PHARM 100 PHARMACOLOGY HESI PRACTICE EXAM

PHARM 100 PHARMACOLOGY HESI PRACTICE EXAM The health care provider prescribes carbamazepine for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have bl ...

PHARM 100 PHARMACOLOGY HESI PRACTICE EXAM The health care provider prescribes carbamazepine for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. The mother asks why so many blood tests are necessary. Which complication is assessed through frequent laboratory testing that the nurse should explain to this mother? Myelosuppression Rationale: Myelosuppression is the highest priority complication that can potentially affect clients managed with carbamazepine therapy. The client requires close monitoring for this condition by weekly laboratory testing. Hepatic function may be altered, but this complication does not have as great a potential for occurrence as Myelosupression A client is prescribed a cholinesterase inhibitor, and a family member asks the nurse how this medication works. Which pharmacophysiologic explanation should the nurse use to describe this class of drug? Improves nerve impulse transmission Rationale: Cholinesterase inhibitors work to increase the availability of acetylcholine at cholinergic synapses, which aids in neuronal transmission and assists in memory formation. A client is ordered 22 mg of gentamicin by IM injection. The drug is available in 20 mg/2 mL. How many milliliters should be administered? 2.2 mLRationale: (22 mg/20 mg) × (x mL/2 mL) = 22x = 40 x = 2.2 mL In addition to nitrate therapy, a client is receiving nifedipine, 10 mg PO every 6 hours. The nurse should plan to observe for which common side effect of this treatment regimen? Hypotension Rationale: Nifedipine reduces peripheral vascular resistance and nitrates produce vasodilation, so concurrent use of nitrates with nifedipine can cause hypotension with the initial administration of these agents. Which response best supports the observations that the nurse identifies in a client who is experiencing a placebo effect? Psychological response to inert medication Rationale: The placebo effect is a response in the client that is caused by the psychological impact of taking an inert drug that has no biochemical properties. A placebo effect can be therapeutic, negative, or ineffective but provides no cure or benefit to the client's progress. The placebo effect may evoke behavioral changes but does not affect neurochemical psychotropic changes. Malingering and drug seeking are behaviors that a client exhibits to obtain treatment for nonexistent disorders or obtain prescription medications.A 42-year-old client is admitted to the emergency department after taking an overdose of amitriptyline in a suicide attempt. Which drug should the nurse plan to administer to reverse the cardiac and central nervous system effects of amitriptyline? Sodium bicarbonate Rationale: Sodium bicarbonate is an effective treatment for an overdose of tricyclic antidepressants such as amitriptyline to reverse QRS prolongation. A 67-year-old client is discharged from the hospital with a prescription for digoxin, 0.25 mg daily. Which instruction should the nurse include in this client's discharge teaching plan? Take and record radial pulse rate daily. Rationale: Monitoring pulse rate is very important when taking digoxin. The client should be further instructed to report pulse rates <60 or >110 beats/min and to withhold the dosage until consulting with the health care provider in such a case. Vision change is an indication of drug toxicity, and the client should be instructed to report this immediately. A 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous hospitalizations have occurred since the diagnosis because of noncompliance with the prescribed medication regimen. Which drug might work best for this particular client? Fluphenazine decanoate Rationale: Fluphenazine, an antipsychotic drug that can be given IM, has a rapid onset (1 to 2 hours) and a long duration of action (up to 3 or 4 weeks), so it would be the drug of choice for a noncompliant psychotic client. Chlorpromazine HCl is an antipsychotic drug used to treat schizophrenia and is usually administered PO (IM doses are short-acting). The client must be compliant in taking this drug for it to be effective. Lithium carbonate is most effective with manic and depressive bipolar affective disorders. Diazepam is an anti-anxiety drug and would not be effective for a psychotic disorder.A client is being discharged with a prescription for sulfasalazine to treat ulcerative colitis. Which instruction should the nurse provide to this client prior to discharge? Drink at least eight glasses of fluid a day Rationale: Adequate hydration is important for all sulfa drugs because they can crystallize in the urine. If possible, the drug should be taken after eating to provide longer intestinal transit time. Maintaining good oral hygiene is important for other medications, such as phenytoin, because of the incidence of gingival hyperplasia, Discontinue use of the drug gradually is important for steroid administration. Amoxicillin, 500 mg PO every 8 hours, is prescribed for a client with an infection. The drug is available in a suspension of 125 mg/5 mL. How many milliliters should the nurse administer with each dose? 20 mL Rationale: 500 mg/x mL = 125 mg/5 mL 125x = 2500 x = 20 mL A client with acute lymphocytic leukemia is to begin chemotherapy today. The health care provider's prescription specifies that ondansetron is to be administered IV 30 minutes prior to the infusion of cisplatin. What is the rationale for administering Zofran prior to the chemotherapy induction? Reduction or elimination of nausea and vomiting Rationale: Ondansetron is a type 3 receptor (5-HT3) antagonist that is recognized for improved control of acute nausea and vomiting associated with chemotherapy. 5-HT3 antagonists are most effective when administered IV prior to the induction of the chemotherapeutic agent(s). A client with chronic gouty arthritis is talking allopurinol, 100 mg PO daily. Which laboratory serum level should the nurse report to the health care provider to determine the therapeutic outcome? Uric acid levelRationale: The primary therapeutic outcome associated with allopurinol therapy is reduced serum uric acid levels with a lower frequency of acute gouty attacks, so uric acid level should be reported to the health care provider. The nurse is reviewing prescribed medications with a female client who is preparing for discharge. The client asks the nurse why the oral dose of an opioid analgesic is higher than the IV dose that she received during hospitalization. Which response is best for the nurse to provide? Oral forms of drugs must pass through the liver first, where more of the dose is metabolized. Rationale: Oral doses of medication are usually larger than parenteral doses to compensate for the first-pass effect in the liver after oral administration, which metabolizes more of the drug's dose before affecting its therapeutic response. Although recommended dose ranges for adults should be individualized, a client's pain should be controlled at discharge. The nurse performs a client assessment prior to the administration of a prescribed dose of dipyridamole and aspirin PO. The nurse notes that the client's carotid bruit is louder than previously assessed. Which action should the nurse implement? Administer the prescribed dose as scheduled. Rationale: A carotid bruit reflects the degree of blood vessel turbulence, which is typically the result of atherosclerosis. Aspirin is prescribed to reduce platelet aggregation and should be administered to this client, who is at high risk for thrombus occlusion. A client experiencing dysrhythmias is given quinidine, 300 mg PO every 6 hours. The nurse plans to observe this client for which common side effect associated with the use of this medication? Diarrhea Rationale: The most common side effects associated with quinidine therapy are gastrointestinal complaints, such as diarrhea.A male client with prostatic carcinoma has arrived for his scheduled dose of docetaxel chemotherapy. What symptom would indicate a need for an immediate response by the nurse prior to implementing another dose of this chemotherapeutic agent? A cough that is new and persistent Rationale: A cough that is new and persistent is an adverse effect that is immediately life threatening. Severe fluid retention can cause pleural effusion (requiring urgent drainage), dyspnea at rest, cardiac tamponade, or pronounced abdominal distention (caused by ascites). Persistent nausea and vomiting, Fingernail and toenail changes and Increasing