SAUNDERS ATI PHARMACOLOGY STUDY GUIDE

SAUNDERS ATI PHARMACOLOGY STUDY GUIDE Week 1: Chapter 35 “Maternity and Newborn Medications” Questions Answers and Rationales 1. The nurse is monitoring a client who is receiving oxytocin (Pitocin) to induce labor. Which assessment finding would cause the nurse to immediately discontinue the oxytocin infusion? 1. Fatigue 2. Drowsiness 3. Uterine hyperstimulation 4. Early decelerations of the fetal heart rate Rationale: Often used to induce labor. High doses are often used for uterine hyperstimulation & C/S births. ADVERSE EFFECTS: Hyperstimulation of uterine contractions & non-reassuring fetal HR DISCONTINUE 2. A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which finding is noted on assessment? 1. Proteinuria of 3 + 2. Respirations of 10 breaths/ minute 3. Presence of deep tendon reflexes 4. Serum magnesium level of 6 mEq/ L Rationale: Mg TOXICITY RESP. DEPRESSION, LOSS OF TENDON REFLEXES & SUDDEN DECLINE IN FETAL HR, MATERNAL HR, & BP caused by Mg tx. Must remain within therapeutic serum levels 4–7.5 mEq/L. Proteinuria 3+ is expected in a pt w/ preeclampsia. 3. The nurse is monitoring a client in preterm labor who is receiving intravenous magnesium sulfate. The nurse should monitor for which adverse effects of this medication? Select all that apply. 1. Flushing 2. Hypertension 3. Increased urine output 4. Depressed respirations 5. Extreme muscle weakness 6. Hyperactive deep tendon reflexes Rationale: Mg sulfate is a CNS depressant that relaxes smooth muscles like the uterus. It’s used to STOP preterm labor contractions and for preeclampsia pts. to PREVENT SEIZURES. ADVERSE EFFECTS: • Flushing • Depressed respirations • Depressed deep tendon reflexes • Hypotension • Extreme muscle weakness • Decreased urine output • Pulmonary Edema • Elevated Mg serum levels 4. The nurse instructor asks a nursing student to describe the procedure for administering erythromycin ointment to the eyes of a newborn. Which student statement indicates that further teaching is needed? 1. “I will flush the eyes after instilling the ointment?” 2. “I will clean the newborn’s eyes before instilling ointment.” 3. “I need to administer the eye ointment within 1 hr. after delivery.” 4. “I will instill the eye ointment into each of the NB’s conjunctiva sacs.” Rationale: Eye prophylaxis protects the NB against Neisseria gonorrhea & Chlamydia trachomatis. The eyes are NOT FLUSHED AFTER INSTILLATION of med because the flush would WASH AWAY the administered medication. 5. A client in preterm labor (31 weeks) who is dilated to 4 cm has been started on magnesium sulfate and contractions have stopped. If the client’s labor can be inhibited for the next 48 hours, the nurse anticipates a prescription for which medication? 1. Nalbuphine (Nubain) 2. Betamethasone (Celestone) 3. Rho(D) immune globulin (RhoGAM) 4. Dinoprostone (Cervidil vaginal insert) Rationale: Betamethasone, a glucocorticoid increases the production of surfactant to stimulate fetal lung maturation. It is administered to clients in preterm labor at 28 to 32 weeks of gestation if the labor can be inhibited for 48 hours. Nalbuphine (Nubain) is an opioid analgesic. Rho(D) immune globulin (RhoGAM) is given to Rh-negative clients to prevent immunological condition aka Rh disease (hemolytic disease of NB); it takes out the + cells that were transported from maternal blood stream  fetal circulation. Dinoprostone (Cervidil vaginal insert) is a prostaglandin given to ripen and soften the cervix and to stimulate uterine contractions. 6. Methylergonovine (Methergine) is prescribed for a woman to treat postpartum hemorrhage. Before administration of methylergonovine, what is the priority nursing assessment? 1. Uterine tone 2. Blood pressure  ABC!!! 3. Amount of lochia 4. Deep tendon reflexes Rationale: Methylergonovine is an ERGOT ALKALOID prevents or controls postpartum hemorrhage by contracting the uterus. This med  continuous uterine contractions and can elevate BP CHECK BP  report to MD if HTN is present 7. The nurse is preparing to administer beractant (Survanta) to a premature infant who has respiratory distress syndrome. The nurse plans to administer the medication by which route? 1. Intradermal 2. Intratracheal 3. Subcutaneous 4. Intramuscular Rationale: Respiratory distress syndrome is a serious lung disorder caused by immaturity and the inability to produce surfactant hypoxia and acidosis. It is common in premature infants and may be due to lung immaturity as a result of surfactant deficiency. The mainstay of tx=exogenous surfactant, which is administered by the intratracheal route. * Note relationship that question states “respiratory distress syndrome” Intratracheal 8. An opioid analgesic is administered to a client in labor. The nurse assigned to care for the client ensures that which medication is readily available if respiratory depression occurs? 1. Naloxone  Antidote! 2. Morphine sulfate 3. Betamethasone (Celestone) 4. Meperidine hydrochloride (Demerol) 9. Rho(D) immune globulin (RhoGAM) is prescribed for a client after delivery and the nurse provides information to the client about the purpose of the medication. The nurse determines that the woman understands the purpose if the woman states that it will protect her next baby from which condition? 1. Having Rh-positive blood 2. Developing a rubella infection 3. Developing physiological jaundice 4. Being affected by Rh incompatibility Rationale: Rh incompatibility can occur when an Rh-negative mother becomes sensitized to Rh antigen. Sensitization may occur when an Rh-negative woman becomes pregnant with a fetus who is positive maternal circulation mother’s immune system to form antibodies against Rh+ blood. This medication prevents mothers from developing antibodies against Rh+ blood by providing passive antibody protection against Rh antigen. 10. Methylergonovine (Methergine) is prescribed for a client with postpartum hemorrhage. Before administering the medication, the nurse contacts the health care provider who prescribed the medication if which condition is documented in the client’s medical history? 1. Hypotension 2. Hypothyroidism 3. Diabetes mellitus 4. Peripheral vascular disease Rationale: Ergot alkaloids are contraindicated in clients with significant cardiovascular disease, peripheral vascular disease, hypertension, preeclampsia, or eclampsia. The vasoconstrictive effects of the ergot alkaloids worsen these conditions. Chapter 49: “Pediatric Med. Administration and Calculations” Questions Answers and Rationales 1. The nurse is providing medication instructions to a parent. Which statement by the parent indicates a need for further instruction? 1. “I should cuddle my child after giving the medication.” 2. “I can give my child a frozen juice bar after he swallows the medication.” 3. “I should mix the medication in the baby food and give it when I feed my child.” 4. “If my child does not like the taste of the medicine, I should encourage him to pinch his nose and drink the medication through a straw.” Rationale: It may give an unpleasant taste to the food, and the child may refuse to accept the same food in the future. In addition, the child may not consume the entire serving and would not receive the required medication dosage. 