Pharm - Archer Review (2/4) - Cardiovascular, Hematological/Oncolgical, Blood and Blood Products, Infectious Disease, Immune

blood pressure waist size body mass index (BMI) dietary habits darkening patches in the skin folds stress

Select the client findings that require follow-up. Select all that apply. respiratory rate blood pressure pulse waist size body mass index (BMI) dietary habits darkening patches in the skin folds alcohol consumption stress

Choice A is correct. Codeine phosphate is an analgesic medication with no aspirin components and is used for moderate to severe pain.

A 16-year-old adolescent client is brought to the emergency department following an injury at a skating rink. The client's left knee is bruised and swollen. Upon interview, the nurse finds out that the client has hemophilia A. Which medication would be most appropriate for this client? A. Codeine phosphate B. Aspirin C. Ibuprofen D. Oxycodone terephthalate and acetyl-salicylate

Choice C is correct. Pain and increasing edema at an infusion site are indicative of extravasation (i.e., the leakage of a vesicant intravenous solution or medication into the subcutaneous tissue). Here, it is essential to note that the infusing medication is a vesicant. Vesicants are medications that cause severe damage to surrounding tissue if they escape into subcutaneous tissue. Specifically, extravasation results in severe tissue integrity impairment as manifested by blistering, tissue sloughing, or necrosis from vesicant infiltration into the surrounding tissues (although some of the symptoms may not appear for a few days). If extravasation occurs, the initial action should be to stop the infusion and disconnect the administration set.

A nurse caring for an oncology client notes the client is receiving a vesicant chemotherapy medication via intravenous (IV) infusion. Which assessment finding would warrant immediate action by the nurse? A. An inflamed and sore mouth B. Nausea and vomiting C. Pain and increasing edema at the infusion site D. Abdominal pain

Choices A and E are correct. The client's digitalis level of 2.5 ng/mL indicates toxicity.Digoxin has a narrow therapeutic index, which can cause significant side effects, such as cardiac arrhythmias (e.g., bradycardia, heart block, ventricular arrhythmias), even at plasma concentrations only twice the therapeutic plasma concentration range. Normal corrective serum digoxin levels range from 0.5-2 ng/mL. A level higher than 2 ng/mL is considered toxic. The nurse is correct in withholding the scheduled dose and assessing the client's heart rate and rhythm, as the client is likely to be experiencing bradycardia.

A nurse is caring for a client receiving digoxin. The client's most recent digitalis level was 2.5 ng/mL (0.5-2 ng/mL). The nurse should take which action? Select all that apply. Withhold the client's scheduled dose Administer the dose, as prescribed Assess the client's 24-hour urinary output Assess the client's most recent sodium level Assess the client's heart rate and rhythm Obtain a prescription for an echocardiogram

Choice D is correct. Nitroglycerin is used in the treatment of angina, pulmonary edema, and hypertensive emergencies. Nitroglycerin decreases both preload and afterload, which may result in hypotension. Thus the client's blood pressure needs to be monitored closely.

A nurse is caring for a client receiving nitroglycerin. It is essential to monitor the client's A. Temperature B. Respirations C. Urinary output D. Blood pressure

Choice B is correct. Isosorbide is a nitrate medication and should not be taken concurrently with phosphodiesterase inhibitors such as sildenafil. The combination of the two may result in profound hypotension.

A nurse is caring for a client taking sildenafil. While reviewing the client's other medications, which medication requires follow-up? A. Furosemide B. Isosorbide C. Atorvastatin D. Losartan

Choices A and E are correct. These two statements indicate that the student nurse needs further teaching on blood transfusions. Crackles in the lung fields suggest a transfusion-associated circulatory overload (TACO). Physicians may prescribe pre-medication with diphenhydramine and acetaminophen only if the client has a history of febrile or allergic reactions to prior blood transfusions. Pre-medications are, therefore, not always required.

A nurse is educating a student nurse about blood transfusions. Which of the following statements by the student nurse indicates the need for additional teaching? Select all that apply. - "If a client should develop crackles in their lung fields, it is a sign of a hemolytic reaction." - "Transfusion-related graft versus host disease most commonly occurs in immuno-suppressed individuals." - "Transfusion-associated circulatory overload (TACO) is more common in clients with renal failure." - "It is important to ask the client about history of previous blood transfusions." - "Pre-medication with diphenhydramine and acetaminophen is always needed before transfusion."

Choice A is correct. HCTZ, like other thiazide diuretics, can increase the skin's sensitivity to sunlight, leading to exaggerated sunburn reactions. The client should be instructed to wear appropriate sunscreen and arrange to complete outdoor activities in the early morning or later evening hours.

A nurse is teaching a client about newly prescribed hydrochlorothiazide. Which of the following statements, if made by the client, indicates an effective understanding of the potential side effects? A. "I should be cautious about prolonged sun exposure as HCTZ can increase photosensitivity." B. "I may experience drowsiness and sedation due to the central nervous system depressant effect of HCTZ." C. "HCTZ can cause hypocalcemia, so I need to increase my intake of foods high in calcium." D. "I might develop taste disturbances or loss of appetite as a common side effect of HCTZ."

Choice C is correct. Grapefruit can interfere with other drugs, as well, including statins (atorvastatin, lovastatin, simvastatin), some antibiotics, and some cancer drugs. Grapefruit and its juice contain furanocoumarins, which block the enzymes that are involved in metabolizing many drugs, including calcium channel blockers. Medication blood levels can increase, resulting in toxicity. The levels of calcium channel blockers are increased when grapefruit or grapefruit juice is consumed, potentially causing hypotension.

A patient is prescribed a calcium channel blocker to treat primary hypertension. When teaching the patient about the medication, which of these foods will the healthcare provider advise the patient to avoid? A. Eggs B. Milk C. Grapefruit D. Bananas

metabolic syndrome

Based on the clinical data, this client is at the highest risk of developing ____

Choice A is correct. Vomiting (emesis) is initiated by a nucleus of cells located in the medulla called the vomiting center. This center coordinates a complex series of events involving pharyngeal, gastrointestinal, and abdominal wall contractions that lead to the expulsion of gastric contents.

Chemotherapy induces vomiting by: A. Stimulating neuroreceptors in the medulla. B. Inhibiting the release of catecholamines. C. Autonomic instability. D. Irritating the gastric mucosa.

Choice D is correct. FFP would be prescribed because this client is experiencing bleeding related to the prescribed warfarin. The client's INR is grossly elevated (therapeutic for VTE prophylaxis is 2-3), and FFP includes the Vitamin K-dependent clotting factors (factors II, VII, IX, X, proteins C, and S) that need to be replaced to stop the bleeding. Vitamin K may be prescribed, but the efficacy takes six to eight hours. FFP can treat the bleeding almost immediately.

