Risk category of pregnancy does the drug belong? 1 B 2 C 3 D 4 X
According to the FDA Pregnancy Risk Category system, category D contains drugs that pose a risk to the fetus, but the benefits of drug use during pregnancy are acceptable despite the risks. Category B contains drugs that may cause fetal harm, but there is no evidence of a definite risk. Category C contains drugs that may cause fetal harm. Category X contains drugs that show definite risk of fetal abnormalities; for these drugs, the risks outweigh the benefits of the drugs.
Which drug used to promote fertility may cause esophageal burns? 1 Estrogen 2 Clomiphene 3 Nifedipine 4 Indomethacin
Clomiphene is a serum selective receptor modulator that may cause esophageal burns. Estrogen may cause a thromboembolism. Nifedipine may cause maternal fetal problems. Indomethacin may cause birth defects.
What is the first line drug used to manage intrauterine fetal death? 1 Dinoprostone 2 Misoprostol 3 Mifepristone 4 Methylergonovine
Dinoprostone is a synthetic derivative of hormone prostaglandin E 2. It is to manage intrauterine fetal death up to 28 weeks of gestational age. Misoprostol is used for cervical ripening, and it is used along with mifepristone to induce abortion. Methylergonovine is prescribed to reduce postpartum hemorrhage.
What is the best drug of choice for treating obsessive-compulsive disorder? Imipramine Lithium salts Amitriptyline Clomipramine
Clomipramine is a tricyclic antidepressant drug prescribed for treating of obsessive-compulsive disorder. Childhood enuresis necessitates the administration of imipramine. Lithium salt is prescribed to treat bipolar disorders. Dysthymias can be treated by the administration of antidepressant drugs such as amitriptyline.
A nurse is administering medications to clients on a psychiatric unit. What does the nurse identify as the reason that so many psychiatric clients are given the drug benztropine or trihexyphenidyl in conjunction with the phenothiazine-derivative neuroleptic medications? 1 They reduce postural hypotension. 2 They potentiate the effects of the neuroleptic drug. 3 They combat the extrapyramidal side effects of the neuroleptic drug. 4 They ameliorate the depression that may accompany schizophrenia.
Benztropine and trihexyphenidyl control the extrapyramidal (parkinsonian) manifestations associated with the neuroleptics and are classified as antiparkinsonian drugs. These drugs do not reduce postural hypotension, nor do they potentiate phenothiazine derivatives or have an effect on depression.
A nurse is teaching a client about tricyclic antidepressants. Which potential side effects does the nurse include? Select all that apply. 1 Dry mouth 2 Drowsiness 3 Constipation 4 Severe hypertension 5 Orthostatic hypotension
1,2,3,5 Dry mouth is a common anticholinergic side effect of tricyclic antidepressants. Drowsiness can be a common side effect of tricyclic antidepressants but usually decreases with continued treatment. Constipation is a common side effect of tricyclic antidepressants that can usually be managed with stool softeners and a high-fiber diet. Orthostatic hypotension is a common side effect of tricyclic antidepressants; the client should be instructed to rise slowly from a sitting to a standing position. Hypertension of any type is not a side effect of tricyclic antidepressants.
A nurse is caring for a client who is being given intravenous magnesium sulfate to treat preeclampsia. Which effect alerts the nurse to notify the primary healthcare provider? 1 Respiratory rate of 18 breaths/min 2 2+ patellar reflex response 3 Blood pressure of 112/76 mm Hg 4 Urine output of less than 100 mL in 4 hours
A decreased urine output of less than 25 mL/hr may be indicative of kidney damage, a result of the preeclampsia, and impending renal failure. Magnesium sulfate is excreted by the kidneys, and magnesium toxicity may occur. Respirations at this rate are within the expected range; a rate of at least 16 breaths/min should be present before each dose of magnesium sulfate. Loss of the patellar reflex is suggestive of magnesium sulfate toxicity; a 2+ reflex is within the expected range. A blood pressure of 112/76 mm Hg is within normal limits.
A nurse is caring for several clients who have severe psychiatric disorders. What is the major reason that a primary healthcare provider prescribes an antipsychotic medication for these clients? 1 To improve judgment 2 To promote social skills 3 To diminish neurotic behavior 4 To reduce the positive symptoms of psychosis
Antipsychotics are used to decrease positive signs and symptoms associated with psychoses, including hallucinations, delusions, paranoia, and disorganized speech. These drugs are used to minimize psychotic, not neurotic, signs and symptoms. Improved judgment and social skills are not prime reasons that antipsychotic drugs are used.
A lactating woman is diagnosed with migraine headaches. What drug should be prescribed to the client if she wishes to continue breast-feeding? 1 Morphine 2 Sumatriptan 3 Bromocriptine 4 Acetaminophen
Because sumatriptan is not excreted in breast milk, this drug is safe for a lactating woman with migraines. Morphine is the drug of choice for a lactating woman who reports severe pain. Bromocriptine is contraindicated for lactating women. Acetaminophen is a drug of choice for lactating women with pain.
MAO inhibitors
Behavioral stimulants that reduce depression by inhibiting the action of an enzyme called MAO, keeps dopamine in the system longer can cause hypertensive crisis (due to increase of tyramine in body)
butorphanol
opioid (contraindicated in transition or expulsion phase of labor because can cause infant resp depression)
Which drug is used to manage nonmetastatic gestational trophoblastic disease? 1 Oxytocin 2 Mifepristone 3 Dinoprostone 4 Methylergonovine
Dinoprostone is a synthetic drug derived from naturally occurring prostaglandins. This drug is used to manage nonmetastatic gestational trophoblastic disease. Methylergonovine is used to treat postpartum hemorrhage. Oxytocin is used for labor induction. Mifepristone is used to induce an abortion.