2. A health care provider’s prescription reads “ampicillin sodium 125 mg IV every 6 hours.” The medication label reads “1 g and reconstitute with 7.4 mL of bacteriostatic water.” The nurse prepares to draw up how many mL to administer one dose? 1. 1.1 mL 2. 0.54 mL 3. 7.425 mL 4. 0.925 mL Rationale: 1 g= 1000 mg 3. A pediatric client with ventricular septal defect repair is placed on a maintenance dosage of digoxin (Lanoxin). The dosage is 0.07 mg/ kg/ day, and the client’s weight is 7.2 kg. The health care provider (HCP) prescribes the digoxin to be given twice daily. The nurse prepares how much digoxin to administer to the client at each dose? 1. 0.5 mg 2. 2.5 mg 3. 0.25 mg 4. 0.37 mg Rationale: 4. Sulfisoxazole (Gantrisin), 1 g orally four times daily, is prescribed for an adolescent with a urinary tract infection. The medication label reads “500-mg tablets.” The nurse has determined that the dosage prescribed is safe. The nurse administers how many tablets per dose to the adolescent? 1. 1⁄2 tablet 2. 1 tablet 3. 2 tablets 4. 3 tablets Rationale: 5. Penicillin G procaine (Wycillin), 1,000,000 units IM (intramuscularly), is prescribed for a child with an infection. The medication label reads “1,200,000 units per 2 mL.” The nurse has determined that the dose prescribed is safe. The nurse administers how many milliliters per dose to the child? 1. 0.8 mL 2. 1.2 mL 3. 1.44 mL 4. 1.66 mL Rationale: 6. The nurse prepares to administer an intramuscular injection to a 4-month-old infant. The nurse selects which best site to administer the injection? 1. Ventrogluteal 2. Dorsal gluteal 3. Rectus femoris 4. Vastus lateralis Rationale: The vastus lateralis is the ONLY SAFE muscle group to use for IM in a 4-month old infant. The other routes are unsafe. 7. Atropine sulfate, 0.6 mg intramuscularly, is prescribed for a child preoperatively. The nurse has determined that the dose prescribed is safe and prepares to administer how many milliliters to the child? Fill in the blank (refer to figure). Answer: 1.5mL Week 2: Chapter 51 Integumentary Medications Questions Answers and Rationales 1. Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which finding indicates the presence of systemic toxicity from this medication? 1. Tinnitus 2. Diarrhea 3. Constipation 4. Decreased respirations Rationale: SA is absorbed readily through skin and systemic toxicity (salicylism– tinnitus, dizziness, hyperpnea, psychological disturbances can result. 2. The health education nurse provides instructions to a group of clients regarding measures that will assist in preventing skin cancer. Which instructions should the nurse provide?” SATA 1. Sunscreen should be applied every 8 hours. 2. Use sunscreen when participating in outdoor activities. 3. Wear a hat, opaque clothing, and sunglasses when in the sun. 4. Avoid sun exposure in the late afternoon and early evening hours. 5. Examine your body monthly for any lesions that may be suspicious. Rationale: Instruct to avoid sun exposure between 10AM and 4PM. Use sunscreen (applied Q2-3hrs) after swimming/sweating, hat, opaque clothing, and sunglasses for outdoors. 3. Mafenide acetate (Sulfamylon) is prescribed for a client with a burn injury. When applying the medication, the client complains of local discomfort and burning. The nurse should take which most appropriate action? 1. Discontinue the medication. 2. Notify the health care provider. 3. Inform the client that this is expected. 4. Apply a thinner film than prescribed to the burn site. Rationale: Sulfamylon is a BACTERIOSTATIC for gram– and gram+ organisms and is used to treat burns to reduce bacteria present avascular tissues. Med will cause local discomfort and burning and that it is a normal rxn. 4. A burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. The nurse monitors the client, knowing that which finding indicates that a systemic effect has occurred?” 1. Hyperventilation 2. Local rash at the burn site 3. Elevated blood pressure 4. Local pain at the burn site 5. Isotretinoin (Amnesteem or Claravis) is pre“scribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed? 1. Platelet count 2. Triglyceride level 3. Complete blood count 4. White blood cell count” Rationale: Because this med can elevate triglyceride levels. Should be measured BEFORE treatment and periodically thereafter until the effect on the triglycerides can be evaluated. 6. A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes isotretinoin (Amnesteem or Claravis). The nurse reviews the client’s medication record and would contact the HCP if the client is taking which medication?” 1. Vitamin A 2. Digoxin (Lanoxin) 3. Furosemide (Lasix) 4. Phenytoin (Dilantin) 7. The nurse is applying a topical corticosteroid to a client with eczema. The nurse should monitor for the potential for increased systemic absorption of the medication if the medication were being applied to which body area?” 1. Back 2. Axilla 3. Soles of the feet 4. Palms of the hands Rationale: Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions where permeability is poor (back, palms, soles). 8. The clinic nurse is performing an admission assessment on a client and notes that the client is taking azelaic acid (Azelex). Because of the medication Rx, the nurse would suspect that the client is being treated for which condition? 1. Acne 2. Eczema 3. Hair loss 4. Herpes simplex Rationale: Azelaic acid is a topical medication used to treat mild to moderate acne. 9. Silver sulfadiazine (Silvadene, Thermazene, SSD cream) is prescribed for a client with a partial-thickness burn and the nurse provides teaching about the medication. Which statement made by the client indicates a need for further teaching about the treatments? 1. The medication is an antibacterial 2. The medication will help heal the burn 3. The medication will permanently stain my skin 4. The medication should be applied directly to the wound Rationale: Broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast to help assist in healing. It does NOT stain the skin. 10. The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied at which times? 1. Immediately before swimming 2. 5 minutes before exposure to the sun 3. Immediately before exposure to the sun 4. At least 30 minutes before exposure to the sun penetrates the skin Week 2: Chapter 53 Antineoplastic Medications Questions Answers and Rationales 1. Chemotherapy dosage is frequently based on total body surface area (BSA), so it is important for the nurse to perform which assessment before administering chemotherapy? 1. Measure client’s abdominal girth 2. Calculate client’s BMI 3. Ask client about his or her weight and height 4. Measure client’s current weight and height 2. A client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? 1. Echocardiography 2. Electrocardiography 3. Cervical radiography 4. Pulmonary function studies Rationale: This med  interstitial pneumonitis pulmonary fibrosis DX Test= hematological, hepatic, renal function tests needs monitoring 3. A client with acute myelocytic leukemia is being treated with busulfan (Myleran, Busulfex). Which laboratory value would the nurse specifically monitor during treatment with this medication? 