Pharm questions 2

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A client has been taking diazepam (Valium) for three months. The nurse determines that the outcome of medication therapy has been successful when the client makes which statement? "I feel like I am able to cope with routine stress at my job." "I like this medication. I know that I needed it to treat my anxiety, which is now better, but I think it just makes me feel good, so I am planning to stay on it for quite a while." "I thought this medication would make me think clearly, but I don't feel any change in my feelings." "I will need to take this medication for the rest of my life."

"I feel like I am able to cope with routine stress at my job." Objective: Use the nursing process to care for clients receiving drug therapy for anxiety and insomnia. Rationale: To answer this question correctly, the statement by the client needs to clearly show that she has experienced the expected benefit of the medication therapy. Diazepam is a benzodiazepine used in the treatment of anxiety, seizure disorders, alcohol withdrawal syndrome, and muscle relaxation.

The nurse evaluates that the patient has understood discharge teaching regarding warfarin (Coumadin) based on which statement? "I will double my dose if I forget to take it the day before." "I should keep taking ibuprofen for my arthritis." "I should decrease the dose if I start bruising easily." "I should use a soft toothbrush for dental hygiene."

"I should use a soft toothbrush for dental hygiene." Correct This statement is accurate and will reduce the risk of bleeding. Ibuprofen will potentiate bleeding. The patient should call the health care provider if experiencing excessive bruising.

A patient is receiving warfarin (Coumadin) for a chronic condition. Which patient statement requires immediate action by the nurse? "I will avoid contact sports." "I will take my medication in the early evening each day." "I will increase dark-green, leafy vegetables in my diet." "I will contact my health care provider if I develop excessive bruising."

"I will increase dark-green, leafy vegetables in my diet." Correct Dark-green, leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Rather than increase the intake of these, it is important to maintain a consistent daily intake of vitamin K. The patient should monitor his or her incidence of bruising carefully. The medication will usually be ordered for the patient to take in the morning.

A patient is started on warfarin (Coumadin) therapy while also receiving intravenous heparin. The patient is concerned about the risk for bleeding. What will the nurse tell the patient? "Your concern is valid. I will call the doctor to discontinue the heparin." "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." "Because of your valve replacement, it is especially important for you to be anticoagulated. The heparin and warfarin together are more effective than one alone." "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications."

"It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." Correct Warfarin works by decreasing the production of clotting factors. However, it takes approximately 3 days for the body to metabolize present clotting factors and thus achieve a therapeutic anticoagulant effect. Because of this, heparin is continued until this is achieved.

A client is beginning to take trimethoprim-sulfamethoxazole (Bactrim) for a recurrent urinary tract infection (UTI). The nurse would give the client which of the following instructions regarding this medication?

"Take each dose with 8 oz of water and drink extra water each day."

The client is prescribed digoxin (Lanoxin) for treatment of HR. Which of the following statements by the client indicates the need for further teaching by the nurse? "I should not get short of breath anymore." "This drug will help my heart muscle pump less." "I may notice my heart rate decrease." "I may feel tired during early treatment."

"This drug will help my heart muscle pump less." Rationale: The ability to increase the strength of contractions is a characteristic of cardiac glycosides. It may result in a decrease in pulse. Initially the client may experience some fatigue. Symptoms of CHF, such as dyspnea, should improve.

Acetazolamide (Diamox) is used to treat which disorder? Select all that apply

*Edema associated with heart failure *High-altitude sickness *Open-angle glaucoma

A client who has overdosed on amphetamine sulfate and dextroamphetamine (Adderall XR) is admitted to the emergency department. The nurse would anticipate which medications to be administered to assist in counteracting the effects of the overdosage? 1. Chlorpromazine (Thorazine) 2. Phenytoin (Dilantin) 3. Propofol (Diprivan) 4. Dexamethasone (Decadron

A client with a UTI also has a history of glucose-6-phosphate dehydrogenase (G6PD) deficiency. Based on the nurse's understanding of urinary drugs, the nurse would expect to administer which drug with caution if prescribed? 1. Nitrofurantoin (Macrobid) 2. Amoxicillin (Amoxil) 3. Ciprofloxacin (Cipro) 4. Methenamine (Hiprex)

A client with chronic glaucoma is being started on medication therapy with acetazolamide. The nurse teaches the client that which symptoms that can occur early in use subsides or disappears in time? 1. Diuresis 2. Fatigue 3. Headache 4. Loss of libido

A nurse is caring for a client who is experiencing amphetamine withdrawal. The nurse should assess the client for which of the following? 1. Disturbed sleep 2. Increased yawning 3. Psychomotor agitation 4. Inability to concentrate

After an adolescent diagnosed with attention deficit-hyperactivity disorder (ADHD) begins methylphenidate (Ritalin) therapy, a nurse notes that the adolescent loses 10 pounds in a 2-month period. What is the best explanation for this weight loss? 1. The pharmacological action of Ritalin causes a decrease in appetite. 2. Hyperactivity seen in ADHD causes increased caloric expenditure. 3. Side effects of Ritalin cause nausea, and, therefore, caloric intake is decreased. 4. Increased ability to concentrate allows the client to focus on activities rather than food.

The nurse is evaluating the therapeutic effects of milrinone (Primacor). The nurse knows that this drug is given to: 1. Increase the force of cardiac contractions and improve cardiac output. 2. Decrease the volume of the cardiac output to reduce hypertension. 3. Relax the myocardial muscle, decreasing the myocardial oxygen requirements. 4. Inhibit cardiac irregularities, decreasing the sensation of palpitations.

nurse is reading the laboratory results for a client being treated with carbamazepine (Tegretol) for prophylaxis of complex-partial seizures. The nurse interprets that which of the following values is consistent with an adverse reaction to this medication? 1. White blood cell count 3200/mm3 2. Blood urea nitrogen 19 mg/dL 3. Sodium 136 mEq/L 4. Platelet count 350,000/mm3

Metronidazole (Flagyl) is being used to treat a client's Gardia lamblia infection, a protozoal infection of the intestines. Which of the following are appropriate to teach this client? (Select all that apply.) 1. Metronidazole may leave a metallic taste in the mouth. 2. The urine may turn dark amber brown while on the medication. 3. The metronidazole may be discontinued once the diarrhea subsides to minimize adverse effects. 4. Taking the metronidazole with food reduces GI upset. 5. Current sexual partners do not require treatment for this infection

1, 2, 4, 5

A nurse is caring for a client receiving nitrofurantoin drug therapy. What instruction should the nurse include in the teaching plan for the client and family? Select all that apply 1. Notify the doctor in case of fever, chills, or cough 2. Avoid excessive intake of citrus products or milk products 3. Continue therapy for at least 1 week 4. Dissolve the drug in 90-120 mL of water 5. Take the drug with food or milk to improve absorption

1, 3, 5

A nurse is providing teaching to a client who has a new prescription for digoxin (Lanoxin) Which of the following may indicate dig toxicity & should be reported to the provider? 1. Fatigue 2. constipation 3. Anorexia 4. Rash 5. Diplopia

1. Fatigue Not constipation but -- nausea, vomiting & diarrhea 3. Anorexia b/c GI disturbances 5. Diplopia -- visual changes , halo, yellow-tinged vision.

Which of the following symptoms are seen when a client abruptly stops taking diazepam (Valium)? Select all that apply. 1. Insomnia. 2. Tremor. 3. Delirium. 4. Dry mouth. 5. Lethargy.

1. Insomnia is correct. 2. Tremor is correct. 3. Delirium is correct.

A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the (HCP) if the client is taking which medication? 1. Vitamin A 2. Digoxin (Lanoxin) 3. Furosemide (Lasix) 4. Phenytoin (Dilantin)

1. Vitamin A Rationale: Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. Options 2, 3, and 4 are not contraindicated with the use of isotretinoin.

A client tells the nurse that he used amphetamines to be productive at work. The nurse is aware that abrupt discontinuation of the drug will produce which symptom? 1. Severe anxiety 2. Increased yawning 3. Altered perceptions 4. Amotivational syndrome

1. When amphetamines are abruptly discontinued, the client may experience severe anxiety or agitation.

The nurse is reviewing the laboratory test results for a 68-year-old patient whose warfarin (Coumadin) therapy was terminated during the preoperative period. The nurse concludes that the patient is in the most stable condition for surgery after noting which INR (international normalized ratio) result? 1.0 1.8 2.7 3.4

1.0 The therapeutic range for INR is 2.0 to 3.0 for many clinical diagnoses. The larger the INR number, the greater the amount of anticoagulation. For this reason, the safest value before surgery is 1.0, meaning that the anticoagulation has been reversed.

Isotretinoin (Accutane) is prescribed for a client to treat severe cystic acne. The nurse tells the client that the length of the usual prescribed course of treatment is which?