The emergency department (ED) nurse cares for a client receiving prescribed warfarin and reports dizziness, black tarry stools, and bloody gums. The international normalized ratio (INR) returns at 5 (0.9-1.2 seconds). The nurse anticipates the primary healthcare provider (PHCP) will prescribe which blood product? A. Packed red blood cells (PRBCs) B. Platelets C. Granulocytes D. Fresh frozen plasma (FFP)

Choice A is correct. The client is experiencing intraabdominal bleeding with manifestations confirming shock. The client will need to have the blood volume replaced with emergent surgery. Type-specific PRBCs would be preferred; however, if the client is critical, O-negative blood may be transfused.

The emergency department (ED) nurse cares for a client with severe intrabdominal bleeding. The client has tachycardia, hypotension, and a thready pulse. The nurse anticipates the primary healthcare provider (PHCP) will prescribe which blood product? A. Packed red blood cells (PRBCs) B. Platelets C. Granulocytes D. Fresh frozen plasma (FFP)

Choice A is correct. For a client with a suspected ruptured (or rupturing) abdominal aortic aneurysm, tight blood pressure control is essential. Having tight blood pressure control decreases the pressure on the aneurysm. Esmolol is a beta-blocker and will exert antihypertensive effects. For a client with an unstable abdominal aortic aneurysm, the nurse should provide close monitoring of their vital signs and adequate pain control.

The emergency department nurse is caring for a client with an abdominal aortic aneurysm at risk of rupturing. The nurse will anticipate the primary healthcare provider (PHCP) to prescribe A. esmolol. B. dexamethasone. C. heparin. D. pantoprazole.

Choice A is correct. This statement requires follow-up because the INR should be between 2.0 and 3.0 before the heparin infusion is discontinued. An INR of 4.0 is concerning because this value is too high.

The newly hired nurse cares for a client with venous thromboembolism (VTE) prescribed a heparin infusion and warfarin. Which statement, if made by the newly hired nurse, requires follow-up? A. "The infusion should be discontinued once the INR is 4.0." B. "Protamine sulfate should be available if the aPTT gets too high." C. "Hypotension and tachycardia may suggest an internal hemorrhage." D. "Both medications increase the client's risk of bleeding."

Choice A is correct. Angioedema is a life-threatening adverse effect that is seen with ACE inhibitors such as enalapril. Angioedema may cause swelling anywhere in the body, but swelling in the face, lips, and eyes can be serious. The client should notify the prescriber immediately. Angioedema may also cause airway obstruction due to swelling of the soft tissues of the upper airway. If the client has trouble breathing, then they should call 911.

The nurse has provided medication instruction to a client who has been prescribed enalapril. Which of the following statements, if made by the client, would indicate a correct understanding of the teaching? A. "I will notify my prescriber if I develop swelling of the face." B. "I will need to weigh myself every day while taking this medication." C. "I should eat foods high in potassium while I am taking this medication." D. "I will need lab work done every so often to evaluate my liver function."

Choice B is correct. Rivaroxaban is a factor Xa inhibitor and is commonly prescribed for the prevention and treatment of venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE). An advantage of rivaroxaban is that no therapeutic monitoring is required, unlike warfarin.

The nurse has received a prescription for rivaroxaban. The nurse understands that this medication is prescribed to treat which condition? A. Pulmonary Hypertension B. Venous Thromboembolism (VTE) C. Congestive Heart Failure D. Hyperlipidemia

Choice B is correct. Tenofovir and emtricitabine are antiretrovirals indicated in the prevention and treatment of HIV infection. This combination of medication aims to decrease the viral load (VL) and increase the CD4/CD8 count.

The nurse has received a prescription for tenofovir and emtricitabine. The nurse understands that this medication is used to treat A. multiple sclerosis. B. human immunodeficiency virus (HIV). C. Parkinson's disease. D. Guillain-Barré syndrome.

Choices A, D, and E are correct. Clients prescribed diuretics (such as furosemide) are at risk for fluid volume deficit. Tachycardia would be a finding consistent with a fluid volume deficit that the nurse should indeed monitor. If the client is tachypneic, the heart is beating faster to increase the cardiac output in a low volume setting - hence, the fluid volume deficit. Decreased urine output would be a finding consistent with a fluid volume deficit. If the client is experiencing a fluid volume deficit, they have a decreased circulating blood volume. This leads to a decreased renal blood flow, causing a reduced urine output. Tenting of the skin can occur due to a lack of fluid in the tissues and is a sign of fluid volume deficit.

The nurse is administering prescribed furosemide to a client. Which of the following clinical manifestations would be consistent with the client developing fluid volume deficit? Select all that apply. tachycardia bradypnea weight gain decreased urine output tenting of the skin

Choice D is correct. Leg pain and muscle aches occur after taking atorvastatin, which may indicate a severe muscular myopathy known as rhabdomyolysis. The nurse would be most accurate to have this patient discontinue their medication and come to the clinic as soon as possible.

The nurse is answering phones in the general practice clinic and receives a call from a patient who is experiencing leg pain after starting atorvastatin. Which of the following instructions, when given by the nurse, is the best course of action? A. Continue taking the medication as this is an expected side effect. B. Discontinue the medication and schedule an appointment for the next week. C. Stretch for 20 minutes or take a warm shower. D. Discontinue the medication and visit the clinic as soon as possible.

Choice B is correct. ABO compatibility with platelets is not required. The nurse can continue with the assessment or document the findings because the assessment findings do not require intervention.

The nurse is assessing a client who is receiving a transfusion of platelets. The client's blood type is A-negative, and the client is receiving O-positive platelets. Which of the following actions should the nurse take? A. Assess the client for fluid volume deficit B. Document the assessment findings C. Stop the transfusion D. Notify the primary health care provider

Choice B is correct. Low-dose beta-blockers (along with ACE inhibitors) are the mainstay treatment in managing heart failure. Carvedilol is a popular drug because it decreases the sympathetic response in heart failure, including tachycardia. While this is a standard compensatory mechanism, it may have deleterious effects by remodeling the heart and causing a vascular strain. An increased left-ventricular ejection fraction (EF) would be a desired response because it increases the amount of blood being ejected per beat. The normal EF is 55% or greater. Systolic heart failure is diagnosed at an EF of 40% or less. For example, if a client has an EF of 30% and 100 mL of blood is in the left ventricle, only 30 mL is being ejected into the systemic circulation.

