Pharm: Exam 4 Part 2

The nurse notes that the diuretic acetazolamide is listed on the client's medication reconciliation sheet. The nurse should check the client's health history for which anticipated health problem?

Open-angle glaucoma

The nurse should conclude that a client newly diagnoses with glaucoma understands the purpose for the prescribed timolo when the client makes which statement?

-"This eye drop will reduce the intraocular pressure"

A client is prescribed the ophthalmic medication latanoprost. The nurse should teach the client about what common effects of this drug? SATA

-maintenance of visual fields -thickening of eyelashes

The nurse teaches the client with acne that which preparations is one of the most effective agents for acne treatment? 1. Mafenide 2. Benzoyl peroxide 3. Chlorhexidine 4. Coal tar

2

A client is prescribed naproxen for the treatment of rheumatoid arthritis. The home care nurse should explain to the client that maximum relief may take up to how many weeks to occur?

3-4 weeks

A client diagnosed with psoriasis vulgaris is using a prescribed topical corticosteroid. What activity should the nurse perform? 1. Protect the unaffected skin from staining 2. HEat cream before applying 3. Provide continuous occlusive therapy 4. Apply warm, moist dressing over occlusive dressing

4

A client is prescribed trimethoprim. The nurse should assess for changes in which laboratory test to determine possible adverse effects of the drug?

white blood cell count

The nurse should include which precaution when teaching a client with liver disease about the use of over-the-counter acetaminophen, aspirin, or nonsteroidal anti-inflammatory drugs (NSAIDS)?

"Consult your healthcare provider before taking one of these medications."

A client suffers from migraine headaches. Which statement indicates the client knows what activity may help to reduce or eliminate the headaches?

"I keep a diary of my headaches so that I can see if there is a pattern."

Which statement made by the client indicates an understanding of client teaching regarding antiepileptic drug therapy?

"I need to take this medication regularly to avoid the recurrence of seizures."

The nurse should include which instruction when teaching a client prescribed ergotamine tartrate for treatment of cluster headaches?

"Lie down in a darkened room after taking the medication."

After phenazopyridine is prescribed for a client, the nurse teaches the client which of the following items of information?

"Report sign of yellow-tinged skin or sclera."

The nurse is providing information to a client who has started drug therapy with sulfisoxazole. Which instruction would be the highest priority of the nurse to provide?

"Report sudden onset of fever, pruritus, and malaise."

The healthcare provider prescribed oxybutynin for a 65 year old female with urinary frequency and urgency. The nurse should include which instruction to manage a primary side effect when providing medication instruction?

"Rinse your mouth or use sugarless hard candy frequently."

A client has received a prescription for supplemental potassium chloride. Which client teaching points should the nurse include in a discussion with the client? Select all that apply.

"Take supplement with meals to reduce GI upset." "report irregular pulse, fatigue, or weakness in legs." "Dissolve soluble tablet in at least 120 mL (4oz) of water or juice." "Avoid use of salt substitutes while taking potassium."

A client has been started on medication therapy with nitrofurantoin as chronic suppressive therapy for UTI. What statements should the nurse include when teaching the client about this medication? Select all that apply.

"This medication causes a harmless brown color to the urine." "Monitor your urine for cloudiness or foul smell." "Promptly report muscle weakness, tingling, or numbness to the prescriber." "Nausea can be a common side effect of this medication."

Because finasteride was prescribed for a 45 year old man, the nurse should include which priority instruction during a teaching session about the medication.

"Use a contraceptive barrier during sexual intercourse."

The external ear canal of a client with an ear infection is obstructed due to swelling. The nurse should instruct the client to use which techniques during otic medication administration? SATA

-insert gauze ear wick and apply medication to wick -avoid using pressure to insert tip of the fluid container

A client with open-angle glaucoma is being treated with acetazolamide 250 mg tablets by mouth twice daily. Which client statements indicate to the nurse an understanding of therapy with this drug?SATA

-"I can take the medication with milk" -"I should take the medication in the morning" -"I can crush the tablet and mix it in with juice"

Before administering preoperative medications to a client with a history of glaucoma, the nurse would question which medication prescription?

-atropine

A client is diagnosed with atopic dermatitis. The nurse should expect that which classes of drugs will be prescribed either alone or in combination? Select all that apply. 1. Antihistamines 2. Analgesics 3. Antimicrobials 4. Topical anesthetics 5. Antifungals

1, 2, 4

A nurse working in a burn center frequently applies topical burn medications to burn wounds. The nurse should anticipate that which medications may be prescribed topically for a newly admitted client with burns? Select all that apply. 1. Mafenide 2. Sulfisoxazole 3. Silver sulfadiazine 4. Nitrofurazone 5. Trimethoprim

1, 3, 4

A nurse is discussing treatment options for a client with acne vulgaris. The nurse should explain to the client that anti-acne medications work in which ways. SATA. 1. Inhibiting viral replication 2. Inhibiting sebaceous gland overactivity 3. Reducing bacterial colonization 4. Preventing follicles from becoming plugged with keratin 5. Reducing inflammation of lesions

2, 3, 4, 5

Permethrin is prescribed for an adult client, and the nurse needs to provide the client with instructions for use. Place the directions in proper sequence that the nurse should provide to the client. 1. Comb hair with a fine-toothed comb 2. Shampoo hair 3. Apply permethrin cream to hair and work through to scalp 4. Let sit for 10 minutes 5. Wash hair to remove drug

2, 3, 4, 5, 1

After listening to the nurse explain the use of isotrentinoin to a 19 year old female client, the client demonstrates understanding of the most important point by making which statement at the end of the teaching lesson. 1. Apply a thick layer of isotrentinoin twice a day. 2. Increase exposure to the sun for added benefits 3. Having pregnancy test prior to beginning therapy and use contraception. 4. Keep lips moist and lubricated to prevent inflammation

3

The nurse teaches the client how to manage an infestation of scabies with crotamiton by providing which direction. 1. Rotate the container gently before using. Do not shake. 2. Vigorously massage the solution into the skin 3. Be sure to apply medication also in skin creases and under fingernails. 4. Apply the product to inflamed areas first.