15 to 20 weeks

A client has been receiving nitrofurantoin sodium (Macrodantin). The nurse determines that the therapy is effective if which result is noted? 1. Cessation of cough 2. Absence of dysuria 3. Relief of chest pain 4. Decreased urge for cigarettes

The nurse is assessing a patient who is receiving antiepileptic drug therapy with phenytoin. What assessment finding requires immediate action? A. Pale skin B. Weight gain C. Nystagmus D. Heart rate 60 beats/min

A family tells the nurse that they are concerned about a family member who stopped using amphetamines 3 months ago and is now acting paranoid. What is the best response by the nurse? 1. " A person gets symptoms of paranoia with polysubstance abuse." 2. " When a person uses amphetamines, paranoid tendencies may continue for months." 3. " Sometimes, family dynamics and a high suspicion of continued drug use make a person paranoid." 4. " Amphetamine abusers may have severe anxiety and paranoid thinking."

A nurse observed that during play therapy, a patient is unable to follow the rules of the game and has conflict with peers. Which of these drugs would you anticipate would be administered to the patient? 1. Botulinum Toxin type A (Botox) 2. Methylphenidate (Ritalin) 3. Naltrexone (Revia) 4. Diphenhydramine (Benadryl)

A patient with attention deficit hyperactivity disorder (ADHD) is prescribed methylphenidate (Daytrana) transdermal patch. How frequently should the nurse change the patch? 1. Once a week 2. Once a day 3. Three times a week 4. Three times a day

Epoetin alfa (Epogen) is prescribed for a client diagnosed with chronic renal failure. The client asks the nurse about the purpose of the medication. The appropriate response would be which of the following? 1. It is used to lower your blood pressure. 2. It is used to treat anemia. 3. It will help to increase the potassium level in your body. 4. It is an anticonvulsant medication given to all clients after dialysis to prevent seizure activity.

The 24-year-old female client with bipolar disorder is prescribed valproic acid (Depakote), an anticonvulsant medication. Which question should the nurse ask the client? 1. "Have you ever had a migraine headache?" 2. "Are you taking any type of birth control?" 3. "When was the last time you had a seizure?" 4. "How long since you have had a manic episode?"

Which drug does a nurse anticipate may be prescribed to produce diuresis and inhibit formation of aqueous humor for a client with glaucoma? 1 Chlorothiazide (Diuril) 2 Acetazolamide (Diamox) 3 Bendroflumethiazide (Naturetin) 4 Demecarium bromide (Humorso

Which therapeutic outcome would the nurse consider more significant in evaluating a client who started atomoxetine (Strattera) 6 months ago? 1. Decrease in attention 2. Decrease in hyperactivity 3. Development of mydriasis 4. Elevated liver enzymes

then nurse instructs the parent of a child with ADHD to administer methylphenidate (ritalin) before 4 pm. which side effect is the nurse addressing by giving this instruction? 1. nausea 2. insomnia 3. lethargy 4. anorexia

The client is to begin taking atorvastatin (Lipitor) and the nurse is providing education about the drug. Which symptom related to this drug should be reported to the health care provider? 1. Constipation 2. Increasing muscle or joint pain 3. Hemorrhoids 4. Flushing or "hot flash"

2 Rationale: "Statins" (HMG-CoA reductase inhibitors) such as atorvastatin (Lipitor) may cause rhabdomyolysis, a rare but serious adverse effect

A client has been prescribed nitrofurantoin (Macrodantin) for treatment of a lower urinary tract infection. Which of the following instructions should the nurse include when teaching the client how to take this medication? Select all that apply. 1. "Take the medication on an empty stomach." 2. "Your urine may become brown in color." 3. "Increase your fluid intake." 4. "Take the medication until your symptoms subside." 5. "Take the medication with an antacid to decrease gastrointestinal distress."

2, 3. Clients who are taking nitrofurantoin (Macrodantin) should be instructed to take the medication with meals and to increase their fluid intake to minimize gastrointestinal distress. The urine may become brown in color. Although this change is harmless, clients need to be prepared for this color change. The client should be instructed to take the full prescription and not to stop taking the drug because symptoms have subsided. The medication should not be taken with antacids as this may interfere with the drug's absorption.

Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed? 1. Platelet count 2. Triglyceride level 3. Complete blood count 4. White blood cell count

2. Triglyceride level Rationale: Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been evaluated. Options 1, 3, and 4 do not need to be monitored specifically during this treatment.

A nurse is caring for an older adult client who has a new prescription for digoxin and takes multiple other medications. concurrent use of which of the following medications places the client at risk for dig toxicity? 1. Phenytoin (Dilantin) 2. Verapamil (Calan) 3. Warfarin (Coumadin) 4. Aluminum hydroxide (Amphojel)

2. Verapamil (Calan) -- CCB, can increase digoxin levels. if used together dig dosage may need to be lowered.

The nurse is caring for a patient with a recent history of deep vein thrombosis (DVT). The patient now needs to undergo surgery for appendicitis. The nurse is reviewing the laboratory results for this patient before administering an ordered dose of vitamin K. The nurse determines that the medication is both safe to give and is most needed when the international normalized ratio (INR) is which result? 1.0 1.2 1.6 2.2

2.2 Vitamin K is the antidote to warfarin (Coumadin), which the patient has most likely been taking before admission for treatment of DVT. Warfarin is an anticoagulant that impairs the ability of the blood to clot. Therefore it is necessary to give vitamin K before surgery to reduce the risk of hemorrhage. The largest value of the INR indicates the greatest impairment of clotting ability, making 2.2 the correct selection.

A 10 year old child has been evaluated for a learning disability and has been diagnosed with absence seizures. Ethosuximide (Zarontin) has been ordered and the nurse is teaching the client and family about the drug. Because of the client's age, it is important to include instructions to: 1. Curtail after-school sports activities because the drug's metabolism may be increased with physical activity. 2. Increase intake of calcium rich foods and vitamin D to prevent bone loss. 3. Monitor height and weight weekly to be sure GI side effects are not hindering nutrition and normal growth. 4. Increase fluid intake to avoid dehydration caused by the drug.

A client has been ordered gemfibrozil (Lopid) for hyperlipidemia. The nurse will first validate the order with the health care provider if the client reports a history of what disorder? 1. Hypertension 2. Angina 3. Galbladder disease 4. Tuberculosis

A client who is taking methylphenidate (Concerta/Ritalin) for ADHD reports having insomnia. Which intervention will assist in the promotion of sleep? 1. Have a glass of wine with dinner. 2. Eat a chocolate bar at bedtime. 3. Take the drug before 4 pm. 4. Switch to decaf coffee.

A client with a urinary tract infection is beginning medication therapy with nitrofurantoin (Macrodantin). The nurse realizes further instructions are necessary if the client states he will need to avoid which item? 1. Oranges 2. Prunes 3. Rhubarb 4. Cranberries

A high school student taking atomoxetine (Strattera) for ADHD disorder visits the school nurse's office and confides "I am so depressed. The world would be better off without me." Which actions would the nurse take for this client. 1. Tell the client to stop taking atomoxetine immediately and not to take it until checking with the provider. 2. Assure the client that these are normal symptoms because the drug may 3 or 4 weeks to work. 3. Alert the family or caregiver that immediate attention and treatment are needed for these symptoms. 4. Have the client increase intake of caffeine by consuming cola products, coffee, or tea to counteract the depressive effect.

Carbamazepine (Tegretol) has been prescribed for a 24-year-old for the control of partial seizures. The nurse will teach the client to immediately report: 1. Blurred vision 2. Leg cramps 3. Blister-like rash 4. Lethargy

Dextroamphetamine (Dexedrine) has been ordered for a client diagnosed with narcolepsy. The nurse understands that this medication acts as: 1. an antianxiety agent. 2. a central nervous system (CNS) depressant. 3. a CNS stimulant. 4. a mood stabilizer

The nurse is administering methylphenidate (Ritalin) to a child. Following medication administration, the nurse observes a disturbance in the child's regular sleep pattern. The nurse reports this to the primary health care provider. What instruction is the nurse most likely to receive from the primary health care provider? 1. "Administer lithium (Lithium) as prescribed." 2. "Make the patient's room environment conducive for sleep." 3. "Reduce the dose of methylpenidate (Ritalin)." 4. "Administer atomoxetine (Strattera) to the patient."

he client has Pickwickian syndrome and falls asleep at inappropriate times. Which medication should the nurse prepare to administer? 1. Maximum Strength NoDoz, a caffeine drug 2. An inhaled steroid in a bi-pap machine for nighttime sleep 3. Modafinil (Provigil), a central nervous system stimulant 4. Amitriptyline (Elavil), a tricyclic antidepressant

A client with a urinary tract infection is to take nitrofurantoin (Macrodantin) four times each day. The client asks the nurse, "What should I do if I forget a dose?" What should the nurse tell the client? 1. "You can wait and take the next dose when it is due." 2. "Double the amount prescribed with your next dose." 3. "Take the prescribed dose as soon as you remember it, and if it is very close to the time for the next dose, delay that next dose." 4. "Take a lot of water with a double amount of your prescribed dose

3. Antibiotics have the maximum effect when a blood level of the medication is maintained. However, because nitrofurantoin (Macrodantin) is readily absorbed from the gastrointestinal tract and is primarily excreted in urine, toxicity may develop by doubling the dose. The client should not skip a dose if she realizes that she has missed one. Additional fluids, especially water, should be encouraged, but not forced to promote elimination of the antibiotic from the body. Adequate fluid intake aids in the prevention of urinary tract infections, in addition to an acidic urine.

