Unit 4 pharm
A client who has undergone renal transplantation is receiving ongoing therapy with cyclosporine. The nurse would be sure to immediately report which abnormal finding? Decreased creatinine level Decreased hemoglobin level Decreased white blood cell (WBC) count Elevated blood urea nitrogen (BUN) level
Elevated blood urea nitrogen (BUN) level Cyclosporine is an immunosuppressant. The use of cyclosporine can cause nephrotoxicity. This complication is detected by assessing for elevated levels of BUN and serum creatinine. Decreased hemoglobin level and WBC count are incorrect because cyclosporine does not depress the bone marrow.
The nurse is monitoring a client receiving cyclosporine. Which sign or symptom would indicate to the nurse that the client is experiencing an adverse effect of this medication? Nausea Tremors Alopecia Hypotension
Tremors Cyclosporine is an immunosuppressant used for prevention of rejection following allogeneic organ transplantation. Adverse effects of cyclosporine are nephrotoxicity, infection, hypertension, tremors, and hirsutism. Of these, nephrotoxicity and infection are the most serious.
A client diagnosed with peptic ulcer disease is prescribed an over-the-counter antacid suspension containing aluminum hydroxide, magnesium hydroxide, and simethicone. What would the nurse include in the client instructions for time of administration of this medication? Just before each meal An hour before breakfast 1 and 3 hours after meals Immediately after each meal
1 and 3 hours after meals Antacids are alkaline compounds that neutralize stomach acid. The objective of peptic ulcer therapy is to promote healing in addition to relieving pain. Consequently, antacids would be taken on a regular schedule, not just in response to discomfort. In the usual dosing schedule, antacids are administered 7 times a day: 1 and 3 hours after each meal and at bedtime. Thus, option 3 is the correct option. Options 1, 2, and 4 are incorrect because they are either not the correct timing or not often enough as recommended.
The nurse is reviewing the laboratory results for a client receiving tacrolimus. Which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medication? Potassium level of 3.8 mEq/L (3.8 mmol/L) Platelet count of 300,000 mm3 (300 × 109/L) Fasting blood glucose of 200 mg/dL (11.1 mmol/L) White blood cell count of 6000 mm3 (6.0 × 109/L)
Fasting blood glucose of 200 mg/dL (11.1 mmol/L) A fasting blood glucose level of 200 mg/dL (11.1 mmol/L) is significantly elevated above the normal range of 70 to 99 mg/dL (3.9-5.5 mmol/L) and suggests an adverse effect. Recall that fasting blood glucose levels are sometimes based on primary health care provider preference. Other adverse effects include neurotoxicity evidenced by headache, tremor, and insomnia; gastrointestinal effects such as diarrhea, nausea, and vomiting; hypertension; and hyperkalemia. The remaining options identify normal reference levels. The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). The normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L).
The nurse is providing dietary instructions to a client who has been prescribed cyclosporine. Which food item would the nurse instruct the client to exclude from the diet? Red meats Orange juice Grapefruit juice Green, leafy vegetables
Grapefruit juice A compound present in grapefruit juice inhibits metabolism of cyclosporine through the cytochrome P450 system. As a result, consumption of grapefruit juice can raise cyclosporine levels by 50% to 100%, thereby greatly increasing the risk of toxicity. Red meats, orange juice, and green, leafy vegetables do not interact with the cytochrome P450 system.
The nurse notes in the medication record that a client is taking calcium carbonate chewable tablets. Based on the data, the nurse would ask the client about a history of which symptom? Flatus Heartburn Rectal pain Muscle twitching
Heartburn Calcium carbonate can be used as an antacid for the relief of heartburn and indigestion. It also can be used as a calcium supplement or to bind phosphorus in the gastrointestinal tract in clients with chronic kidney disease. The other options are incorrect and are not indications for the use of calcium carbonate.