3

A participant in a skin care research project asks the nurse educator to justify the recommendation of a sunscreen. Which response by the nurse provides the best rationale. 1. Sunscreens neutralize the suns rays 2. Sunscreens are waterproof and thus block the suns rays 3. Sunscreens absorb the suns rays and distribute the heat to other body parts 4. Sunscreens prevent sunburn by absorbing and reflecting the suns rays

4

The school nurse explains to a group of adolescents at a school health fair that which medication is considered the more effective for the treatment of acne. 1. Tetracycline 2. Penicillin G 3. Clindamycin 4. Isotrentinoin

4

A client who is starting medication therapy with furosemide 20 mg PO daily asks the nurse what would be the best time of day to take the pill. What time should the nurse recommend?

8:00 AM

1 Rationale: Taking bisacodyl on an empty stomach will result in a more rapid effect. Drinking plenty of fluids is a good general measure to reduce the risk of constipation. Taking the medication with a meal will delay absorption. If taking at bedtime, the client will have a bowel movement in the morning.

A client has a new prescription to take bisacodyl. To enhance a rapid medication effect, the nurse instructs the client to take the medication in which way? 1 On an empty stomach 2 With plenty of fluids 3 With meals 4 At bedtime

A client with chronic renal failure is beginning drug therapy with epoetin alfa. The nurse should monitor for the trend of which vital sign to detect an adverse effect of this medication?

Blood pressure

A client who is taking hydralazine has also been started on drug therapy with amiloride. Which change in client data should the nurse attribute to the interactive effects of these medications?

Blood pressure decrease from 140 to 120 mmHg when standing

Because a client with a spinal cord injury has developed spasticity, the nurse should prepare to teach the client about which newly prescribed medication?

Dantrolene

The nurse should anticipate that mannitol may be prescribed to reduce symptoms in clients recently admitted to the unit with which conditions? Select all that apply.

Increased intracranial pressure Increased intraocular pressure

A client is scheduled to take 4 mg of hydromorphone intravenously (IV). Prior to administering the drug, what should the nurse do?

Obtain a baseline respiratory assessment

A client was started on drug therapy with bumetanide 1 month ago. At a follow up health visit, the nurse should be most concerned with which most recent laboratory test result?

Potassium 3.1 mEq/L

Because phenytoin was prescribed STAT for a client who was just admitted to the nursing unit from the emergency department, which set of assessments is of highest priority for the nurse to perform?

seizure activity, mental status, and respiratory status

A client will be starting drug therapy with spironolactone to manage edema associated with cirrhosis of the liver. The nurse should encourage the client to avoid excessive amounts of which foods? Select all that apply.

bananas cantaloupe spinach

A nurse administering Tamsulosin to a client would expect to note which therapeutic outcomes of drug therapy? Select all that apply.

decreased urethral obstruction increased urine flow decreased urinary frequency

A 45 year old female has been taking indapamide 2.5 mg daily. She reported to the clinic today with leg cramps and a blood pressure of 126/70. The nurse should consult with the prescriber to do which of the following?

evaluate the electrolytes

A client with hypertension and diabetes mellitus is taking hydrochlorothiazide. The client reports onset of an enlarged, red, painful right great toe soon after beginning therapy with this medication. The home health nurse should request a prescription from the healthcare provider for which serum lab test?

uric acid level

A client has begun taking an anticholinergic medication. The nurse should make it a priority to assess for which unintended manifestations?

urinary retention, hesitancy, and constipation

A nurse notes that a client has methenamine on the list of prescribed medications. The nurse should suspect that the client has a diagnosis of which health problem?

urinary tract infection

A client has been started on medication therapy with tolterodine. The home health nurse making a follow up visit should assess for resolution of which symptoms? Select all that apply.

urinary urgency urinary frequency leakage of urine

A client is receiving both selegiline and meperidine. What instructions should the nurse provide to the UAP?

use automatic BP machine to measure client's BP at preset frequencies

A client with a history of asthma is describing symptoms that began after starting drug therapy with pilocarpine to treat glaucoma. The nurse should conclude that which symptom indicates a side effect associated with systemic absorption of this drug?

-wheezing

A client newly diagnosed with psoriasis has been prescribed betamethasone as treatment for the disorder. What statement made by the client indicates further information is needed about this medication? 1. This drug will also help cure my acne. 2. I should report an elevated temperature if it occurs. 3. After applying the medication, I should either leave the skin exposed or cover it lightly. 4. It should only be applied to the affected skin area.

1

After 5-fluorouracil cream is prescribed for a client diagnosed with basal cell carcinoma, what should the nurse teach the client? 1. The drug will cause increasing tenderness as lesions ooze and erode. 2. The drug will cause the lesions to become dry, shrink, and fall off. 3. THe drug will decrease the sensitivity of the lesion. 4. Vigorously massage the lesion after application.

1

After administering silver sulfadiazine to a client with burns, the nurse should perform which assessment to determine the effectiveness of the medication? 1. Measure body temperature 2. Weigh client daily 3. Review serum potassium levels 4. Asses separation of eschar

1

During the first 24 hours, the nurse should manage one of the most common complications associated with burn injury by administering which medications as prescribed for the client? 1. Famotidine 20 mg intravenous every 12 hours 2. Calcium-based antacids by mouth after meals 3. Furosemide 20 mg intravenous twice daily 4. Crotamiton cream, once daily for 2 days

1

The nurse should conclude that a client understands instructions about how to self-administer a prescribed otic solution when the client makes which statement?