weakness and neuropathy are all adverse effects from chemotherapy and need to be monitored consistently. The nurse is preparing to administer a secondary infusion of a dobutamine solution to a client. The nurse notes that the solution is brown in color. Which action should the nurse implement? Administer the drug if the solution's reconstitution time is <24 hours. Rationale: The color of the dobutamine solution is normal, and the solution should be administered within 24 hours after reconstitution, so the time of reconstitution should be verified before administering the solution of medication. Which instruction should the nurse include in the teaching plan for a client who is receiving phenytoin for seizure control? Brush and floss teeth daily. Rationale: Brushing and flossing the teeth daily prevents gingival hyperplasia (gum disease) that is common with long-term phenytoin therapy. When providing client teaching about the administration of methylphenidate (Ritalin) to a parent of a child diagnosed with ADHD, which instruction should the nurse include in the teaching plan? Offer the child the medication with breakfast and after the child eats lunch.Rationale: Administering the medication at breakfast and after lunch provides the correct spacing of the doses to maximize the child's attention span and helps prevent the appetite suppression associated with the drug. Doses should be spaced at 6-hour intervals. A dose given mid-afternoon is likely to increase insomnia. Doses should be discontinued only for brief intervals (with the health care provider's approval) when the client's condition is being evaluated or if the client is being weaned from the medication entirely. A primigravida at 34 weeks of gestation is admitted to labor and delivery in preterm labor. She is started on a terbutaline sulfate continuous IV infusion via pump. This therapy is ineffective, and the baby is delivered vaginally. For which complication should the nurse monitor in this infant during the first few hours after delivery? Hypoglycemia Rationale: Hypoglycemia may occur in the neonate because a side effect of terbutaline sulfate is increased maternal serum glucose levels. Monitoring for hypoglycemia is the priority following the maternal administration of terbutaline sulfate. In administering the antiinfective agent chloramphenicol IV to a client with bacterial meningitis, the nurse observes the client closely for signs of bone marrow depression. Which laboratory data would be most important for the nurse to monitor? Platelet count Rationale: Chloramphenicol can cause irreversible, fatal bone marrow depression, so the nurse should monitor the client's platelet count. A client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCl. Which assessment finding would require immediate intervention by the nurse? Demonstrates Parkinson-like symptoms, such as cogwheel rigidity.Rationale: Metoclopramide HCl blocks dopamine receptors in the brain, which can cause the extrapyramidal symptoms associated with Parkinson disease. Reglan has been associated with hypertension. An unpleasant metallic taste in the mouth is often associated with metronidazole, not metoclopramide HCl. The nurse is scheduling a client's antibiotic peak and trough levels with the laboratory personnel. What is the best schedule for drawing the trough level? Instruct the laboratory to draw the trough immediately before the next scheduled dose. Rationale: The best time to draw a trough is the closest time to the next administration. A client who is HIV-positive is receiving combination therapy with the antiviral medication zidovudine. Which instruction should the nurse include in this client's teaching plan? Return to the clinic every 2 weeks for blood counts. Rationale: Bone marrow depression with granulocytopenia is a severe but common adverse effect of zidovudine. Careful monitoring of CBCs is indicated. Dizziness is an expected side effect. The client should be instructed to avoid driving until this reaction improves. To evaluate whether the administration of an antihypertensive medication has caused a therapeutic effect, which action should the nurse implement? Compare the client's blood pressure before and after the client takes the medication. Rationale: Therapeutic effects are the expected or predictable physiologic responses to a medication. An antihypertensive medication is administered to lower blood pressure, so to determine if the therapeutic effect has been achieved, the nurse should compare the client's blood pressure before and after the client takes the medication. Ask the client about the onset of any dizziness since taking the medication and Measure the client's blood pressure while the client is lying, sitting, and thenstanding provide data related to the side effect of hypotension, which may occur following the administration of an antihypertensive medication. Interviewing the client about any past or recent history of high blood pressure provides useful data but does not evaluate the medication's effectiveness. A female client with myasthenia gravis is taking a cholinesterase inhibitor and asks the nurse what can be done to remedy her fatigue and difficulty swallowing. What action should the nurse implement? Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms. Rationale: Maintaining optimal dosage for cholinesterase inhibitors can be challenging for clients with myasthenia gravis. Clients should be taught to recognize signs of over-medication and under-medication so that they can modify the dosage themselves based on a prescribed sliding scale. The health care provider prescribes oral contraceptives for a client who wants to prevent pregnancy. Which information is the most important for the nurse to provide to this client? Take one pill at the same time every day until all the pills are gone. Rationale: To maintain adequate hormonal levels for contraception and enhance compliance, oral contraceptives should be taken at the same time each day. There is no strong pharmacokinetic evidence that shows a relationship between the category of broad-spectrum antibiotic use and altered hormone levels in oral contraceptive users. Abstinence is the best method to prevent pregnancy during the first cycle. If a client misses two pills during the first week, the client should take two pills a day for 2 days and finish the package while using a backup method of birth control until her next menstrual cycle. Dopamine is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response? Increase in urine output Rationale: Intropin activates dopamine receptors in the kidney and dilates blood vessels to improve renal perfusion, so an increase in urine output indicates an increase in glomerular filtration caused byincreased arterial blood pressure. Dopamine increases cardiac output, which increases a client's blood pressure. A female client is receiving tamoxifen following surgery for breast cancer. She reports the onset of hot flashes to the nurse. Which intervention should the nurse implement? Instruct the client that hot flashes are a side effect that often occurs with the use of this medication. Rationale: Tamoxifen is an estrogen receptor blocker used to treat breast carcinoma. Hot flashes are a common side effect. If the hot flashes become bothersome, the client can be instructed in measures to reduce the discomfort. In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, the nurse writes a nursing diagnosis of alteration in nutrition: less than body requirements, related to inadequate digestion of nutrients. Which intervention would best meet this child's needs? Give pancrelipase capsule mixed with applesauce before each meal. Rationale: Pancreatic enzyme replacement with pancrelipase is a major component of cystic fibrosis nutritional management. Aluminum hydroxide and magnesium hydroxide may be given before meals with enzymes to reduce gastric acidity and prevent enzyme destruction but are ineffective when used alone to promote enzyme replacement. Administering cholestyramine resin before each meal and at bedtime and administering omeprazole for gastroesophageal reflux are used to treat steatorrhea in cystic fibrosis. The nurse is preparing to administer amphotericin B IV to a client. What laboratory data is most important for the nurse to assess before initiating an IV infusion of this medication? Serum potassium level Rationale: The nurse should obtain baseline potassium levels prior to beginning drug therapy because amphotericin B changes cellular permeability, allowing potassium to escape from the cell, which could lead to a decrease in the serum potassium level and severe hypokalemia.The