Azathioprine is prescribed for a client to suppress rejection of a renal transplant. In planning for administration of the medication, the nurse understands that which description is the mechanism of action of this medication? It crosslinks DNA. It blocks all T-cell functions. It inhibits the proliferation of B and T lymphocytes. It decreases the activity of thymus-derived lymphocytes.
It inhibits the proliferation of B and T lymphocytes. Azathioprine is an immunosuppressant; it suppresses cell-mediated and humoral immune responses by inhibiting the proliferation of B and T lymphocytes. It generally is used as an adjunct to cyclosporine and glucocorticoids to help suppress transplant rejection. The remaining options are incorrect mechanisms of action.
A calcium carbonate antacid has been prescribed for a client, and the nurse provides instructions to the client about the medication. The nurse would tell the client that it is best to take the antacid with which item? Milk Water Yogurt Cheese
Water Calcium carbonate antacids would not be taken with milk, milk products, or foods or supplements high in vitamin D because milk-alkali syndrome (headache, urinary frequency, anorexia, nausea, vomiting, and fatigue) can occur. The best item to consume when taking calcium carbonate is water.
Aluminum hydroxide is prescribed for a client with chronic kidney disease (CKD). The nurse would instruct the client to take this medication at what time? At bedtime With meals On an empty stomach In the morning on arising
With meals The client who is receiving aluminum hydroxide would take the medication with meals. The phosphate-binding effect of this medication is most effective when it is taken with food. If tablets are used, they need to be chewed well before swallowing.
The nurse notes that a client is taking lansoprazole. Which question by the nurse helps to determine that this medication is effective? "Has your appetite increased?" "Are you experiencing any heartburn?" "Do you have any problems with vision?" "Do you experience any leg pain when walking?"
"Are you experiencing any heartburn?" Lansoprazole is a gastric acid proton pump inhibitor that is used to treat gastric and duodenal ulcers, erosive esophagitis, and hypersecretory conditions. It also is used to treat gastroesophageal reflux disease (GERD). It is not used to treat problems with appetite, visual problems, or leg pain.
The nurse is preparing to give a client directions for proper use of aluminum hydroxide tablets. Which instruction would the nurse provide to the client? "Take the tablet at the same time as an antacid." "Swallow the tablet whole with a full glass of water." "Take each dose with a laxative to prevent constipation." "Chew the tablet thoroughly and then drink 8 ounces of water."
"Chew the tablet thoroughly and then drink 8 ounces of water." Aluminum hydroxide tablets are an antacid and would be chewed thoroughly before swallowing to prevent them from entering the small intestine undissolved. An antacid would not be taken with the medication to prevent additive and interactive effects. Constipation is a side or adverse effect of the use of aluminum products, but the client would not take a laxative with each dose. This would promote laxative abuse and needs to be avoided if less habit-forming means can be used.
A client who has received a kidney transplant is taking azathioprine, and the nurse provides instructions about the medication. Which statement by the client would indicate a need for further instruction? "I need to watch for signs of infection." "I need to discontinue the medication after 14 days of use." "I can take the medication with meals to minimize nausea." "I need to call my primary health care provider if more than one dose is missed."
"I need to discontinue the medication after 14 days of use." Azathioprine is an immunosuppressant medication that is taken for life. Because of the effects of the medication, the client must watch for signs of infection, which are to be reported immediately to the primary health care provider (PHCP). The medication may be taken with meals to minimize nausea. The client should also call the PHCP if more than one dose is missed.
The nurse reinforces medication instructions on therapy with cyclosporine to a client who has received a kidney transplant. Which statement by the client would indicate a need for further instruction? "I need to obtain a yearly influenza vaccine." "I need to have dental checkups every 3 months." "I need to self-monitor my blood pressure at home." "I need to call the primary health care provider if my urine volume decreases or it becomes cloudy."
"I need to obtain a yearly influenza vaccine." Cyclosporine is an immunosuppressant medication. Because of the effects of the medication, the client would not receive any vaccinations without first consulting the primary health care provider. The client would report decreased urine output or cloudy urine, which could indicate kidney rejection or infection, respectively. The client needs meticulous oral care and dental cleaning every 3 months to help prevent gingival hyperplasia. The client must be able to self-monitor blood pressure to check for the side effect of hypertension.
