A client is prescribed phenobarbital sodium (Luminal) for a seizure disorder. The medication has a long half-life of 4 days. Based on this half-life, the medication will most likely be prescribed
A. once a day.
B. twice a day.
C. three times a day.
D. four times a day.
ANS: A
Medication with long half-lives remain at their therapeutic levels between doses for long periods of time. Therefore, this medication can be administered once a day.
A nurse educator is reviewing medication dosages and factors that influence medication metabolism with a group of nurses. Medication dosages may need to be decreased for which of the following reasons? (Select all that apply.)
A. Increased renal excretion
B. Increased medication-metabolizing enzymes
C. Liver failure
D. Peripheral vascular disease
E. Concurrent use of medication metabolized by the same pathway
ANS: C, E
Liver failure decreases metabolism and thus increase the concentration of medication. This may require decreasing the dosage of medication. When two medications are metabolized in the same way, they may compete for metabolism, thereby increasing the concentration of one or both medications.
Increased renal excretion may decrease concentration of the medication, requiring increased dosage. Increased medication-metabolizing enzymes can decrease the concentration of the medication. The dose might need increased. Peripheral vascular disease may impair distribution, and more of the medication may be needed.
A nurse s preparing to administer eye drops to a client. Which of the following are appropriate nursing interventions related to this procedure? (Select all that apply.)
A. Using medical aseptic technique
B. Asking the client to look up at the ceiling
C. Having the client lie in a side-lying position
D. Dropping medication into the center of the client’s conjunctival sac
E. Instructing the client to close the eye gently
ANS:B, D, E
The medication should be dropped into the center of the conjunctival sac to promote better distribution of the medication. The client should close the eye gently to allow improved distribution of the medication.
Surgical aseptic technique is used to administer eye drops. The client should be sitting or in a supine position to facilitate proper administration of eye drops.
A nurse is completing discharge teaching to a client who has a new prescription for a transdermal medication. Which of the following statements by the client indicates understanding of the teaching?
A. “I will clean the site with an alcohol swab prior to applying the patch.”
B. “I will rotate the application site weekly.”
C. “I will apply the patch to an area of skin with no hair.”
D. “I will place the new patch on the site of the old patch.”
ANS: C
Transdermal medication should be applied to a hairless area of skin to promote absorption of medication.
The skin should be washed with soap and water and dried thoroughly before applying a transdermal patch. Application sites should be rotated on a daily basis to prevent skin irritation.
A nurse is reviewing a client’s health record and notes a new prescription by the provider to verify the trough level of the client’s medication. Which of the following actions should the nurse take?
A. Have a blood specimen obtained immediately prior to the next dose of medication.
B. Verify that the client has been on the medication for 24 hr before ordering a blood specimen.
C. Ask the client to provide a urine specimen after the next dose of medication.
D. Begin administering the medication, and obtain a blood specimen.
ANS: A
To verify trough levels of a medication, a blood specimen is obtained immediately before the next dose of medication.
A nurse is preparing a client’s medication. Which of the following are legal responsibilities of the nurse? (Select all that apply.)
A. Maintaining skill competency
B. Determining the dosage
C. Monitoring for adverse effects
D. Safeguarding medications
E. Identifying the client’s diagnosis
ANS: A, C, D
Determining medication dosage and identifying a diagnosis is the role/responsibility of the provider. The nurse should be informed about a client’s diagnosis.
A nurse is reviewing a client’s health record and notes a new prescription by the provider for lisinopril (Zestril) 10 mg PO every day. The nurse should recognize this as which of the following types of prescription?
A. Single prescription
B. Stat prescription
C. Routine prescription
D. Standing prescription
ANS: C
A routine prescription identifies a medication that is given on a regular schedule. This medication is administered every day until discontinued.
A single prescription is to be given once at a specified time or as soon as possible. A stat prescription is only given once, and it is given immediately. A standing prescription is written for specific circumstances or a specific unit.
A nurse is reviewing a new prescription for ondansetron (Zofran) 4 mg PO PRN nausea and vomiting for a client who has hyperemesis gravidarum. The nurse should clarify which of the following parts of the prescription with the provider?
A. Name
B. Dosage
C. Route
D. Time
ANS: D
The time and frequency of medication administration is not included and should be clarified with the provider.
A nurse is orienting a newly hired nurse and discussing how to take telephone prescription. Which of the following statements by the newly hired nurse indicates understanding of the discussion?
A. “A second nurse enters the prescription into the client’s health record.”
B. “Another nurse should listen to the phone call.”
C. “The provider can clarify the prescription when he signs the health record.”
D. “The ‘read back’ is omitted if this is a one-time prescription.”
ANS: B
The second nurse should listen to a telephone prescription to prevent errors in communication.
The nurse who takes the telephone prescription should enter it into the client’s health record to prevent errors in translation. The nurse verifies the prescription is complete and accurate at the time it is given by reading it back to the provider. A telephone prescription includes reading back all types of medication prescription.
A nurse on a medical unit is admitting a client and completing a preassessment before administration of medications. Which of the following data should the nurse include in the preassessment? (Select all that apply.)
A. Use of herbal teas
B. Daily fluid intake
C. Current health status
D. Previous surgical history
E. Food allergies
ANS: A, C, E
Use of herbal product,s which often contains caffeine, should be assessed prior to medication administration because caffeine can affect medication biotransformation. Current health status should be reviewed because new prescriptions can cause alterations in current health status. Food allergies should be included in the preassessment that is completed prior to medication administration to identify any potential interactions.
Daily fluid intake and surgical history is important, but it is not part of the presassessment that is completed prior to medication administration.
A nurse is assessing a client’s IV. Which of the following findings is indicative of phlebitis? (Select all that apply.)
A. Tingling sensation below insertion site
B. Tachycardia
C. Palpable, hard mass above insertion site
D. Cool, pale skin
E. Pain at site
ANS: C, E
Pain at the IV site and a palpable, hard mass above the insertion site is a clinical manifestation of thrombophlebitis.
A tingling sensation below the insertion site is a clinical manifestation of nerve damage. Tachycardia is a clinical manifestation of fluid volume overload. Cool, pale skin is a clinical manifestation of infiltration.
A nurse manager is reviewing the facility’s policies for IV therapy with the members of his team. The nurse manager should remind the team that which of the following techniques helps minimize the risk of catheter embolism?
A. Performing hand hygiene before and after IV insertion
B. Rotating IV sites at least every 72 hr
C. Minimizing tourniquet time
D. Avoiding reinserting the needle into an IV catheter
ANS: D
The nurse manager should remind the members to avoid reinserting a needle to an IV catheter. This action can result in severing the end of the catheter and consequently cause a catheter embolism.
A nurse is preparing to initiate IV therapy for an older adult client. Which of the following actions should the nurse take?
A. Use a disposable razor to remove excess hair on the extremity.
B. Select the back of the client’s hand to insert the IV catheter.
C. Distend the veins by using a blood pressure cuff.
D. Direct the client to raise his arm above his heart.
ANS: C
The nurse should distend the veins using a blood pressure cuff to reduce overfilling of the vein, which can result in a hematoma.
The nurse should remove excess hair by clipping it with scissors. Shaving with disposable razors can cause skin damage that lead to infection. In most instances, the nurse inserts the IV catheter into a distal site, such as the back of the client’s hand. However, when inserting an IV catheter for an older adult, the nurse should use a site on the arm because older adults typically have fragile veins in the back of their hands. The nurse should direct the client to hold his arm below the level of his heart to distend the vein.
A nurse is caring for a client receiving dextrose 5% in water IV at 250 mL. Which of the following findings are an indication of fluid volume overload? (Select all that apply.)
A. Hypotension
B. Bradycardia
C. Shortness of breath
D. Crackles heard in lungs
E. Distended neck veins
ANS: C, D, E
Due to an increase in fluid in the cardiovascular system, hypertension and tachycardia are manifestations of fluid overload.
A nurse in a clinic is caring for a group of clients. The nurse should contact the provider about a potential contraindication to a medication for which of the following clients? (Select all that apply.)
A. A client at 8 weeks of gestation who asks for an influenza immunization.
B. A client who takes prednisone and has a possible fungal infection.
C. A client who has chronic liver disease and reports he is taking hydrocodone.
D. A client who has PUD and takes sucralfate and tells the nurse she has started taking OTC aluminum hydroxide.
E. A client who has a prosthetic heart valve who takes warfarin and reports a suspected pregnancy.
ANS: B, C, E
Glucocorticoids should not be taken by a client who has possible systemic fungal infection. Acetaminophen is contraindicated due to toxicity for the client who has a liver disorder. Warfarin is a Pregnancy Category X medication, which can cause severe birth defects in a fetus.
The influenza vaccine is recommended for all people older than 6 months of age and is not contraindicated for pregnant women. There is no contraindication for a client who has PUD and takes sucralfate and also starts taking OTC aluminum hydroxide. The nurse should ensure that the client takes medications 3 min apart.
A nurse is preparing to administer an IM dose of penicillin to a client who has a new prescription. The client states she took penicillin 3 years ago and developed a rash. Which of the following is an appropriate nursing action?
A. Administer the prescribed dose.
B. Withhold the medication.
C. Ask the provider to change the prescription to an oral form.
D. Administer an oral antihistamine at the same time.
ANS: B
The nurse should withhold the medication and notify the provider of the client’s previous reaction to penicillin so that an alternative antibiotic can be prescribed.
A nurse is providing discharge instructions for a client who has a new prescription for an antihypertensive medication. Which of the following is an appropriate statement by the nurse?
A. “Be sure to limit your potassium intake while taking this medication.”
B. “You should check your blood pressure every 8 hr while taking this medication.”
C. “Your medication dosage will be increased if you develop tachycardia.”
D. “Change positions slowly when you move from sitting to standing.”
ANS: D
Orthostatic hypotension is a common adverse effect of antihypertensive medications.
Potassium can actually lower blood pressure, so clients who have hypertension should eat plenty of fresh fruit and vegetables. Clients should check their blood pressure daily on a regular basis. Tachycardia is an adverse effect that would not warrant an increase in a dose of medication.
A nurse is reviewing a client’s health record and notes that the client experiences permanent extrapyramidal effects caused by a previous medication. The nurse recognizes that the medication affected the client’s
A. cardiovascular system.
B. immune system.
C. central nervous system.
D. gastrointestinal system.
ANS: C
Extrapyramidal effects are movement disorders that may be caused by a number of CNS medications, such as typical antipsychotic medications.
A nurse is caring for a client who is taking oral oxycodone. The client states he is also taking ibuprofen three recommended doses daily. The interaction between these two medications will cause which of the following?
A. A decrease in serum levels of ibuprofen, possibly leading to a need for increased doses of this medication.
B. A decrease in serum levels of oxycodone, possibly leading to a need for increased doses of this medication.
C. An increase in the expected therapeutic effect of both medications.
D. An increase in expected adverse effects for both medications.
ANS: C
These medications work together to increase the pain-relieving effects of both medications. They work by different mechanisms, but pain is better relieved when they are taken together.
A nurse is preparing to administer medications to a 4-month-old infant. Which of the following pharmacokinetic principles should the nurse consider when administering medications to this client? (Select all that apply.)
A. Gastric emptying time is more rapid in infants
B. Infants have immature liver function
C. An infant’s blood-brain barrier is poorly developed
D. The ability to absorb topical medications is increased in infants
E. Infants have an increased number of protein-binding sites
ANS: B, C, D
Infants have immature liver function until 1 year of age. Because infants have a higher blood flow to the skin and their skin is thin, the absorption is increased in infants, making them prone to toxicity from topical medications.
Gastric emptying is longer and is inconsistent in infants. Medications administered orally remain in the stomach for a longer period of time, and absorption is more complex.
A nurse on a medical-surgical unit administers a hypotonic medication to an older adult client at 2100. The next morning, the client is drowsy and wants to sleep instead of eating breakfast. Which of the following factors may be responsible for the client’s drowsiness?
A. Reduced cardiac function
B. First-pass effect
C. Reduced hepatic function
D. Delayed toxic effect
ANS: C
Older adults have reduced hepatic function, which may prolong the effects of medications metabolized in the liver. The dosage of the client’s hypnotic medication may need to be reduced.
The first-pass effect would cause the hypnotic medication to be metabolized more quickly, thus having a decreased effect.
A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. Which of the following is the priority nursing action?
A. Administer flumazenil.
B. Identify the client’s level of orientation.
C. Infuse IV fluids.
D. Prepare the client for gastric lavage.
ANS: B
When taking the nursing process approach to client care, the initial step is assessment. Therefore, identifying the client’s level of orientation is the priority actin.
Administering flumazenil, infusing IV fluids, and gastric lavage are appropriate actions. However, it is not the priority when taking the nursing process approach to client care.
****ing stupid
A nurse is caring for a client who is to begin taking escitalopram for treatment of generalized anxiety disorder. Which of the following statements by the client indicates understanding of the use of this medication?
A. “I will take the medication at bedtime.”
B. “I will need to follow a low-sodium diet while taking this medication.”
C. “I need to discontinue this medication slowly.”
D. “I probably won’t desire intimacy during the first days of treatment.”
ANS: C
When discontinuing escitalopram, the client should taper the medication slowly according to a prescribed tapered dosing schedule to reduce the risk of withdrawal syndrome.
The client should take escitalopram in the morning to minimize sleep disturbances. The client is at risk for hyponatremia while taking escitalopram. Sexual dysfunction, including decreased libido, is a late adverse effect that is possible after 5-6 weeks of treatment with escitalopram.
A nurse is providing teaching to a client who has a new prescription to start buspirone in place of diazepam. The client has a history of panic disorder and cirrhosis of the liver. The client asks why his provider is making the medication change. Which of the following statements is an appropriate response by the nurse?
A. “Diazepam can cause seizures as an adverse effect.”
B. “Diazepam is not indicated for the treatment of panic disorder.”
C. “Buspirone is a safe medication for clients who have liver dysfunction.”
D. “Buspirone has less risk for dependency than other treatment options.”
ANS: D
Buspirone is preferable to diazepam for long-term use due to the decreased risk for dependency.
Diazepam is indicated for the treatment of seizure activity and does not cause seizures as an adverse effect. Both buspirone and diazepam are indicated for the treatment of panic disorder. Buspirone must be used cautiously in clients with liver dysfunction.
A nurse working in a mental health clinic is caring for a client who has OCD and recently started a new prescription for buspirone. The client tells the nurse that the medication has not helped him sleep and that he is still having obsessive compulsions. Which of the following statements is an appropriate response by the nurse?
A. “It may take several weeks before you feel like the medication is helping.”
B. “Take the medication just before bedtime to promote sleep.”
C. “You should take the medication on an as-needed basis when you experience obsessive urges.”
D. “Your provider may need to increase your prescription due to developing tolerance.”
ANS: A
Buspirone may take 3 to 6 weeks before the client reaches full therapeutic benefit.
Buspirone does not have any sedative effects and therefore will not promote sleep. Buspirone should be taken on a regular basis rather than an as-needed basis. Buspirone does not cause tolerance.
A nurse is caring for a client who takes paroxetine to treat posttraumatic stress disorder. The client states that he grinds his teeth during the night, which causes jaw pain. The nurse should identify which of the following as possible measures to manage the client’s bruxism? (Select all that apply.)