health care provider prescribes cisplatin to be administered in 5% dextrose and 0.45% normal saline with mannitol added. Which assessment parameters would be most helpful to the nurse in evaluating the effectiveness of the therapy? Urine output Rationale: The effectiveness of the diuresis is best measured by urine output. Mannitol, an osmotic diuretic, is given during cisplatin therapy to promote diuresis and reduce the risk of nephrotoxicity and ototoxicity associated with this chemotherapeutic agent. Which statement indicates that client teaching regarding the administration of the chemotherapeutic agent daunorubicin HCl has been effective? "I expect my urine to be red for the next few days." Rationale: Daunorubicin HCl causes the urine to turn red in color. Which question should the nurse ask a client prior to the initiation of treatment with IV infusions of gentamicin sulfate? "Are you having difficulty hearing?" Rationale: Complications of gentamicin sulfate therapy include ototoxicity, nephrotoxicity, and neurotoxicity. Determining if the client is hard of hearing prior to initiation of this aminoglycoside will be helpful as the treatment progresses and ototoxicity is identified as a possible complication. A child with cystic fibrosis is receiving ticarcillin disodium for Pseudomonas pneumonia. For which adverse effect should the nurse assess and report promptly to the health care provider? PetechiaeRationale: Adverse effects of ticarcillin disodium include hypothrombinemia and decreased platelet adhesion, which can result in the presence of petechiae. A client has a positive skin test for tuberculosis. Which prophylactic drug should the nurse expect to administer to this client? Isoniazid Rationale: Isoniazid is the drug of choice for treatment of clients with positive skin tests for tuberculosis. The nurse notes that the hemoglobin level of a client receiving darbepoetin alfa has increased from 6 to 10 g/dL over the first 2 weeks of treatment. Which action should the nurse take? Notify the health care provider of the change in the client's laboratory values. Rationale: Although an increase in the client's hemoglobin level is desired, a rapid increase (more than 1 g/dL in a 2-week period) may lead to hypertension, so the health care provider should be notified of this excessive increase. During the initial nursing assessment history, a client tells the nurse that he is taking tetracycline hydrochloride for urethritis. The nurse is most concerned if the client reports taking which medication concurrently? Sucralfate Rationale: Sucralfate is used to treat duodenal ulcers and will bind with tetracycline hydrochloride, inhibiting this antibiotic's absorption. A client with metastatic cancer who has been receiving fentanyl for several weeks reports to the nurse that the medication is not effectively controlling the pain. Which intervention should the nurse initiate? Notify the health care provider of the need to increase the dose.Rationale: Clients can develop a tolerance to the analgesic effect of opioids and may require an increased dose for effective long-term pain relief. The client is not exhibiting indications of dependence, withdrawal, or toxicity. A client being treated for an acute myocardial infarction is to receive the tissue plasminogen activator alteplase. The nurse would be correct in providing which explanation to the client regarding the purpose of this drug? This drug is a clot buster that dissolves clots within a coronary artery. Rationale: t-PA, or tissue plasminogen activator, is a coronary-specific fibrinolytic agent that dissolves clots within the coronary arteries. This drug is not a calcium channel blocker or nitrate, which would promote vasodilation of the coronary arteries. This medication is not an anticoagulant, such as warfarin or heparin, which would prevent new clot formation. Volume expansion is not provided by an infusion of tPA and would not necessarily improve myocardial perfusion caused by an increased cardiac output in a client with coronary artery disease. A client with angina pectoris is instructed to take sublingual nitroglycerin tablets PRN for chest pain. Which instruction should the nurse include in the client's teaching plan? Take one tablet at the onset of angina and stop activity. Rationale: Nitroglycerin tablets should be taken at the onset of angina, and the client should stop activity and rest. One tablet can be taken every 5 minutes, up to three doses. Nitroglycerin should be replaced every 3 to 6 months. Nitroglycerin should provide relief in 5 minutes. The nurse is preparing a plan of care for a client receiving the glucocorticoid methylprednisolone. Which nursing diagnosis reflects a problem related to this medication that should be included in the care plan? Risk for infection Rationale: Corticosteroids depress the immune system, placing the client at risk for infection.The nurse is providing discharge instructions to a client who has received a prescription for an antibiotic that is hepatotoxic. Which information should the nurse include in the instructions? Avoid ingesting any alcohol or acetaminophen. Rationale: Combining hepatotoxic drugs, such as acetaminophen and alcohol, increases the risk of liver damage. A client who is receiving a hepatotoxic drug should report any hepatotoxic symptoms, such as jaundice, dark urine, or light-colored stools. When providing nursing care for a client receiving pyridostigmine bromide for myasthenia gravis, which nursing intervention has the highest priority? Assess respiratory status and breath sounds often. Rationale: The client should be assessed often for signs of respiratory complications. The client with myasthenia gravis is at greatest risk for life-threatening respiratory complications because of the weakness of the diaphragm and ancillary respiratory muscles caused by the disease process. Cholinergic agents used to reduce muscle weakness can also cause hypersalivation, increased respiratory secretions, and possible bronchoconstriction. Minocycline, 50 mg PO every 8 hours, is prescribed for an adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.) Report vaginal itching or discharge. Protect skin from natural and artificial ultraviolet light. Avoid driving until response to medication is known. Use a nonhormonal method of contraception if sexually active. Rationale: Adverse effects of tetracyclines include superinfections, photosensitivity, and decreased efficacy of oral contraceptives. Therefore, the client should report vaginal itching or discharge, protect the skin from ultraviolet light and use a nonhormonal method of contraception while on the medication. Minocycline is known to cause dizziness and ataxia, so until the client’s response to the medication is known, drivingshould be avoided. Tetracyclines should be taken around the clock. They exhibit decreased absorption when taken with antacid. Which nursing intervention has the highest priority during IV administration of mechlorethamine HCl and actinomycin? Assess for extravasation at the IV site during infusion. Rationale: Mechlorethamine HCl and actinomycin are vesicants; therefore, assessment for blister formation and/or tissue sloughing that can occur with leakage of these agents into surrounding subcutaneous tissues is essential to ensure client safety during the IV infusion. Methenamine mandelate is prescribed for a client with a urinary tract infection and renal calculi. Which finding indicates to the nurse that the medication is effective? The frequency of urinary tract infections decreases. Rationale: Mandelamine is prescribed to acidify the urine, decreasing the incidence of calcium phosphate calculi and urinary tract infections. The urine changing color and pain is diminishing is related to the administration of pyridine. Methylphenidate is prescribed for daily administration to a 10-year-old child with attentiondeficit/hyperactivity disorder (ADHD). In preparing a teaching plan for the parents of this child newly diagnosed with ADHD, which instruction is most important for the nurse to provide to the parents? Administer the medication in the morning before the child goes to school. Rationale: Methylphenidate is a central nervous system (CNS) stimulant. To be most effective in affecting the child's behavior, the dose of the drug should be administered in the morning before the child goes to school. Drug holidays are often prescribed to assess the child's degree of recovery; however, such interruptions are not conducted in the early phase of treatment and are usually implemented when side effects occur over a period of time.Following the administration