Which clients with schizophrenia should not be prescribed chlorpromazine? Select all that apply. 1 Clients with glaucoma 2 Clients with dynamic ileus 3 Clients with Parkinson disease 4 Clients with severe hypertension 5 Clients with prostatic hypertrophy
Chlorpromazine is a first-generation antipsychotic drug that should be avoided in clients with a history of Parkinson disease or severe hypertension. Clients with a history of glaucoma, dynamic ileus, or prostatic hypertrophy should be prescribed chlorpromazine with caution.
Which is a second-generation antidepressant drug? 1 Doxepin 2 Citalopram 3 Protriptyline 4 Trimipramine
Citalopram is an example of a second-generation antidepressant drug. Doxepin, protriptyline, and trimipramine are examples of first-generation antidepressant drugs.
A woman reports irregular menses, back pain, and weight gain. Upon diagnosis, the woman has low levels of estrogen and progesterone. Which drug may be prescribed if the woman wants to conceive? 1 Raloxifene 2 Methergine 3 Clomiphene 4 Dinoprostone
Clomiphene is a fertility drug that can cause ovulation by stimulating the production of the gonadotropin hormone. Raloxifene is used to prevent postmenopausal osteoporosis. Methergine is used to reduce postpartum uterine hemorrhage. Dinoprostone may cause a termination of a pregnancy.
A pregnant woman who is past her due date is hospitalized for a labor induction. Which drug should be administered to the client? 1 Clomiphene 2 Menotropins 3 Dinoprostone 4 Choriogonadotropin alfa
Dinoprostone is a prostaglandin that stimulates uterine contractions to promote the progression of labor. Clomiphene, menotropins, and choriogonadotropin alfa are fertility drugs that are used to increase the likelihood of conception in an infertile woman.
A pregnant client is treated with sertraline for depression. What can be inferred about the drug's action? 1 It will only affect the client. 2 It will only affect the fetus. 3 It will affect both the client and the fetus. 4 It will not have any effect on both client and the fetus.
Drugs taken during pregnancy may act on both the client and the fetus as the drug passes through the placenta from the mother to the fetus. The drug action would be meant for treatment in the client and it may affect the fetus in anyway. The drug does not show effects only on the fetus.
A nurse is caring for an obese client in early labor. The anesthesiologist discusses several types of analgesia and anesthesia with the client and recommends one. The client requests clarification before signing the consent form. Which type has the anesthesiologist recommended? 1 Epidural anesthesia 2 Oral opioid analgesia 3 Pudendal nerve anesthesia 4 Intravenous opioid analgesia
Epidural anesthesia during the first stage of labor decreases metabolic and respiratory demands and is preferred for obese clients. Obese women are sensitive to systemic opioids, which predispose them to respiratory depression; oral medications do not have a uniform rate of absorption and are not recommended during labor. A pudendal block does not reach the uterus, so contractions are felt; it is used during the second stage of labor.
Which statement regarding estradiol is true? 1 Estradiol reduces estrogen levels. 2 Estradiol is slowly absorbed from skin. 3 Estradiol is available in the form of tablets. 4 Estradiol should be used along with sunscreen products.
Estradiol is slowly absorbed from the skin for up to 8 hours after application. Estradiol is administered to increase the levels of estrogen in postmenopausal women to ease hot flashes. Estradiol is available as an emulsion that is typically applied to the thighs or calves. Sunscreen products should not be applied with estradiol because sunscreen may reduce the absorption of estradiol.
Which antipsychotic drugs may cause tardive dyskinesia? Select all that apply. 1 Loxapine 2 Quetiapine 3 Haloperidol 4 Ziprasidone 5 Paliperidone
First-generation antipsychotic drugs such as loxapine and haloperidol may cause tardive dyskinesia, an extrapyramidal reaction. Second-generation antipsychotic drugs such as quetiapine, ziprasidone, and paliperidone have a lower risk of causing extrapyramidal reactions.
Which drug most commonly causes extrapyramidal side effects (EPS)? 1 Clozapine 2 Haloperidol 3 Risperidone 4 Aripiprazole
Haloperidol is a typical antipsychotic that commonly causes extrapyramidal side effects. Clozapine is an atypical antipsychotic that has a low risk of causing extrapyramidal side effects. Risperidone and aripiprazole have a low risk of causing extrapyramidal side effects.
A nurse is counseling a pregnant client with iron-deficiency anemia about when and how to take supplemental iron. With what drink is iron absorption most efficient? 1 Water 2 A strawberry milkshake 3 Skim milk 4 Orange juice
Iron should be taken before breakfast, on an empty stomach, to permit maximal absorption; the ascorbic acid in orange juice enhances the absorption of iron. Water does not provide the ascorbic acid necessary for absorption of iron. Iron should not be taken with milk or other dairy products, which may interfere with its absorption.
A neonate is diagnosed with hypothyroidism. The nurse discovers that the mother was receiving treatment for a thyroid disorder and continued the medication during pregnancy. Which drug might have caused hypothyroidism in the neonate? 1 Lithium 2 Androgens 3 Methimazole 4 Levothyroxine
Methimazole is used to treat hyperthyroidism and is contraindicated during pregnancy because its use may cause hypothyroidism in the neonate. Lithium may cause cardiac defects in a neonate. Androgens may cause masculinization of a female fetus. Used to treat hypothyroidism, levothyroxine is a safe drug to be taken during pregnancy.
