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Pharmacology Exit HESI QUESTIONS AND ANSWERS( 100% CORRECT)

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Pharmacology Exit HESI Nurse should observe most closely for drug toxicity when a client receives med that has what characteristic Narrow therapeutic index The nurse should observe most closely f... or drug toxicity when a client receives a medication that has which characteristic? • Low bioavailability • Rapid onset of action • Short half life • Narrow therapeutic index. • Rationale: A drug with a narrow therapeutic index has a high risk for toxicity because there is a narrow range between the therapeutic dose and the toxic dose. Nurse is conducting DC teaching about anti-anxiety drug diazepam (valium) Evaluate the ingredients of all over-the-counter drugs for alcohol content Nursing instruction most important for patient on Zyloprim Increase fluid intake Client getting Tofranil (Imipramine) Give medication at night Magnesium antidote Calcium gluconate Patient with hyperthyroidism taking inderal (propanalol) Decreases pulse rate A client with hyperthyroidism is receiving propranolol (Inderal). Which finding indicates that the medication is having the desired effect? • Decrease in serum T4 levels • Increase in blood pressure • Decrease in pulse rate • Goiter no longer palpable Medication dosing-heparin 25000 units at 7ml/hr doctor changed rate to 900 units what is the Mls/hr Med was ordered 100mg in 4 divided doses in 24 hours available in 25mg, how many will you give every 6 hours 1 Patient on benzos Answer is not narcan - A client experiencing withdrawal from the benzodiazepines alprazolam (Xanax) is demonstrating severe agitation and tremors. What is the best initial nursing action? • Administer naloxone (Narcan) per PNR protocol • Initiate seizure precautions • Obtain a serum drug screen • Instruct the family about withdrawal symptoms. • Rationale: Withdrawal of CNS depressants, such as Xanax, results in rebound over-excitation of the CNS. Since the client exhibiting tremors, the nurse should anticipate seizure activity and protect the client. Patient Dx with bipolar-how to know if meds are effective Family states patient is doing better with manic phases - A client with bipolar disorder began taking valproic acid (Depakote) 250 mg PO three times daily two months ago. Which finding provides the best indication that the medication regimen is effective? •The family reports a great reduction in client’s maniac behavior Patient on Heparin going for surgery in a.m.,-priority Assess patient for bleeds Best time to give patient Abx (I think) Time was like 1000, 1400, 1200, and 0400…best to give around the clock Medication calculation-patient weighs equal to 16kg-order for Tamiflu 45mg BID Must round up-answer is 3.8ml Peptic ulcer med-what action Histamine 2 agonist Patient on folliculitis medication-what to teach Drink with full glass of water Vasopressin Vasoconstrictor Know why Digoxin and Lasix are used together - Someone's on digoxin and Lasix how do you know the meds are working; is it because potassium is at 4, magnesium or something else Tamoxifen Citrate use and therapeutic outcome - Breast cancer Fosomax for osteoarthritis patient teaching 1. A female client receives a prescription for alendronate sodium (Fosamax) to treat her newly diagnose osteoporosis. W /hat instruction should the nurse include in the client’s teaching plan? • Take on an empty stomach with a full glass of water Rifampin for TB Rusty-orange/red colored urine and body fluids Pyridium for bladder infection Orange/red/pink urine Stay in bed for 3 hours post first Ace Inhibitor dose Avoid grapefruit juice with CCB Lipitor (statins) in PM only-no grapefruit juice Trough draw - A peak and trough level must be drawn for a client receiving antibiotic therapy. What is the optimum time for the nurse to obtain the trough level? A) Sixty minutes after the antibiotic dose is administered. B) Immediately before the next antibiotic dose is given. C) When the next blood glucose level is to be checked. D) Thirty minutes before the next antibiotic dose is given. - Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given (B). (A, C, and D) do not describe the optimum time for obtaining a trough level of an antibiotic. Peak draw 30-60 minutes after administration Potassium sparing diuretic need to watch for hyperkalemia Aldactone (spirinolactone) Using bronchodilators before steroids for asthma teaching Exhale completely, inhale deeply, hold breath for 10 seconds Insulin can be kept at room temp 28 days Drawing insulin Clear (regular) first then cloudy (NPH) Know the insulins and their peak/onset (there are several Qs about this in different formats) Rapid-Lispro (Humalog) and Aspart (Novolog) Onset: 5-15 minutes Peak: . 5-1.5 hours Short acting- regular (humulin) Onset: 30-60 minutes Peak: 2-3 hours (IV ok) Intermediate acting- NPH Onset: 1-2 hours Peak 6-12 hours Long acting- Glargine (lantus) Onset: 1.1 hour Peak: 14-20 hours (DO NOT MIX) Chlamidia Tetracycline Trichomoniasis Flagyl Candidiasis Nystatin Herpes Simplex 2 Acyclovir Parkinson’s disease Levodopa/Carbidopa Phenobarbitol Seizures Preparing to administer a drug to a pt with an infection The drug will destroy the microorganism RN is teaching a pt about a new drug… what’s most important to teach the pt to improve the intensity of the response to the drug Take the prescribed dose A nurse is giving morphine 2 mg IV to a pt after surgery and she has followed the “six rights of administration”… Know the possible reactions to morphine RN doesn’t understand why a pt is to receive a prescribed med Verity the reason with the prescribing healthcare provider for use Administration of schedule IV drug, the RN understands The drug has acceptable medical application with low potential for abuse - A nurse is administering a drug that is categorized as Schedule IV. The nurse understands that this means the drug: A. Has acceptable medical applications with low potential for abuse B. Is a controlled sub with no accepted medical use C. Is dangerous to admin to pregnant or breast-feeding pts D. Has the potential for serious and life-threatening adverse effects Where would a RN direct a pt to obtain more info about prescribed medications A pharmacist RN is prepared to administer Epinephrine to pt that has a severe allergic reaction IV – no first pass effect Digoxin has 36-48 hr half life – because of the length of half life, the RN expects to be dosing this medication Once a day Pt is prescribed Cimetidine (histamine 2 