1. Clotting time 2. Uric acid level 3. Potassium level 4. Blood glucose level 4. A client with small cell lung cancer is being treated with etoposide (Toposar). The nurse monitors the client during administration, knowing that which adverse effect is specifically associated with this medication? 1. Alopecia 2. Chest pain 3. Pulmonary fibrosis 4. Orthostatic hypotension * Etoposide should be administered slowly over 30 to 60 minutes to avoid hypotension. BP is monitored during the infusion 5. A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication. When implementing the plan, the nurse should make which statement to the client? 1. “You can take aspirin (acetylsalicylic acid) as needed for headache.” 2. “You can drink beverages containing alcohol in moderate amounts each evening.” 3. “You need to consult with the health care provider (HCP) before receiving immunizations.” 4. “It is fine to receive a flu vaccine at the local health fair without HCP approval because the flu is so contagious.” *Avoid contact with individuals who have recently received a live virus vaccine. Avoid aspirin and alcohol to minimize risk for bleeding. 6. “A client with ovarian cancer is being treated with vincristine (Vincasar). The nurse monitors the client, knowing that which manifestation indicates an AE specific to this medication? 1. Diarrhea 2. Hair Loss 3. Chest Pain 4. Peripheral neuropathy numbness or tingling in fingers and toes. 7. The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse contacts the health care provider before administering the medication if which disorder is documented in the client’s history? 1. Pancreatitis 2. Diabetes mellitus 3. Myocardial infarction 4. Chronic obstructive pulmonary disease Rationale: The medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between dose administrations. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. 8. Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The nurse administering the medication understands that which is the primary action of this medication? 1. It increases DNA and RNA synthesis. 2. It promotes the biosynthesis of nucleic acids. 3. It increases estrogen concentration and estrogen response. 4. It competitively binds to estrogen receptors on tumors and other tissue targets. Rationale: Used to tx metastic breast carcinoma in women and men. Effective in delaying recurrence of cancer after mastectomy. 9. A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? 1. Glucose level 2. Calcium level 3. Potassium level 4. Prothrombin time 10. Megestrol acetate (Megace), an antineoplastic medication, is prescribed for a client with metastatic endometrial carcinoma. The nurse reviews the client’s history and should contact the health care provider if which diagnosis is documented in the client’s history? 1. Gout 2. Asthma 3. Thrombophlebitis 4. Myocardial Infarction 11. The nurse is monitoring the intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complais of pain at the insertion site. On inspection of the site, the nurse notes redness and swelling and that the infusion of the medication has slowed in rate. The nurse suspects extravasation and should take which actions? SATA 1. Stop the infusion. 2. Notify the health care provider (HCP). 3. Prepare to apply ice or heat to the site. 4. Restart the IV at a distal part of the same vein. 5. Prepare to administer a prescribed antidote into the site. 6. Increase the flow rate of the solution to flush the skin and subcutaneous tissue. 12. The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? 1. Anemia 2. Decreased platelets 3. Increased uric acid level 4. Decreased leukocyte count 13. The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action? 1. Take the medication with food. 2. Increase fluid intake to 2000 to 3000 mL daily. 3. Decrease sodium intake while taking the medication. 4. Increase potassium intake while taking the medication. 14. A client with non–Hodgkin’s lymphoma is receiving daunorubicin (DaunoXome). Which finding would indicate to the nurse that the client is experiencing an AE r/t the medication? 1. Fever 2. Sores in the mouth and throat 3. Complaints of nausea and vomiting 4. Crackles on auscultation of the lungs 15. The nurse is monitoring the laboratory results of a client receiving an antineoplastic medication by the intravenous route. The nurse plans to initiate bleeding precautions if which laboratory result is noted? 1. A clotting time of 10 minutes 2. An ammonia level of 20 mcg/dL 3. A platelet count of 50,000 cells/mm3 Risk for Bleeding 4. A white blood cell count of 5000 cells/mm3 Chapter 55 Endocrine Medications 600. The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? a. withdraws the NPH insulin first b. withdraws the regular insulin first c. injects air into NPH insulin vial first d. injects an amount of air equal to the desired dose of insulin into each vial 601. The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action? a. freeze the insulin b. refrigerate the insulin c. store the insulin in a dark, dry place. d. keep the insulin at room temperature 602. Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. The nurse instructs the client to avoid consuming which food while taking this medication? a. alcohol b. organ meats c. whole-grain cereals d. carbonated beverages 603. Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. The nurse reviews the client’s medical record and should question the prescription if which data is noted in the client’s history? a. insomnia b. neuralgia c. use of nitroglycerin d. use of multivitamins 604. The health care provider (HCP) prescribes exenatide (Byetta) for a client with type 1 diabetes mellitus who takes insulin. The nurse should plan to take which most appropriate intervention? a. withhold the medication and call the HCP, questioning the prescription for the client. b. administer the medication within 60 minutes before the morning and evening meal. c. monitor the client for gastrointestinal side effects after administering the medication. d. withdraw the insulin from the prefilled pen into an insulin syringe to prepare for administration. 605. A client is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply a. hypoglycemia may be experiences before dinnertime. b. the insulin dose should be decreased if illness occurs. c. the insulin should be administered at room temperature. d. the insulin vial needs to be shaken vigorously to break up the precipitates. c. the NPH insulin should be drawn into the syringe first, then the regular insulin. 606. The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these medications. The nurse should provide which instructions to the client? Select all that apply. a. diarrhea may occur secondary to the metformin. b. the repalginide is not taken if a meal is skipped. c. the repaglinide is taken 30 minutes before eating. d. a simple sugar food item is carried and used to treat mild hypoglycemia associated with repaglinide. e. muscle pain is an expected effect of metformin and may be treated with acetaminophen (Tylenol). 