A. Concurrent administration of buspirone
B Administration of a different SSRI
C. Use of a mouth guard
D. Changing to a different class of antianxiety medication
E. Increasing the dose of paroxetine
ANS: A, C, D
Concurrent administration of a low dose of buspirone is an effective measure to manage the adverse effects of paroxetine. Using a mouth guard during sleep can decrease the risk for oral damage resulting from bruxism. Changing to a different class of antianxiety medication that does not have the adverse effect of bruxism is an effective measure.
Other SSRIs also will have bruxism as an adverse effect. Increasing the dose of paroxetine can cause the adverse effect to worsen.
A nurse is caring for a client who has a new prescription for phenelzine for the treatment of depression. Which of the following indicates that the client has developed an adverse effect of this medication?
A. Orthostatic hypotension
B. Hearing loss
C. Gastrointestinal bleeding
D. Weight loss
ANS: A
Orthostatic hypotension is an adverse effect of MAOIs, including phenelzine
Phenelzine is more likely to cause blurred vision than hearing loss. Clients taking phenelzine are at risk for multiple adverse effects, however, this does not include GI bleeding. Clients taking phenelzine are at risk for weight gain rather than weight loss.
A nurse is providing teaching to a client who has a new prescription for amitriptyline for treatment of depression. Which of the following should the nurse include in the teaching? (Select all that apply.)
A. Expect therapeutic effects in 24 to 48 hr.
B. Discontinue the medication after a week of improved mood.
C. Change positions slowly to minimize dizziness.
D. Decrease dietary fiber intake to control diarrhea.
E. Chew sugarless gum to prevent dry mouth.
ANS: C, E
Orthostatic hypotension is an adverse effect of amitriptyline. Chewing sugarless gum can minimize dry mouth, an adverse effect.
Therapeutic effects are expected after several weeks of taking amitriptyline. Stopping amitriptyline abruptly can result in relapse. Clients should increase dietary fiber to prevent constipation, an adverse effect.
A nurse is providing follow-up dietary teaching for a client who was recently prescribed phenelzine. When reviewing the client’s dietary log, which of the following foods requires a need for further teaching?
A. Cottage cheese
B. Banana bread
C. Apple pie
D. Grilled steak
ANS: B
Clients taking phenelzine, an MAOI, should avoid foods containing tyramine. Bananas and yeast products contain tyramine.
The client should avoid aged rather than cottage cheese.
A nurse is providing discharge teaching to a client who is to begin taking fluoxetine for PTSD. Which of the following statements is appropriate for the nurse to include in the teaching?
A. “You may have a decreased desire for intimacy while taking this medication.”
B. “You should take this medication at bedtime to help promote sleep.”
C. “You will have fewer urinary adverse effects if you urinate just before taking this medication.”
D. “You’ll need to wear sunglasses when outdoors due to the light sensitivity caused by this medication.”
ANS: A
Decreased libido is a potential adverse effect of fluoxetine and other SSRIs.
Clients should take fluoxetine in the morning due to CNS stimulation. Clients taking TCA, rather than fluoxetine, should void prior to taking the medication due to the potential for urinary hesitancy or retention. TCA also has potential for photophobia and should advise client to wear sunglasses outdoors.
A nurse is caring for a client who has been taking sertraline for the past 2 days. Which of the following assessment findings should alert the nurse to the possibility that the client is developing serotonin syndrome?
A. Bruising
B. Fever
C. Abdominal pain
D. Rash
ANS: B
Fever is a manifestation of serotonin syndrome, which can result from taking an SSRI such as sertraline.
Bleeding can result if an SSRI is administered with warfarin. However, this is not an indication of serotonin syndrome.
A nurse is reviewing the laboratory findings and notes that a client’s plasma lithium is 2.1 mEq/L. Which of the following is an appropriate action by the nurse?
A. Perform immediate gastric lavage.
B. Prepare the client for hemodialysis.
C. Administer an additional oral dose of lithium.
D. Request a stat repeat of the laboratory test.
ANS: A
Gastric lavage is appropriate for a client who has severe toxicity, as evidenced by a plasma lithium of 2.1 mEq/L. This action will lower the client’s lithium level.
Hemodialysis is appropriate for a client who has a plasma lithium level greater than 2.5 mEq/L.
A nurse is caring for a client who has a new prescription for lithium carbonate. When teaching the client about ways to prevent lithium toxicity, the nurse should advise the client to do which of the following?
A. Avoid the use of acetaminophen for headaches.
B. Restrict the intake of foods rich in sodium.
C. Decrease fluid intake to less than 1,500 mL daily.
D. Limit aerobic activity in hot weather.
ANS: D
The client should avoid activities that have potential to cause sodium/water depletion, which can increase toxicity risk.
The client should use acetaminophen, rather than NSAIDs, such as ibuprofen, for headaches because NSAIDs interact with lithium and can cause increased blood levels of lithium. The client should increase sodium intake to reduce risk for toxicity.
A nurse in a primary care clinic is assessing a client who takes lithium carbonate for the treatment of bipolar disorder. The nurse should recognize which of the following findings as a possible indication of toxicity to this medication?
A. Severe hypertension
B. Coarse tremors
C. Constipation
D. Urinary retention
ANS: B
Severe hypotension, diarrhea, and polyuria are indications of toxicity.
A nurse is caring for a client who has a new prescription for valproic acid. The nurse should instruct the client that while taking this medication he will need to have to which of the following laboratory tests completed periodically? (Select all that apply.)
A. Thrombocyte count
B. Hematocrit
C. Amylase
D. Liver function test
E. Potassium
ANS:A, C, D
Treatment with valproic acid can result in thrombocytopenia, pancreatitis (monitoring amylase), and hepatotoxicity. It is not known to have an effect on hematocrit or potassium.
A nurse is teaching a female client who has bipolar disorder about her new prescription for lithium carbonate. Which of the following is appropriate for the nurse to include in the teaching? (Select all that apply.)
A. An adverse effect of this medication is amenorrhea.
B. An antidepressant is combined with lithium therapy during phases of mania.
C. Take this medication with food or a glass of milk.
D. Avoid pregnancy while taking this medication.
E. Thyroid function is assessed prior to lithium therapy.
ANS: C, D, E
Taking lithium with food or a glass of milk can help reduce GI distress. Lithium is a Pregnancy Risk Category D medication that is teratogenic, especially during the first trimester. Because lithium can cause goiter and hypothyroidism, the client’s thyroid function is assessed prior to lithium therapy.
Lithium does not cause amenorrhea. An antidepressant, combined with lithium, is effective during phases of depression.
A nurse is teaching a client who has schizophrenia strategies to cope with anticholinergic effects of fluphenazine. Which of the following should the nurse suggest to the client to minimize anticholinergic effects?
A. Take the medication in the morning to prevent insomnia.
B. Chew sugarless gum to moisten the mouth.
C. Use cooling measures to decrease fever.
D. Take an antacid to relieve nausea.
ANS: B
Chewing sugarless gum can help the client cope with dry mouth, a potential anticholinergic effect.
Insomnia, fever, and nausea are not anticholinergic effects.
A nurse is assessing a male client who recently began taking haloperidol. Which of the following findings is the highest priority to report to the provider?
A. Shuffling gait
B. Neck spasms
C. Drowsiness
D. Impotence
ANS: B
Neck spasms are an indication of acute dystonia which is a crisis situation requiring rapid treatment.
Shuffling gait is an indication of parkinsonism and should be reported to the provider, however, it is not the greatest risk.
A nurse is providing discharge teaching for a client who has a new prescription for clozapine. Which of the following statements is appropriate for the nurse to include in the teaching?
A. “You should have a high-carbohydrate snack between meals and at bedtime.”
B. “You are likely to develop hand tremors if you take this medication for a long period of time.”
C. “You may experience temporary numbness of your mouth after each dose.”
D. “You should have your white blood cell count monitored every week.”
ANS: D
Due to the risk for fatal agranulocytosis weekly monitoring of the client’s WBC count is recommended while taking clozapine.
Clozapine increases the client’s risk of developing diabetes mellitus and weight gain. Clozapine has low risk of EPS such as hand tremors. Asenapine, rather than clozapine, causes temporary numbing of the mouth.
A nurse performs an Abnormal Involuntary Movement Scale (AIMS) assessment on a client who began taking loxapine 2 years ago for the treatment of schizophrenia. Findings include lip smacking, tongue protrusion, and facial grimacing. The nurse should suspect which of the following?
A. Parkinsonism
B. Tardive dyskinesia
C. Anticholinergic effects
D> Akathisia
ANS: B
These findings indicate tardive dyskinesia, which can occur months to years after the initiation of therapy.
These findings do not indicate akathisia, which is most common during the first 2 months of therapy. Parkinsonism is most common during first month of therapy.
A nurse is preparing to perform follow-up assessment on a client who takes chlorpromazine for the treatment of schizophrenia. The nurse should expect to find the greatest improvement in which of the following manifestations? (Select all that apply.)
A. Disorganized speech
B. Bizarre behavior
C. Impaired social interactions
D. Hallucinations
E. Decreased motivation
ANS:A, B, D
A client who takes a conventional antipsychotic medication should have the greatest improvement in positive symptoms such as disorganizes speech, bizarre behaviors, and hallucinations.
Impaired social interactions and decreased motivation are negative symptoms which conventional antipsythotics are less effective against.
A nurse is teaching the parents of a child who has a new prescription for desipramine about possible adverse effects. The nurse should instruct the parents that which of the following adverse effects is the highest priority to report to the provider?
A. Diaphoresis
B. Confusion
C. Blurred vision
D. Dizziness
ANS: B
Confusion is an indication of toxicity, which is the greatest risk to the client.
A nurse is teaching an adolescent client who has a new prescription for clomipramine for OCD. Which of the following should the nurse teach the client in order to minimize the adverse effect of his medication?
A. Wear sunglasses when outdoors
B. Check temperature daily when taking this medication
C. Take medication first thing in the morning before eating
D. Add extra calories to the diet as between-meal snacks
ANS: A
Wearing sunglasses when outdoors will decrease photophobia, an anticholinergic effect associated with TCA use.
Taking the medication at bedtime rather than in the morning is appropriate to prevent daytime sleepiness. Following a low-calorie diet plan rather than adding extra calories as snacks will help prevent weight gain, a common adverse effect of TCAs.
A nurse is caring for a school-age child who recently began a prescription for atomoxetine. For which of the following possible complications should the nurse monitor the child?
A. Renal toxicity
B. Liver damage
C. Seizure activity
D. Adrenal insufficiency
ANS: B
Liver damage is a potential complication of atomoxetine. The nurse should monitor for manifestations such as jaundice, upper abdominal tenderness, darkening of urine, and elevated liver enzymes.
A nurse is teaching a school-age child and his parents about a new prescription for lisdexamfetamine dimesylate (Vyvanse). Which of the following is appropriate for the nurse to include in the teaching? (Select all that apply.)
A. An adverse effect of this medication is CNS stimulation.
B. Administer the medication 1 hr before breakfast.
C. Monitor blood pressure while taking this medication.
D. Therapeutic effects of this medication will take 1 to 3 weeks to fully develop.
E. This medication raises the levels of dopamine into the brain.
ANS: A, C, E
An adverse effect of Vyvanse is CNS stimulation such as insomnia and restlessness. Monitoring the BP is appropraite due to potential cardiovascular effects. Vyvanse works by raising levels of norepinephrine, serotonin, and dopamine into the CNS.
Atomoxetine, rather than Vyvanse, takes 1 to 3 weeks to fully develop therapeutic effects.
A nurse is providing teaching for a client who is withdrawing from alcohol and has a new prescription for propranolol. Which of the following is appropriate for the nurse to include in the teaching?
A. Increases the risk for seizure activity
B. Provides a form of aversion therapy
C. Decreases cravings
D. Results in mild hypertension
ANS: C
Propranolol is an adjunct medication used during detoxification to decrease the client’s craving for alcohol.
Seizure activity is a potential effect of alcohol withdrawal, however, propranolol does not increase this risk. Disulfiram, rather than propranolol, provides a form of aversion therapy. Propranolol is an antihypertensive medication that can result in hypotension rather than hypertension.
A charge nurse is planning a staff education session to discuss medications appropriate for the use during the care of a client experiencing alcohol detoxification. Which of the following should the charge nurse include? (Select all that apply.)
A. Lorazepam
B. Diazepam
C. Disulfiram
D. Naltrexone
E. Acamprosate
ANS: A, B
Lorazepam and diazepam are benzodiazepines used during alcohol detoxification to decrease anxiety and reduce the risk for seizures.
Disulfiram and naltrexone are administered to assist the client in maintaining abstinence from alcohol following detoxification. Acamprosate decreases unpleasant effects, such as anxiety or restlessness, resulting from abstinence.
A nurse is providing teaching to a client who has a new prescription for clonidine to assist with maintenance of abstinence from opioids. The nurse should instruct the client to watch for which of the following adverse effects?
A. Diarrhea
B. Dry mouth
C. Insomnia
D. Hypertension
ANS: B
Dry mouth is a common adverse effect associated with clonidine use.
Constipation, sedation, and more like hypotension, are common adverse effects associated with clonidine use.
A nurse is teaching a female client who has tobacco use disorder about nicotine replacement therapy. Which of the following statements by the client indicates understanding of the teaching?
A. “I should avoid eating right before I chew a piece of nicotine gum.”
B. “I will need to stop using the nicotine gum after 1 year.”
C. “I know that nicotine gum is a safe alternative to smoking if I become pregnant.”
D. “I must chew the nicotine gum quickly for about 15 minutes.”
ANS: A
The client should avoid eating or drinking 15 min prior to and while chewing the nicotine gum.
The client should not use nicotine gum for longer than 6 months. The client should chew the nicotine gum slowly and intermittently over 30 minutes.
A nurse is preparing discharge instructions for a client who has a new diagnosis of myasthenia gravis. The client is prescribed neostigmine. Which of the following information should the nurse include in the discharge instructions? (Select all that apply.)
A. Wear a medical alert bracelet.
B. Initially start with a high dose of medication then decrease the dosage.
C. Take the medication at the same time each day.
D. Monitor for manifestations of urinary urgency.
E. Modify medication dose based on response.
ANS: A, C, D, E
The nurse should recommend that the client wear a medical alert bracelet when prescribed neostigmine because episodes of difficulty swallowing and muscle weakness may occur until the dose is regulated. Neostigmine increases the urge to void. The nurse should teach the client to modify the medication dosage according to individualized response to improve muscle weakness.
A nurse is providing information about pramipexole to a client who has early Parkinson disease. Which of the following possible adverse side effects should the nurse include in the information?
A. Hallucinations
B. Memory loss
C. Diarrhea
D. Discoloration of urine
ANS: A
Pramipexole may cause hallucinations within 9 months of the initial dose and may need to be discontinued.
A nurse is reviewing food interactions with a client who is taking levodopa/carbidopa for Parkinson’s disease. Which of the following instructions should the nurse include?