What is the drug of choice for a client who wants to abort her pregnancy at three months of gestation? 1 Nifedipine 2 Terbutaline 3 Mifepristone 4 Methylergonovine
Mifepristone is a progesterone antagonist that stimulates uterine contractions; it is used to selectively terminate a pregnancy. Nifedipine is a calcium channel blocker that is used to maintain pregnancy in cases of preterm labor. Terbutaline is a drug used to inhibit labor and maintain pregnancy. Methylergonovine is used to reduce postpartum uterine hemorrhage; this drug is not used for abortion.
Which preparations use toxoids but not live viruses? Select all that apply. Rotarix Varivax M-M-R II PEDIARIX DAPTACEL
PEDIARIX consists of diphtheria and tetanus toxoids plus inactivated bacterial components of pertussis, inactive viral antigen of hepatitis B, and inactivated poliovirus vaccine. DAPTACEL is a preparation consisting of toxoids plus inactive bacterial and viral components of diphtheria and tetanus toxoids and acellular pertussis vaccine. Rotarix, Varivax, and M-M-R II are preparations containing live viruses.
A client with the diagnosis of schizophrenia, paranoid type, has been receiving a phenothiazine drug. When the psychiatric daycare center plans a fishing trip, it will be important for the nurse to take which action? 1 Provide the client with sunscreen. 2 Caution the client to limit exertion during the trip. 3 Give the client an extra dose of medication to take after lunch. 4 Take the client's blood pressure before allowing participation in the outing.
Phenothiazines commonly cause a photosensitivity that can be controlled with sunscreen. Limiting activity is not a necessary precaution when phenothiazines are prescribed. The medication must be administered as prescribed. Participating in the outing should not negatively affect the client's blood pressure.
A client who is at 33 weeks' gestation has contracted gonorrhea and is prescribed probenecid and penicillin. What instructions will the nurse give to the client regarding the reason for dual therapy? 1 "Your allergy to penicillin is minimized." 2 "The side effects of the disease are reduced." 3 "Your immune defense mechanisms are more active." 4 "The amount of penicillin in your blood is increased." 00:00:00 Question Answer Confidence ButtonsJust a GuessPretty SureNailed It
Probenecid reduces renal tubular excretion of penicillin. The options "Your allergy to penicillin is minimized", "The side effects of the disease are reduced," and "Your immune defense mechanisms are more active" are unrelated to the concomitant administration of penicillin and probenecid.
After taking a typical antipsychotic medication for 1 month, a client reports, "I feel stiff, my hands shake, and I started drooling." The picture illustrates the client's physical status observed by the nurse in the clinic. What extrapyramidal side effect does the nurse conclude that the client has developed? 1 Dystonia 2 Akathisia 3 Tardive dyskinesia 4 Pseudoparkinsonism
Pseudoparkinsonism has adaptations similar to those of Parkinson disease (e.g., shuffling gait, tremors, rigidity, bradykinesia). Pseudoparkinsonism, an extrapyramidal side effect of typical antipsychotics, can occur any time after initiation of therapy. Dystonia is muscle spasms of the face, tongue, head, neck, jaw, and back, usually causing exaggerated posturing of the head. Akathisia is exhibited by motor restlessness. Tardive dyskinesia is exhibited by facial, ocular, oral/buccal, lingual/masticatory, and systemic movements.
A client begins fighting and biting other clients. The primary healthcare provider prescribes a stat injection of haloperidol. How will the nurse implement this prescription? 1 Quickly, with an attitude of concern 2 Before the client realizes what is happening 3 After the client agrees to receive the injection 4 Quietly, without any explanation of the reason for it
Quickness is used for safety; an attitude of concern may help reduce the client's anxiety. The client must be told why sedation is being used; to do so surreptitiously will reduce the client's trust. A client who is this upset will not agree to a sedative; the client may harm self or others and must be sedated.
The nurse is caring for a client who has just received epidural anesthesia. The nurse will monitor for which adverse effects? 1 Uterine atony 2 Hypotension 3 Decreased urine production 4 Precipitous second stage of labor
Regional anesthesia lowers the blood pressure, which puts both mother and fetus in jeopardy. The client may not have the sensation to void, but the amount of urine manufactured does not decrease because a regional block does not affect the kidneys. Epidural anesthesia does not shorten the second stage of labor and does not cause uterine atony.
Which monoamine oxidase inhibitor is used to treat Parkinson disease? Correct1 Selegiline 2 Phenelzine 3 Isocarboxazid 4 Tranylcypromine
Selegiline is a monoamine oxidase-B inhibitor used to treat Parkinson disease. Phenelzine, isocarboxazid, and tranylcypromine are nonselective inhibitors of both type A and B used in the treatment of depression.
A client with schizophrenia is given an antipsychotic drug. The nurse recalls all the extrapyramidal effects associated with this type of medication and anticipates that the drug will be discontinued if which occurs? 1 Akathisia 2 Tardive dyskinesia 3 Parkinsonian syndrome 4 Acute dystonic reaction
Tardive dyskinesia is characterized by protrusion and vermicular movements of the tongue, chewing and puckering movements of the mouth, and a puffing of the cheeks. These adverse effects may or may not be reversible when the antipsychotic medication is withdrawn. Motor restlessness (akathisia), parkinsonian symptoms, or an acute dystonic reaction can be treated with an antiparkinsonian or anticholinergic drug while the antipsychotic medication is continued.
After the birth of her child, a mother tells the nurse, "I was told that my baby has to have an injection of vitamin K. Why is this necessary?" How should the nurse respond? 1 "Your baby needs the injection to promote development of red blood cells." 2 "An injection of vitamin K will help keep your baby from becoming jaundiced." 3 "Newborns are deficient in vitamin K. This treatment will ensure adequate levels." 4 "A newborn's blood clots extremely rapidly. This injection will help decrease the clotting time."