antagonist) to treat gastric ulcer Inhibit the action of histamine at receptor sites and block gastric acid secretion - When teaching a patient who has a gastric ulcer about cimetidine (a histamine H2 antagonist) therapy, the nurse should include which information about antagonists A. An antagonist causes a chemical reaction in the stomach B. An antagonist activates receptors in the stomach lining C. An antagonist prevents receptor activation in the stomach D. An antagonist improves receptor sensitivity in the stomach Drug X has a therapeutic index of 10 and drug Y has an index of 2 Drug Y – more potent A pt taking Digoxin is also prescribed Propanolol. The 2 drugs combined may cause a serious decrease in HR An increased adverse effect A pt prescribed CCB Diltiazem to treat hypertension Grapefruit juice - The nurse cares for a patient taking a calcium channel blocker for hypertension. The nurse is most concerned if the patient makes which statement? "I drink a glass of grapefruit juice each evening" Which of the pts would be at highest risk for an adverse reaction An 84 yo with diabetes, HF, hypertension and takes 8 medications per day RN receives a handwritten medication order – can’t read Contact prescriber to clarify order A breast-feeding pt is prescribed an antimicrobial medication Take immediately after breast-feeding The RN is evaluating the kidney fx of an 82 yo pt before administration of medications – Creatinine clearance – a measure of how the kidneys are fx by excreting creatinine. (BUN – good indicator of volume and dehydration) (Creatinine – is reflective very much by your BUN or level of hydration) The most important factor in an adverse drug reaction in the elderly population is Declining renal fx A pt is prescribed Bethanocol (Muscarinic Agonist) for urinary retention – if pt exhibits signs of overdose such as: increased salivation, sweating, bradycardia, hypotention, the RN would administer Atropine (anticholenergic – makes us dry) The pt takes Oxybutinin (anticholenergic) for OOB takes an OTC antihistamine (anticholenergic) for hay fever Dry mouth, increased temp, and blurry vision (myosis) After IM injection of penicillin the pt develops severe difficulty breathing and swollen tongue (Anaphylaxis) Administer epinephrine A pt receives Dopamine for shock (hypotention, vascular collapse, comatose) Mean arterial pressure Pt receives a drug that blocks adrenergic receptors Orthostatic hypotension (no BP to the brain) Reflex tachacardia is caused by hypotention A pt with diabetes gets a beta blocker (mask the signs of hypoglycemia and blocks beta receptors – inhibits glycogenolysis) Atenolol (more selective) A pt with depression is prescribed an antidepressant – the medication will reach full therapeutic effect 2 to 3 weeks (more like 1 to 2 months but this is the best response) A pt taking Levadopa/Carbadopa (dopaminergic) and experiences a frequent “on – off” episodes Avoid high protein meals – competes with drug A pt is prescribed a Dopamine agonist (Mirapex) (adrenergic agonist) for Parkinson’s “This med will stop the progression of Parkinson’s.” – can’t cure Parkinson’s Pt with mild symptoms of Alzheimer’s is prescribed Donepezil (Aricept) The drug will stop the damage to the neurons in my brain - A patient with mild symptoms of Alzheimer's disease is prescribed donepezil (Aricept). Which statement made by the patient indicates a need for further teaching? - "The drug will stop damage to the neurons in my brain." **Donepezil will improve transmission by neurons in the brain because more acetylcholine will be availalble (it is a cholinesterase inhibitor), it may cause an upset stomach, and it is a good idea to take it at bed time because of the side effects. It will not, however, stop the damage in the brain, it only provides symptom control.** Pt is concerned about developing Alzheimer’s disease Naproxen (NSAID’s) Which assessment best determines the effectiveness of Sumatriptan (triptans are used for treatment of Migraines so… Termination of the migraine Pt with schizophrenia is prescribed chlorpromazine (Thorazine – first generation antipsychotic) oral concentrate The medication may cause excessive salivation - A patient with schizophrenia is prescribed chlorpromazine (Thorazine) oral concentrate. Which of the following discharge instructions should the nurse complete? A. Sexual arousal may be enhanced with this medication. B. Avoid direct skin contact with the medication. C. The medication may cause excessive salivation. D. Do not limit salt intake while taking the medication. Which assessment best determines the pt is developing tardive dyskinesia Twisting, writhing, worm-like movements of tongue Pt with depression is proscribed Fluoxitine (Prozac) “It may take 3-4 weeks before my mood is elevated” Pt is on Marplan (MAOIs – have the most food interactions) for depression Bananas, smoked fish, and cheese Pt on Lithium Polydypsia (increased thirst), slurred speech, and fine hand tremors Pt is prescribed Lunesta for insomnia Anterograde amnesia (memory loss of events right before taking drug) A 24 yo female gets Triazolam (Halcion) for insomnia at home (remember to use the process of elimination) “The medication will not alter my breathing” A pt is prescribed Venlafaxine and the pt asks what the purpose of medication is, you should state Depression and anxiety A pt with OCD is prescribed Zoloft – which is not a true statement about the medication “I will get better in 3 weeks.” (full effect in 1 – 2 months, you won’t get “better” necessarily) An RN is teaching a parent about administration of adderall to treat their child’s ADD Give the dose in the morning b4 school. (amphetamine – child needs it to concentrate) Amphetamines can cause growth suppression in children Provide snack or meal b4 giving med (because amphetamines suppress appetite) Pt states that he’s on Oxycodone and the dose that he currently receives does not provide the same pain relief Tolerance A pt with HF is getting Furosemide (Lasix) (loop diuretic is K+ wasting) Oranges, spinach, and potatoes high in potassium A client in renal failure asks why he is being given antacids Calcium and aluminum antacids bind phosphates and help to keep phosphates from being absorbed into blood stream thereby preventing rising phosphate levels, and must be taken with meals Receiving Digoxin for the onset supraventricular tachycardia (SVT) hypokalemnia - A client is receiving digoxin for the onset of supraventricular tachycardia (SVT). Which laboratory findings should the nurse identify that places this client at