A. Eat large amounts of protein-rich foods with the medication.
B. May take the medication with whole-grain cereal.
C. Consider eating a banana with the medication.
D. May take the medication crushed in grapefruit juice.
ANS: D
The client may crush a tablet or empty a capsule of levodopa/carbidopa in juice if having difficulty swallowing.
The client should avoid protein-rich foods, whole grain cereal, and bananas which contain pyridoxine and result in decreased therapeutic effects of levodopa.
A nurse is preparing to administer medication to a client who has absence seizures. Which of the following medications are appropriate for the nurse to administer? (Select all that apply.)
A. Phenytoin
B. Ethosuximide
C. Gabapentin
D. Carbamazepine
E. Valproic acid
F. Lamotrigine
ANS: B, E, F
Ethosuximide’s only MOA is to treat a client who has absence seizures. Valproic acid and lamotrigine have therapeutic effects when treating a client who has absence seizures and all other forms of seizures.
Phenytoin, gabapentin, and carbamazepine are prescribed for partial seizures and tonic-clonic seizures.
A nurse is reviewing a new prescription for oxcarbazepine with a female who has partial seizure. Which of the following statements by the nurse are appropriate? (Select all that apply.)
A. “Use caution if given a prescription for a diuretic medication.”
B. “Consider using an alternate form of contraception.
C. “Chew gum to increase saliva production.”
D. “Avoid drinking until you see how the medication affects you.”
E. “Notify your provider if you develop a skin rash.”
ANS: A, B, D, E
Diuretics administered with caution because of the high risk for hyponatremia when taking oxcarbazepine. An lternative form of contraception is recommended because oxcarbazepine decreases oral contraceptive levels. The client shoud avoid driving if CNS effects of dizziness, drowsiness, and double vision develop. The client should notify the HCP if skin rash occurs because life-threatening skin disorders can develop.
Chewing gum to increase salivation is not indicated because the medication does not cause dry mouth.
A nurse is instruction a client who has a new prescription for timolol how to insert eye drops. The nurse should tell the client to press on which of the following to prevent systemic absorption of the medication?
A. The bony orbit
B. The nasolacrimal duct
C. The conjunctival sac
D. The outer canthus of the eye
ANS: B
Pressing on the nasolacrimal blocks the lacrimal punctum and prevents systemic absorption of the medication.
A client has a new prescription for brimonidine ophthalmic, one drop three times a day. He tells the nurse he also wears soft contact lenses and wants to know whether he can put the drops in his eyes with the lenses in place. Which of the following should the nurse tell this client?
A. “Go ahead and put the drops in your eye with the contact lens in place.”
B. “Take the contact lens out of your eye, then instill the eye drop, and immediately reinsert the contact lens.”
C. “Take the contact lens out of your eye, then instill the eye drop, and wait at least 15 minutes before putting the contact lens back in place.”
D. “You will need to discontinue the use of contact lenses while using brimonidine eye drops.”
ANS: C
The client can continue to wear his contacts. He should instill the medication and wait at least 15 mins.
Contact lenses absorb brimonidine.
A nurse in the emergency unit is reviewing the medical record of a client who is being evaluated for angle-closure glaucoma. Which of the following findings are indicative of this condition?
A. Insidious onset of painless loss of vision
B. Gradual reduction in peripheral vision
C. Report of seeing halos around lights
D. An intraocular pressure (IOP) of 12 mm Hg.
ANS: C
Halos around lights occurs in the presence of angle-closure glaucoma.
Acute-angle glaucoma is painful and has a sudden onset. Gradual loss of vision occurs in the presence of primary open-angle glaucoma. An IOP of 12 mm Hg is within the expected reference range. An elevated IOP is an expected finding in the presence of angle-closure glaucoma.
A nurse in a provider’s office is instructing a parent how to administer ear drops. Which of the following instructions should the nurse include? (Select all that apply.)
A. “Place the child on his unaffected side when you are ready to administer the medication.”
B. “Warm the medication by gently rolling it between your hands for a few minutes.”
C. “Gently shake the medication that is in suspension form.”
D. “Keep the child on his side for 5 minutes after instillation of the ear drops.”
E. “Tightly pack the ear with cotton after instillation of ear drops.”
ANS: A, B, C, D
Positioning on unaffected side allows access to affected ear and to promote drainage by gravity. Administering cold medication can cause dizziness. Gently shaking medication that is in suspension form to evenly disperse medication.
A nurse is caring for a client who received a bolus dose of succinylcholine IV before an endoscopy procedure. During the procedure, the client suddenly develops rigidity, and his body temperature begins to rise. The nurse should anticipate a prescription for which of the following medications?
A. A second dose of succinylcholine
B. Naloxone as an antagonist at receptor sites
C. Dantrolene to slow metabolic activity of muscles
D. Vecuronium as an adjunct to muscle relaxation
ANS: C
Muscle rigidity and a sudden rise in temperature is an indication of malignant hyperthermia. Dantrolene acts on skeletal muscles to reduce metabolic activity.
Vercuronium is an intermediate-acting nondepolarizing neuromuscular blocker, but it is not useful in treating malignant hyperthermia.
A nurse is caring for a client during surgery. The client has been administered dantrolene to treat malignant hyperthermia, and the administration of succinylcholine and other anesthetics has been discontinued. Which of the following additional actions should the nurse take? (Select all that apply.)
A. Place a cooling blanket on the client.
B. Administer oxygen at 100%
C. Administer iced 0.9% sodium chloride
D. Administer potassium chloride IV.
E. Monitor core body temperature.
ANS: A, B, C, E
The nurse should apply a cooling blanket and apply ice to the axilla and groin. the nurse should administer oxygen at 100% to treat client’s decreased oxygen saturation. The nurse should take action to decrease the client’s body temperature by administering iced IV fluids.
A nurse is teaching a client who has begun taking oral baclofen three times daily to treat muscle spasms caused by a spinal cord injury. Which of the following statements by the client indicates a need for further teaching?
A. “I will stop taking this medication right away if I develop dizziness.”
B. “I know the doctor will gradually increase my dose of this medication for a while.”
C. “I’ll make sure that I empty my bladder completely while taking this medication.”
D. “I won’t be able to drink alcohol while I’m taking this medication.”
ANS: A
Abrupt withdrawal from baclofen can result in a number of adverse effects including visual hallucinations and seizures.
The provider starts the client on a low dose, and the dose is increased gradually to prevent CNS depression. Urinary retention is an adverse effect that can occur with baclofen. The intake of alcohol and other CNS depressants can exacerbate the CNS depressant effects of baclofen.
A nurse in a provider’s office is reviewing the health care record of a client who reported urinary incontinence and asked about a prescription for oxybutynin. The nurse should recognize that oxybutynin is contraindicated in the presence of which of the following conditions?
A. Bursitis
B. Sinusitis
C. Depression
D. Glaucoma
ANS: D
Oxybutynin is an anticholinergic and increase intraocular pressure
Oxybutynin is not contraindicated for the rest of the answers.
A nurse is caring for a client who has a prescription for bethanechol 50 mg PO three times a day. The nurse should recognize that which of the following findings is a clinical manifestation of extreme muscarinic stimulation?
A. Tachycardia
B. Hypertension
C. Excessive perspiration
D. Fecal impaction
ANS: C
Bethanechol is a muscarinic agonist. Extreme muscarinic stimulation can result in sweating.
Bradycardia and hypotension is a clinical manifestation of extreme muscarinic stimulation. Fecal impaction is an adverse effect of bethanechol.
A nurse in a provider’s office is providing instruction to a client who has a new prescription for lorazepam. The nurse should inform the client that which of the following are adverse effects of lorazepam? (Select all that apply.)
A. Incoordination
B. Euphoria
C. Pruritus
D. Flatus
E. Amnesia
ANS: A, B, E
Due to CNS depression, incoordination is an adverse effect of lorazepam. Euphoria may occur as a paradoxical adverse effect of lorazepam. Retrograde amnesia is an adverse effect.
A nurse is caring for a client who is receiving moderate sedation with diazepam IV. The client is oversedated. Which of the following medications should the nurse anticipate administering to this client?
A. Ketamine
B. Naltrexone
C. Flumazenil
D. Fluvoxamine
ANS: C
Flumazenil is a competitive benzodiazepine antagonist used to reverse the sedation and other effects of benzodiazepine.
Naltrexone is an opioid antagonist used to treat opioid overdose and alcohol use disorders. Ketamine is an anesthetic agent. Fluvoxamine is a selective serotonin reuptake inhibitor used to treat depression.
A nurse is teaching a client who has a new prescription for ramelteon about the medication. The nurse should instruct the client to avoid which of the following foods while taking this medication?
A. Eggs
B. Grapefruit
C. Whole-grain bread
D. Chicken
ANS: B
Grapefruit juice and high-fat foods increase ramelteon.
A client is admitted to undergo a surgical procedure. the nurse should be aware that which of the following preexisting conditions may be a contraindication for the use of ketamine as an IV anesthetic for this client?
A. PUD
B. Breast cancer
C. Diabetes mellitus
D. Schizophrenia
ANS: D
Ketamine can produce psychological effects such as hallucinations. Therefore, schizophrenia can be contraindicated for use of ketamine.
A nurse is providing information to a female client who has a new prescription for zolpidem. Which of the following instructions should the nurse include?
A. Notify the provider if you plan to become pregnant.
B. Take the medication 1 hr before you plan to go to sleep.
C. Allow at least 6 hr for sleep when taking zolpidem.
D. To increase the effectiveness of zolpidem, take it with a bedtime snack.
ANS: A
Zolpidem is Pregnancy Risk Category C. Therefore, the client should notify the provider if she plans to become pregnant.
Zolpidem should be taken at bedtime. The client should allow at least 8 hr of sleep when taking zolpidem. Zolpidem is absorbed best on an empty stomach.
A nurse is providing instructions to a young adult female client who has a new prescription for beclomethasone. Which of the following should the nurse include in the teaching?
A. “Rinse your mouth after each use.”
B. “Limit fluid intake while taking the medication.”
C. “Increase your intake of vitamin B12 while taking this medication.
D. “You can take this medication as needed.”
ANS: A
The client should rinse her mouth after each use to reduce the risk of oral fungal infections.
Glucocorticoids place the client at risk for bone loss. There is no need for the client to increase her intake of vitamin B12. The client should ensure an adequate intake of calcium and vitamin D. Inhaled glucocorticoids, such as beclomethasone, should be taken on a fixed schedule.
A client is prescribed long-term use of oral prednisone for treatment of chronic asthma. the nurse should instruct the client to watch for which of the following?
A. Weight gain and fluid retention
B. Nervousness and insomnia
C. Chest pain and tachycardia
D. Dry mouth and constipation
ANS: A
Weight gain and fluid retention are adverse effects of oral prednisone due to the effect of sodium and water retention.
Nervousness and insomnia, and angina and tachycardia, are adverse effects of beta agonists, not glucocorticoids. Dry mouth and constipation are adverse effects of tiotropium.
A nurse is caring for a client who states she has been taking phenylephrine nasal drops for the past 10 days for her upper respiratory symptoms. For which of the following adverse effects should the nurse assess?
A. Sedation
B. Nasal congestion
C. Productive cough
D. Constipation
ANS: B
When used for over 5 days, rebound nasal congestion may occur when taking topical sympathomimetic medications, such as phenylephrine.
Insomnia, rather than sedation, is a possible adverse effect of this medication.
A nurse is teaching a client to self-administer nasal drops for allergic rhinitis symptoms. The nurse should teach the client to lie in which of the following positions to obtain the best effect of the medication?
A. Supine with head flexed
B. Sitting with head in neutral position
C. Lateral with head in low position
D. Prone with head extended
ANS: C
Lying on the side with the head in a low position helps spread the nasal drops, allows the medication to be more effective, and prevents swallowing the medication.
A preschool child recently diagnosed with cystic fibrosis has a new prescription for acetylcysteine. The nurse teaches the client and her family that the purpose of this medication is to do which of the following?
A. Suppress cough
B. Decrease pain
C. Minimize nasal congestion
D. Loosen secretions
ANS: D
Acetylcysteine, when administered by inhaler, is a mucolytic medication that liquefies secretions and allows them to be expectorated more easily.
An adult client is taking diphenhydramine for symptoms of allergic rhinitis. For which of the following adverse reactions should the nurse teach the client to watch? (Select all that apply.)
A. Dry mouth
B. Nonproductive cough
C. Skin rash
D. Diarrhea
E. Urinary hesitation
ANS: A, E
Dry mouth and urinary hesitation are anticholinergic symptoms that can occur when taking diphenhydramine.
Diphenhydramine is sometimes prescribed to treat nonproductive cough. It is also sometimes prescribed for skin rashes caused by allergies. Constipation, rather than diarrhea, is an adverse reaction of this medication.
A nurse is evaluating a client’s understanding of the teaching about the use of fluticasone to treat perennial rhinitis. Which of the following statements by the client indicate he understands the teaching?
A. “I should use the spray every 4 hours while I am awake.”
B. “It may take as long as 3 weeks before the medication takes a maximum effect.”
C. “This medication can also be used to treat motion sickness.”
D. “I can use this medication when my nasal passages are blocked.”
ANS: B
The client may see some benefits of the medication within a few hours, but the maximum benefits may not be seen for as long as 3 weeks.
The client should use the medication once a day. Diphenhydramine can be used to treat motion sickness. The client should blow his nose to clear the nasal passages prior to use of this medication.
A nurse is planning care for a client who is receiving furosemide IV for peripheral edema. Which of the following should the nurse include in the plan of care? (Select all that apply.)
A. Assess for tinnitus
B. Report urine output of 50 mL/hr
C. Monitor serum potassium levels
D. Elevate the head of bed slowly before ambulation
E. Recommend eating a banana daily.
ANS: A, C, D, E
An adverse effect of furosemide is ototoxicity. A decrease in serum potassium levels is an adverse effect of furosemide. Slowly elevating head of bed will prevent development of orthostatic hypotension, which is a sign of hypovolemia. A banana is high in potassium. The nurse should encourage the client to eat foods high in potassium to prevent hypokalemia.
A nurse is providing information to a client who has a new prescription for hydrochlorothiazide. Which of the following information should the nurse include?
A. Take the medication with food.
B. Plan to take the medication at bed time.
C. Expect increased swelling of the ankles.
D. Fluid intake should be limited in the morning.
ANS: A
The client should take hydrochlorothiazide with or after meals to prevent GI upset.
The client should take hydrochlorothiazide in the morning or no later than 1400 to prevent nocturia. The client should expect decreased swelling of the ankles. The client should maintain a normal fluid intake (1,5000 mL) throughout the day unless contraindicated because of heart failure.
A nurse is monitoring a client who is receiving spironolactone. Which o the following findings should the nurse report the provider?
A. Serum sodium 148 mEq/L
B. Urine output of 120 mL in 4 hr
C. Serum potassium 5.2 mEq/L
D. Blood pressure 140/90 mm Hg
ANS: C
Serum potassium of 5.2 mEq/L indicates hyperkalemia. Because spironolactone causes potassium retention, the nurse should withhold the medication and notify the provider.
A client who has increased intracranial pressure is receiving mannitol. Which of the following findings should the nurse report to the provider?