The absence of intestinal flora in the newborn results in a low level of vitamin K, causing a transient blood coagulation deficiency; for this reason an injection of vitamin K is given prophylactically on the day of birth. Vitamin K has no effect on erythropoiesis. Vitamin K is important for the synthesis of the clotting factor in the liver, but it will not prevent jaundice. Newborns have a blood coagulation deficiency; the blood clots more slowly, not more quickly.
A client with a history of methamphetamine use is admitted to the medical unit. What clinical manifestation does the nurse expect when assessing the client? a. Constricted pupils b. Intractable diarrhea c. Increased heart rate d. Decreased respirations
Methamphetamine is a stimulant that causes the release of adrenaline, which activates the sympathetic nervous system. The pupils will dilate, not constrict, because the sympathetic nervous system is activated. Clients withdrawing from opioids, not methamphetamine, experience diarrhea. The respirations will be increased, not decreased, because of the activation of the sympathetic nervous system.
cyclophosphamide
used to treat cancer The teratogenic effect includes secondary cancer and central nervous system malfunction
benzodiazapine
seizure and antianxiety drug, raises seizure threshold
Nifedipine
tocolytic agent used without combination to inhibit labor and maintain a pregnancy
Clomiphene
used to induce ovulation tachycardia is associated with use
Which statement is true regarding antipsychotic drugs? A. All first- and second-generation antipsychotics are equally effective. B. Second-generation antipsychotics pose a risk of extrapyramidal symptoms. C. First-generation antipsychotics pose a significant risk of metabolic side effects. D. Clozapine is more effective than other second-generation antipsychotics.
D. Clozapine is more effective than other second-generation antipsychotics.
what has tyramine
smoked meat/fish wine beer aged cheese
Propylthiouracil (PTU)
decreases production of thyroid hormone
Misoprostol
induces labor by cervical ripening and increases force of contraction control postpartum hemmorhage
A nurse notes that haloperidol (Haldol) is most effective for clients who exhibit behavior that is: 1.Depressed 2.Overactive 3.Withdrawn 4.Manipulative
Haloperidol reduces emotional tension, excessive psychomotor activity, panic, and fear. It is used for clients with thought disorders and hyperactivity. Clients exhibiting excited-depressed behavior do not respond well to haloperidol, because it tends to worsen the depression. Haloperidol appears to have few stimulating effects for a withdrawn client and, in fact, increases feelings of lassitude and fatigue. Haloperidol does not decrease manipulative behavior. Clients who are capable of manipulation usually do not exhibit behavior that involves overactivity, fear, and panic.
Which drug would be used to treat a client with severe motor tics, barking cries, and outbursts of obscene language? 1 Loxapine 2 Pimozide 3 Thiothixene 4 Thioridazine
Severe motor tics, barking cries, and outbursts of obscene language are signs of Tourette syndrome. Pimozide is a high-potency drug used to treat this syndrome. Loxapine is a medium-potency agent indicated only for schizophrenia. Thiothixene is a high-potency agent indicated for schizophrenia. Thioridazine is a low-potency first-generation antipsychotic indicated for schizophrenia.
A primary healthcare provider prescribes 0.25 mg of alprazolam by mouth three times a day for a client with anxiety and physical symptoms related to work pressures. For what most common side effect of this drug will the nurse monitor the client? 1 Drowsiness 2 Bradycardia 3 Agranulocytosis 4 Tardive dyskinesia
Alprazolam, a benzodiazepine, potentiates the actions of gamma-aminobutyric acid, enhances presympathetic inhibition, and inhibits spinal polysynaptic afferent pathways. Drowsiness, dizziness, and blurred vision are common side effects. Alprazolam may cause tachycardia, not bradycardia. Agranulocytosis is usually a side effect of the antipsychotics in the phenothiazine, not the benzodiazepine, group. Tardive dyskinesia occurs after prolonged therapy with antipsychotic medications; alprazolam is an antianxiety medication, not an antipsychotic.
A nurse teaches dietary guidelines to a client who will be receiving tranylcypromine sulfate, a monoamine oxidase inhibitor (MAOI). The client compiles a list of foods to avoid. Which foods included on the list indicate that the teaching has been effective? Select all that apply. 1 French fries 2 Pepperoni pizza 3 Bologna sandwich 4 Hamburger on a bun 5 Hash brown potatoes
Cheese and processed meats contain tyramine, which is contraindicated when MAOIs are taken. Tyramine, a precursor in the synthesis of norepinephrine, taken in the presence of MAOIs can lead to a sharp increase in norepinephrine and a potentially fatal hypertensive crisis. Although bread does not contain tyramine, bologna does; delicatessen meats (e.g., bologna, sausage), meat extracts, and liver are high in tyramine and should be avoided. French-fried potatoes, hamburgers and bread, and hash brown potatoes do not contain tyramine and are not contraindicated when a client is taking an MAOI.
A pregnant client at 30 weeks' gestation begins to experience contractions every 5 to 7 minutes. She is admitted with a diagnosis of preterm labor. Although the client is being given tocolytic therapy, her cervix continues to dilate, and it is determined that a preterm birth is inevitable. Which medication does the nurse expect the primary healthcare provider to prescribe? 1 Norgestrel 2 Aminophylline 3 Dexamethasone 4 Magnesium Sulfate
Dexamethasone is a glucocorticoid that stimulates the production of fetal lung surfactants, which are needed for fetal lung maturity; administration is started 48 hours before the expected birth. Norgestrel is a contraceptive hormone; it is not used for preterm labor. Aminophylline is a bronchodilator; it is not used for preterm labor. Magnesium sulfate is used for tocolytic therapy and has been somewhat effective in delaying preterm labor. However, this client's labor is progressing and the birth is inevitable.