The nurse provides instructions regarding the administration of liquid oral cyclosporine solution to a client. Which statement, if made by the client, would indicate the need for further teaching? "I need to mix the concentrate well and drink it immediately." "I will mix the concentrate with orange juice to improve the taste." "I will purchase a dropper from the pharmacy to calibrate the amount of medication that I need." "After taking the medication, I need to rinse the container with diluent and drink it to ensure that I have taken the complete dose."
"I will purchase a dropper from the pharmacy to calibrate the amount of medication that I need." The client needs to be instructed to dispense the oral liquid into a glass container using a specially calibrated pipette. The client would not use any other type of dropper to calibrate the amount of prescribed medication. The remaining options identify correct procedure for administering this medication.
The nurse determines that the client needs further instruction on cimetidine if which statements were made? Select all that apply. "I will take the cimetidine with my meals." "I'll know the medication is working if my diarrhea stops." "My episodes of heartburn will decrease if the medication is effective." "Taking the cimetidine with an antacid will increase its effectiveness." "I will notify my doctor if I become depressed or anxious." "Some of my blood levels will need to be monitored closely since I also take warfarin for atrial fibrillation."
"I will take the cimetidine with my meals." "I'll know the medication is working if my diarrhea stops." "Taking the cimetidine with an antacid will increase its effectiveness." Cimetidine, a histamine (H2)-receptor antagonist, helps alleviate the symptom of heartburn, not diarrhea. Because cimetidine crosses the blood-brain barrier, central nervous system side and adverse effects, such as mental confusion, agitation, depression, and anxiety, can occur. Food reduces the rate of absorption, so if cimetidine is taken with meals, absorption will be slowed. Antacids decrease the absorption of cimetidine and need to be taken at least 1 hour apart. If cimetidine is concomitantly administered with warfarin therapy, warfarin doses may need to be reduced, so prothrombin and international normalized ratio results must be followed.
The nurse is assisting in administering immunizations as well as providing education to the clients who receive them at a health care clinic. Which statement by a client indicates that teaching was successful? 1"Immunizations protect against all diseases." "Immunizations can provide natural immunity." "Immunizations can provide innate immunity." "Immunizations are a way to acquire immunity to a specific disease."
"Immunizations are a way to acquire immunity to a specific disease." Acquired immunity is immunity that can occur by receiving an immunization that causes antibodies to a specific pathogen to form. No immunization protects the client from all diseases. Natural (innate) immunity is present at birth.
A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including clarithromycin, esomeprazole, and amoxicillin. Which statement by the client indicates the best understanding of the medication regimen? "My ulcer will heal because these medications will kill the bacteria." "These medications are taken only when I have pain from my ulcer." "The medications will kill the bacteria and stop the acid production." "These medications will coat the ulcer and decrease the acid production in my stomach."
"The medications will kill the bacteria and stop the acid production." Triple therapy for H. pylori infection usually includes two antibacterial medications and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production.
A client has been given lansoprazole for the chronic management of Zollinger-Ellison syndrome. The nurse instructs the client to take which product for pain while taking this medication? Ibuprofen Acetaminophen Naproxen sodium Acetylsalicylic acid
Acetaminophen Lansoprazole is a proton pump inhibitor. Zollinger-Ellison syndrome is a hypersecretory condition of the stomach, associated with increased risk of problems from irritation of the stomach lining. The client would take acetaminophen for pain relief. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen sodium, would be avoided, as would aspirin, because they are potential stomach irritants.