risk? A) Hypokalemia. B) Hyponatremia. C) Hypercalcemia. D) Low uric acid levels. - Hypokalemia affects myocardial contractility, so (A) places this client at greatest risk for dysrhythmias that may be unresponsive to drug therapy. Although an imbalance of serum electrolytes, (B and C), can effect cardiac rhythm, the greatest risk for the client receiving digoxin is (A). (D) does not cause any interactions related to digoxin therapy for supraventricular tachycardia (SVT). Receiving Albuterol (Proventil) tablets complains of nausea every evening with her 9pm dose administer the dose with a snack The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room The clients’ respiratory rate is 16 breaths/min - The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room. Which assessment data would indicate that the naloxone has been effective? The client's... A. Statement that the chest pain is better B) respiratory rate is 16 breaths/minute. C) seizure activity has stopped temporarily. D) pupils are constricted bilaterally. A client who has been taking levadopa PO Tid to control the symptoms of Parkinson’s disease has a new prescription for sustained-release levadopa/carbidopa (Simemet 25/100) PO Bid and took his levadopa at 0800 “You can begin taking the Sinemet this evening, but do not take any more levadopa” Which action is most important for the nurse to implement during the administration of the antiarrhythmic drug adenosine (Adenocard) Apply continuous cardiac monitoring Nurse is teaching a client with cancer about opioid management for intractable pain and tolerance related side effects. The nurse should prepare the client for which side effect that is most likely to persist during long-term use of opioids? Constipation Which dosing schedule should the nurse teach the client to observe for a controlled release oxycodone Rx q12h The healthcare provider prescribes digitalis (Digoxin) for a client Dx with congestive heart failure Assess the serum potassium level - The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with congestive heart failure. Which intervention should the nurse implement prior to administering the digoxin? A. Observe resp rate and depth B. assess the serum potassium level C. Obtain the clients blood pressure D. Monitor the serum glucose level - hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in persons receiving digoxin Which method of medication administration provides the client with the greatest first pass effect Oral - The first-pass effect is a pharmacokinetic phenomenon that is related to the drug's metabolism in the liver. After oral (A) medications are absorbed from the gastrointestinal tract, the drug is carried directly to the liver via the hepatic portal circulation where hepatic inactivation occurs and reduces the bioavailability of the drug. Alternative method of administration, such as sublingual (B), IV (C), and subcutaneous (D) routes, avoid this first-pass effect. Most important when caring for a client receiving the antimetabolite cytosine arabinoside (ARC-C) for chemotherapy Inspect the clients’ oral mucosa for ulcerations - Cytosine arabinoside (Arc-C) affects the rapidly growing cells of the body, therefore stomatitis and mucosal ulcerations are key signs of antimetabolite toxicity Identify as being at high risk for complications during the use of an opioid analgesic A young adult with inflammatory bowel Dz - Which client should the nurse identify as being at the highest risk for complications during the use of an opioid analgesic? A. an older client with type 2 diabetes B. A client with chronic rheumatoid arthritis C. A client with a open compound fracture D. A young adult with inflammatory bowel disease Rheumatoid arthritis takes ibuprophin (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed Which information is most important for the nurse to include in client teaching? Use contraception during intercourse - Cytotec, a synthetic form of prostaglandin, is classified as pregnancy category X and can act as an abortifacient, so the client should be instructed to use contraception during intercourse to prevent loss of early pregnancy Receiving methylprednisolone (Solu-Medrol) 40 mg IV daily anticipates an increase in which lab value Serum glucose - A client is receiving methylprednisolone (Solu-Medrol) 40 mg IV daily. The nurse anticipates an increase in which laboratory value as the result of this medication? A) Serum glucose. B) Serum calcium. C) Red blood cells. D) Serum potassium. - Solu-Medrol is a corticosteroid with glucocorticoid and mineralocorticoid actions. These effects can lead to hyperglycemia (A), which is reflected as an increase in the serum glucose value. The client taking Solu-Medrol is at risk for hypocalcemia (B) and hypokalemia (D), which result in a decrease, not an increase, in the serum calcium and serum potassium levels. This medication does not adversely affect the RBC count (C). Parkinson’s Dz and is taking carbidopa-levodopa (Sinemet) indicate that the desired outcome of the medication is being achieved Lessening of tremors - Sinemet increases the amount of levodopa to the CNS (dopamine to the brain). Increased amounts of dopamine improve the symptoms of Parkinson's, such as involuntary movements, resting tremors (B), shuffling gait, etc. (A) is a side effect of Sinemet. Decreased drooling would be a desired effect, not (C). Sinemet does not affect (D). Preparing the 0900 dose of losartan (Cozaar) an angiotension-II receptor blocker (ARB) for a client with hypertension and heart failure Withhold the scheduled dose - The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker (ARB), for a client with hypertension and heart failure. The nurse reviews the client's laboratory results and notes that the client's serum potassium level is 5.9 mEq/L. What action should the nurse take first? A) Withhold the scheduled dose. B) Check the client's apical pulse. C) Notify the healthcare provider. D) Repeat the serum potassium level. - The nurse should first withhold the scheduled dose of Cozaar (A) because the client is hyperkalemic (normal range 3.5 to 5 mEq/L). Although hypokalemia is usually associated with diuretic therapy in heart failure, hyperkalemia is associated with several heart failure medications, including ARBs. Because hyperkalemia may lead to cardiac dysrhythmias, the nurse should check the apical pulse for rate and rhythm (B), and the blood pressure. Before repeating the serum study (D), the nurse should notify the healthcare provider (C) of the findings. Taking hydromorphone (Dilaudid) PO q4h at home. Following surgery