of sublingual nitroglycerin, which assessment finding indicates that the medication was effective? Decrease in level of chest pain Rationale: Nitroglycerin reduces myocardial oxygen consumption, which decreases ischemia and reduces chest pain. A client who is receiving chlorpromazine HCl to control his psychotic behavior also has a prescription for benztropine. When teaching the client and/or significant others about these medications, what should the nurse explain about the use of benztropine in the treatment plan for this client? The benztropine is used to control extrapyramidal symptoms. Rationale: Benztropine, an anticholinergic drug, is used to control extrapyramidal symptoms associated with chlorpromazine HCl (Thorazine) use. A client who arrives in the postanesthesia care unit (PACU) after surgery is not awake from general anesthesia. Which action should the nurse implement first? Review the medication administration record (MAR). Rationale: Most general anesthetics produce cardiovascular and respiratory depression, so a review of the client's MAR identifies all the medications received during surgery and helps the nurse anticipate the client's response and emergence from anesthesia. Assessing for deep tendon reflexes and observing urinary output are ongoing postoperative assessments. Based on the medications that the client has received, naloxone may need to be administered if indicated by the client's vital signs and delayed spontaneous reactivity. The charge nurse is reviewing the admission history and physical data for four clients newly admitted to the unit. Which client is at greatest risk for adverse reactions to medications? 75-year-old woman with liver diseaseRationale: Impaired hepatic metabolic pathways for drug and chemical degradation place option an elderly pt at greatest risk for adverse reactions to medications based on advancing age and liver disease. A client with viral influenza is receiving vitamin C, 1000 mg PO daily, and acetaminophen elixir, 650 mg PO every 4 hours PRN. The nurse calls the health care provider to report that the client has developed diarrhea. Which change in prescriptions should the nurse anticipate? Decrease the dose of vitamin C. Rationale: Diarrhea is an adverse effect of high doses of vitamin C, so the nurse should anticipate a reduction in the dose of vitamin C. Acetaminophen does not cause diarrhea and is not available in an injectable form. Because the client has a viral infection Tx with abx will not be beneficial. The nurse is preparing to apply a surface anesthetic agent for a client. Which action should the nurse implement to reduce the risk of systemic absorption? Avoid abraded skin areas when applying the anesthetic. Rationale: To minimize systemic absorption of topical anesthetics, the anesthetic agent should be applied to the smallest surface area of intact skin. Application to the mucous membranes poses the greatest risk of systemic absorption because absorption occurs more readily through mucous membranes than through the skin. Inflamed areas generally have an increased blood supply, which increases the risk of systemic absorption. A large surface area increases the amount of topical drug that is available for transdermal absorption, so the smallest area should be covered not the largest. A client is taking famotidine. Which client statement should the nurse further assess because it may indicate that the client is experiencing a side effect of this drug? "I seem to be having difficulty thinking clearly." Rationale: A common side effect of of famotidine is confusion.The nurse knows that certain antipsychotic drugs cause extrapyramidal symptoms. Which extrapyramidal symptom is a permanent and irreversible adverse effect of long-term phenothiazine administration? Tardive dyskinesia Rationale: Tardive dyskinesia is a permanent irreversable effect of long-term phenothiazine administration. Dystonia, Akathisia and Pseudoparkinsonism are side effects of phenothiazines but do not have the characteristics of being permanent and irreversible. A client who is hypertensive receives a prescription for hydrochlorothiazide. When teaching about the side effects of this drug, which symptoms are most important for the nurse to instruct the client to report? Fatigue and muscle weakness Rationale: Thiazide diuretics, such as HCTZ, cause potassium wasting in the urine, so the client should be instructed to report fatigue and muscle weakness, which are characteristic of hypokalemia. which is a side effect of thiazides that can cause cardiac dysrhythmias. The nurse is reviewing a client's laboratory results before a procedure in which a neuromuscular blocking agent is prescribed. Which finding should the nurse report to the health care provider? Hypokalemia Rationale: Low potassium levels enhance the effects of neuromuscular blocking agents, so the health care provider should be informed of the client's hypokalemia. Hyponatremia, Hypercalcemia and Hypomagnesemia are of concern but do not enhance the effects of neuromuscular blocking agents. A psychiatric client is discharged from the hospital with a prescription for haloperidol. Which instruction should the nurse include in the discharge teaching plan for this client? Use sunglasses and sunscreen when outdoors.Rationale: Photosensitivity is a common adverse effect of haloperidol (Haldol); therefore, the use of sunglasses and sunscreen should be included in the discharge teaching for this client. A female client with trichomoniasis (Trichomonas vaginalis) receives a prescription for metronidazole. Which instruction is most important for the nurse to include in this client's teaching plan? Avoid alcohol consumption. Rationale: Clients should be instructed to avoid alcohol and products containing alcohol while taking metronidazole because of the possibility of a disulfiram-like reaction. A client is receiving oral griseofulvin for a persistent tinea corporis infection. Which response by the client indicates an accurate understanding of the drug teaching conducted by the nurse? "I'll wear sunscreen whenever I mow the lawn." Rationale: Photosensitivity is a side effect of griseofulvin, so clients should be cautioned to wear protective sunscreen during sun exposure. A female client is receiving tetracycline for acne. Which client teaching should the nurse include? Oral contraceptives may not be effective. Rationale: Certain antibiotics, such as tetracycline, decrease the effectiveness of oral contraceptives. A client receives a prescription for theophylline PO to be initiated in the morning after the dose of theophylline IV is complete. The nurse determines that a theophylline level drawn yesterday was 22 mcg/mL. Based on this information, which action should the nurse implement? Hold the theophylline dose and notify the health care providerRationale: The therapeutic range for theophylline is 10 to 20 mcg/mL, so the theophylline dose should be held for fear of causing toxicity. A 3-year-old boy is admitted to the emergency department after ingesting an unknown amount of phenobarbital elixir prescribed for his brother's seizure disorder. Which nursing intervention should the nurse implement first? Take the child's vital signs. Rationale: Phenobarbital causes respiratory depression, so the priority intervention is assessment of vital signs. Administering syrup of ipecac, drawing a blood specimen for a phenobarbital level and teaching the mother safe medication storage practices are actions that may all be used in the treatment of this child, but they do not have the priority over taking the vital signs. A pediatric client is discharged home with multiple prescriptions for medications. Which information should the nurse provide that is most helpful to the parents when managing the medication regimens? Maintain a drug administration record. Rationale: A written drug administration record provides a consistent plan to ensure safe adherence to multiple medication dosages and times. The parents should be given a tool to enhance their confidence and provide a mechanism to ensure accurate and timely medication administration without duplicating or omitting a dose. Using a written record to record medication administration allows more than one person to share the responsibility of giving medications to the child. Although smaller volumes ensure that all the medication is taken, it is more important to maintain an accurate administration schedule. When caring for a client on digoxin therapy, the nurse knows to be alert for digoxin toxicity. Which finding would predispose this client to developing digoxin toxicity? Low serum potassium level Rationale: Hypokalemia predisposes the client on digoxin to digoxin toxicity, which usually presents as abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and atrioventricular (AV) dissociation.Assessment of serum potassium levels with prompt correction of hypokalemia is an important intervention for the client taking digoxin. The nurse is administering the early morning dose of insulin aspart, 5 units subcutaneously, to a client with diabetes mellitus type 1. The client's fingerstick serum glucose level is 140 mg/dL. Considering the onset of insulin aspart, when should the nurse ensure that the client's breakfast be given? 