The nurse is assessing a client with systolic heart failure receiving prescribed carvedilol. Which of the following findings would indicate a therapeutic response? A. Increased urinary output B. Increased left-ventricular ejection fraction (EF) C. Increased left-ventricular remodeling D. Increased brain natriuretic peptide (BNP)

Choice B is correct. A significant precipitator of digoxin toxicity is hypokalemia. Recommending that the client have adequate intake of food rich in potassium is appropriate. Baked potatoes, avocados, bananas, and raisins are all food choices that contain a significant amount of potassium.

The nurse is assisting in discharging a client who was treated for digoxin toxicity. While reinforcing teaching on ways to prevent future toxicity, the nurse should recommend the client have an adequate dietary intake of which electrolyte? A. chloride B. potassium C. phosphorus D. sodium

Choice B is correct. Pernicious anemia is characterized by the inability of the body to utilize Vitamin B12. This results in a decrease in hemoglobin, giving the client anemia. The nurse should anticipate a prescription for Vitamin B12, which may be administered parenterally for the greatest benefit.

The nurse is caring for a client diagnosed with pernicious anemia. The nurse should anticipate a prescription for which medication? A. Thiamine B. Cyanocobalamin C. Iron dextran D. Folic acid

Choice B is correct. Valacyclovir is an antiviral and is effective in the management (and prevention) of outbreaks associated with herpes simplex virus (HSV). It is highly recommended that the client start valacyclovir at the earliest sign of an outbreak which is the prodromal symptoms of headache, fever, malaise, itching, and burning in the affected area. A client will either take this during an outbreak or daily to prevent an outbreak (suppressive therapy).

The nurse is caring for a client with herpes simplex virus who is experiencing an outbreak. Which medication does the nurse anticipate that the primary healthcare provider (PHCP) will prescribe? A. metronidazole B. valacyclovir C. imiquimod D. fluconazole

Choice A is correct. The antidote for digoxin toxicity is the administration of digoxin immune fab. This drug binds to digoxin, preventing it from reaching the tissues. The onset of action is rapid: less than 1 minute after the IV infusion is begun. Cardiac glycosides cause potentially dangerous adverse effects at high doses and in individual clients. The margin of safety between a beneficial dose and a toxic dose is tiny. Therefore, therapy should be closely monitored. Serum digoxin levels above 2.2 ng/mL are considered toxic. Initial side effects are GI-related, including appetite loss, vomiting, and diarrhea. Headache, drowsiness, confusion, and blurred vision may also occur.

The nurse is caring for a client experiencing digitalis toxicity. The nurse anticipates a prescription for which medication? A. digoxin immune fab B. milrinone C. amrinone D. flecainide

Choice B is correct. Polyarthritis is characterized by swollen, painful, hot joints that are commonly seen in rheumatic fever. Other manifestations associated with rheumatic fever include chest pain, fever, muffled heart sounds, pericardial friction rub, chorea, muscle weakness, and emotional lability. Treatment for painful polyarthritis is an NSAID or a steroid. Naproxen is commonly used because of its easy dosing schedule.

The nurse is caring for a client experiencing polyarthritis associated with rheumatic fever. The nurse anticipates a prescription for which medication? A. Prazosin B. Naproxen C. Verapamil D. Furosemide

Choice B is correct. Zidovudine (ZDV) is an antiretroviral medication that may be administered intrapartum to further reduce vertical transmission of HIV. This medication is commonly indicated for women who have a scheduled cesarean delivery or, in the rare instance of a vaginal delivery. This medication is preferred because it may be administered intravenously and can provide pre-exposure prophylaxis to the fetus. Whether this medication is prescribed and administered intrapartum depends on the mother's viral load. The lower the viral load, the less likely of transmission to the fetus.

The nurse is caring for a client in labor who is positive for the human immunodeficiency virus (HIV). The nurse should obtain a prescription for which medication? A. valacyclovir B. zidovudine C. amphotericin b D. metronidazole

Choice B is correct. Tenofovir-emtricitabine is a medication used as pre-exposure prophylaxis (PrEP) for clients at high risk for HIV infection. This medication is taken daily and may provide up to 96% efficacy against HIV infections.

The nurse is caring for a client interested in pre-exposure prophylaxis for human immunodeficiency virus (HIV). Which prescription would the nurse anticipate? A. Voriconazole B. Tenofovir-emtricitabine C. Raloxifene D. Lurasidone

Choices A and B are correct. Heart failure management includes medications such as diuretics, ACE inhibitors, and low-dose beta-blockers. Furosemide (loop diuretic), along with lisinopril (ACE inhibitor), would be an appropriate choice.

The nurse is caring for a client newly diagnosed with heart failure. Which of the following medications would the nurse anticipate to be prescribed? Select all that apply. Furosemide Lisinopril Diltiazem Naproxen Prednisone

Choices A, B, and C are correct. Amphotericin B is a potent antifungal medication. This medication is commonly prescribed for cryptococcal meningitis or histoplasmosis. The infusion can make the client feel quite ill, and preventative treatments such as acetaminophen, 0.9% saline bolus, and diphenhydramine are often used. Symptoms the client experiences during the infusion include nausea, rigors, fever, and chills. Thus, premedication is necessary. Amphotericin B is nephrotoxic, and the client should increase their fluid intake.

The nurse is caring for a client prescribed amphotericin b for a systemic fungal infection. The nurse should anticipate a prescription for which medication before the infusion? Select all that apply. Diphenhydramine Acetaminophen 0.9% saline bolus Regular insulin Sodium bicarbonate

Choices A and B are correct. A client receiving a heparin infusion will need their aPTT and platelet count monitored closely. Heparin prolongs the aPTT (the goal is 1½ to 2½ times the control value) and should be observed frequently. Platelet counts that decrease by approximately 50% may indicate heparin-induced thrombocytopenia, which should be reported. The normal aPTT is 30-40 seconds.

The nurse is caring for a client receiving a continuous heparin infusion. Which of the following laboratory data should the nurse monitor? Select all that apply. Activated Partial thromboplastin time (aPTT) Platelet count Prothrombin time (PT) Neutrophil count International normalized ratio (INR)

Choice B is Correct. The heparin infusion should be stopped because the aPTT is too prolonged. The goal for a client receiving a continuous infusion of heparin is to prolong the control (baseline) aPTT 1.5 to 2.5 times. The normal aPTT is 30-40 seconds. Heparin has a short half-life, so even if the heparin infusion were paused for thirty minutes, this would lower the aPTT. The nurse should refer to the PHCP's order to determine the next course of action after the infusion is paused/stopped.

