Uworld Pharmacology Questions

The emergency department nurse prepares a male client for surgery. The client was admitted with a traumatic open fracture of the femure, hematocrit of 36%, and hemoglobin of 12 g/dL. Which prescription should the nurse validate with the healthcare provider before administration? --cefazolin --enoxaparin --morphine --tetanus toxoid

enoxaparin --Medications commonly prescribed for a client with an open fracture to prevent infection and treat pain and muscle spasm include fetazolin (Ancef), tetanus toxoid, ketorolac (Toradol), opioids, and cyclobenzaprine (Flexeril)

Which type of enema relieves constipation by infusing a hypertonic solution into the bowl, pulling fluid into the colon and causing distension and then defecation?

fleet enema

What drug classification is phenytoin? What is phenytoin prescribed for?

-anticonvulsant --prescribed for treatment of seizures

Discharge teaching for a client on enoxaparin therapy includes...

-mild pain, bruising, irritation, or redness of the skin at the injection site is common. DO NOT rub the site with the hand. --avoid taking aspirin, NSAIDs, and herbal supplements (ginkgo biloba and vitamin E) --monitor complete blood count to assess for thrombocytopenia

Use of ephedra

-treatment of cold and flu -weight loss and improved athletic performance

What is a therapeutic serum phenytoin range?

10-20 mcg/mL

What is the therapeutic index for phenytoin?

10-20 mcg/mL

When do rapid-acting insulins reach their peak effect?

30 minutes to 3 hours

How often and when does the American Diabetes Association recommend that clients using CSII check their blood glucose levels?

4-8 times a day --fasting, pre-meal, 2-hours postprandial, bedtime, at 3:00am weekly, when experiencing symptoms of hypoglycemia, after treating low blood sugar, and before exercise.

What drug classification is captopril?

ACEI

What drug classification is Valsartan?

ARB

What medication is commonly prescribed to treat bradykinesia with Parkinson disease?

Carbidopa-levodopa

The nurse is preparing to administer the fourth dose of vancomycin IVPB to a client with infective endocarditis. Which intervention does the nurse anticipate? --administering PRN antiemetic prior to the infusion --administering via an infusion pump over at least 30 minutes --drawing a trough level just prior to administration of the vancomycin --starting a new IV line before administration

Drawing a trough level just prior to administration of the vancomycin --Vancomycin is a very potent antibiotic that can cause nephrotoxicity and ototoxicity. Measuring for serum concentrations is a way to monitor for risk of nephrotoxicity as well as for therapeutic response. Trough serum vancomycin concentrations are the most accurate and practical method for monitoring efficacy. A through should be obtained just prior (15-30 minutes) to administration of the next dose.

What drug classification is phenytoin?

Phenytoin (AKA dilantin) is an anticonvulsant drug commonly used to treat seizure disorders

Which herbal medication is commonly used by clients with major depressive disorders?

St John's wort

What drug classification is glipizide?

Sulfonylureas

Describe the mechanism of action for methotrexate

acts by interfering with folic acid metabolism, which inhibits DNA synthesis and cell reproduction

Describe the mechanism of action of tamoxifen

blocks estrogen receptors in certain estrogen-sensitive tissues.

What is albuterol used for?

bronchospasm

What drug classification is diltiazem?

calcium channel blocker

What drug classification is methylphenidate?

central nervous system stimulant

What is the primary treatment for Addison disease?

corticosteroid therapy (hydrocortisone, dexamethasone, prednisone)

What drug classification is Dextromethorphan?

cough suppressant

What is the mechanism of action of H1 receptor antagonists?

decrease inflammatory response by blocking histamine receptors.

When might someone use/take evening primrose?

eczema or skin irritations

Long-term use of corticosteroids can cause...

immunosuppression --can also mask the signs of infection (inflammation, redness, tenderness, fever, edema)

Side effects of Ginseng?

increased bleeding risk

side effect of Ginkgo Biloba?

increased bleeding risk

What is the mechanism of action of digoxin?

increases cardiac contractility but slows the heart rate and conduction.

What drug classification is montelukast?

leukotriene inhibitor

What is a normal blood uric acid level for an adult male? An adult female?

male= 4.4-7.6 female= 2.3-6.6

What is ginseng used to promote?

mental alertness and enhance the immune system

What drug classification is cyclobenzaprine?

muscle relaxers

Which type of enema is a medicated enema that reduces the number of bacteria in the intestine in preparation for colon surgery?

neomycin enema

How fast should IV hydromorphone be administered?

over 2-3 minutes. Rapid IV administration of opioid analgesics can cause severe hypotension and respiratory/cardiac arrest.

Describe 1st level of sedation with POSS? --what are the nursing interventions for this level?

patient is awake and alert --the nurse may increase sedation

Describe 2nd level of sedation with POSS --what are the nursing interventions for this level?

patient is slightly drowsy but easy to rouse --no action is necessary from the nurse

What drug classification is slidenafil?

phosphodiesterase inhibitors --used for erectile dysfunction

What is a common side effect of tetracycline antibiotics and sulfa drugs?

photosensitivity reactions.

What drug classification is sumatriptan?

selective serotonin agonist

What drug classification is ipratropium?

short-acting inhaled anticholinergic

Describe the 4th and final level of sedation with POSS --What are the nursing interventions for this stage?

somnolent; minimal or no response to verbal and physical stimuli --nurse needs to stop sedation, consider using naloxone, notify the healthcare provider, and monitor respiratory status.

What drug classification is glyburide?

sulfonylureas

define waxy flexibility

tendency to remainin an immobile posture --motor disturbance seen in schizophrenia

What drug classification is chlorthalidone? When is chlorthalidone prescribed?

thiazide diuretics --prescribed to treat hypertension and edema

Use for echinacea

treatment and prevention of cold and flu

What is Metronidazole used for?

trichomoniasis and amebiasis

What drug classification is amitriptyline?

tricyclic antidepressants

What are thiazolidinediones use to treat?

type 2 diabetes

What is the purpose for guaifenesin?

used to facilitate mobilization of mucus

Describe the mechanism of action for ACE inhibitors

works by blocking a crucial step within the renin-angiotensin-aldosterone system

The home health nurse visits a client with hypertension whose blood pressure has been well controlled on oral valsartan 320 mg daily. The client's blood pressure is 190/88 mm Hg, significantly higher than it was 2 weeks ago. The client reports a cold, a stuffy nose, and sneezing for 3 days. Which question is most appropriate for the nurse to ask? --"Are you taking any over-the-counter medicines for your cold?" --"Are you taking extra vitamin C?" --"Did you babysit your granddaughter this past week?" --"Did you get a flu shot in the past week?"

"Are you taking any over-the-counter medicines for your cold?" ---Clients with hypertension should be instructed not to take potentially high-risk over-the-counter medications, including high-sodium antacids, appetite suppressants, and cold/sinus preparations (which contains phenylephrine or pseudoephedrine), as they can increase blood pressure.

What are the major side effects of thiazide diuretics?

--hypokalemia (manifests as muscle cramps) --hyponatremia (manifests as altered mental status and seizures) --hyperuricemia (may precipitate or worsen gout attacks) --hyperglycemia (may require adjustment of diabetic medications)

Side effects of St. John's wort

-drug interactions (antidepressants, oral contraceptives, anticoagulants, digoxin) -hypertensive crisis

What are clinical manifestations of phenytoin toxicity?

-nystagmus -dysarthria -ataxia -encephalopathy

Hypothyroidism during pregnancy places the client at increased risk for what other complications?

-preeclampsia -placental abruption -preterm labor

What drug classification is methotrexate?

--folate antimetabolite --antineoplastic --immunosuppressant --nonbiologic disease-modifying antirheumatic drug (DMARD)

What are some examples of selective beta blockers?

--metoprolol --atenolol --bisoprolol

What is a normal aPTT (aPTT for someone NOT on heparin)?

25-35 seconds

What is a therapeutic aPTT level for a client being administered heparin?

46-70 seconds

A client is admitted with palpitations. The ECG shows supraventricular tachycardia (SVT) with a rate of 220/min. The nurse has received an order to administer adenosine 6 mg IV. Which action should the nurse take? --adenosine is contraindicated for SVT. Verify the order with the healthcare provider --administer medication only through a central venous access --administer medication rapidly over 1-2 seconds followed by a saline flush --mix medication in 50 mL normal saline and administer over 10 minutes

Administer medication rapidly over 1-2 seconds followed by a saline flush --Adenosine is the drug of choice for the treatment of paroxysmal supraventricular tachycardia. It has a short half-life and should be administered rapidly over 1-2 seconds, followed with a 20 mL saline bolus. A brief period of asystole can be common. Flushing from vasodilation is seen frequently. Although the drug should be administered as close to the heart as possible, central venous access is not required. Due to the short half-life, it should NOT be administered slowly nor should it be diluted.

A client with a history of heart failure calls the clinic and reports a 3-lb weight gain over the past 2 days and increased ankle swelling. The nurse reviews the client's medications and anticipates the immediate need for dosage adjustment of which medication? --bumetanide --candesartan --carvedilol --isosorbide

Bumetanide --A client who reports weight gain and edema requires evaluation for additional symptoms of fluid volume overload and adherence to the current treatment plan. If the client is stable, an increase in the dosage of loop diuretic is anticipated.

The nurse is caring for a client who had surgery yesterday. When administering omeprazole, the cliet asks "What is that for? I don't take it at home." Which reply but the nurse is most appropriate? --"Omeprazole helps prevent nausea by making your stomach empty faster" --"Omeprazole helps prevent you from developing an ulcer due to the stress of surgery" --"Omeprazole protects you from getting an infection while on antibiotics" --"This medication will treat your gastroesophageal reflux disease"

Omeprazole helps prevent you from developing an ulcer due to the stress of surgery" --PPIs such as omeprazole are often prescribed to hospitalized clients without GERD or ulcers to prevent stress ulcers from developing during surgery or a major illness.

What is the reversal agent for heparin?

Protamine

What drug classification is prednisone?

glucocorticoid monitor for hyperglycemia

Side effects of echinacea

anaphylaxis (more likely in asthmatics)

What drug classification is cefazolin (Ancef)?

bone-penetrating cephalosporin antibiotic

What drug classification is levofloxacin?

broad-spectrum antibiotic

How is digoxin excreted from the body?

by the kidney

What drug classification is isocarboxazid?

monoamine oxidase inhibtiors (MAOIs)

A client diagnosed with stable angina is being discharged home on the cholesterol-lowering drug rosuvastatin. The nurse should teach the client to report which side effect to the healthcare provider immediately? --abdominal discomfort --insomnia --morning headache --muscle aches or weakness

muscle aches or weakness --The nurse should teach all clients taking statin drugs to immediately report any muscle aches or weakness, as these can lead to rhabdomyolysis, a muscle disintegration that can cause serious kidney injury. All options are side effects of rosuvastatin but are not as concerning as muscle aches or weakness

Suffix for tricyclic antidepressants

-ine

A client with asthma was recently prescribed fluticasone/salmeterol. After the client has received instructions about this medication, which statement would require further teaching by the nurse? --"After taking this medication, I will rinse my mouth with water" --"At the first sign of an asthma attack, I will take this medication" --"I have been smoking for 12 years, but I just quit a month ago" --"I received the pneumococcal vaccine about a month ago"

"At the first sign of an asthma attack, I will take this medication" --Fluticasone/salmeterol is a combination drug containing a corticosteroid and a bronchodilator. Salmeterol is a long-acting inhaled beta 2-adrenergic agonist that promotes relaxation of the bronchial smooth muscles over 12 hours. Fluticasone decreases inflammation. This medication is used as part of the treatment plan for prevention and long-term control of asthma

Adverse effects of valproate on the fetus

-neural tube defects

What drug classification is digoxin?

cardiac glycoside

What drug classification is duloxetine (Cymbalta)?

serotonin-norepinephrine reuptake inhibitor

What drug classification is doxycycline?

tetracycline antibiotic

A parent calls the after-hours triage nurse about a 3-year-old who issick with the flu. Which report by the parent would necessitate intervention by the nurse? --acetaminophen being given every 4 hours for fever --Bismuth subsalicylate being used for nausea --ibuprofen being given every 6 hours for body aches --popsicles and gelatin desserts being used for hydration

Bismuth subsalicylate being used for nausea --The nurse should tell the parent to discontinue the use of bismuth subsalicylate (Pepto-Bismol) as it contains a salicylate and could possibly cause Reye syndrome. Reye syndrome can develop in children with a recent viral illness such as varicella or influenza. It can cause acute encephalopathy and hepatic dysfunction. Children with viral infections should not be given aspirin or products containing salicylates.

Adverse effects associated with methotrexate?

-bone marrow suppression (leads to anemia, leukopenia, and thrombocytopenia) -hepatotoxicity (drug-induced liver injury) -gastrointestinal irritation (N/V, diarrhea)

What are some commonly prescribed ACE inhibitors?

-captopril --enalapril --lisinopril --ramipril

What is a normal calcium level?

8.6-10.2

What is the target goal HbA1c for diabetic patients?

<7%

What is a common side effect of ACE inhibitors?

angioedema. More common in African Americans --unlike other typical drug allergies, this side effect can occur any time after starting the medication

What drug classification is carvedilol?

beta blocker

Which client finding would be a contraindication for the nurse to administer dicyclomine hydrochloride for irritable bowel syndrome? --bladder scan showing 500 mL urine --hemoglobin of 11 g/dL --history of cataracts --reporting frequent diarrhea today

bladder scan showing 500 mL urine --Dicyclomine hydrochloride is an anticholinergic medication. Anticholinergics are used to relax smooth muscle and dry secretions. Anticholinergic side effects include pupillary dilation, dry mouth, urinary retention, and constipation. Therefore, the classic contraindications are closed-angle glaucoma, bowel ileus, and urinary retention. Anticholinergic drugs do not affect the blood count. The common eye contraindication is narrow-angle glaucoma as it could worsen the condition. Diarrhea is an expected finding with irritable bowel syndrome or other increased peristalsis and is a common reason for the drug to be prescribed.

What is the mechanism of action for Carbidopa-levodopa?

carbidopa prevents the breakdown of levodopa before it can reach the brain and take effect. Levodopa is converted to dopamine in the brain

The nurse is caring for a client with chronic, stable angina. The client takes the long-acting nitrate isosorbide mononitrate. Which client outcome indicates that the drug is effective? -client is able to shower, dress, and fix hair without any chest pain --client reports a reduction in stress level and anxiety --client reports being able to sleep through the night --client's blood pressure is 128/78 mm Hg and heart rate is 82/min

client is able to shower, dress, and fix hair without any chest pain --the ability to perform activities without chest pain is a desirable client outcome of long-acting nitrate use. The nurse would want to assess for this outcome in clients taking these medications

A male client with hypertension was prescribed amlodipine. Which of these adverse effects is most important to teach the client to watch for? --erectile dysfunction --dizziness --dry cough --leg edema

dizziness --calcium channel blockers are utilized to treat hypertension and chronic stable angina. Adverse effects of these medications include dizziness, flushing, headache, peripheral edema, and constipation.

Normal BUN level

6-20

What is a normal platelet count?

150,000-400,000/mm3

What are some of the major symptoms of hyperthyroidism?

-diarrhea -weight loss -palpitations -tachycardia -sweating -heat intolerance

A client with a diagnosis of atrial fibrillation has just been placed on warfarin therapy. The registered nurse (RN) overhears a student nurse teaching the client about potential food-drug interactions. Which statement made by the student nurse requires an intervention by the RN? --"Do you take any nutritional vitamins?" --"You will need to monitor your intake of foods containing vitamin K" --"You will not be able to eat green, leafy vegetables while taking this medication" --"Your blood will be tested at regular intervals"

"You will not be able to eat green, leafy vegetables while taking this medication" ---sudden increases or decreases in the consumption of vitamin-K rich foods could inversely alter the effectiveness of warfarin. Rather than avoid vitamin K-rich foods, the client needs to keep vitamin K intake consistent from day to day to keep INR/PT stable within the recommended therapeutic range. INR/PT is monitored at regular intervals.

Drugs/supplements that decrease warfarin effect

--Rifampin --carbamazepine --oral contraceptives --ginseng --St. John's wort --Vitamin K-rich foods

A client is being discharged after having a stent placed in the left anterior descending coronary artery. The client is prescribed clopidogrel. Which client data obtained by the nurse would be concerning in relation to this new medication? SATA --blood pressure of 140/84 mm Hg --heart rate of 98/min --Platelet count of 200,000/mm3 --report of Ginkgo Biloba use --report of peptic ulcer disease

--report of Ginkgo biloba use --report of peptic ulcer disease ---If a client is prescribed clopidogrel, the nurse should be concerned about a history of peptic ulcer disease and Ginkgo biloba use. In this situation, the client would be at increased risk for bleeding. This data should be reported to the prescribing healthcare provider before the client is discharged.

A client is receiving a continuous heparin infusion and the most recent aPTT is 140 seconds. The nurse notices blood oozing at the surgical incision and IV insertion sites. What interventions should the nurse implement? SATA --continue heparin infusion and recheck aPTT in 6 hours --prepare to administer vitamin K --redraw blood for laboratory tests --Review guidelines for administration of protamine --Stop infusion of heparin and notify the healthcare provider (HCP)

--review guidelines for administration of protamine --Stop infusion of heparin and notify the healthcare provider (HCP) ---The nurse should stop the infusion when there is evidence of bleeding. The HCP should be notified immediately and the nurse should be prepared to give protamine if ordered. Continuing the heparin infusion will put the client at risk for a severe bleeding episode. Vitamin K is the reversal agent for warfarin. There is no reason to redraw blood for laboratory workup at this time as the abnormal aPTT result is consistent with the client's bleeding. Laboratory studies may need to be redone within 1 hour of stopping the infusion or giving a reversal agent.

Instructions for a client taking fluticasone/salmeterol

--rinse the mouth with water without swallowing to reduce the risk of oral/esophageal candidiasis after inhalation of the medication. --avoid smoking and using tobacco products -receive the pneumococcal and influenza vaccines if there is a risk for infection

What are some major side effects associated with beta blockers?

-bradycardia -bronchospasms -hypotension -depression -impotence

What is the inclusion criteria for thrombolytic therapy in clients with myocardial infarction?

-chest pain lasting <12 hours --12-lead ECG findings indicate actue ST-elevation myocardial infarction --no absolute contraindications

What are the symptoms associated with contraceptive use (Think ACHES)

-abdominal pain -chest pain -headaches -eye problems -severe leg pain

When is lactulose administered? What is it's mechanism of action?

-administered for clients with cirrhosis and hepatic encephalopathy --promotes excretion of ammonia via fecal elimination with the goal of 2-3 soft stools daily

What are some of the major side effects of ACEI?

-dry cough -hypotension -reflex tachycardia -hyperkalemia -angioedema

What is a therapeutic aPTT range?

46-70 seconds

A "normal" fasting glucose level

70-99

What is a target blood pressure for a client with diabetes?

<140/90 mm Hg

A client with uncontrolled hypertension is prescribed clonidine. What instruction is most important for the clinic nurse to give this client? --avoid consuming high-sodium foods --change positions slowly to prevent dizziness --Don't stop taking this medication abruptly --Use an oral moisturizer to relieve dry mouth

Don't stop taking this medication abruptly --Clonidine is a very potent antihypertensive. Abrupt discontinuation can result in serious rebound hypertensive crisis. Clonidine should be tapered over 2-4 days. Avoiding high-sodium foods is important for blood pressure control but is not the most important advice for this client as consumption of these is not immediately life-threatening. Dizziness is a side effect of clonidine. The nurse should teach the client to change positions slowly and sit for a few minutes before rising to prevent falls. However, this should diminish with continued use of the medication. Dry mouth is a side effect of clonidine. Use of over-the-counter mouth moisturizers, chewing gum, or hard candy may be helpful for clients with dry mouth.

The nurse is preparing to administer 160 mg of furosemide via IV piggyback to a client with chronic kidney disease and fluid overload. The nurse plans to give the dose slowly over 40 minutes to prevent which adverse effect? --bradycardia --hypokalemia --neprhotoxicity --ototoxicity.

Ototoxicity ---High doses of IV furosemide should be administered slowly to prevent ototoxicity. Bradycardia is an adverse effect of beta blockers, calcium channel blockers, and digoxin but is not for furosemide. Hypokalemia is common with furosemide administration due to the potassiujm-wasting effects of this loop diuretic. However, slower infusion is unlikely to prevent this adverse effect. Although neprhotoxicty can occur with IV furosemide administration, it is dependent on the dose, not the rate of administration.

What occurs when vancomyocin is administered too fast?

Red man syndrome (facial and upper body flushing) --when this occurs, the infusion should be slowed or stopped and restarted at a slower rate after 30 minutes

The nurse is assessing a client 15 minutes after initiating nitroglycerin infusion for suspected acute coronary syndrome. Which clinical findings is the priority? --The client reports a headache --The client reports feeling dizzy and lightheaded --The client reports feeling flushed --The client reports feeling nervous

The client reports feeling dizzy and lightheaded ---Nitroglycerin is a vasodilatory that may be administered by IV infusion in the management of acute coronary syndrome. Clients receiving nitroglycerin are at risk for profound hypotension resulting from systemic vasodilation. The nurse should immediately assess a client with signs of hypotension because the nitroglycerin infusion may need to be decreased or stopped.

How can cold and sinus medications cause vasoconstriction?

These medications have phenylephrine or pseudoephedrine. These are sympathomimetic deccongestants that activate alpha-1 adrenergic receptors, causing vasoconstriction

Which herbal medication is commonly used by clients experiencing hot flashes due to perimenopause?

black cohosh

The clinic nurse reviews the medical record of a client who was prescribed etanercept, a tumor necrosis factor (TNF) inhibitor. Which test result is most important for the nurse to check before initiating this treatment? --c-reactive protein (CRP) --prothrombin time (PT) --serum LDL cholesterol --tuberculin skin test (TST)

Tuberculin skin test (TST) --Major adverse effects of biologic disease-modifying TNF inhibitor drugs include severe infections and bone marrow suppression. TB reactivation is a major concern. Therefore, all clients must receive a TST to rule out latent TB. A baseline TST should be done before initiating therapy and yearly skin tests thereafter. Those with latent TB must be treated with antitubercular agents before initiating treatment with these drugs.

A client with chronic heart failure developed an intractable cough and an incident of angioedema after starting enalapril. Which prescription does the nurse anticipate for this client? --Alprazolam --dextromethorphan --Lisinopril --Valsartan

Valsaratan ---ARBs are recommended for clients unable to tolerate ACE inhibitors

Licorice root is used for...?

a herbal remedy sometimes used for gastrointestinal disorders such as: -stomach ulcers -heartburn -colitis -chronic gastritis.

What is Stevens-Johnson syndrome?

a rare but potentially life-threatening hypersensitivity reaction. it often starts with flu-like symptoms and a painful, purple/red rash to the skin or mucous membranes that may resemble a third-degree burn

A client with type 1 diabetes has a prescription for 30 units of insulin glargine at bedtime. Fingerstick blood glucose measurements are prescribed before meals and at bedtime with regular inslune based on a sliding scale. At 9pm, the client's blood glucose measurement is 180 mg/dL. Based on the sliding scale, the patient needs 2 units of regular insulin. What action should the nurse take? --administer 30 units of glargine; give the client a snack, then administer 2 units of regular insuline --administer 30 units of glargine and 2 units of regular insulin in 2 different injections --mix 30 units of glargine with 2 units of regular insulin in the same syringe, drawing up the glargine first --mix 30 units of glargine with 2 units of regular insulin in the same syringe, drawing up the regular insulin in the same syringe, drawing up the regular insulin first

administer 30 units of glargine and 2 units of regular insulin in 2 different injections --Sliding-scale regular insulin can be administered safely with scheduled insulin glargine without potentiating hypoglycemia if both medications are properly dosed and administered as separate injections. Insulin glargine should not be mixed in a syringe with any other insulin.

Why is albuterol administered before beclomethasone?

albuterol will open the airways and beclomethasone to provide better delivery of the medication

The nurse reviewing new prescriptions for assigned clients. Which prescription would require further clarification from the healthcare provider? --alteplase for an ischemic stroke in a client with a blood pressure of 192/112 mm Hg --Amoxicillin for a respiratory infection in a client who is 20 weeks pregnant --fentanyl for moderate to severe pain in a client post appendectomy with an allergy to codeine --sodium chloride 3% infusion for a client with syndrome of inappropriate antidiuretic hormone

alteplase for an ischemic stroke in a client with a blood pressure of 192/112 mm Hg --Thrombolytic agents are often prescribed to resolve acute thrombotic events (ischemic stroke, myocardial infarction, massive pulmonary embolism). They are recombinant plasminogen activators that activate the blood fibrinolytic system and dissolve thrombi. Thrombolytic agents are contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension. Therefore, the healthcare provider should be consulted for clarification. Administering alteplase in the presence of these conditions can cause hemorrhage, including life-threatening intracerebral hemorrhage. Most penicillin derivates and cephalosporins are generally considered safe for use by women who are pregnant or lactating. Fentanyl is appropriate in postoperative clients with moderate to severe pain, even those with a history of allergies to codeine. Both drugs have opiate agonist effects but are chemically different. Syndrome of inappropriate antidiuretic hormone secretion results in water retention and dilutional hyponatremia. Clients with SIADH often require hypertonic saline for sodium repletion to increase serum sodium levels with a minimal infused volume of water.

What drug classification is tobramycin?

aminoglycoside antibiotic

A nurse is caring for a client with a diagnosis of fibromyalgia. During care, the client reports having suicidal thoughts. What currently prescribed medication should the nurse question in regard to this new finding? --amitriptyline --celecoxib --cyclobenzaprine --hydrocodone

amitriptyline --Fibromyalgia is treated using a variety of medications. Nurses must be aware of the risks associated with medications, specifically antidepressants that may increase suicidal behaviors during the first few weeks of therapy. Any indication of such effects requires immediate intervention by the nurse.

What drug classification is rivaroxaban?

anticoagulants

The office nurse, while reviewing a client's health information, notices that the client has recently started taking St. John's wort for symptoms of depression. What additional information is most important for the nurse to obtain? --ask if the client is currently taking any prescription antidepressant medications --ask if the client has been diagnosed with depression by a mental healthcare provider --ask if the client take a multivitamin with iron --ask if the client uses tanning beds

ask if the client is currently taking any prescription antidepressant medications --St. John's wort interferes with many prescription medications. It is a priority for the nurse to assess for concomitant use of ST. John's wort with prescription SSRIs, MAOIs, or tricyclic antidepressants as such combinations can cause serotonin syndrome. The nurse can ask the client if a diagnosis of depression has been made by a HCP, but inquiring about possible medications that can interact with St. John's wort is more important at this time. St. John's wort may interfere with the absorption of iron and other materials. This is a teaching point, but not high priority. St. John's wort can cause photosensitivity which could be exacerbated by use of tanning beds. However, this is not the highest priority question to ask the client.

What should the nurse assess for before administering a medication such as propanolol to a patient?

assess for any history of asthma or respiratory problems due to propanolol causing bronchoconstriction due to its effects on beta-2 receptors.

An elderly client with type 2 diabetes is admitted to the medical unit due to urosepsis. The client is wearing an insulin pump for continuous subcutaneous insulin infusion therapy. The client's significant other reports that the client self-manages the insulin pump extremely well and keeps blood glucose in the specified target range. What is the admitting nurse's priority action? --assess the client's level of orientation --assess the insulin pump infusion site --check the prescribed insulin pump settings --consult the diabetic resource nurse or educator

assess the client's level of orientation --change in mental status and confusion is a common presenting symptom of sepsis in the elderly. The nurse should assess the client's cognitive status and level of consciousness. Diminished mental acuity, side effects of medication, and impairment related to a medical condition during hospitalization affect the client's ability to manage the insulin pump safely. Mental status is the key to safe insulin pump use, so if the client is not competent to operate the pump, the nurse should notify the healthcare provider and document the findings in the client's electronic medical record. The HCP will determine if continuing the use of the pump during hospitalization is appropriate. Assessing the infusion pump site for signs of infection and intactness of the infusion set is important, but is not priority. The HCP prescribes the basal insulin along with the parameters for bolus and correction doses while the client is hospitalized. Consulting with the diabetic resource nurse or educator to determine the client's competency and ability to manage a specific type of pump and provide on going client education is an appropriate action, but is not priority.

What drug classification is albuterol?

beta-2 agonist

A client with coronary artery disease and atrial fibrillation is being discharged home following coronary artery stent placement. Discharge medications are shown in the exhibit. The nurse identifies which educational topic as the highest priority for this client? Discharge medications; aspirin, Clopidogrel, Rivaroxaban, metoprolol, Rosuvastatin, Lisinopril --bleeding risk --bronchospasm --muscle inury --tinnitus

bleeding risk --Clients taking a combination of antiplatelet agents and anticoagulants (aspirn, clopidogrel, rivaroxaban) are at very high risk for life-threatening bleeding complications. The nurse should teach the client how to recognize and prevent signs and symptoms of increased bleeding. Although bronchospasms should be a teaching topic for the client, bleeding is more critical. Muscle cramps can be common with statins but is not a high priority. Tinnitus may occur with aspirin toxicity, but is not likely nor priority.

A client with active pulmonary tuberculosis is prescribed 4-drug therapy with ethambutol. The community health nurse instructs the client to notify the healthcare provider immediately if which adverse effect associated with ethambutol occurs? --blurred vision --dark-colored urine --difficulty hearing --yellow skin

blurred vision --Clients taking ethambutol must have baseline and periodic eye examinations during therapy as optic neuritis is a potentially reversible adverse effect. This client is instructed to report signs of decreased visual acuity and loss of color (red-green) discrimination. Dark-colored urine and yellow skin can indicate the presence of hepatotoxicity, which is associated with many drugs used to treat tuberculosis, but not with ethambutol. Difficulty hearing is an adverse reaction to streptomycin.

The healthcare provider is starting an elderly client on terazosin to treat prostatic hyperplasia. Which information should be included when teaching this client about the new medication? --change positions slowly when going from lying to standing --do not drink grapefruit juice when taking this drug --take this medication first thing in the morning, before breakfast --your stool may become darker and that's normal

change positions slowly when going from lying to standing --Terazosin is an alpha-adrenergic blocker that can relieve urinary retention in clients with BPH. It relaxes the smooth muscle in the bladder neck and prostate gland; however, it also relaxes smooth muscle in the peripheral vasculature, which can cause orthostatic hypotension, syncope, and falls. This is particularly common when the drug is started or when the dosage is increased. The serious effects can be avoided by instructing the client to take the medication at bedtime, change positions slowly when going from lying to standing, and avoid any medications that also increase smooth muscle relaxation (slidenafil or vardenafil). Some clients may also experience ejaculatory dysfunction. Grapefruit juice can cause significant interactions with drugs such as calcium channel blockers and slidenafil but not with alpha blockers.

A nurse has received new medication prescriptions for a client admitted with hypertension and an exacerbation of chronic obstructive pulmonary disease. Which prescription should the nurse question? --amlodipine --codeine --ipratropium --methylprednisolon

codeine --Codeine is a narcotic medication with antitussive properties that can cause an accumulation of secretions in clients with chronic obstructive pulmonary disease and lead to respiratory distress. Caution is advised when sedatives are prescribed for clients with respiratory diseases. Calcium channel blockers are used to treat hypertension and do not worsen bronchoconstriction, unlike beta blockers. Ipratropium is a short-acting anticholinergic often used in combination with a short-acting beta-agonist to promote bronchodilation and reduce bronchospasm. Methylprednisolone is a systemic glucocorticoid that improves respiratory systems and overall lung function in clients experiencing an exacerbation of COPD.

A client is receiving lithium carbonate 900 mg/day for a schizoaffective disorder. The laboratory notifies the nurse that the client's lithium level is 1.0 mEq/L. Based on this result, which prescription does the nurse anticipate receiving from the healthcare provider? --continue at the current dosage --decrease the dosage --discontinue the medication --increase the dosage

continue at the current dosage. --Lithium levels should be check frequently given the narrow therapeutic index. A level >1.5 mEq/L is considered toxic. Chronic toxicity manifests with neurologic symptoms (confusion, tremor, ataxia) and/or diabetes insipidus (polyuria, polydipsia)

A client with methicillin-resistant Staphyloccocus aureus (MRSA) bacteremia has been receiving IV vancomycin for the last 3 days. Which blood test trend is most important for the nurse to review when preparing to administer this medication? --blood cultures --creatinine levels --magnesium levels --white blood cell count

creatinine levels --Creatinine levels should be closely monitored for signs of nephrotoxicity in the client receiving IV vancomycin. If increasing creatinine is identified, the nurse should hold the dose and consult with the HCP and/or pharmacist before administration. Blood cultures may be checked periodically during vancomycin therapy, but they are not likely to change this quickly. Magnesium levels are typically not affected by vancomycin therapy. The WBC count may be helpful in determining the effectiveness of vancomycin therapy in treating infection. However, this laboratory result is unlikely to influence the nurse's decision on whether to administer the dose. Therefore, it is not of high priority.

The nurse is caring for a client on IV heparin infusion and oral warfarin. Current laboratory values indicate that the client's aPTT is 5 times the control value and the PT/INR is 2 times the control value. What action does the nurse anticipate? --clarify vegetable consumption with client --decrease the heparin rate --decrease the warfarin rate --obtain an order for vitamin K injection

decrease the heparin rate --The therapeutic effect from heparin or warfarin is 1.5-2.0 times the control value. Heparin is measured with aPTT and warfarin is measured with PT/INR. Vitamin K is the antidote for warfarin while protamine sulfate is the antidote for heparin. Clients on warfarin must eat the same amount of dark green leafy vegetables because these foods contain vitamin K and will alter the effects of warfarin. The PT/INR is at therapeutic level so there is no concern related to this client's diet.