5 minutes after subcutaneous administration Rationale: Insulin aspart is a very rapidly acting insulin, with an onset of 5 to 15 minutes. Insulin aspart should be administered when the client's tray is available. Insulin aspart peaks in 45 minutes to 1½ hours and has a duration of 3 to 4 hours. The client should have eaten to ensure absorption of the meal so that serum glucose levels will coincide with the peak. Insulin glargine has a flat peak of action and is usually given at bedtime. A client taking linezolid at home for an infected foot ulcer calls the home care nurse to report the onset of watery diarrhea. Which intervention should the nurse implement? Instruct the client to obtain a stool specimen to be taken to the laboratory for analysis. Rationale: Antibiotics, such as linezolid, can cause pseudomembranous colitis, resulting in severe watery diarrhea. The prescriber should be notified, and a stool specimen should be obtained and analyzed for this complication. Severe diarrhea is not an indication of drug toxicity. Although gastrointestinal disturbance can be an adverse effect of linezolid, a stool specimen should be obtained because the client reports the diarrhea is severe. Antidiarrheal medications are contraindicated in the presence of this colitis and should not be started until this potential complication is ruled out. During therapy with isoniazid, it is most important for the nurse to monitor which laboratory value closely? Liver enzyme levels Rationale: The client receiving isoniazid is at risk for the development of hepatitis; therefore, liver function test results should be monitored carefully during drug therapy.The nurse is preparing a teaching plan for a client who has received a new prescription for levothyroxine sodium. Which instruction should be included? "Take your pulse daily, and if it exceeds 100 beats/min, contact the health care provider." Rationale: Levothyroxine sodium should be withheld if the pulse is over 100 beats/min. To prevent insomnia, the daily dose should be taken early in the morning before breakfast, not at bedtime. Product brands should not be changed without consulting the health care provider because the intended effects and side effects of different formulations of the medication can vary. A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization? Vastus lateralis Rationale: The preferred intramuscular site for children younger than 2 years is the vastus lateralis. During administration of theophylline, the nurse should monitor for signs of toxicity. Which symptom would cause the nurse to suspect theophylline toxicity? Restlessness Rationale: Restlessness is a sign of theophylline intoxication. Other signs of toxicity are anorexia, nausea, vomiting, insomnia, tachycardia, arrhythmias, and seizures. dry mouth, urinary retention and sedation are common side effects of antihistamines but do not indicate theophylline intoxication. Dopamine, 5 mcg/kg/min, is prescribed for a client who weighs 105 kg. The nurse mixes 400 mg of dopamine in 250 mL D5W for IV administration via an infusion pump. What is the hourly rate that the nurse should set on the pump? 20 mL/hrRationale: 400 mg/250 mL equals 1.6 mg/mL, or 1600 mcg/mL. The prescription for 5 mcg/kg/min would result in 31,500 mcg/hr. Delivery of that dose would be achieved by administering 20 mL/hr, which would deliver 5.07 mcg/kg/min. Options A, B, and C are not accurate hourly rates for this infusion. The nurse plans to draw blood samples for the determination of peak and trough levels of gentamicin sulfate in a client receiving IV doses of this medication. When should the nurse plan to obtain the peak level? Thirty minutes after the dose is administered Rationale: Peak drug serum levels are achieved 30 minutes after the IV administration of aminoglycosides. A client with Tourette syndrome takes haloperidol to control tics and vocalizations. The client has become increasingly drowsy over the past 2 days and reports becoming dizzy when changing from a supine to sitting position. Which action should the nurse take? Assess for poor skin turgor, sunken eyeballs, and concentrated urine output. Rationale: Because haloperidol causes CNS effects of sedation and decreased thirst, the nurse should assess for signs of dehydration. Sedation may occur with haloperidol administration, this side effect may signal an adverse CNS reaction. urine pink or reddish brown is expected. A client who is experiencing an acute attack of gouty arthritis is prescribed colchicine USP, 1 mg PO daily. Which information is most important for the nurse to provide the client? Report any vomiting to the clinic. Rationale: The client should be instructed to report signs of colchicine toxicity, such as nausea, diarrhea, vomiting, and/or abdominal pain, to the health care provider. Food inhibits the absorption of colchicine when ingested concurrently. Limited fluid intake decreases the excretion of the uric acid crystals, which contributes to painful attacks. Typically, a client should remain on a daily dose of colchicine to decreasethe number and severity of acute attacks, so stopping the medication after the pain resolves is not indicated. Alteration of which laboratory finding represents the achievement of a therapeutic goal for heparin administration? Partial thromboplastin time (PTT) Rationale: Heparin therapy is guided by changes in the partial thromboplastin time (PTT). A client is receiving acyclovir sodium IV for a severe herpes simplex infection. Which intervention should the nurse implement during this drug therapy? Increase daily fluids to 2000 to 4000 mL/day. Rationale: Increasing fluid intake during treatment prevents precipitation of the drug in the renal tubules, which could lead to obstructive problems that impair kidney function. Acute glomerulonephritis is a possible complication of acyclovir sodium therapy. A chemotherapeutic regimen with doxorubicin HCl is being planned for a client recently diagnosed with cancer. What diagnostic test results should the nurse review prior to initiating this treatment? Electrocardiogram (ECG) Rationale: Baseline cardiac function studies are required to monitor the irreversible cardiotoxic effects of doxorubicin HCl. A client receives pancuronium, a long-acting, nondepolarizing neuromuscular blocker, during surgical anesthesia. Which client situation should alert the nurse to evaluate the client for a prolonged muscle relaxation response to this medication?Renal insufficiency Rationale: Pancuronium is eliminated via the kidneys, so a client with renal failure is at risk for prolonged muscle relaxation. Although hepatitis can interfere with this drug's metabolism, it does not place a client at increased risk for prolonged muscle relaxation. Two hours after taking the first dose of penicillin, a client arrives at the emergency department complaining of feeling ill, exhibiting hives, having difficulty breathing, and experiencing hypotension. These findings are consistent with which client response that requires immediate action? Severe acute anaphylactic response Rationale: Anaphylaxis related to penicillin can cause a life-threatening allergic response characterized by bronchospasm, laryngeal edema, and a precipitous drop in blood pressure. This client's ingestion of penicillin and presenting clinical picture indicate the client is having an acute reaction with respiratory difficulty. A male client asks the nurse why condoms should not be lubricated with the spermicide nonoxynol-9. Which response is best for the nurse to provide? Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of HIV. Rationale: The use of condoms and a water-based spermicide is recommended because nonoxynol-9 can cause a rash that allows viruses a portal of entry if the condom breaks, which increases the risk of transmission of sexually transmitted diseases (STDs), such as human immunodeficiency virus (HIV), herpes, human papillomavirus (HPV), or hepatitis B virus (HBV). Nonoxynol-9 may cause vaginal irritation. A 4-year-old child is receiving chemotherapy for acute lymphocytic leukemia. Which laboratory result should the nurse examine to assess the child's risk for infection? Neutrophil countRationale: During chemotherapy, granulocytes are significantly suppressed. Because neutrophils comprise 60% to 70% of the granulocyte count, these levels are the most useful laboratory results of the options presented to determine the child's risk for infection. An older client who had a colon resection yesterday is receiving a constant dose of hydromorphone via a patient-controlled analgesia (PCA) pump. Which assessment finding is most significant and requires that the nurse intervene? Respirations decrease to 14 breaths/min. Rationale: Hydromorphone is an opioid agonist-analgesic of opiate receptors that inhibits ascending pathways and can cause respiratory depression. Older adults are more sensitive to opioids so the "start low and go slow" approach should be taken. Drowsiness and pruritus are common side effects of opioids, particularly the opiates, which are usually harmless and often transient. The normal range of pupils is 2 to 6 cm. The suture site may be red and swollen as an inflammatory response, but no action is required if the skin around the incision is a normal color and temperature. Prior to administering a scheduled dose of digoxin, the nurse reviews the client's current serum digoxin level, which is 1.3 ng/dL. Which action should the nurse implement? Give the dose of digoxin if the client's heart rate is within a safe range. Rationale: The client's digoxin level of 1.3 ng/dL is not above the upper range of its therapeutic index (toxic level is >2.0 ng/dL), so the dose should be administered after the client's heart rate is evaluated. Digibind is administered for toxic levels of digoxin. The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate, IM STAT. What is the primary purpose for administering this drug to the child at this time? Decrease the oral secretions.Rationale: Atropine sulfate, an anticholinergic agent, is given to decrease oral secretions during a surgical procedure. A child is being treated with mebendazole for pinworms. Which type of diet should the mother be instructed to feed the child while the child is receiving this medication? High-fat diet Rationale: A high-fat diet increases the absorption of mebendazole, which boosts the effectiveness of the medication in eliminating the pinworms. The nurse has completed diabetic teaching for a client who has been newly diagnosed with diabetes mellitus. Which statement by this client would indicate to the nurse that further teaching is needed? "When I exercise, I should plan to increase my insulin dosage." Rationale: Exercise helps facilitate the entry of glucose into the cell, so increasing insulin doses with exercise would place the client at high risk for a hypoglycemic reaction. "Regular insulin can be stored at room temperature for 30 days.", "My legs, arms, and abdomen are all good sites to inject my insulin." And "I will always carry hard candies to treat hypoglycemic reactions." reflect accurate statements about the use of insulin and management of hypoglycemic reactions. The apical heart rate of an infant receiving digoxin for congestive heart failure is 80 beats/min. Which intervention should the nurse implement first? Obtain a serum digoxin level. Rationale: Sinus bradycardia (rate <90 to 110 beats/min in an infant) is an indication of digoxin toxicity, so assessment of the client's digoxin level is the highest priority. Further doses of digoxin should be withheld until the serum level is obtained.A client is receiving antiinfective drug therapy for a postoperative infection. Which complaint should alert the nurse to the possibility that the client has contracted a superinfection? "My mouth feels sore." Rationale: Stomatitis caused by a thrush infection, which can cause mouth pain, is a sign of superinfection. Headache, ears feeling plugged up and constipation are more typical side effects, rather than symptoms, of a superinfection. Which medication is useful in treating digoxin toxicity? Digoxin immune Fab Rationale: Digibind is useful in treating this type of drug toxicity because it is an antibody that binds antigenically to unbound serum digoxin or digitoxin, resulting in renal excretion of the bound complex. A 45-year-old female client is receiving alprazolam for anxiety. Which client behavior would indicate that the drug is effective? The staff observes the client sitting in the day room reading a book. Rationale: The ability to sit and concentrate on reading indicates decreased anxiety. A client receives an antihypertensive agent daily. Which action is most important for the nurse to implement prior to administering the medication? Obtain the client's blood pressure. Rationale: To determine the most accurate response to antihypertensive therapy, baseline blood pressures should be obtained before an antihypertensive drug is administered and should be compared with orthostatic vital signs to determine whether any side effects are occurring.The health care provider prescribes the anticonvulsant carbamazepine for an adolescent client with a seizure disorder. The nurse should instruct the client to notify the health care provider if which condition occurs? Develops a sore throat. Rationale: Blood dyscrasias (aplastic anemia, leukopenia, anemia, and thrombocytopenia) can be an adverse effect of carbamazepine. Flu-ike symptoms, such as pallor, fatigue, sore throat, and fever, are indications of such dyscrasias. Options A and B are expected reactions. Option D is a side effect of phenytoin, not carbamazepine. The nurse is evaluating a client's understanding of the prescribed antilipemic drug lovastatin. Which client statement indicates that further teaching is needed? "I will take the medication every day before breakfast." Rationale: The enzyme that helps metabolize cholesterol is activated at night, so this medication should be taken with the evening meal. Options A, B, and C"My bowel habits should not be affected by this drug." , "This medication should be taken once a day only." And"I will still need to follow a low-cholesterol diet." reflect correct information about lovastatin. A 6-year-old child is admitted to the emergency department with status epilepticus. His parents report that his seizure disorder has been managed with phenytoin, 50 mg PO bid, for the past year. Which drug should the nurse plan to administer in the emergency department? DiazepamRationale: Diazepam is the drug of choice for treatment of status epilepticus. Phenytoin, Phenobarbital and Carbamazepine are used for the long-term management of seizure disorders but are not as useful in the emergency management of status epilepticus. A client who has trouble swallowing pills intermittently has been prescribed venlafaxine (XR) for depression. The medication comes in capsule form. What should the nurse include in the discharge teaching plan for this client? Contact the health care provider for another form of medication. Rationale: Venlafaxine is administered PO in capsule form. Capsules that are extended-release (XR) or continuousrelease (CR) contain delayed-release, enteric-coated granules to prevent decomposition of the drug in the acidic pH of the stomach. The client should notify the health care provider about the inability to swallow the capsule. This medication should not be chewed or opened so that the delayed-release, enteric-coated granules can remain intact. Water or juice will not affect the medication. A client is receiving pyridostigmine bromide to control the symptoms of myasthenia gravis. Which client behavior would indicate that the drug therapy is effective? Clear speech Rationale: Clear speech is the result of increased muscle strength. Muscle weakness characteristic of myasthenia gravis often first appears in the muscles of the neck and face. Decreased oral secretions and increased ptosis are symptoms of multiple sclerosis that would persist if the medication was ineffective. Hand tremors are not typical symptoms of the disease. When developing a written nursing care plan for a client receiving chemotherapy for treatment of cancer, the nurse writes, "Assess each voiding for hematuria." The administration of which type of chemotherapeutic agent would prompt the nurse to add this intervention? CyclophosphamideRationale: Hemorrhagic cystitis is the characteristic adverse reaction of cyclophosphamide. Which factor is most important to ensure compliance when planning to teach a client about a drug regimen? Client education Rationale: The client's educational level is the most important