Pharm EAQ

What should the nurse monitor when a client is receiving a platelet aggregation inhibitor such as clopidogrel?

*EPISTAXIS* The high vascularity of the nose, combined with its susceptibility to trauma (e.g., sneezing, nose blowing), makes it a frequent site of hemorrhage. Nausea, chest pain, and elevated temperature usually are not associated with anticoagulant therapy.

A client has severe diarrhea, and the health care provider prescribes intravenous fluids, sodium bicarbonate, and an antidiarrheal medication. Which drug does the nurse expect the health care provider to prescribe?

*LOPERAMIDE* inhibits peristalsis and prolongs transit time by its effect on the nerves in the muscle wall of the intestines. Bisacodyl is a laxative, not an antidiarrheal; it increases gastrointestinal motility. Psyllium is not an antidiarrheal; it is a bulk laxative that promotes easier expulsion of feces. Docusate sodium corrects constipation, not diarrhea; water and fat are increased in the intestine, permitting easier expulsion of feces

Furosemide (Lasix)

A potent diuretic used to provide rapid diuresis; acts in the loop of Henle causes depletion of electrolytes, such as potassium and sodium. inhibits the *reabsorption*, not retention, of sodium.

A client develops a gallstone that becomes lodged in the common bile duct. An endoscopic sphincterotomy is scheduled. The client asks the nurse what will be done to prevent pain. What should the nurse reply?

An intravenous sedative usually is administered to produce effective sedation (conscious sedation) for the procedure. An oral analgesic is insufficient for this procedure. Epidural anesthesia is not necessary. A local anesthetic is insufficient for this procedure.

A client is receiving *metoprolol*.Which side effect should the nurse teach the client to expect?

Dizziness w/strenous activity

A client with stage III Hodgkin disease is started on ABVD therapy, a multiple-drug regimen. The client asks why so many drugs need to be given all at once. Which is the best response by the nurs

Each drug destroys an cancer cell at at different time in the cell cycle Cells are vulnerable to specific drugs through the stages of mitosis, and a combination bombards the malignant cells at various stages. The side effects of a drug are not ameliorated by a combination with others. Although the statement that several drugs are used to destroy cells that are not susceptible to radiation therapy is true, it is not the reason for using a combination of drugs. Although there is more than one stage of Hodgkin disease of this is not the reason for using a combination of drugs.

A client is receiving furosemide to relieve edema. The nurse should monitor the client for which response to the medication?

HYPOKALEMIA Furosemide is a potent diuretic used to provide rapid diuresis; it acts in the loop of Henle and causes depletion of electrolytes, such as potassium and sodium. Furosemide inhibits the reabsorption, not retention, of sodium. Furosemide does not affect protein metabolism. With edema, the specific gravity of the fluid more likely will be low.

After being hospitalized for a transient ischemic attack (TIA) related to hypertension, a client is discharged with a prescription of hydrochlorothiazide. What should the nurse instruct the client to do when taking this medication?

Increase intake of potassium rich food The client must increase the dietary intake of potassium because of potassium loss associated with hydrochlorothiazide. Protein supplements are not necessary and may be obtained from meat, fish, and dairy products in the diet or complementary vegetable and grain proteins. Foods high in insoluble fiber are part of the food pyramid and should be included in the diet. The client should be taught about medication-induced deficiencies, which may necessitate a change in diet, and not just return to regular eating habits once home

A nurse has administered sublingual nitroglycerin. Which parameter should the nurse use to determine the effectiveness of sublingual nitroglycerin?

Relief of angina Cardiac nitrates relax smooth muscles of the coronary arteries; they dilate and deliver more blood to heart muscle, relieving ischemic pain. Although cardiac output may improve because of improved oxygenation of the myocardium, improved cardiac output is not a basis for evaluating the effectiveness of sublingual nitroglycerin. Although dilation of blood vessels and a subsequent drop in blood pressure is a reason why IV nitroglycerin may be administered, decreased blood pressure is not the basis for evaluating the effectiveness of sublingual nitroglycerin, which is indicated for pain relief. Although superficial vessels dilate, lowering the blood pressure and creating a flushed appearance, dilation of superficial blood vessels is not the basis for evaluating the drug's effectiveness.

A client develops a maculopapular rash on the upper extremities and audible wheezing during the administration of intravenous vancomycin. To ensure the client's safety, which action would the nurse carry out first?

The first action the nurse should take is to stop the infusion immediately. The client may be experiencing an allergic reaction. The nurse should stop the medication infusion and then notify the healthcare provider. Decreasing the flow rate is not an appropriate action. Infusions must be stopped if allergic reaction is suspected. This could be an emergent situation, so reassessing in 15 minutes is not the most appropriate action

A healthcare provider prescribes an antibiotic intravenous piggyback twice a day for a client with an infection. The healthcare provider prescribes peak and trough levels 48 and 72 hours after initiation of the therapy. The client asks the nurse why there is a need for so many blood tests. What reason does the nurse provide?

They determine adequate dosage levels of the drug Drug dose and frequency are adjusted according to peak and trough levels to enhance efficacy by maintaining therapeutic levels. Peak and trough levels reveal nothing about allergic reactions. Blood cultures are obtained when the client spikes a temperature; they are not related to peak and trough levels of an antibiotic. A sustained decrease in fever is the desired outcome, not reduction just at peak serum levels of the medication.

With edema, the specific gravity of the fluid more likely will be low when given a diuretic such as lasix

True