A. Blood glucose 150 mg/dL
B. Urine output 40 mL/hr
C. Dyspnea
D. Headache
ANS: C
Dyspnea can indicate heart failure, an adverse effect of mannitol.
The urine output is adequate, however, kidney failure is an adverse effect of mannitol for which the nurse should continue to monitor. A headache is a manifestation of increased intracranial pressure. Mannitol is given to draw fluid back into the vascular and extravascular space, which can relieve the headache.
A nurse is reviewing a client’s medication history and notes the client is taking digoxin, an antihypertensive medication, and NSAIDs. The client has a new prescription for torsemide. The nurse should plan to monitor for which of the following medication interactions? (Select all that apply.)
A. Decrease in serum digoxin
B. Hypokalemia
C. Hypotension
D. Low urine output
E. Ventricular dysrhythmias
ANS: B, C, D, E
Hypokalemia is an adverse effect of a loop diuretic and can place the client at risk for digoxin toxicity. Hypotension should be monitored for when other antihypertensive medications are being given. Low urine output should be monitored when NSAIDs are administered with a loop diuretic. NSAIDs decrease blood flow to the kidneys, which reduces diuretic effect. Ventricular dysrhythmias can occur with digoxin toxicity when torsemide is given with digoxin.
A nurse is reviewing the health record of a client who is starting propranolol to treat hypertension. Which of the following conditions is a contraindication for taking propranolol?
A. Asthma
B. Diabetes
C. Angina
D. Tachycardia
ANS: A
Propranolol is a nonselective beta-adrenergic blocker that blocks both beta and beta 2 receptors. Blockage of beta2 receptors in the lungs causes bronchoconstriction, so it is contraindicated in clients who have asthma.
Propranolol should be used cautiously in clients who have DM because it can mask signs of hypoglycemia. Propranolol is prescribed to treat angina pectoris and tachydysrhythmias.
A nurse is teaching a client who is taking verapamil to control hypertension. Which of the following should the nurse include in the teaching?
A. Increase the amount of dietary fiber in the diet.
B. Drink grapefruit juice daily to increase vitamin C intake.
C. Decrease the amount of calcium in the diet.
D. Withhold food for 1 hr after the medication is taken.
ANS: A
Increasing dietary fiber intake can prevent constipation, an adverse effect of verapamil.
Clients should be taught to avoid drinking grapefruit juice when taking verapamil because concurrent use can lead to toxicity. Taking extra vitamin C when using verapamil is not necessary. There is no restriction on dietary calcium. There is not restriction regarding food, however, clients can take verapamil with food to prevent GI upset.
A nurse is caring for a client who is starting captopril for hypertension. For which of the following adverse effects should the nurse monitor the client?
A. Hypokalemia
B. Hypernatremia
C. Neutropenia
D. Anemia
ANS: C
Neutropenia is a serious adverse effect that can occur in clients taking an ACE inhibitor. The nurse should monitor the client’s CBC and teach the client to report signs of infection.
Hyperkalemia is a risk for clients taking ACE inhibitors. ACE inhibitors cause excretion of sodium and water, therefore, hypernatremia is not a risk for the client.
A nurse in an acute facility is infusing IV nitroprusside for a client who is in hypertensive crisis. For which of the following adverse reactions should the nurse monitor this client?
A. Intestinal ileus
B. Neutropenia
C. Delirium
D. Hyperthermia
ANS: C
Delirium and other mental status changes may occur in thiocyanate toxicity when IV nitroprusside is infused at a high dosage of in clients who have kidney dysfunction. The thiocyanate level may be monitored during therapy and should remain below 10 mg/dL.
A nurse is planning to administer a first dose of captopril to a hospitalized client who has hypertension. Which of the following medications can intensify early adverse effects of captopril? (Select all that apply.)
A. Simvastatin
B. Hydrochlorothiazide
C. Phenytoin
D. Clonidine
E. Aliskiren
ANS: B, D, E
Hydroclorothiazide, a thiazide diuretic, is often used to treat hypertension. Diuretics may intensify first-dose orthostatic hypotension caused by captopril and may continue to interact with antihypertensive medications to cause hypotension. Clonidine, a centrally acting alpha2 agonist, and aliskiren (a direct renin inhibitor) for the same reasons.
A nurse in a provider’s office is monitoring serum electrolytes for four older adult clients who take digoxin and furosemide. Which of the following electrolyte values puts a client at risk for digoxin toxicity?
A. Calcium 9.2 mg/dL
B. Calcium 10.3 mg/dL
C. Potassium 3.4 mEq/L
D. Potassium 4.8 mEq/L
ANS: C
A potassium of 3.4 mEq/L is below the normal range and puts a client at risk for digoxin toxicity. A low potassium can cause fatal dysrhythmias, especially in older clients who take digoxin. The nurse should notify the provider who may prescribe a potassium supplement or a potassium-sparring diuretic.
A nurse is caring for an older adult client who has a new prescription for digoxin and takes multiple other medications. Concurrent use of which of the following medications places the client at risk for digoxin toxicity?
A. Phenytoin
B. Verapamil
C. Warfarin
D. Aluminum hydroxide
ANS: B
Verapamil, a calcium-channel blocker, can increase digoxin levels. The digoxin dosage may need to be decreased and the nurse should monitor digoxin levels carefully.
When given as an antidysrhythmic, phenytoin can treat dysrhythmias caused by digoxin toxicity. Antacids, such as aluminum hydroxide, can decrease absorption of digoxin and can decrease digoxin levels and effectiveness.
A nurse is administering a dopamine infusion at a moderate dose to a client who has severe heart failure. Which of the following is an expected effect?
A. Lowered heart rate
B. Increased myocardial contractility
C. Decreased conduction through the AV node
D. Vasoconstriction of renal blood vessels
ANS: B
The nurse should expect dopamine to cause increased myocardial contractility, which also increases the cardiac output. This occurs with the stimulation of beta1 receptors and is a positive inotropic effect of dopamine when it is administered at a moderate dose.
At high doses (not moderate), dopamine stimulates alpha1 receptors which can decrease the heart rate. At moderate doses, dopamine stimulates beta1 receptors which increases conduction through the AV node and dilates renal blood vessels. At high doses, dopamine stimulates alpha1 receptors which can constrict blood vessels.
A nurse is providing teaching to a client who has a new prescription for digoxin. Which of the following may indicate digoxin toxicity and should be reported to the provider? (Select all that apply.)
A. Fatigue
B. Constipation
C. Anorexia
D. Rash
E. Diplopia
ANS: A, C, E
Fatigue and weakness are early CNS findings that may indicate digoxin toxicity. GI disturbances such as anorexia is an indication of digoxin toxicity. Visual changes, such as diplopia and yellow-tinged vision, are manifestations of digoxin toxicity.
Nausea, vomiting, and diarrhea (rather than constipation) are GI signs of digoxin toxicity.
A nurse is monitoring the digoxin level for a client who has been taking a daily dose of digoxin for 1 month. The digoxin level is 0.25 ng/mL. The nurse should notify the provider and anticipate which of the following?
A. An increase in the client’s digoxin dose
B. A decrease in the client’s digoxin dose
C. No change in the client’s digoxin dose
D. Discontinuation of the client’s digoxin prescription
ANS: A
The client’s digoxin level is below the therapeutic range of 0.5-2.0 ng/mL. If the client’s clinical findings correlate with the client’s digoxin level, the nurse can expect an increase in the digoxin dose.
A nurse is teaching a client who has angina pectoris and is learning how to treat acute anginal attacks. The client asks, “What is my next step if I take one tablet, wait 5 minutes, but still have anginal pain?” Which of the following replies by the nurse is appropriate?
A. “Take two tablets at the same time and then call 911.”
B. “Call 911 and take a second sublingual tablet.”
C. “Take a sustained-release nitroglycerin capsule rather than a sublingual tablet and wait 5 more minutes before calling 911.”
D. “Wait another 5 minutes before taking a second sublingual tablet.”
ANS: B
The next step is to call 911 and then take a second sublingual tablet. If the first tablet does not work, the client may be having a myocardial infarction, so should call for emergency care. The client may take a third tablet if the second one has not relieved the pain after waiting an additional five minutes.
A nurse is taking a medication history from a client who has angina and is to begin taking ranolazine. The nurse should report which of the following medications in the client’s history that may interact with ranolazine? (Select all that apply.)
A. Digoxin
B. Simvastatin
C. Verapamil
D. Amlodipine
E. Nitroglycerin transderm patch
ANS: A, B, C
Concurrent use with digoxin raises serum levels of digoxin which may result in digoxin toxicity. Concurrent use with simvastatin raises serum levels of simvastatin, so liver toxicity may result. Verapamil is a CYP3A4 inhibitor which can increase levels of ranolazine and lead to the dysrhythmia, torsades de pointes.
A nurse is caring for a client who is prescribed isosorbide mononitrate for chronic stable angina and develops reflex tachycardia. Which of the following medications should the nurse expect to administer?
A. Furosemide
B. Captopril
C. Ranolazine
D. Metoprolol
ANS: D
Metoprolol, a beta adrenergic blocker, is used to treat hypertension, stable angina pectoris, and is often prescribed to decrease heart rate in clients who have tachycardia.
A nurse is teaching a client who has angina how to use nitroglycerin transdermal ointment. Which of the following instructions by the nurse is appropriate?
A. “Spread the ointment onto a premarked paper using an applicator.”
B. “Rub the ointment directly into your skin until it is no longer visible.”
C. “Cover the applied ointment with a clean gauze pad.”
D. “Apply the ointment to the same skin area each time.”
ANS: A
The ointment should not be rubbed directly onto the skin. It is also important to tell the client to not touch the ointment with the fingers. It should not be covered with a gauze, can be covered with a transparent dressing and taped securely to the skin. The client should rotate application sites each time the ointment is used. Sites include the chest, abdomen, forearm, or anterior thigh.
A nurse is caring for a client who took amiodarone for 2 months before it was discontinued due to toxicity. Which of the following should guide the nurse when assessing the client for toxicity to amiodarone?
A. Visual impairment resolves when the medication is withdrawn.
B. Ototoxicity is irreversible.
C. Lung damage continues after medication is stopped.
D. Myopathy is a common manifestation of toxicity.
ANS: C
Because this medication has such a long half-life, indications of lung damage may continue for months following discontinuance of amiodarone. Findings the nurse should assess for include cough, chest pain, and shortness of breath.
Visual impairment is a toxicity caused by amiodarone, which may persist and become permanent following discontinuation. Ototoxicity does not occur as a result of taking amiodarone. Myopathy may be seen in clients who are receiving statins or fibrates, but it does not occur as a result of taking amiodarone.
A nurse is caring for a client whose supraventricular tachycardia (SVT) was treated with verapamil IV. The client’s pulse rate is now 98/min and his blood pressure is 74/44 mm Hg. For which of the following IV medications should the nurse anticipate a prescription?
A. Calcium gluconate
B. Sodium bicarbonate
C. Potassium chloride
D. Magnesium sulfate
ANS: A
Severe hypotension caused by verapamil may be reversed with calcium gluconate, given slowly IV. The calcium counteracts vasodilation caused by verapamil. Other measures to increase BP may include IV fluid therapy and placing the client in a modified Trendelenburg position.
A nurse is caring for four clients who are each taking digoxin. The client who is taking which of the following medications concurrently is at risk for digoxin toxicity?
A. Procainamide for premature ventricular contractions.
B. Ranitidine for PUD.
C. Phenytoin for a seizure disorder.
D. Amiodarone for ventricular dysrhythmias.
ANS: D
Amiodarone greatly increases the risk for digoxin toxicity. Other antidysrhythmic that increase the risk include quinidine, verapamil, diltiazem, propafenone, and flecainide.
A nurse is preparing to administer propranolol to a hospitalized client who has a dysrhythmia. Which of the following nursing actions should the nurse plan to take while the client is receiving propranolol?
A .Hold propranolol for apical pulse greater than 100/min.
B. Administer propranolol to increase the client’s blood pressure.
C. Assist the client when she sits or stands after taking this medication.
D. Check for hypokalemia frequently due to the risk for propranolol toxicity.
ANS: C
Propranolol may cause orthostatic hypotension.
Propranolol is a beta adrenergic blocker that is used to slow tachydysrhythmias. The nurse should hold it for a very low pulse rate, such as below 60/min. Propranolol is an antihypertensive drug. The client is at risk for toxicity with digoxin, rather than propranolol, when the serum potassium is low.
A nurse in an outpatient facility is assessing a client who has taken procainamide to treat dysrhythmias for the last 12 months. The nurse should assess for which of the following adverse effects? (Select all that apply.)
A. Hypertension
B. Widened QRS complex
C. Narrowed QT interval
D. Easy bruising
E. Swollen joints
ANS: B, D, E
Procainamide may cause a widened QRS complex, which is a sign of cardiotoxicity if the QRS complex becomes widened by more than 50% of the expected reference range. Procainamide may cause a QT interval which is prolonged, rather than narrowed. This is a sign of cardiotoxicity. Hypotension, rather than hypertension, is an adverse effect.
Procainamide may cause bone marrow depression, with neutropenia (infection) and thrombocytopenia (easing bruising, bleeding). Systemic lupus erythematosus-like syndrome may occur as an adverse effect. Clinical manifestations include swollen, painful joints. Clients who take procainamide in large doses or for more than 1 year are at risk.
A nurse is providing teaching to a client who is starting simvastatin. Which of the following should the nurse include in the teaching?
A. Take this medication in the evening.
B. Change position slowly when rising from a chair.
C. Maintain a steady intake of green leafy vegetables.
D. Consume no more than 1 L of fluid/day.
ANS: A
The client should take simvastatin in the evening because nighttime is when most cholesterol is synthesized in the body. Taking statin medications in the evening increases effectiveness.
A nurse is collecting data from a client who is taking gemfibrozil. Which of the following assessment findings is an adverse reaction to the medication?
A. Mental status change
B. Tremor
C. Jaundice
D. Pneumonia
ANS: C
Jaundice, anorexia, and upper abdominal discomfort may be findings in liver impairment, which may occur in clients taking gemfibrozil.
A nurse is teaching a client who is taking digoxin and has a new prescription for colesevelam. Which of the following should the nurse include in the teaching?
A. Take digoxin with your morning dose of colesevelam.
B. Your sodium and potassium levels will be monitored periodically while taking colesevelam.
C. Watch for bleeding or bruising while taking colesevelam.
D. Take colesevelam with food and at least one glass of water.
ANS: D
Colesevelam should be taken with food and at least 8 oz of water.
Many medications, including digoxin, should be taken 4 hr before colesevelam to prevent decreased absorption of the other medications. Serum electrolytes are not checked periodically while taking colesevelam. However, total cholesterol, LDL, HDL, and triglycerides are checked, as well as blood glucose and HbA1C.
A nurse is completing a nursing history for a client who currently takes simvastatin. The provider recommends adding ezetimibe to the client’s medications. Which of the following disorders is a contraindication to adding ezetimibe to the client’s medication?
A. History of severe constipation
B. History of hypertension
C. Active hepatitis C
D. Type 2 diabetes mellitus
ANS: C
Ezetimibe is contraindicated in clients who have an active moderate-to-severe liver disorder, especially if the client is already taking a statin.
