pharmacology hesi

For which clients should the nurse withhold the initial dose of a cyclooxygenase 2 (COX-2) inhibitor until notifying the health care provider? (Select all that apply.)

-An older adult with a history of a skin rash while taking glyburide (DiaBeta) - An adolescent with a history of an anaphylactic reaction to penicillin - An adolescent at 34 weeks of gestation experiencing 1+ pitting edema rational: COX-2 inhibitors are contraindicated for those who are allergic to sulfa drugs (C), aspirin, and nonsteroidal antiinflammatory drugs (NSAIDs). Drug safety for adolescents (D and F) is not yet established, and COX-2 inhibitors, as well as NSAIDs, are contraindicated during the third trimester of pregnancy (F) because they can cause a premature closure of the patent ductus arteriosus.

A client is being discharged with a prescription for sulfasalazine to treat ulcerative colitis. Which instruction should the nurse provide to this client prior to discharge?

. Drink at least eight glasses of fluid a day. rational: Adequate hydration is important for all sulfa drugs because they can crystallize in the urine. If possible, the drug should be taken after eating to provide longer intestinal transit time

When providing nursing care for a client receiving pyridostigmine bromide for myasthenia gravis, which nursing action has the highest priority?

Assess respiratory status and breath sounds often. rational:The client should be assessed often for signs of respiratory complications. The client with myasthenia gravis is at greatest risk for life-threatening respiratory complications because of the weakness of the diaphragm and ancillary respiratory muscles caused by the disease process.

The nurse is administering the early morning dose of insulin aspart, 5 units subcutaneously, to a client with diabetes mellitus type 1. The client's fingerstick serum glucose level is 140 mg/dL. Considering the onset of insulin aspart, when should the nurse ensure that the client's breakfast be given?

5 minutes after subcutaneous administration rational:Insulin aspart is a very rapidly acting insulin, with an onset of 5 to 15 minutes. Insulin aspart should be administered when the client's tray is available.

The charge nurse is reviewing the admission history and physical data for four clients newly admitted to the unit. Which client is at greatest risk for adverse reactions to medications?

75-year-old woman with liver disease ratinal: mpaired hepatic metabolic pathways for drug and chemical degradation place option C at greatest risk for adverse reactions to medications based on advancing age and liver disease.

A client has started long-term corticosteroid therapy tells the nurse that the daily dose will be taken at bedtime with a snack of crackers and milk. Which is the best response by the nurse?

Advise the client to take the medication in the morning, rather than at bedtime. rational: Daily doses of long-term corticosteroid therapy should be administered in the morning to coincide with the body's normal secretion of cortisol

Which class of antineoplastic chemotherapy agents resembles the essential elements required for DNA and RNA synthesis and inhibits enzymes necessary for cellular function and replication?

Antimetabolites rational:Antimetabolites exert their action by inhibiting the enzymes necessary for cellular function and replication

Which instruction should the nurse include in the teaching plan for a client who is receiving phenytoin for seizure control?

Brush and floss teeth daily. rational:Brushing and flossing the teeth daily prevent gingival hyperplasia (gum disease) that is common with long-term phenytoin therapy.

A 26-year-old primigravida client is experiencing increasing discomfort and anxiety during the active phase of labor. She requests something for pain. Which analgesic should the nurse anticipate administering?

Butorphanol rational:Butorphanol is a mixed agonist-antagonist analgesic resulting in good analgesia but with less respiratory depression, nausea, and vomiting compared with opioid agonist analgesics.

Which assessment datum indicates to the nurse that a dose of granisetron administered IV prior to chemotherapy has had the desired effect?

Client denies nausea rational: Granisetron is an antiemetic administered before chemotherapy to prevent chemotherapy-induced nausea and vomiting. Chemotherapy can cause oral sores, but granisetron does not prevent this problem.

The health care provider has prescribed a low-molecular-weight heparin, enoxaparin prefilled syringe, 30 mg/0.3 mL IV every 12 hours, for a client following hip replacement. Prior to administering the first dose, what is the priority nursing action?

Contact the health care provider to clarify the prescription. rational:Enoxaparin is a low-molecular-weight heparin that should be administered subcutaneously when given as a prophylaxis for deep vein thrombosis, so the nurse should contact the health care provider to clarify the route of administration.

The nurse is teaching an obese client, newly diagnosed with arteriosclerosis, about reducing the risk of a heart attack or stroke. Which health promotion brochure is most important for the nurse to provide to this client?