A nurse provides instructions regarding the use of permethrin 1% (Nix) to the parents of a child who has been diagnosed with pediculosis capitis (head lice). Which statement by a parent indicates the need for further instruction? 1. "The hair should not be shampooed for 24 hours after treatment." 2. "The medication can be obtained over the counter in a local pharmacy." 3. "The medication is applied to the hair after shampooing and left on for 24 hours." 4. "The medication is applied to the hair after shampooing, left on for 5 to 10 minutes, and then rinsed out."

3. "The medication is applied to the hair after shampooing and left on for 24 hours." Permethrin 1% is an over-the-counter anti-lice product that kills lice and eggs with one application and that has residual activity for 10 days. It is applied to dried hair after shampooing and left for 5 to 10 minutes before it is rinsed (not shampooed) out. The hair should not be shampooed for 24 hours after the treatment.

The nurse has reinforced instructions to a client who has been prescribed cholestyramine (Questran). Which statement by the client indicates a need for further instructions? 1. "I will continue taking vitamin supplements." 2. "This medication will help lower my cholesterol." 3. "This medication should only be taken with water." 4. "A high-fiber diet is important while taking this medication."

3. "This medication should only be taken with water." Rationale: Cholestyramine (Questran) is a bile acid sequestrant used to lower the cholesterol level, and client compliance is a problem because of its taste and palatability. The use of flavored products or fruit juices can improve the taste. Some side effects of bile acid sequestrants include constipation and decreased vitamin absorption.

A patient is receiving a thrombolytic agent, alteplase (Activase), following an acute myocardial infarction. Which condition is most likely attributed to thrombolytic therapy with this agent? 1 Skin rash with urticaria 2 Wheezing with labored respirations 3 Bruising and epistaxis 4 Temperature elevation of 100.8º F

3. Bruising and epistaxis Rationale: Thrombolytic agents dissolve existing clots rapidly and continue to have effects for 2 to 4 days. All forms of bleeding must be monitored and reported immediately.

A client taking metronidazole for the treatment of Trichomonas vaginalis calls the nurse employed in the health care provider's office and is concerned because the color of the urine is very dark. Which information should the nurse provide to the client? 1. Increase fluid intake. 2. Discontinue the medication. 3. The darkening of the urine is a harmless side effect. 4. Report to the clinic to see the health care provider immediately.

3. The darkening of the urine is a harmless side effect. Rationale: Metronidazole can produce a variety of untoward effects, but these rarely require termination of treatment. Harmless darkening of the urine may occur, and the client should be forewarned of this effect. The nurse would not instruct the client to discontinue the medication. It is not necessary for the client to see the health care provider. Increasing fluid intake is a good health measure but will not prevent this side effect from occurring.

A 32 year-old female client is started on metronidazole (Flagyl) for treatment of a trichomonas vaginal infection. What must the client eliminate from her diet for the duration she is on this medication? 1. Caffeine 2. Acidic juices 3. Antacids 4. Alcohol

A client on the nursing unit has a prescription for dextroamphetamine (Dexedrine) orally daily. The nurse collaborates with the dietitian to limit the amount of which of the following items on the client's dietary trays? 1.Fat 2.Protein 3.Starch 4.Caffeine

A client who is receiving carbamazepine (Tegretol) daily has a white blood cell (WBC) count of 2800 cells/mm3, blood urea nitrogen (BUN) of 17 mg/dL, sodium of 141 mEq/L, and uric acid of 5 mg/dL. The nurse makes which interpretation, based on these laboratory values? 1. The uric acid level is elevated, indicating the risk for renal calculi. 2. The sodium level is low, indicating an electrolyte imbalance. 3. The BUN is elevated, indicating nephrotoxicity. 4. The WBC count is low, indicating a blood dyscrasia.

A client with narcolepsy has been prescribed dextroamphetamine (Dexedrine). The client complains to the nurse that he cannot sleep well anymore at night and does not want to take the medication any longer. Before making any specific comment, the nurse plans to investigate whether the client takes the medication at which of the following proper time schedules? 1. After dinner each day 2. Just before going to bed 3. Two hours before bedtime 4. At least 6 hours before bedtime

An 80-year old client is prescribed carbamazepine (Tegretol) for a newly diagnosed seizure disorder. The nurse will implement safety measures because this client is at an increased risk for which adverse effects with the administration of this drug? 1. Dementia and confusion. 2. Insomnia and forgetfulness related to sleep deprivation. 3. Stroke and decreased motor function. 4. Sedation and falls.

Whn describing the use of nitrofurantoin (Macrobid), a nurse explains that this drug has been known to cause acute and chronic reactions in which of the following systems? 1. Digestive 2. Nervous 3. Cardiovascular 4. Respiratory

A client at a health care facility is receiving nitrofurantoin drug therapy for acute bacterial UTIs. The nurse would be alert to which of the following as a possible adverse reaction? Select all that apply 1. Urinary retention 2. Glossitis 3. Diarrhea 4. Bacterial superinfection 5. Peripheral neuropathy

4 5

A client receiving nitrofurantoin (Macrodantin) calls the health care provider's office complaining of side effects related to the medication. Which side effect indicates the need to stop treatment with this medication? 1. Nausea 2. Diarrhea 3. Anorexia 4. Cough and chest pain

4. Cough and chest pain

A home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which of the following statements, if made by the client, indicates the need for further education? 1. "Constipation and bloating might be a problem." 2. "I'll continue to watch my diet and reduce my fats." 3. "Walking a mile each day will help the whole process." 4. "I'll continue my nicotinic acid from the health food store."

4. "I'll continue my nicotinic acid from the health food store." Rationale: Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin is to be avoided. Constipation and bloating are the two most common side effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

Permethrin 5% (Elimite) is prescribed for a 4-year-old child with a diagnosis of scabies. The nurse instructs the mother regarding the use of this treatment. Which instruction is appropriate? 1. Apply the lotion and leave it on for 4 hours. 2. Apply the lotion to the hair, the face, and the entire body. 3. The child should wear no clothing while the lotion is in place. 4. Apply the lotion to cool, dry skin at least half an hour after bathing.

4. Apply the lotion to cool, dry skin at least half an hour after bathing. Rationale: Permethrin is applied from the neck downward, with care taken to ensure that the soles of the feet, the areas behind the ears, and the areas under the toenails and fingernails are covered. The lotion should be kept on for 8 to 14 hours, and then the child should be given a bath. The lotion should be applied at least 30 minutes after bathing, and it should be applied only to cool, dry skin. The child should be clothed during treatment.

A patient was admitted from the emergency department after receiving treatment for dysrhythmias and will be started on amiodarone (Cordarone, Pacerone) because of lack of therapeutic effects from his other antidysrhythmic therapy. When the nurse checks with him in the afternoon, he complains of feeling lightheaded and dizzy. The nurse will first assess: 1. Whether there is the possibility of sleep deprivation from the stress of admission to the hospital 2. Whether an allergic reaction is occurring with anticholinergic-like symptoms 3. Whether the amiodarone level is not yet therapeutic enough to treat the dysrhythmias 4. Whether the patient's pulse and blood pressure are within normal limits

4. Whether the patient's pulse and blood pressure are within normal limits Rationale: Potassium channel blockers such as amiodarone, like other antidysrhythmics, may cause significant bradycardia and hypotension. The light-headedness and dizziness may be associated with a drop in cardiac output due to bradycardia and hypotension. The significant finding of dizziness would first be assessed in relation to the known adverse effects of the drug.

A 20-year-old client is starting isotretinoin (Accutane) therapy. What is an essential nursing intervention for this client? a. Perform pregnancy test. b. Assess sputum cultures. c. Make sure IV is patent. d. Force fluids.

A boy comes to the school nurse's office and states, "I did not take my Ritalin today." Which of the following is the most important nursing intervention? A. Call the child's parent or guardian to try to find out if the boy has taken his medication B. Give the child his morning dose since it is in the office C. Send him back to class and tell him it is not necessary to take the medication D. Call the child's physician to obtain a one-time dose of methylphenidate

A client is admitted for an overdose of amphetamines. When assessing this client, the nurse should expect to see: A. tension and irritability. B. slow pulse. C. hypotension. D. constipation.

A client receiving phenytoin (Dilantin) complains of "blurred vision." What is the priority nursing action? A. Assess serum phenytoin levels. B. Monitor for seizure activity. C. Assess the client's pupils. D. Hold the client's medication.