607. The community health nurse visits a client at home. Prednisone, 10mg orally daily, has been prescribed for the client and the nurse teaches the client about the medication. Which statement, if made by the client, indicates that further teaching is necessary? a. “I can take aspirin or my antihistamine if I need it.” b. “I need to take the medication every day at the same time.” c. “I need to avoid coffee, tea, cola, and chocolate in my diet.” d. “If I gain more than 5 pounds a week, I will call my health care provider (HCP). 608. A client with hyperthyroidism has been given methimazole (Tapazole). Which nursing considerations are associated with this medication? Select all that apply. a. administer methimazole with food. b. place the client on a low-calorie, low-protein diet. c. assess the client for unexplained bruising or bleeding. d. instruct the client to report side/adverse effects such as sore throat, fever, or headaches e. use special radioactive precautions when handling the clients urine for the first 24 hours following initial administration. 609. The nurse is monitoring a client receiving levothyroxine sodium (Synthroid) for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. a. insomnia b. weight loss c. bradycardia d. constipation e. mild heat intolerance 610. The nurse provides instructions to a client who is taking levothyroxine (Synthroid). The nurse should tell the client to take the medication at which time? a. with food b. at lunchtime c. on an empty stomach d. at bedtime with a snack 611. The nurse provides medication instructions to a client who is taking levothyroxine (Synthroid) and should tell the client to notify the health care provider (HCP) if which problem occurs? a. fatigue b. tremors c. cold intolerance d. excessively dry skin 612. The nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of which condition? a. myxedema b. graves’ disease c. addison’s disease d. cushing’s syndrome 613. The nurse is instructing a client regarding intranasal desmopressin (DDAVP). The nurse should tell the client that which occurrence is a side effect of the medication? a. headache b. vulval pain c. runny nose d. flushed skin 614. A daily dose of prednisone is prescribed for a client. The nurse provides instructions to the client regarding administration of the medication and should instruct the client that which time is best to take this medication? a. at noon b. at bedtime c. early morning d. any time, at the same time, each day 615. Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin NPH insulin daily. Which prescription change does the nurse anticipate during therapy with the prednisone? a. an additional dose of prednisone daily b. a decreased amount of daily Humulin NPH insulin c. an increased amount of daily Humulin NPH insulin d. the addition of an oral hypoglycemic medication daily 616. A client with diabetes mellitus visits a health care clinic. The clients diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia? a. Prednisone b. Phenelzine (Nardil) c. Atenolol (Tenormin) d. Allopurinol (Zyloprim) Chapter 57: GI Medications 643. A client with Crohn’s disease is scheduled to receive an infusion of infliximab (Remicade). What intervention by the nurse will determine the effectiveness of treatment? a. monitoring the leukocyte count for 2 days after the infusion. b. checking the frequency and consistency of bowel movements. c. checking serum liver enzyme levels before and after the infusion d. carrying out a Hematest on gastric fluids after the infusion is completed. 644. A client has a PRN prescription for loperamide hydrochloride (Imodium). For which condition should the nurse administer this medication? a. constipation b. abdominal pain c. an episode of diarrhea d. hematest-positive nasogastric tube drainage 645. A client has a PRN prescription for ondansetron (Zofran). For which condition should the nurse administer this medication to the postoperative client? a. paralytic ileus b. incisional pain c. urinary retention d. nausea and vomiting 646. A client has begun medication therapy with pancrelipase (Pancrease MT,). The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed? a. weight loss b. relief of heartburn c. reduction of steatorrhea d. absence of abdominal pain 647. An older client recently has been taking cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system side effect of this medication? a. tremors b. dizziness c. confusion d. hallucination 648. A client with a gastric ulcer has a prescription for sucralfate (Carfate), 1g by mouth four times daily. The nurse should schedule the medication for which times? a. with meals and at bedtime b. every 6 hours around the clock c. one hour after meals and at bedtime d. one hour before meals and at bedtime 649. A client who chronically uses nonsteroidal anti-inflammatory drugs (NSAIDS) had been taking misoprostol (Cytotec). The nurse determines that the medication is having the intended therapeutic effect if which finding is noted? a. resolved diarrhea b. relief of epigastric pain c. decreased platelet count d. decreased white blood cell count 650. A client has been taking omeprazole (Prilosec) for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? a. diarrhea b. heartburn c. flatulence d. constipation 651. A client with a peptic ulcer is diagnosed with a Helicobactor pylori infection. The nurse is teaching the client about the medicaitons prescribed, including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin (Amoxil). Which statement by the client indicates the best understanding of the medication regimen? a. “My ulcer will heal because these medications will kill the bacteria.” b. “These medicaitons are only taken when I have pain from my ulcer.” c. “The medicaitons will kill the bacteria and stop the acid production.” d. “These medications will coat the ulcer and decrease the acid production in my stomach.” 652. A client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition? a. intestinal obstruction b. peptic ulcer with melena c. diverticulitis with perforation d. vomiting following cancer chemotherapy 653. A histamine (H2)receptor antagonist will be prescribed for a client. The nurse understands that which medications are H2 – receptor antagonist? Select all that apply. a. Nizatidine (Axid) b. Ranitidine (Zantac) c. Famotidine (Pepcid) d. Cimetidine (Tagamet) e. Esomeprazole (Nexium) f. Lansoprazole (Prevacid) 654. The nurse has given instructions to a client who has just been prescribed cholestyramine (Questran). Which statement by the client indicates a need for further instructions? a. “I will continue taking vitamin supplements.” b. “This medication will help lower my cholesterol.” c. “This medication should only be taken with water.” d. “A high-fiber diet is important while taking this medication.” Chapter 59 679. A client has a prescription to take guaifenesin (Mucinex). The nurse determines that the client understands the proper administration of this medication if the client states that he or she will perform which action? 