A client receives an injection ob botulinum toxin type A for facial and neck rejuvenation. What complications of this procedure should the nurse be aware of for monitoring and teaching? --abdominal rigidity and diarrhea --back pain and urge incontinence --Difficulty swallowing and breathing --difficulty walking and hand tremor

difficulty swallowing and breathing --Botulinum toxin type A blocks neuromuscular transmission by inhibiting acetylcholine release from nerve endings. The drug is used for treating wrinkles, blepharospasm, and cervical dystonia. Complications are uncommon when Botox is used for cosmetic purposes but can be life-threatening if they occur. The toxin can also relax the muscles used for swallowing and breathing, resulting in dysphagia and respiratory paralysis. Botulism can be associated with constipation and urinary retention due to relaxation of smooth muscle. Painful rigidity and spasms of the neck, back, and abdominal muscles are absent. Ataxia and hand tremor usually indicate drug toxicity.

The nurse administers 15 units of aspart insulin subcutaneously to a hospitalized client with type 1 diabetes mellitus at 7:00am for a fasting blood glucose of 180 mg/dL. Which nursing action is a priority. --ensure that the client continues to fast for atleast 30 more minutes --give the client breakfast within 15 minutes --recheck the blood glucose in 1 hour --teach the client about the signs and symptoms of hyperglycemia

give the client breakfast within 15 minutes --It is important for the nurse to ensure that the client eats within 15 minutes of administration of rapid-acting insulins such as aspart, lispro, and glulisine to prevent an insulin-related hypoglycemic reaction. Rechecking the blood glucose in 1 hour is not indicated unless hypoglycemia is suspected.

A client with seizure disorder is prescribed a moderately high dose of phenytoin. Which teaching topic should the nurse discuss with the client? --diet high in iron --good oral care and dental follow-up --shaving with an electric razor --use of sunglasses for eye protection

good oral care and dental follow-up --The nurse should encourage the client taking phenytoin to perform good oral hygiene and visit the dentist regularly to prevent gingival hyperplasia. The other major side effects of phenytoin use are an increase in body hair, rash, folic acid depletion, and decreased bone density. Long-term use of phenytoin can cause folic acid deficiency and decreased bone density. Therefore, a diet high in folic acid and calcium should be recommended. Exposure of the eyes to ultraviolet light and use of corticosteroids are risk factors for cataract development

The nurse receives a new prescription for tamoxifen for a client with breast cancer. Which information found in the client's medical record would require follow-up with the healthcare provider? --Documentation of an allergy to shellfish and peanuts --history of quitting cigarette smoking 5 years ago --hospitalization with deep vein thrombosis 1 year ago --previous treatment for depression following the death of a parent

hospitalization with deep vein thrombosis 1 year ago --Tamoxifen is a selective estrogen receptor modulator prescribed for the treatment and prevention of estrogen receptor-positive breast cancers. Serious side effects include thromboembolic events and endometrial cancer.

What herbal medication can be used for clients diagnosed with heart failure?

hawthorn extract

Describe the mechanism of action of thiazolidinediones

improve insulin sensitivity but do not release excess insulin.

Use for Ginseng?

improved mental performance

The nurse is caring for a client with cirrhosis who has hepatic encephalopathy. The client is prescribed lactulose. Which assessment by the nurse will most likely indicate that the medication has achieved the desired therapeutic effect? --higher potassium level --improved mental status --looser stool consistency --reduced abdominal distension

improved mental status --Lactulose is a laxative used to trap and expel ammonia in clients with cirrhosis who have hepatic encephalopathy. Elevated ammonia levels cause mental confusion. Abdominal distension in cirrhosis is treated with diuretics and paracentesis. Lactulose does not influence this pathology or symptom.

Methylphenidate is administered how?

in divided doses 2 or 3 times daily, usually 30-45 minutes before meals

How does iodine help treat thyrotoxicosis?

in large doses, iodine quickly blocks the release of T4 and T3 from the gland. -iodine also decreases thyroid gland vascularity and is helpful when preparing the client for a thyroidectomy.

A client in the intensive care unit is receiving IV vancomycin and gentamicin. The nurse should monitor for which potential complication with the administration of these medications? --blood is nasogastric tube drainage --decrease in red blood cell count --increase in serum creatinine level --onset of muscle aches and cramping

increase in serum creatinine level --The nurse should recognize that the risk of neprhotoxicity and ototoxicity is potentiated when vancomycin and aminoglycosides are administered together. Kidney and hearing functions should be closely monitored in these clients. Blood in the nasogastric tube could be a complication of peptic ulcer disease and the use of NSAIDs and corticosteroids. A decrease in the RBC count may be evidence of bone marrow suppression that can occur with use of certain cancer drugs. Muscle cramping can occur occasionally with use of gentamicin but is not an indication to stop the infusion.

Describe the mechanism of action of metoclopramide

increases gastrointestinal motility and promotes stomach emptying

A nurse is caring for a client with an exacerbation of chronic obstructive pulmonary disease and a history of type 2 diabetes mellitus requiring insulin. The client has been prescribed prednisone. The nurse anticipates which need? --close monitoring for hypotension --gradually increasing the prednisone dose --increasing the insulin dose --monitoring and recording intake and output

increasing the insulin dose --corticosteroids are given to combat inflammation in the lungs in clients with COPD exacerbation. All glucocorticoids can cause an increase in blood sugar. This may lead to the need for a higher dose of insulin based on the client's blood sugar level. Most glucocorticoids have some mineralocorticoid activity, causing fluid retention and worsening hypertension. Prednisone is started at a higher dose and then gradually decreased for COPD exacerbation and most other conditions. A slow taper will prevent adrenal crisis. Intake and output are not affected by corticosteroids.

What is another name for guaifenesin?

mucinex

The nurse teaches the client taking atorvastatin to call the healthcare provider if experiencing which symptom associated with a serious adverse effect of atorvastatin? --diarrhea --headache --muscle aches --numbness in the feet

muscle aches -The client taking a statin such as atorvastatin or rosuvastatin should be taught to call the HCP if generalized muscle aches develop as this may be a symptom of mypoathy, a serious adverse effect of this type of medication. Diarrhea, headache, and numbness in the feet is not a side effect of statin drugs

What can ethambutol (myambutol) cause?

ocular toxicity, resulting in vision loss and loss of red-green color discrimination. It is important to regularly monitor vision acuity and color discrimination

What are serious and important adverse effects of carbidopa-levodopa?

orthostatic hypotension and neuropsychiatric disturbances (confusion, hallucinations, delusions, agitation, psychosis)

The clinic nurse prepares to administer a newly prescribed dose of sumatriptan to a client with a migraine headache. Which item in the client's history would cause the nurse to question the prescription? --BUN of 12 mg/dL --BMI o 34 kg/m2 recorded during today's examination --past medical history of uncontrolled hypertension --takes alprazolam as prescribed for anxiety

past medical history of uncontrolled hypertension --Sumatriptan relieves migraines by constricting dilated cranial blood vessels. Sumatriptan is contraindicated in clients with coronary artery disease and uncontrolled hypertension because the vasoconstrictive effects can cause hypertensive urgency, angina, decreased cardiac perfusion, and acute myocardial infarction. Sumatriptan is not contraindicated with alprazolam therapy. However, because of its serotonergic effects, clients already taking selective serotonin reuptake inhibitors or selective norepinephrine reuptake inhibitors should be monitored for signs of serotonin syndrome.

Describe the 3rd stage of level of sedation with POSS? --What are the nursing interventions for this stage?

patient falls asleep during conversation --nurse should monitor respiratory status and notify the healthcare provider to decrease sedation by 25-50%

What is S level of sedation on the POSS scale? --What nursing intervention is expected?

patient is sleeping and easy to arouse --no action is needed from the nurse

What is another name for bismuth subsalicylate?

pepto-bismol

What can affect the absorption of levothyroxine and decrease its effectiveness?

prenatal vitamins containing iron

A student nurse is caring for a client with iron deficiency anemia who is newly prescribed ferrous sulfate. Which action by the student nurse requires the supervising nurse to intervene? --encourages the client to drink extra fluids while taking ferrous sulfate --offers the client orange juice for administration of ferrous sulfate --plans to administer ferrous sulfate one hour before breakfast --prepares to administer a prescribed calcium supplement with ferrous sulfate

prepares to administer a prescribed calcium supplement with ferrous sulfate. --Ferrous sulfate is an oral iron supplement prescribed to prevent or treat iron defiency anemia. The nurse should administer the medication 1 hour before or 2 hours after meals because it is best absorbed in an acidic environment. Antacids or calcium supplements decrease absorption of iron if administered with or within 1 hour of ferrous sulfate. Taking an iron supplement increases the client's risk for constipation. Instructing the client to increase fluid intake during therapy may help prevent hard stools. Taking an iron supplement with vitamin C further enhances duodenal acidity and increases absorption.

What is the mechanism of action of unfractionated heparin?

prevents the conversion of fibrinogen to fibrin and prothrombin to thrombin, which are components of clot formation

What classification of drug is Levofloxacin (Levaquin)?

quinolone antibiotic

Function of long-acting nitrates

reduce the incidence of anginal attacks

Describe the mechanism of action of sumatriptan

relieve migraine headaches by constricting cranial blood vessels.

A nurse is discharging a client who is receiving lithium for treatment of a bipolar disorder. It is most important for the nurse to provide which instruction to the client? --avoid a high-potassium diet --exercise regularly and maintain a high-fiber diet --maintain oral hygiene --report excessive urination and increased thirst

report excessive urination and increased thirst --lithium is a mood stabilizer most often used to treat bipolar affective disorders. It has a narrow therapeutic index. Risk factors for lithium toxicity include dehydration, decreased renal function, diet low in sodium, and drug-drug interations (NSAIDs and thiazide diuretics). Dietary potassium should be avoided when taking drugs such as potassium-sparing diuretics and ACEI/ARB. Regular exercise and a high-fiber diet can prevent constipation, which is not a known side effect of lithium. Good oral hygiene is ideal for every client but is not specially indicated for those taking lithium.

A client is started on lisinopril therapy. Which assessment finding requires immediate action? --Blood pressure 129/80 mm Hg --heart rate 100/min --serum creatinine 2.5 mg/dL --serum potassium 3.5 mEq/L

serum creatinine 2.5 mg/dL ---Evaluation of kidney function is essential for clients taking medications that are excreted renally or can worsen renal injury. These include ACE ihibitors and digoxin. The client's blood pressure, heart rate, and serum potassium are within normal limits.

Contraindications for the inactivated vaccine

severe allergy to vaccine or its components

Side effects of Kava

severe liver damage

The nurse is preparing to administer a scheduled dose of metoclopramide IV to a client with diabetic gastroparesis. Which clinical finding causes the nurse to question the prescription? --diarrhea --frequent burping --headache --sucking lip motions

sucking lips motion --Clients receiving metoclopramide at high doses and/or for extended periods are at risk for developing tardive dyskinesia (TD), an often irreversible movement disorder. The nurse should question a prescription for metoclopramide if symptoms of TD are present. Diarrhea is a symptom commonly seen in a client taking metoclopramide. Burping is not a typical side effect associated with metoclopramide. Headache is a common adverse effect of metoclopramide that typically improves spontaneously.

The healthcare provider has prescribed amitriptlyine 25 mg orally every morning for an elderly client with recent herpes zoster infection and severe postherpetic neuralgia. What is the priority nursing action? --Encourage increased fluid intake --provide frequent rest periods --teach the client to get up slowly from the bed or a sitting position --tell the client to wear sunglasses when outdoors

teach the client to get up slowly from the bed or a sitting position. --The most common side effects experienced by clients taking tricyclic antidepressants include dizziness, drowsiness, dry mouth, constipation, photosensitivity, urinary retention, and blurred vision. The priority nursing action is to teach caution in changing positions due to the increased risk for falls from dizziness and orthostatic hypotension, especially in elderly clients.

A client with cancer is to receive a third dose of cisplatin. The client's laboratory results are as followed: Hemoglobin is 12 mg/dL; creatinine 2.2 mmg/dL; Blood urea nitrogen 28 mg/dL. Which factor would be important for the nurse to assess before confirming the dose with the healthcare provider? --blood pressure --capillary refill --skin turgor --urine output

urine output --Urine output is a good indicator of renal function. Cisplatin is an antineoplastic medication that can cause renal toxicity. The client's elevated BUN may be due to dehydration or decreased kidney function. The creatinine is also elevated, which is an indication of kidney injury. In addition to laboratory results, the healthcare provider will also need to know urine output. The medication dosage may then be adjusted or discontinued. Blood pressure may be part of the assessment of kidney function, but multiple disorders can cause changes in blood pressure. Capillary refill is used to assess the circulatory system and is not a good indicator of a decrease in renal function. Skin turgor is important in assessing hydration status.

When is c-reactive protein (CRP) test performed?

used to evaluate the effectiveness of medications that decrease inflammation.

The nurse is preparing to administer the fourth dose of IV vancomycin to a client. Which set of laboratory values would alert the nurse to hold the vancomycin and notify the healthcare provider? --vancomycin trough 10 mg/K, creatinine 1.1 mg/dL, BUN 6 mg/dL --vancomycin trough 14 mg/L, creatinine 1.2 mg/dL, BUN 10 mg/dL --Vancomycin trough 18 mg/L, creatinine 0.6 mg/dL, BUN 18 mg/dL --vancomycin trough 23 mg/L, creatinine 1.5 mg/dL, BUN 24 mg/dL

vancomycin trough 23 mg/L, creatinine 1.5 mg/dL, BUN 24 mg/dL --The normal therapeutic level of vancomycin is 10-20 mg/dL. Elevated vancomycin trough levels, creatiine, and blood urea nitrogen are associated with nephrotoxicity and should be reports to the healthcare provider.

Which vitamin is essential for blood clotting?

vitamin K

Describe the mechanism of action of warfarin

warfarin works by blocking the availability of vitamin K, which is essential for blood clotting. As a result, the clotting mechanism is disrupted, reducing the risk of a stroke, venous thrombosis, or pulmonary embolism

The healthcare provider prescribes simvastatin for a client with hyperlipidemia. The nurse instructs the client to take this medication in which manner. --at noon with a meal --in the morning on an empty stomach --in the morning with breakfast --with the evening meal

with the evening meal --The client taking a statin drug such as simvastatin should be taught to take the medication with the evening meal or at bedtime to promote maximal effectiveness.

What is a normal creatinine level?

0.6-1.3 mg/dl

Use of licorice

-stomach ulcers -bronchitis/viral infections

What are the three commonly used tumor necrosis factor inhibitor, biologic-modifying antirheumatic drugs?

--adalimumab (humira) --etanercept (Enbrel) --infliximab (Remicade)

Use of Kava

-anxiety -insomnia

Use of St. John's wort

-depression -insomnia

A therapeutic INR for most conditions is...? --a therapeutic INR for heart valve disease?

2-3 --up to 3.5

What is the therapeutic INR for a client with a mechanical heart valve?

2.5-3.5

Which herbal supplements pose an increased risk for bleeding in surgical clients and should be discontinued prior to major surgery? SATA --black cohosh --garlic --ginger --ginkgo biloba --hawthorn

--garlic --ginger --ginko biloba ----Clients are often aware of the need to discontinue prescription medications such as aspirin and anticoagulants prior to elective surgery, but they may not know that some herbal supplements can increase bleeding risk. The nurse should question the client specifically about the use of herbal supplements.

What is desmopressin acetate (DDAVP)?

synthetic form of ADH

What symptoms are associated with excess thyroid hormone?

--heart palpitations/tachycardia --weight loss --insomnia

A hospitalized client has been treated for the past 48 hours with a continuous heparin infusion for a deep vein thrombosis. When the nurse prepares to administer the evening dose of warfarin, the client's spouse says "Wait! My spouse can't have that. My spouse is already getting heparin for DVT." How should the nurse respond? --"Both medications will be given for several days until the warfarin has time to take effect" --"I will be discontinuing the heparin infusion as soon as I give this dose of warfarin" --"The two medications work synergistically to help break down the clot in your spouse's leg" --"We will hold the medication until I can call the healthcare provider for clarification"

"Both medications will be given for several days until the warfarin has time to take effect" --Warfarin requires an overlap of therapy with unfractionated heparin infusion or low-molecular-weight heparin for several days until the INR is in the therapeutic range for the client's condition.

A client with primary hypothyroidism has been taking levothyroxine for a year. Laboratory results today show high levels of TSH. Which statement by the nurse to the client is appropriate? --"A new prescription will likely be issued for a decrease dose of levothyroxine" --"Dosage of levothyroxine may need to be increased to improve TSH levels" --"Levothyroxine should be held, and the TSH levels will be reassessed in 3 months" --"Start taking your levothyroxine with dietary fiber or calcium to increase its effectiveness"

"Dosages of levothyroxine may need to be increased to improve TSH levels" --In primary hypothyroidism, the thyroid does not produce enough hormones. In response to low circulating thyroid hormones, the pituitary continues to release TSH, resulting in high levels of circulating TSH. Levothyroxine is usually started or increased to lead to an euthyroid (normal) state. Decreasing the dose or discontinuing levothyroxine would lead to increased TSH and worsening hypothyroidism as the amount of circulating thyroid hormone decreases.

The nurse in the same-day surgery unit admits a client who will receive general anesthesia. The client has never had surgery before. Which question is most critical for the nurse to ask the client during the preoperative assessment and health history? 1. "Has any family member ever had a bad reaction to general anesthesia?" 2. "Have you ever experienced low back pain?" 3. "Have you ever had an anaphylactic reaction to a bee sting?" 4. "Have you ever received opioid pain medications?"

"Has any family member ever had a bad reaction to general anesthesia?" --Malignant hyperthermia is a rare, life-threatening inherited muscular abnormality that is triggered by specific drugs used to induce general anesthesia. Therefore, it is critical for the perioperative nurse to screen for MH susceptibility by asking if any of the client's blood relatives had ever experienced adverse reaction to general anesthesia, including unexplained death. Cervical spine problems should be assessed before the intubation but low back pain history is not a priority. It would be appropriate to ask about allergies, but asking about an anaphylactic reaction to a bee sting is not the most critical question. History of prior opioid intake may be helpful,but the most important question is to ask about side effects and allergies.

A client has been on long-term therapy with esomeprazole. What is essential for the nurse to ask the client? --"Are you drinking plenty of water with the medication?" --"Are you taking the medication after meals?" --"Have you had a bone density test recently?" --"Have you had your blood pressure taken regularly?"

"Have you had a bone density test recently" --Long-term therapy with a proton pump inhibitor may decrease the absorption of calcium and promote osteoporosis. A bone density test can assess if the client already has osteoporisis. Hospitalized clients also have an increased risk of diarrhea caused by C.Diff. PPIs cause suppression of acid that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonia. Drinking extra water and being upright for 30 minutes after takingbisphosphonates is necessary, not with PPI. PPIs should be taken prior to meals. PPIs do not affect blood pressure.

A client with deep vein thrombosis (DVT) is receiving a continuous infusion of unfractionated heparin. The client asks the nurse what the heparin is for. How should the nurse respond? --"Heparin is a blood thinner that will help to dissolve the clot in your leg" --"Heparin will help stabilize the clot in your leg and prevent it from breaking off and traveling to your lungs" --"Heparin will keep the current clot from getting bigger and help prevent new clots from forming" --"I'm sorry. This is something that your healthcare provider (HCP) can answer better upon arriving"

"Heparin will keep the current clot from getting bigger and help prevent new clots from forming" ---The nurse should teach the client that the purpose of unfractionated heparin infusion in the treatment of DVT is to slow the time it takes blood to clot, thereby keeping the current clot from getting bigger and preventing new clots from forming. Anticoagulants do not dissolve clots. Heparin does not prevent the clot from breaking off, but will deter the clot from growing larger. The nurse should be able to answer client questions regarding medications being administered.

The home health nurse reviews the serum laboratory test results for a client with seizures. The phenytoin level is 27 mcg/mL. The client makes which statement that may indicate the presence of dose-related drug toxicity and prompt the nurse to notify the healthcare provider? --"I am feeling unsteady when I walk" --"I am getting up to urinate about 4 times during the day" --"I have a metallic taste in my mouth when I eat" --"My gums are getting so puffy and red"

"I am feeling unsteady when I walk" --Phenytoin is an anticonvulsant drug used to treat generalized tonic-clonic seizures. The therapeutic serum phenytoin reference range is between 10-20 mcg/mL. Levels are measured when therapy is initiated, periodically throughout treatment to guide dosing until a steady state is attained and if seizure activity increases. Early signs of toxicity include horizontal nystagmus and gait unsteadiness. These may be followed by slurred speech, lethargy, confusion, and even coma. Bradyarrhythmias and hypotension are usually seen with intravenous phenytoin. Nocturia is an expected side effect of diuretics but not phenytoin. Metallic taste in the mouth is often seem with metronidazole, but not phenytoin. Gingival hyperplasia is a common expected side effect of phenytoin and does not indicate drug toxicity.

Chronic lithium toxicity can result in....

--neurologic manifestations (ataxia, confusion/agitation, and neuromuscular excitability) --neprhogenic diabetes insipidus (polyuria and polydipsia)

The home health nurse prepares to give benztropine to a 70-year-old client with Parkinsondisease. Which client statement is most concerning and would warrant health care provider notification? --"I am going for repeat testing to confirm galucoma" --"I am not able to exercise as much as I used to" --"I started taking esomeprazole for heartburn" --"My bowel movements are not regular"

"I am going for repeat testing to confirm glaucoma" --Parkinson disease is a progressive neurological disorder characterized by bradykinesia, rigidity, and tremors. Clients with PD have an imbalance between dopamine and acetylcholine in which dopamine is not produced in high enough quantities to inhibit acetylcholine. Anticholinergic medications (benztropine, trihexyphenidyl) are commonly used to treat tremor in these clients. However, in clients with benign prostatic hyperplasia or galucoma, caution must be taken as anticholinergic drugs can precipitate urinary retention and an acute glaucoma episode. As a result, such medications are contraindicated in these clients. Decreased ability to exericse is common in clients with PD due to tremors and bradykinesia, and they require physical and occupational therapy consultations. However, acute glaucoma can be sight threatening and is the priority. Esomeprazole is safe to take with benztropine and will not cause an adverse reaction. Constipation is a common side effect of benztropine. Due to the characteristic decreased mobility, PD can also cause constipation. The client should be instructed to increase dietary fiber intake and drink plenty of water. However, this is not the most concerning issue.

The nurse is providing discharge instructions to a client receiving oxubutynin for overactive bladder. Which client statement indicates that further teaching is required? --"I am looking forward to our summer vacation at the beach" --"I plan to eat more fruits and vegetables to prevent constipation" --"I should not drive until I know how this drug affects me" --"I will drink at least 6-8 glasses of water daily"

"I am looking forward to our summer vacation at the beach" ---decreased sweat production (a symptom from Oxybutynin) may lead to hyperthermia. The nurse should instruct the client to be cautious in hot weather and during physical activity. Increasing dietary intake of fluids and bulk-forming foods promotes normal bowel function and prevents constipation. Sedation is a common side effect of anticholinergic drugs. Clients should be taught not to drive or operate heavy machinery until they know how the drug affects them.

The nurse is assessing a client with rheumatoid arthritis who is being considered for adalimumab therapy. Which statement made by the client needs further investigation? --"I am taking an antibiotic for a urinary tract infection" --"I had a negative tuberculosis skin test 2 weeks ago" --"I just received my yearly flu shot a week ago" --"I will continue taking naproxen at night to help with pain"

"I am taking an antibiotic for a urinary tract infection" --Clients with infection should not take tumor necrosis factor (TNF) inhibitors as these suppress the immune response. Before starting drug therapy, clients should be tested for tuberculosis and receive the inactivated influenza vaccine. Clients taking TNF inhibitors should avoid live vaccines.

The nurse is reinforcing education to a client newly prescribed levetiracetam for seizures. Which statement made by the client indicates a need for further instruction? --"Drowsiness is a common side effect of this medication and will improve over time" --"I can begin driving again after I have been on this medication for a few weeks" --"I need to immediately report any new or increased anxiety when on this medication" --"I need to immediately report any new rash when on this medication"

"I can begin driving again after I have been on this medication for a few weeks" --Levetiracetam is an anticonvulsant prescribed for seizure disorders. It may have depressing effects on the central nervous system as the body adjusts to therapy. Serious adverse effects include suicidal ideation and Stevens-Johnson syndrome. Clients with seizure disorders must meet the guidelines of their department of transportation and receive permission from their healthcare provider prior to legally operating a motor vehicle.

The clinic nurse is preparing to administer an allergy immunotherapy injection to a client recently initiated on the therapy. Which statement by the client indicates a need for further teaching? --"I can leave right after the shot as I didn't have a reaction last time" --"I will be back in a week for my next allergy shot" --"I will let the doctor know if I get any itchy hives tonight" --"It is okay if I have some redness at the injection site tonight"

"I can leave right after the shot as I didn't have a reaction last time" --Allergy immunotherapy injections trigger an increase in the body's production of specific immunoglobulins to reduce the client's allergy symptoms when exposed to specific allergens. Small doses of the allergen(s) are injected subcutaneously on a client-specific schedule. Rarely, allergy shots may induce an immediate and potentially fatal anaphylatic reaction. The client must remain at the facility after 30 minutes after an injection so the nurse can monitor for severe systemic reactions. For a first few months, allergy shots are typically given every week, with adose increase at every injection until the target maintenance dose is reached. The maitenance dose is then given ever few weeks for 3-5 years. Although rare, the client may have a mild, systemic allergic reaction up to 24 hours after an allergy shot. The occurrence of any systemic reaction should be reported to the healthcare provider as the next dose increase may need to be delayed. It is common to have a localized reaction to an allergy shot. The nurse should reinforce teaching that some redness and swelling at the injection site is expected and not life-threatening.

The nurse is reviewing discharge instructions with a client going home on linezolid therapy for a vancomycin-resistant enterococcus infection. Which client statement requires further teaching? --"I can restart my paroxetine once I get back home" --"I can take acetaminophen for headaches" --"I will avoid foods and drinks that contain tyramine" --"I will report any increased fever or diarrhea"

"I can restart my paroxetine once I get back home" --Linezolid is an oxazolidinone antibiotic prescribed for vancomycin and methicillin-resistant bacteria, pneumonia, and skin infections. Linezolid has monoamine oxidase inhibitor type properties; concurrent use with selective serotonin reuptake inhibitors increases the risk of serotonin syndrome, a potentially fatal accumulaton of serotonin. Due to this risk, SSRIs are contraindicated while on linezolid therapy. SSRIs can be resumed 24 hours after linezolid therapy has been discontinued. Headaches may be a side effect of linezolid therapy. Acetaminophen is not contraindicated. Due to the MAOI-like properties of linezolid, clients should not consume foods or beverages containing tyramine during therapy to avoid adverse effects. Diarrhea is a common adverse effect of linezolid therapy. However, increased diarrhea or fever may indicate a complication from the reigmen and should be reported promptly.

A client with coronary artery disease and stable angina is being discharged home on sublingual nitroglycerin. The nurse has completed discharge teaching related to this medication. Which statement by the client indicates that the teaching has been effective? --"I can keep a few pills in a plastic bag in my pocket in case I need them while I'm out" --"I can still take this with my vardenafil prescription' --"I can take up to 3 pills in a 15-minute period if I am experiencing chest pain" --"I should stop taking the pills if I experience a headche"

"I can take up to 3 plls in a 15-minute period if I am experiencing chest pain" ---The nurse should instruct the client who is taking sublingual NTG to keep the tablets in a tightly capped, dark bottle away from heat and light. The client should be taught to take 1 tablet every 5 minutes (up to 3 tablets) but notify EMS if the pain does not improve or worsens 5 minutes after the first pill has been taken. These instructions should be reinforced at each appointment.

A client having an ischemic stroke arrives at the emergency department. The healthcare provider prescribes tissue plasminogen activator (tPA). Which client statement would be most important to clarify before administering tPA? --"I can't believe this is happening right after my stomach surgery" --"I had a concussion after a car accident a year ago" --"I started noticing my right arm becoming weak approximately an hour ago" --"I stopped taking my warfarin 4 weeks ago"

"I can't believe this is happening right after my stomach surgery" --Tissue plasminogen activator dissolves clots and restores perfusion in clients with ischemic stroke. It must be administered within a 3-4.5 hour window from the onset of symptoms for full effectiveness. The nurse assesses for contraindications to tPA due to the risk of hemorrhage. The client should not have a history of intracranial hemorrhage or be actively bleeding. Surgery within the last two weeks is a contraindication as tPA dissolves allclots in the body and may disrupt the surgical site. This client indicates a recent stomach surgery, which would need further clarification to determine eligibility to receive tPA. A client's history of stroke or head trauma in the last 3 months could exclude tPA use. Current anticoagulant use may exclude a client from receiving tPA. The duration of action for warfarin is 2-5 days, this client can safely receive tPA as warfarin was discontinued 4 weeks ago. However, if pending coagulation studies drawn prior to tPA administration are elevated, the infusion may be discontinued.

A client in the emergency department is being discharged with a prescription for trimethoprim-sulfamethoxazole. Which statement by the client would indicate a need for further evaluation? --"I developed a whole-body rash while on glyburide" --"I drink atleast 5 large bottles of water daily" --"I had to stop using lisinopril due to a bad cough" --"I have a birth control implant in place

"I developed a whole-body rash while on glyburide" --Clients prescribed sulfa antibiotics should be assessed for allergies to sulfa drugs and sulonylurea medications, such as glyburide, due to potential cross-sensitivity reactions. Crystalluria is a potential adverse effect of sulfa medications. Clients should drink at least 2-3 L of water daily to prevent crystalluria.

The nurse is assessing a client diagnosed with tuberculosis who started taking firapentine a week ago. Which statement by the client warrants further assessment and intervention by the nurse? --"I do not want to get pregnant, so I restarted my oral contraceptive last month" --"I have been taking my medications with breakfast every morning" --"I should alert my healthcare provider if I notice yellowing of my skin" --"Since I started this medicine, my saliva has become a red-orange color"

"I do not want to get pregnant, so I restarted my oral contraceptive last month" --Clients taking rifampin or firapentine as part of antitubercular combination therapy should be taught to prevent pregnancy with non-hormonal contraceptives, notify the healthcare provider of any signs or symptoms of hepatotoxicity (jaundice, fatigue, weakness, nausea, anorexia) and expect red-orange-colored body secretions. Rifapentine should be taken with meals for best absorption and to prevent stomach upset.

A behavioral health clinic nurse assesses a 23-year old client who started taking paroxetine 3 weeks ago. Which statement made by the client is most important for the nurse to investigate? --"I don't have much of an appetite since starting this medication" --"I have a lot more energy, but I'm feeling just as depressed" --"I have been feeling dizzy when I walk around at home" --"I have experienced frequent headaches lately"

"I have a lot more energy, but I'm feeling just as depressed" --Selective serotonin reuptake inhibitors are used to treat psychiatric conditions. A client reporting increased energy with little or no reduction of depression needs immediate assessment for suicide risk.

The nurse prepares to administer clozapine to a client with schizophrenia. Which client statement would require priority investigation before administering the medication? -"I have gained a few pounds since I started this medication" -"I have had a sore throat for 3 days and feel feverish today" -"I have noticed increased salivation and drooling" -"I often feel sleepy when I take this medication"

"I have had a sore throat for 3 days and feel feverish today" --Clozapine is an atypical antipsychotic medication used to manage schizophrenia in clients who have not improved with other antipsychotic medications. Clozapine is highly effective at controlling schizophrenia; however, it has many severe, life-threatening adverse effects, including agranulocytosis, cardiac disease, and seizures. Agranulocytosis increases the risk for infection. Clients require serial monitoring of white blood cell counts and frequent assessment for signs of infection (sore throat, flulike symptoms), which should be reported immediately to the healthcare provider. Weight gain is a common side effect. Clients should be educated about weight management. Hypersalivation and drooling are common side effects. When excessive, they can occasionally pose risk for aspiration, especially while the client is sleeping. The side effect can be reduced by lowering the dose. Many clients experience significant sedation when the medication is started. Most will develop tolerance to this and eventually improve.

A client with stable angina is being discharged home with a prescription for a transdermal nitroglycerin patch. The nurse has reviewed discharge instructions on the medication with the client. Which statement by the client indicates that teaching has been effective? --"I can continue to take my prescription of slidenafil" --"I should take the patch off when I shower" --"I will remove the patch if I develop a headache" --"I will rotate the site where I apply the patch"

"I will rotate the site where I apply the patch" --Nursing education about transdermal nitroglycerin includes application of the patch to the upper arms or body, rotating the sites daily, removing the patch at night, taking no erectile dysfunction medications, and informing clients that headaches are common. Patches do not need to be removed for bathing.

The nurse is speaking to a client who takes desmopressin nasal spray for diabetes insipidus. Which statement by the client is most important for the nurse to report to the healthcare provider? --"I am tired of restricting my fluids but know I need to" --"I feel like I am beginning to get sick with a bad cold" --"I have been getting a lot of nasal pain with this spray" --"I have recently started to experience frequent headaches"

"I have recently started to experience frequent headaches" --Desmopressin is a medication often used to treat central diabetes insipidus, a disease characterized by reduced antidiuretic hormone levels that may result in dehydration and hypernatremia. Desmopressin mimics the effects of naturally occurring ADH, which increases renal water resorption and concentrates urine. However, this effect also increases the risk for water intoxication from decreased urine output. Clients receiving desmopressin must have their fluid and electrolyte status closely monitored for symptoms of water intoxication/hyponatremia (headache, mental status changes, weakness). The nurse should immediately notify the healthcare provider of client reports of water intoxication symptoms, as severe hyponatremia may progress to seizure, neurologic damage, or death. Clients on desmopressin are often on fluid restriction as part of therapy. Rhinitis and upper respiratory infection can decrease the effectiveness of desmopressin and may require dosage adjustments by the HCP. Side effects of desmopressin nasal spray includes nasal irritation, congestion, and pain.