Dilaudid IV q4h PRN and butorphanol tartrate (Stadol) IV q4h PRN are prescribed for pain. The pt received a dose of dilaudid IV 4 hours ago and is again requesting pain medication. What intervention should the nurse implement? Administer only the Dilaudid q4h PRN for pain Dobutamine (Dobutrex) is an emergency drug most commonly prescribed for which condition Heart failure - Dobutamine is a beta-1 adrenergic agonist that is indicated for short term use in cardiac decompensation or heart failure (D) related to reduced cardiac contractility due to organic heart disease or cardiac surgical procedures. Alpha and beta adrenergic agonists, such as epinephrine and dopamine, are sympathomimetics used in the treatment of shock (A). Other selective beta-2 adrenergic agonists, such as terbutaline and isoproterenol, are indicated in the treatment of asthma (B). Although dobutamine improves cardiac output, it is not used to treat hypotension (C). Giardiasis is taking metronidazole (Flagyl) 2 grams PO Take the medication with food - A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information should the nurse include in the client's instruction? A) Notify the clinic of any changes in the color of urine. B) Avoid overexposure to the sun. C) Stop the medication after the diarrhea resolves. D) Take the medication with food. - Flagyl, an amoebicide and antibacterial agent, may cause gastric distress, so the client should be instructed to take the medication on a full stomach (D). Urine may be red-brown or dark from Flagyl, but this side effect is not necessary to report (A). Photosensitivity (B) is not a side effect associated with Flagyl. Despite the resolution of clinical symptoms, antiinfective medications should be taken for their entire course because stopping the medication (C) can increase the risk of resistant organisms. The nitrate isosorbide denitrate (Isordil) is prescribed for a client with angina Do not get up quickly, always rise slowly - The nitrate isosorbide dinitrate (Isordil) is prescribed for a client with angina. Which instruction should the nurse include in this client's discharge teaching plan? A) Quit taking the medication if dizziness occurs. B) Do not get up quickly. Always rise slowly. C) Take the medication with food only. D) Increase your intake of potassium-rich foods. - An expected side effect of nitrates is orthostatic hypotension and the nurse should address how to prevent it--by rising slowly (B). Dizziness is expected, and the client should not quit taking the medication without notifying the healthcare provider (A). (C and D) are not indicated when taking this medication. Reviewing the use of the patient controlled analgesics (PCA) pump with a client in the immediate postoperative period The client will receive Morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per PCA to total 5 mg IV maximally per hour The rate and depth of the clients’ respirations - The nurse is reviewing the use of the patient-controlled analgesia (PCA) pump with a client in the immediate postoperative period. The client will receive morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per PCA to total 5 mg IV maximally per hour. What assessment has the highest priority before initiating the PCA pump? A) The expiration date on the morphine syringe in the pump. B) The rate and depth of the client's respirations. C) The type of anesthesia used during the surgical procedure. D) The client's subjective and objective signs of pain. - A life-threatening side effect of intravenous administration of morphine sulfate, an opiate narcotic, is respiratory depression (B). The PCA pump should be stopped and the healthcare provider notified if the client's respiratory rate falls below 12 breaths per minute, and the nurse should anticipate adjustments in the client's dosage before the PCA pump is restarted. (A, C, and D) provide helpful information, but are not as high a priority as the assessment described in (B). A peak and trough level must be drawn for a client receiving antibiotic therapy Immediately before the next antibiotic dose is given When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most important for the nurse to assess for pain in which area of the body Abdomen - Acetaminophen toxicity can result in liver damage; therefore, it is especially important for the nurse to assess for pain in the right upper quadrant of the abdomen (B), which might indicate liver damage. (A, C, and D) are not areas where pain would be anticipated. A client has myxedema which results from a deficiency of thyroid hormone synthesis in adults Pentobarbital sodium Nembutal Sodium for sleep - A client has myxedema, which results from a deficiency of thyroid hormone synthesis in adults. The nurse knows that which medication should be contraindicated for this client? A) Liothyronine (Cytomel) to replace iodine. B) Furosemide (Lasix) for relief of fluid retention. C) Pentobarbital sodium (Nembutal Sodium) for sleep. D) Nitroglycerin (Nitrostat) for angina pain - Persons with myxedema are dangerously hypersensitive to narcotics, barbiturates (C), and anesthetics. They do tolerate liothyronine (Cytomel) (A) and usually receive iodine replacement therapy. These clients are also susceptible to heart problems such as angina for which nitroglycerin (Nitrostat) (D) would be indicated, and congestive heart failure for which furosemide (Lasix) (B) would be indicated. Receiving ampicillin sodium (Omnipen) for a sinus infection Rash - A client is receiving ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs? A) Rash. B) Nausea. C) Headache. D) Dizziness. - Rash (A) is the most common adverse effect of all penicillins, indicating an allergy to the medication which could result in anaphylactic shock, a medical emergency. (B, C, and D) are common side effects of penicillins that should subside after the body adjusts to the medication. These would not require immediate medical care unless the symptoms persist beyond the first few days or become extremely severe. A client is being treated for osteoporosis with alendronate (Fosamax) and the nurse has completed discharge teaching regarding medication administration. Which morning schedule would indicate to the nurse that the client teaching has been effective? Take medication, go for a 30 minute morning walk, then eat breakfast - Alendronate (Fosamax) is best absorbed when taken thirty minutes before eating in the morning. The client should also be advised to remain in an upright position for at least thirty minutes after taking the medication to reduce the risk of esophageal