1. Take an extra dose if fever develops 2. Take the medication with meals only 3. Take the tablet with a full glass of water 4. Decrease the amount of daily fluid intake 680. The nurse is preparing to administer a dose of naloxone hydrochloride intravenously to a client with an intravenous opioid overdose. Which supportive medical equipment should the nurse plan to have at the client’s bedside if needed? 1. Nasogastric tube 2. Paracentesis tray 3. Resuscitation equipment 4. Central line insertion tray 681. The nurse teaches a client about the effects of diphenhydramine (Benadryl), which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction if the client makes which statement? 1. “I will take the medication on an empty stomach.” 2. “I won’t drink alcohol while taking this medication.” 3. “I will use sugarless gum, candy, or oral rinses to decrease dryness in my mouth.” 4. “I won’t do activities that require mental alertness while taking this medication.” 682. A cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the side and adverse effects of this medication and should tell the client that which undesirable effect is associated with this medication? 1. Insomnia 2. Constipation 3. Hypotension 4. Bronchospasm 683. Terbutaline is prescribed for a client with bronchitis. The nurse understands that this medication should be used with caution if which medical condition is present in the client? 1. Osteoarthritis 2. Hypothyroidism 3. Diabetes mellitus 4. Polycystic disease 684. Zafirlukast (Accolate) is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? 1. Platelet count 2. Neutrophil count 3. Liver function tests 4. Complete blood count 685. A client has been taking isoniazid for 11⁄2 months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? 1. Hypercalcemia 2. Peripheral neuritis 3. Small blood vessel spasm 4. Impaired peripheral circulation 686. A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? 1. Use alcohol in small amounts only. 2. Report yellow eyes or skin immediately. 3. Increase intake of Swiss or aged cheeses. 4. Avoid vitamin supplements during therapy. 687. A client has been started on long-term therapy with rifampin (Rifadin). The nurse should provide which information to the client about the medication? 1. Should always be taken with food or antacids 2. Should be double-dosed if one dose is forgotten 3. Causes orange discoloration of sweat, tears, urine, and feces 4. May be discontinued independently if symptoms are gone in 3 months 688. The nurse has given a client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client states he or she will immediately report which finding? 1. Impaired sense of hearing 2. Gastrointestinal side effects 3. Orange-red discoloration of body secretions 4. Difficulty in discriminating the color red from green 689. A client with tuberculosis is being started on antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse should ensure that which baseline study has been completed? 1. Electrolyte levels 2. Coagulation times 3. Liver enzyme levels 4. Serum creatinine level 690. The nurse has a prescription to give a client salmeterol (Serevent Diskus), two puffs, and beclomethasone dipropionate (Qvar), two puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure? 1. Beclomethasone first and then the salmeterol 2. Salmeterol first and then the beclomethasone 3. Alternating a single puff of each, beginning with the salmeterol 4. Alternating a single puff of each, beginning with the beclomethasone 691. Rifabutin (Mycobutin) is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. For which side/ adverse effects of the medication should the nurse monitor? Select all that apply. 1. Signs of hepatitis 2. Flulike syndrome 3. Low neutrophil count 4. Vitamin B6 deficiency 5. Ocular pain or blurred vision 6. Tingling and numbness of the fingers 692. A client has begun therapy with theophylline (Theo-24). The nurse should plan to teach the client to limit the intake of which items while taking this medication? 1. Coffee, cola, and chocolate 2. Oysters, lobster, and shrimp 3. Melons, oranges, and pineapple 4. Cottage cheese, cream cheese, and dairy creamers 693. The nurse has just administered the first dose of omalizumab (Xolair) to a client. Which statement by the client would alert the nurse that the client may be experiencing a life-threatening effect? 1. “I have a severe headache.” 2. “My feet are quite swollen.” 3. “I am nauseated and may vomit.” 4. “My lips and tongue are swollen.” 694. The nurse is caring for a client with a diagnosis of influenza who first began to experience symptoms yesterday. Antiviral therapy is prescribed and the nurse provides instructions to the client about the therapy. Which statement by the client indicates an understanding of the instructions? 1. “I must take the medication exactly as prescribed.” 2. “Once I start the medication, I will no longer be contagious.” 3. “I will not get any colds or infections while taking this medication.” 4. “This medication has minimal side effects and I can return to normal activities.” Chapter 61: Cardiovascular Medications 723. A client is being treated with procainamide for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take first? 1. Measure the heart rate on the rhythm strip. 2. Administer prescribed nitroglycerin tablets. 3. Obtain a 12-lead electrocardiogram immediately. 4. Auscultate the client’s apical pulse and obtain a blood pressure. 4 Auscultate the client’s apical pulse and obtain a BP Rationale: Signs of toxicity from procainamide include confusion, dizziness, drowsiness, decreased urination, nausea, vomiting, and tachydysrhythmias. If the client complains of dizziness, the nurse should assess the vital signs first. Although measuring the heart rate on the rhythm strip and obtaining a 12-lead EKG may be interventions, these would be done after the vital signs are taken. Nitroglycerin is a vasodilator and will lower the blood pressure. 724. The nurse is monitoring a client who is taking propranolol (Inderal LA). Which assessment data indicates a potential serious complication associated with this medication? 1. The development of complaints of insomnia 2. The development of audible expiratory wheezes 3. A baseline blood pressure of 150/ 80 mm Hg followed by a blood pressure of 138/ 72 mm Hg after two doses of the medication 4. A baseline resting heart rate of 88 beats/ minute followed by a resting heart rate of 72 beats/ minute after two doses of the medication 2 The development of audible expiratory wheezes Rationale: Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. β-Blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored. 725. A client with atrial fibrillation secondary to mitral stenosis is receiving a heparin sodium infusion at 1000 units/ hour and warfarin sodium (Coumadin) 7.5 mg at 5: 00 PM daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT) = 32 seconds; internationalized normalized ratio (INR) = 1.3. The nurse should plan to take which action based on the client’s laboratory results? 