The nurse assesses a client who is receiving methotrexate for rheumatoid arthritis. Which statement by the client is most concerning? --"I am nauseated and vomited three times today" --"I drink four large cups of coffee every day" --"I have small, purple spots all over my skin" --"I plan to stop taking birth control together"

"I have small, purple spots all over my skin" --Methotrexate is an antirheumatic drug prescribed to treat rheumatoid arthritis. It acts by interfering with folic acid metabolism, which inhibits DNA synthesis and cell reproduction. Adverse effects assocaited with methotrexate include bone marrow suppression, hepatotoxicity, and gastrointestinal irritation. Bone marrow suppression is a serious adverse effect that leads to anemia, leukopenia, and thrombocytopenia. Thrombocytopenia is characterzed by petechae, purpura, and.or other signs of bleeding. Bone marrow suppression is managed by dose reduction or discontinuation of the medication. N/V are the most common side effects associated with methotrexate. The nurse should notify the healthcare provider and request a prescription for an antiemetic, but it is not the priority concern. Some substances decreases the effectiveness of methotrexate (caffeine, folic acid) and should be avoided. Methotrexate is teratogenic, so pregnancy must be prevented.

A client with obesity has just started taking orlistat. Which statement by the client indicates a need for further teaching? --"I have started taking a daily multivitamin with my dinner-time dose of medication" --"I may have oily stools and fecal incontinence when taking this medication" --"I will consume a low-fat diet in which no more than 30% of my calories are from fat" --"I will take my medication with, or within 1 hour of, meals that contain fat"

"I have started taking a daily multivitamin with my dinner-time dose of medication" --Orlistat is a lipase inhibitor that prevents the breakdown and absorption of fats from the intestine. This medication is prescribed to clients with obesity who have difficulty losing weight or a comorbidity that makes weight loss therapeutically essential. Orlistat should always be used with diet modification and an exercise regimen. Because orlistat blocks the absorption of fats, it also interferes with fat-soluble vitamin uptake. Clients should offset this effect by taking a multivitamin that contains vitamins A, D, E, and K. To be most effective, multivitamins should be taken >2 hours after taking orlistat. Clients may experience fecal incontinence, flatulence, oily stools, and oily spotting because unabsorbed fat is eliminated through defecation. A low-fat diet is an essential component of weight loss when a lipase inhibitor has been prescribed. The nurse should teach the client to take orlistat with, or within 1 hour of, meals that contain fat. If the client selects foods that do not contain fat, the dose may be skipped.

The healthcare provider prescribes paroxetine to a client with depression. What statement by the client indicates proper understanding of the medication? --"I can discontinue the medication if my symptoms improve" --"I need a healthy diet and regular exericse to combat weight gain" --"If I don't feel better in 1-2 weeks, then the medication is not working" --"This medication might increase my sexual performance"

"I need a healthy diet and regular exercise to combat weight gain" --Paroxetine is a selective serotonin reuptake inhibitor often prescribed for major depression and anxiety disorders. Other SSRIs include citalopram, escitalopram, fluoxetine, and sertaline. Weight gain is a common side effect of long-term SSRI use. The nurse should teach the client to eat a healthy diet and engage in regular exercise to combat the weight gain. Other major side effects of SSRIs include increased suicide risk, sexual dysfunction, and serotonin syndrome when taken in excess doses. SSRIs should not be stopped abruptly without discussion with the HCP. Dosages should be gradually tapered before discontinuation to avoid withdrawal symptoms. Most clients will start to see symptom improvement in 1-2 weeks. However, some may take several weeks and require dose adjustments. SSRIs can cause sexual dysfunction. Clients should notify the HCP for a change of medication or to add medications to increase sexual performance.

A client with fibromyalgia refuses to take the prescribed drug duloxetine. When the nurse asks why, the client responds, "because I'm not depressed". What is the nurse's most appropriate response? --"Depression is common with fibromyalgia but a low dose of this drug can prevent it" --"It can relieve your chronic pain and help you sleep better at night" --"It helps to relieve the adverse effects of your other prescribed drugs" --"You have the right to refuse. I will notify your healthcare provider."

"It can relieve your chronic pain and help you sleep better at night" --Medications such as duloxetine, pregabalin, and amitriptyline have neuropathic pain-relieving effects. They are commonly used for treating pain associated with diabetic neuropathy and FM. Duloxetine is particularly effective for treating both depression and pain. A client has the right to refuse any drug. However, the nurse should first explain the purpose of the drug to the client before notifying the HCP

The nurse reinforces medication teaching to a client prescribed metronidazole. Which client statement indicates a need for further education? --"I might have a metallic state in my mouth when I'm taking this medication" --"I need to decrease the amount of alcohol I drink while taking this medicine" --"I should not worry if my urine turns a dark color while taking this medication" --"I will immediately call the clinic if I get a new rass or have skin peeling"

"I need to decrease the amount of alcohol I drink while taking this medicine" --Metronidazol is an antibiotic medication used to treat bacterial, parasitic, and protozoal infections. Nurses educating clients about metronidazole should ensure that the client is aware of drug interactions and side effects to watch for and report.. The client should be instructed to abstain completely from consuming food, drinks, or products containing alcohol during, and for 3 days after, therapy. The combination of alcohol and mtronidazole may cause clients to experience facial flushing, headaches, N/V, and abdominal cramping. Metronidazole commonly causes a harmless but unpleasant metallic taste in the mouth and darkening of urine.. Although it is rare, metronidazole may cause Stevens-Johnson syndrome, a life-threatening complication characterized by necrosis and sloughing of the skin and mucus membranes. Clients should be educated to immediately report signs of SJS

During a routine office visit, the nurse documents the list of current medications of a client with a history of hypertension. Which statement by the client would cause the most concern? --"I periodically take docusate sodium for constipation" --"I regularly take ibuprofen for chronic low back pain" --"I tale hydrochlorothiazide to prevent swelling around my ankles" --"I take omeprazole daily to prevent heartburn"

"I regularly take ibuprofen for chronic low back pain" --OTC NSAIDs such as ibuprofen can cause cardiovascular side effects, including heart attack, stroke, high blood pressure, and heart failure from fluid retention. These drugs also decrease the effectiveness of diuretics and other blood pressure medications. The risks can be even higher in the client who already has cardiovascular disease or takes NSAIDs routinely or for a long time. In addition, long-term use of NSAIDs is associated with peptic ulcers and chronic kidney disease. These clients should use NSAIDs cautiously, at the lowest dose necessary and for a short time. The nurse should notify the healthcare provider that this client is routinely taking ibuprofen. Taking docusate sodium occasionally for constipation is appropriate. Hydrochlorothiazide is a weak diuretic and is commonly used to treat hypertension. Omeprazole for heartburn is appropriate for this client.

The nurse is reinforcing education to a client with a venous thrombembolism who is prescribed rivaroxaban. Which statement by the client indicates the medication teaching has been effective? --"I need to continue to avoid eating spinach and kale" --"I probably will have some weakness in my legs when I take this medication" --"I should avoid taking aspirin while receiving this medication" --"I will have to get blood drawn routinely to check my clotting levels"

"I should avoid taking aspirin while receiving this medication" --The nurse should instruct clients receiving factor Xa inhibitors which are anticoagulants, to avoid taking additional medications or supplements with anticoagulant effects. The combined anticoagulant effects increase the risk for uncontrolled bleeding and hemorrhage. Unlinke warfarin, factor Xa inhibitors are not affected by vitamin K, which is found in many green, leafy vegetables. Anticoagulants, particularly factor Xa inhibitors, increase the risk for spontaneous intracranial bleeding or formation of epidural hematomas. Clients taking factor Xa inhibitors should be instructed to immediately contact their healthcare provider for symptoms of neurological impairment. Routine monitoring of clotting times is unnecessary for clients prescribed factor Xa inhibitors.

A nurse has completed teaching a client who is being discharged on lithium for a bipolar disorder. Which statement by the client indicates a need for further teaching? --"I need to drink 1-2 liters of fluid daily" --"I need to have my blood levels checked periodically" --"I should not limit my sodium intake" --"I should use ibuprofen for pain relief"

"I should use ibuprofen for pain relief" --lithium is a mood stabilizer most often used to treat bipolar affective disorders. It has avery narrow therapeutic serum range of 0.6-1.2 mEq/L. Levels >1.5 mEq/L are considered toxic. Lithium toxicity usually occurs with the following: dehydration, decreased renal function, diet low in sodium, and drug-drug interactions, such as with NSAIDs and thiazide diuretics. Lithium is cleared renally. Even a mild change in kidney function can cause serious lithium toxicity. Therefore, drugs that decrease renal blood flow (NSAIDs) should be avoided. Acetaminophen would be a better choice for pain relief.

A client is in the cardiovascular clinic for a 3-month follow-up visit. At the first visit,the client was prescribed hydroxhlorothiazide and amlopdipine for hypertension. Which statements by the client would be concerning to the nurse and should be reported to the primary healthcare provider? --"I like to have a banana morning with my breakfast" --"I occasionally experience slight dizziness when I get up in the morning" --"I started taking licorice root my occasional heartburn" --"I usually take my hydrochlorothiazide first thing in the morning"

"I started taking licorice root for my occasional heartburn" ---The nurse should discourage the client from using the herbal remedy licorice root when taking thiazide diuretics. Licorice root can potentiate potassium loss and increase the client's risk for hypokalemia. Use of licorice root should be reported to the PCHP. Bananas are rich in potassium, so eating one each morning is beneficial. Diuretics and calcium channel blockers commonly cause postural hypotension or dizziness on rising. Diuretics should be taken in the morning as nighttime dosing will cause nocturia and interrupted sleep.

The nurse is teaching a client with advanced chronic obstructive pulmonary disease who was prescribed oral theophylline. Which client statement indicates that additional teaching is required? --"I need to avoid caffeinated products" --"I need to get my blood drug levels checked periodically" --"I need to report anorexia and sleeplessness" --"I take cimetidine rather than omeprazole for heartburn"

"I take cimetidine rather than omeprazole for heartburn" --Theophylline is a bronchodilator with a low therapeutic index and a narrow therapeutic range (10-20 mcg/mL). The serum level should be monitored frequently to avoid severe adverse effects. Toxicity is likely to occur at levels >20 mcg/mL. Individual titration is based on peak serum theophylline levels, so it is necessary to draw a blood level 30 minutes after dosing. Theophylline can cause seizures and life-threatening arrhythmias. Toxicity is usually due to intentional overdose or concurrent intake of medications that increase serum theophylline levels. Cimetidine and ciprofloxacin can dramatically increase serum theophylline levels. Therefore, they should not be used in these clients. Caffeinated products should be avoided as they would intensify the adverse effects of theophylline. The best way to prevent toxicity is to monitor drug levels periodically and adjust the dose. The signs of toxicity that should be reported are anorexia, N/V, restlessness, and insomnia.

The nurse provides teaching about methotrexate to a 28 year old client with rheumatoid arthritis. Which client statement indicates the need for further instruction regarding this drug? --"I know my resistance to germs will be lower, so I should get a flu shot this year" --"I should take precaution to prevent pregnancy while I take this medication" --"I will have an eye examination every 6 months to check for damage caused by my medication" --"It will be a difficult change for me, but I will not have wine with dinner anymore"

"I will have an eye examination every 6 months to check for damage caused by my medication" --Methotrexate is a disease-modifying antirheumatic drug used to treat rheumatoid arthritis and psoriasis. The major adverse effects associated with methotrexate include bone marrow suppression, hepatotoxicity, congenital abnormalities, and fetal death. Client is at risk for infection. They should avoid crowded places and should receive appropriate killed vaccines. Live vaccines are contraindicated. Clients should not become pregnant while taking methotrexate or for at least 3 months after it is discontinued as the drug is teratogenic and can cause congenital abnormalities and fetal death. Clients taking methotrexate should avoid alcohol as the prescription drug is hepatotoxic and drinking alchol increases the risk for hepatotoxicity.

A client with atrial fibrillation is being discharged home after being stabilized with medications, including digoxin. Which of the following statements regarding digoxin toxicity indicates that further teaching is needed? --"I must visit my healthcare provider to check my drug levels" --"I should report to my HCP if I develop nausea and vomiting" --"I should tell my HCP if I feel m heart skip a beat"

"I will need to increase my potassium intake" --Drug toxicity is common with digoxin due to its narrow therapeutic range. Drug levels are frequently monitored. Nonspecific gastrointestinal symptoms similar to gastroenteritis are common and can lead to serious cardiac arrhythmias if not recommended.

The nurse reinforces teaching a client on prescribed dabigatran for chronic atrial fibrillation. Which statement by the client indicates a need for further teaching? --"I will call my healthcare provider if I noticed red urine or blood in by stool" --"I will not stop taking dabigatran even if I get a stomachache" --"I will place capsules in my pill box so I will not forget to take a dose" --"I will swallow the capsule whole with a full glass of water"

"I will place capsules in my pill box so I will not forget to take a dose" --Thrombin inhibitors such as dabigatran reduce the risk for clots and stroke in clients with chronic atrial fibrillation. The nurse should teach the client to use bleeding precautions and monitor for symptoms of bleeding, swallow capsules whole with a full glass of water, and keep capsules in their original container until time of use. The nurse should educate the client that stopping dabigatran wil increase the risk for stroke. Taking the medication with food will not affect how much is absorbed and food or a full glass of water may prevent gastrointestinal side effects. Opening or crushing gabigatran increases absorption and risk of bleeding.

The nurse has provided education for a client newly prescribed alprazolam for generalized anxiety disorder. Which client statement indicates that teaching has been effective? --"Eliminating aged cheeses and processed meats from my diet is essential" --"I can skip doses on days that I am not feeling anxious" --"I will take my daily dose at bedtime" --"Using sunscreen is important as this drug will make me sensitive to sunlight"

"I will take my daily dose at bedtime" --Benzodiazepines are commonly used antianxiety drugs. They work by potentiating endogenous GABA, a neurotransmitter that decreases excitability of nerve cells, particularly in the limbic system of the brain, which controls emotions. Benzodiazepines may cause sedation, which can interfere with daytime activities. Giving the dose at bedtime will help the client sleep. Eliminating aged cheeses and processed meats, which contain tyramine, is necessary with monoamine oxidase inhibitors, which are used for depressive disorders. A benzodiazepine should never be stopped abruptly. Photosensitivty is a problem with most antipsychotics and many antidepressants, but not with benzodiazepines.

The nurse reinforces teaching to a female client about taking misoprostol to prevent stomach ulcers. Which statement by the client would prompt further instruction? --"I can take this medication with food if it hurts my stomach" --"I must use a reliable form of birth control while taking this medication" --"I should continue to take my ibuprofen as prescribed" --"I will take this medicine with an antacid to decrease stomach upset"

"I will take this medicine with an antacid to decrease stomach upset" --Misoprostol is a snythetic prostaglandin that protects against gastric ulcers by reducing stomach acid and promoting mucus production and cell regeneration. It is often prescribed to prevent gastric ulcers in clients receiving long-term NSAID therapy. Antacids, especially those that contain magnesium can increase the adverse effects of misoprostol (diarrhea, dehydration). If clients require therapy with antacids, they should choose one that does not contain magnesium and contact the healthcare provider if adverse effects occur. Taking misoprostol with food can help decrease gastrointestinal side effects. Misoprostol is also used for labor induction and is classified as a pregnancy category X drug. The client can continue taking ibuprofen with misprostol because it is designed to reduce side effects of ibuprofen.

The nurse reinforces education with a client starting isotretinoin for acne. Which statement indicates the client needs further instruction? --"I should not donate blood while taking this medication" --"I will stop taking my tetracycline prior to taking this medication" --"I will take vitamin A supplements" --"I will use condoms and birth control pills"

"I will take vitamin A supplements" ---Isotretinoin is a vitamin A derivative prescribed to treat severe and/or cystic acne. Side effects include birth defects, skin changes, and risk for increased intracranial pressure. Clients need to be instructed to avoid tetracycline, excess sun and tanning, and vitamin A supplements. Women of child-bearing age should use 2 forms of contraception to prevent pregnancy

The nurse teaches a client about the use of regular and neutral protamin Hagedorn (NPH) insulin. Which statement by the client indicates that further teaching is needed? --"I will always check my blood glucose prior to using the sliding scale" --"I will eat breakfast 30 minutes after taking my morning NPH and regular insulin" --"I will use a new insulin syringe each time I give myself an injection" --"I will use the sliding scale to determine my NPH dose 4 times a day"

"I will use the sliding scale to determine my NPH dose 4 times a day" --NPH is an intermediate-acting insulin with a duration of 12-18 hours and typically prescribed twice a day (morning and evening). Regular insulin and other rapid-acting insulins are typically used with a sliding scale for tighter control of blood glucose throughout the day. These are generally taken before meals and at bedtime.

A client with coronary artery disease was discharged home with a prescription for sublingual nitroglycerin (NTG) to treat angina. Which statement by the client indicates that further teaching is required? --"I may experience flushing but will continue to take the medication as prescribed" --"I should lie down before taking the medication" --"I should not swallow the tablet" --"I will wait to call 911 if I don't experience relief after the third tablet"

"I will wait to call 911 if I don't experience reflief after the third tablet" ---The nurse should instruct clients taking sublingual NTG that they should call EMS if their chest pain is unrelieved or worsening 5 minutes after the first tablet. The tablet should be allowed to dissolve under the tongue to allow for adequate absorption and should never be swallowed. Headache and flushing are common side effects of NTG due to systemic vasodilation. The client should lie down before taking the pill as it can cause dizziness from possible orthostatic hypotension.

The nurse has just completed discharge teaching about sublingual nitroglycerin tablets to a client with stable angina. Which statement by the client indicates the need for further teaching? --"I will call 911 if my chest pain isn't relieved by NTG" --"If I have chest pain, I can take up to 3 pills 5 minutes apart" --"I'll call my doctor if I start having chest pain at night" --"I'll keep one bottle in the house and one in the car"

"I'll keep one bottle in the house and one in the car" --Education about sublingual nitroglycerin should include placing the tablet or spray under the tongue, repeating the dose every 5 minutes, with up to 3 total doses if angina is not relieved. Client should notify EMS if the first dose does not improve the symptoms. The tablets should be kept in the original container away from light and heat. The bottle should also be replaced every 6 months once opened. c

The clinic nurse is teaching a client about levothyroxine, which the healthcare provider has prescribed for newly diagnosed hypothyroidism. Which statement by the client indicates that further teaching is needed? --"I will probably need to get my blood drawn to see if I'm taking the right dose" --"I will probably need to take this the rest of my life" --"I will take this once a day in the morning" --"If this makes my stomach upset, I will take it with antacid"

"If this makes my stomach upset, I will take it with an antacid" --Several medications impair the absorption of levothyroxine. Common offenders are antacids, calcium, and iron preparations. Some of these could be present in several over-the-counter multivitamin and mineral tablets. Therefore, clients with hypothyroidism should be instructed to take levothyroxine on an empty stomach, preferably in the morning, separately from other medications. The most common reason for inadequately treated hypothyroidism is deficient knowledge related to the medication regimen. Levothyroxine dosing is adjusted based on blood tests for thyroid-stimulating hormone or other thyroid hormone levels. Thyroid supplementation with levothyroxine usually requires lifelong therapy. Levothyroxine has a long half-life, so dosing is once daily.

A client with type 1 diabetes mellitus is prescribed an insulin pump. The nurse reinforces the diabetic educator's teaching regarding transitioning from multiple daily injections to continuous subcutaneous insulin infusion therapy. Which statement indicates that the client understands the advantages of using this therapy? --"I wont need a bolus dose of insulin before my meals anymore" --"I'm glad my blood sugars won't go way up and way down, like they did before" --"I'm so glad I don't have to stick my finger 4 times a day to test my sugar anymore" --"It'll finally be easier for me to lose some weight"

"I'm glad my blood sugars won't go way up and way down, like they did before" --An insulin pump is a small, battery-operated device about the size of a pager. The infusion set holds a syringe filled with rapid-acting insulin and delivers the drug from the pump to the client through a needle or catheter that is usually secured to the abdomen with an adhesive patch. The pump delivers insulin in 2 ways: as a steady, measured, and continuous dose 24 hours a day; and as an intermittent dose administered manually at mealtime to cover carbohydrate intake and as a supplemental dose to correct pre- or postprandial hyperglycemia. This therapy delivers the insulin more accurately than injections, so the client experiences fewer swings in blood glucose levels and hypoglycemic episodes as compared with the administration of insulin using a needle and syringe. Although the pump can calculate and deliver a more precise dose to regulate blood glucose levels more effectively, a bolus dose must be administered manually at mealtime to cover carbohydrate intake. Pumps used most commonly cannot respond to changes in the client's glucose levels, and would therefore still require checking blood glucose levels. Use of the insulin pump facilitates tighter glucose control, leading to more normal metabolism. However, if the client continues to take in more calories than needed for a given amount of activity or exercise, glucose that is not used by the cells accumulates as fat and results in weight gain.

A client with long-term hypertension and hypercholesterolemia comes to the clinic for an annual checkup. The client takes nifedipine, simvastatin, and spironolactone and reports some occasional dizziness. Which statement by the client would warrant intervention by the nurse? --"I've been better about walking for 20 minutes 3 days a week on my treadmill" --"I've been trying to eat more fruits and vegetables. I discovered that I really like grapefruit" --"I've heard that having a glass of red wine with dinner every night is good for my heart" --"We no longer add salt when preparing meals. It has really been hard to get used to that"

"I've been trying to eat more fruits and vegetables. I discovered that I really like grapefruit" --The nurse should tell the client not to eat grapefruit or drink grapefruit juice while taking calcium channel blockers due to the possible development of severe hypotension. The nurse should report this cient's statement to the HCP. The nurse should praise and encourage the client to continue exercising and possibly increase the amount. It is thought that red wine in moderation has some beneficial effects on the heart. Excessive alcohol consumption is strongly associated with hypertension. Therefore, the nurse should encourage the client to discuss alcohol consumption with the HCP. Sodium restriction is important in the management of hypertension and the nurse should encourage the client to continue the restriction of salt.

The clinic nurse evaluates a client who was prescribed lithium therapy a month ago for bipolar disorder. Which client statement would cause the most concern? --"I've felt the need for an afternoon nap most days this week" --"I've gained 3 lb since I began taking this medication" --"I've had the stomach flu for the past couple of days" --"My mouth seems to be drier than usual lately"

"I've had the stomach flu for the past couple of days" --Lithium is often used in the treatment of bipolar disorder. It has expected, mild side effects as well as potentially serious ones related to drug toxicity. Drowsiness, weight gain, dry mouth, and gastrointestinal upset are expected. Lithium toxicity occurs with dehydration, hyponatremia, decreased renal function, and drug-drug interactions. Lithium and sodium are closely related in the body. Acute viral gastroenteritis presents with abrupt onset of diarrhea, N/V, and abdominal pain. Clients with vomiting and diarrhea are at risk of developing dehydration and/or low serum sodium, increasing the risk for lithium toxicity.

The nurse is reviewing teaching about newly prescribed clonazepam with a client who is receiving palliative care for cancer. Which client statement shows a correct understanding of the nurse's teaching? --"I am glad that I can continue to take my kava supplement each morning" --"If I can't sleep, I will take some melatonin with my evening dose of clonazepam" --"If I feel restless, I can put some drops of lavender essential oil in a diffuser to calm myself" --"When my anxiety is getting really intense, I will drink some valerian tea to help me relax"

"If I feel restless, I can put some drops of lavender essential oil in a diffuser to calm myself" --Lavender aromatherapy is a safe, low-risk, complementary intervention for clients experiencing anxiety. Valerian root, kava, and melatonin may potentiate the adverse effects of clonazepam or other benzodiazepines, and should not be combined with them.

The nurse in an ambulatory care center is teaching a client with a diagnosis of persisitent depressive disorder (dysthymia) about the appropriate use of bupropion hydrochloride SR. Which statement made by the client indicates a need for further teaching? --"If I have a sudden change in my mood, I should call my physician immediately" --"If I have trouble swallowing the tablet, I can cut it in half" --"If I miss a dose, I should not double the next dose to catch up" --"It may take several weeks before I get better"

"If I have trouble swallowing the tablet, I can cut it in half" --Buproprion hydrochloride (wellbutrin) is an atypical antidepressant used to treat depressive disorders, including major depressive disorder, seasonal affective disorder, and persistent depressive disorder (dysthymia). Preparations of bupropion hydrochloride include immediate-release, sustained release (SR), and extended-release (XL) tablets. Any medications marked SR or XL should not be chewed, cut, or crushed due to the risk of adverse effects from too rapid absorption of the drug, No form of buproprion hydrochloride should be altered; tabelts should be swallowed whole, with or without food. Seizures are of particular concern if a client takes a higher or toxic dose of bupropion hydrochloride.

An elderly client with depression is given trazodone. Which statement by the client indicates that additional teaching is needed? --"I will call the healthcare provider if I develop a prolonged erection" --"I will get up slowly, in stages, from supine to standing" --"I will take this medication at night to avoid daytime drowsiness" --"It is okay to drink 2 glasses of wine at night"

"It is okay to drink 2 glasses of wine at night" --Trazodone, a serotonin modulator, is used to treat major depressive disorders. In addition to affection serotonin levels, the drug blocks alpha and histamine receptors. Blockade of alpha receptors can cause orthostatic hypotension similiar to that from other alpha blockers used to treat bening prostatic hyperplasia. Blockage of H1 receptors leads to sedation. Therefore, this drug is particularly effective in treating insomnia associated with depression. However, concurrent intake of other medications or substances that cause sedation can be detrimental; these include benzodiazepines, sedating antihistamines, and alcohol. Priapism is a known serious side effect of trazolone. A client with an erection lasting several hours should go to the hospital. Clients should be advised to rise from supine to standing slowly, in stages, due to the risk of orthostatic hypotension. The drug should be taken at bedtime to avoid daytime sedation.

The nurse is caring for a client who is taking riluzole for amyotrophic lateral schlerosis (ALS). The client asks "There's no cure for ALS, so why should I keep taking this expensive drug?" What is the nurse's best response? --"It may be able to slow the progression of ALS" --"It reduces the amount of glutamate in your brain" --"The case manager may be able to find a program to assistn with cost" --"You have the right to refuse the medication"

"It may be able to slow the progressin of ALS" --Amyotrophic laterla sclerosis (ALS), also known as Lou Gehrig disease, is a debillitating, progressive neurodegenerative disease with nocure. Clients develop fatigue and muscle weakness that progresses to paralysis, dysphagia, difficulty speaking, and respiratory failure. Most clients diagnosed with ALS survive only 3-5 years. Riluzole is the only medication approved for ALS treatment. Riluzole, a glutamate antagonist, is thought to slow neuron degeneration by decreasing the production and activity of the neurotransmitter glutamate in the brain and spinal cord. In some clients, riluzole may slow disease progression and prolong survival by 3-6 months. The nurse should provide teaching about the purpose of the medication so that the client can make an informed decision about taking it. Explaining the pharmacology of riluzole is not the best response for helping the client understand the purpose of taking the medication. It would be appropriate to consult the case manager if the client expresses concern about not taking the appropriate resources to acquire a costly medication, but the nurse should first ensure that the client understands the medication's purpose

The nurse reinforces teaching for a client newly prescribed buspirone for generalized anxiety disorder. Which client statement indicates that teaching has been effective? --"Driving is not recommended until I stop taking this medication" --"If I experience a panic attack, I should take an extra dose of medication" --"It will be 2-4 weeks before I feel the full effect of this medication" --"Withdrawal symptoms will occur if I abruptly stop taking this medication"

"It will be 2-4 weeks before I feel the full effect of this medication that differs from other medications used to manage anxiety disorders because it typically lacks central nervous system depressant effects and has a low abuse potential. Therefore, buspirone has a favorable side-effect profile because it usually does not produce withdrawal symptoms, dependence, or psychomotor slowing. However, unlike other anxiolytic medications, buspirone does not work immediately. Onset of symptoms relief occurs after 1 week of therapy,with full effects occurring between 2 and 4 weeks. As with any medication, the nurse should advise clients to avoid driving until individual effects are known. However, it is unlikely that buspirone will cause psychomotor impairment and require cessation of driving or operating machinery. Buspirone should be taken as prescribed and is not indicated for relief of acute anxiety or panic attacks.

A client is being discharged on enoxaparin therapy following total knee replacement surgery. Which teaching instruction does the nurse include in the teaching plan? --"eliminate green, leafy, vitamin K-rich vegetables from your diet" --"mild bruising or redness may occur at the injection site" --"You can take over the counter drugs such as ibuprofen to relieve mild discomfort" --"You will need PT/INR assessments at regular intervals while on enoxaparin therapy"

"Mild bruising or redness may occur at the injection site" --Vitamin K-rich foods do not need to be eliminated from the diet during enoxaparin therapy; PT and INR are not affected. Avoid taking aspiring, NSAIDs, and herbal supplements (ginkgo biloba,vitamin E) without healthcare provider approval as these can increase the risk of bleeding. Routine coagulation studies do not need to be monitored in a client who is taking enoxaparin. However, periodic assessment of complete blood count is usually required to monitor for hidden bleeding and thrombocytopenia.

The registered nurse is counseling the parent of a child who was diagnosed with attention-deficit-hyperactivity disorder and received a prescription for methylphenidate immediate-release tablet. Which statement by the parent demonstrates that teaching has been effective? --"An additive-free, low-sugar diet will reduce my child's symptoms" --"I can now manage my child's condition on my own" --"My child should not take the last daily dose after 6 PM" --"Once medication is started, I will not have to monitor my child anymore"

"My child should not take the last daily dose after 6 PM" --Methylphenidate is a stimulant drug with the potential to cause insomnia. Parents are instructed to administer the last dose no later than 6 PM to prevent sleep disruption. Contrary to popular myth, sugar does not increase hyperactivity; although an additive-free diet may be a healthy approach for children, eliminating additives or food colorings does not decrease the symptoms of ADHD. A team approach is the most effective way to help a child with ADHD. School-based interventions may include specific classroom modifications or accommodations to be incorporated into the treatment plan. Children should be monitored closely during initial treatment for development of tics and continuously for adherence and response to therapy.

The nurse is caring for a client taking tamoxifen for breast cancer. Which client statement is most concerning and a priority to report to the healthcare provider? --"I don't have much interest in sex lately" --"I feel like I might be getting a cold" --"My periods have been heavy lately" --"These hot flashes are occurring a lot"

"My periods have been heavy lately" --Tamoxifen has mixed agonist and antagonist activity on estrogen receptors in various tissues. It is used for several years in estrogen-responsive breast cancer. However, it is associated with increased risk of endometrial cancer and venous thromboembolism. Irregular or excessive menstrual bleeding in premenopausal women or any bleeding in postmenopausal women can be a sign of endometrial cancer. Menopausal symptoms (vaginal dryness, hot flashes, and decreased libidio) are the most common side effect. Tamoxifen is not associated with significant immunosuppression although it may rarely cause leukopenia.

A client had a levonorgstrel-releasing intrauterine device placed during a well-woman visit. Which teaching is appropriate for the nurse to include? --"Avoid oil-based personal lubricants, which can damage the device's silicone" --"Notify the healthcare provider if the string feels longer or shorter after menses" --"Placement will need to be reassessed if you lose or gain significant weight" --"The device will provide protection from pregnancy for up to 10 years"

"Notify the healthcare provider if the string feels longer or shorter after menses" --Priority teaching related to intrauterine devices focuses on prevention of sexually transmitted infections and early recognition of a dislodged device. A longer, shorter, or missing string may indicate that the device is no longer in the uterus and should be reported to the healthcare provider. Clients using latex condoms should use water-based personal lubricants; oil-based lubricants can weaken the condom and cause damage or breakage. IUD placement is not affected by significant weight changes. Levonorgestrel-releasing IUDs provide 3 years of contraception.

A client diagnosed with vaginal candidiasis is instructed on self-care management techniques and proper administration of the prescribed micronazole vaginal cream. Which statement by the client indicates that further teaching is needed? --"Each time I use the bathroom, I will wipe myself from the front to the back" --"I should choose loose-fitting cotton underwear instead of nylon undergarments" --"I will refrain from having sex until my partner is also tested and treated for the infection" --"Prior to going to bed at night, I will apply miconazole cream using the vaginal applicator"

"Prior to going to bed at night, I will apply miconazole cream using the vaginal applicator" --Candida albicans can colonize and cause infections of the vulvovaginal region. Vaginal candidiasis often causes itching and painful urination due to urine stinging the inflamed areas of the vulva. Assessment shows a thick, white, curd-like vaginal discharge and reddened vulvar lesions. Miconazole, an antifungal cream commonly prescribed to treat vaginal candidiasis, is inserted high into the vagina using an applicator. It is best applied at bedtime so that it will remain in the vagina for an extended period. Sexual intercourse is avoided until the inflammation is resolved, typically for the duration of treatment, approximately 3-7 days. However, sexual activity is not a significant cause of infection or reinfection of candida, and partner evaluation is not needed.

A client with chronic heart failure is being discharged home on furosemid and sustained-release potassium chloride tablets. Which instructions related to the potassium supplement should the nurse give to the client? --"A diet rich in protein and vitamin D will help with absorption" --"If the tablet is too large to swallow, crush and mix it with applesauce or pudding" --"Potassium tablets should be taken on an empty stomach" --"Take it with a full glass of water and stay sitting upright afterward"

"Take it with a full glass of water and stay sitting upright afterward" --The nurse should teach the client to take potassium tablets with plenty of water and to sit upright after ingestion ( for >30 minutes) to prevent pill-induced esophagitis. Potassium should be taken during or immediately following meals to prevent gastric upset. Sustained-release tablets should not be crushed as this would cause the client to absorb the medication too rapidly. A diet rich in protein and vitamin D helps with calcium-supplement.