Decreasing Cholesterol Levels Through Diet rational: A health promotion brochure about decreasing cholesterol is most important to provide this client, because the most significant risk factor contributing to development of arteriosclerosis is excess dietary fat, particularly saturated fat and cholesterol.

A client experiencing dysrhythmias is given quinidine, 300 mg PO every 6 hours. The nurse plans to observe this client for which common side effect associated with the use of this medication?

Diarrhea The most common side effects associated with quinidine therapy are gastrointestinal complaints, such as diarrhea.

A 6-year-old child is admitted to the emergency department with status epilepticus. The parents report that the seizure disorder has been managed with phenytoin, 50 mg PO bid, for the past year. Which drug should the nurse plan to administer?

Diazepam rational: Diazepam is the drug of choice for treatment of status epilepticus.

A chemotherapeutic regimen with doxorubicin HCl is being planned for a client recently diagnosed with cancer. What diagnostic test results should the nurse review prior to initiating this treatment?

Electrocardiogram (ECG) rational: Baseline cardiac function studies are required to monitor the irreversible cardiotoxic effects of doxorubicin HCl.

In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, because the nurse is concerned about adequate nutrition, which intervention would best meet this child's needs?

Give pancrelipase capsule mixed with applesauce before each meal. rational: Pancreatic enzyme replacement with pancrelipase is a major component of cystic fibrosis nutritional management. Aluminum hydroxide and magnesium hydroxide may be given before meals with enzymes to reduce gastric acidity and prevent enzyme destruction but are ineffective when used alone to promote enzyme replacement

Prior to administering a scheduled dose of digoxin, the nurse reviews the client's current serum digoxin level, which is 1.3 ng/dL. Which action should the nurse take first?

Give the dose of digoxin if the client's heart rate is within a safe range. rational:The client's digoxin level of 1.3 ng/dL is not above the upper range of its therapeutic index (toxic level is >2.0 ng/dL), so the dose should be administered after the client's heart rate is evaluated.

A child is being treated with mebendazole for pinworms. What dietary information will the nurse relay to the client's mother?

High-fat diet rational: A high-fat diet increases the absorption of mebendazole, which boosts the effectiveness of the medication in eliminating the pinworms.

The nurse is reviewing a client's laboratory results before a procedure in which a neuromuscular blocking agent is prescribed. Which finding should the nurse report to the health care provider?

Hypokalemia rational:Low potassium levels enhance the effects of neuromuscular blocking agents, so the health care provider should be informed of the client's hypokalemia

In addition to nitrate therapy, a client is receiving nifedipine, 10 mg PO every 6 hours. The nurse should plan to observe for which common side effect of this treatment regimen?

Hypotension rational:Nifedipine reduces peripheral vascular resistance and nitrates produce vasodilation, so concurrent use of nitrates with nifedipine can cause hypotension with the initial administration of these agents.

A client is taking famotidine. Which client statement should the nurse further assess because it may indicate that the client is experiencing a side effect of this drug?

I seem to be having difficulty thinking clearly rational: A common side effect of famotidine is confusion

The nurse is evaluating a client's understanding of the prescribed antilipemic drug lovastatin. Which client statement indicates that further teaching is needed?

I will take the medication every day before breakfast. rational:The enzyme that helps metabolize cholesterol is activated at night, so this medication should be taken with the evening meal

A client is prescribed a cholinesterase inhibitor, and a family member asks the nurse how this medication works. Which pharmacophysiologic explanation should the nurse use to describe this class of drug?

Improves nerve impulse transmission rational: Cholinesterase inhibitors work to increase the availability of acetylcholine at cholinergic synapses, which aids in neuronal transmission and assists in memory formation.

Dopamine is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response?

Increase in urine output rational: Intropin activates dopamine receptors in the kidney and dilates blood vessels to improve renal perfusion, so an increase in urine output indicates an increase in glomerular filtration caused by increased arterial blood pressure.

A female client is receiving tamoxifen following surgery for breast cancer. She reports to the nurse the onset of hot flashes. Which is the best nursing action?

Instruct the client that hot flashes are a side effect that often occurs with the use of this medication. rational: Tamoxifen is an estrogen receptor blocker used to treat breast carcinoma. Hot flashes are a common side effect.

A client taking linezolid at home for an infected foot ulcer calls the home care nurse to report the onset of watery diarrhea. What is the best nursing action for this client?

Instruct the client to obtain a stool specimen to be taken to the laboratory for analysis. rational: Antibiotics, such as linezolid, can cause pseudomembranous colitis, resulting in severe watery diarrhea.