-"I place the bottle of medication under warm running water before using"

A client who has a new prescription for dorzolamide asks the nurse how the medication will help treat glaucoma. The nurse's best response should include which item of information?

-"It decreases the production of aqueous humor"

A client telephones the outpatient clinic and reports severe car pain that ceased suddenly when copious drainage came from the ear. The client wants to instill remnants of a 2-month-old otic antibiotic prescription left over from a previous ear infection. What is the best response by the nurse?

-"See a healthcare provider. Do not treat the ear with the antibiotic"

A client is scheduled for an annual eye exam. What instructions should the nurse provide? SATA

-"Wear sunglasses after the exam because atropine will cause photophobia" -"Tropicamide may be administered to dilate the pupil" -"Because you have dry eyes the doctor may prescribe cyclosporine drugs"

Because a client with glaucoma is scheduled for removal of a cataract from the left eye, the nurse should anticipate a prescription from the surgeon to administer which drug?

-Acetazolamide

What should be the priority of the nurse in assessing a client prior to administering the first dose of an ophthalmic medication?

-Client's history of medication allergies

After a nurse provides instructions about betaxolol to a client with chronic obstructive pulmonary disease (COPD), the client asks, "How can eyedrops affect the lungs?" The nurse's best response includes which information?

-If betaxolo is systemically absorbed, it can exert the same systemic effects as other beta-blockers

A nurse should conclude that a client can safely self-administer ophthalmic medications after the client demonstrates which aspects of correct technique? SATA

-Pulls lower lid down and instills medication into conjunctival sac -Applies gentle pressure to inner canthus for 30 seconds after medication administration -Cleanses exudates from eye before instillation of medication

A client with diabetes and glaucoma has NPH insulin and carteolol listed on the medication administration record. The nurse should consider which assessment to be of priority when seeing the client?

-blood glucose

The nurse should question an order for brinzolamide for a client who has which disorder listed in the health history section of the EMR?

-chronic renal failure

The nurse should conclude that a client is demonstrating appropriate technique for instilling ophthalmic medication when the client performs which action?

-cleanses crust from eye by wiping from the inner cannthus outward with a cotton ball

The nurse should conclude that a 68-year-old client understands proper otic medication administration after observing the client perform which actions during self-administration? SATA

-client pulls pinna up and back before administering medication -client gently massages the anterior ear area after medication administration

Because a prescription of gentamicin sulfate for an ear infection reads "for ophthalmic use," the client refuses to instill the medication. After verifying the prescription with the client's chart, what is the most appropriate conclusion by the nurse?

-it is an accepted and safe practice in the US for clinicians to prescribe ophthalmic gentamicin for otic use

A client is receiving an ophthalmic anesthetic agent prior to removal of sutures. The nurse should consider implementing which priority nursing measures?

-measures to protect the eye

A nurse is administering a very high-potency topical corticosteroid clobetasol to certain assigned clients. Which client is most at risk for systemic absorption. 1. 35 year old with psoriasis 2. 72 year old with eczema 3. 59 year old with seborrhea 4. 38 year old with contact dermititus

2

AN adult client with a pediculosis infestations has a prescription for a drug to treat the condition. The nurse anticipates providing which information as an instruction to the client about application methods. 1. Chlorhexidine: Apply with sterile gloves 2. Lindane: Leave in place for 12-24 hours 3. Collagenase: Apply with fingertips 4. Terbinafine: Apply a thin layer

2

After a healthcare provider prescribed minocycline for a client with acne, the nurse explains to the client which disadvantage of the medication? 1. Suppression of sebum production 2. Lupuslike syndrome and pigmentation changes 3. Open pores promoting excessive production of accumulated sebum 4. Occurrence of spontaneous abortion

2

The nurse teaches the parents of a child with impetigo to apply which topical medications as prescribed to the affected area of the child's skin? 1. Ketoconazole 2. Mupirocin 3. Capsaicin 4. Acyclovir

2

The client with a burn injury reports a stinging and burning sensation when topical mafenide acetate is applied. Which action should the nurse take? 1. Withhold medication and notify the prescriber 2. Remove that dose of the medication 3. Premedicate client with moderate analgesic before applying. 4. Chill preparation before applying.

3

The nurse is most likely to apply a hydrocolloid dressing during wound care for which client? 1. CLient who has a necrotic wound with a thick layer of eschar attached. 2. CLient who has a new, partial thickness burn 3. Client who has a wound that needs debriding 4. Client who has an uninfected venous stasis ulcer

4

1 Rationale: Diphenoxylate inhibits nerve endings that cause intestinal movement. Decreasing the velocity increases opportunity for absorption of fluid resulting in increased viscosity of the stools. The drug is a narcotic w/ a structure similar to meperidine and has no effect on the shifts of sodium. Increased bulk would increase peristalsis. The drug primarily affects the NS, not the CS

A client asks, "How does diphenoxylate help stop diarrhea?" Which of the following is the best response by the nurse? 1 "It slows down the motility of the intestine, thereby increasing fluid absorption" 2 "Because of the increased sodium in the stool, fluid moves into the bloodstream." 3 "It increases the bulk in the intestines, resulting in decreased peristalsis." 4 "It decreases circulation of blood to the bowels, making them less reactive to stimulation."

2 Rationale: Photosensitivity is a side effect of both classes of antibiotics. The client should avoid sun exposure and tanning beds. These drugs would not increase the client's risk for upper respiratory infections. Orthostatic hypotension and constipation are not side effects of either drug.

A client has been prescribed to take both a tetracyline and a sulfonamide drug. When providing client teaching, what priority information should the nurse give the client R/T adverse drug effects? 1 Avoid exposure to upper respiratory infections 2 Use protective measures when exposed to the sun 3 Report problems with constipation to your provider 4 Change position slowly to avoid orthostatic hypotension

1 Rationale: Ursodiol is a naturally occurring bile acid used to dissolve gallstones. It is believed to suppress hepatic synthesis and secretion of cholesterol as well as intestinal absorption. Omeprazole is a proton pump inhibitor that reduces gastric acid production. Cimetidine is an H2 antagonist that reduces gastric acid production, but is not designed to treat cholelithiasis. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) and may be needed should the client develop a fever secondary to the process of inflammation.