A client with peptic ulcer disease asks the nurse what medications they might be prescribed for this problem. The nurse tells the client that which medications will be prescribed? Select all that apply. Antacids Antibiotics Proton pump inhibitors Cytoprotective therapy Histamine H2-receptor blockers Nonsteroidal anti-inflammatory drugs (NSAIDs)
Antacids, Antibiotics, Proton pump inhibitors, Cytoprotective therapy, Histamine H2-receptor blockers Medications to treat peptic ulcer disease include antacids, antibiotics, proton pump inhibitors, cytoprotective therapy, and histamine H2-receptor blockers. NSAIDs are contraindicated in peptic ulcer disease because of the risk of bleeding.
A client is receiving tacrolimus to prevent organ rejection. Which is a nursing consideration associated with this medication? Give with cyclosporine. Assess for hypoglycemia. Give with grapefruit juice. Assess platelet count for thrombocytopenia.
Assess platelet count for thrombocytopenia. Tacrolimus is an immunosuppressant and is an alternative to cyclosporine for prevention of organ rejection in clients receiving an organ transplant. It would never be given with cyclosporine because of its toxic effects on the kidney. This medication will cause hyperglycemia (not hypoglycemia). Grapefruit juice can increase tacrolimus levels, so it would be avoided to prevent toxicity. Tacrolimus suppresses the bone marrow, so it can cause anemia, thrombocytopenia, and neutropenia
The nurse is monitoring a client receiving muromonab-CD3. Which finding is a priority assessment required in monitoring for adverse effects of this medication? Assessing pedal pulses Assessing lung sounds Assessing for pain in the calf Assessing for positive bowel sounds
Assessing lung sounds Muromonab-CD3 is an immunosuppressant. Potentially fatal anaphylactic reactions can occur with this medication. Manifestations include pulmonary edema, cardiovascular collapse, and cardiac or respiratory arrest. Assessing lung sounds is a priority.
Muromonab-CD3 is prescribed for a client to manage allograft rejection after renal transplantation. The nurse plans care, knowing that the primary mechanism of action of this medication is what? Suppresses B lymphocytes Inhibits the proliferation of B lymphocytes Crosslinks DNA, causing cell injury and death Binds to the CD3 site and blocks all T-cell functions
Binds to the CD3 site and blocks all T-cell functions Muromonab-CD3 is a monoclonal antibody. On binding to the CD3 site, the antibody blocks all T-cell functions. The remaining options are not actions of this medication.
The nurse is caring for a postrenal transplantation client taking cyclosporine. The nurse notes an increase in one of the client's vital signs, and the client is complaining of a headache. What vital sign is most likely increased? Pulse Respirations Blood pressure Pulse oximetry
Blood Pressure Hypertension can occur in a client taking cyclosporine, and because this client is also complaining of a headache, the blood pressure is the vital sign to be monitored most closely. Other adverse effects include infection, nephrotoxicity, and hirsutism. Options 1, 2, and 4 are unrelated to the use of this medication
Cyclosporine is prescribed for the client following allogenic kidney transplantation. The nurse would provide which instruction to the client regarding the medication? There are no known adverse effects of the medication. The medication will need to be taken for a period of 6 months. Blood levels of the medication will need to be measured periodically. The medication is administered by the intravenous (IV) route on a monthly basis.
Blood levels of the medication will need to be measured periodically. Cyclosporine is an immunosuppressant. To avoid toxicity from high medication levels and to avoid organ rejection from low medication levels, blood levels of cyclosporine would be measured periodically. In the organ transplant client, an immunosuppressant will need to be taken for life. Oral administration is the route of choice; IV administration is reserved for clients who cannot take the medication orally. The most serious adverse effects are nephrotoxicity and infection.
Blood work has been drawn on a client who has been taking cyclosporine following allogeneic liver transplantation. The nurse would check the results of which test to determine the presence of an adverse effect related to this medication? Hematocrit level Cholesterol level Hemoglobin level Blood urea nitrogen (BUN) level
Blood urea nitrogen (BUN) level Cyclosporine is an immunosuppressant. Nephrotoxicity is one of the most common adverse effects of cyclosporine. Nephrotoxicity is evaluated by monitoring the BUN and creatinine levels. The laboratory tests in the remaining options are unrelated to the adverse effects associated with the administration of this medication.