A nurse is observing a nursing student reinforce teaching to a client on how to take sucralfate. Which statement made by the student would require intervention by the nurse? --"Take this in the morning 1 hour before breakfast" --"Take this with your other stomach medications" --"Take your heart medication 2 hours after sucralfate" --"You might experience constipation while taking this"

"Take this with your other stomach medications" --Sucralfate is an oral medication that forms a protective layer in the gastrointestinal mucosa,which provides a physical barrier against stomach acids and enzymes. It does not neutralize or reduce acid production but is prescribed to treat and prevent both stomach and duodenal ulcers. Sucralfate is generally prescribed 1 hour before meals and at bedtime and, for effective results, is taken on an empty stomach with a glass of water. Sucralfate forms a better protective layer at a low pH level. Therefore, antacids or other acid-reducing medications should be avoided within 30 minutes of taking sucralfate to prevent altered absorption. Scuralfate binds with many medications, reducing their bioavailability and effectiveness. Therefore, all other medications are generally taken >1-2 hours before or after taking sucralfate. Constipation is a common side effect of sucralfate.

The nurse obtains a health history from a client who states "I skip dinner most nights to lose weight. I don't want to get low blood sugar, so I don't take my evening dose of metformin when I skip dinner." Which response by the nurse is appropriate? --"Have your blood sugars been in the desired range when you skip doses?" --"Take half of the evening dose to prevent a low blood sugar level" --"The risk of low blood sugar is minimal when metformin is taken without food" --"Why are you skipping meals? That is not a healthy weight loss strategy."

"The risk of low blood sugar is minimal when metformin is taken without food" --Metformin is an oral antidiabetic medication that increases insulin sensitivity and inhibits liver glucose production. Metformin does not increase insulin secretion, so the risk of hypoglycemia is minimal, even when meals are skipped.

The graduate nurse is reinforcing teaching for a client who is initiating contraception with the etonogetrel and ethinyl estradiol vagina ring. Which statement by the graduate nurse would require the nurse preceptor to intervene? --"Hormones from the ring are absorbed into the bloodstream through the vaginal mucosa" --"If the ring is accidently removed, rinse and place it back in the vagina within 3 hours" --"The vaginal ring is effective as soon as you insert it" --"Wear the vaginal ring for 3 weeks, then remove it for 1 week"

"The vaginal ring is effective as soon as you insert it" --The etonogestrel and ethinyl estradiol vaginal ring is combined hormonal contraceptive. The client inserts the ring into the posterior vagina, though positioning is not crucial. Unlike some contraceptives that are placed vaginally, the ring is not a barrier method and requires time for hormone absorption. For clients initiating contraception with the etonogestrel and ethinyl estradiol vaginal ring, abstinence or a barrier method is necessary during the first 7 days of use or until hormones produce their full contraceptive effect. Hormones from the vaginal ring are absorbed into circulation through the vaginal mucosa and work systemically to prevent ovulation. If the ring is displaced, it should be rinsed and placed back into the vagina within 3 hours; otherwise, back-up contraception is required for 1 week; The client should insert and leave the ring in place for 3 weeks. When the client removes the ring, withdrawal bleeding occurs. The client should place a new ring after 7 hormone-free days.

The nurse is preparing to administer a sodium polystyrene sulfonate retention enema. Which explanation by the nurse best describes the purpose of this type of enema? --"A contrast medium is administered rectally to visualize the colon via X-ray" --"Bedridden clients receive this enema to stimulation defecation and relieve constipation" --"This enema assists the large intestines in removing excess potassium from the body" --"This enema is administered before bowel surgery to decrease bacteria in the colon"

"This enema assists the large intestine in removing excess potassium from the body" --Kayexalate retention enemas are medicated enemas administered to clients with high serum potassium levels. The resin in Kayexalate replaes sodium ions for potassium ions in the large intestine and promotes evacuation of potassium-rich waste from the body, thereby lowering the serum potassium level.

The nurse is caring for a client with diabetes who is being discharge with a prescription for glyburide. Which statement by the client indicates a need for further instruction? --"I should avoid alcohol intake with this new medication" --"I should call my primary car provider if my morning blood glucose is below 60 mg/dL" --"I should read the labels on all foods I eat, including those that say sugarless" --"This medication will help me lose weight"

"This medication will help me lose weight" --The major adverse effects of sulfonylurea medications are hypogylcemia and weight gain. Weight gain should be addressed. Clients taking glyburide should be taught to use sunscreen and protective clothing as serious sunburns can occur. Clients taking sulfonylureas should avoid alcohol as it lowers blood glucose and can lead to severe hypoglyemia. A fasting blood glucose <60 mg/dL indicates moderate to severe hypoglycemia and the medication needs to be reassessed. Even foods labeled "diabetic" or"sugar free" may contain carbohydrates such as honey, brown sugar, and corn syrup, all of which can elevate blood sugar.

A client is taking morphine sulfate for acute pain. Which statement will best assist the client worried about nausea and vomiting while taking this medication? --'Nausea and vomiting rarely occur with this medication" --"Nausea and vomiting rarely occur when you are up and walking" --"Take the medication on an empty stomach" --"Tolerance develops quickly and persistent nausea is rare"

"Tolerance develops quickly and persistent nausea is rare" --nausea and vomiting are expected side effects of opioid medications when the treatment is initiated. However, tolerance develops quickly and persistent nausea is rare. It is recommended that the client take an anti-emetic with the pain medication.

The nurse is performing discharge teaching for the parents of a 4-year-old with heart failure. Which statement by the parents indicates the need for further teaching related to the administration of digoxin? --"If our child vomits after a dose, we won't give a second one" --"Symptoms of nausea and vomiting should be reported to our healthcare provider" --"We will hold the dose if our child's heart rate is above 90/min" --"We will not mix the medication with other foods or liquids"

"We will hold the dose if our child's heart rate is above 90/min" --Nausea, vomiting, or slow pulse rate can indicate digoxin toxicity. General guidelines are to hold digoxin for pulse <90-110/min in infants and young children and <70/min in older children.

A pediatric client is diagnosed with an acute asthma attack. Which immediate-acting medication should the nurse prepare to administer to this client? SATA --albuterol --ibuprofen --ipratropium --montelukast --tobramycin

--albuterol --ipratropium ---Inhaled corticosteroid and leukotriene inhibitors are typically used to achieve and maintain control of inflammation for long-term management of asthma. Quick-relief medications (albuterol and ipratropium) are used to treat acute symptoms and exacerbations. NSAIDs and aspirin can worsen asthma symptoms in some clients and are not indicated unless necessary. Montelukast is a leukotriene inhibitor and is not used to treat acute episodes. Rather, it is given orally in combination with beta agonists and corticosteroid inhalers to provide long-term asthma control. Tobramycin is an aminoglycoside antibiotic used in aerosolized form to treat cystic fibrosis exacerbation when Pseudomonas is the predominant organism causing lung infection.

An African American client comes to the clinic for a follow-up visit 2 months after starting enalapril for hypertension. Which client statement should be reported to the healthcare provider immediately? --"Is there anything I can take for my dry, hacking cough?" --"My blood pressure this morning was 158/84 mm Hg" --"Sometimes I feel somewhat dizzy when I stand up" --"Will you look at my tongue? It feels thicker than normal"

"Will you look at my tongue? It feels thicker than normal" --Swelling of the tongue can be a sign of angioedema in clients taking ACE inhibitors; this can be potentially life-threatening if the airway becomes compromised. The nurse should report this immediately to the healthcare provider. Angioedema occurs more commonly in African American clients. A persistent, dry, hacking cough is a common side effect of ACE inhibitors. The nurse should review the client's blood pressure readings over the past month since starting enalapril. The client may need a dosage change or an additional medication. Occasional dizziness upon rising is a common side effect of most antihypertensives. The client should be taught to rise slowly and sit on the side of the bed for a few minutes before standing up.

The parent of a child diagnosed with attention-deficit hyperactivity disorder (ADHD), predominantely inattentive type, says to the nurse, "I hate the idea of my child taking a drug that's a stimulant. How will I know that the methylphenidate is even working?" Which is the best response by the nurse? --"Methylphenidate is generally a safe and effective drug for children with ADHD" --"Methylphenidate will increase the levels of neurotransmitters in your child's brain" --"You should see your child's school grades improve" --"Your child should be able to more easily complete school assignments and other tasks"

"Your child should be able to more easily complete school assignments and other tasks" --Although methylphenidate is classified as a stimulant, in children with ADHD, it improves attention, decreases distractibility, helps maintain focus on an activity, and improves listening skills. For many years, the effects of methylphenidate in children were labeled as paradoxical. Now, research has shown that methylphenidate significantly increases levels of dopamine in the central nervous system that lead to stimulation of the inhibitory system of the CNS. Methylphenidate works quickly; symptom relief is often seen after the first dose. All other statements are correct, but not the most effective to state to the mother in order to answer her question.

A hospitalized client with thyrotoxicosis receives atenolol 50 mg PO daily. Which statement by the nurse accurately reinforce the client's understand of this medication's purpose? --"Atenolol is an iodine-based medication that blocks the release of thyroid hormones" --"It is used to treat some of the symptoms of hyperthyroidism, such as increased heart rate" --"This drug is radioactive and damages or destroys the thyroid tissue" --"This first-line antithyroid drug inhibits the synthesis of thyroid hormones"

"it is used to treat some of the symptoms of hyperthyroidism, such as increased heart rate" --Beta-adrenergic blockers are given to relieve some of the symptoms of thyrotoxicosis. They block the effects of the sympathetic nervous system and treat symptoms such as tachycardia, hypertension, irritability, tremors, and nervousness in hyperthyroidism. Atenolol is not iodine based. Atenolol does not contain radioactive iodine. Propulthiouracil andmethimazole are first-line antithyroid drugs used to inhibit thyroid hormone synthesis

A client with a brain tumor is admitted for surgery. The healthcare provider prescribes levetiracetam. Th client asks why. What is the nurse's response? --"It destroys tumor cells and helps shrink the tumor" --"it prevents seizure development" --"it prevents blood clots in legs" --"It reduces swelling around the tumor"

"it prevents seizure development" --Levetiracetam (Keppra) is a medication often used to treat seizures in various settings. Corticosteroids (dexamethasone) are used to reduce inflammation and cerebral edema in clients with brain injury and tumors.

A 21-year old client is being evaluated in the outpatient psychiatric clinic after starting isocarboxazid 2 weeks ago. Which of the client's statements needs to be addressed first? --"I am not sleeping well at night and would like a sleeping aid" --"I do not know how well I will do on this restricted diet" --"I have been having quite a bit of nausea and constipation" --"This medicine is not working; I am so tired of being depressed"

"this medicine is not working; I am so tired of being depressed" --MAOIs and other antidepressants are associated with increased risk of suicidal ideation during the first few weeks of treatment. Clients taking MAOIs need to avoid tyramine-containing foods due to risk of hypertensive crisis. MAOIs should be administered in the morning, as sleep dysfunction is common. This statement should prompt a discussion of current medication habits, but is not priority. Nausea and constipation are adverse effects of MAOIs. Although strategies for management of adverse effects should be discussed, it is not priority.

What are the common clinical manifestations of Kawasaki disease?

-- >5 days of fever --bilateral noexudative conjunctivitis --mucositis --cervical lymphadenopathy --rash --extremity swelling

A nurse teaches a client who is being discharged on warfarin for atrial fibrillation. Which client statements indicate that teaching has been effective? SATA --"Antibiotics can affect my INR value" --"I am going to eat more leafy greens" --"I will shoot for my INR value to be between 4 and 5" --"I will take warfarin at the same time daily" --"If I miss a dose, I can double it on the following day"

--"Antibiotics can affect my INR value --"I will take warfarin at the same time daily" ---warfarin must be taken at the same time daily to reach a therapeutic INR of 2-3. A diet high in vitamin K may decrease warfarin's anticoagulant effect. The client does not have to avoid consumption of leafy-green vegetables, but they should eat a consistent quantity and have their INR checked periodically. Most antibiotics will increase INR by causing a vitamin K deficiency. Clients should call their healthcare provider if they miss or forget to take a warfarin dose. Double dosing is contraindicated.

A teaching plan for a client prescribed INH includes

--avoid intake of alcohol and lmit the use of other hepatotoxic agents --take pyridoxine to prevent neuopathy --avoid aluminum-containing antacids --report changes in vision --report signs/symptoms of severe adverse effects (hepatoxicity and peripheral neuropathy)

The nurse administers a dose of radioactive iodine to a female client for treatment of hyperthyroidism. Which of the following precautions should the nurse teach the client to follow on discharge? SATA --"Avoid close contact with pregnant women, infants, and children" --"If applicable, you may resume breastfeeding when you return home" --"If possible, use a separate toilet from your family, and flush 2 or 3 times after each use" --"Use disposable cups, plates, and utensils, and do not share food items with others" --"Wash your clothing and towels separately from the rest of the laundry in your home"

--"Avoid close contact with pregnant women, infants, and children" --"If possible, use a separate toilet from your family, and flush 2-3 times after each use" --"Use disposable cups, plates, and utensils, and do not share food items with others" --"Wash your clothing and towels separately from the rest of the laundry in your home" ---Radioactive iodine treats hyperthyroidism by damaging or destroying the thyroid gland. After ingesting radioactive iodine, clients and their bodily secretions are radioactive. They should avoid pregnant women and children, use a separate toilet and disposable tableware, sleep in a separate bed, and isolate personal laundry. After RAI therapy, breast milk excreted by the client is radioactive and can permanently damage an infant's thyroid. Breastfeeding should be stopped 6 weeks before treatment to prevent RAI from accumulating in the breasts after treatment. Breastfeeding is not resumed with the current child but can be resumed with future pregnancies.

The clinic nurse is instructing a client who is newly prescribed transdermal scopoamine to prevent motion sickness during an upcoming vacation on a cruise ship. Which of the following statements made by the nurse are appropriate? SATA --"Apply the patch when the ship starts moving and not before" --"Dispose of the patch out of reach of children and pets" --"Make sure to remove the old patch before applying a new one" --"Place the patch on a hairless, clean, dry area behind the ear" --"Wash your hands with soap and water after handling the patch"

--"Dispose of the patch out of reach of children and pets" --"Make sure to remove the old patch before applying a new one" --"Place the patch on a hairless, clean, dry area behind the ear" --"Wash your hands with soap and water after handing the patch" ---Scopolamine is an anticholinergic medication used to prevent nausea and vomiting from motion sickness and as an adjunct to anesthesia to control secretions. Transdermal scopolamine is placed on a hairless, clean, dry area behind the ear for proper absorption.

The nurse is caring for a client who will have a copper intrauterine device inserted. When reinforcing teaching related to the copper IUD, which of the following statements are appropriate? SATA --"Backup contraception is needed for 2 days until the IUD is effective" --"Heavier menses and more menstrual cramping are common in clients using a copper IUD" --"Missing a period while using a copper IUD is normal and no reason for concern" --"You may have cramping and vaginal spotting for a short time after IUD insertion" --"You should check for the IUD strings at least once a month after menses"

--"Heavier menses and more menstrual cramping are common in clients using a copper IUD" --"You may have cramping and vaginal spotting for a short time after IUD insertion" --"You should check for the IUD strings at least once a month after menses" ---A cooper intrauterine device is a form of long-acting, reversible contraception that has an immediate contraceptive effect upon placement (therefore backup contraception is not required). Mild discomfort is associated with IUD insertion, and clients should anticipate heavier bleeding and increased cramping during menses. IUD strings should be checked at least every month to ensure that the IUD has not been expelled. Although pregnancy risk is low when using the copper IUD, pregnancy is possible. Ovulation and menses still occur when using the copper IUD because the device does not contain hormones. A pregnancy test is necessary if a period is missed.

The nurse has provided education about proper use of an epinephrine auto-injector to a client with a history of a severe hypersensitivity reaction to bee stings. Which of the following client statements indicate that teaching has been effective? SATA --"I may have a rapid heartbeat and palpitations after injecting the medication" --"I must call an ambulance or go to the nearest hospital following an injection" --"I should avoid storing my device in extremely hot or cold temperatures" --"The area to be injected should be cleansed with alcohol or soap and water" --"The medication is injected at a 90-degree angle into the outer thigh

--"I may have have a rapid heartbeat and palpitations after injecting the medication" --"I must call an ambulance or go to the nearest hospital following an injection" --"I should avoid storing my device in extremely hot or cold temperatures" --"The medication is injected at a 90-degree angle into the outer thigh" ---Clients should be instructed to administer EAIs as quickly as possible if symptoms of anaphylaxis develop. Skin preparation is not necessary, and delaying administration to cleanse the injection site increases the risk of death from anaphylatic shock.

The home health nurse visits a client with atrial fibrillation who is newly prescribed digoxin 0.25 mg orally on even-numbered days. Which of the following client statements show that teaching has been effective? SATA --"I need to call the health care provider if I have trouble reading" --"I need to check my blood pressure before taking my medication" --"I should call the HCP if I develop nausea and vomiting" --"I should check my heart rate prior to taking this medication" --"I will call the HCP if I feel dizzy and lightheaded"

--"I need to call the healthcare provider if I have trouble reading" --"I should call the HCP if I develop nausea and vomiting" --"I should check my heart rate prior to taking this medication" --"I will call the HCP if I feel dizzy and lightheaded" ---cardiac glycosides have positive inotropic effects (increased cardiac output) and negativechronotropic effects (decreased heart rate). Clients are instructed to check their pulse before administration and to report gastrointestinal, neurologic, and cardiac symptoms and visual changes.

The nurse provides instructions to a client discharged on warfarin, after being treated for a pulmonary embolism following surgery. Which statements made by the client indicate the need for further teaching? SATA --"I will need to take my blood thinner for about 3-6 months" --"I will place small rugs on my wood floors to cushion a fall" --"I will take a baby aspirin if I have mild chest pain" --"I will use a soft-bristled toothbrush to clean my teeth" --"I will wear a blood thinner MedicAlert tag"

--"I will place small rugs on my wood floors to cushion a fall" --"I will take a baby aspirin if I have mild chest pain" ---Clients on warfarin or heparin should avoid using aspirin or nonsteroidal anti-inflammatory drugs, wear a MedicAlert device, avoid activites that increase the risk for bleeding, limit alcohol intake, and remove scatter rugs in the home to reduce the risk of tripping and falling. Warfarin is usually administered for 3-6 months following PE to prevent further thrombus formation. A longer duration of anticoagulation is recommended in clients with recurrent PE.

An elderly client is prescribed codeine for a severe cough. The home health nurse teaches the client how to prevent the common adverse effects associated with codeine. Which client statements indicate an understanding of how to prevent them? SATA --"I'll be sure to apply sunscreen if I go outside" --"I'll drink at least 8 glasses of water a day" --"I'll drink decaffinated coffee so I can sleep at night" --"I'll sit on the side of my bed for a few minutes before getting up" --"I'll take my medicine with food"

--"I'll drink at least 8 glasses of water a day" --"I'll sit on the side of my bed for a few minutes before getting up" --"I'll take my medicine with food" ---Codeine is an opioid drug prescribed as an analgesic to treat mild to moderate pain and as an antitussive to suppress the cough reflex. Although the antitussive dose is lower than the analgesic dose, clients can still experience the common adverse effects (constipation, N/V, orthostatic hypotension, dizziness) associated with the drug. Codeine decreases gastric motility, resulting in constipation. Increasing fluid intake and fiber in the diet and taking laxatives are effective measures to prevent constipation. Changing position slowly is effective in preventing the orthostatic hypotension associated with codeine, especially in the elderly. Taking the medication with food is effective in preventing the gastrointestinal irritation associated with codeine.

The graduate nurse is admitting a client for labor induction who is prescribed misoprostol for cervical ripening. Before misoprostol is adminstered, which of the following statements by the graduate nurse should be concerning to the supervising nurse? SATA --"IV oxytocin and misoprostol may be administered at the same time" --"The client has had two prior cesarean births" --"The client's cervical examination is 0 cm, 25% effaced, -3 station" --"The client's contraction pattern is currently 6 contractions in 10 minutes" --"The prescribed oral route of administration is appropriate"

--"Iv oxytocin and misoprostol may be administered at the same time" --"The client has had two prior cesarean births" --"The client's contraction pattern is currently 6 contractions in 10 minutes" ---Misoprostol is a cervical ripening agent administered orally or vaginally. It is contraindicated in clients who are receiving another uterotonic simultaneously, have had previous uterine surgery, or have abnormal fetal heart rate patterns or uterine tachysystole.

The nurse provides medication teaching to a client with primary adrenal insufficiency (Addison's disease) who is prescribed hydrocortisone 10 mg by mouth 3 times a day. Which instructions should be included in the client's teaching plan? SATA --"Discontinue hydrocortisone if you note mood changes or disruptions in behavior" --"Make an appointment with an optometrist yearly to assess for cataracts" --"Report even a low-grade fever to the healthcare provider immediately" --"Report signs of hyperglycemia, including increased urine, hunger, and thirst" --"Take the medication on an empty stomach" --"The dose of hydrocortisone may need to be decreased during times of stress"

--"Make an appointment with an optometrist yearly to assess for cataracts" --"Report even a low-grade fever to the healthcare provider immediately" --"Report signs of hyperglycemia, including increased urine, hunger, and thirst"

The nurse is providing discharge instructions on the proper use of prescribed short-acting beta agonist and inhaled corticosteroid metered-dose inhalers to a client with newly diagnosed asthma. Which instructions should the nurse include? SATA --"omit the beclomethasone if the albuterol is effective" --"Rinse your mouth well after using the beclomethasone inhaler and do not swallow the water" --"Take the albuterol inhaler apart and wash it after every use" --"Use the albuterol inhaler first if needed. then the beclomethasone inhaler" --"Use the beclomethasone inhaler first, then the albuterol, if needed"

--"Rinse your mouth well after using the beclomethasone inhaler and do not swallow the water" --"Use the albuterol inhaler first if needed, then the beclomethasone inhaler" ---Asthma is a disorder of the lungs characterized by reversible airway hyper-reactivity and chronic inflammation of the airways. Albuterol is a short-acting agonist administered as a quick-relief rescue drug to relieve symptoms (wheezing, breathlessness, chest tightness) associated with intermittent or persistent asthma. Beclomethasone is an inhaled corticosteroid (ICS) normalled used as a long-term, first-line drug to control chronic airway inflammation. When useing an ICS metered-dose inhaler (MDI), small particles of the medication are deposited and can impact the tongue and mouth. Rinsing the mouth and throat well after using the MDI and not swallowing the water are recommended to help prevent thrush, a common side effect of ICSs. When both MDIs are to be taken at the same time, clients are instructed to take the SABA first to open the airways and then the ICS to provide better delivery of the medication. It is important for the nurse to clarify indications and sequencing as the SABA is a rescue drug taken on an as-needed basis and is not always taken with the ICS. Inhaled corticosteroids are not rescue drugs. They are prescribed to be taken on a regular schedule (morning, bedtime) on a long-term basis to prevent exacerbations and shoult not be omitted even if the SABA is effective. Taking the albuterol inhaler apart, washing the mouthpiece under warm running water and letting it air dry at least 1-2 times a week is recommended. Medication particles can deposit in the mouthpiece and prevent a full dose of medication from being dispensed.Taking the ICS inhaler apart and cleaning it every day is recommended.

The nurse is providing education to a client diagnosed with a trichomoniasis vaginal infection who has been prescribed a one time dose of oral metronidazole. Which of the following statements by the nurse are appropriate? SATA --"Abstain from sexual intercourse until the symptoms are cleared" --"Avoid drinking alcohol for at least 3 days after taking the last dose" --"Inform your sexual partners that they need to be treated" --"Metronidazole may temporarily turn your urine a dark, brownish color" --"Vaginal douching after intercourse may prevent recurrence of infection"

--"abstain from sexual intercourse until the symptoms are cleared" --"Avoid drinking alcohol for at least 3 days after taking the last dose" --"Inform your sexual partners that they need to be treated" --"Metronidazole may temporarily turn your urine a dark, brownish color" ----Trichomoniasis is a sexually transmitted infection. Infected clients may be asymptomatic, but usually seek care when a profuse, frothy, yellow-green malodorous vaginal discharge is noted. Pruitus, dysuria, and dyspareunia may also occur. Oral metronidazole is the most common drug used to treat trichomoniasis. Vaginal douching is not recommended as it gets rid of good bacteria and altered to pH of the vagina, increasing the risk for infection. Teach the client to cleanse the exterior vulva using only unscented products, wear breathable undergarments, and report persisting odors/discharge to the healthcare provider.

A client with Parkinson disease is prescribed carbidopa-levodopa. Which of the following instructions should the nurse include with the client's discharge teaching? SATA --"change positions slowly, and sit on the side of the bed before standing" --"This medication takes several weeks to reach maximum benefit" --"You may experience some facial and eye twitching, but this is not harmful" --"Your tremors should disappear completely while on this medication" --"Your urine and saliva may turn reddish-brown, but this is not harmful"

--"change positions slowly, and sit on the side of the bed before standing" --"This medication takes several weeks to reach maximum benefit" --"Your urine and saliva may turn reddish-brown, but this is not harmful" ---Carbidopa-levodopa is a medication used to reduce symptoms of tremor and rigidity in clients with Parkinson disease. Teach clients that the medication takes several weeks to become effective; urine, perspiration, or saliva discoloration is a common side effect; and fall precautions should be implemented for client safety. Dyskinesia (facial/eyelid twitching) may indicate overdose or toxicity of carbidopa-levodopa and should be reported immediately to the healthcare provider. Cardipoa-levodopa often decreases, but does not eliminate, tremor and rigidity.

A community health nurse is preparing to administer influenza vaccines. Which clients can safely receive the live-attenuated, intranasal influenza vaccine? SATA --4 month old client who is receiving scheduled vaccinations --3 year old client who is afraid of needles --24 year old client who is 6 weeks postpartum --32 year old client who is pregnant at 12 weeks gestation --45 year old client with a history of HIV

--3 year old client who is afraid of needles --24 year old client who is 6 weeks postpartum ---The live-attenuated, intranasal influenza vaccine is a safe and effective choice for many healthy clients age 2-49 years but should not be given to clients who are immunocompromised, pregnant, or age <2 years.

The nurse evaluating a 52-year-old diabetic male client's therapeutic response to rosuvastatin would notice changes in which laboratory values? SATA --alanine aminotransferase from 20U/L to 80 U/L --high-density lipoprotein cholesterol from 48 mg/dL to 30 mg/dL --low-density lipoprotein cholesterol from 176 mg/dL to 98 mg/dL --total cholesterol from 250 mg/dL to 180 mg/dL --Triglycerides from 180 mg/dL to 149 mg/dL

--Low-density lipoprotein cholesterol from 176 mg/dL to 98 mg/dL --total cholesterol from 250 mg/dL to 180 mg/dL --triglycerides from 180 mg/dL to 149 mg/dL ---A therapeutic response to statin medication includes a decrease in a client's LDL cholesterol, total cholesterol, and triglyceride levels to within normal range. An increase in HDL cholesterol to within normal range is also expected outcome. Potential adverse effects include hepatic dysfunction and muscle injury.

Client education when taking metronidazole includes

--abstaning from sexual intercourse until the infection is cleared. --avoid drinking alcohol while taking metronidazole and for 3 days after completion of therapy. The combination can cause flushing, N/V, and severe abdominal pain --have partner(s) treated simultaneously to avoid reinfection. --potential side effect of metronidazole includes metallic taste, gastrointestinal upset, or dark-colored urine

Drugs/supplements that increase the warfarin effect

--acetaminophen, NSAIDs --antibiotics/antifungal agents --amiodarone --cranberry juice, ginkgo biloba, vitamin E --omeprazole --thyroid hormone --selective serotonin reuptake inhibitors

The nurse is administering IV hydromorphone to a client every 3-4 hours as needed for postoperative pain. Which interventions should the nurse implement? SATA --administer IV hydromorphone over 5-10 seconds --administer PRN stool softener with daily medications --hold hydromorphone if client is not practicing deep breathing exercises --perform reassessment an hour after administration --tell the client to call for assistance before getting out of bed

--administer PRN stool softener with daily medications --tell the client to call for assistance before getting out of bed ---Opioid analgesics are effective for managing postoperative pain, which encourages participation in deep breathing exercises. Side effects of opioid analgesics include sedation, respiratory depression, hypotension, and constipation. The nurse should administer IV hydromorphone slowly over 2-3 minutes, monitor sedation level, instruct the client not to get out of bed unassisted, and administer PRN stool softeners. The nurse should administer opioids to achieve adequate pain control as needed to encourage participation in postoperative exercises and prevent complications. The nurse should reassess pain and sedation level during the opioids peak effect, which is 15-30 minutes after administration of IV hydromorphone.

The healthcare provider prescribes amoxicillin/clavulanate (liquid) twice a day for a child with acute sinusitis. What instructions are most important for the parents? SATA --administer it with food if nausea or diarrhea develops --complete the medication course even if the child is better --expect a rash, which is normal, as a side effect --shake the medicine well before use --use a household spoon to measure the dose

--administer it with food if nausea or diarrhea develops --complete the medication course even if the child is better --shake the medicine well before use ---Rash, itching, dyspnea, or facial/layrngeal edema may indicate an allergic reaction and the medication should be discontinued. Pediatric liquid medications are often dispensed with a measuring device designed to administer the exact dose prescribed.

A post-surgical client is unresponsive to painful stimuli and is given naloxone. Within 5 minutes, the client is arousable and responds to verbal commands. One hour later, the client is again difficult to arouse, with minimal response to physical stimuli. Which actions should the nurse take? SATA --administer oxygen --assess respiratory rate --initiate rapid response or code team --notify the healthcare provider --prepare a second dose of naloxone

--administer oxygen --assess respiratory rate --notify the healthcare provider --prepare a second dose of naloxone ---A client in the post-operative period that is unresponsive to painful stimuli is likely still under the effects of medications used during anesthesia. Using the opioid antagonist naloxone will temporarily reverse the effects of any opioid medications. Unfortunately, the half-life of naloxone is much shorter than most opioid medications, wearing off in 1-2 hours. The nurse should make repeat assessments of the post-surgical client's respiratory rate and administer prescribed oxygen for respiratory support. The healthcare provider should be notified and a second dose of naloxone should be prepared and administered as prescribed.

Contraindications for the live-attenuated intranasal vaccine (LAIV)

--age <2 or >50 --immunosuppressed patients and those in close contact --chronic cardiovascular, pulmonary, neurologic, neuromuscular, or metabolic diseases --history of Gullain-Barre syndrome following previous influenza immunization --pregnant women --children/adolescents on long-term aspirin --severe allergy to vaccine or its components

The nurse reviews an elderly client's medication administration record and identifies which prescriptions as having the potential for injury in the elderly? SATA --amitriptyline --chlorpheniramine --docusate --donepezil --lorazepam

--amitriptyline --chlorpheniramine --lorazepam ----polypharmacy and physiologic changes associated with aging place the elderly at increased risk of adverse drug effects. The Beers criteria provides a list that classifies potentially harmful drugs to avoid or administer with caution in the elderly due to the high incidence of drug-induced toxicity, cognitive dysfunction, and falls. Some commonly used medications in this list include antipsychotics, anticholinergics, antihistamines, antihypertensives, benzodiazepines, diuretics, opioids, and sliding insulin scales. Amitriptyline is a tricyclic antidepressant. Chlorpheniramine is a sedating histamine H1 antagonists. Lorazepm is a benzodiazepine.

The clinic nurse evaluates a client's response to levothyroxine after 8 weeks of treatment. What therapeutic responses to the medication should the nurse expect? SATA --apical heart rate of 88/min --elevation of mood --improved energy levels --skin is cool and dry --slight weight gain

--apical heart rate of 88/min --elevation of mood --improved energy levels ---The client's therapeutic response to levothyroxine is evaluated by resolution of hypothyroidism symptoms. The expected response includes improved well-being with elevated mood, higher energy levels, and a heart rate that is within normal limits. The nurse should consult the healthcare provider if the heart rate is greater than 100/min or if the client reports chest pain, nervousness, or tremors; this may indicate that the dose is higher than necessary. Pharmacological therapy manages the symptoms of hypothyroidism, but it takes up to 8 weeks after initiation to see the full therapeutic effect. In hypothyroidism, the skin is cool, pale, and rough. These characteristics result from decreased blood flow. A therapeutic response to levothyroxine would be skin that is normal. The client experiencing a therapeutic response to levothyroxine would experience weight loss due to the increased metabolic rate. However, the client with untreated hypothyroidism would experience weight gain.

Client taking scopolamine should be instructed to

--apply the patch >4 hours before starting travel to allow for absorption and medication onset --replace the patch every 72 hours as prescribed to ensure continuous medication delivery --dispose of the old patch out of reach of children and pets to avoid accidental ingestion --wash hands with soap and water after handling the patch to avoid inadvertent drug absorption or contact with the eyes.

The nurse is monitoring a client who has been on clopidogrel therapy. Which assessments are essential? SATA --assess for bruising --assess for tarry stools --monitor intake and output --monitor liver function tests --monitor platelets

--assess for bruising --assess for tarry stools --monitor platelets ---Antiplatelet therapy can pose a risk for serious bleeding. Clients should be monitored for bruising, signs of bleeding (tarry stools, hematuria), and decreased platelet counts (assess for thrombotic thrombocytopenic purpura). Monitoring intake and output is indicated while a client is on diuretic medications but not for antiplatelet agents. Baseline liver enzymes are obtained for clients taking statins and isoniazid. Elevated liver enzymes are an infrequent side effect of clopidogrel, and regular monitoring is usually not required in clients without hepatic impairment.

The nurse cares for a client following a percutaneous coronary interventin via the right groin. The client received an IV infusion of abciximab during the procedure. Which actions should the nurse implement? SATA --assess invasive procedure sites for bleeding --check hemoglobin and platelet count --initiate a second large-bore IV line --place the client on continuous cardiac monitoring --report black tarry stools to the healthcare provider

--assess invasive procedure sites for bleeding --check hemoglobin and platelet count --place the client on continuous cardiac monitoring --report black tarry stools to the healthcare provider ---Glycoprotein llb/llla receptor inhibitors inhibit platelet aggregation and increase bleeding risk. Serious thrombocytopenia can occur within few hours, further increasing bleeding risk. After administration, the nurse should monitor the client's blood counts, blood pressure, and heart rate/rhythm, as well as watch for signs of bleeding. During and after the infusion of GP llb/llla receptor inhibitors, no traumatic procedures (initiation of IV sites, intramuscular injections) should be performed unless absolutely necessary due to the risk of bleeding.