The nurse is caring for a client receiving a continuous infusion of heparin and warfarin. Based on the client's laboratory data, the nurse should take which action? See the image below. A. Document the findings B. Stop the heparin infusion C. Hold future doses of the warfarin D. Obtain a prescription of Vitamin K

Choices A and E are correct. Discontinuing the heparin infusion is essential because this is a life-threatening complication. Heparin-induced thrombocytopenia (HIT) is a hypercoagulable condition and promotes clotting. Continuing heparin in a client with HIT and acute pulmonary embolism may cause an extension of thrombus and even death. The physician must be notified; however, the heparin infusion must be held while awaiting the physician's orders.

The nurse is caring for a client receiving a continuous infusion of heparin for a pulmonary embolism. The nurse reviews the client's laboratory data and should take which action? See the image below. Select all that apply. Discontinue the heparin infusion Obtain an immediate activated partial thromboplastin time (aPTT) Assess the client's intravenous site for bleeding Prepare to administer a unit of packed red blood cells Notify the primary healthcare provider (PHCP)

Choices A, B, and D are correct. The vital signs show hypotension (90/60 mm Hg). The nurse should clarify the prescriptions of atenolol, spironolactone, and fentanyl. All these medications decrease blood pressure, and considering how low the client's blood pressure is, it would be highly detrimental.

The nurse is caring for a client with the following clinical data. Based on the vital signs, which medications would the nurse clarify with the primary healthcare provider (PHCP) prior to administration? See the exhibit. Select all that apply. View Exhibit Atenolol 50 mg PO Daily Spironolactone 50 mg PO Daily Albuterol 2.5 mg via nebulizer Daily Fentanyl 50 mcg IV Push q 6 hours PRN Pain Modafinil 100 mg PO Daily

Choices A, C, D, and E are correct. An infusion of norepinephrine is indicated if the client is in shock. This medication helps restore vascular tone and is useful in treating life-threatening hypotension. This medication is a vesicant, and the preferred delivery is through a central line. If this is not possible, a large-bore intravenous catheter should be utilized. The patency of this catheter should be assessed frequently to prevent damaging extravasation. Blood pressure must be monitored continuously while this medication is administered to assess the desired response of increased vascular tone. This medication causes vasoconstriction, decreasing renal blood flow and decreasing urine output. Norepinephrine causes an increase in blood glucose because of its ability to cause the liver to discharge more glucose by breaking down glycogen.

The nurse is caring for a client receiving a continuous infusion of norepinephrine. The nurse should plan to monitor which of the following for the client? Select all that apply. Blood pressure Intracranial pressure Intravenous site Urine output Blood glucose

Choice A is correct. The ABO type of the donor should be compatible with the recipient. Type "A" can receive blood from type "A" or "O" as type "O" blood does not contain any antigens against type "A" or "B" blood. The blood can be administered once proper cross-matching is done.

The nurse is caring for a client requiring an emergent transfusion of packed red blood cells. The nurse checks the blood bank, but the only available blood is O + (positive). The client's blood type is A+ (positive). What is the nurse's most appropriate action? A. Arrange for a cross-match between the available blood and the client's blood. B. Call the other blood banks and ask if they have blood units available with the client's blood type. C. Notify the physician that there is no available blood in the blood bank. D. Call the client's family and tell them that he needs blood.

Choice A is correct. 325 mg of chewable aspirin should be prescribed to a client with acute myocardial infarction (AMI). This medication exerts antiplatelet effects and is the standard of care for an AMI.

The nurse is caring for a client who has an acute myocardial infarction (AMI). The nurse should anticipate an immediate prescription for which of the following? A. Aspirin B. Warfarin C. Propranolol D. Amiodarone

Choice B is correct. Oseltamivir is an antiviral agent approved for the treatment of influenza. This medication should be initiated within 48 hours of symptom onset.

The nurse is caring for a client who has influenza. Which of the following prescriptions may be prescribed by the primary healthcare provider (PHCP)? A. Valacyclovir B. Oseltamivir C. Azithromycin D. Omeprazole

Choice A is correct. Enoxaparin is a low molecular weight-based heparin (LMWH) indicated for VTE prophylaxis following surgery. This medication is given subcutaneously, usually via a prefilled syringe.

The nurse is caring for a client who is postoperative and at risk for venous thromboembolism (VTE). Which of the following medications would prevent this complication? A. Enoxaparin B. Verapamil C. Tranexamic acid D. Aspirin

Choice A is correct. Enoxaparin is a low molecular weight-based heparin (LMWH). One of the adverse events of enoxaparin is heparin-induced thrombocytopenia (HIT). This severe condition results in a 50% or more decrease in the platelet count while also causing thrombosis. Therefore, it is reasonable to monitor the platelet count after initiating enoxaparin.

The nurse is caring for a client who is prescribed enoxaparin. Which laboratory value should the nurse monitor? A. Platelet count B. Activated Partial Thromboplastin Time (aPTT) C. International Normalized Ratio (INR) D. Troponin

Choice B is correct. Doxorubicin is an antineoplastic that may cause pancytopenia. Pancytopenia is when the client has low WBCs, RBCs, and platelets. The significant leukopenia caused by this medication makes the client quite susceptible to infection. A fever for a client receiving an antineoplastic is highly concerning because it could indicate infection.

The nurse is caring for a client who is receiving prescribed doxorubicin. Which of the following findings would warrant immediate follow-up? A. Anorexia B. Fever C. Alopecia D. Malaise

Choice A is correct. Thrombocytopenia is an adverse effect associated with this medication. This effect is linked to Heparin-Induced Thrombocytopenia (HIT). This may occur within five to fourteen days of exposure to the drug and may be hastened by exposure to higher-than-normal doses.

The nurse is caring for a client who is receiving prescribed enoxaparin. Which of the following findings would indicate the client is having an adverse effect? A. Thrombocytopenia B. Leukocytosis C. Polycythemia D. Neutropenia

Choice B is correct. The client's symptoms suggest fluid volume excess due to the client's congestive heart failure. A loop diuretic, such as furosemide, is highly effective in treating this exacerbation.

The nurse is caring for a client with an exacerbation of congestive heart failure (CHF). The client has generalized edema, dyspnea, and jugular venous distention. The nurse should anticipate a prescription for which medication? A. Mannitol B. Furosemide C. Diltiazem D. Verapamil

Choice B is correct. Prednisone is a corticosteroid that causes sodium retention, thereby increasing fluid volume. This is detrimental to a client with heart failure. The increased fluid volume may exacerbate heart failure symptoms.