Unlike the bile-acid sequestrants, ezetimibe does not cause constipation and is not contraindicated in clients with a history of constipation.
A nurse is caring for a client who is starting niacin to reduce cholesterol. The nurse should monitor the client for which of the following adverse effects? (Select all that apply.)
A. Muscle aches
B. Hyperglycemia
C. Hearing loss
D. Flushing of the skin
E. Jaundice
ANS: B, D, E
Hyperglycemia may occur as an adverse effect and the nurse should plan to monitor the blood glucose periodically. Flushing of the skin, along with tingling of the extremities, occurs soon after taking niacin. The effect should decrease in a few weeks, and can be minimized by taking an aspirin tablet 30 min before niacin. Niacin may cause liver disorders, so the nurse should monitor for jaundice, abdominal pain, and anorexia.
Myopathy may occur with statins and other antilipemic medications.
A nurse is planning to administer subcutaneous enoxaparin to an adult client following hip anthroplasty. Which of the following actions should the nurse plan to take?
A. Choose a 22-gauge needle to administer the injection.
B. Use a 5/8 inch needle to administer the injection.
C. Administer the injection in the client’s thigh.
D. Aspirate carefully after inserting the needle into the client’s skin.
ANS: B
The nurse should plan to use a 1/2 to 5/8 inch needle to perform the injection. The nurse should use a 25 or 26 gauge needle to administer the injection.
A deep subcutaneous injection should be administered into the subcutaneous tissue of the abdomen, at least 2 inches away from the umbilicus. The nurse should not aspiration when giving enoxaparin or other heparin products subcutaneously.
A nurse is caring for a hospitalized client who is receiving IV heparin for a deep-vein thrombosis. The client begins vomiting blood. After the heparin has been stopped, which of the following medications should the nurse prepare to administer?
A. Vitamin K1 (Phytonadione)
B. Atropine
C.Protamine
D. Calcium gluconate
ANS: C
Protamine reverses the anticoagulant effect of heparin.
Vitamin K1 is used to reverse the effects of warfarin. Atropine is used to reverse bradycardia caused by beta adrenergic blockers. Calcium gluconate is used to treat magnesium sulfate toxicity.
A nurse is planning to administer IV alteplase to a client who is demonstrating manifestations of a massive pulmonary embolism. Which of the following interventions is appropriate for the nurse to plan?
A. Give IM enoxaparin along with alteplase dose.
B. Hold direct pressure on the puncture sites for up to 30 min.
C. Administer aminocaproic acid IV prior to alteplase infusion.
D. Prepare to administer alteplase within 8 hr of manifestation onset.
ANS: B
The nurse should plan to hold direct pressure on puncture sites for 10 to 30 min or until oozing of blood stops.
Enoxaparin is only available in a SQ form. SQ and IM injections and other punctures should be avoided due to bleeding risk when alteplase is given. Aminocaproic acid is an antidote to alteplase and should only be administered in the event of serious bleeding that does not stop after blood products are administered or other remedies are tried. It would not be given prior. Alteplase must be given as soon as possible after manifestations of MI, PE, or CVA begin.
A nurse is monitoring a client who takes aspirin, 81 mg PO daily. Which of the following clinical manifestations are adverse effects of daily aspirin therapy? (Select all that apply.)
A. Hypertension
B. Coffee-ground emesis
C. Tinnitus
D. Paresthesias of the extremities
E. Nausea
ANS: B, C, E
GI bleeding with dark stools or coffee-ground emesis may be an adverse effect of aspirin therapy.
A nurse is caring for a client who has atrial fibrillation and has a new prescription for dabigatran to prevent development of thrombosis. Which of the following medications is prescribed concurrently to treat an adverse effect of dabigatran?
A. Vitamin K1 (Phytonadione)
B. Protamine
C. Omeprazole
D. Probenecid
ANS: C
Omeprazole or another PPI is prescribed for a client who is taking dabigatran and has abdominal pain and other GI findings that may occur as an adverse effect of dabigatran. The nurse should advise the client who has GI effects to take dabigatran with food.
A nurse is caring for a client who is receiving daily doses of oprelvekin. Which of the following laboratory values should the nurse monitor to determine effectiveness of this medication?
A. Hemoglobin
B. Absolute neutrophil count
C. Platelet count
D. Total white blood count
ANS: C
The expected outcome for oprelvekin is a platelet count greater than 50,000/mm^3.
Hemoglobin levels should be monitored for a client receiving epoetin alfa. Absolute neutrophil count should be monitored for a client receiving filgrastim. A total WBC should be monitored for a client receiving sargramostim.
A nurse is preparing to administer filgrastim for the first time to a client who has just undergone a bone marrow transplant. Which of the following interventions is appropriate?
A. Administer IM in a large muscle mass to prevent injury.
B. Ensure the medication is refrigerated until just prior to administration.
C. Shake vial gently to mix well before withdrawing dose.
D. Discard vial after removing one dose of the medication.
ANS: D
Only one dose of filgrastim should be withdrawn from the vial and the vial should be discarded.
Filgrastim is not administered by the IM route (given intermittent IV bolus, continuous IV, SQ infusion, or SQ injection). The nurse can allow medication to reach room temperature. Nurse should take care to not shake vial.
A nurse is monitoring a client who is receiving epoetin alfa for adverse effects. Which of the following is an adverse effect of this medication?
A. Leukocytosis
B. Hypertension
C. Edema
D. Blurred vision
ANS: B
Hypertension is an adverse effect that should be monitored for throughout treatment.
Leukocytosis is an adverse effect of filgrastim. Edema is an adverse effect of oprelvekin caused by fluid retention. Blurred vision is an adverse effect of oprelvekin.
A nurse is assessing a client who has chronic neutropenia and who has been receiving filgrastim. Which of the following actions should the nurse take to assess for an adverse effect of filgrastim?
A. Assess for bone pain.
B. Assess for right lower quadrant pain.
C. Auscultate for crackles in the bases of the lungs.
D. Auscultate the chest to listen for a heart murmur.
ANS: A
Bone pain is a dose-related adverse effect of filgrastim. It can be treated with acetaminophen and, if necessary, an opioid analgesic.
A nurse is preparing to administer an infusion of 300 mL of platelet concentrate. The nurse should plan to administer the infusion over which of the following time frames?
A. Within 30 min/unit
B. Within 60 min/unit
C. Within 2 hr/unit
D. Within 4 hr/unit
ANS: A
Platelets are fragile and should be administered quickly to reduce the risk of clumping.
The nurse should administer fresh frozen plasma within 30 to 60 min/unit. The nurse should administer a unit of whole blood or PRBCs within 2 to 4 hr.
A nurse is preparing to transfuse a unit of PRBCs for a client who has severe anemia. Which of the following interventions will prevent an acute hemolytic reaction?
A. Ensure that the client has a patent IV line before obtaining blood product from the refrigerator.
B. Obtain help from another nurse to confirm the correct client and blood product.
C. Take a complete set of vital signs before beginning transfusion and periodically during the transfusion.
D. State with the client for the first 15 to 30 min of transfusion.
ANS: B
Identifying and matching the correct blood product with the correct client will prevent an acute hemolytic reaction from occurring because this reaction is caused by ABO or Rh incompatibility.
A nurse is caring for a hospitalized client who has an activated partial thromboplastin time (aPTT) greater than 1.5 times the expected reference range. Which of the following blood products should the nurse prepare to transfuse?
A. Whole blood
B. Platelets
C. Fresh frozen plasma
D. Packed RBCs
ANS: C
Fresh frozen plasma is indicated for a client who has an elevated aPTT because it replaces coagulation factors and helps prevent bleeding.
Platelets are transfused for clients who have severe hypothrombocytopenia.
A nurse is assessing a client during transfusion of a unit of whole blood. The client develops a cough, shortness of breath, elevated blood pressure, and distended neck veins. The nurse should anticipate a prescription for which of the following medications?
A. Epinephrine
B. Lorazepam
C. Furosemide
D. Diphenhydramine
ANS: C
Furosemide, a loop diuretic, may be prescribed to relieve manifestations of circulatory overload.
A nurse is transfusing a unit of packed red blood cells (PRBCs) for a client who has anemia due to chemotherapy. The client reports a sudden headache and chills. The client’s temperature is 2 ° F higher than her baseline. In addition to notifying the provider, which of the following actions should the nurse take? (Select all that apply.)
A. Stop the transfusion
B. Place the client in an upright position with feet down.
C. Remove the blood bag and tubing from the client’s IV catheter.
D. Obtain a urine specimen from the client.
E. Infuse dextrose 5% in water through the client’s IV.
ANS: A, C, D
The client may be having a hemolytic reaction to the blood or a febrile reaction. The nurse should avoid infusing more PRBCs into the client’s vein, and should remove the blood bag and tubing from the client’s IV catheter. Obtaining a urine specimen to check for hemolysis is standard procedure when a client has a reaction to blood transfusion.
The nurse should only infuse 0.9% sodium chloride into the client’s IV along with a transfusion of PRBCs. The nurse should infuse 0.9% sodium chloride until a new prescription is received. The nurse should place the client who has circulatory overload in the upright position with the feet down, but this manifestations do not indicate circulatory overload.
A nurse is caring for a client who is starting omeprazole PO for management of GERD. The nurse should recognize that this medication works by
A. improving gastric motility.
B. decreasing the production of gastric acid.
C. neutralizing gastric acid.
D. antagonizing serotonin receptors.
ANS: B
Omeprazole reduces gastric acid secretion by inhibiting the enzyme that produces gastric acid.
Gastric acid is neutralized by aluminum hydroxide, an antacid. Gastric motility is improved by metoclopramide, a prokinetic agent. Ondansetron, an antiemetic, antagonizes serotonin receptors, decreasing nausea and vomiting.
A client taking sucralfate PO for PUD has been started on phenytoin to control seizures. Which of the following should be included in the client’s teaching?
A. Take both of these medications at the same time.
B. Take sucralfate with a glass of milk.
C. Allow a 2-hr interval between these medications.
D. Chew the sucralfate thoroughly before swallowing.
ANS: C
Sucralfate can interfere with absorption of phenytoin, so the client should allow a 2-hr interval between sucralfate and phenytoin.
Sucralfate should be taken on an empty stomach and swallowed whole.
For which of the following clients with PUD is misoprostol contraindicated?
A. 27-year-old client who is pregnant
B. 75-year-old client who has osteoarthritis
C. 37-year-old client who has a kidney stone
D. 46-year-old client who has a UTI
ANS: A
Misoprostol can induce labor.
A nurse is caring for a client who was administered prochlorperazine 4 hr ago. The client reports spasms of his face. The nurse should anticipate a prescription for which of the following medications?
A. Fomepizole
B. Naloxone
C. Phytonadione (Vitamin K1)
D. Diphenhydramine
ANS: D
An adverse effect of prochlorperazine is acute dystonia, which is evidenced by spasms of the muscles in the face, neck, and tongue. Diphenhydramine is used to suppress extrapyramidal effects of prochlorperazine.
Fomepizole is an antidote used to treat ethylene glycol poisoning.
A nurse is providing instruction to a client who has a new prescription for ondansetron. The nurse should advise the client that which of the following is an adverse effect of the medication?
A. Headache
B. Urinary retention
C. Tachycardia
D. Black stools
ANS: A
Headache is a common adverse effect of ondansetron. The client may require a nonopioid analgesic to treat the headache.
Urinary retention is a common adverse effect of anticholinergics such as scopolamine. Black stools occur when a client takes bismuth.
A nurse is providing instructions about the use of laxatives to a client who has heart failure. The nurse should tell the client he should avoid which of the following laxatives?
A. Sodium phsphate
B. Psyllium
C. Bisacodyl
D. Polyethylene glycol
ANS: A
Typically, clients who have heart failure are on a sodium-restricted diet. Absorption of sodium from sodium phosphate can cause fluid retention and is contraindicated for clients who have heart failure.
A nurse is taking a history for a female client who has irritable bowel syndrome with constipation. Which of the following in the client’s history is a contraindication to lubiprostone?
A. Myocardial infarction
B. Crohn’s disease
C. Diabetes mellitus
D Rheumatoid arthritis
ANS: B
Lubiprostone enhances intestinal mobility and is therefore contraindicated in clients who have Crohn’s disease.
A nurse is providing information about probiotic supplements to a male client. Which of the following information should the nurse include? (Select all that apply.)
A. “Probiotics are micro-organisms that are normally found in the GI tract.”
B. “Probiotics are used to treat Clostridium difficile.”
C. “Probiotics are used to treat benign prostatic hyperplasia.”
D. “You may experience bloating while taking probiotic supplements.”
E. “If you are prescribed an antibiotic, you should take it at the same time you take your probiotic supplement.”
ANS: A, B, D
Saw palmetto is used to treat benign prostatic hyperplasia. The client should take the probiotic supplement at least 2 hr after taking an antibiotic or antifungal medication.
A nurse is providing teaching to a client who has anemia and has a new prescription for an iron supplement. Which of the following should be included in the teaching? (Select all that apply.)
A. Add foods that are high in fiber to the diet.
B. Rinse the mouth after taking the liquid formulation.
C. Expect stools to be green or black in color.
D. Take the medication on a full stomach.
E. Add additional red meat to the diet.
ANS: A, B, C, E
Iron supplements are maximally absorbed when taken on an empty stomach or 1 hr before meals.
A nurse is evaluating a group of clients at a health fair in relation to the need for folic acid therapy Which of the following clients may benefit from folic acid therapy? (Select all that apply.)
A. A 12-year-old child with iron deficiency anemia
B. A 24-year-old female with no health problems
C. A 44-year-old male with hypertension
D. A 55-year-old female with alcohol use disorder
E. A 35-year-old male with type 2 diabetes mellitus
ANS: B, D
The female client of childbearing age should take folic acid to prevent neural tube defects in the fetus. The client who has alcohol use disorder may require folic acid therapy. Excess alcohol consumption leads to poor dietary intake of folic acid and injury to the liver.
A nurse is preparing to administer potassium chloride IV to a client who has hypokalemia. Which of the following are appropriate actions by the nurse? (Select all that apply.)
A. Infuse medications no faster than 10 mEq/hr.
B. Monitor urine output to ensure at least 20 mL/hr.
C. Administer medication via direct IV bolus.
D. Implement cardiac monitoring.
E. Administer the infusion using an IV pump.
ANS: A, D, E
Potassium should be infused no faster than 10 mEq/hr to prevent vein irritation, phlebitis, and infiltration.
Administering potassium via IV bolus can result in fatal hyperkalemia. The nurse should monitor urine output to ensure at least 30 mL/hr for adequate kidney function.
A nurse is caring for a client who has increased liver enzymes and it asking herbal supplements. The use of which of the following herbal supplements should be reported to the provider?
A. Ma huang
B. Saw palmetto
C. Kava
D. St. John’s wort
ANS: C
Chronic use of kava or high doses can cause liver damage, including severe liver failure.
Ma huang stimulates the CNS, suppresses the appetite, and causes bronchodilation. Saw palmetto can cause mild GI effects. St. John’s wort can cause GI symptoms and constipation.