Following kidney transplantation, cyclosporine is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? Hemoglobin level of 14.0 g/dL (140 mmol/L) Creatinine level of 0.6 mg/dL (53 mcmol/L) Blood urea nitrogen level of 25 mg/dL (8.8 mmol/L) Fasting blood glucose level of 99 mg/dL (5.5 mmol/L)
Blood urea nitrogen level of 25 mg/dL (8.8 mmol/L) Cyclosporine is an immunosuppressant. Nephrotoxicity can occur from the use of cyclosporine. Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels. The normal blood urea nitrogen level is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). The normal creatinine level ranges from 0.5 to 1.2 mg/dL (44 to 106 mcmol/L). Cyclosporine can lower complete blood cell count levels. A normal hemoglobin ranges from12 to 18 g/dL (120 to 180 mmol/L). A normal hemoglobin is not an adverse effect. The normal fasting glucose is 70 to 99 mg/dL (3.9-5.5 mmol/L).
A client with Crohn's disease is scheduled to receive an infusion of infliximab. What intervention by the nurse will determine the effectiveness of treatment? Monitoring the leukocyte count for 2 days after the infusion Checking the frequency and consistency of bowel movements Checking serum liver enzyme levels before and after the infusion Carrying out a Hematest on gastric fluids after the infusion is completed
Checking the frequency and consistency of bowel movements. The principal manifestations of Crohn's disease are diarrhea and abdominal pain. Infliximab is an immunomodulator that reduces the degree of inflammation in the colon, thereby reducing the diarrhea. Options 1, 3, and 4 are unrelated to this medication.
The nurse is providing instructions to the client who is taking antacid tablets. How would the nurse instruct the client to take this medication? Chew the tablet thoroughly. Swallow the tablet with water. Place the tablet under the tongue. Place the tablet between the gum and the cheek.
Chew the tablet thoroughly. Antacid tablets need to be chewed thoroughly and followed by a full glass of water or milk.
The nurse is giving the client directions for proper use of aluminum hydroxide tablets. What would the nurse tell the client? Swallow the tablets whole with a full glass of water. Take the tablets at the same time as other medications. Take each dose with a laxative to prevent constipation. Chew the tablets thoroughly and follow with 8 oz of water.
Chew the tablets thoroughly and follow with 8 oz of water. Aluminum hydroxide tablets need to be chewed thoroughly before swallowing followed by drinking 8 oz of water. This prevents them from entering the small intestine undissolved. They would not be swallowed whole. Antacids need to be taken at least 1 hour apart from other medications to prevent interactive effects. Constipation is a side effect of the use of aluminum products, but it is incorrect for the client to take a laxative with each dose. This promotes laxative abuse. The client needs to first try other means to prevent constipation.
The nurse is reviewing a client's medication reconciliation form in the medical record and notes that the client is taking tamsulosin at home. Which medication, if started in the hospital, would the nurse question? Lisinopril Valsartan Metoprolol Cimetidine
Cimetidine Tamsulosin is used most commonly for the treatment of benign prostatic hyperplasia. This medication would not be used concurrently with cimetidine because of the risk of tamsulosin toxicity. The other medications noted do not cause interactions with this medication.
An older client with peptic ulcer disease recently has been taking cimetidine. The nurse monitors the client for which most frequent central nervous system side effect of this medication? Tremors Dizziness Confusion Hallucinations
Confusion Cimetidine is a histamine (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.
The nurse instructs a client taking aluminum hydroxide that a common side or adverse effect associated with administration of this medication is which effect? Cramping Headache Constipation Muscle weakness
Constipation Aluminum-containing antacids are constipating, so the client would be instructed to take a stool softener or additional bulk-type laxatives to relieve this uncomfortable side effect. Cramping, headache, and muscle weakness are not side or adverse effects of this medication.