1. Collaborate with the health care provider (HCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed. 2. Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed. 3. Collaborate with the HCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range. 4. Collaborate with the HCP to continue the heparin infusion at the same rate and to discuss use of dabigatran etexilate (Pradaxa) in place of warfarin sodium. 2 Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed. Rationale: When a client is receiving warfarin (Coumadin) for clot prevention due to atrial fibrillation, an INR of 2 to 3 is appropriate for most clients. Until the INR has achieved a therapeutic range the client should be maintained on a continuous heparin infusion with the aPTT ranging between 60 and 80 seconds. Therefore, the nurse should collaborate with the health care provider to obtain a prescription to increase the heparin infusion and to administer the warfarin as prescribed. 726. A client is diagnosed with an ST-segment elevation myocardial infarction (STEMI) and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention? 1. Monitor for kidney failure. 2. Monitor psychosocial status. 3. Monitor for signs of bleeding. 4. Have heparin sodium available. 3 Monitor for signs of bleeding. Rationale: Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client’s psychosocial status are important but are not the most critical interventions. Heparin may be administered after thrombolytic therapy, but the question is not asking about follow-up medications. 727. The nurse is planning to administer hydrochlorothiazide to a client. The nurse understands that which is a concern related to the administration of this medication? 1. Hypouricemia, hyperkalemia 2. Increased risk of osteoporosis 3. Hypokalemia, hyperglycemia, sulfa allergy 4. Hyperkalemia, hypoglycemia, penicillin allergy 3 Hypokalemia, hyperglycemia, sulfa allergy Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia. 728. The home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/ dL. The client is taking cholestyramine (Questran). Which statement, by the client, indicates the need for further education? 1. “Constipation and bloating might be a problem.” 2. “I’ll continue to watch my diet and reduce my fats.” 3. “Walking a mile each day will help the whole process.” 4. “I’ll continue my nicotinic acid from the health food store.” 4 “I’ll continue my nicotinic acid from the health food store.” Rationale: Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid- lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin needs to be avoided. Constipation and bloating are the two most common side effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels. 729. The nurse is monitoring a client who is taking digoxin (Lanoxin) for adverse effects. Which findings are characteristic of digoxin toxicity? Select all that apply. 1. Tremors 2. Diarrhea 3. Irritability 4. Blurred vision 5. Nausea and vomiting 2 Diarrhea 4 Blurred vision 5 Nausea and vomiting Rationale: Digoxin (Lanoxin) is a cardiac glycoside. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea. Subsequent manifestations include headache; visual disturbances such as diplopia, blurred vision, yellow-green halos, and photophobia; drowsiness; fatigue; and weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. Therapeutic levels for digoxin range from 0.5 to 2 ng/ mL. 730. Prior to administering a client’s daily dose of digoxin, the nurse reviews the client’s laboratory data and notes the following results: serum calcium, 9.8 mg/ dL; serum magnesium, 1.2 mg/ dL; serum potassium, 4.1 mEq/ L; serum creatinine, 0.9 mg/ dL. Which result should alert the nurse that the client is at risk for digoxin toxicity? 1. Serum calcium level 2. Serum potassium level 3. Serum creatinine level 4. Serum magnesium level 4 Serum magnesium level Rationale: An increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function. The calcium, creatinine, and potassium levels are all within normal limits. The normal range for magnesium is 1.6 to 2.6 mg/ dL and the results in the correct option are reflective of hypomagnesemia. 731. A client being treated for heart failure is administered intravenous bumetanide. Which outcome indicates the medication has achieved the expected effect? 1. Cough becomes productive of frothy pink sputum 2. The serum potassium level changes from 3.8 to 3.1 mEq/ L 3. B-natriuretic peptide (BNP) factor increases from 200 to 262 pg/ mL 4. Urine output increases from 10 mL/ hour to greater than 50 mL hourly 4 Urine output increases from 10 mL/hour to greater than 50 mL hourly Rationale: Bumetanide is a diuretic and expected outcomes include increased urine output, decreased crackles, and decreased weight. Options 1, 2, and 3 are incorrect. 732. Intravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit? 1. Vitamin K 2. Protamine sulfate 3. Potassium chloride 4. Aminocaproic acid (Amicar) 2 Protamine sulfate Rationale: The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin sodium. Potassium chloride is administered for a potassium deficit. Aminocaproic acid is the antidote for thrombolytic therapy. 733. A client receiving thrombolytic therapy with a continuous infusion of alteplase (Activase) suddenly becomes extremely anxious and complains of itching. The nurse hears stridor and notes generalized urticaria and hypotension. Which nursing action is the priority? 1. Administer oxygen and protamine sulfate. 2. Cut the infusion rate in half and sit the client up in bed. 3. Stop the infusion and call the health care provider (HCP). 4. Administer diphenhydramine (Benadryl) and continue the infusion. Rationale: The client is experiencing an anaphylactic reaction. Therefore, the priority action is to stop the infusion and notify the HCP. The client may be treated with epinephrine, antihistamines, and corticosteroids as prescribed. 734. The nurse should report which assessment finding to the health care provider (HCP) before initiating thrombolytic therapy in a client with pulmonary embolism? 1. Adventitious breath sounds 2. Temperature of 99.4 ° F orally 3. Blood pressure of 198/ 110 mm Hg 4. Respiratory rate of 28 breaths/ minute Rationale: Thrombolytic therapy is contraindicated in a number of preexisting conditions in which there is a risk of uncontrolled bleeding, similar to the case in anticoagulant therapy. Thrombolytic therapy also is contraindicated in severe uncontrolled hypertension because of the risk of cerebral hemorrhage. Therefore the nurse would report the results of the blood pressure to the HCP before initiating therapy. Chapter 63: Renal Medications Questions and Choices Correct Answer with Rationale #756 A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which medication? 1. Diuretics 2. Antibiotics 3. Antitussives 4. Decongestants 4. Decongestants Rationale: In the client with benign prostatic hyperplasia, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. The client should be questioned about the use of these medications if the client has urinary retention. Retention can also be precipitated by other factors, such as alcoholic beverages, infection, bed rest, and becoming chilled. #757 Nitrofurantoin (Macrodantin) is prescribed for a client with a urinary tract infection. The client contacts the nurse and reports a cough, chills, fever, and difficulty breathing. The nurse should make which interpretation about the client’s complaints? 