A nurse is completing an assessment of a client’s current medications. The client states she also takes gingko biloba. Which of the following medications is contraindicated for a client taking gingko biloba?
A. Acetampinophen
B. Warfarin
C. Digoxin
D. Lisinopril
ANS: B
Warfarin is contraindicated for a client taking gingko biloba due to the risk of bleeding or hemorrhage.
A nurse is reviewing the health care record of a client who has a prescription for conjugated equine estrogens. In which of the following conditions is the use of estrogens contraindicated?
A. Atrophic vaginitis
B. Dysfunctional uterine bleeding
C. Osteoporosis
D. Thrombophlebitis
ANS: D
Estrogen increases the risk of thrombolytic events.
Dysfunctional uterine bleeding and atrophic vaginitis can occur when there is estrogen deficiency. This medication is used to treat these conditions. Women are at risk for osteoporosis after the onset of menopause. Estrogen is used to slow the progression of osteoporosis.
A nurse is explaining the mechanism of action of combination oral contraceptives to a group of clients. The nurse should tell the clients that which of the following actions occur with the use of combination oral contraceptives? (Select all that apply.)
A. Thickening the cervical mucosa
B. Inducing maturation of ovarian follicle
C. Increasing the development of the corpus luteum
D. Altering the endometrial lining.
E. Inhibiting ovulation
ANS: A, D, E
I don’t understand any of these rationales.
A nurse is providing teaching to a female client who is taking testosterone to treat advanced breast cancer. The nurse should tell the client that which of the following are adverse effects of this medication?
A. Deepening voice
B. Male pattern baldness
C. Sedation
D. Constipation
E. Facial hair
ANS: A, B, E
Excitation and insomnia are adverse effects of this medication, not sedation. Diarrhea is an adverse effect, not constipation.
A nurse is providing teaching to a client who is to start alfuzosin for treatment of benign prostatic hyperplasia. Which of the following is an adverse effect of this medication?
A. Rash
B. Edema
C. Hypotension
D. Jaundice
ANS: C
Alfuzosin relaxes muscle tone in veins and cardiac output decreases, which leads to hypotension. Clients taking this medication are advised to rise slowly from a sitting or lying position.
A nurse is caring for a client who has angina and asks about obtaining a prescription for sildenafil (Viagra) to treat erectile dysfunction. Which of the following medications should not be taken concurrently with sildenafil?
A. Ranolazine
B. Isosorbide
C. Clopidogrel
D. Lisinopril
ANS: B
Isosorbide is an organic nitrate that manages pain from angina. Concurrent use of it is contraindicated because fatal hypotension can occur. The client should avoid taking a nitrate medication for 24 hr after taking isosorbide.
A nurse is providing care to a client who is prescribed terbutaline by the provider. The nurse should recognize that terbutaline is administered to
A. stop uterine contractions.
B. prevent bleeding
C. promote placental blood flow.
D. increase prostaglandin production.
ANS: A
Terbutaline blocks beta2-adrenergic receptors, which causes uterine smooth muscle relaxation. It is used to suppress preterm labor, but does not preventing bleeding nor promotes placental blood flow. Terbutaline suppresses uterine contractions.
A nurse in labor and delivery is caring for a client who has a new prescription for oxytocin to stimulate uterine contractions. Which of the following are appropriate nursing interventions? (Select all that apply.)
A. Use an infusion pump for medication administration.
B. Provide continuous monitoring of vital signs.
C. Stop infusion if uterine contractions occur every 4 min and last 45 seconds.
D. Increase medication infusion rate rapidly.
E. Monitor FHR continuously.
ANS: A, B, E
Vital signs must be monitored to assess for hypertension, an adverse effect. Continuous FHR monitoring is required to assess for fetal distress.
Infusion should not be stopped because therapeutic effect has not been achieved. Generally goal is uterine contractions that last less than 1 minute every 2-3 minutes.
A nurse is caring for a client who has preeclampsia and is receiving IV magnesium sulfate. Which of the following findings should the nurse report to the provider?
A. 2+ deep tendon reflexes
B. 2+ pedal edema
C. 24 mL/hr urinary output
D. Respirations 12/min
ANS: C
Urine output of less than 25 to 30 mL/hr is associated with magnesium sulfate toxicity and should be reported to the provider.
Rest of the answers are expected findings.
A nurse in labor and delivery is caring for a client who is in labor and receiving IV opioid analgesics. Which of the following is an appropriate action by the nurse?
A. Instruct the client to self-ambulate every 2 hrs.
B. Offer oral hygiene every 2 hr.
C. Anticipate medication administration 2 hr prior to delivery.
D. Monitor fetal heart rate every 2 hr.
ANS: B
Oral hygiene should be offered on a regular basis to a client receiving opioid analgesics due to adverse effects of dry mouth, nausea, and vomiting.
Clients should be assisted with ambulation. Opioid analgesics should not be administered within 4 hr of delivery.
A nurse is reviewing a new prescription for terbutaline with a client who has a history of preterm labor. Which of the following client statements indicates understanding of the teaching?
A. “I can increase my activity now that I’ve started on this medication.”
B. “I will increase my daily fluid intake to 3 quarts.”
C. “I will report intensity of contractions to my doctor.”
D. “I am gland this will prevent preterm labor.”
ANS: C
The client should report increasing intensity, frequency, or duration of contractions to provider because these are manifestations of preterm labor.
Fluid intake should be no more than 2,400 mL/day. Terbutaline delays preterm labor, it does not prevent it.
A nurse is preparing to administer auranofin for a client who has rheumatoid arthritis. The nurse should monitor the client for which of the following adverse effects of this medication? (Select all that apply.)
A. Insomnia
B. Stomatitis
C. Visual changes
D. Bruising
E. Pruritus
ANS: B, D, E
The nurse should hold the medication and notify the provider if the client reports stomatitis. Thrombocytopenia is an adverse effect of auranofin, and bruising is a common finding in thrombocytopenia. Hold medication and notify. Hold med for pruritus too.
A
NurseHero2022HESI RN Pharmacology REVIEW 2022 V2 –65 Questions + Review of important pointsPLEASE NOTE: Health care system is continuously changing, guidelines andrecommendation could differ from time to time, the answers of below questions weremade up to our best knowledge and elimination of wrong answers – and remember thatmost of the time there are more than a correct answer but you have to choose theMOST important or priority or what’s within nursing scope of practice. We tried our bestto have all answers correct but we do not guarantee that 100%. You must study andreview them as well. Good luck!1. Before administering a laxative to a bedfast client, it is most important forthe nurse to perform what assessment?A. Observe the skin integrity of the client’s rectal and sacral areasB. assess the client strength in moving and turning in the bedC. evaluate the client’s ability to recognize the urge to defecateD. determine the frequency and consistency of bowel movements2. A female client with multiple sclerosis reports having less fatigue andimproved memory since she began using the herbal supplement, ginkgobiloba. Which information is most important for the nurse to include in theteaching plans for this client?A. Aspirin and nonsteroidal anti-inflammatory drugs interact withginkgoB. nausea and diarrhea can occur when using this supplementC. anxiety and headaches increased with use of ginkgoD. ginkgo biloba use should be limited and not taken during pregnancy
NurseHero20223. In explaining the benefits of the combination anti-infective drug code TMP-SMZ (Bactrim) to a client receiving the medication for a urinary tractinfection, more rationale to the nurse provide?A. Each drug could cause damage to the kidneys if taken separatelyB. One drug reduces the risk of side effects caused by the drugC. while one drug provide relief, the other fights the infectionD. the two drugs work together to reduce resistance of the bacterialinfection of symptoms4. Client being treated with Haldol for schizophrenia is complaining of jawtightness and a stiff neck. Which interventions should the nurse implement?A. give PRN dose of diphenhydramine BenadrylB. assess client other sensory hallucinationsC. massage neck until muscles begin to relaxD. obtain a 12 lead EKG5. Which intervention is most important for the nurse implement for a clientis receiving Lispro Humalog insulin?A. Check blood glucose levels every six hoursB. Provide meals at the same time that insulin is givenC. Assess for hypoglycemia between mealsD. Keeping oral liquid or glucose source available6. Client takes nonsteroidal anti-inflammatory drugs every day for rheumatoidarthritis is being treated for anemia which intervention is most importantfor the nurse to include any plan of careA. Observe for gastrointestinal bleedingB. Monitor liver function test resultsC. Protect skin from bruisingD. Offered dietary selections rich in iron
NurseHero20227. A client receives a prescription for theophylline (Theo-Dur) PO to beinitiated in the morning after the dose of theophylline IV is complete. Thenurse determines that a theophylline level drawn yesterday was 22 mcg/mL.Based on this information, which action should the nurse implement?A. Hold the theophylline dose and notify the health care provider.B. Start the client on a half-dose of theophylline PO.C. The theophylline dose can be initiated as planned.D. The client is not ready to be weaned from the IV to the PO route8. The nurse is reviewing a client’s laboratory results before a procedure inwhich a neuromuscular blocking agent is a standing order. Which findingshould the nurse report to the health care provider?A. HypokalemiaB. HyponatremiaC. HypercalcemiaD. Hypomagnesemia9. The nurse is preparing a child for transport to the operating room for anemergency appendectomy. The anesthesiologist prescribes atropine sulfate(Atropine), IM STAT. What is the primary purpose for administering thisdrug to the child at this time?A. Decrease the oral secretionsB. Reduce the child’s anxietyC. Potentiate the opioid effectsD. Prevent possible peritonitis10.When caring for a client on digoxin (Lanoxin) therapy, the nurse knows tobe alert for digoxin (Lanoxin) toxicity. Which finding would predispose thisclient to developing digoxin toxicity?A. Low serum sodium levelB. High serum sodium levelC. Low serum potassium levelD. High serum potassium level
NurseHero202211.A client is receiving anti-infective drug therapy for a postoperative infection.Which complaint should alert the nurse to the possibility that the client hascontracted a superinfection?A. “My mouth feels sore”B. “I have a headache.”C. “My ears feel plugged up.”D. “I feel constipated”12.During the initial nursing assessment history, a client tells the nurse that heis taking tetracycline hydrochloride (Sumycin) for urethritis. Whichmedication taken concurrently with Sumycin could interfere with itsabsorption?A. Sucralfate (Carafate)B. Hydrochlorothiazide (Diuril)C. Acetaminophen (Tylenol)D. Phenytoin (Dilantin)13.Following the administration of sublingual nitroglycerin, which assessmentfinding indicates that the medication was effective?A. Decrease in level of chest painB. Clear bilateral breath soundsC. Increase in blood pressureD. Increase in urinary output14.Alteration of which laboratory finding represents the achievement of atherapeutic goal for heparin administration?A. Prothrombin time (PT)B. Fibrin split productsC. Platelet countD. Partial thromboplastin time (PTT)
NurseHero202215.The nurse is assessing a stuporous client in the emergency department whois suspected of overdosing with opioids. Which agent should the nurseprepare to administer if the client becomes comatose?A. Naloxone hydrochloride (Narcan)B. Atropine SulfateC. Vitamin KD. Romazicon16.A client with HIV who was recently diagnosed with tuberculosis (TB) asksthe nurse, “Why do I need to take all of these medications for TB?” Whatinformation should the nurse provide?A. Antiretroviral medications decrease the efficacy of the TB drugs.B. Multiple drugs prevent the development of resistant organisms.C. Duration of the medication regimen is shortened.D. Potential adverse drug reactions are minimized.17.Two hours after taking the first dose of penicillin, a client arrives at theemergency department complaining of feeling ill, exhibiting hives, havingdifficulty breathing, and experiencing hypotension. These findings areconsistent with which client response that requires immediate action?A. Severe acute anaphylactic responseB. Side reaction that should resolveC. Idiosyncratic reactionD. Cumulative drug response18.Which question should the nurse ask a client prior to the initiation oftreatment with IV infusions of gentamicin sulfate (Garamycin)?A. “Are you having difficulty hearing?”B. “Have you ever been diagnosed with cancer?”C. “Do you have any type of diabetes mellitus?”D. “Have you ever had anemia?”
NurseHero202219.A male client who has chronic back pain is on long-term pain medicationmanagement and asks the nurse why his pain relief therapy is not aseffective as it was 2 months ago. How should the nurse respond?A. The phenomenon occurs when opiates are used for more than 6months to relieve pain.B. Withdrawal occurs if the drug is not tapered slowly while beingdiscontinued.C. Pharmacodynamics tolerance requires increased drug levels toachieve the same effect.D. A consistent dosage with around-the-clock administration is the mosteffective.20.The nurse is providing discharge instructions to a client who has received aprescription for an antibiotic that is hepatotoxic. Which information shouldthe nurse include in the instructions?A. Avoid ingesting any alcohol or acetaminophen (Tylenol).B. Schedule a follow-up visit for a liver biopsy in 1 month.C. Activities that are strenuous should be avoided.D. Notify the health care provider of any increase in appetite.21.A client with mild Parkinsonism is started on oral amantadine (Symmetrel).Which statement accurately describes the action of this medication?A. Viral organisms that cause Parkinsonism are eliminated.B. Acetylcholine in the myoneural junction is enhanced.C. Dopamine in the central nervous system is increased.D. Norepinephrine release is reduced within the periphery.
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NurseHero202222.A female client who has started long-term corticosteroid therapy tells thenurse that she is careful to take her daily dose at bedtime with a snack ofcrackers and milk. Which is the best response by the nurse?A. Advise the client to take the medication in the morning, rather thanat bedtime.B. Teach the client that dairy products should not be taken with hermedication.C. Tell the client that absorption is improved when taken on an emptystomach.D. Affirm that the client has a safe and effective routine for taking themedication.23.A female client with myasthenia gravis is taking a cholinesterase inhibitorand asks the nurse what can be done to remedy her fatigue and difficultyswallowing. What action should the nurse implement?A. Explore a plan for development of coping strategies for thesymptoms with the client.B. Explain to the client that the dosage is too high, so she should skipevery other dose of medication.C. Advise the client to contact her health care provider because of thedevelopment of tolerance to the medication.D. Develop a teaching plan for the client to self-adjust the dose ofmedication in response to symptoms24.A female client is receiving tetracycline (Vibramycin) for acne. Which clientteaching should the nurse include?A. Oral contraceptives may not be effective.B. Drinking cranberry juice will promote healing.C. Breast tenderness may occur as a side effect.D. The urine will turn a red-orange color.
NurseHero202225.A female client with trichomoniasis (Trichomonas vaginalis) receives aprescription for metronidazole (Flagyl). Which instruction is most importantfor the nurse to include this client’s teaching plan?A. Avoid alcohol consumption.B. Complete the medication regimen.C. Use a barrier contraceptive method.D. Treat partner(s) concurrently.26.A 2-month-old infant is scheduled to receive the first DPT immunization.What is the preferred injection site to administer this immunization?A. Dorsal glutealB. Vastus lateralisC. Ventral glutealD. Deltoid27.The nurse is evaluating a client’s understanding of the prescribedantilipemic drug lovastatin (Mevacor). Which client statement indicatesthat further teaching is needed?A. “My bowel habits should not be affected by this drug.”B. “This medication should be taken once a day only.”C. “I will still need to follow a low-cholesterol diet.”D. “I will take the medication every day before breakfast.”28.An older client who had a colon resection yesterday is receiving a constantdose of hydromorphone (Dilaudid) via a patient-controlled analgesia (PCA)pump. Which assessment finding is most significant and requires that thenurse intervene?A. The client is drowsy and complains of pruritus.B. Pupils are 3 mm; PERRLA.C. The area around the sutures is reddened and swollen.D. Respirations decrease to 14 breaths/min.