A man has not been able to decrease his low-density lipoprotein (LDL) cholesterol levels with lifestyle management, and his nurse practitioner has prescribed atorvastain, a hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor. The nurse explains to him that atorvastatin is best administered A. without regard for time of day B. at noon, taken with grapefruit juice C. with a snack in the early afternoon D. every other day with a dose of red yeast rice

A pt has a potassium level of 6.0 and a digoxin level of 3.0. What medication would the nurse be giving: A. digibind B. sodium citrate C. epinephrine D. lidocaine

Drug therapy with atorvastatin (Lipitor) is initiated for a client with hyperlipidemia. The nurse develops a teaching plan and includes what information? a) Continues to make lifestyle changes toward lowering cholesterol levels. b) Stop taking the drug when dietary changes are accomplished. c) Eliminate all cholesterol from the diet. d) Always take the drug just before bedtime.

For a client having an episode of acute narrow-angle glaucoma, a nurse expects to give which of the following medications? A. Acetazolamide (Diamox) B. Atropine C. Furosemide (Lasix) D. Urokinase (Abbokinase

The client is also taking a diuretic that decreases her potassium level. The nurse expects that a low potassium level (hypokalemia) could have what effect on the digoxin? a. Increase the serum digoxin sensitivity level b. Decrease the serum digoxin sensitivity level c. Not have any effect on the serum digoxin sensitivity level d. Cause a low average serum digoxin sensitivity level

The nurse completes a history and physical on a client admitted with an exacerbation of a seizure disorder. The client is currently taking ethosuximide (Zarontin) 500 mg twice daily by mouth. Which information warrants immediate notification of the healthcare provider? a. Use of the herb Ginkgo biloba b. History of asthma c. Use of aspirin daily d. History of diabetes mellitus

The nurse is administering phenytoin (Dilantin) intravenously. What intervention is essential? A. Administer the medication no faster than 50 mg/min. B. Mix the medication in 5% dextrose with 0.9% saline. C. Administer the medication in a 22-gauge or smaller catheter D. Push the medication quickly through a central line.

The nurse is preparing a discharge plan to a female client with peptic ulcer for the dietary modification she will need to follow at home. Which of the following statements indicates that the client understands the instruction of the nurse? A) "I should not drink alcohol and caffeine." B) "I should eat a bland, soft diet." C) "It is important to eat six small meals a day." D) "I should drink several glasses of milk a day."

The nurse receives a lab report indicating that the phenytoin (Dilantin) level for the patient she saw in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? A) Continue as planned since the level is within normal limits. B) Tell the patient to hold today's dose and return to the clinic. C) Consult the prescriber to recommend an increased dose. D) Have the patient call 911 and meet the patient in the emergency department.

The nurse who is teaching the client to self-administer medications explains to the client that which drug treats narcolepsy? a. modafinil b. atomoxetine c. lisdexamfetamine d. methylphenidate

The nurse would question an order for cholestyramine (Questran) if the client has which condition? a. Impaction b. Glaucoma c. Hepatic disease d. Renal disease

What nursing intervention is essential for the client receiving alteplase? a. Assess for reperfusion dysrhythmias. b. Monitor liver enzymes. c. Administer vitamin K if bruising is observed. d. Monitor blood pressure and stop the medication if blood pressure drops below 110 systolic.

Which is the most important action for the nurse to take before administering digoxin? A. monitor the potassium level B. assess the BP C. evaluate urinary output D. avoid giving with a thiazide diuretic

Which of the following best describes the action of milrinone lactate (Primacor)? A. it relaxes the smooth muscles of the blood vessels to make the vessels wider B. titration of the medication provides an inotropic effect C. it produces vasoconstriction to increase both the preload and after load D. the medication decreases the levels of cyclic adenosine monophosphate (cAMP)

When teaching a patient about trimethoprim-sulfamethoxazole (TMP-SMZ), the nurse gives highest priority to teaching the patient to a. increase fluid intake. b. report signs of ringing in the ears or loss of hearing. c. expect the color of their urine to change to a reddish orange. d. take this drug with dairy products or antacids to protect the stomach

A (Fluid intake should be increased to at least 2000 mL/day when taking sulfonamides to prevent crystalluria. Ototoxicity is not a common adverse effect of sulfonamides. The urine will not change colors. Dairy products or antacids should not be taken at the same time as sulfonamides because they decrease absorption.)

A 60-year-old patient complains of paresthesias and occasional nausea associated with one of her drugs. She is found to have hyperchloremic metabolic acidosis. She is probably taking (A) Acetazolamide for glaucoma (B) Amiloride for edema associated with aldosteronism (C) Furosemide for severe hypertension and heart failure (D) Hydrochlorothiazide for hypertension (E) Mannitol for cerebral edema

A -gi distress and paresthesias are common SE of acetazolamide when taken chronically (i.e glaucoma) -metabolic acidosis also is a SE

A client has been started on gemfibrozil (Lopid) in combination with atorvastatin (Lipitor) for treatment of severely elevated triglyceride levels. When the client develops bruising, the nurse anticipates what orders? a) Obtain an international normalized ratio (INR). b) The dose of atorvastatin will be reduced. c) An ECG will be ordered. d) A p.r.n. analgesic will be ordered.

A Rationale: Fibric acid derivatives, such as gemfibrozil, can increase bleeding times. The INR or prothrombin time will help to evaluate the client's clotting state. The statin is not the cause of the problem. An analgesic or ECG would not help to correct the underlying problem

The nurse would question the use of mannitol for which patient?

A 47-year-old patient with anuria

Which client will the nurse assess first

A client started on valproic acid (Depakene) with a creatinine level of 3 As valproic acid is excreted by the kidneys, this level is cause for concern because the drug could become toxic.

For which potential side effects would the nurse monitor patients prescribed amiodarone? (Select all that apply.) Bluish skin discoloration Hyperglycemia Hypothyroidism Photosensitivity

A) Bluish skin discoloration C) Hypothyroidism D) Photosensitivity Potential side effects from amiodarone include photosensitivity, bluish skin discoloration, hyperthyroidism, hypothyroidism, and decreased libido.

The nurse is teaching a patient about trimethoprim-sulfamethoxazole (Bactrim). Which instructions will the nurse plan to include? (Select all that apply.) a.Report any bruising or bleeding. b.Report any diarrhea or bloody stools. c.Report any fever, rash, or sore throat. d.Avoid unprotected exposure to sunlight. e.Report thirst and polyuria

A, B, C, D

The nurse is conducting discharge teaching related to a new prescription for phenytoin (Dilantin). Which statements are appropriate to include in the teaching for this patient and his family? Select all that apply. A) "Be sure to call the clinic if you or your family notice increased anxiety or agitation." B) "You may have some mild sedation. Do not drive until you know how this drug will affect you." C) "This drug may cause easy bruising. If you notice this, call the clinic immediately." D) "It is very important to have good oral hygiene and visit your dentist regularly." E) "You may continue to have wine with your evening meals but only in moderation."

A, B, D Patients receiving an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin even at therapeutic levels. Carbamazepine(Tegretol), not phenytoin, increases the risk for hematologic effects, such as easy bruising. Phenytoin causes gingival hyperplasia in about 20% of patients who take it. Dental hygiene is important. Patients receiving phenytoin should avoid alcohol and other central nervous system depressants because they have an additive depressant effect.

A 10-year-old child diagnosed with ADHD has been taking amphetamine sulfate (Adderall) for the past 2 years. Which of the following are normal adverse effects of the drug? (Choose all that apply) A, weight loss B. anorexia C. dry mouth D. bradycardia

A,B,C

Nursing implications for health teaching with clients taking isotretinoin include which implications? (Select all that apply.) a. Avoid sunlight. b. Monitor weight c. Monitor CBC, glucose, and lipids. d. Do not breastfeed or give blood

A,C,D

When administering intravenous phenytoin (Dilantin), which action will the nurse perform? A. Always use an infusion pump. B. Flush the line with normal saline before and after administration to prevent precipitation. C. Administer through peripheral intravenous sites only. D. Monitor for hypertension.

A client receives metronidazole (Flagyl) for treatment of a vaginal yeast infection. What should the nurse include in medication education for this client? (Select all that apply) A. do not drink alcohol with this medication. B. do not take this medication with milk or milk products. C. Drink at least 3,000 ml of fluid per day with this medication. D. Take precaution to not become pregnant while on this medication because this medication should be avoided, if possible, in the first trimester of pregnancy. E. you may continue to breast feed your infant while on this medication because this medication does not cross into your breast milk.

A. do not drink alcohol with this medication. D. Take precaution to not become pregnant while on this medication because this medication should be avoided, if possible, in the first trimester of pregnancy

While providing patient education for a patient who has been prescribed modafinil (Provigil), the nurse should explain that this drug differs from the more traditional amphetamines in which of the following ways? a. Modafinil has a higher potential for abuse. b. Modafinil will not disrupt nighttime sleep. c. Modafinil is safer for patients with liver disease. d. Modafinil is approved for narcolepsy.