1. The client may have contacted the flu. 2. The client is experiencing anaphylaxis. 3. The client is experiencing expected effect of the medication. 4. The client is experiencing a pulmonary reaction requiring cessation of the medication. 4. The client is experiencing a pulmonary reaction requiring cessation of the medication. Rationale: Nitrofurantoin can induce two kinds of pulmonary reactions: acute and subacute. Acute reactions, which are most common, manifest with dyspnea, chest pain, chills, fever, cough, and alveolar infiltrates. These symptoms resolve 2 to 4 days after discontinuing the medication. Acute pulmonary responses are thought to be hypersensitivity reactions. Subacute reactions are rare and occur during prolonged treatment. Symptoms (e.g., dyspnea, cough, malaise) usually regress over weeks to months following nitrofurantoin withdrawal. However, in some clients, permanent lung damage may occur. The remaining options are incorrect interpretations. #758 The nurse is providing discharge instructions to a client receiving sulfamethoxazole. Which instruction should be included in the list? 1. Restrict fluid intake. 2. Maintain a high fluid intake. 3. If the urine turns dark drown, call the health care provider (HCP) immediately. 4. Decrease the dosage when symptoms are improving to prevent an allergic response. 2. Maintain a high fluid intake Rationale: Each dose of sulfamethoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfamethoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the HCP. #759 Trimethoprim-sulfamethoxazole (TMP-SMZ); Bactrim) is prescribed for a client. The nurse should instruct the client to report which symptom if it develops during the course of this medication therapy? 1. Nausea 2. Diarrhea 3. Headache 4. Sore throat 4. Sore throat Rationale: Clients taking trimethoprim (TMP)-sulfamethoxazole (SMZ) should be informed about early signs/symptoms of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, ant the client should be instructed to notify the health care provider (HCP) if these occur. The other options do not require HCP notification. #760 Phenazopyridine (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. The nurse should provide the client with which information regarding this medication? 1. Take the medication at bedtime. 2. Take the medication before meals. 3. Discontinue the medication if a headache occurs. 4. A reddish orange discoloration of the urine may occur. 4. A reddish orange discoloration of the urine may occur. Rationale: The nurse should instruct the client that a reddish- orange discoloration of the urine may occur. The nurse also should instruct the client that this discoloration can stain fabric. The medication should be taken after meals to reduce the possibility of GI upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication. #761 Bethanechol chloride (Urecholine) is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this medication? 1. Gastric atony 2. Urinary strictures 3. Neurogenic atony 4. Gastroesophageal reflux 2. Urinary strictures Rationale: Bethanechol chloride (Urecholine) can be hazardous to clients with urinary tract obstruction of weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions. #762 The nurse, who is administering bethanechol chlorine (Urecholine), is monitoring for cholinergic overdose associated with the medication. The nurse should check the client for which sign of overdose? 1. Dry skin 2. Dry mouth 3. Bradycardia 4. Signs of dehydration 3. Bradycardia Rationale: Cholinergic overdose of bethanechol chloride produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Treatment includes supportive measures and the administration of atropine sulfate subcutaneously or intravenously. #763 Oxybutinin chloride (Ditropan XL) is prescribed for a client with neurogenic bladder. Which sign would indicate a possible toxic effect related to the medication? 1. Pallor 2. Drowsiness 3. Bradycardia 4. Restlessness 4. Restlessness Rationale: Toxicity (overdosage) of oxybutynin produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a frequent side effect of the medication but does not indicate overdosage. #764 Following kidney transplantation, cyclosporine (Sandimmune) is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1. Normal hemoglobin level 2. Decreased creatinine level 3. Decreased white blood cell count 4. Elevated blood urea nitrogen level 4. Elevated blood urea nitrogen level Rationale: Nephrotoxicity can occur from the use of cyclosporine (Sandimmune). Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels. Cyclosporine does not depress the bone marrow. #765 The nurse is providing dietary instructions to a client who has been prescribed cyclosporine (Sandimmune). Which food item should the nurse instruct the client to exclude from the diet? 1. Red meats 2. Orange juice 3. Grapefruit juice 4. Green leafy vegetables 3. Grapefruit juice Rationale: A compound present in grapefruit juice inhibits metabolism of cyclosporine. As a result, consumption of grapefruit juice can raise cyclosporine levels by 50% to 100%, thereby greatly increasing the risk of toxicity. #766 Tacrolimus (Prograf) is prescribed for a client. Which disorder, if noted in the client’s record, would indicate that the medication needs to be administered with caution? 1. Pancreatitis 2. Ulcerative colitis 3. Diabetes insipidus 4. Coronary artery disease 1. Pancreatitis Rationale: Tacrolimus (Prograf) is used with caution in immunosuppressed clients and in clients with renal, hepatic, or pancreatic function impairment. Tacrolimus is contraindicated in clients with hypersensitivity to thus medication or hypersensitivity to cyclosporine. #767 The nurse is reviewing the laboratory results for a client receiving tacrolimus (Prograf). Which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medication? 1. Blood glucose of 200 mg/dL 2. Potassium level of 3.8 mEq/L 3. Platelet count of 300,000 cells/mm3 4. White blood cell count of 6000 cells/mm3 1. Blood glucose of 200 mg/dL Rationale: A blood glucose level of 200 mg/dL is significantly elevated above the normal range of 70 to 110 mg/dL and suggests an adverse effect. Other adverse effects include neurotoxicity evidenced by headache, tremor, and insomnia; GI effects such as diarrhea, nausea, and vomiting; hypertension; and hyperkalemia. #768 The nurse receives a call from a client concerned about eliminating brown-colored urine after taking nitrofurantoin (Furadantin) for a urinary tract infection. The nurse should make which appropriate response? 1. “Discontinue taking the medication and make an appointment for a future urine culture.” 2. “Decrease your medication to half the dose because your urine is too concentrated.” 3. “Continue taking the medication because the urine is discolored from the medication.” 