reflux and irritation. (A) is the best schedule to meet these needs. (B, C, and D) do not meet these criteria. Continuous IV infusion of dopamine (Intiropin) and an IV of normal saline at 50 ml/hr the nurse notes that the clients urinary output has been 20 ml/hr for the last 2 hours Notify the healthcare provider of the urinary output Which change in data indicates to the nurse that the desired effect of the angiotension II receptor antagonist valsartan (Diovan) has been achieved Blood pressure reduced from 160/90 to 130/80 - Which change in data indicates to the nurse that the desired effect of the angiotensin II receptor antagonist valsartan (Diovan) has been achieved? A) Dependent edema reduced from +3 to +1. B) Serum HDL increased from 35 to 55 mg/dl. C) Pulse rate reduced from 150 to 90 beats/minute. D) Blood pressure reduced from 160/90 to 130/80. - Diovan is an angiotensin receptor blocker, prescribed for the treatment of hypertension. The desired effect is a decrease in blood pressure (D). (A, B, and C) do not describe effects of Diovan. A healthcare provider prescribes cephalexin monohydrate (Keflex) for a postoperative infection Penicillins - A healthcare provider prescribes cephalexin monohydrate (Keflex) for a client with a postoperative infection. It is most important for the nurse to assess for what additional drug allergy before administering this prescription? A) Penicillins. B) Aminoglycosides. C) Erythromycins. D) Sulfonamides. - Cross-allergies exist between penicillins (A) and cephalosporins, such as cephalexin monohydrate (Keflex), so checking for penicillin allergy is a wise precaution before administering this drug. Prescription for a scopolamine patch (Transderm Scop) to prevent motion sickness while on a cruise Apply the patch at least 4 hrs prior to departure - Scopolamine, an anticholinergic agent, is used to prevent motion sickness and has a peak onset in 6 hours, so the client should be instructed to apply the patch at least 4 hours before departure (A) on the cruise ship. The duration of the transdermal patch is 72 hours, so (B) is not needed. Scolopamine blocks muscarinic receptors in the inner ear and to the vomiting center, so the best application site of the patch is behind the ear, not at the base of the skull (C). Anticholinergic medications are CNS depressants, so the client should be instructed to avoid alcohol (D) while using the patch. Which antidiarrheal agent should be used with caution in clients taking high dosages of aspirin for arthritis Bismuth subsalicylate (Pepto Bismol) - Bismuth subsalicylate (Pepto Bismol) contains a subsalicylate that increases the potential for salicylate toxicity when used concurrently with aspirin (acetylsalicylic acid, another salicylate preparation). (A, B, and D) do not pose the degree of risk of drug interaction with aspirin as Pepto Bismol would. Prescriptions for morphine sulphate 2.5 mg IV q6h and ketorolac (Toradol) 30 mg IV q6h administer both medications according to the prescription - An adult client has prescriptions for morphine sulfate 2.5 mg IV q6h and ketorolac (Toradol) 30 mg IV q6h. Which action should the nurse implement? A) Administer both medications according to the prescription. B) Hold the ketorolac to prevent an antagonistic effect. C) Hold the morphine to prevent an additive drug interaction. D) Contact the healthcare provider to clarify the prescription. - Morphine and ketorolac (Toradol) can be administered concurrently (A), and may produce an additive analgesic effect, resulting in the ability to reduce the dose of morphine, as seen in this prescription. Toradol is an antiinflammatory analgesic, and does not have an antagonistic effect with morphine (B), like an agonist-antagonist medication would have. An additive analgesic effect is desirable (C), because it allows a reduced dose of morphine. This prescription does not require any clarification, and can be administered safely as written (D). Hyperlipidemia receives a prescription for niacin (Niaspan) Expected duration of flushing - A client with hyperlipidemia receives a prescription for niacin (Niaspan). Which client teaching is most important for the nurse to provide? A) Expected duration of flushing. B) Symptoms of hyperglycemia. C) Diets that minimize GI irritation. D) Comfort measures for pruritis. - Flushing of the face and neck, lasting up to an hour, is a frequent reason for discontinuing niacin. Inclusion of this effect in client teaching (A) may promote compliance in taking the medication. Which drug is used as a palliative treatment for a client with tumor-induced spinal cord compression Dexamethasone (Decadron) - Dexamethasone (D) is a palliative treatment modality to manage symptoms related to compression due to tumor growth. Morphine sulphate (A) is an opioid analgesic used in oncology to manage severe or intractable pain. Ibuprofen (B), a nonsteroidal antiinflammatory drug (NSAID), provides relief for mild to moderate pain, suppression of inflammation, and reduction of fever. Amitriptyline (C), a tricyclic antidepressant, is often prescribed for pain related to neuropathic origin and provides a reduction in opioid dosage. Upon admission to the emergency center, an adult client with acute status asthmaticus is prescribed this series of medications In which order Albuterol (Proventil) puffs Salmeterol (Serevent Diskus) Prednisone (Deltasone) orally Gentamicin (Garamycinim) IM - Status asthmaticus is potentially a life-threatening respiratory event, so albuterol (C), a beta2 adrenergic agonist and bronchodilator, should be administered by inhalation first to provide rapid and deep topical penetration to relieve bronchospasms, dilate the bronchioles, and increase oxygenation. In stepwise management of persistent asthma, a long-action bronchodilator, such as salmeterol (Serevent Diskus) (D) with a 12-hour duration of action should be given next. Prednisone (A), an oral corticosteroid, provides prolonged anti-inflammatory effects and should be given after the client's respiratory distress begins to resolves. Gentamicin (B), an antibiotic, is given deep IM, which can be painful, and may require repositioning the client, so should be last in the sequence. 