ANS: B Modafinil does not disrupt nighttime sleep, a side effect often seen with other amphetamines. Modafinil has a lower potential for abuse than traditional amphetamines. Modafinil is eliminated primarily by the liver, therefore it would not be safer for patients with liver disease. As can most amphetamines, modafinil can be prescribed for narcolepsy.

The patient has an international normalized ratio (INR) value of 1.5. In response to this, the nurse could anticipate the health care provider placing which order? Administer an additional dose of warfarin (Coumadin). Hold the next dose of warfarin (Coumadin). Increase the heparin drip rate. Administer protamine sulfate.

Administer an additional dose of warfarin (Coumadin). Correct A therapeutic INR is 2 to 3. The patient needs more warfarin to reach a therapeutic level.

Which of the following data obtained by the nurse during the history and physical of a client receiving atorvastatin (Lipitor) requires immediate attention? a) History of diabetes mellitus b) Possibility of pregnancy c) History of glaucoma d) Coronary artery disease

Which of the following signs should the nurse expect in a client with known amphetamine overdose? A. Hypotension B. Tachycardia C. Hot, dry skin D. Constricted pupils

Which statement indicates the client understands discharge instructions regarding cholestyramine (Questran)? a. "I will take Questran 1 hour before my other medications." b. "I will increase fiber in my diet." c. "I will weigh myself weekly." d. "I will have my blood pressure checked weekly."

The nurse is monitoring a pt taking digoxin (Lanoxin) for treatment of heart failure. Which assessment finding indicates a therapeutic effect of the drug? A. HR 110 beats/minute B. HR 58 beats/minute C. urinary output 40 mL/hr D. BP 90/50 mm Hg

The nurse is preparing to give ethosuximide (Zarontin). The nurse understands that this drug is only indicated for which seizure type? A) Tonic-clonic B) Absence C) Simple partial D) Complex partial

The nurse is reviewing the classes of antidysrhythmic drugs. Amiodarone (Cordarone) is classified on the Vaughan Williams classification as a class III drug, which means it works by which mechanism of action? a. Blocking slow calcium channels b. Prolonging action potential duration c. Blocking sodium channels and affecting phase 0 d. Decreasing spontaneous depolarization and affecting phase 4

Your patient has been switched from valproic acid (Depakote) to gabepentin (Neurontin). Which of the following is a false statement? a. Gabapentin (Neurontin) is also used for bipolar disorder therapy b. Gabapentin (Neurontin) requires more frequent hepatic monitoring c. Gabapentin (Neurontin) is also used for migraine therapy d. Gabapentin (Neurontin) should not be given concurrently with antacids containing magnesium

When working with a patient receiving epoetin alpha (Procrit), it is most important for the nurse to assess the patient for the development of bone pain and headaches. hypertension and edema. nausea and vomiting. fluid retention and allergic reactions.

Answer: B - Hypertension and edema Rationale: Hypertension and edema are the most common side effects/adverse reactions of epoetin alpha (Procrit) therapy.

An older adult taking digoxin and furosemide (Lasix) for chronic heart failure is admitted to the emergency department (ED) with an apical pulse of 52. A family member states that the client has fallen four times this week. What is the nurse's first action? a. Call the ED physician immediately. b. Draw a serum digoxin level. c. Assess for signs of hypokalemia. d. Establish the client's airway.

Answer: Draw a serum digoxin level Rationale: The client has signs and symptoms of digoxin toxicity and needs to be placed on a monitor immediately to determine the extent of effects on the heart and conduction system. Symptoms of digoxin toxicity include blurred vision or yellow or green halos around visual images, confusion, muscle weakness, and vertigo. Toxicity may be increased from furosemide-induced hypokalemia. This can lead to premature ventricular contractions (PVCs) that may lead to other life-threatening dysrhythmias and death. Clients need to be cautioned not to store both digoxin and furosemide in the same container. The most common dose of each medication is available in a small white pill (similar in appearance), increasing the chances of error.

The nurse would expect the physician to order which drug for the treatment of attention deficit hyperactivity disorder (ADHD) in children?

Answer: Methylphenidate HCl (Ritalin) Rationale: Methylphenidate is most commonly used to treat ADHD.

The nurse caring for the client with heart failure is concerned that digoxin toxicity has developed. For which signs and symptoms of digoxin toxicity does the nurse notify the provider? Select all that apply. a. Hypokalemia b. Sinus bradycardia c. Fatigue d. Serum digoxin level of 1.5 e. Anorexia

Answer: Sinus bradycardia; Fatigue; Anorexia

Which would indicate to the nurse that the child taking methylphenidate requires more teaching?

Answer: The child drinking a carbonated beverage Rationale: The nurse should teach the child to avoid caffeine because of its potentiation of methylphenidate. The child should be checked twice a week for weight loss. The drug should be taken 30 to 45 minutes before a meal to promote absorption. The drug should be taken before breakfast and lunch and not within 6 hours of sleeping.

A patient taking methylphenidate HCl (Ritalin) is nauseous and vomiting. What is the nurse's best action?

Ask the patient if he or she has been taking the medication regularly. these symptoms are signs of withdrawal. The nurse should find out if the patient has been taking the medication regularly.

The nurse is caring for a child taking methylphenidate for ADHD. Assessment reveals a heart rate of 110, and the child is complaining of chest pain. What is the nurse's best action?

Assess for over-the-counter medication use. This medication interacts with over-the-counter cold medication. The nurse should assess for the use of over-the-counter medication use.

The nurse provides discharge instructions to a pt about the use of amiodarone. Which of the following statements indicates that the pt has the knowledge necessary to safely administer the drug? A. as soon as the physician says I can stop taking this medication, I will be able to enjoy the sun again B. the side effects of this med may not begin to show up for several weeks or even months after I start taking it C. If my pulse drops below 100 beats/minute, I should call the physician right away D. If I miss a dose of me, I should take it as soon as I remember it

The nurse would question the prescription for epoetin alfa (Epogen) in a client with which condition? A. End-stage renal disease B. Uncontrolled hypertension C. Chemotherapy-induced anemia D. Acquired immunodeficiency syndrome (AIDS)

When a pt is experiencing digitalis toxicity, in which of the following situations would it be appropriate to treat with digoxin immune Fab (Digibind)? A. hypokalemia B. hyperkalemia C. apical heart rate of 60 bpm D. supraventricular dysrhythmias

The mother of a child with attention deficit hyperactivity disorder (ADHD) who has been prescribed methylphenidate (Ritalin) expresses concern regarding the use of a controlled substance to treat her child and asks if there are any other options. The nurse's response is based on the knowledge that an option for treatment for ADHD might include which non-controlled central nervous system (CNS) stimulant?

Atomoxetine (Strattera) Atomoxetine (Strattera) is not a controlled substance as it lacks addictive properties, unlike amphetamines and phenidates.

20-year-old client presents to the clinic with complaints of breast tenderness, nausea, vomiting, and absence of menses for 2 months. She has a history of a seizure disorder well controlled with carbamazepine (Tegretol). She tells the nurse that she has been taking her oral contraceptives as directed, but she wonders if she might be pregnant. The nurse's best response to her concern should be which of the following? A. "You can't be pregnant if you have been taking your oral contraceptives correctly." B. "Carbamazepine can decrease the effectiveness of oral contraceptive drugs, so we need to do a pregnancy test." C. "There is no need to worry. Oral contraceptives are very effective." D. "Taking antiseizure drugs with oral contraceptives significantly decreases your risk of getting pregnant."

A 7-year-old boy takes methylphenidate every morning. Which of the following behaviors would a nurse expect the child to engage in? A. to sit and play with his toys for 90 minutes B. to get along better with his peers C. to express his anger in an appropriate manner D. not to throw his toys across the room

A client is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally? a. enoxaparin sodium (Lovenox) b. warfarin (Coumadin) c. bivalirudin (Angiomax) d. lepirudin (Refludan)

A client is prescribed gemfibrozil (Lopid) for treatment of hyperlipidemia type IV. What is important for the nurse to teach the client? a. "Take aspirin before the medication if you experience facial flushing." b. "You may experience headaches with this medication." c. "You will need to have weekly blood drawn to assess for hyperkalemia." d. "Cholesterol levels will need to be assessed daily for one week."