A client is told by the primary health care provider to take aluminum hydroxide as needed for heartburn. The nurse advises the client to watch for which common side effect of this medication? Dizziness Excitability Restlessness Constipation
Constipation Because of the antacid's aluminum base, aluminum hydroxide causes constipation as a side effect. The other side effect is hypophosphatemia, which is noted by monitoring serum laboratory studies. The other options are not side effects of this medication.
Mycophenolate mofetil is prescribed for a client for prophylaxis of organ rejection following allogenic renal transplantation. Which instruction would the nurse provide to the client regarding administration of this medication? Administer the medication following meals. Take the medication with a magnesium-type antacid. Open the capsule and mix with food for administration. Contact the primary health care provider (PHCP) if a sore throat occurs.
Contact the primary health care provider (PHCP) if a sore throat occurs. Mycophenolate mofetil is an immunosuppressant. A client taking mycophenolate mofetil would contact the PHCP if unusual bleeding or bruising, sore throat, mouth sores, abdominal pain, or fever occurs. This medication needs to be administered on an empty stomach. Antacids containing magnesium and aluminum may decrease the absorption of the medication and therefore would not be taken with the medication. The medication is given with corticosteroids and cyclosporine. The capsules would not be opened or crushed.
The nurse is collecting data from a client with a history of renal transplantation. The nurse understands that which medication is the medication of choice for preventing organ rejection? Probenecid Prednisone Indomethacin Cyclosporine
Cyclosporine Cyclosporine is a powerful immunosuppressant and is the medication of choice for preventing organ rejection following allogeneic transplantation. Prednisone is a glucocorticoid and may be administered concurrently with the cyclosporine. Probenecid is a uricosuric agent used to treat hyperuricemia. Indomethacin is a nonsteroidal anti-inflammatory agent.
The nurse is providing discharge instructions to a client who will be taking tacrolimus daily following allogeneic liver transplantation. The nurse instructs the client that which is a frequent side effect related to this medication? Diarrhea Confusion Loss of memory A decrease in urine output
Diarrhea Tacrolimus is an immunosuppressant medication used in the prophylaxis of organ rejection in clients who receive allogeneic liver transplants. Frequent side effects include headache, tremors, insomnia, paresthesia, diarrhea, nausea, constipation, vomiting, abdominal pain, and hypertension. Toxic effects include nephrotoxicity and pleural effusion, which can occur frequently. Nephrotoxicity is characterized by increasing serum creatinine and a decrease in urine output. Thrombocytopenia, leukocytosis, anemia, and atelectasis occur occasionally. Neurotoxicity, including tremor, headache, and mental status changes, also can occur. It is imperative for the nurse to assess laboratory results, particularly renal function tests, and to monitor intake and output closely.
The nurse is preparing to administer a prescribed dose of cyclosporine by intravenous (IV) administration. Which priority item would the nurse have available during administration of this medication? A code cart Oral airway Epinephrine A suction catheter
Epinephrine Cyclosporine is an immunosuppressant medication used to prevent rejection following allogeneic organ transplantation. Because of the risk of anaphylaxis during administration of cyclosporine by the IV route, epinephrine and oxygen must be immediately available for use. An oral airway or a suction machine is not the priority item. A code cart needs to be available, but it is not the priority item.
A client with peptic ulcer disease has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? Diarrhea Heartburn Flatulence Constipation
Heartburn Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4.
A client has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates medication effectiveness by asking the client whether relief was obtained from which symptom? Diarrhea Heartburn Flatulence Constipation
Heartburn Rationale: Omeprazole is a proton pump inhibitor and is classified as an antiulcer agent. The medication relieves pain from gastric irritation, which often is experienced as "heartburn" by clients. The medication does not relieve the symptoms identified in the remaining options.
A client with a history of duodenal ulcer is taking calcium carbonate chewable tablets. Which finding indicates that the client is experiencing optimal effects of the medication? Heartburn is relieved. Muscle twitching stops. The serum calcium level increases. The serum phosphorus level decreases.