A client has cholelithiasis, but is a poor surgical candidate because of comorbid conditions. The nurse is most likely to teach the pt about which of the following medications? 1 Ursodiol 2 Omeprazole 3 Cimetidine 4 Ibuprofen

3,4,5 Rationale: Drug therapy for tuberculosis lasts 6-24 months. The medications are taken concurrently, not one after another. Alcohol intake can cause hepatotoxicity when ingested in combination with these drugs. Aluminum-containing antiacids decrease the absorption of isoniazid. Vitamin B6 is used to prevent seizures and to prevent or correct metabolic acidosis. The dose may be repeated several times.

A client is receiving combinatioin drug therapy of isoniazid, rifampin, and pyrazinamide for treatment of tuberculosis. What information should the nurse include in client education? SATA 1. Treatment will take 2 weeks 2. Finish taking all doses of isoniazid before starting ethambutol 3. Eliminate alcohol intake during drug therapy 4. Aluminum-containing antacids decrease the absorption of isoniazid 5. Vitamin B6 may help prevent side effects such as seizures and metabolic acidosis

2 Rationale: A common side effect of oseltamivir is diarrhea; others include nausea and vomiting and dizziness. Stevens-Johnson syndrome is a rare side effect of peramivir. Urinary frequency is not associated with oseltamivir. Nephrotoxicity is not associated with oseltamivir, although it is an adverse effet of aminoglycoside antiobiotics

A client is receiving oseltamivir for influenza A. The nurse should monitor for which common side effect? 1. Stevens-Johnson syndrome 2. Diarrhea 3. Excessive urination 4. Nephrotoxicity

1,3,4,5 Rationale: Fidaxomicin is a macrolide antibiotic that does not absorb and therefore is effective against Clostridium difficile or pseudomembranous colitis. It is not used for tuberculosis. It is not effective for treatment of systemic infections. As with other antibiotics, the client should not stop taking until full course of treatment is completed. Because it is a macrolide antibiotic, it should not be taken if the client is allergic to erythromycin, another macrolide antibiotic.

A client is scheduled to receive fidaxomicin. What information should the nurse include in client teaching? SATA 1. Because the drug is not absorbed, it is effective against Clostridium difficile 2. This is one of the medications used for combination therapy of tuberculosis 3. This medication is not effective for treatment of systemic infections 4. Do not stop taking until full course of treatment is completed 5. Do not take if allergic to erythromycin

4 Rationale: Dicyclomine hydrochloride relieves GI smooth muscle spasm, alleviating the symptoms and leading to a balanced state of nutritional and fluid status. Presence of mucus in the stool is one of the Manning criteria associated with irritable bowel syndrome (IBS). During the recovery phase the weight should be stable with no further weight loss. Bowel sounds should be normal, not hypoactive.

A client is taking dicyclomine for irritable bowel syndrome (IBS). Which nursing assessment is the best indicator that the client is self-administering the medication properly? 1. Presence of mucus in stool. 2. Weighs 4.5 kg (10 lb) less than last examination 3. Bowel sounds are hypoactive 4. Nutritional intake within normal ranges

4,2,5,1,3 Rationale: The client is manifesting indications of an infiltrated IV line. The nurse should first stop the infusion. After stopping the infusion, the nurse should remove the peripheral catheter. apply sterile dressing-elevate extremity-apply warm compress to help reabsorb IV fluid that has infiltrated tissue

A client receiving an intravenous infusion of a cephalosporin medication reports pain and irritation at the infusion site. After noting thrombophlebitis at the site, in what order should the nurse complete these actions? 1. Elevate extremity 2. Remove the peripheral catheter 3. Apply a warm compress 4. Stop the infusion 5. Apply a sterile dressing

2 Rationale: All of the drugs listed are histamine 2 (H2)-receptor blockers that inhibit the secretion of gastric acid. Cimetidine interacts with a large number of drugs. Because it decreases the hepatic metabolism of phenytoin therapy. Ranitidine reduces the absorption of several antibiotics.

A client who has a history of a seizure disorder is newly diagnosed with a gastric ulcer. The pt has maintained seizure-free status using phenytoin. The nurse would question a new prescription for which of the following drugs to treat symptoms caused by the ulcer? 1 Famotidine 2 Cimetidine 3 Nizatidine 4 Ranitidine

2 Rationale: Bismuth subsalicylate has a salicylate base and is containdicated in clients who are allergic to aspirin, also known as acetylsalicylic acid. Attapulgite and loperamide may be given safely to a client allergic to aspirin. Diphenoxylate with atropine contains codeine as well as atropine as ingredients.

A client who is allergic to aspirin has acute diarrhea. Based on the aspirin allergy, which medication should the nurse avoid administering? 1. Attapulgite 2. Bismuth subsalicylate 3. Diphenoxylate with atropine 4. Loperamide

1 Rationale: Metoclopramide is a GI stimulant, increasing motility of the GI tract, shortening gastric emptying time, and thus reducing the risk of the esophagus being exposed to gastric contents. Decreased lower esophageal sphincter (LES) tone will increase the risk of gastric contents being regurgitated upward into the esophagus. Because the drug increases GI motility, it can cause diarrhea rather than combating it. GERD can place clients at increased risk for H. pylori bacterial infection; however, anti-infectives would be used to treat this infection.

A client with gastroesophageal reflux disease (GERD) is taking metoclopramide as prescribed. What client is statement indicates to the nurse that the medication intruction was effective? 1. The purpose of this drug is to increase GI motility. 2. This drug will prevent or stop diarrhea from occuring. 3. This drug decreases the tone of the lower esophageal sphincter. 4. This drug kills the H. pylori organism that causes peptic ulcer disease.