The nurse is caring for a client with heart failure. Which medication should the nurse clarify with the primary healthcare provider (PHCP)? A. Lisinopril B. Prednisone C. Hydralazine D. Carvedilol

Choice B is correct. Acyclovir is an antiviral and is effective in the management (and prevention) of outbreaks associated with herpes simplex virus (HSV). A client will either take this during an outbreak or daily to prevent an outbreak (called suppressive therapy). It is highly recommended that the client start this medication at the earliest sign of an outbreak which is the prodromal symptoms of headache, fever, malaise, itching, and burning in the affected area.

The nurse is caring for a client with herpes simplex virus who is experiencing an outbreak. Which medication does the nurse anticipate that the primary healthcare provider (PHCP) will prescribe? A. Metronidazole B. Acyclovir C. Imiquimod D. Fluconazole

Choice B is correct. When infusing fresh frozen plasma (FFP), the nurse should ensure that the FFP is ABO compatible with the recipient. FFP should be ABO compatible because plasma may contain enough antibodies and may cause hemolysis in the recipient.

The nurse is preparing to transfuse fresh frozen plasma (FFP) to a client. Which of the following actions would be appropriate for the nurse to take? A. Obtain baseline platelet count B. Verify ABO compatibility C. Infuse over two to four hours D. Obtain a 12-lead electrocardiogram

Choice A is correct. Atenolol is a selective beta-blocker that is used for hypertension. This medication not only decreases blood pressure but also decreases the heart rate. The vital signs (VS) are all within normal limits except the pulse, which is 54 bpm. This should cause the nurse to clarify the prescription with the PHCP. The nurse should also assess the client for bradycardia-related symptoms such as dizziness and chest pain.

The nurse is caring for a client with the following clinical data. Which medication would the nurse clarify with the primary healthcare provider (PHCP) before administration based on the vital signs? See the exhibit. View Exhibit A. Atenolol 50 mg PO Daily B. Simvastatin 40 mg PO Daily C. Albuterol 2.5 mg via nebulizer Daily D. Spironolactone 25 mg PO Daily

Choice B is correct. Heparin-induced thrombocytopenia (HIT) may be a life-threatening complication of exposure to heparinoids. The treatment for HIT Is to discontinue exposure to the heparin product immediately and to continue the anticoagulation with a non-heparin product. Agents that may be safely used include apixaban, dabigatran, or rivaroxaban.

The nurse is caring for a client with venous thromboembolism who has developed heparin-induced thrombocytopenia. After discontinuing the heparin infusion, the nurse anticipates which prescription from the primary healthcare provider (PHCP)? A. Enoxaparin B. Dabigatran C. Ketorolac D. Epoetin alfa

Choice D is correct. An abdominal aortic aneurysm (AAA) is a severe condition that may lead to potential rupture. Depending on the size of the aneurysm, patients may be taken in for emergent or elective surgery. Priority action is to maintain the blood pressure appropriately. Hypertension is a potential risk factor for abdominal aorta aneurysms. In patients with AAA, hypertension should be aggressively treated with a blood pressure goal of < 140/90 mmHg. Apart from controlling blood pressure, beta blockers have another advantage of reducing the rate of expansion of an AAA. Thus, beta-blockers such as atenolol are used to lower blood pressure and decrease the risk of aneurysm progression and the risk of rupture.

The nurse is caring for a newly diagnosed abdominal aortic aneurysm patient. The nurse should anticipate a prescription for which of the following medications? A. Naproxen B. Digoxin C. Prednisone D. Atenolol

Choice C is correct. The earliest sign of digitalis toxicity is vomiting. Digoxin increases the force of myocardial contraction, decreases conduction through the SA and AV nodes, and prolongs the refractory period of the AV node. The result is increased cardiac output and reduced heart rate.

The nurse is caring for a three-year-old with congestive heart failure receiving digoxin. The nurse recognizes which of the following manifestation is an early sign of digitalis toxicity? A. Dizziness B. Tachycardia C. Vomiting D. Failure to thrive

Choice C is correct. For a client with congestive heart failure prescribed bumetanide, a loop diuretic, the client should verbalize the importance of weighing themselves daily. Their daily weight should be obtained in the morning after the first void.

The nurse is counseling a client with congestive heart failure (CHF) about newly prescribed bumetanide. The nurse determines that the teaching has been effective when the client plans to A. increase their daily intake of protein. B. record their daily urinary output. C. weigh themselves daily. D. take their blood pressure and pulse daily.

Choice C is correct. For a client with congestive heart failure prescribed torsemide, a loop diuretic, the client should verbalize the importance of weighing themselves daily. Their daily weight should be obtained in the morning after the first void.

The nurse is counseling a client with congestive heart failure (CHF) about newly prescribed torsemide. The nurse determines that the teaching has been effective when the client plans to A. decreases their dietary potassium. B. record their daily urinary output. C. measure their weight daily. D. take their blood pressure and pulse daily.

Choice B is correct. Normal saline is the most appropriate intravenous fluid for blood transfusions. 0.9% saline (normal saline) is an isotonic solution and will not cause red blood cell (RBC) hemolysis or clumping.

The nurse is gathering supplies for a transfusion of packed red blood cells (PRBCs). The nurse should obtain which intravenous (IV) fluid to accompany this transfusion? A. Lactated Ringers (LR) B. 0.9% saline C. 0.45% saline D. 3% saline

Choice D is correct. Azithromycin is a macrolide antibiotic used to treat and prevent many infections. The critical advantage of azithromycin is that it has significant lung penetration, making it an attractive option for treating and preventing pneumonia. Following a hematopoietic stem cell transplant, the client is at high risk for infection, and prophylactic antibiotics are commonly prescribed. Pulmonary infections, such as pneumonia, are a common infection, thus making azithromycin a plausible treatment option.

The nurse is planning care for a client following a hematopoietic stem cell transplant. The nurse anticipates the primary healthcare provider (PHCP) will prescribe which medication? A. desmopressin B. montelukast C. zidovudine D. azithromycin

low back pain; chills; urticaria

The nurse is preparing to administer one unit of packed red blood cells (PRBCs) to a client with sickle cell disease. The nurse suspects that the client is experiencing a transfusion reaction. Select the clinical manifestation with the corresponding transfusion reaction Suspected ReactionClinical Findings Hemolytic reaction ____ Febrile reaction ____ Allergic reaction ____

Choice B is correct. The client is experiencing bradycardia. Therefore, it is important to withhold medications that may exacerbate bradycardia. Diltiazem is a calcium channel blocker (CCB). Because of its cardiac depressant (negative chronotropic and negative inotropic) properties, diltiazem reduces the heart rate and contractility. Because of negative chronotropic action, it can cause bradycardia. For this reason, therapeutic uses of diltiazem include atrial arrhythmia and paroxysmal supraventricular tachycardia. When the client has baseline bradycardia, it is important to hold the diltiazem and notify the healthcare provider for further orders or dosage modification.