Heartburn is relieved. Rationale:Calcium carbonate can be used as an antacid for the relief of heartburn and indigestion. Calcium carbonate also can be used as a calcium supplement (serum calcium level increases) or to bind phosphorus in the gastrointestinal tract with chronic kidney disease (serum phosphorus level decreases). Although adequate calcium levels are needed for proper neurological function, a reduction in muscle twitching is not an expected outcome when taking the medication for duodenal ulcer.
The nurse is reviewing the prescriptions for a newly admitted client. The nurse sees a prescription for intravenous pantoprazole but does not see any gastrointestinal conditions in the medical record. How would the nurse interpret this prescription? It is used as a prophylactic measure. It is inaccurate and needs to be questioned. It is likely that the client has a new gastrointestinal disorder. It is used before surgery, so the client will probably require surgery.
It is used as a prophylactic measure. Pantoprazole is a proton pump inhibitor and is commonly used as a gastrointestinal prophylactic measure to prevent stress ulcers. The other options are incorrect.
A client reports frequent use of sodium bicarbonate to relieve heartburn after meals. The nurse would monitor the client for which condition that the client is at risk for with long-term frequent use of this medication? Urinary calculi Chronic bronchitis Metabolic alkalosis Respiratory acidosis
Metabolic alkalosis Sodium bicarbonate is an electrolyte modifier and antacid. With large doses or long-term use, it can cause metabolic alkalosis. The other options are incorrect.
The nurse provides instructions to a client who will be taking cyclosporine oral solution. Which action would the nurse tell the client to do? Mix the concentrate with orange juice. Mix the concentrate with grapefruit juice. Avoid diluting the concentrate for administration. Dilute the concentrate in a Styrofoam cup before administration.
Mix the concentrate with orange juice. Cyclosporine is an immunosuppressant used for prevention of rejection following allogeneic organ transplantation. To improve palatability the client would be taught to mix the concentrated medication solution with chocolate milk or orange juice just before administration. Grapefruit juice is avoided because it can raise cyclosporine levels. The client is instructed to dilute the concentrate in a glass, not Styrofoam, to ensure ingestion of the complete dose because the medication adheres to Styrofoam.
Cyclosporine is prescribed to be administered by the intravenous (IV) route. Which is an inappropriate action in preparing and administering this medication? Mixing the solution and covering it with a paper bag Administering the medication over a period of 2 to 6 hours Mixing 1 mL of concentrate in 50 mL of 0.9% sodium chloride and administering by infusion Mixing 1 mL of concentrate in 10 mL of 0.9% sodium chloride and administering by bolus injection
Mixing 1 mL of concentrate in 10 mL of 0.9% sodium chloride and administering by bolus injection Cyclosporine is an immunosuppressant medication used to prevent rejection following allogeneic organ transplantation. For IV administration of cyclosporine, 1 mL of concentrate is diluted in 20 to 100 mL of 0.9% sodium chloride or 5% dextrose. The solution should be protected from light. The initial dose is 5 to 6 mg/kg (one-third of the oral dose) administered over a 2- to 6-hour infusion.
A client must begin medication therapy with mycophenolate mofetil to prevent organ rejection following renal transplantation. The nurse would provide which important teaching point to the client? Take the dose following meals. Open the capsule and mix with food before use. Take the medication with an aluminum-based antacid. Notify the primary health care provider (PHCP) if a fever develops.
Notify the primary health care provider (PHCP) if a fever develops. Mycophenolate mofetil is an immunosuppressant. The client would contact the PHCP if unusual bleeding, bruising, sore throat, mouth sores, abdominal pain, or fever occurs. Antacids containing magnesium and aluminum may decrease the absorption of the medication and would not be taken with it. The medication is given in combination with corticosteroids and cyclosporine. Mycophenolate mofetil may be administered on an empty stomach. The capsules should not be opened or crushed.