1 Rationale: Gram stain testing is a method of classifying bacteria. Bacteria with a thick cell wall retain a purple color after staining and are called gram-positive bacteria. Bacteria with thinner cell walls lose that violet stain and are called gram-negative bacteria. Some antibiotics are only effective for gram positive or gram-negative bacteria, so this is necessary information. Gram stain has no use in determining drug therapy for acute viral infection, parasitic infection, or fungal infection.

A client's sputum specimen is sent to the laboratory for a gram stain testing. The nurse should assess the client for signs of what type of infection? 1. Bacterial 2. Acute viral 3. Parasitic 4. Fungal

2 Rationale: Psyllium mucilloid should be mixed with 8 ounces of water and an additional 8 ounces of water should be consumed after the initial dose to avoid esophageal obstruction. There is no need to refrain from physical activity while taking psyllium mucilloid. Psyllium mucilloid should be mixed in water consumption, not sprinkled on food.

A constipated client is given a prescription to use psyllium mucilloid. What information should the nurse provide during client education about the medicatioin? 1. Refrain from physical activity for 2 hrs 2. Follow the initial dose with an additional 8 oz of water 3. Take an antiemetic 4. Sprinkle the powder formulation on food

2 Rationale: Laxatives are included on the list of drugs in which misuse results in dependence. A healthy client who regularly ingests a laxative needs to be taught about laxatives and physical dependence. A fluid and/or electrolyte imbalance may be present, but the primary focus is to address the cause and not the outcome. Since the client is healthy, one can presume the nutritional status is adequate.

A healthy adult client has been taking a laxative 3 days per week for 9 months. What primary risk should the nurse address in a teaching plan with this client? 1 Risk of electrolyte imbalance 2 Risk of drug dependence 3 Risk of fluid imbalance 4 Risk for inadequate nutritional status

3 Rationale: Since this drug can be nephrotoxic, it would be most important to check BUN and creatinine as indicators of renal function. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) reflect liver function and damage and would be assessed prior to beginning drug therapy as a general routine measure. Serum sodium levels could indirectly reflect renal function, but are not as important as checking direct indicators of kidney function. Monitoring serum protein is not necessary. Diarrhea can be a side effect but the priority assessment is the client's renal function.

A nurse is assigned to a client who has received amphotericin B 0.3 mg/kg/day IV for 5 days. The nurse should place priority on reviewing the client's record for which data? 1. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels 2. Sodium level and serum protein 3. Blood urea nitrogen (BUN) and creatinine 4. Number and consistency of stools in the past 24 hours

3 Rationale: Because it may induce premature labor, castor oil is a Pregnancy Category X preparation. Bisacodyl is Pregnancy Category C. Mineral oil and sodium biphosphate are listed as unknown. It is recommended that the client utilize preventive methods such as adequate dietary fiber and at least 8 glasses of fluid per day.

A pregnant client asks the nurse about laxative use during pregnancy. After recommending that the healthcare provider be consulted before using any drug, the nurse should instruct the client to avoid using which laxative during pregnancy? 1. Bisacodyl 2. Mineral oil 3 Castor oil 4 Sodium biphosphate

A medication regimen that includes phenytoin has controlled the seizures of an adult client for several days. Prior to discharge, the nurse should place highest priority on including which information in the teaching plan? Select all that apply.

Adherence to medication therapy is essential to avoid recurrence of seizures, side effects may include confusion and headache, lab work for drug levels will need to be done routinely

A 71 year old client in long term care has been taking phenytoin 100 mg by mouth 3 times daily for some time. The nurse carries out which most important health promotion measure as prescribed?

Administer calcium supplements as well as vitamin D

4 Rationale: Elevated serum ammonia levels are commonly associated with hepatic encephalopathy. AST and ALT are liver enzymes indicating liver impairment. The enzyme level does not have a direct relationship to the cause of the impaired mental function. BUN and creatinine levels provide evidence of renal function. Bilirubin is elevated and urobilinogen may be normal or decreased in liver disease. Neither test would provide information regarding the hepatic encephalopathy.

After a family member reported altered mental function in a client with end-stage liver disease, the healthcare provider prescribed lactulose 30 mL by mouth, three times daily. The home health nurse reviews the client's chart for which lab test(s) to monitor medication effectiveness? 1 Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) 2 Blood urea nitrogen (BUN) and creatinine 3 Bilirubin and urobilinogen 4 Serum ammonia

2,4,5 Rationale: Discussion of feelings with another person helps the client manage emotional reactions. The nurse does not know why the client manage emotional reactions. The nurse does not know why the client is crying. Although the client is emotionally upset, the nurse is obligated to inform the client of the risks associated with refusing medication. Although the client does need to know that ranitidine is an H2-receptor blocker that reduces gastric acid production, resulting in less exposure of the open crater to irritants, the client does not appear to be ready for teaching. Because it seals the open crater and protects it from gastric contents, misoprostol is commonly used in open-crater gastric ulcers. The nurse should encourage the client to take the medication to reduce risk of perforation.

After being diagnosed with an open cratered gastric ulcer, a 19 yr old female client starts crying and refuses to take the prescribed medications. The nurse should perform which activities at this time? SATA 1 Explain in detail the action of ranitidine 2 Sit with client to allow her to express her feelings 3 Teach client about ways to prevent future ulcerations 4 Explain risks associated with not treating the open-crater gastric ulcer 5 Encourage the client to ingest the dose of misoprostol

2 Rationale: Tetracycline is contraindicated in children less than 8 years of age because it causes permanent tooth discoloration. The prescription should be questioned by the nurse. Drinking through a straw is necessary when administering liquid iron preparations, but not tetracycline. Tooth discoloration is caused by systemic absorption, not direct contact. The drug may cause diarrhea, but this is not the most important consideration. Milk and other diary products will decrease the absorption of tetracycline.