Which tocolytic agent inhibits prostaglandin activity and is given along with sucralfate to help manage preterm labor? 1 Nifidipine 2 Indomethacin 3 Calcium gluconate 4 Magnesium sulfate
Indomethacin is a nonsteroidal antiinflammatory agent that may cause gastric irritation so sucralfate is administered along with this drug. Nifidipine is a calcium channel blocker used to manage preterm labor. Calcium gluconate is used to reverse magnesium sulfate toxicity. Magnesium sulfate is used to manage preterm labor and pregnancy-induced hypertension.
A pregnant woman at risk of preterm labor is diagnosed with hypertension. Which drug should be administered? 1 Terbutaline 2 Indomethacin 3 Calcium gluconate 4 Magnesium sulfate
Magnesium sulfate is administered to treat pregnancy-induced hypertension. Terbutaline is used to treat preterm labor, but does not reduce hypertension. Indomethacin inhibits prostaglandin activity and seizes uterine contractions. Calcium gluconate is given to reduce magnesium toxicity.
A client at 38 weeks' gestation is admitted for induction of labor. Her membranes ruptured 12 hours ago. There are no other signs of labor. Which medication does the nurse anticipate will be prescribed? 1 Oxytocin 2 Estrogen 3 Ergonovine 4 Progesterone
Oxytocin is a small-polypeptide hormone synthesized in the hypothalamus and secreted from the neurohypophysis (posterior pituitary gland) during parturition or suckling; it promotes powerful uterine contractions and is therefore used to induce labor. Estrogen suppresses follicle-stimulating and luteinizing hormones, thereby helping maintain a pregnancy. Ergonovine can induce sustained contractions, which is contraindicated during labor; it may be prescribed in the postpartum period to promote or maintain a contracted uterus. Progesterone causes hyperplasia of the endometrium in preparation for implantation of the fertilized ovum; later it helps maintain the pregnancy.
Which condition contraindicates the use of ginseng herbal therapy? 1 Pregnancy 2 Schizophrenia 3 Bipolar depression 4 Alzheimer disease
Pregnancy is contraindicated for ginseng herbal therapy. Schizophrenia, bipolar depression, and Alzheimer disease are contraindicated for St. John's Wort herbal therapy.
A pregnant woman continues consuming alcohol during pregnancy. Which teratogenic effects might be seen in the fetus or neonate? Select all that apply. 1 Stillbirth 2 Ebstein anomaly 3 Neural tube defects 4 Spontaneous abortion 5 Intellectual disabilities
Prolonged fetal exposure to alcohol may cause a stillbirth. A spontaneous abortion may occur if the pregnant woman consumes alcohol in excess amounts. Intellectual disabilities may be seen in the neonate if it is exposed to alcohol in the fetal stage. Ebstein anomaly is caused by lithium exposure during pregnancy. Neural tube defects may be due to exposure to antiseizure drugs during pregnancy.
A head nurse teaches a group of nursing students about the physiologic changes that may occur during pregnancy. What statement by a nursing student indicates effective teaching? 1 Hepatic metabolism decreases for antiseizure drugs. 2 Enterohepatic recirculation causes a decrease in drug reabsorption. 3 Bowel motility decreases, causing a decrease in intestinal transit time. 4 Renal blood flow is doubled during the third trimester, which increases the glomerular filtration rate.
Renal blood flow doubles during the last trimester and the glomerular filtration rate is increased. Therefore drugs that are eliminated through glomerular filtration need an increased dose. Hepatic metabolism is altered and increases for some antiseizure drugs. Drugs that undergo enterohepatic recirculation cause an increase in drug reabsorption. Bowel motility and tone decreases during pregnancy, which causes an increase in intestinal transit time. Therefore the drug absorption increases.
Which type of immune preparation, made from donated blood, contains antibodies that provide passive immunity? Toxoid Killed vaccine Live attenuated vaccine Specific Immune Globulin
Specific immune globulins contain a high concentration of antibodies directed at specific antigens. Toxoid vaccines contain a bacterial toxin that has been changed to a nontoxic form. Killed vaccines contain killed microbes or isolated microbes. Live attenuated vaccines are composed of live microbes that have been weakened or rendered completely avirulent.
A client with depression is to be given fluoxetine. What precaution will the nurse consider when initiating treatment with this drug? 1 It must be given with milk and crackers to prevent hyperacidity and discomfort. 2 Eating cheese or pickled herring or drinking wine may cause a hypertensive crisis. 3 The blood level may not be sufficient to cause noticeable improvement for 2 to 4 weeks. 4 The blood level should be checked weekly for 3 months to monitor for an appropriate level.
Fluoxetine does not produce an immediate effect; nursing measures must be continued to reduce the risk for suicide. Consuming milk and crackers to help prevent hyperacidity and discomfort is not necessary. Avoiding cheese, pickled herring, and wine is a precaution taken with the monoamine oxidase inhibitors. Weekly blood level checks are not necessary with fluoxetine.
A depressed client has been prescribed a tricyclic antidepressant. How long does the nurse inform the client that it usually takes before clients notices a significant change in the depression? 1 4 to 6 days 2 2 to 4 weeks 3 5 to 6 weeks 4 12 to 16 hours
It takes 2 to 4 weeks for the tricyclic antidepressant to reach a therapeutic blood level. Time spans of 4 to 6 days and 12 to 16 hours are both too short for a therapeutic blood level of the drug to be achieved. Improvement in depression should be demonstrated sooner than 5 to 6 weeks.
