NURSING 304 - SAUNDERS ATI PHARMACOLOGY STUDY GUIDE (UPDATED) Complete Solution, A 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