After liquid tetracycline is prescribed for a 2-year-old child, the nurse provides which most important instruction to the LPN/LVN who is administering the medication? 1. Have the client drink the dose through a straw 2. Withhold the dose until I telephone the prescriber 3. Monitor the client for diarrhea 4. Administer with 6-8 ounces of milk

4 Rationale: Loperamide is indicated for the treatment of diarrhea. If this is a new prescription, then critical thinking suggests that the diarrhea is relatively new in onset. Placing a commode at the bedside would provide for proper management of an older adult client with diarrhea. There is no evidence that ingestion of normal dosages of this drug places the client at significant risk for falls or significant changes in V.S.

After noting a new prescription for loperamide 4 mg by mouth, every 6 hrs as needed for a 71-year-old client, the nurse should provide which instruction to unlicensed assistive personnel (UAP)? 1 Set up seizure precautions 2 Set up safety precautions 3 Measure vital signs every 4 hrs 4 Place a commode at the bedside

1,4 Rationale: The client is at risk for developing metabolic acidosis because of increased loss of bowel contents that consist primarily of alkaline fluids. Excessive watery stools or stools that contain blood may indicate pseudomembranous colitis, caused by the toxins released by C. difficile. A stool specimen should be collected as a priority measure. If the cause of the diarrhea is C. difficile, the toxin needs to be eliminated. Antiperistaltic agents or antidiarrheal agents can promote retention of toxins and should not be given. Some fruit juices could further exacerbate diarrhea and would not be encouraged.

After taking amoxicillin for 10 days, the client has developed diarrhea, with approximately eight watery stools per day. The nurse should anticipate the need for which priority interventions? SATA 1. Monitor for clinical manifestations of metabolic acidosis 2. Administer an antiperistaltic agent such as dicyclomine hydrochloride. 3. Administer an antidiarrheal agent such as kaolin and pectin 4. Collect stool specimen for a cytotoxin assay to detect Clostridium difficile 5. Instruct client to increase intake of fruit juices

4 Rationale: Morphine sulfate is the drug of choice of the options listed because it is an opioid analgesic that is strong enough to relieve the pain, and it does not intensify biliary spasms, although this was a widely held notion in the past. Codeine sulfate is not utilized because it is a weaker opioid analgesic, although morphine sulfate is commonly administered. Bethanecol is a cholinergic drug that results increased smooth muscle tone and motility. Dicyclomine is an antispasmodic that could decrease the biliary spasms, but is not an analgesic. The pain is also related to the inflammotory process.

An otherwise healthy client diagnosed with cholecystitis reports to the ED with severe pain. The nurse is most likely to administer which of the following drugs with an appropriate order? 1 Codeine sulfate 2 Bethanecol 3 Dicyclomine 4 Morphine sulfate

1,2,3,4,5 Rationale: Misoprostol is administered for open-cratered gastric ulcers. The nurse may want to elevate the head of the bed because of the high risk of aspiration of blood. Maintaining an airway and breathing are high in priority. One side effect is abdominal pain, and increased restlessness could indicate the client is experiencing pain, making this second in priority. Ingestion of misoprostol can result in diarrhea. To prevent skin breakdown, placing a bed protector beneath the buttocks as the third action will help the skin to remain clean and dry. A log would help determine the bowel pattern and would be done fourth as it is a routine care activity. One side effect of the drug is spotting. This problem lacks the immediacy of aspiration, pain, and maintaining skin integrity, and would be done last if it occurs.

Because magnetic resonance imaging (MRI) revealed an open-cratered gastric ulcer, a semi-comatose female client is receiving misoprostol. In what order should the nurse prioritize directions about client care to the unlicensed assistant personnel (UAP)? Place the activities in order of priority 1 Maintain head of bed at 35 degrees 2 Report restlessness 3 Place bed protector beneath client 4 Keep a log of client's bowel patterns 5 Report vaginal spotting

The healthcare provider has prescribed cyclobenzaprine for a 16 year old football player who sustained a back injury during the first game of the season. The pediatric office nurse provides which instruction to the client and his parents?

Client should report edema of the tongue immediately.

2,3,5 Rationale: Docusate sodium is appropriate for the postoperaive client taking opioid analgesics, the client who had a myocardial infarction 24 hrs ago, and the client with painful hemorrhoids. The client preparing for a colonoscopy would likely use a stimulant laxative. The client trying to reduce the chances of chronic constipation would likely use a bulk-forming laxative.

The nurse concludes that docusate sodium is appropriate for use in which of the following clients? SATA 1 A client preparing for a colonoscopy who needs a bowel prep 2 A postoperative client taking opiod analgesics for pain 3 A client who experienced a myocardial infarction 24 hrs ago 4 A client trying to reduce the chances of chronic constipation 5 A client with painful hemorrhoids

4 Rationale: Metamucil is a bulk-forming laxative that could aggravate diarrhea, and this statement indicates that the client has a lack of understanding. The other statements made by the client are true and indicate proper understanding. Dairy products may aggravate diarrhea and it is helpful to avoid these during a bout of diarrhea. Kaopectate is an antidiarrheal agent that is commonly used to manage this health problem, which is usually self-limiting. The client should contact the healthcare provider if diarrhea persists more than 2 days.

The nurse determines that further instructions are needed if a client with diarrhea makes which statement? 1. I need to avoid intake of dairy products 2. I should take bismuth subsalicylate as directed. 3. I should call my healthcare provider if diarrhea lasts more than 2 days. 4. If the diarrhea persists, I should start taking psyllium mucilloid

A client with chronic depression has a new medication prescription for phenelzine. The nurse calls the prescriber to clarify the prescription if the client is already taking which medications? Select all that apply.

propranolol meperidine carbamazepine

3 Rationale: Clients with eating disorders such as anorexia nervosa or bulimia nervosa are most likely to abuse laxatives. Older adults often believe having a stool every day is healthy and they are also a group that may excessively use laxatives, but they are not as at risk as clients who have eating disorders. Clients with irritable bowel syndrome (IBS) are not likely to disturb the GI tract with drugs that could further irritate the tissue. Clients who are obese are more likely to be inactive and ingest diets high in fat and cholesterol.