The nurse is preparing to administer prescribed medications to a client. After reviewing the client's vital signs below, the nurse plans on holding which prescribed medication? See the image below. A. Amlodipine 5 mg PO B. Diltiazem 60 mg PO C. Ibuprofen 500 mg PO D. Ciprofloxacin 500 mg PO

Choice A is correct. This hemoglobin and hematocrit are critically low. A transfusion of PRBCs is typically indicated once the hemoglobin is 7 g/dL or less.

The nurse receives the following critical laboratory result for a client with end-stage renal disease. The nurse anticipates the physician to prescribe which blood product? See the image below. A. Packed Red Blood Cells (PRBCs) B. Fresh Frozen Plasma (FFP) C. Albumin D. Platelets

Choices A, C, D, and F are correct. Furosemide helps to reduce fluid overload by promoting diuresis, often prescribed to manage fluid retention in heart failure clients. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor frequently prescribed for heart failure. It helps improve cardiac function and reduce the workload on the heart. Digoxin is a cardiac glycoside used to enhance heart contractility. It helps increase cardiac output and reduces symptoms such as dyspnea and fatigue. Metoprolol is a beta-blocker and helps reduce heart rate and blood pressure, improving cardiac function.

The nurse is presenting at a staff development conference about medications used to treat heart failure. Which of the following medications are used in the treatment of heart failure? Select all that apply. furosemide metformin lisinopril digoxin warfarin metoprolol

Choice C is correct. Sulfamethoxazole trimethoprim is a sulfa-based antibiotic indicated in the treatment of urinary tract infections and other skin infections. Sulfa is nephrotoxic, and the client should be instructed to take this medication with a full cup of water (eight ounces; 240 mL) and to increase fluid intake in general during the course of therapy. Also, sulfamethoxazole-trimethoprim is an antibiotic that can increase the risk of crystalluria (the formation of crystals in the urine), which can be minimized by ensuring adequate fluid intake. Therefore, instructing the client to increase fluid intake while on this medication is appropriate and helps prevent potential side effects.

The nurse is providing discharge instructions to a client prescribed sulfamethoxazole-trimethoprim. Which of the following instructions should the nurse include? A. "It is okay to stop taking this medication when you feel better." B. "Restrict fluid intake to prevent hypertension." C. "Increase your fluid intake while on this medication." D. "Seek emergency care if your urine turns a dark brown."

Choices B, C, E, and F are correct. Onychomycosis, also known as Tinea unguium, is a fungus infection of the nails (fingernails, toenails) that causes the nails to look thick, discolored, opaque, and crumbling. Dermatophytes cause 90% of these toenail infections. The remaining 10% are caused by non-dermatophytes (Saprophytes) and yeast (Candida). Treatment involves topical antifungals and systemic antifungals (Terbinafine, Lamisil). By inhibiting squalene epoxidase, terbinafine blocks the synthesis of ergosterol (Ergosterol is a crucial component of the fungal cell membranes). The nurse should be aware of the interactions and common side effects of terbinafine because it is one of the commonly prescribed antifungal drugs. Client education points include: Even after prolonged treatment, failure and recurrence rate is high (20 to 50% failure). The cure rate with terbinafine is close to 50% (Choice A is incorrect). Duration of treatment of toenail onychomycosis is typically much longer (3 to 6 months) compared to that of fingernails (1 month). Educate the client regarding the prolonged duration of treatment and instruct them to be compliant (Choice B is correct). Educate the client regardin

The nurse is providing education for a diabetic client who is given a terbinafine prescription for onychomycosis. Which statements by the client demonstrate a good understanding regarding the treatment with terbinafine? Select all that apply. - "Following a successful course of treatment, my chance of getting cured is 90%." - "I will have to take terbinafine for 3 to 6 months." - "I will need liver function tests before starting terbinafine." - "I will take this on an empty stomach to help improve its absorption." - "It may cause taste or vision changes, so I will report vision changes to my doctor." - "Dark urine, pale stools, and persistent nausea may indicate a serious side effect."

Choices B and E are correct. These statements are false and require follow-up. Digoxin is not a diuretic, and the client does not explicitly need to check the weight daily. Further, visual changes are concerning because they are signs of digitalis toxicity (although the initial sign of digoxin toxicity is anorexia and nausea). However, the client with visual changes should not call their eye doctor. The client should notify the medication prescriber.

The nurse is reviewing discharge teaching with a client who was newly prescribed digoxin. Which statement, if made by the client, would require follow-up? Select all that apply. "I should take my pulse before taking each dose." "This medication will require me to take my weight daily." "This medication will require me to have periodic blood work." "I will ensure I get plenty of potassium in my diet." "If I notice visual changes, I will call my eye doctor."

Choice D is correct. Spironolactone is a potassium-sparing diuretic and is primarily indicated in treating essential hypertension. The potential (significant) issue is that clients with end-stage renal disease commonly have hyperkalemia because of the significantly reduced glomerular filtration rate and rely on dialysis to remove nitrogenous waste, water, and electrolytes. It would be detrimental for a client with ESRD to receive spironolactone because this medication will raise serum potassium levels that are already high. This prescription requires follow-up.

The nurse is reviewing newly prescribed medications for assigned clients. Which of the following prescribed medications should the nurse question? A. captopril for a client with congestive heart failure B. metoprolol for a client with multiple premature ventricular contractions (PVCs) C. verapamil for a client with atrial fibrillation D. spironolactone for a client with end-stage renal disease

The nurse is reviewing the client's serum digoxin level resulting in 2.5 ng/mL (3.2 nmol/L). The nurse should initially A. Notify the primary health care provider (PHCP) regarding this laboratory result. B. Review the client's medical record for the most recent pulse rate. C. Record this laboratory value as within the therapeutic range. D. Administer the next dose of digoxin as prescribed.

The nurse is reviewing the client's serum digoxin level resulting in 2.5 ng/mL (3.2 nmol/L). The nurse should initially A. Notify the primary health care provider (PHCP) regarding this laboratory result. B. Review the client's medical record for the most recent pulse rate. C. Record this laboratory value as within the therapeutic range. D. Administer the next dose of digoxin as prescribed.