A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. What type of electrolyte imbalance does the nurse expect to occur? a. Hypocalcemia b. Hypokalemia c. Hyperkalemia d. Hypermagnesemia

A client is taking warfarin 5 mg/day for atrial fibrillation. The client's international normalized ration (INR) is 3.8. The nurse would consider the INR to be what? a. Within normal range b. Elevated INR range c. Low INR range d. Low average INR range

Before administering trimethoprim, it is most important for the nurse to assess the patient for a history of what? A. Heart failure B. Alcoholism C. Diabetes D. Emphysema

Blurred vision or halos are signs of: A. beta blocker toxicity B. digoxin toxicity C. diuretic toxicity D. ACE inhibitor toxicity

The client is taking rosuvastatin (Crestor). What severe skeletal muscle adverse reaction should the nurse observe for? a. Myasthenia gravis b. Rhabdomyolysis c. Dyskinesia d. Agranulocytosis

Your patient is taking valproic acid (Depakote). Which of the following is a false statement? a. Valproic acid requires hepatic monitoring b. Valproic acid has the lowest seizure relapse rate when discontinued c. Valproic acid is also used in migraine therapy d. Valproic acid is also used in bipolar disorder therapy

the nurse reviews lab studies of a pt receiving digoxin (Lanoxin). Intervention by the nurse is required if the results include which of the following laboratory values? A. serum digoxin level of 1.2 ng/dL B. Serum potassium level of 3 mEq/L C. hemoglobin of 14.4 g/ dL D. serum sodium level of 140 mEq/L

A 20-year-old woman comes to the clinic for follow-up related to isotretinoin use. The nurse reviews the iPLEDGE program, which includes which important information? (Select all that apply.) a. That an effective method of contraception must be used throughout treatment b. A review of iPLEDGE educational materials c. That a negative pregnancy test is required before each monthly refill d. That informed consent is not required

B, C

For patients prescribed amiodarone (Cordarone), the nurse should monitor for which potential adverse effects of this drug? (Select all that apply.) a. Diarrhea b. Visual halos c. Hypothyroidism d. Photosensitivity e. Overgrowth of gum tissue f. Blue gray skin discoloration

B, C, D, F

The nurse is monitoring for adverse effects in a patient who is receiving an amiodarone (Cordarone) infusion. Which are adverse effects for amiodarone? (Select all that apply.) a. Tachycardia b. Constipation c. Chest pain d. QT prolongation e. Headache f. Hypotension g. Blue-gray coloring of the skin on the face, arms, and neck

B, D, F, G

The nurse administers amiodarone (Cordarone) to a client with ventricular tachycardia. Which monitoring by the nurse is necessary with this drug? Select all that apply. a. Respiratory rate b. QT interval c. Heart rate and rhythm d. Magnesium level e. Urine output

B,C,D

The nurse is assessing a patient for possible substance abuse. Which assessment finding indicates possible use of amphetamines? a) lethargy and fatigue b) cardiovascular depression c) talkativeness and euphoria d) difficulty swallowing and constipation

A patient taking Dilantin (phenytoin) for a seizure disorder is experiencing breakthrough seizures. A blood sample is taken to determine the serum drug level. Which of the following would indicate a sub-therapeutic level? A. 15 mcg/mL. B. 4 mcg/mL. C. 10 mcg/dL. D. 5 mcg/dL.

B. 4 mcg/mL. The therapeutic serum level for Dilantin is 10 - 20 mcg/mL. A level of 4 mcg/mL is sub-therapeutic and may be caused by patient non-compliance or increased metabolism of the drug. A leve of 15 mcg/mL is therapeutic. Choices C and D are expressed in mcg/dL, which is the incorrect unit of measurement.

A client has been given a prescription for gemfibrozil (Lopid). The nurse plans to instruct the client to limit intake of which food while taking this medication? A. Fish B. Beef C. Spicy foods D. Citrus products

B. Beef Gemfibrozil is a lipid-lowering agent. It is given as part of a therapeutic regimen that also includes dietary counseling, specifically, the limitation of saturated and other fats in the diet. Therefore, the intake of red meats is limited. Fish, foods that are spicy, and citrus products do not affect the cholesterol level

Which statement by the nurse explains to the patient the action of cholestyramine to decrease blood lipid levels?

Binds to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces.

A patient is receiving milrinone (Primacor). What assessment finding would lead the nurse to suspect that the patient is experiencing thrombocytopenia?

Bruising

A 16-year-old adolescent who is 6 weeks pregnant has acne that has been exacerbated during the pregnancy. She asks the nurse if she can resume taking her isotretinoin (Accutane) prescription. The best response by the nurse is: a) "you should reduce your accutane dose by half during pregnancy" b) "you should check with your doctor at your next visit" c) "Accutane is known to cause birth defects; you should never take it during pregnancy" d) "since you have a prescription for Accutane, it is safe to take"

A client is to begin treatment for short-term management of heart failure with milrinone lactate (Primacor). What is the priority nursing action? a. Administer digoxin via IV infusion with the Primacor. b. Administer Lasix (furosemide) via IV infusion after the Primacor. c. Monitor blood pressure continuously. d. Maintain an infusion of lactated Ringers with Primacor infusion.

A nurse is caring for a client receiving acetazolamide (Diamox). Which assessment finding will require immediate nursing intervention? a. A decrease in bicarbonate level b. An increase in urinary output c. A decrease in arterial pH d. An increase in PaO2

A nurse is caring for a client taking cholestyramine (Questran). The client is complaining of constipation. What will the nurse do? a. Call the health care provider to change the medication. b. Tell the client to skip a dose of the medication. c. Have the client increase fluids and fiber in his diet. d. Administer an enema to the client.

A nurse is caring for a client with elevated triglyceride levels who is unresponsive to HMG-CoA reductase inhibitors. What medication will the nurse administer? a. cholestyramine (Questran) b. colestipol (Colestid) c. gemfibrozil (Lopid) d. simvastatin (Zocor)

A patient is taking nitrofurantoin (Macrodantin). What will the nurse teach the patient? a.Expect the urine to turn blue. b.Keep the urine acidic by drinking milk. c.Rinse the mouth after taking oral nitrofurantoin to avoid teeth staining. d.Take an antacid with oral nitrofurantoin to avoid gastrointestinal distres

A patient with increased ICP has mannitol (Osmitrol) prescribed. Which option is the best indication that the drug is achieving the desired therapeutic effects? A. Urine output increases from 30 mL to 50 mL/hour. B. Blood pressure remains less than 150/90 mm Hg. C. The LOC improves. D. No crackles are auscultated in the lung fields.

A patient with increased ICP is being monitored in the intensive care unit (ICU) with a fiberoptic catheter. Which order is a priority for you? A. Perform hourly neurologic checks. B. Take a complete set of vital signs. C. Administer the prescribed mannitol (Osmitrol). D. Give an H2-receptor blocker.

A provider has ordered once-daily phenytoin (Dilantin) for an 8-year-old child who has a seizure disorder, and the parents say that is is "impossible" to have the child take pills by mouth. What intervention would the nurse recommend? A. The parents should learn to administer shots, and phenytoin could be given IM. B. The parents should open the medication and put it in food without the child's knowledge. C. The parents should ask the healthcare provider for a suspension form of the medication. D. The parents should request a chewable form of phenytoin and put it into the child's food.

A pt is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase (Activase). Which of the following is a priority nursing intervention? A. monitor for renal failure B. monitor for psychosocial status C. monitor for signs of bleeding D. have heparin sodium available

During the administration of milrinone lactate (Primacor), the patient's blood pressure decreases from 170/96 mm Hg to 96/60 mm Hg. What is the most appropriate nursing action? A. Call the physician B. Administer a vasoconstrictor C. Reduce the infusion rate D. Reassess the blood pressure

The action of medication is inotropic when it: A. decreases afterload B. increases heart rate C. increases the force of contraction D. is uses to treat CHF

The client was dx with iron-deficiency anemia is prescribed ferrous gluconate orally. Which should the nurse teach the client? A.Take Imodium, and anti diarrheal, OTC for diarrhea B.Limit exercise for several weeks until a tolerance is achieved C.The stools may be very dark, and this can mask blood D.Eat only red meats and organ meats for protein

The nurse is caring for a client who is prescribed epoetin alfa (Epogen). What does the nurse expect as the reason for use of this medication in this client? A. To cure or reverse kidney failure B. To replace blood loss from surgery C. Treatment of anemia due to renal failure D. Management of pregnancy-associated anemia

The nurse reviews the history for a client taking atorvastatin (Lipitor). What will the nurse act on immediately? a. Client takes medications with grape juice. b. Client takes herbal therapy including kava kava. c. Client is on oral contraceptives. d. Client was started on penicillin for a respiratory infection.