43- year-old female receiving thyroid replacement hormone following a thyroidectomy What adverse effects associated with thyroid hormone toxicity should the nurse instruct the client to report promptly to the healthcare provider? Tachycardia and chest pain - Thyroid replacement hormone increases the metabolic rate of all tissues, so common signs and symptoms of toxicity include tachycardia and chest pain (B). (A, C, and D) do not indicate a thyroid hormone toxicity. Receiving clonidine (Catapres) 0.1 mg q24h via transdermal patch Blood pressure changed from 180/120 to 140/70 - A client is receiving clonidine (Catapres) 0.1 mg/24hr via transdermal patch. Which assessment finding indicates that the desired effect of the medication has been achieved? A) Client denies recent episodes of angina. B) Change in peripheral edema from +3 to +1. C) Client denies recent nausea or vomiting. D) Blood pressure has changed from 180/120 to 140/70. - Catapres acts as a centrally-acting analgesic and antihypertensive agent. (D) indicates a reduction in hypertension. Catapres does not affect (A, B, or C), so these findings do not indicate desired outcomes of Catapres. Which nursing Dx is important to include in the plan of care for a client receiving the angiotension II receptor antagonist irbesartan (Avapro) Risk for injury - Avapro is an antihypertensive agent, which acts by blocking vasoconstrictor effects at various receptor sites. This can cause hypotension and dizziness, placing the client at high risk for injury (C). Avapro does not act as a diuretic (A), impact the immune system (B), or alter sleep patterns (D). Osteoarthritis receives a new prescription for celecoxib (Celebrex) orally for symptom management. The nurse notes the client is allergic to sulfa Notify the healthcare provider In evaluating the effects of lactulose (Cefulac) which outcome should indicate that the drug is performing as intended? Two or three soft stools per day - Lactulose is administered to reduce blood ammonia by excretion of ammonia through the stool. Two to three stools a day indicate that lactulose is performing as intended (B). (A) would be expected if the patient received a diuretic. (C) would indicate an overdose of lactulose and is not expected. Lactulose does not affect (D). Patient with dysrhythmia is to receive procainamide (Pronestyl) in a 4 divided dose over the next 24 hours. What dosing schedule is best for the nurse to implement? Q6h The nurse is transcribing a new prescription for spironolactone (Adactone) for pt who receives an angiotension-converting enzyme (ACE) inhibitor Verify both prescriptions with the healthcare provider - The nurse is transcribing a new prescription for spironolactone (aldactone) for a client who receives an angiotensin-converting enzyme inhibitor. Which action should the nurse implement A. verify both prescriptions with the HCP B. report the med interactions to the nurse manager C. hold the ACE inhibitor and give the new prescription D. Transcribe and send the prescription to the pharmacy - the concomitant use of an ACE inhibitor and a potassium-sparing diuretic sucha s spironolactone, should be given with caution b/c the two drugs may interact to cause an elevation in serum potassium levels. Admitted to the coronary care unit with a medical Dx of acute myocardial infarction. Which medication prescription decreases both preload and afterload? Nitroglycerin - Nitroglycerin (A) is a nitrate that causes peripheral vasodilation and decreases contractility, thereby decreasing both preload and afterload. (B) is a beta adrenergic blocker that decreases both heart rate and contractility, but only decreases afterload. Morphine (C) decreases myocardial oxygen consumption and preload. Capoten (D) is an angiotensin converting enzyme (ACE) inhibitor that acts to prevents vasoconstriction, thereby decreasing blood pressure and afterload. After abdominal surgery prescribed low molecular weight heparin (LMWH) This medication is a blood thinner given to prevent blood clot formation An antacid, (Maalox) is prescribed for a client with peptic ulcer Dz Maintain a gastric pH of 3.5 or above Pt states “I am allergic to penicillin” Cephalosporins A category X drug is prescribed for a young adult female client Use a reliable form of birth control - A category X drug is prescribed for a young adult female client. Which instruction is most important for the nurse to teach this client? A) Use a reliable form of birth control. B) Avoid exposure to ultra violet light. C) Refuse this medication if planning pregnancy. D) Abstain from intercourse while on this drug. - Drugs classified in the category X place a client who is in the first trimester of pregnancy at risk for teratogenesis, so women in the childbearing years should be counseled to use a reliable form of birth control (A) during drug therapy. (B) is not a specific precaution with Category X drugs. The client should be encouraged to discuss plans for pregnancy with the healthcare provider, so a safer alternative prescription (C) can be provided if pregnancy occurs. Although the risk of birth defects during pregnancy explains the restriction of these drugs during pregnancy, (D) is not indicated. Admitted to the hospital for Dx testing for possible myasthenia gravis prepares for IV administration of edrophonium chloride (Tensilon) Decreases muscle weakness - A client is admitted to the hospital for diagnostic testing for possible myasthenia gravis. The nurse prepares for intravenous administration of edrophonium chloride (Tensilon). What is the expected outcome for this client following administration of this pharmacologic agent? A) Progressive difficulty with swallowing. B) Decreased respiratory effort. C) Improvement in generalized fatigue. D) Decreased muscle weakness. - Administration of edrophonium chloride (Tensilon), a cholinergic agent, will temporarily reduce muscle weakness (D), the most common complaint of newly-diagnosed clients with myasthenia gravis. This medication is used to diagnose myasthenia gravis due to its short duration of action. This drug would temporarily reverse (A and B), not increase these symptoms. (C) is not a typical complaint of clients with myasthenia gravis, but weakness of specific muscles, especially after prolonged use, is a common symptom. Which symptoms are serious adverse effects of Beta-adrenergic blockers such as propranolol (Inderal) Wheezing, hypotension and AV block - (B) represents the most serious adverse effects of beta-blocking agents. AV block is generally associated with bradycardia and results in potentially life- threatening decreases in cardiac output. Additionally, wheezing secondary to bronchospasm and hypotension represent life-threatening respiratory and cardiac disorders. (A, C, and D) are not associated with beta-blockers. Prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs Make an appointment to see the healthcare provider because muscle pain may be a serious