Choice C is correct. INH is a first-line therapy treatment for pulmonary tuberculosis. The major adverse effect associated with INH is peripheral neuropathy. This may be ameliorated by a client taking prescribed B-complex vitamins as INH depletes the stores of pyridoxine (Vitamin B6).

The nurse is teaching a client about isoniazid (INH). Which of the following statements should the nurse include? A. "This medication may turn your secretions reddish/orange." B. "Yellowing of your eyes is a normal side-effect." C. "A B-complex vitamin should be taken to help with the neuropathy." D. "This medication will need to be taken every day for at least one week."

Choices A, B, and E are correct. Methotrexate (MTX) is indicated for a variety of autoimmune conditions. This medication carries serious adverse effects such as pancytopenia (low red blood cells, white blood cells, and platelets). Thus, the client may bruise more easily and be at a higher risk of infection, so avoiding crowded areas and practicing good hand hygiene are essential. MTX antagonizes folic acid, and while a client is taking MTX, folic acid supplementation is typically prescribed.

The nurse is teaching a client about methotrexate (MTX). Which of the following statements should the nurse include? Select all that apply. "This medication may cause you to bruise more easily." "You will need to take folic acid with this medication." "You must remain upright for thirty minutes after taking a dose." "You should avoid receiving inactivated vaccinations." "Avoid large crowds and wash your hands frequently."

Choices A and D are correct. These statements are incorrect and require follow-up. ➢ Premature discontinuation of antibiotics leads to therapeutic failure. Therefore, all antibiotics must be continued for the entire course, not when the symptoms abate. ➢ Doxycycline absorption may decrease when the client takes it with calcium. ➢ The client should be instructed not to take this medication with calcium-rich foods, dairy products, or antacids containing calcium. The client should take this medication on an empty stomach.

The nurse is teaching a client about newly prescribed doxycycline. Which of the following statements, if made by the client, would require further teaching? Select all that apply. - "I should take this medication with milk or cheese." - "If I develop foul-smelling diarrhea I should contact my doctor." - "I need to wear sunscreen outdoors while taking this medication." - "I can stop this medication when I feel better." - "I should take this medication on an empty stomach."

Choice C is correct. Epoetin alfa is an erythropoietic growth factor indicated to increase red blood cell production for those with chronic kidney disease. This medication expands blood plasma with the therapeutic effect of increasing hemoglobin and hematocrit. It is essential to monitor the client's blood pressure while taking this medication, as an increase in blood pressure may be seen secondary to the increased blood volume. Uncontrolled hypertension is a contraindication of this medication.

The nurse is teaching a client about the newly prescribed medication, epoetin alfa. Which of the following should the nurse include in the teaching? A. This medication will decrease your risk for infection. B. You may notice black tarry stools while on this medication. C. This medication may raise your blood pressure. D. Take this medication with food rich in Vitamin C.

Choice B is correct. Before the start of a transfusion for a unit of PRBCs, the nurse will need to collect the client's signature for blood consent. Baseline vital signs will be taken. The nurse is to remain with the client for the first fifteen minutes to monitor for transfusion reactions.

The nurse is teaching a client who is scheduled for a transfusion of one unit of packed red blood cells (PRBCs). Which of the following information should the nurse include? A. "A baseline weight will be taken before the start of the transfusion." B. "I will be with you during the first fifteen minutes of the transfusion." C. "You will need to provide a urine sample at the end of the transfusion." D. "Please complete the required surgical consent before the transfusion."

Choice D is correct. For the client in cardiogenic shock, administering a beta-blocker would be contraindicated because they are negatively inotropic and would decrease cardiac output (CO) that is already compromised. Often, cardiogenic shock occurs due to an acute drop in cardiac output from a massive acute myocardial infarction. Cardiogenic shock is a medical emergency, and the treatment aims to quickly increase cardiac output and restore blood pressure. Medical management includes the use of dopamine, norepinephrine, dobutamine, and vasopressin to increase CO. Primary percutaneous coronary intervention is performed in clients with acute myocardial infarction-related cardiogenic shock. PCI aims to restore blood flow to the involved myocardium and improve the ejection fraction. In clients not responding to medical management, mechanical circulatory support devices (percutaneous support devices, intra-aortic balloon pumps) may be utilized.

The nurse is teaching a continuing education course regarding cardiovascular medications. It would be appropriate for the nurse to reinforce which condition is a contraindication to administering beta-blockers? A. Atrial fibrillation B. Myocardial infarction C. Congestive heart failure (CHF) D. Cardiogenic shock

Choice A is correct. The increase in the client's temperature (compared to the baseline) is concerning and meets the threshold for a febrile reaction to the blood product. For any transfusion reaction the client may be experiencing, the nurse must stop the transfusion. While febrile reactions are generally not life-threatening, the nurse needs to temporarily suspend the transfusion, maintain vascular access, and notify the primary healthcare provider (PHCP). The client would likely be prescribed antipyretics such as ketorolac or acetaminophen.

The nurse is transfusing one unit of packed red blood cells (PRBCs) to a client. The nurse initiated the transfusion at 1400. After completing the 1545 vital signs, the nurse should take which action? See the image below. A. Stop the transfusion B. Verify the blood product with another nurse C. Apply nasal cannula oxygen D. Document the findings and continue the transfusion

EKG, atrioventricular block, reduce triglycerides, liver function tests

The nurse needs to obtain baseline ____ prior to administering atenolol because atenolol would be contraindicated if the client _____ The nurse understands that the prescribed fenofibrate is intended to ____ Prior to administering the prescribed pitavastatin, the nurse needs to obtain baseline ______

Choice D is correct. Observing a client at the start of the blood transfusion is to quickly assess a potentially fatal hemolytic / ABO incompatibility reaction - not a febrile reaction. A hemolytic reaction would manifest as lower back or chest pain, apprehension, and dyspnea. A febrile reaction would not manifest as quickly as a hemolytic reaction. Therefore, this action requires follow-up.

The nurse observes a newly hired nurse caring for a client prescribed a unit of packed red blood cells. It would require immediate intervention if the nurse observes the newly hired nurse A. spikes the unit of blood with Y-type blood tubing. B. verifies the client's name, date of birth, blood compatibility, and expiration date C. instructs the unlicensed assistive personnel (UAP) to obtain pre-transfusion vital signs. D. remains with the client for the first 15-30 minutes to observe for a febrile reaction.