When assessing a pt who has been taking amiodarone for 6 months, which adverse reaction might the nurse identify? A. glycosuria B. dysphagia C. photophobia D. urticaria

Which of the following is a contraindication for digoxin administration? A. BP of 140/90 B. HR>80 C. HR<60 D. RR>18

Which of the following statements made by a client taking phenytoin indicates understanding of the nurse's teaching? A. "I will increase the dose if my seizures don't stop." B. "I don't need to contact my health care provider before taking an over-the-counter cold remedy." C. "I will take good care of my teeth and see my dentist regularly." D. "I cannot take this drug with food."

a pt with congestive heart failure is receiving digoxin. What is the desired effect: A. neck vein distention B. decreased appetite C. increased urinary output D. increased pedal edema

during assessment of a pt who is receiving digoxin, which finding would indicate an increased possibility of toxicity? A. apical pulse rate of 60 bpm B. digoxin level of 1.5 C. serum potassium level of 2.0 D. serum potassium level of 4.8

The nurse identifies which appropriate uses of metronidazole? (Select all that apply.) Colorectal surgery Vaginal surgery Adjunct treatment for a Helicobacter pylori ulcer Tendonitis

Colorectal surgery Vaginal surgery Adjunct treatment for a Helicobacter pylori ulcer

A nurse is teaching a parent of a child who has pediculosis capitis. Which of the following should the nurse include in the teaching? A.Apply mayonnaise to the affected area at night. B.Treat all household pets. C.Use an over-the-counter medication containing 1% permethrin. D.Discard the child's stuffed animals

C. CORRECT: Pediculosis capitis is treated with 1% permethrin, which can be purchased over the counter.

Which information should be given to the client taking phenytoin (Dilantin)? A. Taking the medication with meals will increase its effectiveness. B. The medication can cause sleep disturbances C. More frequent dental appointments will be needed for special gum care. D. The medication decreases the effects of oral contra- ceptives.

C. More frequent dental appointments will be needed for special gum care. Gingival hyperplasia is a side effect of phenytoin. The client will need more frequent dental visits.

A patient who has acquired immunodeficiency syndrome (AIDS) is receiving trimethoprim/sulfamethoxazole (Bactrim). Which response should a nurse expect if the medication is achieving the desired effect? A. Increase in CD4 T cells B. Increased appetite and weight gain C. Resolution of pneumonia D. Decrease in joint pain

C. Resolution of pneumonia Trimethoprim/sulfamethoxazole is the treatment of choice for Pneumocystis pneumonia (PCP), an infection caused by Pneumocystis jiroveci (formerly thought to be Pneumocystis carinii). PCP is an opportunistic pneumonia caused by a fungus that thrives in immunocompromised hosts. It does not increase the number of CD4 T cells, the targeted cells of the human immunodeficiency virus (HIV), nor does it affect joint pain. Increased appetite and weight gain are not therapeutic actions of trimethoprim/sulfamethoxazole.

The nurse is caring for a patient who has been receiving warfarin (Coumadin) and digoxin (Lanoxin) as treatment for atrial fibrillation. Because the warfarin has been discontinued before surgery, the nurse should diligently assess the patient for which complication early in the postoperative period until the medication is resumed? Decreased cardiac output Increased blood pressure Cerebral or pulmonary emboli Excessive bleeding from incision or IV sites

Cerebral or pulmonary emboli Warfarin is an anticoagulant that is used to prevent thrombi from forming on the walls of the atria during atrial fibrillation. Once the medication is terminated, thrombi could again form. If one or more thrombi detach from the atrial wall, they could travel as cerebral emboli from the left atrium or pulmonary emboli from the right atrium.

A 36-year-old woman has been taking atorvastatin 20 mg PO daily for 6 months to treat mild dyslipidemia. At a clinic appointment, she tells the nurse she is 6 weeks pregnant. The nurse counsels the patient that it is likely that her midwife will counsel her A. to increase the dose of prenatal vitamins B. to reduce the dosage of her lovastatin to 20 mg PO daily C. to increase the dosage to 40 mg PO twice daily D. about discontinuing the drug during pregnancy

A client is taking valproic acid (Depakote). The nurse should monitor the client for a which therapeutic serum range? a. 10 to 20 mcg/mL b. 15 to 40 mcg/mL c. 20 to 80 ng/mL d. 40 to 100 mcg/mL

A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous gluconate therapy should the nurse include in the teaching plan? a. "Take the medication with an antacid." b. "Take the medication with a glass of milk." c. "Take the medication with cereal." d. "Take the medication on an empty stomach

A patient is ordered to take trimethoprim-sulfamethoxazole (Bactrim). The nurse knows to be aware of which adverse effect? a.Bronchospasm b.Dysrhythmias c.Pseudomembranous colitis d.Stevens-Johnson syndrome

A patient is taking the urinary antiseptic methenamine mandelate for a urinary tract infection. The nurse understands that this drug should not be given concurrently with which other drug to avoid potential crystalluria? a.ertapenem (Invanz) b.ciprofloxacin (Cipro) c.nalidixic acid (NegGram) d.trimethoprim-sulfamethoxazole (Bactrim)

A patient with cardiovascular dse is taking rosuvastatin. The nurse is monitoring for potential adverse effects. Which finding indicates a potential adverse effect of this drug? a) BP of 140/90 b) wheezing and SOB c) platelet count of 100 x 10^3 d) Muscle pain and tenderness

Patient teaching for children taking methylphenidate for attention deficit hyperactivity disorder should include which of the following? A. Give the child the drug at bedtime B. Drowsiness may be a side effect C. If necessary, the child may take over the counter cold products without problems D. Provide for periodic drug free holidays

The nurse is assessing a patient who is receiving a milrinone infusion and checks the patient's cardiac rhythm on the heart monitor. What adverse effect is most likely to occur in a patient who is receiving intravenous milrinone? a. Tachycardia b. Bradycardia c. Atrial fibrillation d. Ventricular dysrhythmia

The nurse is scheduled to administer a dose of digoxin to and adult pt with atrial fibrillation. The pt has a potassium level of 4.3 mEq/L. The nurse should perform which of the following activities next? A. withhold dose only for that day B. obtain order for dose of potassium before giving digoxin C. withhold dose and notify prescriber D. administer dose as ordered

The therapeutic drug level for digoxin is: A. 0.1-2.0 B. 1.0-2.0 C. 0.1-0.5 D. 0.5-2.0

Which of the following would the nurse incorporate into the teaching plan for a "PT" to promote healthy urinary function? A)Drinking more then 2,000mL per day will cause fluid retention B)The healthy adult should drink four to six 8oz glasses of water per day C)Children need fewer reminds to drink because of a greater thirst sensitivity D)Caffeine-containing beverages should be monitored to prevent excess intake

When developing a nursing care plan for a client receiving epoetin alfa (Epogen), the nurse will include monitoring for which adverse effect? A. Chronic diarrhea B. Severe hypotension C. Impaired liver function D. Change in level of consciousness

D. Epoetin alfa has an increased risk of thrombolic events. If the client has a change in the level of consciousness, this might be a sign of a stroke or myocardial infarction. Clients taking this medication need assessment and monitoring for this possibility.

Acetazolamide is prescribed for a client with a diagnosis of a supratentorial lesion. The nurse monitors the client for effectiveness of this medication, knowing which is its primary action?

Decrease cerebrospinal fluid production Acetazolamide is a carbonic anhydrase inhibitor. It is used in the client with, or at risk for, increased intracranial pressure to decrease cerebrospinal fluid production. Options 1, 2, and 4 are not actions of this medication.

A client who is taking warfarin (Coumadin) after an acute a pulmonary embolism is transferred from the ICU after 5 days of heparin therapy. The nurse reviews the client's electronic medical record and notes an international normalized ratio (INR) of 3.4. After notifying the provider of this result, which order does the nurse expect for this client?

Give Phytonadione

A client diagnosed with pernicious anemia is to start cyanocobalamin (Nascobal) injections. Which of the following client statements demonstrates an understanding of the nurse's teaching?

I will need to take this drug for the rest of my life. I may be able to switch over to nasal sprays once my vitamin B12 levels are normal.

The nurse will assess a patient receiving gemfibrozil (Lopid) and warfarin (Coumadin) for which adverse effect?

Increased risk of bleeding

A patient who is taking nitrofurantoin is experiencing muscle weakness, tingling sensations, and numbness in the fingers. What should the nurse tell this patient to do? Take the medication at bedtime to decrease these side effects. Increase fluid intake to decrease these side effects. Inform the health care provider immediately. Decrease the medication to half the regular dose.

Inform the health care provider immediately.

A client who is prescribed metronidazole (Flagyl) for a gynecologic infection provides the nurse with a list of medications that are routinely taken. Which medication would lead the nurse to question the prescription for Flagyl?

Lithium

The parent of a child with attention-deficit/hyperactivity disorder (ADHD) asks the nurse how a drug like methylphenidate (Ritalin), a CNS stimulant, can help the child. What is the nurse's best response?

Methylphenidate has a paradoxical effect in children Methylphenidate (Ritalin), a CNS stimulant, has a paradoxical effect in children, producing calmness in children with hyperactive behavior. The exact mechanism of action is not clearly understood

The nurse receives an order to administer a phosphodiesterase inhibitor to the patient in heart failure. What drug will the nurse administer?

Milrinone (Primacor)

A nurse is reinforcing teaching with a client who is to start therapy with gemfibrozil. Which of the following should the nurse instruct the client to watch for and report to the provider? Bruising Numbness in the feet Facial flushing Muscle weakness

Muscle weakness Myopathy is an adverse effect of gemfibrozil. The nurse should instruct the client to report any muscle weakness or muscle tenderness.