The nurse is assessing a stuporous client in the emergency department who is suspected of overdosing with opioids. Which agent should the nurse prepare to administer if the client becomes comatose?

Naloxone hydrochloride rational: Naloxone is an opioid antidote used in opioid overdose to reverse CNS and respiratory depression.

The nurse notes that the hemoglobin level of a client receiving darbepoetin alfa has increased from 6 to 10 g/dL over the first 2 weeks of treatment. Which is the best nursing action for this client?

Notify the health care provider of the change in the client's laboratory values. rational: Although an increase in the client's hemoglobin level is desired, a rapid increase (more than 1 g/dL in a 2-week period) may lead to hypertension, so the health care provider should be notified of this excessive increase.

A client receives an antihypertensive agent daily. Which action is most important for the nurse to implement prior to administering the medication?

Obtain the client's blood pressure. rational: To determine the most accurate response to antihypertensive therapy, baseline blood pressures should be obtained before an antihypertensive drug is administered and should be compared with orthostatic vital signs to determine whether any side effects are occurring

A 21-year-old female client is receiving tetracycline for acne. Which client teaching should the nurse include?

Oral contraceptives may not be effective. rational: Certain antibiotics, such as tetracycline, decrease the effectiveness of oral contraceptives.

A client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCl. Which assessment finding would require immediate intervention by the nurse?

Parkinson-like symptoms Metoclopramide HCl blocks dopamine receptors in the brain, which can cause the extrapyramidal symptoms associated with Parkinson disease.

The nurse is teaching a student about the dynamics of medication administration. Which physiologic mechanism will the nurse include in the teaching which explains a drug's increased metabolism triggered by a disease process?

Pharmacokinetics rational:Pharmacokinetics describes the physiologic process of a drug's movement throughout the body and how the drug's interaction is affected by an underlying disease.

During administration of theophylline, the nurse should monitor for signs of toxicity. Which symptom would cause the nurse to suspect theophylline toxicity?

Restlessness rational: Restlessness is a sign of theophylline intoxication. Other signs of toxicity are anorexia, nausea, vomiting, insomnia, tachycardia, arrhythmias, and seizures

The nurse is preparing to administer amphotericin B IV to a client. What laboratory data is most important for the nurse to assess before initiating an IV infusion of this medication?

Serum potassium level The nurse should obtain baseline potassium levels prior to beginning drug therapy because amphotericin B changes cellular permeability, allowing potassium to escape from the cell, which could lead to a decrease in the serum potassium level and severe hypokalemia.

Two hours after taking the first dose of penicillin, a client arrives at the emergency department complaining of feeling ill, exhibiting hives, having difficulty breathing, and experiencing hypotension. The nurse will develop an immediate plan of care based on which finding?

Severe acute anaphylactic response rational: Anaphylaxis related to penicillin can cause a life-threatening allergic response characterized by bronchospasm, laryngeal edema, and a precipitous drop in blood pressure.

The health care provider prescribes oral contraceptives for a client who wants to prevent pregnancy. Which information is the most important for the nurse to provide to this client?

Take one pill at the same time every day for the entire pack of pills. rational:To maintain adequate hormonal levels for contraception and enhance compliance, oral contraceptives should be taken at the same time each day. There is no strong pharmacokinetic evidence that shows a relationship between the category of broad-spectrum antibiotic use and altered hormone levels in oral contraceptive users, so option B is not indicated at this time.

Methenamine mandelate is prescribed for a client with a urinary tract infection and renal calculi. Which finding indicates to the nurse that the medication is effective?

The frequency of urinary tract infections decreases. rational:Mandelamine is prescribed to acidify the urine, decreasing the incidence of calcium phosphate calculi and urinary tract infections.

A client who has chronic back pain is on long-term pain medication management and asks the nurse why his pain relief therapy is not as effective as it was 2 months ago. How should the nurse respond?

Tolerance to medication requires increased drug levels to achieve the same effect. rational: Pharmacodynamic tolerance explains the client's need for an increased drug level to produce effects that formerly occurred at lower drug levels. Tolerance can occur with opioids during shorter periods of use.

A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization?

Vastus lateralis ratonal:The preferred intramuscular site for children younger than 2 years is the vastus lateralis

A client receiving a continuous infusion of heparin IV starts to hemorrhage from an arterial access site. Which medication should the nurse anticipate administering to prevent further heparin-induced hemorrhaging?

protamine sulfate rational: Protamine sulfate is the antagonist for heparin and is given for episodes of acute hemorrhage.