The nurse is selecting candidates for a health screening project regarding the abuse of laxatives. The best client group includes which of the following? 1 Older adult clients with congestive heart failure (CHF) 2 Clients with irritable bowel syndrome (IBS) 3 Clients with bulima nervosa or anorexia nervosa 4 Clients who are obese

4 Rationale: NRTIs suppress production of reverse transcriptase, which prevents conversion of viral RNA to DNA similar to human DNA. Entry inhibitors work by blocking attachment of the HIV virus to the host cell. Protease inhibitors block protease (which is needed for cell replication) and are used in conjunction with other drugs to reduce the viral load in HIV. NNRTI drugs work by reducing the synthesis of reverse transcriptor A.

The nurse is teaching a group of clients who are infected with HIV about the various available drug treatments. Which point of information would be important for the nurse to explain during the discussion using appropriate terminology? 1. Entry inhibitors enhance release of reverse transcriptase 2. Protease inhibitors are the most potent anti-HIV 3. Nonnucleoside reverse transcriptase inhibitors (NNRTIs) prevent replication of HIV 4. Nucleoside transcriptase inhibitors (NRTIs) suppress production of reverse transcriptase

1 Rationale: A full course of antibiotic therapy must be taken in order to decrease the risk of resistance to the antibiotic or recurrence of the infection. Missed doses should be taken as soon as they are remembered and the dose should not be doubled. Antibiotic doses are to be taken at regular intervals spaced throughout the 24 hours, w/o interrupting sleep when possible, to maintain effective therapeutic blood level of the antibiotic. Chewable tablets must be crushed or chewed of the drug may not absorb adequately. Attempting to swallow chewable tablets could also put the client at risk for airway obstruction.

The nurse should conclude that a client with bacterial pneumonia understands self-administration of a prescribed oral antibiotic after the client makes which statement? 1. I will continue to take the antibiotic as it is prescribed, even though I no longer have a cough with yellow sputum 2. When I missed a does of my antibiotic this morning, I made up by taking two doses at the time of the next dose 3. I am careful to take the antibiotic every day at break-fast, lunch, and dinner 4. Even though my provider prescribed a chewable tablet, I have no problem swallowing it whole

1,2,3,5 Rationale: Mineral oil should not be administered to clients with swallowing problems due to increased risk of aspiration leading to lipoid pneumonia. If a drug that may increase peristalsis is introduced, it may intensify the signs or symptoms or blur the clinical picture in a client with appendicitis. The client with fecal impaction needs to be disimpacted and may require enemas. Steatorrhea causes excessive stimulation of peristalsis because of the excessive fat content in the stool. There is no contraindication to giving this medication to a client with occasional heartburn, since this is likely due to food intolerance.

The nurse should consult with the prescriber if oral mineral oil is prescribed for which of the following clients? SATA 1. Client with dysphagia following a cerebral vascular accident (CVA) 2. Client who has suspected appendicitis 3. Client who has a fecal impaction 4. Client who has infrequent heartburn 5. Client who has steatorrhea

2 Rationale: Taking mebendazole with fatty food will help to improve absorption. The tablets may be chewed for a maximum effectiveness, swallowed whole, crushed, or mixed with food. Mebendazole does not cause photosensitivity so sunscreen is not necessary because of this drug. It may cause abdominal cramping and diarrhea, but not constipation.

The nurse should include which information when instructing a client who has been started on mebendazole for the treatment of pinworms? 1 Do not chew or crush the tablets 2 Take the medication with fatty foods 3 Use sunscreen when going outdoors 4 The drug may cause constipation

4 Rationale: There is a small chance that the client may have a cross-allergenicity with penicillin, and it is worth discussing with the prescriber, who may choose a drug from another category. The BUN is within normal limits. It is expected that granulocytosis (such as elevated neutrophils) would occur in response to a bacterial infection. It is common practice to collect the specimen for culture and sensitivity (C+S), then begin therapy with a broad-spectrum antibiotic, which can be changed if the C+S reveals that a different drug would be more appropriate.

The prescriber has just ordered cefdinir, a third-generation cephalosporin, for a client with a staphylococcal infection. The nurse collaborates with the prescriber about which data R/T the client? 1. Blood urea nitrogen (BUN) 14 mg/dL 2. Elevated granulocyte count 3. Culture and sensitivity (C+S) results not yet available 4. History of Type I hypersensitivity to penicillin

1 Rationale: Anticholinergic effects include drying of mucous membranes, dilated pupils, and decreased motility of the GI tract, which may result in constipation. Pupillary constriction, bronchoconstriction, and bradycardia are the opposite of anticholinergic outcomes. The parasympathetic system participates in establishing an erection, hence, blockers would result in erectile dysfunction, and the drugs increase the HR. Because dry mouth is an anticholinergic effect, excessive salivation is incorrect.

When the nurse teaches a client about the side effects of anticholinergic medications, what set of signs or symptoms should be included? 1 Urinary retention, constipation, or dilated pupils 2 Pupillary constriction, bronchoconstriction or bradycardia 3 Inability to obtain an erection, irregular heart rhythm 4 Increased salivation, dysphagia, confusion, restlessness

2,5 Rationale: Aminoglycosides, such as tobramycin, can cause ototoxicity and nephrotoxicity. The nurse should review the client's creatinine level to detect onset of nephrotoxicity. The nurse should assess for ringing in the ears as an indicator of ototoxicity. Hand strength is a routine neurologic assessment that is not required during aminoglycoside therapy. ALT levels are an indicator of liver function. Amylase levels are an indicator of pancreatic functioin.