The nurse is caring for a preoperative patient who has an order for vitamin K by subcutaneous injection. The nurse should verify that which laboratory study is abnormal before administering the dose? Hematocrit (Hct) Hemoglobin (Hgb) Prothrombin time (PT) Partial thromboplastin time (PTT)

Prothrombin time (PT) Vitamin K counteracts hypoprothrombinemia and/or reverses the effects of warfarin (Coumadin) and thus decreases the risk of bleeding. High values for either the prothrombin time (PT) or the international normalized ratio (INR) demonstrates the need for this medication.

Amiodarone toxicity is evidenced in which body system? Renal Hepatic Pulmonary Hematologic

Pulmonary Patients taking amiodarone must have baseline and serial pulmonary function tests in order to monitor for potential pulmonary toxicity.

A mother questions the decreased effectiveness of methylphenidate (Ritalin), prescribed for her child's ADHD. Which nursing response best addresses the mother's concern? 1. "The physician will probably switch from Ritalin to a central nervous system stimulant." 2. "The physician may prescribe an antihistamine with the Ritalin to improve effectiveness." 3. "Your child has probably developed a tolerance to Ritalin and may need a higher dosage." 4. "Your child has developed sensitivity to Ritalin and may be exhibiting an allergy."

Rationale: The nurse should explain to the mother that the child has probably developed a tolerance to Ritalin and may need a higher dosage. Methylphenidate is a central nervous system stimulant, and tolerance can develop rapidly. Physical and psychological dependence can also occur.

A physician orders methylphenidate (Ritalin) for a child diagnosed with ADHD. Which information about this medication should the nurse provide to the parents? 1. If one dose of Ritalin is missed, double the next dose. 2. Administer Ritalin to the child after breakfast. 3. Administer Ritalin to the child just prior to bedtime. 4. A side effect of Ritalin is decreased ability to learn.

Rationale: The nurse should instruct the parents to administer Ritalin to the child after breakfast. Ritalin is a central nervous system stimulant and can cause decreased appetite. Central nervous system stimulants can also temporarily interrupt growth and development.

The client, age 8, is prescribed valproic acid (Depokene) for treatment of a seizure disorder. The nurse should monitor the client closely for: Vitamin B deficiency. Restlessness and agitation. Hyperthermia. Respiratory distress

Restlessness and agitatio

The nurse should instruct the patient taking nitrofurantoin and complaining of nausea and diarrhea to do what to decrease this side effect? Take the medication at bedtime. Take the medication with meals or milk. Take the medication with a large glass of water. Take the medication with bismuth subsalicylate.

Take the medication with meals or milk.

A patient taking warfarin (Coumadin) asks for an aspirin for a headache. What is the nurse's best action? Administer 650 mg of acetylsalicylic acid (ASA) and reassess pain in 30 minutes. Teach the patient of potential drug interactions with anticoagulants. Explain to the patient that ASA is contraindicated and administer ibuprofen as ordered. Explain that the headache is an expected side effect and will subside shortly.

Teach the patient of potential drug interactions with anticoagulants. Correct Patients taking an anticoagulant should not use medications that would further increase the risk of bleeding, which includes aspirin as well as ibuprofen. Aspirin should not be administered to the patient taking other anticoagulants, unless it is ordered specifically as a low-dose daily therapy. Ibuprofen is not the best choice of medication for the patient receiving Coumadin. Tylenol (acetaminophen) would be preferred for pain relief. Headache is not an expected side effect of Coumadin therapy.

A teenaged boy will be receiving atomoxetine (Strattera) as part of treatment for attention deficit hyperactivity disorder (ADHD). Which statement about this drug therapy is accurate? The patient should be monitored for possible suicidal thoughts and behavior. Strattera is used to treat narcolepsy as well as ADHD. Psychotherapy is rarely helpful in cases of ADHD. Strattera is highly addictive

The patient should be monitored for possible suicidal thoughts and behavior. Prescribers are advised to work with parents to monitor closely for suicidal thoughts and behavior. In addition, psychosocial problems within the patient's family should be addressed if needed. Strattera is not addictive, and it is not used to treat narcolepsy.

What information should the nurse provide to a patient taking nitrofurantoin for a UTI? The patient should avoid the sun and wear sunscreen. The patient's urine will turn a harmless brown color. The patient will have an increased urine output. The patient will have to increase fluid intake.

The patient's urine will turn a harmless brown colo

A patient receiving valproic acid (Depakote) should be monitored for which adverse effects? (Select all that apply.)

Tremors Weight gain Hepatoxicity

patient who has been taking warfarin (Coumadin) is admitted with coffee-ground emesis. What can the nurse anticipate being prescribed for this patient? Vitamin E Vitamin K Protamine sulfate Calcium gluconate

Vitamin K

The nurse is admitting a 68-year-old preoperative patient with a suspected abdominal aortic aneurysm (AAA). The medication history reveals that the patient has been taking warfarin (Coumadin) on a daily basis. Based on this history and the patient's admission diagnosis, the nurse should prepare to administer which medication? Vitamin K Cobalamin Heparin sodium Protamine sulfate

Vitamin K Coumadin is a Vitamin K antagonist anticoagulant that could cause excessive bleeding during surgery if clotting times are not corrected before surgery. For this reason, vitamin K is given as the antidote for warfarin (Coumadin).

The client asks the nurse why the health care provider prescribed acetazolamide (Diamox), a diuretic, to treat gout. What is the nurse's best response? a. It causes an alkaline urine, which facilitates the elimination of uric acid. b. It increases alkalinity of urine, thus decreasing the formation of uric acid. c. It causes an acid urine, which facilitates the elimination of uric acid. d. It decreases alkalinity of urine, thus decreasing the formation of uric acid.

a. It causes an alkaline urine, which facilitates the elimination of uric acid.

A client with subdural hematoma was given mannitol to decrease intracranial pressure (ICP). Which of the following results would best show the mannitol was effective? a.) Urine output increases b.) Pupils are 8 mm and nonreactive c.) Systolic blood pressure remains at 150 mm Hg d.) BUN and creatinine levels return to normal

a.) Urine output increases Rationale: Mannitol promotes osmotic diuresis by increasing the pressure gradient in the renal tubes. Fixed and dilated pupils are symptoms of increased ICP or cranial nerve damage. No information is given about abnormal BUN and creatinine levels or that mannitol is being given for renal dysfunction or blood pressure maintenance.

22 year old patient has characteristics of severe Parkinson's, the nurse suspects an overdose of:

amphetamines

The nursing care plan for a client receiving epoetin alfa (Epogen, Procrit) should include careful monitoring for symptoms of

angina, or a change in level of consciousness.

A client is prescribed isotretinoin (Accutane). What is the most important instruction to teach the client before beginning this medication? a. Do not go out in the sun while on this medication. b. Call the health care provider if you have muscle weakness. c. Increase fluid intake while on this medication. d. Do not take aspirin while on this medication.

b. Call the health care provider if you have muscle weakness.

The nurse is providing discharge teaching for a client receiving carbamazepine (Tegretol) for seizure management. What information should the nurse include during the medication teaching? a. Take on an empty stomach for better absorption. b. Expect a discoloration of the contact lenses. c. Report unusual bleeding or bruises immediately. d. Caffeinated drinks can decrease the drug's efficacy.

c. Report unusual bleeding or bruises immediately. Carbamazepine (Tegretol), a phenytoin-like drug, affects the metabolism and absorption of vitamin K, which can lead to impaired clotting activity as evidenced by unusual bleeding or bruising. The drug can be taken with food to decrease GI upset. This drug does not change the color of body fluids. Caffeine may decrease the effectiveness of the benzodiazepines.

A client with a subdural hematoma becomes restless and confused, with dilation of the ipsilateral pupil. The physician orders mannitol for which of the following reasons? a.) To reduce intraocular pressure b.) To prevent acute tubular necrosis c.) To promote osmotic diuresis to decrease ICP d.) To draw water into the vascular system to increase blood pressure

c.) To promote osmotic diuresis to decrease ICP Rationale: Mannitol promotes osmotic diuresis by increasing the pressure gradient, drawing fluid from intracellular to intravascular spaces. Although mannitol is used for all the reasons described, the reduction of ICP in this client is a concern.

A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition? diazepam (Valium) midazolam (Versed) carbamazepine (Tegretol) valproic acid (Depakote)

diazepam (Valium) Diazepam (Valium) is considered by many to be the drug of choice for status epilepticus. Other drugs that are used are listed in Table 15-3 and do not include the drugs listed in the other options.

The client with a diagnosis of cancer is receiving epoetin alfa (Epogen, Procrit) as part of the treatment regimen. The nurse evaluates the effectiveness of this drug by

monitoring the hematocrit and hemoglobin level.

a nurse is applying a 5% permethrin lotion to a toddler with scabies. how should the nurse apply the lotion?

over the entire body, from the chin down, as well as the scalp and forehead.

The nurse would teach a client prescribed metronidazole (Flagyl) to avoid ingestion of which drink?

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