NurseHero202229.A client receives an antihypertensive agent daily. Which action is mostimportant for the nurse to implement prior to administering the medication?A. Verify the expiration date.B. Obtain the client’s blood pressure.C. Determine the client’s history of adverse reactions.D. Review the client’s medical record for a change in drug route.30.The charge nurse is reviewing the admission history and physical data forfour clients newly admitted to the unit. Which client is at greatest risk foradverse reactions to medications?A. 30-year-old man with a fractureB. 7-year-old child with an ear infectionC. 75-year-old woman with liver diseaseD. 50-year-old man with an upper respiratory tract infection31.The health care provider has prescribed a low-molecular-weight heparin,enoxaparin (Lovenox) prefilled syringe, 30 mg/0.3 mL IV every 12 hours, fora client following hip replacement. Prior to administering the first dose,which intervention is most important for the nurse to implement?A. Assess the client’s IV site for signs of inflammation.B. Evaluate the client’s degree of mobility.C. Instruct the client regarding medication side effects.D. Contact the health care provider to clarify the prescription.32.The nurse is preparing a plan of care for a client receiving the glucocorticoidmethylprednisolone (Solu-Medrol). Which nursing diagnosis reflects aproblem related to this medication that should be included in the care plan?A. Ineffective airway clearanceB. Risk for infectionC. Deficient fluid volumeD. Impaired gas exchange
NurseHero202233.The nurse is reviewing prescribed medications with a female client who ispreparing for discharge. The client asks the nurse why the oral dose of anopioid analgesic is higher than the IV dose that she received duringhospitalization. Which response is best for the nurse to provide?A. A higher dose of analgesic medication may be needed after discharge.B. An error in the dose calculation may have occurred when theprescribed dose was converted.C. The doses should be the same unless the pain is not well controlled.D. Oral taken drugs dissolves in the gut its not %100 absorbed unlikewhen it is administered as an IV. (that is the concept of the answerbut it is not exactly the same choice).34.Amoxicillin, 500 mg PO every 8 hours, is prescribed for a client with aninfection. The drug is available in a suspension of 125 mg/5 mL. How manymilliliters should the nurse administer with each dose?Answer: 20 mL= 500 x 5 / 125 = 2035.Minocycline (Minocin), 50 mg PO every 8 hours, is prescribed for anadolescent girl diagnosed with acne. The nurse discusses self-care with theclient while she is taking the medication. Which teaching points should beincluded in the discussion?(Select all that apply.)A. Report vaginal itching or discharge.B. Take the medication at 0800, 1500, and 2200 hours.C. Protect skin from natural and artificial ultraviolet light.D. Avoid driving until response to medication is known.E. Take with an antacid tablet to prevent nausea.F. Use a nonhormonal method of contraception if sexually active.
NurseHero202236.The health care provider prescribes carbamazepine (Tegretol) for a childwhose tonic-clonic seizures have been poorly controlled. The nurse informsthe mother that the child must have blood tests every week. The motherasks why so many blood tests are necessary. Which complication isassessed through frequent laboratory testing that the nurse should explainto this mother?A. NephrotoxicityB. OtotoxicityC. MyelosuppressionD. Hepatotoxicity37.A 67-year-old client is discharged from the hospital with a prescription fordigoxin (Lanoxin), 0.25 mg daily. Which instruction should the nurse includein this client’s discharge teaching plan?A. Take the medication in the morning before rising.B. Take and record radial pulse rate daily.C. Expect some vision changes caused by the medication.D. Increase intake of foods rich in vitamin K.38.A pediatric client is discharged home with multiple prescriptions formedications. Which information should the nurse provide that is mosthelpful to the parents when managing the medication regimens?A. Maintain a drug administration record.B. Fill all prescriptions at one pharmacy.C. Allow one person to give the medications.D. Give all medications in small volumes.39.A 6-year-old child is admitted to the emergency department with statusepilepticus. His parents report that his seizure disorder has been managedwith phenytoin (Dilantin), 50 mg PO bid, for the past year. Which drugshould the nurse plan to administer in the emergency department?A. Phenytoin (Dilantin)B. Diazepam (Valium)C. Phenobarbital (Luminal)D. Carbamazepine (Tegretol)
NurseHero202240.A client who is hypertensive receives a prescription for hydrochlorothiazide(HCTZ). When teaching about the side effects of this drug, which symptomsare most important for the nurse to instruct the client to report?A. Fatigue and muscle weaknessB. Anxiety and heart palpitationsC. Abdominal cramping and diarrheaD. Confusion and personality changes41.When providing nursing care for a client receiving pyridostigmine bromide(Mestinon) for myasthenia gravis, which nursing intervention has thehighest priority?A. Monitor the client frequently for urinary retention.B. Assess respiratory status and breathe sounds often.C. Monitor blood pressure each shift to screen for hypertension.D. Administer most medications after meals to decrease gastrointestinalirritation.42.A client is being discharged with a prescription for sulfasalazine (Azulfidine)to treat ulcerative colitis. Which instruction should the nurse provide to thisclient prior to discharge?A. Maintain good oral hygiene.B. Take the medication 30 minutes before a meal.C. Discontinue use of the drug gradually.D. Drink eight glasses of fluid a day.43.Which parameter is most important for the nurse to check prior toadministering a subcutaneous injection of heparin?A. Heart rateB. Urinary outputC. Activated partial thromboplastin time (aPTT)D. Prothrombin time (PT) and international normalized ratio (INR)
NurseHero202244.The nurse plans to draw blood samples for the determination of peak andtrough levels of gentamicin sulfate (Garamycin) in a client receiving IVdoses of this medication. When should the nurse plan to obtain the peaklevel?A. Thirty minutes after the dose is administeredB. Immediately before giving the next doseC. When the next electrolyte levels are drawnD. Sixty minutes after the dose is administered45.A client receiving a continuous infusion of heparin IV starts to hemorrhagefrom an arterial access site. Which medication should the nurse anticipateadministering to prevent further heparin-induced hemorrhaging?A. Vitamin K1 (AquaMEPHYTON)B. Protamine sulfateC. Warfarin sodium (Coumadin)D. Prothrombin46.A client with acute lymphocytic leukemia is to begin chemotherapy today.The health care provider’s prescription specifies that ondansetron (Zofran)is to be administered IV 30 minutes prior to the infusion of cisplatin(Platinol). What is the rationale for administering Zofran prior to thechemotherapy induction?A. Promotion of diuresis to prevent nephrotoxicityB. Reduction or elimination of nausea and vomitingC. Prevention of a secondary hyperuricemiaD. Reduction in the risk of an allergic reaction47.The health care provider prescribes cisplatin (Platinol) to be administered in5% dextrose and 0.45% normal saline with mannitol (Osmitrol) added.Which assessment parameters would be most helpful to the nurse inevaluating the effectiveness of the Osmitrol therapy?A. Oral temperatureB. Blood culturesC. Urine outputD. Liver enzyme levels
NurseHero202248.Which factor is most important to ensure compliance when planning toteach a client about a drug regimen?A. GeneticsB. Client ageC. Client educationD. Absorption rate49.A client being treated for an acute myocardial infarction is to receive thetissue plasminogen activator altaplase (Activase). The nurse would becorrect in providing which explanation to the client regarding the purposeof this drug?A. This drug is a nitrate that promotes vasodilation of the coronaryarteries.B. This drug is a clot buster that dissolves clots within a coronary artery.C. This drug is a blood thinner that will help prevent the formation of anew clot.D. This drug is a volume expander that improves myocardial perfusionby increasing output.50.In addition to nitrate therapy, a client is receiving nifedipine (Procardia), 10mg PO every 6 hours. The nurse should plan to observe for which commonside effect of this treatment regimen?A. HypotensionB. HyperkalemiaC. HypokalemiaD. Seizures51.Dopamine (Intropin) is administered to a client who is hypotensive. Whichfinding should the nurse identify as a therapeutic response?A. Gain in weightB. Increase in urine outputC. Improved gastric motilityD. Decrease in blood pressure
NurseHero202252.A client taking linezolid (Zyvox) at home for an infected foot ulcer calls thehome care nurse to report the onset of watery diarrhea. Whichintervention should the nurse implement?A. Schedule appointments to obtain blood samples for drug peak andtrough levels.B. Reassure the client that this is an expected side effect that willresolve in a few days.C. Instruct the client to obtain a stool specimen to be taken to thelaboratory for analysis.D. Advise the client to begin taking an over-the-counter antidiarrhealagent.53.To evaluate whether the administration of an antihypertensive medicationhas caused a therapeutic effect, which action should the nurse implement?A. Ask the client about the onset of any dizziness since taking themedication.B. Measure the client’s blood pressure while the client is lying, sitting,and then standing.C. Compare the client’s blood pressure before and after the client takesthe medication.D. Interview the client about any past or recent history of high bloodpressure.54.The nurse is scheduling a client’s antibiotic peak and trough levels with thelaboratory personnel. What is the best schedule for drawing the troughlevel?A. Give the dose of medication, and call the laboratory to draw thetrough STAT.B. Arrange for the laboratory to draw the trough 1 hour after the doseis given.C. Instruct the laboratory to draw the trough immediately before thenext scheduled dose.D. Give the first dose of medication after the laboratory reports that thetrough has been drawn.
NurseHero202255.Salicylic acid is prescribed for a client with a diagnosis of psoriasis. Thenurse monitors the client, knowing that which finding indicates thepresence of systemic toxicity from this medication?A. tinnitusB. diarrheaC. constipationD. decreased respirations56.Isotretinoin is prescribed for a client with severe acne. Beforeadministration of this medication, the nurse anticipates that whichlaboratory test will be prescribed?A. K levelsB. triglyceride levelsC. Hemoglobin A1CD. total cholesterol level57.A client with severe acne is seen in the clinic and the HCP prescribesisotretinoin. The nurse reviews the client’s medication record and wouldcontact the HCP if the client is also taking which medication?A. digoxinB. phenytoinC. vitamin AD. furosemide58.The camp nurse asks the children preparing to swim in the lake if they haveapplied sunscreen. The nurse reminds the children that chemicalsunscreens are most effective when applied at which times?A. immediately before swimmingB. 5 minutes before exposure to the sunC. immediately before exposure to the sunD. at least 30 minutes before exposure to the sun
NurseHero202259.The nurse is teaching a client how to mix regular insulin and NPH insulin inthe same syringe. Which action, if performed by the client, indicates theneed for further teaching?A. withdraws the NPH insulin firstB. withdraws the regular insulin firstC. injects air into NPH insulin vial firstD. injects an amount of air equal to the desired dose of insulin into eachvial60.The home care nurse visits a client recently diagnosed with diabetesmellitus who is taking Humulin NPH insulin daily. The client asks the nursehow to store the unopened vials of insulin. The nurse should tell the clientto take which action?A. freeze the insulinB. refrigerate the insulinC. store the insulin in a dark, dry placeD. keep the insulin at room temperature61.A nurse is preparing to administer a dose of warfarin to a patient. Based onthe nurse’s knowledge of this drug, the nurse knows to monitor for whichof the following side effects?A. Black stoolsB. ConstipationC. Abdominal bloatingD. Back pain62.Which of the following is considered a contraindication for administrationof Furosemide [Lasix®]?A. 4+ pitting edema in the lower extremitiesB. HypertensionC. Facial swellingD. Decreased urine output
NurseHero202263.After starting an IV dose of sulfamethoxazole (Bactrim®), the nurse notesthat the patient is having difficulty breathing, his face is flushed, and hecomplains of back pain. Which type of hypersensitivity reaction is thispatient most likely experiencing?A. CytotoxicB. Serum sicknessC. AnaphylacticD. Infectious64.A nurse is caring for a pregnant patient who needs treatment for rosacea.The patient asks the nurse about using topical corticosteroids for treatment.Which of the following information should the nurse provide this patient?A. The patient can safely use this type of medicationB. The patient can only use this medication in areas away from theabdomenC. This medication causes teratogenic effects and should be avoidedD. There is no safety evidence of this medication during pregnancy, so itshould be avoided65.Which of the following agents would increase sedation caused by morphine?A. ethanolB. diazepamC. chlorpromazineD. clomipramineE. All of the above
NurseHero2022Important points that you must knowNitroglycerineVasodilator to reduce angina by increasing blood oxygen to the heart and bydecreasing its work load. Vasodilation lowers the BP. Give break at night for 8hours, then apply new in morning; rotate sites. If irregular angina occurs followsteps for NTG, 3 times, every 5 minutes, call 911, etc.Peak LevelsDrawn 30 minutes after a medication is given IV or 1-2 hours after it is given orallyTrough LevelsDrawn 30 minutes before medication is given.Transdermal Fentanyl patchApplied once every 72 hours. Given for opioid tolerant patients. Never apply heatto patch and always remove previous patch.Orlistat (Xenical)Unabsorbed fat causes oily/fatty stool, diarrhea, and flatulence.Psychotropic drugs and grief teachingSupport groups and collaborative grief care; make sure pt. adheres to medication.Lithium therapeutic values in blood0.6 – 1.8 mg/dLPilocarpineCholinergic miotic; used as a miotic in the treatment of glaucoma to increaseaqueous fluid outflow.Side Effects = decreased visual acuity, especially in dim light; other side effectsinclude transient burning/discomfort, blurred vision, pain, photophobia,lacrimation.