side effect - A client who was prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs. Which statement reflects the correct drug-specific teaching the nurse should provide to this client? A) Increase consumption of potassium-rich foods since low potassium levels can cause muscle spasms. B) Have serum electrolytes checked at the next scheduled appointment to assess hyponatremia, a cause of cramping. C) Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. D) Be sure to consume a low-cholesterol diet while taking the drug to enhance the effectiveness of the drug. - Myopathy, suggested by the leg pain and weakness, is a serious, and potentially life-threatening, complication of Lipitor, and should be evaluated immediately by the healthcare provider (C). Although electrolyte imbalances such as (A or B) can cause muscle spasms in some cases, this is not the likely cause of leg pain in the client receiving Lipitor, and evaluation by the healthcare provider should not be delayed for any reason. A low-cholesterol diet is recommended for those taking Lipitor since the drug is used to lower total cholesterol (D), but diet is not related to the leg pain symptom. The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands Another type of non- steroidal anti-inflammatory drug may be indicated - The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide? A) The frequency of the dosing is necessary to increase the effectiveness. B) Therapeutic blood levels of this drug are reached in 4 to 6 weeks. C) Another type of nonsteroidal antiinflammatory drug may be indicated. D) Systemic corticosteroids are the next drugs of choice for pain relief. - Individual responses to nonsteroidal antiinflammatory drugs are variable, so (C) is the best response. Naproxen is usually prescribed every 8 hours, so (A) is not indicated. The peak for naproxen is one to two hours, not (B). Corticosteroids are not indicated for osteoarthritis (D). Dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol) - A client's dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily. When the client reports the onset of a headache prior to the next scheduled dose, which action should the nurse implement? A) Hold the next scheduled dose of Imdur 60 mg and administer a PRN dose of acetaminophen (Tylenol). B) Administer the 40 mg of Imdur and then contact the healthcare provider. C) Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol). D) Do not administer the next dose of Imdur or any acetaminophen until notifying the healthcare provider. - Imdur is a nitrate which causes vasodilation. This vasodilation can result in headaches, which can generally be controlled with acetaminophen (C) until the client develops a tolerance to this adverse effect. (A and B) may result in the onset of angina if a therapeutic level of Imdur is not maintained. Lying down (D) is less likely to reduce the headache than is a mild analgesic. Coronary artery Dz. is taking digoxin (Lanoxin) receives a new prescription for atorvastatin (Lipitor) Vomiting - A client with coronary artery disease who is taking digoxin (Lanoxin) receives a new prescription for atorvastatin (Lipitor). Two weeks after initiation of the Lipitor prescription, the nurse assesses the client. Which finding requires the most immediate intervention? A) Heartburn. B) Headache. C) Constipation. D) Vomiting. - Vomiting, anorexia and abdominal pain are early indications of digitalis toxicity. Since Lipitor increases the risk for digitalis toxicity, this finding requires the most immediate intervention by the nurse (D). (A, B and C) are expected side effects of Lipitor. A client is being treated for hyperthyroidism with propylthiouracil (PTU) Inhibit synthesis of T3 and T4 by the thyroid gland - A client is being treated for hyperthyroidism with propylthiouracil (PTU). The nurse knows that the action of this drug is to A) decrease the amount of thyroid-stimulating hormone circulating in the blood. B) increase the amount of thyroid-stimulating hormone circulating in the blood. C) increase the amount of T4 and decrease the amount of T3 produced by the thyroid. D) inhibit synthesis of T3 and T4 by the thyroid gland. - PTU is an adjunct therapy used to control hyperthyroidism by inhibiting production of thyroid hormones (D). It is often prescribed in preparation for thyroidectomy or radioactive iodine therapy. Thyroid-stimulating hormone (TSH) is produced by the pituitary gland, and PTU does not affect the pituitary (A and B). PTU inhibits the synthesis of all thyroid hormones--both T3 and T4(C). Following sublingual nitroglycerin to a pt experiencing an acute anginal attack Client states chest pain is relieved Spironolactone (Aldactone) for heart failure is Rx Refrain from eating foods high in potassium - A client with heart failure is prescribed spironolactone (Aldactone). Which information is most important for the nurse to provide to the client about diet modifications? A) Do not add salt to foods during preparation. B) Refrain for eating foods high in potassium. C) Restrict fluid intake to 1000 ml per day. D) Increase intake of milk and milk products. - Spironolactone (Aldactone), an aldosterone antagonist, is a potassium- sparing diuretic, so a diet high in potassium should be avoided (B), including potassium salt substitutes, which can lead to hyperkalemia. Although (A) is a common diet modification in heart failure, the risk of hyperkalemia is more important with Aldactone. Restriction of fluids (C) or increasing milk and milk products (D) are not indicated with this prescription. Medication described as a Beta1 agonist is most commonly prescribed for a client with which condition Heart failure Assessing a client that is experiencing anaphylaxis from an insect sting Epinephrine Instruction to give to a female who just received a Rx for oral metronidazoleI(Flagyl) for treatment of trichomonas vaginalis Increase fluid intake, especially cranberry juice Avoid drinking alcohol while taking this medication Use condoms until Tx is completed Ensure that all sexual partners are Tx at the same time Receiving doxorubicin (Adriamycin) IV complains of pain at the insertion site and the nurse notes edema at the site D/C IV fluids Assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis Notify the healthcare provider of this finding immediately - The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports that she can't hear the nurse's questions because her ears are ringing. What action should the nurse implement? A) Refer the client to an audiologist for evaluation of her hearing. B) Advise the client