factor when planning teaching to ensure a client's compliance with taking a prescribed drug. Genetics and absorption rate are physiologic responses that do not relate to a client's compliance. Although maturity level and age contribute to compliance, the client's basic understanding of instructions, which is best indicated by educational level, is more significant. . A client with a dislocated shoulder is being prepared for a closed manual reduction using conscious sedation. Which medication should the nurse explain as a sedative used during the procedure? Midazolam IV Rationale: Conscious sedation uses sedative-hypnotics that do not compromise the airway, so IV midazolam, a short-duration benzodiazepine sedative, provides conscious sedation with local and regional anesthesia and has an amnestic effect. Inhaled nitrous oxide is a weak anesthetic and is rarely used alone. Ketamine causes profound analgesia that causes a client to appear catatonic and amnestic. Fentanyl is an opioid more commonly used as an analgesic during anesthesia, whereas droperidol is a skeletalmuscle anesthetic agent used to reduce spasticity to ensure a smooth induction under general anesthesia and requires intubation and ventilation during its onset and duration. . A client with metastatic cancer reports severe continuous pain. Which route of administration should the nurse use to provide the most effective continuous analgesia? Transdermal Rationale: Continuous pain is best managed by maintaining a constant serum drug level. Transdermal drug administration of an analgesic provides around-the-clock, controlled release of the medication that is absorbed through intact skin into the bloodstream to provide continuous pain relief. Oral administration is convenient, but gastrointestinal variables affect the absorption rate of the drug, its onset and intensity, and duration of response and requires repeated doses around the clock. Intravenous provides immediate action because the drug is infused directly into the bloodstream and is quickly metabolized, and repeated IV doses are required to maintain a continuous blood level. With Intramuscular administration repeated injections at regular intervals are needed, which are uncomfortable, and absorption rates vary between muscle sites. A mother brings her 18-month-old child to the community health center because the child has had "bad diarrhea" for the last 3 days. She states, "I bought some of this liquid at the pharmacy and gave mydaughter a half-ounce." The nurse sees that the bottle contains loperamide. Which intervention is most important for the nurse to implement initially? Ask the mother when the child last voided. Rationale: Determining when the child last voided is most important because urine output is decreased with dehydration and an 18-month-old with a 3-day history of diarrhea could be severely dehydrated. Although the manufacturer states that loperamide should not be given to a child younger than 2 years except under the direction of a health care provider,telling the mother never to give this drug to her toddler is not the best answer for this question. In addition, loperamide causes an anticholinergic effect of urinary retention. Data obtained by asking if any other siblings have experienced diarrhea and taking the child’s oral and tympanic temperatures are not as high a priority as assessing when the child last voided. The health care provider prescribes ipratropium for a client. An allergic reaction to which other medication would cause the nurse to question the prescription for? Atropine sulfate Rationale: Clients who have experienced allergic reactions to atropine sulfate and belladonna alkaloids may also be allergic to ipratropium, so the prescription for Atrovent should be questioned. . Which parameter is most important for the nurse to check prior to administering a subcutaneous injection of heparin?Activated partial thromboplastin time (aPTT) Rationale: The laboratory value that measures heparin's therapeutic anticoagulation time is the aPTT. Heart rate should be checked before the administration of digoxin. Urinary output is valuable information but not a parameter measured for heparin therapy. Prothrombin time (PT) and International Normalized Ratio (INR) is evaluated during anticoagulation therapy using sodium warfarin. An older client is receiving a water-soluble drug that is more than the average dose for a young adult. Which action should the nurse implement first? Determine the drug's serum levels for toxicity Rationale: Older clients usually have a decline in lean body mass and total body water that causes water-soluble drugs to become distributed in fluid compartments, resulting in an increased concentration, so determining the drug's serum level for toxicity should be implemented first. Although obtaining a prescription for a lower medication dosage, starting IV fluids to decrease the serum drug levels and holding the next dose and notifying the healthcare provider may be indicated, an increased plasma drug level should be the determining factor to consider when water-soluble drugs warrant a reduced dosage in the older client.A client who is HIV-positive is receiving epoetin alfa for the management of anemia secondary to zidovudine (AZT) therapy. Which laboratory finding is most important for the nurse to report to the health care provider? Hematocrit (HCT) of 58% Rationale: Hematocrit (HCT) of 58 % should be reported to the health care provider immediately because of the likelihood of a hypertensive crisis and because seizure activity increases with an increase in HCT of more than 4 points, or an HCT above 36%. Epoetin alfa stimulates erythropoiesis (production of red blood cells), thereby decreasing the need for blood transfusions. Uncontrolled hypertension can occur if erythropoietin levels are too high. A hemoglobin 0f 10.8 would be the reason why the client is receiving epoetin alpha. A white blood cell count of 5000 and a serum potassium level of 5 mEq/L are both within normal limits. A lidocaine IV infusion at 4 mg/min via infusion pump is prescribed for a client having premature ventricular contractions (PVCs). The available premixed infusion contains 2 mg/mL of D5W. How many milliliters per hour should the nurse program the pump to deliver to this client? 120 Rationale: 120 is the correct calculation; 120 mL/hr = 1 mL/2 mg × 4 mg/min × 60 min/hr.The nurse is preparing to administer the disease-modifying antirheumatic drug (DMARD) methotrexate to a client diagnosed with rheumatoid arthritis. Which intervention is most important to implement prior to administering this medication? Have another nurse check the prescription. Rationale: Double-checking the prescription is an important intervention because death can occur from an overdose. This medication is administered weekly and in low doses for rheumatoid arthritis and should not be confused with administration of the drug as a chemotherapeutic agent. Assessing the client’s liver function test results and monitoring their intake and output are appropriate interventions for those who are receiving this drug, but they are not the most important interventions. Stomatitis (inflammation of the oral mucosa) is an expected side effect of this medication. Which class of antineoplastic chemotherapy agents resembles the essential elements required for DNA and RNA synthesis and inhibits enzymes necessary for cellular function and replication? Antimetabolites Rationale: Antimetabolites exert their action by inhibiting the enzymes necessary for cellular function and replication. Which intervention is most important for a nurse to implement prior to administering atropine PO? Determine the presence of 5 to 35 bowel sounds/min. Rationale: Anticholinergic drugs, such as atropine, have antispasmodic and antisecretory properties, which relax the gastrointestinal tract, and are therefore contraindicated in a client with intestinal atony. Oral care may be required after administration since atropine can dry secretions. Atropine itself has no analgesic effect; it is used with opioids to potentiate their effect. Which instructions should the nurse provide to an adolescent female client who is initiating treatment with isotretinoin for acne vulgaris? (Select all that apply.)"Notify the health care provider immediately if you think you are pregnant." "If you begin crying more than usual and feel sad, stop the drug and call the health care provider." “Before, during, and after therapy, two effective forms of birth control must be used at the same time." Rationale: Isotretinoin has been found to cause pregnancy category D drug-related birth