Cyclosporine is prescribed for a client who received a kidney transplant. The nurse would be most concerned if a review of the medical record revealed that the client currently is taking which prescribed medication? Digoxin Phenytoin Prednisone Propranolol
Phenytoin Cyclosporine is an immunosuppressant medication used to prevent rejection following allogeneic organ transplantation. Medications known to lower cyclosporine levels include phenytoin (anticonvulsive medication), phenobarbital, rifampin, and trimethoprim-sulfamethoxazole. Cyclosporine levels would be monitored and the dosage adjusted in clients taking these medications.
Intravenous (IV) antithymocyte globulin is prescribed to a client for treatment of transplant rejection. Which intervention is the priority in planning the administration of this medication? Assess bowel sounds. Assess the neurovascular status. Premedicate the client with acetylsalicylic acid. Plan for a skin test dose to identify hypersensitivity.
Plan for a skin test dose to identify hypersensitivity. Antithymocyte globulin is an immunosuppressant used to prevent rejection after kidney, heart, liver, and bone marrow transplantation. The nurse would plan for a skin test dose before IV administration of antithymocyte globulin to identify hypersensitivity to the medication. Options 1 and 2 are not specific to this medication. The client would not be premedicated with acetylsalicylic acid (aspirin). Premedication with acetaminophen or diphenhydramine, or both, may be prescribed to prevent reaction to the medication.
Tacrolimus is prescribed to a client for prevention of organ rejection after renal transplantation. Which prescription would the nurse anticipate to be prescribed, along with the tacrolimus, for this client? Phenytoin Prednisone Fluconazole Erythromycin
Prednisone Tacrolimus is an immunosuppressant used as an alternative medication to cyclosporine for prevention of organ rejection in clients after transplantation. The medication is more effective than cyclosporine but is more toxic. Concurrent use of glucocorticoids such as prednisone is recommended during administration of this medication. The medications in the remaining options would not be prescribed unless a secondary disorder existed.
A hospitalized client asks the nurse for sodium bicarbonate to relieve heartburn after a meal. The nurse reviews the client's medical record, knowing that the medication is contraindicated in which condition? Atelectasis on chest x-ray Hydronephrosis on renal ultrasound Serum pH 7.52 (7.52), bicarbonate 30 mEq/L (30 mmol/L) Serum pH 7.22 (7.22), bicarbonate 29 mEq/L (29 mmol/L)
Serum pH 7.52 (7.52), bicarbonate 30 mEq/L (30 mmol/L) Sodium bicarbonate is an electrolyte modifier and antacid, and it would aggravate metabolic alkalosis, which is a difficult acid-base imbalance to correct. Atelectasis, hydronephrosis, and metabolic acidosis are the other conditions noted. The medication is not contraindicated with these conditions.
The client with gastroesophageal reflux disease (GERD) has a new prescription for pantoprazole. Which instruction would the nurse provide to the client? Chew the pill thoroughly. Swallow the tablet whole. Headache is expected to occur. Crush the pill if it is difficult to swallow.
Swallow the tablet whole. Pantoprazole, a proton pump inhibitor, is a delayed-release medication and would be swallowed whole. It would not be chewed or crushed. Headache is a potential side effect of the medication and needs to be reported to the primary health care provider if it is troublesome.
Tacrolimus is prescribed for a client who underwent a kidney transplant. Which instruction would the nurse include when teaching the client about this medication? Eat at frequent intervals to avoid hypoglycemia. Take the medication with a full glass of grapefruit juice. Change positions carefully due to risk of orthostatic hypotension. Take the oral medication every 12 hours at the same times every day.
Take the oral medication every 12 hours at the same times every day. Tacrolimus is a potent immunosuppressant used to prevent organ rejection in transplant clients. It is important that the medication be taken at 12-hour intervals to maintain a stable blood level to prevent organ rejection. Adverse effects include hyperglycemia and hypertension, so the client does not eat frequently to avoid hypoglycemia or use precautions to avoid orthostatic hypotension. Tacrolimus is metabolized through the cytochrome P450 system, so grapefruit juice is not allowed.