that this is a common side effect of aspirin therapy. C) Notify the healthcare provider of this finding immediately. D) Ask the client to turn off her hearing aid during the exam. - Tinnitus is an early sign of salicylate toxicity. The healthcare provider should be notified immediately (C), and the medication discontinued. (A and D) are not needed, and (B) is inaccurate. Pt asks the nurse if glipizide (Glucotrol) is oral insulin No, it is not oral insulin and can be used only when some Beta cell function is present - A client asks the nurse if glipizide (Glucotrol) is an oral insulin. Which response should the nurse provide? A) "Yes, it is an oral insulin and has the same actions and properties as intermediate insulin." B) "Yes, it is an oral insulin and is distributed, metabolized, and excreted in the same manner as insulin." C) "No, it is not an oral insulin and can be used only when some beta cell function is present." D) "No, it is not an oral insulin, but it is effective for those who are resistant to injectable insulins." - An effective oral form of insulin has not yet been developed (C) because when insulin is taken orally, it is destroyed by digestive enzymes. Glipizide (Glucotrol) is an oral hypoglycemic agent that enhances pancreatic production of insulin. (A, B, and D) do not provide accurate information. Which medication should the nurse caution the client about taking while receiving an opioid analgesic Benzodiazepines - Respiratory depression increases with the concurrent use of opioid analgesics and other central nervous system depressant agents, such as alcohol, barbiturates, and benzodiazepines (B). (A and D) do not interact with opiates to produce adverse effects. Antihypertensives (C) may cause morphine-induced hypotension, but should not be withheld without notifying the healthcare provider. Postoperative and has been receiving a continuous IV infusion of mepreidine (Demerol) 35 mg per hr for 4 days and has a PRN Rx for Demerol for 100 mg PO q3h Decrease the IV infusion rate of the mepreidine (Demerol) per protocol - A postoperative client has been receiving a continuous IV infusion of meperidine (Demerol) 35 mg/hr for four days. The client has a PRN prescription for Demerol 100 mg PO q3h. The nurse notes that the client has become increasingly restless, irritable and confused, stating that there are bugs all over the walls. What action should the nurse take first? A) Administer a PRN dose of the PO meperidine (Demerol). B) Administer naloxone (Narcan) IV per PRN protocol. C) Decrease the IV infusion rate of the meperidine (Demerol) per protocol. D) Notify the healthcare provider of the client's confusion and hallucinations. - The client is exhibiting symptoms of Demerol toxicity, which is consistent with the large dose of Demerol received over four days. (C) is the most effective action to immediately decrease the amount of serum Demerol. (A) will increase the toxic level of medication in the bloodstream. Naloxone (B) is an opioid antagonist that is used during an opioid overdose, but it is not beneficial during Demerol toxicity and can precipitate seizures. The healthcare provider should be notified (D), but that is not the initial action the nurse should take; first the amount of drug infusing should be decreased. Congestive heart failure (CHF) is being discharged with a new Rx for the angiotension-converting enzyme (ACE) inhibitor captopril (Capoten) Dizziness - A client with congestive heart failure (CHF) is being discharged with a new prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten). The nurse's discharge instruction should include reporting which problem to the healthcare provider? A) Weight loss. B) Dizziness. C) Muscle cramps. D) Dry mucous membranes. - Angiotensin-converting enzyme (ACE) inhibitors are used in CHF to reduce afterload by reversing vasoconstriction common in heart failure. This vasodilation can cause hypotension and resultant dizziness (B). (A) is desired if fluid overload is present, and may occur as the result of effective combination drug therapy such as diuretics with ACE inhibitors. (C) often indicates hypokalemia in the client receiving diuretics. Excessive diuretic administration may result in fluid volume deficit, manifested by symptoms such as (D). Heparin Tx for a pulmonary embolism a client is being discharged with a Rx for warfarin (Coumadin) Prothrombin Time (PT/INR) - Following heparin treatment for a pulmonary embolism, a client is being discharged with a prescription for warfarin (Coumadin). In conducting discharge teaching, the nurse advises the client to have which diagnostic test monitored regularly after discharge? A) Perfusion scan. B) Prothrombin Time (PT/INR). C) Activated partial thromboplastin (APTT). D) Serum Coumadin level (SCL). - When used for a client with pulmonary embolus, the therapeutic goal for warfarin therapy is a PT 1½ to 2½ times greater than the control, or an INR of 2 to 3 (B). A perfusion might be performed to monitor lung function, but not monthly (A). APTT is monitored for the client receiving heparin therapy (C). A blood level for Coumadin cannot be measured (D). Receiving metoprolol (Lopressor SR) Blood pressure - A client is receiving metoprolol (Lopressor SR). What assessment is most important for the nurse to obtain? A) Temperature. B) Lung sounds. C) Blood pressure. D) Urinary output. Teaching for liver transplant about cyclosporine (Sandimmune) the nurse should encourage the pt to report which adverse response Presence of hand tremors - Neurological complications, such as hand tremors (B), occur in about 50% of clients taking cyclosporine and should be reported. Although this drug can be nephrotoxic, (A) typically does not occur. (C and D) are common side effects, but are not usually severe. Older client with a decreased percentage of lean body receives a Rx that is adjusted based on which pharmacokinetic process? Distribution - A decreased lean body mass in an older adult affects the distribution of drugs (D), which affects the pharmacokinetics of drugs. Decreased gastric pH, delayed gastric emptying, decreased splanchnic blood flow, decreased gastrointestinal absorption surface areas and motility affect (A) in the older adult population. Decreased hepatic blood flow, decreased hepatic mass, and decreased activity of hepatic enzymes affect (B) in older adults. Decreased renal blood flow, decreased glomerular filtration rate, decreased tubular secretion, and decreased number of nephrons affects (C) in an older adult. [Show More]

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