4. “Take magnesium hydroxide (Maalox) with your medication to lighten the urine color.” 3. “Continue taking the medication because the urine is discolored from the medication.” Rationale: Nitrofurantoin (Furadantin) imparts a harmless brown color to the urine and the medication should not be discontinued until the prescribed dose is completed. Magnesium hydroxide (Maalox) will not affect urine color. In addition, antacids should be avoided because they interfere with mediation effectiveness. #769 A client with chronic kidney disease is receiving epoetin alfa (Epogen). Which laboratory result would indicate a therapeutic effect of the medication? 1. Hematocrit of 32% 2. Platelet 400,000 cells/mm3 3. Blood urea nitrogen level of 15 mg/dL 4. White blood cell count of 6000 cells/mm3 1. Hematocrit of 32% Rationale: Epoetin alfa is used to reverse anemia associated with chronic kidney disease, Therapeutic effect is seen when the hematocrit is between 30% and 33%. Options 2, 3, and 4 are not associated with the action of this medication. A client with a urinary tract infection is receiving ciprofloxacin (Cipro) by the intravenous (IV) route. Nurse appropriately administers the medication by performing which action? 1. Infusing slowly over 60 minutes. 2. Infusing in light-protective bag. 3. Infusing only through a central line. 4. Infusing rapidly as direct IVP 1. Infusing slowly over 60 minutes. Rationale: Ciprofloxacin (Cipro) is prescribed for treatment of mild, moderate, severe, and complicated infections of the urinary tract, lower respiratory tract, and skin and skin structures. A single does is administered slowly over 60 minutes to minimize discomfort and vein irritation. Other solutions infusing at the same site need to be temporarily discontinued while the ciprofloxacin in infusing. Chapter 65: Optic & Ophthalmic Questions and Choices Answers and Rationales Betaxolol hydrochloride eyedrops have been prescribed for a client with glaucoma. Which nursing action is most appropriate related to monitoring for side/adverse effects of this medication? 1. Monitoring temperature 2. Monitoring blood pressure 3. Assessing peripheral pulses 4. Assessing blood glucose level 2. Monitoring blood pressure Rationale: Hypotension, dizziness, nausea, diaphoresis, headache, fatigue, constipation, and diarrhea are side/adverse effects of the medication. Nursing interventions include monitoring the blood pressure for hypotension and assessing the pulse for strength, weakness, irregular rate, and bradycardia. Options 1, 3, and 4 are not specifically associated with this medication. The nurse is preparing to administer eyedrops. Which interventions should the nurse take to administer the drops? Select all that apply. 1. Wash hands. 2. Put gloves on. 3. Place the drop in the conjunctival sac. 4. Pull the lower lid down against the cheekbone. 5. Instruct the client to squeeze the eyes shut after instilling the eye drop. 6. Instruct the client to tilt the head forward, open the eyes, and look down. 1. Wash hands. 2. Put gloves on. 3. Place the drop in the conjunctival sac. 4. Pull the lower lid down against the cheek bone. Rationale: To administer eye medications, the nurse should wash hands and put gloves on. The client is instructed to tilt the head backward, open the eyes, and look up. The nurse pulls the lower lid down against the cheekbone and holds the bottle like a pencil with the tip downward. Holding the bottle, the nurse gently rests the wrist of the hand on the client’s check and squeezes the bottle gently to allow the drop to fall into the conjunctival sac. The client is instructed to close the eyes gently and not to squeeze the eyes shut to prevent loss of the medication. The nurse prepares a client for an ear irrigation as prescribed by the healthcare provider. Which action should the nurse take when performing the procedure? 1. Warm the irrigation solution to 98.6° F. 2. Position the client with the affected side up following the irrigation. 3. Direct a slow steady stream of irrigation solution toward the eardrum. 4. Assist the client to turn his or her head so that the ear to be irrigated is facing upward. 1. Warm the irrigation solution to 98.6° F. Rationale: Before an ear irrigation, the nurse should inspect the tympanic membrane to ensure that it is intact. The irrigating solution should be warmed to 98.6° F because a solution temperature that is not close to the client’s body temperature will cause ear injury, nausea, and vertigo. The affected side should be down following the irrigation to assist in drainage of the fluid. When irrigating, a direct and slow steady stream of irrigation solution is directed toward the wall of the canal, not toward the eardrum. The client is positioned sitting, facing forward with the head in natural position; if the ear is faced upward, the nurse would not be able to visualize the canal. The nurse is providing instructions to a client who will be self- administering eyedrops. To minimize systemic absorption of the eyedrops, the nurse should instruct the client to take which action? 1. Eat before instilling the drops. 2. Swallow several times after instilling the eyedrops. 3. Blink vigorously to encourage tearing after instilling the drops. 4. Occlude the nasolacrimal duct with a finger after instilling the drops. 4. Occlude the nasolacrimal duct with a finger after instilling the drops. Rationale: Applying pressure on the nasolacrimal duct prevents systemic absorption of the medication. Options 1, 2, and 3 will not prevent systemic absorption. A client is prescribed an eyedrop and an eye ointment for the right eye. How should the nurse best administer the medication? 1. Administer the eyedrop first, followed by the eye ointment. 2. Administer the eye ointment first, followed by the eyedrop. 3. Administer the eyedrop, wait 15 minutes, and administer the ointment. 4. Administer the ointment, wait 15 minutes, and administer the eyedrop. 1. Administer the eyedrop first, followed by the eye ointment. Rationale: When an eyedrop and an eye ointment are scheduled to be administered at the same time, the eyedrop is administered first. The instillation of two medications is separated by 3 to 5 minutes. #795 Which medication, if prescribed for the client with glaucoma, should the nurse question? 1. Betaxolol (Betoptic) 2. Atropine sulfate (Isopto Atropine) 3. Pilocarpine hydrochloride (Isopto Carpine) 4. Pilocarpine (Ocusert Pilo-20, Ocusert Pilo-40) 2. Atropine sulfate (Isopto Atropine) Rationale: Options 1, 3, and 4 are miotic agents used to treat glaucoma. The correct option is a mydriatic and cycloplegic (also anticholinergic) medication, and its use is contraindicated in clients with glaucoma. Mydriatic medications dilate the pupil and can cause an increase in intraocular pressure in the eye. #796 A miotic medication has been prescribed for the client with glaucoma and the client asks the nurse about the purpose of the medication. Which response should the nurse provide to the client? 1. “The medication will help dilate the eye to prevent pressure from occurring.” 2. “The medication will relax the muscles of the eyes and prevent bl