defects, premature births, and fetal death which necessitates the use of effective birth control methods before, during, and after therapy . Isotretinoin is associated with sadness depression, suicidal ideations, and other serious mental health problems. An initial exacerbation of acne is common when starting drug therapy. Isotretinoin is a retinoid related to vitamin A, and taking additional multivitamin supplements can predispose the client to vitamin A toxicity. The client should stop taking isotretinoin at least 6 months before cosmetic procedures, such as dermabrasion because the drug can increase the chances of scarring. A client with HIV who was recently diagnosed with tuberculosis (TB) asks the nurse, "Why do I need to take all of these medications for TB?" What information should the nurse provide? Multiple drugs prevent the development of resistant organisms. Rationale: A multidrug regimen is prescribed for a client with HIV and TB to prevent the development of resistance of the tubercle bacilli. Although antitubercular medications can inhibit some antiretrovirals, a multidrug regimen is needed to inhibit the proliferation of the virulent tubercle bacilli. The duration of antitubercular therapy is typically 6 to 9 months and is not shortened by the use of multiple medications. A client who is receiving HIV and TB therapy is at an increased risk of adverse reactions because of the complex medication regimens and complications secondary to immunosuppression. A 26-year-old primigravida client is experiencing increasing discomfort and anxiety during the active phase of labor. She requests something for pain. Which analgesic should the nurse anticipate administering? ButorphanolRationale: Butorphanol is a mixed agonist-antagonist analgesic resulting in good analgesia but with less respiratory depression, nausea, and vomiting compared with opioid agonist analgesics. Hydromorphone, Morphine and Codeine are not drugs of choice in this situation. A female client who has started long-term corticosteroid therapy tells the nurse that she is careful to take her daily dose at bedtime with a snack of crackers and milk. Which is the best response by the nurse? Advise the client to take the medication in the morning, rather than at bedtime. Rationale: Daily doses of long-term corticosteroid therapy should be administered in the morning to coincide with the body's normal secretion of cortisol. Clients receiving long-term corticosteroids need to increase their intake of calcium, which generally means an increase in dairy products. Corticosteroids can often cause gastrointestinal distress and should be administered with meals. The client has established a safe routine by taking the medication with a snack, but the routine will be more effective if done in the morning. A client who has chronic back pain is on long-term pain medication management and asks the nurse why his pain relief therapy is not as effective as it was 2 months ago. How should the nurse respond? Pharmacodynamic tolerance requires increased drug levels to achieve the same effect. Rationale: Pharmacodynamic tolerance explains the client's need for an increased drug level to produce effects that formerly occurred at lower drug levels. Tolerance can occur with opioids during shorter periods of use. Although a withdrawal syndrome can occur if the client develops a dependency, this does not address the client's immediate concern of drug effectiveness. Although a stable serum drug level provides effective pain management, the client's complaint is consistent with a tolerance to his current pain management regimen.For which clients should the nurse withhold the initial dose of a cyclooxygenase 2 (COX-2) inhibitor until notifying the health care provider? (Select all that apply.) An older adult with a history of a skin rash while taking glyburide (DiaBeta) An adolescent with a history of an anaphylactic reaction to penicillin An adolescent at 34 weeks of gestation experiencing 1+ pitting edema The health care provider prescribes the H2 antagonist famotidine, 20 mg PO in the morning and at bedtime. Which statement regarding the action of H2 antagonists offers the correct rationale for administering the medication at bedtime? Hydrochloric acid secreted during the night is blocked. Rationale: H2 antagonists act on the parietal cells to inhibit gastric secretion. Some gastric secretion occurs all the time, even when the stomach is empty, unless medications are taken to inhibit this action. Options © The drug relaxes stomach muscles at night to reduce acid and (D) ingestion of the medication at night offers a sedative effect, promoting sleep are not actions of famotidine. Antacids do not affect healing or prevent the recurrence of ulcers; they merely provide symptomatic relief. Knowing the difference between H2 antagonists and antacids is important when teaching clients. The nurse is assessing a stuporous client in the emergency department who is suspected of overdosing with opioids. Which agent should the nurse prepare to administer if the client becomes comatose? Naloxone hydrochloride Rationale: Naloxone is an opioid antidote used in opioid overdose to reverse CNS and respiratory depression. Atropine is used for bradycardia, intestinal hypertonicity and hypermotility, muscarinic agonist poisoning, peptic ulcer disease, and biliary colic. Vitamin K is used to manage warfarin overdose andvitamin K deficiency in newborns. Flumazenil reduces the sedative effects of benzodiazepines following general anesthesia or overdose. The health care provider has prescribed a low-molecular-weight heparin, enoxaparin prefilled syringe, 30 mg/0.3 mL IV every 12 hours, for a client following hip replacement. Prior to administering the first dose, which intervention is most important for the nurse to implement? Contact the health care provider to clarify the prescription. Rationale: Enoxaparin is a low-molecular-weight heparin that should be administered subcutaneously when given as a prophylaxis for deep vein thrombosis, so the nurse should contact the health care provider to clarify the route of administration. Assessing the IV site for inflammation and evaluating the client’s degree of mobility are important nursing interventions but not necessary to the administration of this medication. The client should be instructed about medication side effects, but this is of lower priority than obtaining a correct prescription. A 19-year-old male client who has sustained a severe head injury is intubated and placed on assisted mechanical ventilation. To facilitate optimal ventilation and prevent the client from "fighting" the ventilator, the healthcare provider administers pancuronium bromide IV, with adjunctive opioid analgesia. What medication should be immediately accessible for a potential complication with this drug? Neostigmine bromide Rationale: Neostigmine bromide and atropine sulfate, both anticholinergic drugs, reverse the respiratory muscle paralysis caused by pancuronium bromide. Which physiologic mechanism explains a drug's increased metabolism that is triggered by a disease process?Pharmacokinetics Rationale: Pharmacokinetics describes the physiologic process of a drug's movement throughout the body and how the drug's interaction is affected by an underlying disease. Selectivity, or a selective drug, is defined as a drug that elicits only the response for which it is given. Pharmacodynamics is the impact of drugs on the body. Pharmacotherapeutics is defined as the use of drugs to diagnose, prevent, or treat disease or prevent pregnancy. A client receiving a continuous infusion of heparin IV starts to hemorrhage from an arterial access site. Which medication should the nurse anticipate administering to prevent further heparin-induced hemorrhaging? Protamine sulfate Rationale: Protamine sulfate is the antagonist for heparin and is given for episodes of acute hemorrhage. A client with mild parkinsonism is started on oral amantadine. Which statement accurately describes the action of this medication? Dopamine in the central nervous system is increased. Rationale: Amantadine is a dopamine-releasing agent; therefore, this medication increases the amount of dopamine present in the central nervous system. Although this medication is also an antiviral agent, the antiviral effect is not significant in the treatment of parkinsonism. Which assessment datum indicates to the nurse that a dose of granisetron administered IV prior to chemotherapy has had the desired effect? Client denies nausea Rationale: Granisetron is an antiemetic administered before chemotherapy to prevent chemotherapy-induced nausea and vomiting.