A client undergoing treatment for a medical condition gave birth to a baby with renal failure as a result of the teratogenic effect of the medications. Which medical condition is the client likely getting treated for? 1 Cancer 2 Epilepsy 3 Hypertension 4 Microbial infection
Angiotensin-converting enzyme inhibitors used for treating hypertension may cause renal failure as a teratogenic effect. Treatment of cancer may cause central nervous system malformations. Treatment of epilepsy may cause growth delay. Antimicrobials may cause heart defects.
Which drug may cause Ebstein anomaly as a teratogenic effect and is also contraindicated in breast-feeding clients? 1 Lithium 2 Ibuprofen 3 Vitamin A 4 Nitrofurantoin
Lithium may cause Ebstein anomaly as a teratogenic effect. This drug is also contraindicated in breast-feeding clients. Ibuprofen is a nonsteroidal antiinflammatory drug that may cause the premature closure of the ductus arteriosus as a teratogenic effect. This drug is safe for breast-feeding clients to use. Vitamin A may cause heart defects as a teratogenic effect. Nitrofurantoin may cause heart defects.
Which statement regarding a teratogenic drug is incorrect? 1 Teratogenic drugs cause characteristic malformation. 2 Teratogenic drugs act during all periods of gestation. 3 An increase in the dosage of teratogenic drugs increases the incidence of malformation. 4 An increase in the duration of exposure to teratogenic drugs increases the incidence of malformation.
A drug is considered a teratogen if it acts during the fourth to seventh week of pregnancy, which is referred to as a specific window of vulnerability. The occurrence of characteristic malformations may prove that a drug is a teratogen. An increase in the dosage and duration of exposure to teratogenic drugs may cause an increase in malformations.
Which statement about primary anxiolytic drugs requires correction? 1 Benzodiazepines are indicated for ethanol withdrawal. 2 Benzodiazepines increase the activity of gamma-aminobutyric acid. 3 Benzodiazepines are the first-line drugs used in chronic anxiety disorders. 4 Benzodiazepines act by depressing the activity in the region of the brainstem
Benzodiazepines act by decreasing the activity of gamma-aminobutyric acid, which is an inhibitory neurotransmitter. Apart from its indication in the treatment of depression, benzodiazepines are also prescribed for ethanol withdrawal, insomnia, and muscle spasms. Benzodiazepines are the first-line drug of choice in acute and chronic anxiety disorders. Benzodiazepines act by depressing activity in the areas of the brain called the brainstem and the limbic system.
teratogenic effect of thalidomide
shortened limbs and inernal organ defects
Which drugs are considered neuroleptics? Select all that apply. 1 Asenapine 2 Lurasidone 3 Aripiprazole 4 Thioridazine 5 Chlorpromazine
First-generation antipsychotic drugs are also known as neuroleptics. Thioridazine and chlorpromazine are neuroleptics. Asenapine, lurasidone, and aripiprazole are second-generation drugs, which are considered as atypical antipsychotic drugs.
A client wants to abort her pregnancy after 4 months of gestation. Which oral medication would be given to the client? 1 Oxytocin 2 Misoprostol 3 Indomethacin 4 Dinoprostone
Misoprostol is an oral drug used to induce an abortion. Oxytocin is available as an injection; it is used to induce labor at or near full-term gestation. Indomethacin is used to maintain a pregnancy during preterm labor. Dinoprostone is used to induce an abortion; it is available only for vaginal use.
What is an important nursing intervention when a client is receiving intravenous (IV) magnesium sulfate for preeclampsia? 1 Limiting IV fluid intake 2 Preparing for a possible precipitous birth 3 Maintaining a quiet, darkened environment 4 Obtaining magnesium gluconate as an antagonist
A quiet, darkened room reduces stimuli, which is essential for limiting or preventing seizures. IV infusions are not limited. Infusions are monitored closely and usually maintained at a volume of 125 mL/hr. Precipitous birth is not a usual side effect of magnesium therapy. Calcium gluconate, not magnesium gluconate, is the antagonist for magnesium sulfate and should be kept on hand in case signs of toxicity appear.
A 19-year-old adolescent is admitted to the emergency department with multiple fractures and potential internal injuries. The client's history reveals multiple drug abuse for the past 8 months. When caring for this client, the nurse determines that the most serious life-threatening responses usually result from withdrawal from which drug? 1 Heroin 2 Methadone 3 Barbiturates
Withdrawal from central nervous system depressants, such as barbiturates, is associated with more severe morbidity and mortality. Symptoms begin with anxiety, shakiness, and insomnia; within 24 hours convulsions, delirium, tachycardia, and death may occur. Withdrawal from heroin or methadone is rarely life threatening, but it does cause severe discomfort, including abdominal cramping and diarrhea. Withdrawal from amphetamines is rarely life threatening, but it causes severe exhaustion and depression.
The nurse cares for a client with schizophrenia and who is receiving ziprasidone. Which conditions in the client may indicate discontinuation of the drug? Select all that apply. 1 Leukopenia 2 Tachycardia 3 Hypokalemia 4 Hypermagnesemia 5 Prolonged QT interval
Ziprasidone is a second generation antipsychotic drug indicated for schizophrenia. The drug may cause leukopenia, hypokalemia, and hypomagnesemia. This drug may cause a prolonged QT interval, which indicates torsades de points. Bradycardia may occur in torsades de pointes, but not tachycardia.
valproic acid
seizures causes neural tube defects
Diethylstilbestrol
treatment of menopausal and postmenopausal disorders vaginal cancer in fetus
A client has recently started taking a new neuroleptic drug, and the nurse notes extrapyramidal effects. Which drug does the nurse anticipate will be prescribed to limit these side effects? 1 Zolpidem 2 Hydroxyzine 3 Dantrolene 4 Benztropine mesylate
Benztropine, an anticholinergic, helps balance neurotransmitter activity in the central nervous system (CNS) and helps control extrapyramidal tract symptoms. Zolpidem is a sedative-hypnotic drug used for short-term insomnia. Hydroxyzine is a sedative that depresses activity in the subcortical areas in the CNS; it is used to reduce anxiety. Dantrolene, a muscle relaxant, has a direct effect on skeletal muscle by acting on the excitation-contraction coupling of muscle fibers and not at the level of the CNS, unlike most other muscle relaxation drugs.