The nurse administers IV vancomycin to a client with a methicillin-resistant STaphylococcus aureus infection. Which nursing actions are most appropriate? SATA --assess client for lethargy --assess skin for flushing and red rash on face and torso --infuse medication over at least 60 minutes --monitor blood pressure during infusion --observe IV site every 30 minutes for pain, redness, and swelling

--assess skin for flushing and red rash on face and torso --infuse medication over at least 60 minutes --monitor blood pressure during infusion --observe IV site every 30 minutes for pain, redness, and swelling.

The nurse cares for a client who has oral candidiasis. The healthcare provider has prescribed nystatin oral suspension. Which of the following nursing actions are appropriate? SATA --assist the client in removing dentures and soaking them in nystatin --inspect the oral mucous membranes thoroughly before administering nystatin --instruct the client to discontinue the medication as soon as symptoms subside --instruct the client to swish the suspension in the mouth for several minutes --shake the bottle of suspension thoroughly before measuring the dose

--assist the client in removing dentures and soaking them in nystatin --inspect the oral mucous membranes thoroughly before administering nystatin --instruct the client to swish the suspension in the mouth for several minutes --shake the bottle of suspension thoroughly before measuring the dose ---clients receiving nystatin should be educated to take the medication as prescribed each day and avoid missing doses

The community health nurse prepares a teaching plan for a client with latent tuberculosis who is prescribed oral isoniazid (INH). Which instructions should the nurse include? --avoid drinking alcohol --expect body fluids to change color to red --report yellowing of skin or sclera --report numbness and tingling of extremities --take with aluminum hydroxide to prevent gastric irritation

--avoid drinking alcohol ---report yellowing of skin or sclera --report numbness and tingling of extremities ---Isoniazid (INH) is a first-line antitubercular drug prescribed as monotherapy to treat latent tuberculosis infection. Combined with other drugs, INH is also used for active tuberculosis treatment. Two serious adverse effects of INH use are hepatotoxicity and peripheral neuropathy.

Adverse effects of ACE inhibitors on the fetus

-renal dysgenesis -oligohydramnios

The nurse is providing discharge teaching for several clients with new prescriptions. Which instructions by the nurse are correct in regard to medication administration? SATA --avoid salt substitutes when taking valsartan for hypertension --take levofloxican with an aluminum antacid to avoid gastric irritation --take sucralfate after meals to minimize gastric irritation associated with a gastric ulcer --when taking ethambutol, notify the healthcare provider of any changes in vision --when taking rifampin, notify the HCP if the urine turns red-orange

--avoid salt substitutes when taking valsartan for hypertension --when taking ethambutol, notify the HCP of any changes in vision ---The nurse should watch for vision changes with ethambutol. Potassium supplements or salt substitutes should not be given to a client taking an ACE inhibitor or angiotensin receptor blocker. Sucralfate must be given before meals to prevent irritation of the ulcer. Quinolone antibiotics should not be given with antacids or supplements that reduce drug efficacy. Rifampin commonly causes red-orange discoloration of body fluids.

How can a client prevent lithium toxicity?

--avoid sodium depletion (low sodium intake precipitates lithium toxicity) -eat regular diet and drink adequate fluids (2-3 L/day)

A home health nurse is preparing to start milrinone infusion via a peripherally inserted central catheter for a client with end-stage heart failure. What equipment is most important to be present in the home? SATA --bathroom scale for daily weights --blood pressure cuff --central line dressing change kits --infusion pump --intermittent urinary catheterization kits

--bathroom scale for daily weights --blood pressure cuff --central line dressing change kits --infusion pump ---A client may receive a milrinone infusion in the home for pallative treatment of end-stage heart failure. The infusion is set up via an infusion pump and infused through a central line. The client and family should be instructed on basic pump troubleshooting as well as the importance of measuring daily weight and blood pressure. Milrinone causes vasodilation, which may result in increased urinary output, but intermittent catheterization is not indicated.

The nurse prepares to administer 9:00AM medications to a client. Which data should the nurse evaluate prior to administration? SATA --blood pressure --blood sugar --heart rate --International Normalized Ratio --Potassium level

--blood pressure --heart rate --potassium level ---Beta blockers lower blood pressure and heart rate. Angiotensin-converting enzyme inhibitors lower blood pressure and increase potassium (by decreasing urinary potassium excretion). Aspirin, an antiplalelet medication, increases the risk for bleeding.

What are some adverse effects of beta blockers?

--bradycardia --bronchospasm --depression --decreased libido with erectile dysfunction

The nurse is providing discharge teaching for a client with a new prescription for warfarin. The nurse should instruct the client to avoid excess or inconsistent intake of which foods? SATA --bananas --broccoli --liver --oranges --spinach

--broccoli --liver --spinach ---Clients receiving warfarin therapy should maintain consistent intake of foods high in vitamin K; it is not necessary to remove vitamin K-rich foods completely. Clients should avoid excess or inconsistent intake of green vegetables and liver to promote steady warfarin efficacy.

The nurse reviews the serum laboratory results and medication administration records for assigned clients. Which prescriptions should the nurse question and validate with the healthcare provider before administering? SATA --bumetanide in the client with heart failure who has hypokalemia -calcium acetate in the client with chronic kidney disease who has hyperphosphatemia --carvedilol in the client with heart failure who has an elevated B-type natriuretic peptide level --isoniazid in the client with latent tuberculosis who has elevated liver enzymes --Metronidazole in the client with C. diff infection who has leukocytosis

--bumetanide in the client with heart failure who has hypokalemia --isoniazid in the client with latent tuberculosis who has elevated liver enzymes ---Bumetanide is a potent loop diuretic used to treat edema associated with heart failure and liver and renal disease. The diuretic inhibits reabsorption of sodium and water from the tubules and promotes renal excretion of water an potassium. The nure should question the bumetanide prescription as the client with heart failure has hypokalemia and is already at increased risk for life-threatening cardiac dysrhythmias associated with this electrolyte imbalance. Isoniazid is a first-line antitubercular drugused to treat latent or active tuberculosis. The nurse should questions this prescription as increased liver function tests can indicate development of drug-induced hepatitis. Calcium acetate is a phosphate binder used to treat hyperphosphatemia in clients with chronic kidney disease. Calcium acetate lowers the serum phosphorous level by binding to dietary phosphate and excreting it in feces. Carvedilol is a beta blocker used to improve cardiac output and slow the progression of heart failure. B-type natriuretic peptide is secreted from the ventricles in response to the increased ventricular stretch. Elevated BNP is expected in a client with heart failure; the nurse does not need to question this prescription. Metronidazole is the first-line anti-infective drug used to treat infectious diarrhea caused by C. diff. Leukocytosis is expected with this bacterial infection.

Clinical manifestations of digoxin toxicity

--cardiac arrhythmias (most dangerous) --dizziness or lightheadedness (commonly due to bradycardia and heart block) --visual symptoms (alterations in color vision, scotomas, blindness) --gastrointestinal symptoms (anorexia, N/V, abdominal pai) --neurologic manifestations (lethargy, fatigue, weakness, confusion)

Which medication prescriptions should the nurse question? SATA --cephalexin for a client with severe allergy to penicillin --fexofenadine for a client with hive --ibuprofen for a client with asthma and nasal polyps --lisinopril for a client with diabetes mellitus --propanolol for a client with asthma

--cephalexin for a client with severe allergy to penicillin --ibuprofen fora client with asthma and nasal polyps --propanolol for a client with asthma ---Cephalexin is a cephalosporin, which is chemically similar to penicillin. If a client has had a severe allergic reaction to penicillin, there is a 1-4% chance of an allergic reaction to a cephalosporin. Clients with nasal polyps often have sensitivity to NSAIDs, including aspirin. In addition, NSAIDs can exacerbate asthma symptoms. Therefore, acetaminophen may be a better choice for these clients. The selective beta blockers (metoprolol, atenolol, bisoprolol) are generally given for heart failure and hypertension control due to their beta 1-blocking effect. The nonselective beta blockers (propanolol, nadolol) in addition, have a beta 2-blocking effect that results in bronchial smooth muscle constriction. Therefore, nonselective beta blockers are generally contraindicated in clients with asthma. H1 receptor antagonists (fexofenadine, cetirizine, levocetirizine, loratadine) decrease the inflammatory response by blocking histamine receptors. Histamine is released from mask cells during a type 1 hypersensitivity reaction. ACE inhibitors are the drug of choice in diabetic clients with hypertension or proteinuria.

The emergency department nurse is caring for a client who has recently been prescribed methadone for chronic severe back pain. The client ingested extra tablets tonight because the pain returned. Which assessment findings during discharge require the client to be monitored longer in the hospital setting? SATA --client falls asleep while the nurse is talking --client frequently scratches due to pruritus --client has third emesis since taking medication --monitor reveals one premature ventricular contraction --pulse oximeter shows oxygen saturation is 90%

--client falls asleep while the nurse is talking --client has third emesis since taking medication --pulse oximeter shows oxygen saturation is 90% ---Methadone is a potent narcotic with a long half-life. Early signs of toxicity include N/V and lethargy. The nurse should monitor the client's respiratory rate, pulse oximetry, and electrocardiogram tracing. Respiratory depression and QT interval prolongation can lead to life-threatening complications.

In which scenarios should the nurse hold the prescribed medication and question its administration? SATA --client on IV heparin and the platelet count is 50,000/mm3 --client on newly prescribed lisinopril and is at 8 weeks gestation --client on nitroglycerin patch for heart failure and blood pressure is 84/56 mm Hg --client on phenytoin for epilepsy and the nurse notes gingival hyperplasia --client on warfarin and prothrombin time.international normalized ratio is 1.5 times control value

--client on IV heparin and the platelet count is 50,000/mm3 --client on newly prescribed lisinopril and is at 8 weeks gestation --client on nitroglycerin patch for heart failure and blood pressure is 84/56 mm Hg ---heparin should be held when there is significant thrombocytopenia. Angiotensin-converting enzyme inhibitors are not administered to pregnant women, and nitrates are not administered when a client is hypotensive. Prothrombin time/INR is expected to be 1.5-2.5 times the control, but up to 3-4 times the control in high-risk situations such as an artificial heart valve. Gingival hyperplasia is a side effect of phenytoin administration and is not a reason to stop the drug.

Which prescriptions for these clients does the nurse question? SATA --Client with Clostridium difficile colitis, prescribed vancomycin 125 mg PO --Client with diabetes and elevated mealtime glucose, prescribed lispro insulin scale 6 mg intravenous --Client with gastrointestinal bleed and nasogastric tube, prescribed pantoprazole 40 mg intravenous --Client with hypertension and blood pressure 94/40 mm Hg, prescribed metoprolol succinate SR 50 mg PO --Client with otitis media and penicillin allergy, prescribed ampicillin 500 mg PO

--client with hypertension and blood pressure 90/40 mm Hg, prescribed metoprolol succinate SR 50 mg PO --client with otitis media and penicillin allergy, prescribed ampicillin 500 mg PO ---IV proton pump inhibitors are used for gastric ulcer bleeding. Oral vancomycin can be used for C. difficile colitis. Ampicillin or amoxicillin are contraindicated in clients with a penicillin allergy. Antihypertensives are held if the client has borderline low BP.

The nurse is conducting intake interviews at the clinic. Which client situations would require the nurse to intervene? SATA --client with iron deficiency anemia takes iron supplements with milk --client takes levothyroxine early in the morning or an empty stomach --client taking phenazopyridine for urine infection states that the urine has turned orange --client taking metronidazole mentions going to a wine-tasting party tonight --client with closed-angle glaucoma takes over-the-counter diphenhydramine for a cold

--client with iron deficiency anemia takes iron supplements with milk --client taking metronidazole mentions going to a wine-tasting party tonight --client with closed-angle glaucoma takes over-the-counter diphenhydramine for a cold ---Clients taking metronidazole (Flagyl) should avoid alcohol. Those with glaucoma or urinary retention should avoid anticholinergic drugs. Oral iron is better absorbed on an empty stomach and with vitamin C. Milk products decrease iron absorption and should be avoided. Phenazopyridine (Pyridium) will turn urine an orange-red color. Enteral nutrition decreases levothyroxine absorption; therefore, it should be taken early in the morning on an empty stomach, at least 30 minutes before food intake

The nurse is caring for a client diagnosed with endometrial cancer who is receiving brachytherapy. Which interventions should the nurse implement while caring for this client? SATA --cluster care to limit each staff member's time in the room to 30 minutes a shift --instruct the client to be up and around in the room, but no to leave the room --keep the door to the room closed as radiation is emitting constantly from the client --teach family members and visitors to stay at least 6 feet away from the client --use a lead apron when providing direct client care to reduce exposure to radiation --wear a radiation film-badge while in the client's room to monitor radiation exposure

--cluster care to limit each staff member's time in the room to 30 minutes a shift --keep the door to the room closed as radiation is emitting constantly from the client --teach family members and visitors to stay at least 6 feet away from the client --use a lead apron when providing direct client care to reduce exposure to radiation --wear a radiation film-badge while in the client's room to monitor radiation exposure ---Following the principles of time, distance, and shielding provides staff protection from exposure to internal radiation emissions. Staff should spend no more than 30 minutes in a client's room; should remain at least 6 feet away from the radiation source; and should wear lead aprons when providing direct client care. The client receiving brachytherapy for endometrial cancer is instructed to remain on bedrest while the radiation implant is in place. If the implant dislodges from the vaginal cavity, the implant is never touched with the hands; instead, long-handed forceps are used to pick it up for placement in a lead container.

A diabetic client is prescribed metolopramide. Which of the following side effects must the nurse teach the client to report immediately to the healthcare provider? SATA --excess blinking of eyes --dry mouth --dull headache --lip smacking --puffing of cheeks

--excess blinking of eyes --lip smacking --puffing of cheeks ---metoclopramide is prescribed for the treatment of delayed gastric emptying, gastroesophageal reflux, and as an antiemetic. Similar to antipsychotic drugs, metoclopramide use is associated with extrapyramidal adverse effects, including tardive dyskinesia. This is especially common in older adults with long-term use. The client should call the healthcare provider immediately if TD symptoms develops, including uncontrollable movements such as: protruding and twisting of the tongue, lip smacking, puffing of cheeks, chewing movements, frowning or blinking of eyes, twisting fingers, twisted or rotated neck.

Steps to administering enoxaparin

--expose the abdomen and find a spot at least 2 cm from the umbilicus --pinch skin to create a fold --insert needle at a 90-degree angle and administer the medication --remove needle at a 90-degree angle

What are some examples for H1 receptor antagonists?

--fexofenadine --cetirizine --levocetirizine --loratadine

The registered nurse and practical nurse are conducting a workshop on contraceptive methods for a group of outpatient clients. Which instructions should the nurse include when discussing combined estrogen-progestin oral contraceptives? SATA --consult the healthcare provider if you experience leg pain or swelling --discontinue contraceptives if you experience spotting between menses --do not smoke while taking combined contraceptives --immediately report any breast tenderness to the HCP --seek immediate medical treatment if you experience vision loss

--consult the healthcare provider if you experience leg pain or swelling --do not smoke while taking combined contraceptives --seek immediate medical treatment if you experience vision loss ---The use of hormonal contraception places a women at a 2-4 fold increased risk for developing blood clots due to resulting hypercoagulability. Hormone levels vary among contraceptives, and higher levels of hormone content correlate to an increased risk of adverse thrombotic events (stroke, MI). Clients who are prescribed oral contraceptive pills containing estrogen should be educated on potential warning signs (chest pain, vision loss, severe leg pain). In addition, clients should be instructed not to smoke while taking combined OCP due to an increased risk of blood clots. Irregular bleeding and spotting between menses are common side effects of combined OCPs. These side effects may be bothersome but are not serious and may improve within 3 months of initiation. If the client cannot tolerate side effects, a different OCP may be considered. Clients should be counseled that breast tenderness is a common side effect of combined OCPs and does not warrant emergent reporting to the healthcare provider.

What are SOME common drinks that could interfere with the effectiveness of warfarin?

--cranberry juice -grapefruit --green tea --alcohol

Common side effects of "sulfa" medications

--crystalluria, causing kidney injury. --photosensitivity and the risk for sunburn --folic acid deficiency (client should eat folate-rich foods and take 1 mg/day folic acid supplement) --rarely life-threatening agranulocytosis (client should be monitored for complete blood count at the start of therapy and report fever or sore throat immediately) --Stevens-Johnson syndrome (client should stop medicine if rash develops)

A client with an asthma exacerbation has been using her albuterol rescue inhaler 10-12 times a day because she cannot take a full breath. What possible side effects of albuterol does the nurse anticipate the client will report? SATA --constipation --difficulty sleeping --hives with pruritus --palpitations --tremor

--difficulty sleeping --palpitations --tremor ---Albuterol is a short-term beta-agonist rescue drug used to control symptoms of airway obstruction and promote bronchodilation. It is a sympathomimetic drug; common expected side effects include insomnia, N/V, palpitations, and mild tremor. Hives can occur as a sign of an allergic reaction and are not a common anticipated side effect of an inhaled beta-agonist drug.

The nurse is reviewing the medication administration record of a client with atrial fibrillation. Which of the following should the nurse monitor before giving these medications (Prednisone, Metoprolol, Digoxin, and Enoxaparin). SATA --digoxin level --glucose --INR --platelet count --serum potassium

--digoxin level --glucose --platelet count --serum potassium ----The nurse should routinely monitor laboratory values prior to administering medications. A complete blood count should be assessed periodically in clients receiving enoxaparin to monitor for bleeding and thrombocytopenia. Digoxin and potassium levels should be assessed with the administration of digoxin. Glucose levels should be monitored in the client receiving glucocorticoids (prednisone).

What are some common side effects of clonidine?

--dizziness --drowsiness --dry mouth

Clients taking long-term corticosteroid replacement should be taught?

--do not discontinue abruptly. It can lead to addisonian crisis --report any signs and symptoms of infection to HCP immediately --increase dose of corticosteroids during times of stress. A stress response can cause a sudden decrease in cortisol levels, triggers addisonian crisis. --A side effect of corticosteroid therapy is hyperglycemia. Report signs of such (increased urine, hunger, and thirst). --corticosteroids are catabolic to bone and muscle breakdown. A diet high in calcium and protein but low in fat and simple carbohydrates is recommended. --cataracts are a side effect of corticosteroids, particularly glucocorticoid therapy. See an optometrist yearly to assess for cataracts. --corticosteroid medications can cause gastric irritation and should not be taken on an empty stomach --recognize signs and symptoms of Cushing syndrome and report to the PHCP --Develop a regular HCP-approved exercise program.

A client at 9 weeks gestation arrives at the clinic for an initial obstetric appointment. The nurse reviews the client's medical history and obtains a list of current medications. The nurse recognizes that which of the following medications should be clarified with the healthcare provider immediately? SATA --albuterol --doxycycline --insulin aspart --isotretinoin --levothyroxine --lisinopril

--doxycycline (can impair bone mineralization and discolor permanent teeth in the fetus) --isotretinoin (accutane) --lisinopril (can affect fetal renal function and lung development or cause fetal death) --- Clients with preexisting conditions may require changees to medication therapy if they become pregnant. In particular, teratogenic or unnecessary medications should be discontinued before conception.

A client with ulcerative colitis is prescribed the drug sulfasalazine. Which information should the nurse discuss with the client concerning this drug? SATA --drinking 8 glasses of water daily --stopping the medicine if blood is present in stool --stopping the medicine if urine turns an orange-yellow color --taking folic acid supplements --wearing sunscreen when outdoors

--drinking 8 glasses of water daily --taking folic acid supplements --wearing sunscreen when outdoors ---Sulfasalazine is a sulfonamide and nonbiologic disease-modifying antirheumatic drug (DMARD) used for mild to moderate chronic inflammatory rheumatoid arthritis (RA) and inflammatory bowel disease (ulcerative collitis). It inhibits the production of prostaglandin, a mediatory in the body's inflammatory response.

What are some common adverse effects of ACE inhibitors?

--dry cough --orthostatic hypotension --hyperkalemia

What should you monitor for in a patient who just received adenosine?

--flushing -dizziness --chest pain -palpitations

suffix for angiotensin receptor blockers --give examples

-sartans valsartan, losartan, telmisartan

The nurse is preparing to administer medications to a client admitted with atrial fibrillation. The nurse notes the vital signs: Temp. 98.4; BP 124/78; HR 48/min and irregularly irregular; RR 22/min. Which medications due at this time are safe to administer? SATA --diltiazem extended-release PO --heparin subcutaneous injection --lisinopril PO --metoprolol PO --timolol ophthalmic

--heparin subcutaneous injection --lisinopril PO ---Medications that decrease the heart rate should be held in clients with bradycardia. These include beta blockers such as metoprolol and timolol (including eye drops) and some types of calcium channel blockers (diltiazem and verapamil). Heparin is most commonly used to prevent deep venous thrombosis in hospitalized clients on bed rest. Heparin will not affect the vital signs and is safe to administer. Lisinopril does not lower HR and would not be contraindicated in this client.

What are the clinical manifestations of neuroleptic malignant syndrome (NMS)?

--high fever --muscular rigidity --altered mental status --autonomic dysfunction

Parent teaching for administration of digoxin includes:

--informing that digoxin is held if pulse is <90-110/min for infants and young children or <70/min for an older child --administer oral liquid in the side and back of mouth --do NOT mix with food or liquids --If a dose is missed, do not give an extra dose or increase the dose --If more than 2 doses are missed, notify the HCP --If the child vomits, do NOT give a second dose. N/V and slow pulse rate could indicate toxicity. --Give water or brush the client's teeth after administration to remove the sweetened liquid

A client is having a severe asthma attack lasting over 4 hours after exposure to animal dander. On arrival, the pulse is 128/min, respirations are 36/min, pulse oximetry is 86% on room air, and the client is using accessory muscles to breathe. Lung sounds are diminished and high-pitched wheezes are present on expiration. Based on this assessment, the nurse anticipates the administration of which of the following medications? SATA --inhaled albuterol nebulizer every 20 minutes --inhaled ipratropium nebulizer every 20 minutes --intravenous methylprednisolone --montelukast 10 mg by mouth STAT --salmeterol metered-dose inhaler every 20 minutes

--inhaled albuterol nebulizer every 20 minutes --inhaled ipratropium nebulizer every 20 minutes --intravenous methylprednisolone ----Clinical manifestations characteristic of moderate to severe asthma exacerbations include tachycardia, tachypnea, saturation <90% on room air, use of accessory muscles to breathe, and peak expiratory flow (PEF) <40% of predicted or best. Montelukast is a leukotriene receptor blocker with both bronchodilator and antiinflammatory effects; it is used to prevent asthma attacks but is not recommended as an emergency rescue drug in asthma. A long-acting beta agonist is administered with an inhaled corticosteroid for long-term control of moderate to severe asthma; it is not used as an emergency rescue drug to asthma

What are some major side effects of metformin?

--lactic acidosis --gastrointestinal disturbances (metallic taste in mouth, nausea, diarrhea)

Instructions for a client taking bupropion hydrochloride include:

--limit alcohol; inform healthcare provider if consuming large amounts of alcohol --do not double up on the medication if a scheduled dose is missed --take medication at the same time each day --it may take several weeks to feel effects of bupropion hydrochloride --weight loss may occur when taking this medication

What are the clinical manifestations of tardive dyskinesia?

--lip movement (smacking, sucking, puckering) --tongue movement (Protrusion, curling) --grimace --brown furrow or twitch --excess blinking --foot tap --hand winging --tremor or shake --rocking --torticollis (persistent neck flexion or extension)

What are the common side effects of SSRIs?

--loss of appetite --weight loss or weight gain --gastrointestinal disturbances (N/V, diarrhea) --HAs --dizziness --drowsiness --insomnia --sexual dysfunction ---side effects should gradually diminish over 3 months, although some may persist.

Instructions for parents administering amoxicillin to their child includes:

--medication can be taken with or without food; food does not affect absorption --most common side effects are N/V and diarrhea. If nausea or diarrhea develops, the medicine may be administered with food to decrease the gastrointestinal side effects. --Shake the liquid well prior to administration. Administer at evenly spaced intervals throughout the day to maintain therapeutic blood levels. --Ensure that the child receives the full course of therapy; do not discontinue the medication if the child is feeling better or symptoms have resolved.

Symptoms of serotonin syndrome

--mental status change (anxiety, agitation, disorientation) --autonomic dysregulation (hyperthermia, diaphroesis, tachycardia/hypertension) --neuromuscular hyperactivity (tremor, muscle rigidity, clonus, hyperreflexia)

What are the first-line agents in the treatment of ADHD?

--methylphenidate --dextroamphetamine --lisdexamfetamine ---these are all stimulant medications

A newly admitted client descries symptoms of dizziness and feeling faint on standing. The client has a history of type 2 diabetes, coronary artery disease, and bipolar disorder. Which medications may be contributing to the client's symptoms? SATA --atorvastatin --metformin --metoprolol --olanzapine --omeprazole

--metoprolol --olanzapine ---Medications commonly associated with orthostatic hypotension include most antihypertensive, most antispsychotics and antidepressants, and volume-depleting agents. Clients are instructed to rise slowly when standing to prevent a drop in blood pressure.

What are some major adverse effects commonly associated with statin medications?

--muscle cramps --liver injury

Treatment for fibromyalgia often includes?

--muscle relaxers (cyclobenzaprine) --narcotic analgesics (tramadol, hydrocodone) --nonsteroidal anti-inflammatory drugs --neuropathic pain relievers (pregabalin, gabapentin) --antidepressants such as selective serotonin reuptake inhibitors (fluxetine, duloxetine)

The nurse is caring for a client admitted with serotonin syndrome after taking citalopram and tramadol. Which assessment findings does the nurse expect to find? SATA --absent deep tendon reflexes --cold, clammy skin --muscle rigidity --restlessness and agitation --sinus tachycardia

--muscle rigidity --restlessness and agitation --sinus tachycardia ---Clinical manifestations of serotonin syndrome include mental status changes (anxiety, agitation, disorientation), autonomic dysregulation (hypertheria, diaphroesis, tachycardia/hypertension), and neuromuscular hyperactivity (tremor, muscle rigidity, clonus, hyperreflexia)

The healthcare provider has just prescribed tetracycline for an adolescent with acne vulgaris. The client takes oral contraceptive pills. The clinic nurse should educate the teen about which topics? SATA --not taking tetracycline with dairy products --taking tetracycline at bedtime --taking tetraclycline with food --using additional contraceptive techniques --using sunblock

--not taking tetracycline with dairy products --using additional contraceptive techniques --using sunblock ---Tetracyclines should be taken 1 hour before or 2 hours after meals with plenty of water in order to reduce pill-induced esophagitis and gastritis. They should not be taken with dairy products or within 2 hours of taking antacids, as they bind with the drug and decrease its absorption. Clients should use sunblock due to photosensitivity and plan to use additional contraceptive techniques. Tetracycline taken at bedtime has been associated with esophageal irritation and stricture development as it increases reflux of the gastric contents into the esophagus.

The healthcare provider prescribes naproxen for a client who has degenerative joint disease. What instructions regarding this drug does the nurse include in the client's discharge plan? SATA --avoid driving while taking this medicine --change positions slowly --discontinue immediately if suicidal thoughts occur --notify the HCP of tarry stools --take the medicine with food

--notify the HCP of tarry stools --take the medicine with food --Naproxen is an NSAID commonly prescribed to decrease joint pain and inflammation.

The nurse plans teaching for a client who was newly prescribed levothyroxine sodium after thyroid removal. Which instructions will the nurse include in the teaching plan? SATA --drowsiness is a common side effect; taking the dose at bedtime will make this less noticeable --notify the healthcare provider if you become pregnant as the medication is harmful to the fetus --notify the healthcare provider if you feel a fluttering or rapid heartbeat --take the medication with a meal to prevent stomach upset --you will need to take this medication for the rest of your life

--notify the healthcare provider if you feel a fluttering or rapid heartbeat --you will need to take this medication for the rest of your life ---Client receiving thyroid hormone replacement therapy should understand that treatment is lifelong and be taught the signs of excess hormones (tachycardia/palpitations, weight loss, insomnia) The medication is best absorbed on an empty stomach ( 1 hour before or 2 hours after a meal) and is safe to take during pregnancy, although the dose may need to be altered due to the metabolic demands of pregnancy.

What is sucralfate (Carafate, Sulcrate) used for? When should it be administered?

--prescribed to treat gastric ulcers --administered BEFORE meals to coat the mucosa and prevent irritation of the ulcer during meals.

What are the absolute contraindications to thrombolytics?

--prior intracranial hemorrhage --structural cerebrovascular lesion (arteriovenous malformation, aneurysm) --ischemic stroke within 3 months --suspected aortic dissection --active bleeding or bleeding diathesis --significant head trauma within 3 months.

What are some examples of nonselective beta blockers?

--propranolol --nadolol

What are the treatment goals for a patient with atrial fibrillation?

--reduce ventricular rate to <100/min --prevent a stroke Medications such as calcium channel blockers, beta blockers, and digoxin are administered.

What patient education should be provided for a client taking long-acting nitrates?

--report any increase in chest pain --how to manage headaches (common side effect of nitrates)

Which drugs may trigger serotonin syndrome?

--selective serotonin reuptake inhibitors --monoamine oxidase inhibitors --dextromethorphan --ondansetron --St. John's wort --tramadol

Instructions for proper NTG administration includes...

--tablets should be kept in a dark bottle and capped tightly. Open bottles should be discarded after 6 months. --take up to 3 pills in a 15 minute period. Call EMS if pain does not improve or worsens 5 minutes after the first tablet has been taken. --Avoid fatal drug interactions. Concurrent use of erectile dysfunction drugs or alpha blockers is contraindicated due to potentially fatal hypotension. --headache and flushing may occur due to vasodilation. These symptoms do not warrant medication discontinuation.

Clients at risk for developing orthostatic hypotension should be instructed to....

--take medication at bedtime --rise slowly from a supine to standing position --avoid activities that reduce venous return and worsen orthostatic hypotension (straining, coughing, walking in hot weather) --maintain adequate hydration

Side effects associated with short-acting beta-2 agonists?

--tremor (most frequent) --tachycardia and palpitations --restlessness --hypokalemia

Behavioral interventions for trigeminal neuralgia includes

--using a small, soft-bristled toothbrush or a warm mouth wash --use lukewarm water; avoid beverages or food that are too hot or cold --room should be kept at an even and moderate temperature --avoid rubbing or facial massage. Use cotton pads to wash the face if necessary --have a soft diet with high calorie content; avoid foods that are difficult to chew. Chew on the unaffected side of the mouth.

What is methylphenidate used to treat?

-ADHD -narcolepsy

Contraindications to combined hormonal contraceptives

-active breast cancer -migraines with aura -uncontrolled hypertension -active hepatitis, severe cirrhosis, liver cancer -age >35 and >15 cigarettes/day -ischemic heart disease, stroke - <3 weeks postpartum -prolonged immobilization -thrombophilia -venous thromboembolism

What drug classification(s) is spironolactone?

-aldosterone inhibitor -potassium-sparing diuretic

What are the symptoms associated neuroleptic malignant syndrome?

-altered mental status -fever -muscle rigidity leading to resistance -autonomic instability (diaphoresis, tachypnea, hypertension, tachycardia, dysrhythmia)

What are the potential side effects of methylphenidate?

-anorexia and weight loss -growth delays -restlessness and insomnia -- hypertension and tachycardia -vocal or motor tics -abuse potential

What are some of the commonly used medications (drug classifications) that fall within Beers Criteria?

-antipsychotics -anticholinergics -antihistamines -antihypertensives -benzodiazepines -diuretics -opioids -sliding insulin scale

What is involved in the risk management program for females prescribed isotretinoin?

-two negative pregnancy tests before initiation of treatment -two forms of contraception (started one month before treatment, continued throughout treatment, and 1 month after treatment has been discontinued) ---refills can only be obtained after a negative pregnancy test and blood donation is discouraged.

What is the therapeutic index for lithium?

0.6-1.2

Normal creatinine level

0.6-1.3

The home health nurse visits a client with hand osteoarthritis whose healthcare provider has recommended topical capsaicin for pain relief. Which instruction about capsaicin should the nurse provide the client? --apply a heating pad or warm compress for 20 minutes after applying cream --apply cream to hands and wait at least 30 minutes before washing them --discontinue immediately if burning or stinging sensation occurs --use only if oral pain medications have not been effective

-apply cream to hands and wait at least 30 minutes before washing them. ---topical capsaicin cream is an over-the-counter analgesic that effectively relieves minor pain. The nurse should instruct the client to wait at least 30 minutes after massaging the cream into the hands before washing to ensure adequate absorption. The client should avoid contact with mucous membranes or skin that is not intact, as capsaicin is a component of hot peppers and can cause burning. When applying cream to other areas of the body, the client should wear gloves or wash hands immediately after application. The application of heat with capsaicin is contraindicated as heat causes vasodilation, which increases medication absorption and can possibly lead to a chemical burn. Local irritation is quite common and usually subsides within the first week of regular use. If the client experiences persistent pain, redness, or blistering, the cream should be discontinued and the healthcare provider notified. Topical capsaicin is often used concurrently with acetaminophen or NSAIDs to effectively treat osteoarthritis pain.

What drug classifications can cause bradycardia?

-beta blockers -calcium channel blockers -digoxin

What are some commonly prescribed antiplatelet agents?

-clopidogrel --ticagrelor --prasugrel --aspirin

What are the common side effects of tricyclic antidepressants?

