pharm nclex remidiation
A client has been prescribed oxybutynin for treatment of overactive bladder and has been experiencing anticholinergic side effects. List two (2) actions the client will take to prevent adverse effects of the medication therapy.
1. Anticholinergic effects: increase daily fiber, increase fluids 2-3L/day, avoid driving if vision is impaired. 2. Monitor EKG because this medication can cause prolonged QT wave.
A nurse is placing an IV line on an older adult client. List three (3) considerations the nurse should take when placing an IV line in this client?
1. Assess for allergies to latex, iodine, or tape. 2. Distal vein first in nondominant hand 3. Insertion of IV at 15-20-degree angle
A nurse is administering a unit of packed red blood cells (PRBCs) to a client. What symptoms would indicate circulatory overload? Name three (3) clinical manifestations
1. Cough 2. Sob 3. Crackles 4. Tachycardia 5. Htn Interventions: 1. If manifestations occur stop the transfusion, place the client in a sitting position with legs down and notify the provider. 2. Prior to any transfusion, assess kidney, respirtory, and cardiovascular function for risk of overload. 3. In older adults or clients at risk for overload, transfuse 1 unit of PRBCs over 2-4 hour. Monitor vital sings every 15 minutes throughout transfusion.
The client has been ordered ranitidine. List three (3) teaching points to discuss with the client prior to the first administration.
1. Need to report nausea, constipation, diarrhea. 2. Avoid drinking alcohol 3. Avoid caffeinated beverages
A nurse is caring for a client with many different medications who is newly prescribed acetazolamide-reduction of aqueous humor through diuresis in kidneys. What medications can interact with acetazolamide?
Aspirin, quinidine, lithium, phenytoin, sodium bicarbonate.
A nurse is caring for a client who has a new prescription for raloxifene. What are contraindications for this medication that the nurse should discuss with the client?
Contraindications: pregnancy, history of venous thromboembolism, stop 3 days before period.
A nurse is caring for a client who has a new prescription for alosetron. What are the expected therapeutic effects of this medication?
Evidence can by relief of diarrhea and decrease in urgency and frequency of defecation. This is used for female clients that have severe IBS-D that has lasted more than 6 months and has been resistant to conventional management.
A nurse has provided education to a client who has a new prescription for brimonidine ophthalmic drops. What statements by the client would indicate they understand the instructions?
I should not rub my eyes. I should report dilated pupils, blurred vision, headache, dry mouth. Reddened sclera is a common side effect.
A nurse is administering gemfibrozil to a client with elevated cholesterol. Identify two (2) adverse effects related to this medication.
Jaundice, anorexia, and upper abdominal discomfort can be findings in liver impairment, which can occur in clients taking gemfibrozil. Also, myopathy.
A nurse is preparing to administer a topoisomerase inhibitor to a client with ovarian cancer. What are adverse effects the nurse should monitor when administering this medication?
Nausea, vomiting, assess for bleeding gums and bruising, instruct people to avoid crowds related to neutropenia, alopecia.
A nurse is caring for a client with asthma who asks if Montelukast sodium can be taken for acute asthma symptoms. When should Montelukast sodium be taken?
Once daily at bedtime. For exercise induced bronchospasms, take 2 hours before exercise.
A client has a new prescription for salmeterol. The nurse is teaching the client about adverse effects of the medication. What instructions should the nurse include in this education?
Salmeterol can cause headaches, nervousness, palpitations, tachycardia, abdominal pain, diarrhea, nausea, muscle cramps, soreness, trembling, paradoxical bronchospasm and cough.
A critical care client is in need of adenosine. What is the indication of this medication and how is this medication administered?
Supraventricular tachycardia. Administer IV bolus flush with saline following administration.
A nurse is instructing a client who has a new prescription for nitroglycerin transdermal patch about administration. What instructions should the nurse include?
To ensure appropriate dose, patches should not be cut. Place the patch on a hairless area of skin (chest, back, or abdomen) and rotate sites to prevent skin irritation. Remove old patch, wash skin with soap and water, and dry thoroughly before applying new patch. Remove the patch at night to reduce the risk of developing tolerance to nitroglycerin. Be medication free between 10 and 12 hr./day.
What class of medication is amitriptyline and why is this medication used as an adjuvant medication for pain?
Tricyclic antidepressant. Adjuvant medications for pain are used with a primary pain medication, usually an opioid agonist, to increase pain relief while reducing the dosage of the opioid agonist.
A client is to take metronidazole. List three (3) teaching points to review with the client prior to administering the first dose.
• Can cause GI discomfort- advise client to take with food. •Can cause darkening of urine- advise client that this is normal. •Can cause numbness of extremities, ataxia, and seizures- Stop medication and notify physician