Which food should be avoided by a client who is prescribed monoamine oxidase inhibitors (MAOIs)? 1 Bologna 2 Potatoes 3 Citrus fruit 4 Grapefruit juice
Bologna has a high tyramine content; tyramine should not be consumed by clients taking monoamine oxidase inhibitors (MAOIs) because the drug interaction may cause severe hypertension. Potatoes and citrus fruits do not contain tyramine. Grapefruit juice may cause a negative drug interaction in clients taking buspirone.
A client with schizophrenia is started on a regimen of chlorpromazine. After 10 days a shuffling gait, tremors, and some rigidity are apparent. Benztropine mesylate 2 mg by mouth daily is prescribed. What does the nurse remember when administering these medications together? 1 Both medications are cholinesterase inhibitors. 2 Both medications have a cholinergic-blocking action. 3 The antipsychotic effects of chlorpromazine will be decreased. 4 The synergistic effect of these medications will cause drooling.
Both medications block central acetylcholine receptors. Neither medication inhibits cholinesterase; neostigmine (Prostigmin) acts in this manner. Although benztropine mesylate can cause mental confusion when given in large doses, it does not reduce the antipsychotic effect of chlorpromazine. Both medications cause dry mouth.
Which adverse effect is least likely to occur in a client who is prescribed clozapine? Seizures Sedation Akathisia Myocarditis
Clozapine is a second-generation antipsychotic drug. Myocarditis is a very rare side effect caused by clozapine. Seizures, sedation, and akathisia are common side effects of clozapine.
A nurse administers the prescribed intravenous dose of magnesium sulfate to a client with severe preeclampsia. What adverse effect should the nurse address when evaluating the client's response to the medication? 1 Blurred vision 2 Epigastric pain 3 Fetal tachycardia 4 Respiratory depression
Respiratory depression is a late indicator of toxicity; if the respiratory rate decreases below 12 breaths/min, the infusion should be discontinued. Blurred vision and epigastric pain are both associated with worsening of preeclampsia, which could lead to a seizure; neither is a toxic effect of the magnesium sulfate. The fetal heart rate is not affected by the infusion of magnesium sulfate.
Which drug taken by a pregnant woman shows a delayed teratogenic effect in the offspring, making the effect difficult to identify? 1 Aspirin 2 Heparin 3 Ethyl alcohol 4 Diethylstilbestrol
Diethylstilbestrol may cause vaginal cancer in a female child 18 or more years after birth. Aspirin suppresses contractions during labor and may cause bleeding in the mother. Heparin does not cause fetal harm but may cause osteoporosis in the mother. Ethyl alcohol causes drug dependence or alcohol withdrawal syndrome in neonates.
What does exposure of fetus to lithium do?
Ebstein anomaly (is a rare heart defect in which the tricuspid valve — the valve between the upper right chamber (right atrium) and the lower right chamber (right ventricle) of the heart — isn't formed properly. As a result, blood leaks back through the valve and into the right atrium)
A lactating woman has developed thromboembolism. Which drug should be prescribed if she wishes to continue breast-feeding? 1 Aspirin 2 Heparin 3 Dicumarol
Heparin is the drug of choice to treat thromboembolism in a lactating woman because it is not absorbed in the breast milk. Aspirin may cause severe bleeding so is not preferred. Dicumarol may cause a hemorrhage and therefore is not preferred. Phenindione may cause a bruising effect and therefore is not the drug of choice.
A pregnant woman was exposed to a teratogenic drug during her first trimester. Which nursing interventions would be beneficial to the client? Select all that apply. 1 Ultrasound scanning should be avoided. 2 The woman should be referred for evaluation. 3 The woman's pregnancy should be terminated even if minor malformations are found. 4 The woman should be educated about the risks of drug-induced malformations. 5 The woman should be assured that the risk is minimal if the malformation is minor.
If a pregnant woman is exposed to a teratogenic drug, further evaluation is needed to determine the type of malformation that can be expected. The woman should be educated about the effects of drugs on the fetus so she can avoid being exposed to drugs with teratogenic effects. If the malformations are minor, the woman should be assured the risk is minimal and can be corrected by surgery. Ultrasound scanning should be done to assess the extent of the injury. The pregnancy should be terminated only if the malformation is severe.
A primary healthcare provider prescribes an intravenous infusion of magnesium sulfate for a client with preeclampsia. What baseline assessment is essential before the nurse initiates the infusion? 1 Serum glucose 2 Respiratory rate 3 Body temperature 4 Level of consciousness
Magnesium sulfate toxicity depresses respiration; therefore it is essential to obtain a baseline respiratory rate before initiating therapy. The serum glucose level is unrelated to magnesium sulfate toxicity. Deviations in temperature do not indicate magnesium sulfate toxicity. A decreased level of consciousness may indicate worsening preeclampsia, not magnesium sulfate toxicity.