-dizziness -orthostatic hypotension -tachycardia -increased risk of falling -dry mouth -constipation -urinary retention and/or difficulty initiating a urinary stream -blurred vision -drowsiness -confusion -photosensitivity

When administering IV vancomycin, the nurse should assess for and work to prevent possible complications by performing what:

-draw prescribed trough level prior to administration --infuse medication over at least 60 minutes-faster rate increases the likelihood of complications --monitor blood pressure during the infusion. Hypotension is a possible adverse effect --assess for hypersensitivity --monitor for anaphylaxis. (rahs, pruritis, laryngeal edema, wheezing) --observe IV site every 30 minutes for pain, redness, or swelling

Adverse effects of lithium on the fetus

-ebstein anomaly -nephrogenic diabetes insipidus -hyothyroidism

The management of anaphylactic shock includes:

-ensure patent airway, administer oxygen -remove insect stinger -IM epinephrine, repeating dose every 5-15 minutes -place in recumbent position and elevate legs -maintain blood pressure with IV fluids, volume expanders, or vasopressors -bronchodilator administration to dilate the small airways and reverse bronchoconstriction -antihistamine to modify the hypersensitivity reaction and relieve pruitus --corticosteroids to decrease airway inflammation and swelling associated with the allergic reaction -anticipate cricothyrotomy or tracheostomy with severe laryngeal edema.

Symptoms of hypothyroidism

-fatigue -cold intolerance -constipation -dry skin -brittle hair/nails

NSAIDs are associated with what type of symptoms?

-gastrointestinal toxicity (symptoms of GI bleeding, such as black tarry stools) -kidney injury (associated with long-term use) --hypertension and heart failure (can be exacerbated due to fluid retention) --bleeding risk

Herbal supplements that can increase risk for bleeding includes:

-ginko biloba -garlic -ginseng -ginger -feverfew

Suffix for thiazolidinediones

-glitazone

Side effects of ephedra

-hypertension -arrhythmia/MI/sudden death -stroke -seizure

Side effects of licorice

-hypertension -hypokalemia

What are some of the major side effects of Sulfonylureas?

-hypoglycemia (will have symptoms such as: diaphoresis, HA, hunger, tachycardia, confusion)

Adverse effects of methotrexate on the fetus

-limb and craniofacial abnormalities -neural tube defects -abortion

What does pancrelipase contain?

-lipase -protease -amylase

What is spironolactone typically used for? --what is it's function?

-liver failure -ascites -edema --it promotes diuresis and prevents fluid retention

What are some common side effects of methylphenidate?

-loss of appetite, resulting in weight loss -increased blood pressure -tachycardia

Adverse effects of isotretinoin on the fetus

-microcephaly -thymic hypoplasia -small ears -hydrocephalus

Side effects of Saw palmetto?

-mild stomach discomfort -increased bleeding risk

Adverse effects of warfarin on the fetus

-nasal hypoplasia -stippled epiphysis

Adverse effects of phenytoin on the fetus

-neural tube defects -microcephaly -orofacial clefts -dysmorphic facial features -distal digit/nail hypoplasia

Common side effects of oxybutynin

-new onset constipation -dry mouth -flushing -heat intolerance -blurred vision -drowsiness

Suffix for ACE inhibitors --give examples

-pril captopril, enalapril, lisinopril, ramipril

What are the first-line antithyroid drugs used to inhibit thyroid hormone synthesis?

-propylthiouracil -methimazole (tapazole)

When should digoxin be withheld?

-pulse is <60/min -pulse has skipped beats -possible digoxin toxicity

When does regular insulin reach its peak effect?

2-5 hours after subcutaneous administration

The nurse should call the primary healthcare provider to obtain a new prescription prior to administering which medication to a client with type 1 diabetes mellitus? --10 units regular insulin IV push for blood glucose >250 mg/dL --14 units glargine insulin subcutaneous injection every night at 8:00 pm --18 units aspart insulin subcutaneous injection 15 minutes before breakfast --20 units NPH insulin IV push administered every morning at 7:00 am

20 units NPH insulin IV push administered every morning at 7:00 am --Subcutaneous injection is the indicated route for NPH insulin administration; it should never be administered via IV push. Regular insulin is the only insulin that can be administered via IV push; this is typically performed only in an acute care facility under close observation by the nurse.

The nurse administers 8 units of regular insulin subcutaneously at 11:30 am to a client with type 1 diabetes mellitus and serves the client lunch 30 minutes later. The client eats a few bites, becomes nauseated, and is unable to finish the meal. When is the client at highest risk for experiencing an insulin-related hypoglycemic reaction? --12:30pm --2:00pm --5:00pm --6:00pm

2:00pm --Insulin is a medication commonly used to control and lower blood glucose levels in clients with diabetes mellitus. The nurse must be familiar with the various insulin types and their times of peak effect,which are the periods of highest risk for hypoglycemic events. Regular insulin is a short-acting insulin that reaches the peak effect within 2-5 hours after subcutaneous administration. Therefore, clients who receive regular insulin subcutaneously at 11:30 am are at highest risk for hypoglycemia between 1:30 pm and 4:30 pm

A client with unstable angina and chronic kidney disease is receiving a continuous infusion of unfractionated heparin. Which value for activated partial thromboplastin time (aPTT) would indicate to the nurse that the heparin therapy is at an optimal therapeutic level? --30 seconds --35 seconds --60 seconds --85 seconds

60 seconds --A therapeutic level is 1.5-2 times normal, or an aPTT of 46-70 seconds

Which client is at greatest risk for respiratory depression when receiving opioids for pain control? --20 year old client with bronchitis receiving inhaled bronchodilator therapy every 4 hours --30 year old client with heroin addiction with rotator cuff repair surgery this morning --50 year old client with sleep apnea and left food cellulitis and scheduled for a bone scan --70 year old client with chronic obstructive pulmonary disease with knee replacement this morning

70 year old client with chronic obstructive pulmonary disease with knee replacement this morning ---Factors that increase risk for respiratory depression related to opioid use for pain control include advanced age, underlying pulmonary disease, snoring, obesity, smoking, opiate naive, and surgery

What plasma concentration is associated with theophylline drug toxicity?

> 20 mcg/mL

A nurse on the behavioral health unit is reviewing medication prescriptions for 4 clients. Which combination of medications does the nurse question? --a client with anxiety prescribed escitalopram and alprazolam --a client with bipolar disorder prescribed risperidone and lithium --a client with depression prescribed escitalopram andselegiline --a client with depression prescribed sertraline and zolpidem

A client with depression prescribed escitalopram and selegiline --Clients are often prescribed medications from more than one class to effectively treat anxiety and depression; however, monoamine oxidase inhibitors (MAOIs) interact with many medications, including many antidepressants. Concurrent use of MAOIs with selective serotonin reuptake inhibitors may precipitate life-threatening adverse reactions (serotonin syndrome, neuroleptic malignant syndrome, hypertensive crisis). If a client's prescribed medication regimen will change to or from an MAOI, the existing medication should be tapered and discontinued, followed by a 2-week period without either medication. The client can then begin taking the new medication.

A community health nurse evaluates several clients vaccination status. Which clients would the nurse recommend receive the influenza vaccine injection? SATA --9 month old with no known medical conditions --5 year old with congenital heart defect --23 year old recently diagnosed with HIV --45 year old caretaker of elderly parent --75 year old with end-stage renal failure

ALL OF THEM --annual vaccination during influenza season is recommended for all clients age > 6 months without life-threatening allergy to the vaccine or its ingredients. High-risk groups include clients who have chronic conditions, those who work in healthcare settings or as caretakers, those age 6-23 months or >65 and pregnant clients.

The nurse is preparing medications for the following 4 clients. Which prescription should the nurse clarify with the healthcare provider before administration? -acetaminophen for a client with a temperature 102.2 F with productive cough --azathioprine for a client with Crohn disease with leukopenia who is reporting malaise --Baclofen for a client with multiple sclerosis who reports dizziness when changing positions --Colchicine for a client with an acute gout attack who reports intense, burning left toe pain

Azathioprine for a client with Crohn disease with leukopenia who is reporting malaise --Azathioprine is an immunosuppressant drug that can cause bone marrow depression and increase the risk for infection. It is prescribed to treat autoimmune conditions such as inflammatory bowel diseases and to prevent organ transplant rejection. Fatigue and nausea can be expected as minor adverse effects or may be associated with the disease. However, leukopenia can be a severe adverse effect of the drug and should be reported to the healthcare provider before administering the medication due to high risk for infection. Acetaminophen is a nonopioid analgesic with antipyretic properties. The client with a productive cough and fever should be assessed further for infection and this prescription is appropriate. Baclofen is an antispasmodic drug commonly prescribed to clients with multiple sclerosis to relive uncomfortable spasms and muscular pain. Dizziness when attempting to stand or changing positions is a common adverse effect but is not a contraindication. Cochicine is prescribed for clients with an acute attack of gout because it decreases the inflammation and pain associated with deposition of uric acid crystals in the joints. This is an appropriate prescription.

A nurse in the emergency department is titrating a continuous infusion of nitroglycerin to a client admitted for acute coronary syndrome. The client's vital signs, including blood pressure, heart rate, and pain level, are being monitored frequently. Which assessment findings indicate that the current rate of administration should be maintained? --BP 80/50 mm Hg, HR 110/min, client reports pain is 0 out of 10 --BP 100/60 mm Hg, HR 90/min, client reports pain is 3 out of 10 --BP 110/70 mm Hg, HR 80/min, client reports pain is 0 out of 10 --BP 120/80 mm Hg, HR 70/min, client reports pain is 5 out of 10

BP 110/70 mm Hg, HR 80/min, client reports pain is 0 out of 10 ---Nitroglycerin and other nitrates increase cardiac blood flow and provide relief from the pain of ischemia in acute coronary syndrome by causing vasodilation. Their infusion should not cause systolic blood pressure to fall to <90 mm Hg or to drop >30 mm Hg below baseline.

A client suffering from chronic kidney disease is scheduled to receive recombinant human erythropoietin and iron sucrose. The client's hemoglobin is 9.7 g/dL and hematocrit is 29%. What is the appropriate nursing action? --administer the erythropoietin in the client's ventrogluteal muscle --check the blood pressure prior to administering the erythropoietin --hold the client's next scheduled iron sucrose dose --hold the erythropoietin and inform the healthcare provider

Check blood pressure prior to administering the erythropoietin --Anemia associated with chronic kidney disease is treated with recombinant human erythropoietin. Therapy is initiated when hemoglobin is <10 g/dL to alleviate the symptoms of anemia and the need for blood transfusions. Therapy should be discontinued or the dose reduced for hemoglobin > 11 g/dL to prevent venous thromboembolism and adverse cardiovascular outcomes from blood thickened by high concentrations of RBCs. Hypertension is a major adverse effect of erythropoietin administration. Therefore, uncontrolled hypertension is a contraindication to recombinant erythropoietin therapy. Blood pressure should be well controlled prior to administering erythropoietin. Erythropoietin is administered intravenously or in any subcutaneous area. Iron in the form of iron sucrose or ferric gluconate may be prescribed to promote an adequate response to erythropoietin. Adeuqate stores of iron, vitamin B12, and folic acid are required for erythropoietin to work. The dose should be held if the client has a hemoglobin level >11 or uncontrolled hypertension.

A client has a follow-up checkup in the urology clinic. Six months ago, the client started taking tolterodine. What data collected from the client should the nurse report to the healthcare provider? --client excitedly reports being able to go an entire work day without having to urinate --client is using an over-the-counter artificial saliva product for dry mouth --client reports occasional dizziness in the morning and when changing positions --client reports symptoms of constipation

Client excitedly reports being able to go an entire work day without having to urinate --Tolterodine, oxybutynin, and solifenacin are antimuscarinic/anticholinergic medications used for overactive bladder and urge urinary incontinence. They decrease urinary urgency and frequency. The most common side effects are anticholinergic (dry mouth, constipation, cognitive dysfunction). The client's report of not urinating the entire day while at work may indicate that the dosage is too high and is causing urinary retention. Urinary retention can lead to bladder infections and distension. This information should be reported to the healthcare provider. Artificial saliva products and sugar-free hard candy and gum are acceptable ways to manage dry mouth caused by anticholinergic medications. Occasional dizziness is a side effect of tolerodine. If this client is receiving too high a dose, reduction of the dose may alleviate the dizziness. Constipation can be managed with increased fiber in the diet, fluids, stool softeners, or laxative.s

The nurse administers the prescribed dose of hydromorphoe 2 mg to a client who is 2 days postoperative from a colostomy. Which assessment finding is most important for the nurse to follow-up? --client has 1 emesis of green fluid --client has had no bowel movement for 2 days --client falls asleep while talking to the nurse --client reports experiencing pruitus

Client falls alsspe while talking to the nurse --Respiratory depression is the most serious side effect of narcotic medication. Sedation precedes respiratory depression. Falling asleep during a conversation scores "3" on the Pasero opioid-induced sedation scale (POSS). No additional narcotics should be given to the client. The client will also be at increased risk for respiratory depression if the pain is completely relieved and/or it is night time. No additional narcotics should be given until the client is at level 2 sedation on POSS.

A client in the emergency department has an acute myocardial infarction. The healthcare provider has prescribed thrombolytic therapy. Which assessment data should the nurse report immediately to the HCP? --client has a history of cerebral arteriovenous malformation --client is currently menstruating --client rates chest pain as 8 on a scale of 0-10 --current blood pressure is 190/92 mm Hg

Client has a history of cerebral arteriovenous malformation. ---The candidate for thrombolytic therapy should be screened for absolute and relative contraindications. The nurse should immediately notify the healthcare provider if the client has history of arteriovenous malformation, which is an absolute contraindication to the use of thrombolytics. Acute menstruation is not a contraindication for thrombolytic therapy. Research shows that the risk of increased menstrual bleeding due to thrombolytic administration is low and not life-threatening. Chest pain is one of the inclusion criteria for thrombolytic therapy. Uncontrolled blood pressure of >180 mm Hg systolic or >110 mm Hg diastolic is a relative contraindication for thrombolytic therapy.

A client is being discharged with a prescription for apixaban after being treated for a pulmonary embolus. Which clinical data is most concerning to the nurse? --client eats a vegetarian diet --client has chronic atrial fibrillation --client takes indomethacin for osteoarthritis --Client's platelet count is 176 X 10^3/mm3

Client takes indomethacin for osteoarthritis --Maintenance drug therapy after a pulmonary embolus typically includes administration of oral anticoagulants such as factor Xa inhibitors. NSAIDs increase the risk of bleeding when used concurrently with apixaban therapy. The nurse should question initiation of apixaban therapy in the context of NSAID use. Vegetarian diets and the consumption of leafy green vegetables high in vitamin K affect the action of warfarin. However, factor Xa inhibitors such as apixaban are not affected by vitamin K. Chronic atrial fibrillation increases the risk for thromboembolic events and would be an indication for anticoagulant therapy. The current platelet count is within a normal range.

The nurse is working in the emergency department. Which client should the nurse see first? --12 year old with severe neck muscle spasms who is taking haloperidol for Tourette syndrome --80 year old with irritability and agitation who has taken alprazolam for 2 weeks --Client taking clozapine who has sudden onset of high fever, diaphoresis, and change in mental status --client taking olanzapine who has dry mouth, blurry vision, and constipation

Client taking clozapine who has sudden onset of high fever, diaphoresis, and change in mental status --Neuroleptic malignant syndrome (NMS) usually presents with mental status changes, fever, muscle rigidity, and autonomic instability after starting antipsychotic medications. Treatment involves discontinuation of the medication and supportive care (rehydration, cooling body temperature_

The nurse receives telephone messages from the following 4 clients. Which client should the nurse call back FIRST? --client taking cyclosporine who reports swollen and bleeding gums for several days --Client taking doxycycline who reports severe sunburn after sun exposure --Client taking phenytoin who reports flu-like symptoms and a new painful skin rash --Client taking Slidenafil who reports dizziness when standing up from a seated position

Client taking phenytoin who reports flu-like symptoms and a new painful skin rash --clients taking phenytoin should discontinue the medication immediately if a rash develops and notify the healthcare provider. The rash may indicates Stevens-Johnson syndrome, a potentially life-threatening hypersensitivity reaction

The nurse reviews the laboratory results of several clients. Which finding should the nurse report to the healthcare provider immediately? --client who is receiving tube feedings and has a phenytoin level of 8 mcg/mL --client with a heart rate of 62/min who has digoxin level of 1.3 mg/mL --client with a new prosthetic aortic valve who has an INR of 3.0 --client with a poor appetite and a lithium level of 0.8 mEq/L

Client who is receiving tube feedings and has a phenytoin level of 8 mcg/mL --Tube feedings decrease phenytoin absorption, which reduces serum drug concentrations and may precipitate seizures. The nurse should pause tube feedings for 1-2 hours before and after phenytoin administration to ensure adequate absorption. A heart rate of 62/min is expected in a client taking digoxin. The therapeutic INR for a client with a mechanical heart valve is 2.5-3.5. Anorexia is a common side effect of lithium.

The clinic nurse is reviewing messages from four clients. Which client's call should the nurse return first? --client who has just taken albuterol and reports a heart rate of 108/min and a coarse tremor in both arms --client who is prescribed azithromycin and reports frequent, foul-smelling, liquid stools and abdominal cramping --client who is prescribed metformin and reports a blood glucose of 284 mg/dl and frequent urination --client who takes amiodarone and reports a dry cough and increased dyspnea when walking around the house

Client who takes amiodarone and reports a dry cough and increased dyspnea when walking around the house ---Amiodarone is an antiarrythmic medication used to treat life-threatening arrhythmias. Pulmonary toxicity is a life-threatening complication that may cause symptoms such as dry cough, pleuritic chest pain, and dyspnea. Clients taking amiodarone with signs of pulmonary toxicity require immediate follow-up. Albuterol is a beta-2 agonist used to treat bronchospasm that commonly causes tachycardia adn tremor. Clients reporting these symptoms may require a dose adjustment or change in medication regimen. Frequent liquid stools in a client receiving antibiotics may indicate development of C. Diff infection, but is not priority. Clients taking metformin who report hyperglycemia and polyuria require follow-up to evaluate medications efficacy and glycemic control, but is not priority.

The nurse is preparing medication for 4 clients on a respiratory medical-surgical unit. Which situation would prompt the nurse to clarify the prescribed treatment with the healthcare provider? --client with bronchospasm who is due to receive nebulized acetylcysteine --client with chronic obstructive pulmonary disease due to receive PO prednisone --client with cystic fibrosis who is due to receive PO pancrealipase with breakfast --Client with suspected bacterial pneumonia due to receive IV levofloxacin

Client with bronchospasm who is due to receive nebulized acetylcysteine --Acetylcysteine is a medication that can be inhaled to help loosen thick respiratory secretions. Nurses caring for clients with reactive airway diseases who are prescribed acetylcysteine should clarify the prescription with the healthcare provider as it may cause and/or worsen bronchospasm. COPD is a respiratory illness in which excess mucus, inflamed bronchioles, and easily collapsible airways trap air within the alveoli. Oral corticosteroisd may be used to reduce airway inflammation and improve ventilation in clients with acute COPD exacerbation. Cystic fibrosis is a genetic condition that causes dehydration and thickening of mucus in the respiratory, gastrointestinal, and genitourinary systems. Thick mucus within the pancreas impairs the release of digestive enzymes, requiring supplementation to improve digestion and prevent malnutrition in clients with CF. Levofloxacin is a broad-spectrum antibiotic that may be used to treat respiratory tract infections, such as bacterial pneumonia.

The home health nurse reviews the laboratory results for 4 clients. Which laboratory value is most important for the nurse to report to the healthcare provider? --client with Clostridium difficile infection receiving metronidazole has a white blood cell count of 15,000/mm3 --client with liver cirrhosis has an INR of 1.5 --Client with mild asthma exacerbation receiving prednisone has a blood glucose of 250 mg/dL --client with rheumatoid arthritis taking adalimbumab has a white blood cell count of 14,000/mm3

Client with rheumatoid arthritis taking adalimumab has a white blood cell count of 14,000/mm3 --Adalimumab is a tumor necrosis factor inhibitor, a biologic disease-modifying antirheumatic drug classified as a monoclonal antibody. Its major adverse effects are similar to those of other TNF inhibitor drugs and include immunosuppression and infection. An elevated white blood cell count in this client can indicate underlying infection and should be reported immediately. This client with C diff infection will have an elevated white blood cell count. The client is receiving appropriate therapy. The liver produces most blood clotting factors. Clients with liver cirrhosis wll lose this ability and are at risk for bleeding. This client's INR is mildly elevated, which is expected with cirrhosis. Corticosteroids increase blood glucose. This is expected, and the client may need treatment if the glucose levels are markedly increased for a prolonged period. Most clients with asthma exacerbation are expected to take a 5-7 day course of steroids.

During shift report it was noted that the off-going nurse had given the client a PRN dose of morphine 2 mg every 2 hours for incisional pain. What current client assessment would most likely affect the oncoming nurse's decision to discontinue the administration every 2 hours? --Client reports burning during injection into the IV line --Client report dizziness when getting up to use the bathroom --Client's blood pressure is 106/68 mm Hg --Client's respiratory rate is 11/min

Client's respiratory rate is 11/min --Morphine administration can cause respiratory depression. The nurse should hold a dose of morphine for a client whose respiratory rate is <12/min. Morphine can cause burning during IV administration. This can be reduced by diluting the morphine with normal saline and administering it slowly over 4-5 minutes. The nurse should instruct the client to call for help before getting up to go to use the bathroom to avoid falls caused by dizziness from the morphine. Morphine can lower blood pressure, and clients receiving it should have blood pressure monitored. This blood pressure reading is not severely low and is not a priority over the respiratory depression.

The nurse reviews the medication administration records and laboratory results for assigned clients. Which medication requires that the healthcare provider be notified before administration? --calcium acetate for a client with a phosphate level of 8.5 mg/dL --Clopidogrel for a client with a platelet count of 70,000/mm3 --magnesium sulfate for a client with a magnesium level of 1.0 mEq/L --metformin for a client with a glycosylated hemoglobin level of 11%

Clopidogrel for a client with a platelet count of 70,000/mm3 --Clopidogrel is a platelet aggregation inhibitor used to prevent blood clot formation in clients with recent myocardial infarction, acute coronary syndrome, cardiac stents, stroke, or peripheral vascular disease. Because it can cause thrombocytopenia and increase the risk for bleeding, the nurse should notify the healthcare provider of the low platelet count before administration. Calcium acetate is used to control hyperphosphatemia in clients with end-stage kidney disease by binding to phosphate in the intestines and excreting it in the stool. Because the phosphate level is high (normal is 2.4-4.4) it is not necessary to notify the healthcare provider. Magnesium sulfate is used to correct hypomagnesemia and treat torsade de pointes and seizures assocaited with eclampsia. Because the magnesium level is low (1.5-2.5) it is not necessary to notify the healthcare provider. Metformin is a first-line drug for the control of blood sugar in clients with type 2 diabetes mellitus. Glycosylated hemoglobin has no effect on the administration of metformin.

A client who has been on long-term omeprazole therapy for gastresophageal reflux disease is admitted to the hospital for a urinary tract infection. The nurse recognizes that this client is at highest risk for which complication due to omeprazole use? --Clostridium difficile infection --gait disturbance --jaw necrosis --tremor

Clostridium difficile infection --Long-term use of proton pump inhibitors is common as these medications are available over the counter. PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist. PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonia. PPI use may also increase the risk for clostridium difficile-associated diarrhea. This client would be receiving antibiotics for a urinary tract infection, further increasing the risk for C difficile infection.

The nurse is conducting a hospital admission history and assessment. The client informs the nurse of taking the herb black cohosh (Actaea racemosa) daily. What is the best nursing response? --ask the client about menopausl symptoms --ask the healthcare provider to write a prescription for use of the herb during hospitalization --contact the pharmacy to see if the herb interacts with the client's medications --tell the client to stop taking it

Contact the pharmacy to see if the herb interacts with the clien'ts medications --The nurse should follow up regarding the quantity of the herb and how it is used. Black cohosh is used by some clients for menopausal hot flashes. The main side effects are thickening of the uterine lining and potential liver toxicity. Herbs can cause harmful reactions when taken in combination with other drugs. It is most important to determine that an herb does not interfere with other medications. Herbal therapy is usually stopped 2-3 weeks before any surgery.

A client with bipolar disorder is admitted to the psychiatric unit with acute mania and dehydration. Which prescription does the nurse question? --administer zolpidem at bedtime as needed for insomnia --continue prescribed home dose of 300 mg lithium PO every 8 hours --give haloperidol and lorazepam IM together for aggressive behavior --infuse 500 mL normal saline IV bolus over 1 hour

Continue prescribed home dose of 300 mg lithium PO every 8 hours --Lithium, a mood stabilizer commonly prescribed for clients with mania, has a narrow therapeutic range. Clients with conditions that increase serum lithium levels (dehydration, hyponatremia, severe renal dysfunction) are at increased risk for toxicity. Zolpidem is a hypnotic medication that induces sleep for clients with sleep disturbances. Haloperidol and lorazepam are commonly administered together to depress the central nervous system and decrease aggressive behaviors. Isotonic IV fluid boluses are often required to reverse moderate to severe dehydration and prevent lithium toxicity.

The nurse is reviewing prescriptions for the assigned clients. Which prescription should the nurse question? --allopurinol for a client who developed tumor lysis syndrome from chemotherapy for acute leukemia --dicyclomine for a client with a history of irritable bowel syndrome who develops a postoperative paralytic ileus --IV morphine for a client after percutaneous neprholithotripsy who reports the last bowel movement was 2 days ago --LEvofloxacin for a client with a urinary tract infection who has a history of anaphylasix to penicillin drugs

Dicylcomine for a client with a history of irritable bowel syndrome who develops a postoperative paralytic ileus. --Dicyclomine is an anticholinergic/antispasmodic drug prescribed to manage symptoms of intestinal hypermotility in clients with irritable bowel syndrome. Dicyclomine is contraindicated in clients with paralytic ileus as it decreases intestinal motility and would exacerbate the condition. The nurse should question this prescription and contact the healthcare provider. Tumor lysis syndrome occurs due to rapid lysis ofcells and the resulting release of intracellular potassium and phosphorus into serum. Phosphorus binds to calcium, leading to hypocalcemia. The breakdown of cellular nucleic acidscauses severe hyperuricemia. IV hydration and hypouricemic medications (allopurinol) are prescribed to promote purine excretion and prevent acute kidney injury. Although opioids can cause constipation, symptoms can be managed with pharmacologic and nonpharmacologic interventions. Levofloxacin, afluoroquinolone antibiotic prescribed to treat urinary tract infections, has no known cross-sensitivity to penicillin.

A client is admitted to the ambulatory care unit for an endoscopic procedure. The gastroenterologist administers midazolam 1 mg intravenously for sedation and titrates the dosage upward to 3.5 mg. The client becomes hypotensive, develops severe respiratory depression, and has periods of apnea. The nurse anticipates the administration of which antidote drug? --benztropine --flumazenil --naloxone -phentolamine

Flumazenil --Flumazenil is the antidote drug used to reverse the sedative effects of benzodiazepines. Benztropine is used in the treatment of extrapyramidal side effects associated with antipsychotic medications or metoclopramide. Naloxone is the antidote drug to reverse the effects of opioids. Phentolamine is the antidote drug used to treat a norepinephrine extravasation.

A nurse is preparing an education presentation on herbal supplements for the local community center. Saw plametto is one herbal medicine being discussed. Which audience participants would find this information beneficial? --clients diagnosed with heart failure --clients experiencing major depressive disorder --elderly clients with benign prostatic hyperplasia --perimenopausal clients experiencing hot flashes

Elderly clients with benign prostatic hyperplasia --Herbal preparations are not regulated by governmental agencies and are generally classified as food or dietary supplements. Manufacturers are therefore able to avoid the scientific scrutiny exercised when prescription drugs are readied for the market. Saw palmetto is one such herbal preparation, and clients most often use it to treat benign prostatic hyperplasia. Hawthorn extract is used to treat heart failure. St John's wort has been used to treat depression. It may cause hypertension and serotonin syndrome when used with other antidepressants. Black cohosh is an herbal supplement often used by perimenopausal clients experiencing hot flashes.

A client diagnosed with trigeminal neuralgia is given a prescription of carbamazepine by the healthcare provider. Which intervention does the nurse add to this client's care plan? --Encourage client to drink cold beverages --Encourage client to eat a high-fiber diet --Encourage client to perform facial massage --Encourage client to report any fever or sore throat

Encourage client to report any fever or sore throat. --Trigeminal neuralgia is sudden, sharp pain along the distribution of the trigeminal nerve. The symptoms are usually unilateral and primarily in the maxillary and mandibular branches. Clients may experience chronic pain with periods of less severe pain, or "cluster attacks" of pain between long periods without pain. Triggers can include washing the face, chewing food, brushing teeth, yawning, or talking. Pain is severe, intense, burning, or electric shock-like. The primary intervention for trigeminal neuralgia is consistent pain control with medications and lifestyle changes. The drug of choice is carbamazepine. It is a seizure medication but is highly effective for neuropathic pain. Carbamazepine is associated with agranulocytosis and infection risk. Clients should be advised to report any fever or sore throat.

A client is 6 hours postoperative from hip surgery after receiving regional anesthesia and has epidural continuous anesthesia in place. Which is the most important reason for the nurse to contact the health care provider? 1. Client reports paresthesia bilaterally since the surgery 2. Fondaparinux is prescribed for STAT administration 3. Lower-extremity muscle strength is 3/5 bilaterally 4. Postoperative laboratory results show hemoglobin of 9.9 g/dL (99 g/L)

Fondaparinux is prescribed for STAT administration. --residual paresthesia and motor weakness for several hours are expected findings after regional anesthesia. Anticoagulants are not given while an epidural catheter is in place. Major orthopedic surgery can result in significant blood loss and it is not unusual for the client to have hemoglobin drop of -2 g/dl. Blood loss should be monitored over time and a transfusion is typically not indicated unless hemoglobin is <7-8 g/dl.

The nurse is caring for a client who started receiving chemotherapy 10 days ago. Today, the healthcare provider prescribes filgrastim. Which of the following is an expected outcome of this medication? --decrease in serum uric acid --increase in hemoglobin level --increase in neutrophil count --increase in platelet count

Increase in neutrophil count --Chemotherapy can cause suppression of rapidly reproducing cells, including bone marrow suppression. This can result in decreased red blood cells, white blood cells, and platelets, all manufactured in the bone marrow. It is most likely to be seen with chemotherapy, with the lowest counts, usually at 7-10 days after therapy initiation. Leukopenia is a decrease in total circulating white blood cell count and neutropenia is a decrease in circulating neutrophils. Cancer chemotherapy causes cell lysis, which results in tumor lysis syndrome due to massive release of nucleic acid and its metabolic product, uric acid. Medications such as allopurinol or rasburicase and aggressive IV hydration are used to prevent this complication. Anemia is also common with chemotherapy. Epoetin stimulates the body to make additional red blood cells. Low platelet count is not considered an urgent need until it is at <50,000/mm3. Usually, platelet transfusions are given.

A client with a history of cirrhosis has a new prescription for lactulose 30 mL four times a day. What does the nurse explain to the client about this medication? --it will decrease intestinal absorption of ammonia --it will facilitate diuresis of excess fluid --it will promote renal excretion of bilirubin --it will reduce portal pressure contributing to esophageal varices

It will decrease intestinal absorption of ammonia --lactulose is a syruplike liquid that decreases intestinal ammonia absorption in clients with liver disease and hepatic encephalopathy. Hepatic encephalopathy occurs when the failing liver does not adequately detoxify ammonia in the body, leading to changes in mental status and death if not adequately and promptly treated. The lactulose dosing frequency should be adjusted to ensure 2-3 soft stools per day with no confusion or lethargy. Spironolactone, an aldosterone inhibitor and potassium-sparing diuretic, is typically used in a client with liver failure, ascites, and edema to promote diuresis and to prevent fluid retention. If more diuresis is needed, then intravenous furosemide is used, often in combination with albumin infusion. Lactulose does not promote renal excretion of bilirubin. a transjugular intrahepatic portosystemic shunt (TIPS) procedure and beta blockers are used to reduce portal pressure in the client with liver failure and esophageal varices.

The nurse prepares to administer morning medications to assigned clients. Which prescription should the nurse clarify with the healthcare provider? --clopidogrel for client with history of stroke and platelet count of 154,000/mm3 --Losartan for client with hypertension who is 8 weeks pregnant --prednisone for client with herpes simplex lesions and Bell palsy --Tiotropium for client with pneumonia and chronic obstructive pulmonary disease

Losartan for client with hypertension who is 8 weeks pregnant. ---Angiotensin II receptor blockers and ACE inhibitors are teratogenic, causing fetal injury or death, and are contraindicated in pregnancy. The healthcare provider should be notified so that an alternate antihypertensive may be prescribed that is safe to take during pregnancy (Labetalol, methyldopa)

The client is brought to the emergency department in handcuffs by the police. Witnesses said that the client became violent and confused after consuming large amounts of alcohol at a party. The client is placed in 4-point restraints, and ziprasidone hydrochloride is administered. The client is sleeping 30 minutes later. What is a priority action for the nurse at this time? --check for a history of bipolar disease --determine if restraints can now be removed --monitor for widened QT intervals and hypotension --obtain blood for the current blood alcohol level

Monitor for widened QT intervals and hypotension --Ziprasidone hydrochloride is an atypical antipsychotic drug that is used for acute bipolar mania, acute psychosis, and agitation. Its use carries a risk for QT prolongation leading to torsades de pointes. A baseline electrcardiogram and potassium are usually checked. At a minimum, the client should be placed on a cardiac monitor. The client should also be monitored for hypotension and seizures, especially if the previous medical history is not known of obtainable. The risk for adverse effects is increased with the interaction of alcohol. Although knowing past psychiatric history will assist in determining the cause of this episode, this knowledge is not essential when caring for this client's current needs. Use of restraints should be reassessed after the drug is wearing off, not before the medication is peaking. The client could suddenly wake up and become violent again. It would be beneficial to know the current alcohol level in order to estimate the client's level of intoxication and when the client will be sober. However, there is a reliable history that the client had been drinking, and the presence of alcohol in the blood carries a risk for drug interaction.