Y-type tubing; check vascular access patency

The nurse plans to administer the unit of blood with _____ Prior to the transfusion, the nurse should_____

Choice D is correct. Liver toxicity is a severe adverse effect of isoniazid. Healthcare providers should monitor for signs of jaundice, fatigue, elevated liver enzymes, and loss of appetite. Liver enzyme tests are usually performed monthly during therapy to identify early hepatotoxicity. Isoniazid is a bacteriocidal for actively growing organisms and a bacteriostatic for dormant mycobacteria. It is selective for M. tuberculosis. Isoniazid is used alone for chemoprophylaxis, or in combination with other antitubercular drugs when treating active disease.

The nurse reviews a client's medical record taking prescribed isoniazid for pulmonary tuberculosis. Which laboratory data is most important to monitor? A. PT and PTT B. CBC C. BUN D. Liver enzymes

Choice B is correct. Echinacea is a complementary alternative therapy (CAM) purported to increase immune system activity. The efficacy of this CAM is disputed. However, it has demonstrated interaction with antiretrovirals used to treat HIV. Specifically, it may decrease certain antiretrovirals, causing an increase in HIV VL. This medication should be clarified with the PHCP as this could be the potential cause of the VL increase.

The nurse reviews laboratory data for a client with human immunodeficiency virus (HIV) and notes an increased viral load (VL). The nurse reviews the client's current medications and should clarify which medication with the primary healthcare provider (PHCP)? A. Acetaminophen B. Echinacea C. Cetirizine D. Calcium carbonate

Choice B is correct. Rivaroxaban is advantageous because it does not require frequent laboratory monitoring. International Normalized ratio (INR) monitoring is required for a client receiving selected anticoagulants such as warfarin. Rivaroxaban and apixaban (direct factor Xa inhibitors) may increase prothrombin time (PT) and INR. However, these tests are not reliable in assessing the anticoagulation effects of these agents. Therefore, INR monitoring is not recommended for clients on prescribed rivaroxaban. The nurse should question this because it is unnecessary.

The nurse reviews newly prescribed laboratory tests and medications for the following clients. Which of the laboratory tests and prescriptions should the nurse question? A. Liver function tests (LFTs) for a client prescribed atorvastatin B. International normalized ratio (INR) for a client prescribed rivaroxaban C. Serum creatinine level for a client prescribed lisinopril D. Glycosylated hemoglobin (HgbA1C) level for a client prescribed olanzapine

Choices A and B are correct. Beta-blockers decrease blood pressure by causing vasodilation of the vessels. They block catecholamines from the beta receptor sites found in the heart and lungs. Beta-blockers decrease the heart's workload through vasodilation and lowering the heart rate. This relaxation of the vasculature and reduction in heart rate will reduce the myocardial oxygen demand. This is why beta blockers (low doses) may be prescribed during an acute myocardial infarction and afterward.

The nurse reviews the function of a prescribed beta-blocker in the cardiovascular system. It would be appropriate for the nurse to state that beta-blockers Select all that apply. - block catecholamines from binding to the beta receptors. - reduce myocardial oxygen demand. - increase cardiac contractility. - increase cardiac output. - prevent sodium and water resorption by inhibiting aldosterone secretion.

lisinopril - adverse reaction: elevation in creatinine - anticipated physician's order: discontinuation of medication and follow up laboratory testing atorvastatin - adverse reaction: elevation in liver enzymes - anticipated physician's order: order for creatine kinase (CK) level nifedipine - adverse reaction: peripheral edema - anticipated physician's order: order for compression hose

The nurse reviews the progress note and laboratory data lisinopril - adverse reaction - anticipated physician's order atorvastatin - adverse reaction - anticipated physician's order nifedipine - adverse reaction - anticipated physician's order

To solve this problem, the nurse will use the formula of total volume x drop factor / time in minutes First, take the prescribed volume and multiply it by the drop factor 150 mL x 10 gtt = 1500 mL Next, divide the total volume by the minutes 1500 mL / 60 minutes = 25 gtts/min Finally, perform appropriate rounding (if needed)

The primary healthcare provider (PHCP) prescribes doxycycline to be administered over one hour. The pharmacy supplies the medication in a bag labeled 200 mg of doxycycline in 150 mL of 0.9% saline. The drop factor is 10 gtts/mL. The nurse sets the flow rate at how many drops per minute? Round your answer to the nearest whole number. Fill in the blank.

Choice B is correct. Amlodipine is a calcium channel blocker that reduces blood pressure and treats certain vascular disorders, such as peripheral arterial disease. A blood pressure of 119/79 mm Hg is optimal and would indicate a positive response.

This nurse is caring for a client who is receiving prescribed amlodipine. Which of the following findings would indicate a therapeutic response? A. Hemoglobin A1C 5.6% (< 5.7%) B. Blood pressure 119/79 mm Hg C. Capillary blood glucose 88 mg/dL (70-110 mg/dL) D. Total cholesterol 190 (< 200 mg/dL)

Choice A is correct. Epinephrine rapidly affects both alpha and beta-adrenergic receptors, eliciting a sympathetic response. Epinephrine is a hormone secreted by the medulla of the adrenal glands. Strong emotions such as fear or anger cause epinephrine to be released into the bloodstream, which causes an increase in heart rate, muscle strength, blood pressure, and sugar metabolism.

When epinephrine is administered to a client, the nurse should expect this agent to rapidly affect: A. Adrenergic receptors B. Muscarinic receptors C. Cholinergic receptors D. Nicotinic receptors

Choices A, C, and D are correct. Epinephrine, Diphenhydramine, and Corticosteroid drugs treat allergic reactions resulting from a blood transfusion or any other allergen. Diphenhydramine is an antihistamine agent that is useful both as premedication and treatment. Clients may be premedicated with diphenhydramine to prevent allergic reactions. If ordered for prevention, it is usually given 30 minutes before transfusion. If a response occurs even after premedication, the dose can be repeated. It's administered in 25 to 50 mg dosages. Corticosteroids (e.g., methylprednisolone) are indicated in moderate to severe allergic reactions. They help reduce inflammation and may also prevent delayed phase reactions that follow the initial allergic event. Epinephrine is indicated in the most severe allergic reactions (anaphylaxis) associated with shock or bronchoconstriction. This agent is both an alpha and a beta-agonist. In anaphylactic shock, it helps by causing vasoconstriction (via alpha receptors) and bronchodilation (via beta-2 receptors)

Which of the following medications would be appropriate for the treatment of an allergic reaction to a blood transfusion? Select all that apply. Epinephrine Acetaminophen Diphenhydramine Hydrocortisone Pantoprazole