A lactating woman takes fluoxetine to treat depression. Her newborn developed tremors, seizures, and fever. Which drug-induced physiologic alterations may be responsible for the central nervous system effects of the drug on the neonate? 1 Increase in fat content 2 Increase in protein binding 3 Immature blood-brain barrier 4 Delayed first stooling
Many drugs are able to enter the neonate's brain due to the immature blood-brain barrier causing central nervous system effects. Neonates have a low fat content. Protein binding is decreased in neonates because the liver is immature and produces fewer proteins. First pass elimination is decreased in neonates due to the liver's immaturity.
Which medication is the first choice drug for the treatment of attention deficit hyperactivity disorder (ADHD)? 1 Clonidine 2 Guanfacine 3 Atomoxetine 4 Methylphenidate
Methylphenidate is the first choice drug for the treatment of attention deficit hyperactivity disorder (ADHD). Clonidine, guanfacine, and atomoxetine are nonstimulants used to treat ADHD; these medications are less effective than methylphenidate.
After assessing a client, the nurse suspects that the client has shift-work sleep disorder (SWSD). Which medication would be prescribed to the client? 1 Caffeine 2 Modafinil 3 Atomoxetine 4 Methylphenidate
Modafinil is a unique nonamphetamine stimulant used to treat shift-work sleep disorder (SWSD). This drug promotes wakefulness in clients suffering from excessive sleepiness associated with SWSD. Caffeine is a central nervous stimulant used to promote wakefulness, but this drug is not as effective in the treatment of SWSD. Atomoxetine is a nonstimulant used to treat attention deficit hyperactivity disorder (ADHD). Methylphenidate is considered the first choice drug for the treatment of attention deficit hyperactivity disorder (ADHD).
Which toxic effect would the nurse find in a client who has overdosed on isocarboxazid? 1 Mydriasis 2 Bradycardia 3 Hypothermia 4 Circulatory Collapse
The clinical symptoms of monoamine oxidase inhibitors (MAOIs) generally appears after 12 hours of ingestion. Circulatory collapse is associated with MAOI toxicity. Mydriasis, bradycardia, and hyperthermia are not associated with an isocarboxazid overdose.
Which drug impairs fertility when administered along with fertility drugs? 1 Clomiphene 2 Menotropins 3 Promethazine 4 Choriogonadotropin alfa
When taken with fertility drugs, promethazine increases prolactin concentration, which may impair fertility. Clomiphene and menotropins are ovulation stimulants given to induce ovulation in infertile women. Choriogonadotropin alfa is a recombinant form of human gonadotropin hormone; this drug is an ovulation stimulant.
A child with acute lymphoid leukemia is started on a chemotherapy protocol that includes prednisone. What side effect of this medication does the nurse anticipate? Alopecia Anorexia Weight loss Mood changes
Mood swings may result from steroid therapy. Alopecia does not result from steroid therapy. An increased appetite, not anorexia, results from steroid therapy. Weight gain, not weight loss, results from steroid therapy.
Which atypical antipsychotics are approved for long-term use to prevent the recurrence of mood episodes in clients with bipolar disease? Select all that apply. 1 Olanzapine 2 Quetiapine 3 Ziprasidone 4 Risperidone 5 Aripiprazole
Olanzapine, ziprasidone, and aripiprazole are atypical antipsychotics approved for long-term use to prevent recurrence of mood episodes. Quetiapine and risperidone are atypical antipsychotics approved for use in bipolar disease but are not approved for long-term use to prevent the recurrence of mood episodes.
A 5-year-old child is being given dactinomycin and doxorubicin therapy after nephrectomy for Wilms tumor. What will the nursing care include? Administering aspirin for pain Offering citrus juices with meals Ensuring meticulous oral hygiene Eliminating spicy foods from the diet
Oral hygiene is essential, especially during the administration of medications that have a negative effect on the oral mucosa. Although pain may be present, aspirin is avoided because doxorubicin is also being used, and a side effect of this medication is thrombocytopenia. Aspirin is contraindicated for children because it is associated with Reye syndrome. Citrus juice will aggravate stomatitis, which is a common side effect of dactinomycin. Spicy foods may aggravate the stomatitis that occurs with chemotherapy. However, usually any food that the child requests is permitted.
Which class of medications is used to reduce tremors caused by lithium therapy? 1 Diuretics 2 Beta blockers 3 Anticholinergics 4 Nonsteroidal antiinflammatory drugs
Lithium can cause fine hand tremors that can interfere with motor skills. Tremors can be reduced by using a beta blocker, such as propranolol. Diuretics lead to accumulation of lithium levels by promoting the loss of sodium. Because they cause urinary hesitancy, drugs with anticholinergic actions may intensify discomfort associated with lithium-induced dieresis. Some nonsteroidal antiinflammatory drugs can increase the renal reabsorption of lithium, thereby causing lithium levels to rise.
A nurse is caring for a pregnant woman in active labor who is lying in bed in the high Fowler position. Epidural anesthesia and an oxytocin infusion were started 45 minutes ago. The client complains of feeling lightheaded and nauseated. What should the nurse do first after reviewing the client's admission data, vital signs, and current status? 1 Interrupt the oxytocin infusion for 5 minutes. 2 Give the client oxygen via a facemask at 15 L/min. 3 Place the client in a 15-degree side-lying position. 4 Notify the primary healthcare provider that the fetus is experiencing distress.
The client's blood pressure has decreased, causing supine hypotension. The side-lying position promotes placental perfusion. The contractions and fetal heart rates are within the expected range. Interrupting the oxytocin infusion is counterproductive and will prolong labor. If the client continues to feel lightheaded after the position change, oxygen administration is the next nursing action. The fetal heart rates are within the expected range. Episodic accelerations occur during fetal movement and are indications of fetal well-being. Early decelerations occur in response to fetal head compression and are a benign finding.