What drug classification is indomethacin?

NSAIDs

The nurse is caring for a client receiving IVPB azithromycin. Which client data obtained by the nurse should be reported to the healthcare provider prior to administering any additional doses? --currently nauseated and vomited once --decreased white blood cell (WBC) count --prolonged QT interval --temperature of 101.4 F

Prolonged QT interval --all macrolide antibiotics (azithromycin, erythromycin, clarithomycin) can cause a prolonged QT interval, which may lead to sudden cardiac death due to torsades de pointes. Therefore, an ECG should be monitored. Concurrent use of macrolide antibiotics with other drugs that prolong QT interval will further increase this risk. Macrolides can also cause hepatotoxicty when taken in high doses or in combination with other hepatotoxic medications such as acetaminophen, phenothiazines, and sulfonamides. Elevation of aspartate transaminase and alanine transaminase levels may indicate that hepatotoxicity is occurring, and the nurse should report these results to the HCP. N/V can be side effects of azithromycin and are not concerning. A decrease in the WBC count would be expected as infection is resolving. Fever may be present in a client with an infection. The nurse should use as-needed acetaminophen cautiously in a client also receiving azithromyci due to the risk of hepatotoxicity.

What is the only medication approved for ALS treatment?

Riluzole (Rilutek)

An elderly client with depression, diabetes mellitus, and heart failure has received a new digoxin prescription for daily use. Which client assessment indicates that the nurse should follow up on serum digoxin levels frequently? --apical heart rate is 62/min --Blood sugar level is 240 mg/dl --Client is taking 20 mg fluoxetine daily --Serum creatinine is 2.3 mg/dl

Serum creatinine is 2.3 mg/dl ---Digoxin is excreted almost exclusively by the kidneys. Decreased kidney function usually requires decreased digoxin dosage and frequent drug level monitoring. BUN and creatinine are measurements of kidney function. An apical heart rate is taken for a full minute prior to administration. It is safe to administer the drug when the apical heart rate is >60 min. An elevated blood sugar level requires attention, but is unrelated to digoxin toxicity. However, hypokalemia can increase the risk of digoxin toxicity. Fluoxetine (Prozac) is an antidepressant drug that is a selective serotonin reuptake inhibitor. It does not usually interact with digoxin and its use is unaltered by cardiac disease. This is a normal dose.

A client is receiving IV sodium bicarbonate for acute metabolic acidosis. Which of these laboratory values would best indicate that the sodium bicarbonate has been effective? --Serum pH 7.32, HCO3 26 mEq/L, potassium 4.9 mEq/L --Serum pH 7.34, HCO3 21 mEq/L, potassium 5.1 mEq/L --Serum pH 7.39, HCO3 24 mEq/L, potassium 3.8 mEq/L --Serum pH 7.41, HCO3 18 mEq/L, potassium 4.3 mEq/L

Serum pH 7.39, HCO3 24 mEq/L, potassium 3.8 mEq/L --All other options were not within normal limits and do not indicate that the sodium bicarbonate has effectively corrected acidosis

A client recently diagnosed with a major disorder reports use of herbal supplements. It is most important for the nurse to provide education about which supplement reported by the client? --Echinacea --garlic --glucosamine --St John's wort

St. John's wort --St. John's wort is a herbal supplement commonly used to treat depression and anxiety. Some clients with mild or moderate depression claim that its antidepressant effect is comparable to that of prescription medications. The herbal supplement mimics the action of selective serotonin reuptake inhibitors by increasing available serotonin in the brain. Taken in combination with an SSRI, St. John's wort may cause an excess of serotonin, resulting in serotonin syndrome, which is characterized by mental status changes, autonomic dysregulation, and neuromuscular hyperactivity. The client with a newly diagnosed depressive disorder will likely be prescribed an antidepressant. The nurse should teach the client not to take St. John's wort concurrently with SSRIs to prevent serotonin syndrome.

A client has just been prescribed allopurinol for chronic gout. Which instruction is most important for the nurse to emphasize to the client? --report for periodic laboratory tests for kidney, liver, and blood functions --store the medication in a cool, dry place away from direct heat and light --take the medication after a meal to prevent gastric distress --take the medication with a full glass of water and increase fluids during the day

Take the medication with a full glass of water and increase fluids during the day --It is important for the nurse to educate the client taking allopurinol about drinking a full glass of water with each dose and increasing overall fluid intake. Increased fluids help to prevent renal stones and promote diuresis and uric acid excretion. Biosynthesis of uric acid occurs in the iver, and antigout medications are excreted via the kidneys. Therefore, liver and renal function should be checked periodically. In addition, blood counts should be monitored as some antigout medications can cause blood dyscrasias. This is important but does not have priority over the daily need for increased fluids. This is a common instruction given about the storage of many medications. It helps to ensure potency of the medication and prevent deterioration. Taking allopurinol with food or after a meal can help to prevent gastric upset.

A client with latent tuberculosis has been taking oral isoniazid (INH) 300 mg daily for 2 months, The client tells the nurse that for the past week she has had numbness, a burning sensation, and tingling in her hands and feet. Additional intake of which of the following would most likely have prevented this? --folic acid --vitamin B6 --Vitamin B12 --Vitamin D

Vitamin B6 --high-risk clients on isoniazid therapy for treatment of tuberculosis may experience neurological side effects due to a decrease in the body's ability to utilize vitamin B6 (pyridoxine). A vitamin B supplement will prevent these effects. Folic acid deficiency does not cause peripheral neuropathy. It is associated with macroytic anemia and neural tube defects in children. Vitamin B12 deficiency can cause peripheral neuropathy, but is not seen with INH therapy. Vitamin D deficiency causes osteomalacia but not peripheral neuropathy.

The nurse develops a teaching plan for a client prescribed isoniazid, rifampin, ethambutol, and pyrazinamide to treat active tuberculosis (TB). Which of the following instructions assocaited with the adverse effects of rifampin is most important for the nurse to include? --notify the healthcare provider if your urine is red --take acetaminophen every 6 hours for drug-associated joint pain while taking this medication --wear eyeglasses instead of soft contact lenses while taking this medication --you can stop taking the medications as soon as one sputum culture comes back normal

Wear eyeglasses instead of soft contact lenses while taking this medication --Active TB is treated with combination drug therapy. Isoniazid causes hepatotoxicity and peripheral neuropathy. Rifampin also causes hepatotoxicity. Therefore, baseline liver function tests should be obtained. Clients should be advised to watch for signs and symptoms of hepatotoxicity (jaundice, anorexia). Ethambutol causes ocular toxicity and clients will need frequent eye examinations. Red urine is an expected finding with rifampin use and should be of no concern. Clients should be advised to not consume alcohol and drugs that can increase the risk for hepatotoxicity during long-term use of this drug. The effectiveness of treatment for active TB is determined by 3 negative sputum cultures and chest x-ray. If the entire course of therapy is not completed, reinfection, spread to others, and development of resistant strains of TB bacteria can result.

A parent rushes a 4 year old child to the emergency department after finding the child sitting on the kitchen floor holding an empty bottle of aspirin. The parent has no idea how many tablets were left in the container. The child is sniffling and quietly crying. The nurse anticipates initially implementing which treatment? --activated charcoal --gastric lavage --sodium bicarbonate --syrup of ipecac

activated charcoal --activated charcoal is an important treatment in early acetylsalicyclic acid toxicity; it is recommended for gastrointestinal decontamination in clients with clinical signs of ASA poisoning as well as those who are asymptomatic. Activated charcoal binds to avaiable salicylates, thus limiting further absorption in the small intestine and enhancing eliminations. Similar to syrup of ipecac, gastric lavage is associated with risk of aspiration. In addition, there is no convincing evidence that it decreases morbidity. It is not routinely recommended by may be performed for the ingestion of a massive or life-threatening amount of drug. IV sodium bicarbonate is an appropriate treatment for aspirin toxicity after the administration of activated charcoal. It is given to make the blood and urine more alkaline, therefore promoting urinary excretion of salicylate. Syrup of ipecac has been shown to have minimal benefit in treating aspiring overdose; it is not recommended due to the risk of aspiration pneumonia secondary to induced vomiting.

A client with chronic stable angina is reporting chest pain. The nurse notices that the transdermal nitroglycerin patch that was applied 1 hour ago has peeled off. The client's vital signs are stable. What is the nurse's priority action? --administer PRN morphine --administer PRN sublingual nitroglycerin --apply a new transdermal nitroglycerin patch --obtain a 12-lead electrocardiogram

administer PRN sublingual nitroglycerin --acute stable angina is managed with nitroglycerin, which causes vasodilation and restores myocardial perfusion. Sublingual nitroglycerin has a rapid onset and is used to treat acute angina by increasing myocardial perfusion; Transdermal patches have a delayed onset (40-60 minutes) and are used prophylactically. If a patch is accidentally removed, a new one may be applied after the nurse first administers sublingual nitroglycerin. Morphine sulfate relieves pain and has a mild vasodilatory effect that decreases cardiac workload. Morphine is given if nitroglycerin does not relieve chest pain. The nurse should consider obtaining an ECG and implementing emergency measures if the pain does not resolve after 3 doses of sublingual nitroglycerin.

A client is admitted to the cardiac care unite with atrial fibrillation. Vital signs are: Temp 98.2; BP 120/80; HR 140/min and irregular, RR 18/min; SpO2 98%. Which prescription should the nurse perform first? --administer diltiazem 20 mg IVP --administer rivaroxaban20 mg PO --draw blood for a thyroid function test --send the client for echocardiogram

administer diltiazem 20 mg IVP ---Ventricular rate control is a priority in the client with atrial fibrillation; therefore, the nurse should administer the medication that will accomplish this first. Anticoagulants (rivaroxaban) are used for long-term prevention of atrial thrombus and embolic complications. The thyroid function test would be useful for confirmation, but it is not a priority. An echocardiogram can be obtained once the rate is controlled, but is not a priority.

The home health hospice nurse visits a client who is newly prescribed extended-release oxycodone 40 mg orally, scheduled every 12 hours to treat severe chronic cancer pain. Which information is most important to reinforce to the client's caregiver? --administer the medication around the clock even if the client denies having pain --avoid administering with immediate-release opiods to prevent respiratory depression --change the dosage and frequency to 20 mg every 6 hours if breakthrough pain occurs --request a tapered dose from the healthcare provider if pain decreases to prevent tolerance

administer the medication around the clock even if the client denies having pain --Long-acting controlled-release opioid drugs for chronic pain require regularly scheduled dosing to maintain a therapeutic drug level. Immediate-release opioids may be required for breaththrough pain. Long-term opioid use leads to tolerance and physical dependence; higher doses are eventually required for therapeutic effect.

What could make levofloxacin (Levaquin) ineffective?

administration of aluminum/magnesium antacids, iron supplements, multivitamins with zinc, or sucralfate without allowing two hours to pass.

What drug classification is metoclopramide? What does it treat?

antiemetic medication --treats N/V and gastroparesis

What drug classification is clopidogrel?

antiplatelet agent

What drug classification is clopidogrel? When is it prescribed?

antiplatelet agents -prescribed to prevent thromboembolic events in clients with increased risk for stroke or myocardial infarction.

What drug classification is olanzapine?

antipsychotic

What is lorazepam used to treat?

anxiety and restlessness in terminally ill patients.

What drug classification is Alprazolam?

anxiolytic

The nurse prepares to administer a prescribed dose of sodium polystyrene sulfonate to a client with hyperkalemia. Which action by the nurse is most important prior to administrating the dose? --assessing the client's abdomen and reviewing the medical record for frequency of stools --assisting the client onto a bedside commode --teaching the client the importance of frequent assessment of potassium and sodium levels --verifying that the client had a daily weight assessment

assessing the client's abdomen and reviewing the medical record for frequency of stools --Clients receiving sodium polystyrene sulfonate must have normal bowel function to avoid the risk of intestinal necrosis. The nurse must assess for constipation, signs of impaction, and recent bowel patterns.

What is the rate of infusion for vancomyocin?

at least 60 minutes (100 minutes if infusing >1 gram)

The hospice nurse is caring for an actively dying client who is unresponsive and has developed a loud rattling sound with breathing ("Death rattle") that distresses family members. Which prescription would be most appropriate to treat this symptom? --atropine sublingual drops --lorazepam sublingual tablet --morphine sublingual liquid --ondansetron sublingual tablet

atropine sublingual drops --The "death rattle" is a noisy rattling sound with breathing commonly seen in a dying client who is unresponsive and no longer able to manage airway secretions. Anticholinergic medications such as transdermal scopolamine or atropine sublingual drops effectively treat this symptom by drying up the excess secretions. Lorazepam is an benzodiazepine that is used to treat anxiety and restlessness in terminally ill clients. It can be effective for alleviating dyspnea exacerbated by anxiety, but it is ineffective for controlling secretions. Morphine is an opioid analgesic that is effective for pain treatment as well as terminal dyspnea. The client is not exhibiting these symptoms, so morphine would be inappropriate. Ondansetron will help the nausea and vomiting but is not very effective for treating the "death rattle"

Which type of enema involves the use of contrast medium being administered rectally to visualize the colon using fluoroscopic x-ray?

barium enema

Use of Saw palmetto?

benign prostatic hyperplasia

What drug classification is lorazepam?

benzodiazepine

A nurse is assessing a client with type 2 diabetes mellitus who was recently started on pioglitazone. Which client data obtained by the nurse is most important to bring to the attention of the healthcare provider? --bilateral pitting edema in ankles --blood pressure is 140/88 mm Hg --most recent HbA1c is 6.7% --retinal photocoagulation in right eye

bilateral pitting edema in ankles --Thiazolidinediones are used to treat type 2 diabetes mellitus. These agents improve insulin sensitivty but do not release excess insulin, leading to a low risk for hypoglycemia. These drugs can worsen heart failure by causing fluid retention and increase the risk of bladder cancer. Heart failure or volume overload is a contraindication to thiazolidinedione use. These medications also increase the risk of cardiovascular events such as myocardial infarction. The target blood pressure for a client with diabetes is <140/90 mm Hg. The goal HbA1c for diabetic clients is <7%. Diabetic retinopathy, a condition treated with retinal photocoagulation, is unrelated to thiazolidinedione use.

An 80-year-old client is receiving amkacin,anaminoglucoside antibiotic, IVPB every 12 hours. Which data obtained by the nurse is most important to report to the healthcare provider befor hanging the next dose? --blood pressure 104/62 mm Hg --blood urea nitrogen 20 mg/dL --client report of tinnitus --urine output of 400 mL since last dose

client report of tinnitus --Serious adverse reactions to aminoglucosides (gentamycin, tobramycin, amikacin) include ototoxicity and nephrotoxicity. AGe, renal function, and drug dose affect the occurrence of these adverse reactions. Careful dosing is especially important for older clients. Tinnitus and vertigo are early signs of ototoxicity. The nurse should carefully assess for changes in the client's hearing, balance, and urinary output. The blood pressure is low, but the nurse should compare it to previous readings. Blood pressure is not generally affected by IV antibiotics. BUN is within normal range, but is at the high end of normal and should continue to be monitored. Urine output is adequate but should be closely monitored.

The nurse completes the following drug administration. Which would require an incident report? --client with chronic stable angina and blood pressure of 84/52 mm Hg; isosorbide mononitrate held --client with depression stopped phenelzine yesterday; escitalopram given today --client with diabetes and morning glucose of 90 mg/dL; the daily NPH insulin 20 units given at 8:00am --client with pulmonary embolism and INR of 2.5; warfarin given

client with depression stopped phenelzine yesterday; escitalopram given today --There must be a minimum of 14 days between the administration of MAOIs and SSRIs to avoid serotonin syndrome; these medications cannot be administered concurrently. The isosorbide has actions identical to nitroglycerin and can cause hypotension from vasodilation. It should be held when the systolic blood pressure is <90 mm hg. Insulin is given to control diabetes. A 'normal" fasting glucose level is 70-99 and indicates that the dosing is correct and should be given to continue control of blood glucose. The effect of warfarin is monitored by INR. The therapeutic range of INR is 2-3;therefore, the current dosing is achieving the desired effect

The postoperative client on hydromorphone becomes hypoxic, and naloxone is administered per protocol. What is most important for the nurse to consider in the follow-up care of this client? --Client's respiratory status 60 minutes later --documenting the client's hypoxic event --obtaining an order for a different analgesic --potential for drug-drug interaction now

client's respiratory status 60 minutes later --Hydromorphone duration of action is 3-4 hours. The effects of naloxone start to wane at 20-40 minutes after administration, and its duration of action is approximately 90 minutes. Therefore, depending on the hydromorphone dose, its duration of action can continue beyond the duration of the naloxone. Repeat naloxone doses may be necessary. Documentation is essential, but client care is more important than paperwork. Naloxone will reverse the effects of the narcotic in the body and, as long as it is in the body, will reverse the effects of any additional narcotic administered. This client will need a different class of analgesic at this time. However, adequate respiration/oxygenation as the naloxone wears off is more important. Naloxone is the reversal agent for narcotics, and a drug-drug interaction is not a concern.

The nurse prepares to administer a dose of radioactive iodine (RAI) to a 39-year-old female client with Graves' disease. Which action is most important for the nurse to take? --ask client when her last menstrual cycle occurred --Confirm pregnancy test result is negative --obtain a baseline assessment of the mouth and throat --teach the client the signs and symptoms of hypothyroidism

confirm pregnancy test result is negative --RAI destroys the thyroid gland, making clients permanently hypothyroid and requiring life-long thyroid supplements. In female clients, a nonpregnant status should be confirmed with a valid pregnancy test prior to administering RAI. RAI is contraindicated in pregnancy and may cause harm to a fetus. Radiation thyroiditis and parotitis, which cause dryness and irritation to the mouth, may occur after RAI treatment. A baseline assessment is helpful but is not the most important action listed. RAI damages or destroys the thyroid tissue, thereby limiting thyroid secretion, and can result in hypothyroidism. Clients need to take thyroid supplementation for life. Because these symptoms are delayed, this teaching can occur before or after the procedure.

A client was prescribed phenytoin (100 mg PO 3 times a day) a month ago. Today, the client has a serum phenytoin level of 32 mcg/mL. The nurse notifies the healthcare provider and expects which prescription? --Continue phenytoin as prescribed --decrease phenytoin daily dose --increase phenytoin daily dose --repeat serum phenytoin level in 2 hours

decrease phenytoin daily dose --Phenytoin is an anticonvulsant drug used to treat generalized tonic-clonic seizures. The therapeutic serum phenytoin range is 10-20 mcg/mL. In the presence of an elevated phenytoin level (32 mcg/mL), the nurse anticipates that the healthcare provider will prescribe a decreased daily dose. The nurse should continue to monitor for signs of toxicity, typically presenting as neurologial manifestations (ataxia, nystagmus, slurred speech, decreased mentation).

Define tangentiality

deviating from the original topic of discussion --abnormal thought process seen in schizoprenia

A client has been on lithium carbonate therapy for 7 days. Which of the following findings would be most important to report to the healthcare provider? --diarrhea, vomiting, and mild tremor --dry mouth and mild thirst --hyperactivity and auditory hallucinations --lithium level of 1.3 mEq/L

diarrhea, vomiting, and mild tremor --lithium carbonate is used for the initial and maintenance treatment of bipolar mania. Acute lithium toxicity presents primarily with gastrointestinal side effects such as persistent nausea and vomiting and diarrhea. Neurologic symptoms typically manifest later and include tremor, confusion, ataxia, and sluggishness. Severe toxicity results in seizures and encephalopathy. Serum lithium levels and clinical condition must be monitored before medication administration. Serum levels >1.5 mEq/L and/or even the mildest symptoms of lithium toxicity must be reported to the healthcare provider. Dry mouth and thirst are common and expected side effects of lithium when treatment is initiated. Hyperactivity and auditory hallucinations are clinical findings associated with bipolar mania. Because lithium may take up to 3 weeks to become effective, it would not be unusual for a client to experience these symptoms after only 7 days of treatment.

The healthcare provider prescribes phenazopyridine hydrochloride for a client with a urinary tract infection. What would the office nurse teach the client to expect while taking this medication? --constipation --difficulty sleeping --discoloration of urine --dry mouth

discoloration of urine --Phenazopyridine hydrochloride is a urinary analgesic prescribed to relieve the pain and burning associated with a urinary tract infection. The urine will turn bright red-orange while on this medication; other body fluids can be discolored as well. Because staining of underwear, clothing, bedding, and contact lenses can occur, the nurse should suggest that the client use sanitary napkins and wear eyeglasses while taking the medication. Phenazopyridine hydrochloride provides symptomatic relief but no antibiotic action, and so it is important that the client take a full course of antibiotics.

What is Slidenafil used to treat?

erectile dysfunction --can commonly cause vasodilation and orthostatic hypotension. Clients should move slowly and carefully when changing to a standing position to decrease risk for falls.

What drug classification is apixaban?

factor Xa inhibitors

What is a common side effect of cyclosporine and phenytoin?

gingival hyperplasia (swollen, bleeding gums) --Clients should be instructed on proper dental hygiene

The nurse performs medication reconciliation for a 94-year-old client who has type 2 diabetes, hypothyroidism, and heart failure caused by a previous myocardial infarction. Due to risks outweighing benefits, the nurse plans to talk with the healthcare provider about discontinuing which medication? --aspirin 81 mg PO once a day --furosemide 40 mg PO once a day --Glyburide 10 mg PO once a day --levothyroxine 50 mcg PO once a day

glyburide 10 mg PO once a day ---Beers criteria lists medications that may be inappropriate for the geriatric population due to risks outweighing benefits. The nurse collaborates with the healthcare provider to minimize polypharmacy and reduce adverse effects. Sulfonylureas (glyburide) stimulate insulin release via the pancreas and carry a risk for severe and prolonged hypoglycemia in the geriatric population due to potential delayed elimination. Avoidance of these drugs is recommended by the Beers criteria. Instead, other medications that are at lower risk for hypoglycemia should be used (metformin). Aspirin is used to prevent platelet aggregation in clients with a history of stroke or myocardial infarction. Aspiring and other NSAIDs have an increased risk of gastrointestinal bleeding. Therefore, aspirin is used cautiously in older adult populations and doses should not exceed 325 mg/day. Furosemide is a loop diuretic used to treat fluid overload in heart failure, making it an important part of symptom management. Levothyroxine is required to maintian thyroid hormone levels in clients with hypothyroidism.

A client is prescribed long-term pharmacologic therapy with hydroxychloroquine to treat systemic lupus erythematosus. Which intervention related to the drug's adverse effects should the nurse include in the teaching plan? --have an ophthalmologic examination every 6 months --take the medication on an empty stomach --take vitamin D and calcium supplements --wear a MedicAlert bracelet

have an ophthalmologic examination every 6 months --Hydroxychloroquine isan antimalarial drug, but is more commonly prescribed to reduce fatigue and treat the skin and arthritic manifestations of systemic lupus erythematosus (SLE). Hydroxhloroquine can also help to reduce lupus exacerbations in clients with inactive to mild disease, but several months can pass before its therapeutic effects become apparent. Although rare, serious adverse drug reactions such as retinal toxicity and visual disturbances can occur with hydroxychloroquine. Therefore, clients are instructed to undergo regular ophthalmologic examination every 6-12 months. Hydroxychloroquine should be taken with food to decrease gastrointestinal upset (a common side effect). Some clients with severe SLE are prescribed long-term corticosteroid therapy to prevent organ damage and are at risk for adverse reactions, such as accelerated osteoporosis. Osteoporosis is not an adverse reaction of hydroxychloroquine, and vitamin D and calcium supplementation is not required. There are no effects of hydroxychloroquine that would require wearing a MedicAlert bracelet.

What is a common side effect of nitrates?

headaches

A client with bronchial asthma and sinusitis has increased wheezing and decreased peak flow readings. During the admission interview, the nurse reconciles the medications and notes that which of the following over-the-counter medication taken by the client could be contributing to increased asthma symptoms? --Guaifenesin 600 mg orally twice a day as needed --ibuprofen 400 mg orally every 6 hours for pain as needed --loratadine 1 tablet orally every day as needed --vitamin D 2,000 units orally every day

ibuprofen 400 m orally every 6 hours for pain as needed --Two groups of commonly used drugs, NSAIDs and beta-adrenergic antagonists (beta blockers), have the potential to cause problems for clients with asthma. Ibuprofen and aspirin are common over-the-counter anti-inflammatory drugs that are effective in relieving pain, discomfort, and fever. About 10-20% of asthmatics are sensitive to these medications and can experience severe bronchospasm after ingestion. This is prevalent in clients with nasal polyposis. Guaifenesin is an expectorant used to facilitate mobilization of mucus and should not have the potential to exacerbate asthma or cause an attack. Loratadine is an antihistamine and should not have the potential to exacerbate asthma or cause an attack. Vitamin D is used to help maintain bone density and should not have the potential to exacerbate asthma or cause an attack.

A child with attention-deficit hyperactivity disorder (ADHD) has been taking methylphenidate for a year. What are the priority nursing assessments when the client comes to the clinic for a well-child visit? --attention span and activity level --dental health and mouth dryness --height/weight and blood pressure --progress with schoolwork and in making friends

height/weight and blood pressure --Methylphenidate is a central nervous system stimulant used to treat ADHD and narcolepsy. It affects neurotransmitters dopamine and norepinephrine in the brain that contribute to hyperactivity and lack of impulse control. A common side effect of methylphenidate is loss of appetite with resulting weight loss. Parents and caregivers should be instructed to weigh the child with ADHD at least weekly due to the risk of temporary interruption of growth and development. It is very important to compare weight/height measures from one well-child check-up to the next. If weight loss becomes a serious porblem, methylphenidate can be given after meals. Another side effect of methylphenidate is increased blood pressure and tachycardia. These should be monitored before and after starting treatment with stimulants. Therapuetic effects of methylphenidate include increased attention span and improvement in hyperactivity. Dry mouth is not a common side effect of methylphenidate. Expected outcome of methylphenidate therapy include improvement in schoolwork and social relationships.

Side effects of black cohosh

hepatic injury

Hepatic encephalopathy in cirrhosis results from...?

higher serum ammonia levels that cause neurotoxic effects, causing neurotoxic effects, including mental confusion

The women's health nurse is caring for a 30 year-old client who wants to use the ethinyl estradiol and norelgestromin patch for contraception. Regarding this method of birth control, which finding should be most concerning to the nurse? --client reports heavy menstrual cycles --history of breast cancer in maternal aunt --history of deep venous thrombosis --weight is 186 lb and BMI is 31.0 kg/m2

history of deep venous thrombosis --the transdermal contraceptive patch is a combined hormonal contraceptive (CHC) that is absorbed through the skin. The client applies a patch weekly for 3 weeks, then removes it for 1 hormone-free week. The patch has similar contraindications as other CHCs, and some research shows that the patch may have an increased risk of thromboembolism (compared with oral contraception) due to higher serum concentrations of estrogen. A history of deep venous thrombosis is the most concerning finding because of the additional risk of thromboembolic events when using CHCs. CHCs help regulat menstraul cycles, typically reducing the amount of bleeding during menses; therefore, heavy menses is not as concerning as the client's history of DVT. A personal history of breast cancer or the breast cancer susceptibility gene is concerning because contraceptives may stimulate hormone-dependent tumor growth. The nurse should report the family history to the healthcare provider, but not more concerning than the DVT. The patch may have a higher failure rate in obese clients who are approximately >200 lb and should be avoided. The nurse should counsel the client about diet and exercise, but this is not more concerning than the history of DVT.

The nurse working on the inpatient psychiatric unit is preparing to administer 9:00am medications to a client, including (Haloperidol, Hydrochlorothiazide, omeprazole, acetaminophen). On assessment, the client is tremulous, exhibits muscle rigidity, and has a temperature of 101.1 F. Which action should the nurse take? --give all medications, including acetaminophen, and reassess in 30 minutes -hold the haloperidol, give acetaminophen, and reassess in 30 minutes -hold the haoperidol and notify the healthcare provider immediately --hold the hydrochlorothiazide and notify the HCP immediately

hold the haloperidol and notify the healthcare provider immediately --This client is exhibiting signs and symptoms of neuroleptic malignant syndrome (NMS), a rare but potentially life-threatening reaction. NMS is most often seen with the "typical" antipsychotics. NMS is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction (sweating, hypertension, tachycardia). The most important intervention is to immediately discontinue the antipsychotic medication and notify the HCP for further assessment. Administering acetaminophen may be appropriate, but it is more important to discontinue the haloperidol and notify the HCP immediately. Due to the life-threatening nature of NMS, the HCP should be informed immediately. Hydochlorothiazide is a diuretic commonly used for hypertension. It does not cause NMS symptoms.

A child with cystic fibrosis is to receive a dose of pancrealipase at 12:00 PM. The client states that he is not hungry and will eat his lunch in an hour. Which action is appropriate for the nurse to take? --administer the prescribed pancrealipase --hold the pancrealipase until the client eats --notify the healthcare provider --skip this dose of the pancrealipase

hold the pancrealipase until the client eats --Pancrealipase is a medication containing lipase, protease, and amylase. In cystic fibrosis, the client's pancreas does not excrete these necessary enzymes. To prevent malabsorption syndrome, the enzymes must be taken with every snack and every meal. If the client is not eating when the medication is schedule, there are no nutrients to digest; therefore, the dose should be held until the client eats.

What electrolyte imbalance does ACEI and angiotensin receptor blockers cause?

hyperkalemia. Salt substitutes contain high potassium and must not be consumed unless approved by HCP

A client is receiving scheduled doses of carbidopa-levodopa. The nurse evaluates the medication as having the intended effect if which finding is noted? --improvement in short-term memory --improvement in spontaneous activity --reduction in number of visual hallucinations --reduction of dizziness with standing

improvement in spontaneous activity --The combination medication carbidopa-levodopa is most helpful for treating bradykinesia in Parkinson disease and can also improve tremor and rigidity to some extent. It is started in low doses to prevent orthostatic hypotension and neuropsychiatric adverse effects. Carbidopa-levodopa once started should never be stopped suddenly as doing so can lead to akinetic crisis (complete loss of movement).

A client taking a diuretic for chronic heart failure experiences constipation. What is the nurse's best recommendation? --drink 2 extra glasses of water with each meal --exercise for longer periods --include more fiber in the diet --take warm baths to relax the abdomen

include more fiber in the diet --When a client taking a diuretic experiences constipation, the nurse must consider the reason for taking the diuretic before offering a recommendation. Increased fluid intake is usually contraindicated in clients with a history of heart failure. Exercise is important, but clients with heart failure may not exercise for long periods due to fatigue. Warm baths are not helpful for constipation.

At what age can start receiving the inactivated influenza vaccine?

individuals age >6 months

What drug classification is Tiotropium? What is the mechanism of action of Tiotropium? When is Tiotropium prescribed?

inhaled anticholinergic drug --inhibit receptors in the smooth muscles of the airways ---prescribed daily for the long-term management of bronchospasm in clients with COPD

The nurse is preparing to administer IV cefazolin to a client with cellulitis. The client's allergies are listed as amoxicillin, ciprofloxacin, and sulfa drugs. What should the nurse do first? --administer the medication as prescribed --clarify the prescription with the healthcare provider --inquire about the type of allergic reaction --notify the pharmacy that the drug is inappropriate

inquire about the type of allergic reaction --Clients with an allergy to penicillin antibiotics can possibly experience a cross-sensitivity reaction to cephalosporin antibiotics because the drug molecules are structurally similar. The nurse should obtain more information about this client's reported allergies, as reactions range from mild to severe. In particular, the nurse must first assess the type of reaction the client had to amoxicillin. The nurse should then clarify the prescription with the healthcare provider prior to administration. If this client's reaction to amoxicillin was a rash or other mild reaction that was not life-threatening, the HCP may decide that cephalosporin can be safely administered. However, cephalosporins are contraindicated for a client with a history of anaphylactic reactions to penicillin, and a different antibiotic should be prescribed.

How does IV iodinated contrast affect a patient taking metformin?

it can cause an accumulation of metformin in the bloodstream, which increases the risk for lactic acidosis.

What happens if a client taking metronidazole consumes alcohol?

it can elicit a disulfiram (Antabuse)-like reaction.

What is the first-line medication for treatment of hypothyroidism during pregnancy?

levothyroxine (Synthroid)

Is insulin glargine long acting or rapid acting insulin?

long-acting

What drug classification is Bumetanide?

loop diuretic

The nurse provides discharge teaching for the parent of a child newly prescribed methylphenidate for attention-deficit hyperactivity disorder (ADHD). The nurse advises the parent that the child might experience which side effects? --decreased blood pressure and growth delays --heart palpitations and weight gain --loss of appetite and restlessness --trouble sleeping and a dry cough

loss of appetite and restlessness --Methylphenidate is a central nervous system stimulant with the following potential side effects: anorexia and weight loss/growth delays, restlessness and insomnia, hypertesion and tachycardia, vocal or motor tics, and abuse potential.

A nurse in an outpatient clinic is caring for a client with Addison disease who has been taking hydrocortisone 20 mg daily for the last 8 years. Which client data is most important to report to the healthcare provider? --blood pressure of 140/90 mm Hg --low-grade fever of 100.4 F --mild increase in fasting blood glucose --weight gain of 6 lb in 3 months

low-grade fever of 100.4 F --Addison disease is characterized by a deficiency in all three types of adrenal steroids (glucocorticoids, androgens, mineralocorticoids), most commonly caused by an autoimmune response. Corticosteroid therapy (hydrocortisone, dexamethasone, prednisone) is the primary treatment for Addison disease. Long-term use of corticosteroids can cause immunosuppression, and the anti-inflammatory effects may also mask signs of infection (inflammation, redness, tenderness, fever, edema). Signs and symptoms of infection should be reported to the healthcare provider immediately as infection can develop quickly and spread rapidly. Side effects of long-term corticosteroid therapy mimic the signs and symptoms of Cushing syndrome, including buffalo hump, moon-shaped face, and hypokalemia. Increased weight, blood pressure, and blood glucose levels can also occur, but are not life-threatening.