When assessing a client for toxicities associated with tobramycin therapy, the nurse should include evaluation of which client data? SATA 1. Hand strength 2. Creatinine levels 3. Alanine aminotransferase (ALT) levels 4. Amylase levels 5. Ringing in the ears

3 Rationale: Flushing of the face, neck, and chest, which is known as "red man syndrome" or "red neck syndrome," is associated with too-rapid administration of vancomycin. Hypotension, not hypertension, is associated with vancomycin administration. Vancomycin may cause nausea, but not projectile vomiting. Vancomycin is often used to treat C. diff., associated with pseudomembranous colitis. This complication is not associated with speed of transfusion.

When hanging an IV dose of vancomycin, the nurse administers the drug over 90 minutes to prevent which speed-related adverse drug effect? 1. Hypertension 2. Projectile vomiting 3. Flushing of face, neck, and chest 4. Pseudomembranous colitis

1,3,4,5 Rationale: Isoniazid can be hepatotoxic and aspartate aminotransferase (AST) levels refect liver inflammation or damage. The pt should be monitored for elevated levels. Antacids interfere with absorption of isoniazid when taken within 1-2 hours of the isoniazid, so the nurse should ensure that ingestion of the antacid dose is seperated from the isoniazid dose by 2 hours. Vit B6 should be administered with isoniazid therapy to reduce the incidence of peripheral neuritis. Thrombocytopenia is an adverse effect of isonizid, which can lead to the potential for bleeding and excessive brusing. Isoniazid can cause hypocalcemia, not hypercalcemia.

When overseeing drug therapy for a client taking isoniazid, the nurse should assess for which of the following? SATA 1. Elevated aspartate aminotransferase (AST) 2. Clinical manifestations hypercalcemia 3. Concurrent self-administration of aluminum antacids 4. Compliance with ingestion of pyridoxine vitamin Vitamin B6 supplements 5. Excessive bruising on the skin

3,5 Rationale: The tablets should not be crushed because it can alter drug release for absorption. Erythromycin can cause severe diarrhea with life-threatening pseudomembranous colitis, so the provider should be notified if this occurs. Erythromycin should be taken with a full glass of water for best absorption. Fruit juices and some carbonated beverages can interfere with complete absorption and so should be avoided. Abdominal fullness is a vague symptom that is not expected during therapy with erythromycin therapy, because it is a mavrolide antibiotic, not an aminoglycoside.

Which client statement indicates an understanding of the use of erythromycin? SATA 1. I will always take this medication with fruit juices 2. If I experience abdominal fullness I will contact my provider 3. I know I should not crush the pills 4. I understand it is common to have some hearing loss while taking this medication 5. I will let my provider know if I begin to have a lot of diarrhea

4 Rationale: Acyclovir can be nephrotoxic and so it is important to ensure high fluid intake to keep the client well hydrated and perfuse the kidneys. Acyclovir is not hepatotoxic. It would not be necessary to avoid sexual intercourse while taking this medication. Acyclovir drug may cause headaches and nausea and vomiting, but not insomnia

Which intervention is of highest priority for the nurse working with a client who has herpes zoster (shingles) and who recently began drug therapy with acyclovir? 1. Monitor for jaundice and elevated liver enzymes 2. Teach client to avoid sexual intercourse during therapy 3. Administer the dose early in the day, as it may cause insomnia 4. Encourage fluid intake of 2,500-3,000 mL daily if not contraindicated

3 Rationale: A different gloved finger or a different finger cot should be used to apply acyclovir to each lesion not only to prevent spread of the virus. Hand hygiene is a standard precaution associated with infection control for all clients. One thin layer of medication is sufficient. Not sharing medication with others is a universal principle associated with drug therapy.

Which statement by an immunocompromised client to the nurse best indicates that the client understands self-application of the topical drug acyclovir? 1. I need to wash my hands for at least 10 seconds before and after applying the drug 2. I need to apply several thin layers of the medication on the lesions 3. I need to avoid touching the lesions and opening the container with the same finger cot 4. I should not allow anyone else to use this drug

1 Rationale: Ingesting alcoholic beverages with metronidazole can result in a disulfiram reaction, including exaggerated sympathomimetic signs/symptoms. Headache, constipation, and vaginal dryness may occur and can be easily managed, but are not as significant as tachycardia and flushing.

While teaching the client about newly prescribed oral metronidazole, what information would be most important for the nurse to include? 1. Avoid intake of alcoholic beverages 2. Headache may accompany drug ingestion 3. Drug may cause constipation 4. Drug may cause vaginal dryness

An opioid analgesic has been administered to a client postoperatively. The nurse should make which priority follow up assessments? Select all that apply.

respiratory rate and level of consciousness, blood pressure and heart rate, pain level

The nurse should include in a teaching plan for a client diagnosed with seizure disorder that which drug groups can potentiate the effects of the prescribed carbamazepine?

anorexiants and amphetamines

Because a healthcare provider prescribed levodopa for a client newly diagnosed with Parkinson disease, the nurse should place a high priority on teaching the client which information prior to discharge?

avoid taking medication with high protein foods

Methylphenidate is newly prescribed for a client with narcolepsy. The nurse should report which priority health history component to the prescriber?

congestive heart failure (CHF)

The client with a spinal cord injury is taking dantrolene for spasticity. The nurse should instruct the client to notify the healthcare provider immediately if which adverse effects occur? Select all that apply.

persistent diarrhea abdominal pain, scleral jaundice painful urination and urinary frequency

The provider prescribed methylphenidate for a client diagnosed with attention-deficit/hyperactivity disorder (ADHD). The nurse should question the prescription if the client has which contraindication?

history of Tourette syndrome