Explain the mechanism of action of beta blockers

lower heart rate by blocking the action of beta receptors that increase the heart rate and contractility.

The nurse assesses pitting edema of the extremities, dyspnea, bilateral crackles posteriorly, and a serum sodium level of 130 mEq/l in a client with chronic heart failure. The nurse should question which prescription? --Furosemide 20 mg IV push twice daily --maintenance IV line of 0.9% normal saline at 85 mL/h --Potassium chloride 20 mEq orally twice daily --sodium-restricted diet

maintenance IV line of 0.9% normal saline at 85 mL/h --Dilutional hyponatremia is an electrolyte disturbance caused by an excess of total body water in relation to total sodium content and can occur in clients with heart failure. Treatment includes the administration of diuretics and fluid/salt restriction. An infusion of an isotonic solution of 0.9% normal saline at 85 mL/h is contraindicated in this client as it would increase the circulating extracellular fluid volume, worsen the symptoms, and exceed the <2L/day fluid restriction. Converting the running IV line to a lock for medication administration would be appropriate.

A nurse is preparing for a medical relief trip to West Africa and is concerned about a disruption in circadian rhythm from traveling across several time zones. Which herbal supplement might help synchronize the body to environmental time? --evening primrose --ginseng --melatonin --St. John's wort

melatonin --Short-term use of low-dose melatonin may be considered to treat jet lag and fatigue from traveling across time zones. Most practitioners agree that the lowest possible dose should be used and should be taken only for a short time. Higher doses may cause side effects such as vivid dreams and nightmares.

Use of Ginkgo biloba?

memory enhancement

The nurse is administering medications to a client who is being evaluated for a brain malignancy. The client is scheduled for a CT scan with IV iodinated constrast the next morning. Which medication should the nurse clarify with the healthcare provider? --amlodipine --gabapentin --metformin --phenytoin

metformin --Iodinated contrast is commonly administered during computed tomography scans to enhance visualization of certain body structures. Clients who receive IV iodinated constrast while taking metformin are at increased risk for lactic acidosis; therefore, the healthcare provider may discontinue metformin 24-48 hours before administration of IV contrast and restart the medication after 48 hours. Amlodipine is a calcium channel blocker commonly used to treat hypertension. Gabapentin is an anticonvulsant that is also used for neuropathic pain. Phenytoin is an anticonvulsant. None of these medications are known to interact with the iodinated contrast or worsen kidney injury.

A client with gout who was started on allopurinol a week ago calls the healthcare provider's office with several concerns. The nurse should recognize which report by the client as being significant and requiring immediate follow-up? --also takes ibuprofen for pain --frequency of urination has increased --mild red rash have developed over torso --nausea occurs after each dose

mild red rash has developed over torso --The nurse should direct the client taking allopurinol for gout to immediately discontinue the medication and report to the HCP if any rash develops. Allopurinol-induced rashes can develop into severe and sometiems fatal hypersensitivity reactions, such as Stevens-Johnson syndrome. Similar instructions should be given to clients taking anticonvulsants and sulfa antibiotics. Clients are directed to take allopurinol with a full glass of water and to increase daily fluid intake to prevent kidney stones. This will cause an increase in urination and is an expected outcome. Nausea can be prevented by instructing the client to take the medication with food or following a meal.

What intervention is essential prior to starting a clinet on atorvastatin therapy? --assessing for muscle strength --assessing the client's dietary intake --determining if the client is on digoxin therapy --monitoring liver function tests

monitoring liver function tests ---Statin medications can cause hepatotoxicity and muscle aches (and rarely causes rhabdomyolysis). Liver funcion tests should be assessed prior to the start of therapy. Assessment of dietary intake prior to therapy is not essential. Dietary teaching would have been performed prior to determining that medication therapy was necessary. Atorvastatin may slightly increase serum digoxin levels; however, it is not essential to determine if the client is on this medication prior to starting therapy.

A home health nurse visits a client 2 weeks after the client is discharged from treatment for an acute myocardial infarction and heart failure. After a review of the home medications, which symptom reported by the client is MOST concerning to the nurse? **Home Medications: Aspirin 81 mg PO, daily; Clopidogrel 75 mg PO, daily; Metoprolol XL 50 mg PO, daily; Furosemide 40 mg PO, twice daily. --bruising easily, especially on the arms --fatigue --feeling depressed --muscle cramps in the legs

muscle cramps in the legs --Nurses caring for clients receiving potassium-wasting diuretics should monitor for and report signs of hypokalemia as unmanaged hypokalemia may result in lethal complications. Bruising, a side effect of antiplatelet medications, and fatigue, a side effect of beta blockers, should be monitored but are not lethal.

The nurse reviews a client's medical record and notes the following PRN medication prescriptions: acetaminophen, haloperidol, and benztropine. The nurse would administer a dose of benztropine on assessing which client behavior? --muscle rigidity and shuffling gait --nihilistic delusions --tangentiality --waxy flexibility

muscle rigidity and shuffling gait --benztropine is an anticholinergic medication used to treat some extrapyramidal symptoms, which are side effects of some antipsychotic medications. These side effects include: pseudoparkinsonism (symptoms that resemble parkinsonism, suchas mask-like face, shuffling gait, ridigity, resting tremor, psychomotor retardation) and dystonia (abnormal muscle movements of the face, neck, and trunk caused by sustained muscular contractions). Delusions, tangentially, and waxy flexibility are all symptoms of schizophrenia.

A nurse conducting rounds checks on a client receiving continuous total parenteral nutrition (TPN). The infusion pump is found to be powered down, and TPN is no longer infusing. Which action should the nurse take first? --notify the healthcare provider that the infusion has stopped --obtain a blood specimen for serum electrolyte testing --obtain a STAT finger-stick capillary blood glucose level --remove the infusion pump and tag the device as malfunctioning

obtain a STAT finger-stick capillary blood glucose level --Total parental nutrition is an IV nutrition solution containing carbohydrate, amino acids, vitamins, minerals, electrolytes, and lipids that is administered to clients who are unable to receive enteral nutrition. TPN is rich in glucose, which supplies caloric energy and stimulates the pancreas to secrete insulin. If TPN is stopped abruptly, the pancreas may continue to secrete increased amounts of insulin in anticipation of glucose metabolism, placing the client at risk for rapid-onset hypoglycemia. Therefore, clients whose TPN infusion has stopped or abruptly slowed should be assessed for signs of hypoglycemia and have blood glucose measured immediately, because hypoglycemia is associated with potentially life-threatening neurologic complications. All other options should be performed after assessing the client for hypoglycemia

A postoperative client is prescribed IV patient-controlled analgesia (PCA) with morphine. The client tells the nurse, "I am pushing the button, but I'm still having a lot of pain." What is the priority nursing action? --Administer a bolus dose --notify the healthcare provider to request a higher dose --perform a thorough pain assessment --reinforce the proper use of the IV PCA pump

perform a thorough pain assessment --when providing care a client prescribed IV PCA, the nurse assesses pain on a regular and as needed basis, assesses the client's knowledge level regarding its use, and reinforces previous teaching. an IV PCA bolus is an extra, as-needed dose of analgesia for increased pain that is prescribed by the HCP when the PCA is initiated. If needed, the nurse programs the pump to deliver the bolus dose because no one but the client is permitted to push the button, but this is not a priority action. If the client's attempts are twice the number of doses actually delivered and adequate pain relief is not achieved, the nurse would notify the HCP to request a dose increase or shorter dose interval; However, this is done after the pain assessment. The clients learns how to use the IV PCA pump when it is initiated. The nurse should reassess the client's knowledge level regarding proper use and reinforce previous teaching. However, this is not a priority intervention.

Use of Black Cohosh

postmenopausal symptoms (hot flashes and vaginal dryness)

The healthcare provider has prescribed spironolactone to be given in addition to hydrochlorothiazide to a client with hypertension. Which finding by the nurse indicates that the spironolactone is having the desired effect? --Blood glucose of 95 mg/dL --potassium level of 4.2 mEq/: --reduction in dizziness --sodium level of 138 mEq/L

potassium level of 4.2 mEq/L --potassium-sparing diuretics are often combined with thiazide diuretics to reduce potassium loss. Blood glucose levels can be increased by thiazide diuretics but are not affected by potassium-sparing diuretics. All diuretics, including spironolactone, have the potential to cause dizziness. The nurse should monitor the client for orthostatic hypotension and implement safety precautions. Potassium-sparing diuretics exchange sodium for potassium in the kidneys; potassium is saved but sodium is lost. Therefore, a normal sodium level is not the desired effect.

A client with hypertension and type 2 diabetes has recently started taking chlorthalidone. Which report by the client is most concerning to the nurse? --dizziness on standing --fasting blood glucose of 160 mg/dl --presence of muscle cramps --sunburn on both arms

presence of muscle cramps ---The nurse should suspect hypokalemia in the presence of muscle cramps in a client taking diuretics. Hypokalemia can lead to dangerous ventricular dysrhythmias. Orthostatic hypotension may be a side effect of any diuretic. The nurse should teach the client to sit for a few minutes before standing and rise slowly. Mild to moderate hyperglycemia is common with thiazides and needs to be addressed. However, it is not life-threatening and not a priority. Most thiazide diuretics are sulfa derivatives and can therefore cause photosensitivity. The nurse should encourage the client to use sunscreen and wear protective clothing.

The nurse is caring for a child with Kawasaki disease who is receiving IV immunoglobulin. The child's parent wants to know why this treatment is required. The nurse explains that this therapy is given to: --fight the infection --minimize rash --prevent heart disease --reduce spleen size

prevent heart disease ---IVIG along with aspirin is the recommended initial treatment for Kawasaki disease, with the primary goal of coronary disease prevention. KD is a vasculitis of unknown etiology, but it is not an infectious process. Because the child will often have a similar clinical presentation to that of an infection, KD may be mistaken for a bacterial or viral illness. Polymorphous rash of the trunk and extremities is an expected finding in a child with KD. Cool compresses, unscented lotions, and loose-fitting clothing can minimize discomfort. Lymphadenopathy and splenomegaly are included in the clinical presentation of KD. IVIG therapy is not indicated to reduce incidence of these findings.

What is montelukast adminsitered for?

provides long-term asthma control when given orally in combination with beta agonists and corticosteroid inhalers

A client comes to the emergency department following a bee sting. The client has a diffuse rash, hypotension, and throat tightness. One injection of IM epinephrine does not improve the client's condition. What action should the nurse take next? --Administer IV fluid bolus --administer methylprednisolone --prepare for emergency cricothyrotomy --repeat IM epinephrine injection

repeat IM epinephrine injection --IM epinephrine is the single most important medication to be given in anaphylatic shock. The dose should be repeated every 5-15 minutes if symptoms are still present. Antihistamines, corticosteroids, and IV fluids are other supportive treatments that should be tried after a repeat dose of epinephrine has been given.

The nurse is reviewing laboratory data of a client who is receiving warfarin therapy for atrial fibrillation. Today's INR is 5.0. What action should the nurse take? --administer the next scheduled dose of warfarin --anticipate infusing fresh, frozen plasma --call the pharmacy to see if protamine is available --request a prescription from the healthcare provider for vitamin K

request a prescription from the healthcare provider for vitamin K --The nurse should hold a dose of warfarin for an INR over 4 and notify the healthcare provider. Vitamin K may need to be administered for INRs of 5 or greater. Fresh, frozen plasma is considered when major bleeding is occurring related to warfarin overdose, but this is typically after the vitamin K has been administered. Protamine is the reversal agent for heparin overdoses.

The nurse is caring for a client with asthma exacerbation. Blood pressure is 146/86 mm Hg, pulse is 110/min, and respirations are 32/min. The respiratory therapist administers nebulized albuterol as prescribed. One hour after treatment, the nurse assesses which finding that indicates the drug is producing the therapeutic effect? --constricted pupils --heart rate of 120/min --respirations of 24/min --tremor

respirations of 24/min --Albuterol is a short-acting beta-2 agonist that produces immediate bronchodilation by relaxing smooth muscles. Bronchodilation decreases airway resistance, facilitates mucus drainage, decreases the work of breathing, and increases oxygenation. Peak flow will improve. The most frequent side effects are tremors, tachycardia, restlessness, and hypokalemia.

The nurse provides teaching about methotrexate to a client with rheumatoid arthritis. It is most important to address which topic regarding this drug? --need for eye examination --need for sunblock --risk for infection --risk for kidney injury

risk for infection --Methotrexate is classified as a folate antimetabolite, antineoplastic, immunosuppressant drug used to treat various malignancies and as a nonbiologic disease-modifying antirheumatic drug (DMARD) used to treat rheumatoid arthritis and psoriasis. Methotrexate can cause bone marrow suppression resulting in anemia, leukopenia, and thrombocytopenia. Leukopenia and its immunosuppressant effects can increase susceptibility to infection. Clients should be educated about obtaining routine killed vaccines and avoiding crowds and persons with known infections. Live vaccines are contraindicated in clients receiving immunosuppressants, such as methotrexate. Alcohol should be avoided in clients taking methotrexate as it is hepatotoxic and drinking alcohol increases the client's risk for hepatotoxicity. Regular eye examinations every 6 months are indicated for clients prescribed the nonbiological DMARD antimalarial hyroxychloroquine as it causes retinal damage. Photosensitivity and nephrotoxicity can occur, but immunosuppression is more likely and potentially fatal.

An elderly client with a history of stable chronic obstructive pulmonary disease,alcohol abuse, and cirrhosis has a serum theophylline level of 25.8 mcg/mL. Which clinical manifestation associated with theophylline toxicity should worry the nurse most? --alterations in color vision --gum hypertrophy --hyperthermia --seizure activity

seizure activity --Theophylline has narrow therapeutic index and plasma concentrations >20 mcg/mL are associated with theophylline drug toxicity. Toxicity can be acute or chronic. Conditions associated with chronic toxicity include advanced age, drug interaction, and liver disease. Acute toxicity is associated with intentional or accidental overdose. Symptoms of toxicity usually manifest as central nervous system stimulation, gastrointestional disturbances, and cardiac toxicity. Alteration in color perception and visual changes are commonly seen with digoxin toxicity.. Gum hypertrophy is seen with phenytoin toxicity. Hyperthermia and tinnitus are often seen with aspirin overdose.

What serum level describes digoxin toxicity?

serum levels >2 ng/mL

A client is receiving chemotherapy for acute myeloid leukemia. The healthcare provider prescribes allopurinol to prevent tumor lysis syndrome (TLS). Which laboratory value indicates a therapeutic response to the medication? --serum calcium 9.5 mg/dL --serum phosphate 4.0 mg/dL --serum potassium 4.5 mEq/L --serum uric acid level 6.0 mg/dL

serum uric acid level 6.0 mg/dL --The therapeutic effect of allopurinol is to decrease hyperuricemia caused by TLS. Allopurinol blocks the nucleic acid catabolism and prevents hyperuricemia, butwould not affect potassium, phosphate, and calcium levels. Laboratory values of significance in TLS include rising blood uric acid, potassium, and phosphate levels, with decreasing calcium levels.

A client with generalized anxiety disorder has received a new prescription fro sertraline. The nurse should teach this client about which possible side effect? --Constipation --sedation --sexual dysfunction --weight loss

sexual dysfunction --Selective serotonin reuptake inhibitors are commonly used to treat major depression and anxiety disorders. SSRIs are generally well tolerated except for sexual dysfunction. Clients often underreport this side effect. However, when asked specifically, over 50% of clients taking SSRIs may be experiencing some type of sexual dysfunction. This can be a decrease in sexual desire, arousal, or orgasm and may vary by gender. The nurse should discuss this with the client. The side effect may decrease or cease after a 2-4 week waiting period for the therapeutic effect, or the client may be able to switch to a different antidepressant medication. Constipation is uncommon with SSRIs. Sedation is a common side effect of benzodiazepines, first generation antihistamines, and narcotic medications. Weight gain is a common side effect of most SSRIs, especially with long-term therapy.

The registered nurse supervises a student nurse who is caring for a client newly prescribed lithium for the treatment of bipolar disorder. Which action by the student indicates a need for further teaching? --advises the client to drink 2-3 liters of water each day --instructs the client to limit intake of cola, tea, coffee, and alcohol --shows the client how to carefully check food labels to follow a low-sodium diet --teaches the client that it may take up to several weeks for the drug to be effective

shows the client how to carefully check food labels to follow a low-sodium diet --Clients initiating lithium therapy should be instructed that therapeutic effects may take several weeks to achieve. Clients taking lithium should maintain a normal dietary sodium intake, consume 2-3 liters of fluids per day, and be advised to avoid diuretics or products with diuretic effects. Blood sodium levels affect the renal excretion of lithium, as lithium and sodium are excreted in a parallel mechanism by the kidney. If sodium intake is limited or the body is depleted of its normal sodium, lithium is reabsorbed by the kidneys, increasing the possibility of toxicity.

The nurse is assessing a client with hypertension and essential tremor 2 hours after receiving a first dose of propanolol. Which assessment is most concerning to the nurse? --client reports a headache --current blood pressure is 160/88 mm Hg --heart rate has dropped from 70/min to 60/min --slight wheezes auscultated during inspiration

slight wheezes auscultated during inspiration --The nurse should be concerned about the presence of wheezing in a client taking a nonselective beta-blocker like propanolol. Wheezing may indicate bronchoconstriction or bronchospasm. The nurse should assess for any history of asthma or other respiratory problems and report to the HCP. A headache is a common occurrence with hypertension. It is expected that after several days of treatment, the blood pressure will reduce to a more normal reading. A reduction in the heart rate is expected with a beta blocker and the nurse should continue to monitor for further reduction.

A client has a serum potassium level of 2.8 mEq/L and the healthcare provider prescribes intravenous potassium chloride. The nurse administers 10 mEq/L KCL/100 mL 5% dextrose in water at 100 mL/hr through the client's peripheral IV line using an infusion pump. Shortly after initiation of the infusion, the client reports feeling burning and discomfort at the IV site. What is the nurse's priority action? --notify HCP to request a peripherally inserted central catheter --notify HCP to request an oral preparation of KCL --Slow the rate of the KCL infusion --Stop the infusion of KCL immediately

slow the rate of the KCL infusion --KCL, an electrolyte replacement to correct hypokalemia, is a high-alert drug that is never administered by the IV push, intramuscular,or subcutanous routes. The recommended peripheral infusion rate is <5-10 mEq/hr. However, the nurse should always follow institution IV guidelines and policy and procedure for administering KCL. The nurse's priority action is to slow the infusion rate if the client feels a burning discomfort at the IV site shortly after initiation of the infusion. KCL irritates the vein, and irritation and discomfort at the site is expected. Slowing the infusion rate is effective in alleviating discomfort. IV infusion is preferred over the oral preparation to decrease the risk for dysrhythmias when hypokalemia must be corrected quickly. Some clients may need both oral and IV forms if the serum potassium levels are markedly low. Rapid correction of this client's hypokalemia is necessary due to risk for hypokalemia-associated dysrhythmias. Stopping the infusion when not necessary further increases risk.

A client with seizure activity is receiving a continuous tube feeding via a small-bore enteral tube. The nurse prepares to administer phenytoin oral suspension via the enteral route. What is the nurse's priority action before administering this medication? --check renal function laboratory results --flush tube with normal saline, not water --stop the feeding for 1-2 hours --take the blood pressure

stop the feeding for 1-2 hours --Phenytin is an anticonvulsant drug commonly used to treat seizure disorders. Steady absorption is necessary to maintain a therapeutic dosage range and drug level to control seizure activity. Administration of phenytoin concurrent with certain drugs (antacids, calcium) and/or enteral feedings can affect the absorption of phenytoin. Unless clients have renal insufficiency, renal function tests are not routinely monitored during prescribed phenytoin therapy. Phenytoin is metabolized in the liver and can cause liver damage-therefore, monitoring liver function during therapy is recommended. Flushing the tube with 30-50 mL of water before and after administration is recommended to minimize drug loss and drug-drug incompatibility. Flushing with normal saline before and after drug administration is recommended in clients receiving IV phenytoin. Blood pressure is not usually affected in clients prescribed oral phenytoin therapy for seizure disorders. However, it can cause hypotension and arrhythmias.

What is the function of tumor necrosis factor (TNF) inhibitors?

suppress the inflammatory response in autoimmune diseases such as rheumatoid arthritis, Crohn disease, and psoriasis.

A client with hypertension is prescribed lisinopril. The nurse instructs the client to notify the healthcare provider immediately if which adverse effect occurs when taking this medication? --cough --dizziness --rapid-onset confusion --swelling of the lips and tongue

swelling of the lips and tongue. **If this occurs, the client should discontinue the drug and notify the healthcare provider immediately ---ACE inhibitors have a low incidence of serious adverse effects except angioedema (rapid swelling of lips, tongue, throat, face, and larynx). More common adverse effects of ACE inhibitors include dry cough, orthostatic hypotension, and hyperkalemia.

The nurse is providing education to a pregnant client diagnosed with symptomatic hypothyroidism regarding levothyroxine therapy during pregnancy. Which is appropriate teaching for the nurse to include? --after symptoms resolve, levothyroxine may be discontinued --levothyroxine should be taken in the evening with a prenatal vitamin --medication dose will remain the same throughout pregnancy --symptoms should begin improving within 4 weeks of starting levothyroxine

symptoms should begin improving within 4 weeks of starting levothyroxine --levothyroxine is the first-line treatment for hypothyroidism during pregnancy to maintain adequate levels of maternal thyroid hormones, which are critical for fetal brain development. Symptoms of hypothyroidism typically begin to improve approximately 3-4 weeks after initiating levothyroxine. Therapy should not be stopped, even if symptoms resolve. Prenatal vitamins containing iron can affect the absorption of levothyroxine and decrease its effectiveness. The nurse should instruct the client to take levothyroxine in the morning on an empty stomach, at least 4 hours before or after taking a prenatal vitamin. As the pregnancy advances, the client's dose of levothyroxine may need to be increased. Thyroid stimulating hormone levels are closely monitored during pregnancy, and the client's dose is modified as needed to maintain normal levels.

The healthcare provider has told a client to take over-the-counter supplemental calcium carbonate 1000 mg/day for treatment of osteoporosis. Which instruction should the clinic nurse give the client? -monthly calcium levels will need to be drawn -stop vitamin D supplements when taking calcium -take calcium at bedtime -take calcium in divided doses with food

take calcium in divided doses with food --Calcium and vitamin D are essential for bone strenght. Calcium carbonate has the most available elemental calcium of OTC products and is inexpensive; it is therefore the preferred calcium supplement for most clients with osteoporosis. Calcium absorption is impaired when taken in excess of 500 mg per dose. Therefore, most clients should take supplements in divided doses. These should be taken within an hour of meals as food increases calcium absorption. Constipation is a frequent side effect of calcium supplements, so clients should be advises to take appropriate precautions Calcium carbonate and calcium acetate are used to reduce serum phosphorous levels in clients with chronic kidney disease. In such cases, calcium should remain in the intestine and bind the phosphorous present in food; the calcium phosphorous product would then be excreted in stool. Therefore these clients should take calcium supplements before meals. Calcium levels may need to be checked periodically, but is not necessary to do so monthly. Vitamin D also increases calcium absorption and is important for treatment of osteoporosis, so no need to stop it. Calcium does not need to be taken at any particular time of day.

The nurse develops a teaching care plan for the client with a prescription to change antidepressant medications from imipramine to phenelzine. Which instruction is appropriate to include in the teaching? --continue avoiding foods high in tyramine until the imipramine withdrawal period is over --skip the nighttime dose of impiramine and start the phenelzine in the morning --taper down the impiramine, then discontinue for 2 weeks before starting phenelzine --taper down the impiramine while gradually increasing the phenelzine

taper down the imipramine, then discontinue for 2 weeks before starting phenelzine --When a client switches from a tricyclic antidepressant to a monoamine oxidase inhibitor, a drug-free period of at least 2 weeks should elapse between the tapered discontinuation of the TCA and the initiation of the MAOI. This timing is based on the half-life value and allows for the first medication to leave the system. Without a washout period, the client could experience hypertensive crisis. If the TCA is withdrawn abruptly, the client may experience a discontinuation syndrome. A tyramine-restricted diet is indicated for clients on an antidepressant regimen containing an MAOI to decrease the risk of hypertensive crisis. An overnight washout period is inadequate to clear the imipramine from the client's system before starting the phenelzine. TCAs and MAOIs cannot be taken at the same time due to the risk of a hypertensive crisis.

A client recently diagnosed with heart failure is being discharged with a prescription for lisinopril. Which client teaching related to this new medication is important to review at discharge? --instruct client to report for monthly blood work to monitor drug levels --review foods high in potassium that client should include in diet --teach client to count own pulse for 1 minute; hold medication if pulse is <60/min --teach client to rise slowly and sit on side of bed for several minutes before rising

teach client to rise slowly and sit on side of bed for several minutes before rising ---Client education after initiation of an angiontensin converting enzyme inhibitor includes a discussion on development of a dry cough, taking several minutes to get out of bed, possible allergic reactions (rash, angioedema), and the teratogenic effects of the drug. Renal function is commonly checked during the first week of treatment. A common side effect of ACEI is mild hyperkalemia, which may require a lower intake of foods high in potassium. ACEI do not directly affect the heart rate.

A client with cancer pain is prescribed oxycodone. Which teaching is most essential to help prevent long-term complications? --teach the client how to assess blood pressure daily --teach the client how to prevent constipation --teach the client how to prevent itching --teach the client how to prevent nausea

teach the client how to prevent constipation --Oxycodone is a morphine-like opioid medication. Opioid medications bind to opioid receptors in the intestine, which slows peristalsis and increases water absorption, leading to constipation. Constipation is an almost universally expected side effect from opioid medications. Clients will not develop tolerance to this side effect. Although clients with idiopathic chronic constipation are not commony advised to take laxatives, opioid-induced constipation is treated with simultaneous use of senna (stimulant) and docusate (stool softener). Opioids cause the release of histamine, a vasodilator which is responsible for pruritus and flushing. Opioids can also cause peripheral vasodilation and nervous system depression; both can lead to hypotension. These develop in some clients when the treatment is initiated but usually resolve over time. Antihistamines can prevent the pruritus. Lifestyle changes and adequate hydration can prevent hypotension. Opioids stimulate the opioid receptors in the gastrointestinal tract and the chemoreceptor trigger zone in the bran, producing nausea. This is also not seen with long-term use. Antiemetics can be helpful.

How should lactulose dosing frequency be adjusted to ensure?

that 2-3 soft stools occur per day

What is ethambutol (myambutol) used to treat?

tuberculosis

What is rifampin used to treat?

tuberculosis

What drug classification are adalimbumab?

tumor necrosis factor (TNF) inhibitors

The nurse evaluates the effectiveness of desmopressin use for diabetes insipidus in a client with a pituitary tumor. Which client assessment finding indicates that the medication is having the desired effect? --appetite has improved --blood glucose is 110 mg/dL --urine output has decreased --urine specific gravity is lower

urine output has decreased --use of desmopression acetate in clients with diabetes insipidus will lower urinary output and cause the urine specific gravity to increase. A client's thirst, not appetite, is affected by DI. DI is related to water balance, but not to diabetes mellitus, a disorder of glucose metabolism. If desmopressin therapy is effective, the client's urine specific gravity will be higher due to the urine output decreasing and becoming less dilute.

The nurse is caring for a client with an inflammatory bowel disease exacerbation. The client is prescribed sulfasalazine. Which finding would require a priority follow-up by the nurse? --elevated erythrocyte sedimentation rate --hemoglobin 10.5 g/dL --urine with yellow-orange discoloration --urine specific gravity of 1.035

urine specific gravity 1.035 --Sulfasalazine contains sulfapyridine and aspirin and is used as a topical gastrointestinal anti-inflammatory and immunomodulatory agent in inflammatory bowel disease. When the 5-ASA is combined with the sulfa preparation, the drug does not become absorbed until it reaches the colon. Dehydration is a risk with IBD as the client can have up to 20 diarrheal stools a day. The client usually does not feel thirsty until after there is a fluid volume deficit. Sulfa can crystallize in the kidney if the client is dehydrated. Normal urine specific gravity is 1.00-1.030. Elevated specific gravity can indicate concentrated urine and be a sign of dehydration. Due to the inflammatory nature of IBD, erythrocyte sedimentation rate, C-reactive protein, and white blood cells can be elevated. Mild to moderate anemia is common with most chronic inflammatory conditions as the body cannot use the available iron in bone marrow with active inflammation. Yellow-orange discoloration of the clients skin and urine is an expected side effect from the drug.

A 24-year old female client is prescribed isotretinoin for severe cystic acne. Which instruction is most important for the nurse to reinforce? --apply lubricating eye drops when wearing contacts --do not break, crush, or chew capsules --use sunscreen routinely during therapy --use two forms of contraception consistently

use two forms of contraception consistently. ---Isotretinoin is a teratogenic medication known to cause serious harm to a fetus if taken during pregnancy. The client must use two forms of contraception prior to, during, and after therapy. Negative pregnancy tests are required before initiating therapy and prior to refills. Dryness of the eyes, mouth, and skin are common side effects. Lubricating eye drops may be needed to wear contacts. Capsules should be swallowed whole with 8 oz of water or other fluid. Isotretinoin sometimes causes photosensitivty, so the client should use sunscreen routinely.

The nurse admits a client with newly diagnosed unstable angina. Which information obtained during the admission health history is most important for the nurse to report to the healthcare provider immediately? --drinks 6 cans of beers on the weekend --gets up 4 times during the night to void --smokes 1 pack of cigarettes daily --uses sildenafil occasionally

uses sildenafil occasionally --nitrate drugs are prescribed to treat angina. The concurrent use sildenafil and nitrates is contraindicated as it can cause life-threatening hypotension. Clients do not always report the amount of alcohol they consume accurately. The nurse should monitor all clients for alcohol withdrawal syndrome as it is quite common in hospitalized clients. Getting up 4 times during the night to void can be associated with medication, a enlarged prostate gland, or drinking fluids at bedtime. Further action may be needed to determine the cause of the nocturia, but this is not the most significant information to report to the HCP. Smoking 1 pack of cigarettes daily needs to be addressed as tobacco causes vasoconstriction and decreased oxygen supply to the body tissues.

A 45-year-old client with atrial fibrillation has been prescribed diltiazem. Which client outcome would best indicate that the medication has had its intended effect? --atrial fibrillation is converted to sinus rhythm --blood pressure is 126/78 mm Hg --no signs or symptoms of stroke --ventricular rate decreased from 158/min to 88/min

ventricular rate decreased from 158/min to 88/min --The nurse should monitor for a reduction in ventricular rate in the client with atrial fibrillation who is receiving diltizem, metoprolol, or digoxin. Anticoagulatns are used to prevent embolic complications. Diltiazem is unlikely to convert atriall fibrillation to sinus rhythm. Calcium channel blockers may reduce blood pressure, but the nurse is not evaluating this client in atrial fibrillation for this outcome. While no signs/symptoms of stroke is a positive outcome, it s not the desired outcome.

A client with chronic kidney disease has received a continuous intravenous infusion of heparin for 5 days. The nurse reviews the coagulation studies. (aPTT is 53 seconds; INR is 2.3). Which prescription would the nurse question? --epoetin --sodium polystyrene sulfonate --vitamin K --Warfarin

vitamin K ---Vitamin K is a fat-soluble vitamin that is administered as an antidote for warfarin-related bleeding. This medication prescription should be questioned as vitamin K reverse the anticoagulant effect of warfarin, and the client's coagulation studies are in the therapeutic range. Epoetin is a synthetic hormone that stimulates the production of erythropoietin and is used to treat anemia associated with chronic kidney disease. This is appropriate for this client. Sodium polystyrene sulfonate is a sodium exchange resin administered to reduce elevated serum potassium levels in clients with chronic kidney disease and hyperkalemia. This is an appropriate prescription for this client.

A client just diagnosd with methicillin-resistant Staphylococcys aureus septic arthritis is receiving the first dose of IV vancomycin. Which finding is most concerning to the nurse? --diffuse muscle pain --flushing and pruritis --low blood pressure --wheezing and hives

wheezing and hives --Red man syndrome (RMS) is a condition that can occur with rapid IV vancomycin administration. It is characterized by flushing, erythema, and pruritus, typically on the face, neck, and chest. Muscle pain,spasms, dyspnea, and hypotension may also occur. RMS is usually a rate-related infusion reaction and not an allergic reaction. It can be reduced by infusing vancomycin over a minimum of 60 minutes. It can be difficult to differentiate severe RMS from anaphylaxis as flushing and hypotension can occur in both conditions. However, hives, angioedema (lip swelling), wheezing and respiratory distress are more suggestive of anaphylaxis. The client exhibiting signs and symptoms suggestive of anaphylaxis should have the vancomycin infusion stopped immediately and be treated with intramuscular epinephrine. The infusion must not be restarted if anaphylaxis is suspected. A slow infusion rate or pre-medications will not prevent a future anaphylactic response. Muscle pain and spasms may be symptoms of RMS. The nurse should also assess for other medications the client may be taking that could cause these symptoms (statins). Flushing and pruritis may also be symptoms of RMS. The nurse should further assess the client's airway for possible anaphylaxis. Low blood pressure can have many causes, RMS being one of them. If low BP is due to RMS, stopping or reducing the rate of vancomycin would solve this. If low BP is due to anaphylaxis, IM epinephrine must be given in addition to stopping the vancomycin infusion.

What are some adverse effects of thiazolidinediones?

worsening heart failure (d/t fluid retention) --increases the risk of bladder cancer