NurseHero2022Muscarinic Drugs/ AnticholinergicAdverse Effects = blurred vision, worsening of angle-closure glaucoma, dry mouth,tachycardia, constipation, urinary retention, and decreased sweatingReduce overactive bladder contractions in urge urinary incontinence andoveractive bladderBactrimFirst choice drugs to treat uncomplicated or initial UTI.Used prophylactically to prevent UTI in transplant.Adverse Effects = hemolytic and aplastic anemia, agranulocytosis,thrombocytopenia, photosensitivity, exfoliative dermatitis, Steven-Johnsonsyndrome, neutropenia etc.Also nausea/vomit/diarrhea, nephrotoxicity, HA, peripheral pruritus, cough, etc.May interact with oral contraceptives; reduces effects.Patient Controlled Analgesia PumpUsed only by patients to help prevent addiction and promote self-management ofcare; also prevents accidental overdose. Continue monitoring respiratory statusDilantinSide effect= Gingival hyperplasia is long term of phenytoin use; therapeutic levelsof Dilantin are 10-20 mg/dLTylenol overdoseNo more than 3000 mg/day for adults; patients who are hepatically compromisedshould not take more than 2000 mg/dayEpivir for HIV (nucleoside reverse transcriptase inhibitors)Prevent viral reproduction and are also used in the treatment of chronic HBVwhen evidence of replication is present.Reduces viral load, decreases liver damage, and liver enzymesKetorolac (Toradol)
NurseHero2022NSAID and used because it is the most powerful in its drug classification; usedshort-term for moderate to severe pain.Main side effect= renal impairment, edema, GI pain, dyspepsia, and nauseaLactuloseGiven in cirrhosis to counteract effects of ammonia buildup which has severeneurological manifestations.Binds to ammonia and is excreted in stools.Evaluate pt. LOC and neurologic status to determine effectiveness of therapy.Glucagon Emergency KitStimulates glycogenolysis and gluconeogenesis; used to treat hypoglycemia ifpatient becomes unresponsive.Instruct family when and how to use; in emergency it is given as 1 mg by IM or SQwhen Dextrose 50% cannot be given.To prevent aspiration if vomiting occurs (common side effect of glucagon), turnpatient on side until they become alert.ByettaIndicated only for Type II diabetes patients who have been unable to achieveblood glucose control with metformin, or glitazone and cannot be used withinsulin; best given 60 minutes before a meal.Side effect = nausea/vomit/diarrhea, and some patients may experience weightloss of 5-10 pounds.LabetalolBeta blocker used to manage HTN.Labetalol and other beta blockers have major impacts on cardiac and respiratorysystems.Side effects includes weight gain so monitor and assess I &O and daily weightsassociated with pulmonary edema especially if the pt. has diabetes.LasixDecreases reabsorption of Na and water; is a loop diuretic.Can cause fluids and electrolytes imbalances such as hypokalemia, hyperglycemia,hyperuricemia which can lead to cramps, especially hypokalemia.
NurseHero2022Dopamine IV infiltrationWhen the drugs move into the tissues surrounding the infusion site causing localtissue damage; cardinal sign of infiltration is pain but also includes pain, swelling,redness, and vesicles on the skin.Immediately turn off the infusion and intervene to prevent further complicationsDigoxin ToxicityImproves myocardial contractility and reduces HR; used mostly in heart failure.Therapeutic index is 0.5-2.0 mg/dL and treatment of toxicity consists ofwithholding drug and giving the antidote (Digibind).Monitor for signs of hypo and hyperkalemia, these can increase or decreaseeffects of digoxinEarly signs of toxicity include n/v, anorexia, fatigue, HA, depression, and visualchanges (halos, bright lights)Late signs of toxicity include dysrhythmias (bradycardia and AV block)Coumadin (Warfarin) precautionsInterferes with hepatic synthesis of vitamin K dependent clotting factors; is ananticoagulantCheck pt. BP, monitor for bleeding, takes 3-5 days to be active or show effects;know INR and monitor blood values (platelets); Vit K is antidote.Do not give antiplatelet or NSAIDs with warfarinBaclofenA muscle relaxer and an antispastic agent and can be used for multiple sclerosis,muscle spasms, pain, and stiffness.Side effects= include seizures (convulsions), confusion, hallucinations, or anirregular heartbeat.Other less serious side effects include drowsiness, dizziness, weakness, HA,insomnia, nausea, constipation, and frequent urination.Bulk forming laxativePsyllium (Metamucil, Naturacil); high fiber content absorbs water and increasessolid intestinal bulk, stimulate peristalsis.
NurseHero2022Must be mixed and taken with at least 240 mL of water or juice and swallowedquickly, and follow with water.BonivaTreats osteoporosis. Side Effects: mild flu like symptoms, vision changes,heartburn, chest pain, blood in stool and vomit.DilaudidSide Effects: dizziness, drowsiness, sedation, hypotension,bradycardia/tachycardia, NVC, resp. depressionSteroidsDo not stop taking abruptly, they must be weaned off. Patient is at risk forhypoadrenal crisis (shock and circulatory collapse) if stopped abruptly.Vitamin D overdoseMost common in children. Discontinue use / calcium intake reverses toxic effectsAriceptAlzheimer’s medication used to slow progression and improve quality of life. Donot cureAccutaneAcne drug that causes birth defects (abnormalities of the skull, face, ears, eyes)and spontaneous abortions. Patients should be on two contraception methods.Sun exposure should be avoided. No longer on the market due to suicides.Levothyroxine (Synthroid) overdoseMonitor HR, report pulse > 100 bpm, or an irregular heartbeat; promptly reportchest pain, weight loss, nervousness, tremors, and /or insomnia.May take up to 8 weeks before full effect of hormone therapy is seen so don’toverdose; monitor SE before increasing dosage.
NurseHero2022Intranasal anti-diuretic hormone (Desmopressin)Used to control polydipsia (excessive thirst), polyuria, and dehydration in patientswith DI. Intranasal form can have unpredictable absorption, so contact HCP ifcondition worsens. Pump needs to be primed prior to administration. 10 mcg perpump is the dose. If more needs to be given, it needs to be split between nostrilsVasopressin nasal is used topically to nasal membranes and must not be inhaled;Desmopressin is given via nasal pump. These meds should be used with caution inpatients with seizure disorders, asthma, CVD, and renal diseasePrevacidUsed with GERD. Decreases the amt. of acid in the stomach and helps heal aciddamage. OTC can treat frequent heartburn. Takes 2-7 days for full effect.TiganUsed post op to treat/prevent N/V. Monitor fluid and electrolytes along with BP,HR, and respirations. Side Effects= include diarrhea, HA, dizziness, drowsiness,muscle cramps; rare SE include confusion, muscle spasms, uncontrolledmovements, tremor, mouth sores, unusual bleeding, seizures, mental moodchanges, depression, yellowing of the eyes, and dark urineAnti-tussiveGiven to suppress coughing (only given in non-productive coughs or afterabdominal surgery)Side Effects = dizziness, HA, nausea, sedation, drowsiness, constipationPerform respiratory assessment and allergy assessment before administering.Monitor for therapeutic responsesRifampinAntibiotic used for TB. Can color urine red-orange. Reduces effectiveness of birthcontrol
NurseHero2022TheophyllineMehtylxanthine used in COPD patients as a bronchodilator; half-life is decreasedby smoking and increased by HF and liver diseaseSigns of toxicity include nausea, vomiting, seizures, and insomniaAvoid caffeine to prevent intensifying adverse effectsMonitor serum blood levels regularly to determine drug is in therapeutic range(10-20 mcg/mL)GaramycinAminoglycoside antibiotic. Can cause toxicities to renal system and ears.PilocarpineUsed as a miotic in the treatment of glaucoma to increase aqueous fluid outflowSide Effects = warn pt. about decreased visual acuity, especially in dim light; otherside effects include transient burning/discomfort, blurred vision, pain,photophobia, lacrimation, iritisAbilify (Aripiprazole)Anti-psychotic used to treat schizophrenia, bipolar, major depression, tics, andirritability of autism. Commercial promotion has increased inappropriate use foranxietyLamisil (Terbinafine)Antifungal that is contraindicated with renal and kidney failureExelonTransdermal patch for dementia, Alzheimer’s & Parkinson’s.Adverse Effects: nausea, bloody vomit & stool, confusion, tremors, chest pain,burning urinationAmiodaronePotassium channel blocker / anti-dysrhythmia. Ventricular tachycardia andventricular fibrillation
NurseHero2022Nasal inhaler useShake well. Pt should be sitting upright. Have pt hold one nostril shut whileinhaling it into opposite nostril. Pt needs to sit supine for 5 min them repeat asorderedNasogastric Tube administrationFowler’s position. Double check tube. Crush and mix or use liquid medication.Administer one drug at a time, flushing with 10ml of water between and 30 mLafter last doseSingulairLong term treatment for prevent asthma in adults and kids >12. Given once dailyin the evening.TetracyclineAntibiotic. Avoid sun. Use probiotic to counter side effects. Finish all themedication. Effects can start immediately and last several days afterdiscontinuationTyramineINH / anti-tubercular medication. Avoid foods that contain tyramine (aged cheese,red wine, preserved meat). Causes hypertensive crisis.Herbal Gingko bilobaHelps with cognitive dysfunction due to anti-inflammatory and platelet activationfactor inhibiting properties. Used for memory loss, peripheral artery occlusivedisease, and tinnitusAldactone (Spironolactone)Potassium sparing diuretic. Used for severe heart failure. SE: gynecomastia,testicular atrophy, hirsutism. Avoid foods high in potassiumSpiriva (Tiotropium)
NurseHero2022Used with COPD. Inhaler. Anticholinergic that bronchodilators. Prevents spasms.Used to prevent, will not work if attack is already happening.Vancomycin peak & troughPeak – 18-50Trough – 10-20Xenical (orlistat)Protein bound drug that inhibits fat absorption. Causes diarrhea, fatty stool, andflatulence. Uses for weight lossCalcium channel blockersReduce electrical conduction w/in the heart which decreased the force of thecontraction and dilates the arteries. Dilation of the arteries increases oxygen tothe heart while the reduced contractions decrease the demand for oxygen by theheart muscle. Used for angina, HTN, abnormal heart rhythms.Crestor/LipitorAntilipemic used for the reduction of LDL’s and triglycerides while increasingHDL’s. No pregnant womenEliquis/EnoxaparinAnticoagulants that causes increased bleeding. Tarry stool is indicative of internalbleeding and the doctor needs to be contacted immediatelyLabetalolBeta adrenergic blocker for HTN. Reduces HR/BP, force of contraction andconductionZipsor (diclofenac)NSAID for acute and chronic RA / osteoarthritis. Risks include CHF, MI, stroke,hepatotoxicity, bronchospasm, and anaphylaxisLantus (Glargine)Long acting insulin that has no peak.
NurseHero2022Victoza (Liraglutide)Non-insulin treatment for obese patient with type II diabetesCalcitriol (Miacalcin)Synthetic vit. D for hypocalcemia. Patients with chronic renal failure in dialysis.Also used as supplemental vitamin D for thyroid issuesLactuloseLaxative used to reduce blood ammonia levels. Monitor serum electrolytes. Canraise blood glucose levels in diabeticsReglan (Metoclopramide)Used for GERD. Black box warning for rhythmic involuntary movements (tremors).Notify MD immediately as effect can sometime be irreversibleFlu vaccinationSingle most important influenza control. Each vaccine contains 3 strains based onrecent outbreak data. Effectiveness varies with age, immunocompromised statusof patient, and similarity to strains occurring during seasonVidex (Didanosine)Immunosuppressant therapy raises risk for infection. AIDS medicationPlavix (clopidogrel)Hold prior to surgery to reduce risk of bleeding outEpogenAnti-anemic raises rate of RBC production. Teach patients how to take BP, takeiron/B12/folic acid. No hazardous activities or drivingGengrafGrapefruit increases absorption of the drug causing toxicityEchinacea
NurseHero2022OTC ViraMedx. Herbal remedy used for treating cold sores. Antiseptic action, doesnot kill virusActonelBisphosphonate for osteoporosis and Paget’s. Increases bone mass. Take withplain waiter at least 30 minutes before first food or drink of the day. Do not liedown for 30 minutesCelebrexDecreases pain and inflammation caused by RA and osteoarthritisClonazepam (Klonopin)Anticonvulsant used for various types as well as panic disorders. Monitor forsuicidal thoughts or behavioral changesDuragesic patchesOpioid, fentanyl patch, pain reliefNubainSynthetic opioid antagonist analgesic. Watch for resp. depression, bradycardia,sedation, euphoria, hallucinationsSt John’s wortHerbal for mild depression, anxiety, OCD. Do not take with antidepressants,opioids, liver medications, or transplant medicationsZovirax (acyclovir)Antiviral used to treat herpes and varicella infections. Reduces severity andhealing time. Watch for sore throat, fever, fatigue – could indicate superinfectionMydriaticsDrugs that dilate pupils. Used for chronic open angle glaucoma and ocular HTNFlagyl
NurseHero2022Antimicrobial agent used to treat Clostridium difficile. acute interaction withalcohol or alcohol containing products (cough med) causing severe vomiting. Noalcohol 24 hours before or 36 hours after taking the medicationAtivanUsed for delirium tremens. Benzos are the #1 choice for alcohol withdrawal anddelirium tremens.Antidepressants & addictionGenerally considered non addictive however some such as Prozac and Xanax canbe highly addictiveAdderallShould be timed for periods when symptoms control is needed most. Last doseshould be taken 4-6 hours before bedtime.Exelon side effectsTransdermal patch – for dementia (Alzheimer’s/ Parkinson’s)AE -Nausea and bloody vomit, bloody stool, confusion, tremors, chest pain, burning urinationAmiodaronePotassium Channel Blocker – lowers BP and HRAntidysrhythmic (most successful) – Ventricular tachycardia & Ventricular fibrillationLipophilicAdverse Effects: pulmonary toxicity, eyes (dry, photophobia, halos)Drug Interactions: with Warfarin and Digoxin (increases toxicity)Do not give for severe bradycardiaNasal inhaler use
NurseHero2022Shake wellUpright client holds one nostril closed while inhaling and squeezing into opposite nostrilMaintain patient in supine for 5 min then repeat as orderedNGT Med AdministrationHave patient upright in Fowler positionDouble check placement of tubeCrush and mix or use liquid medicationAdminister one drug at a time flushing with 10ml of water between and 30 ml after last doseMontelukast (Singulair) Administration TimeLong-term treatment of asthma in adults and kids >12-years-oldOnce daily in evening timeTetracycline teachingAntibioticAvoid sunUse probiotics to counter side effects (diarrhea)Finish all medicationEffects can start immediately and last several days after discontinuationMath – IM med administrationmg/ mL – milligrams per milliliter used for liquid, suspensionIM sites (ventro glut (preferred), vastus lateralis (infants), and deltoidZ-track for irritating meds (Iron)
NurseHero2022INH (isoniazid) and TyramineAntituberculosis drugTyramine in foods should be avoided (aged cheese, red wine, preserved meats) causeshypertensive crisisMultiple Sclerosis and Herbal GingkoGinkgo can help with cognitive dysfunction due to anti-inflammatory and platelet activationfactor inhibiting propertiesGinkgo is for memory loss, peripheral artery occlusive disease and tinnitusSpironolactone (Aldactone)Potassium sparing diuretic and aldosterone antagonistUsed for severe heart failureHas greatest antihypertensive benefits (compared to others of same class)Side Effects: gynecomastia, testicular atrophy, hirsutismAdverse Effects: Hyperkalemia (avoid K+ rich foods while taking)Oxybutynin (Ditropan) side effectsAnti-cholinergic -Used to treat overactive bladderAnti-SLUDGESide Effects – dry mouth, constipation, and vision (dry eyes, blurred vision, halos)Avoid overheating outdoors (reduces sweating)Spiriva (Tiotropium) for COPDInhaler used with tablet (not oral)Anticholinergic – bronchodilatorsPrevents bronchospasms – used to prevent, will not reverse attack once it occurs
NurseHero2022Vancomycin – Peak/TroughPeak 18-50 mcg/mLTrough – 10-20 mcg/mLLow dosage = reduced antibacterial effectHigh dosage = ototoxicity and nephrotoxicityXenical (orlistat)Weight managementProtein bound drug that inhibits fat absorptionCauses: diarrhea, fatty stool, flatulenceBaclofen – teachingSkeletal muscle relaxant/ antispasmodic for Multiple SclerosisAvoid activities that require alertness (driving)Do not stop taking abruptly – withdrawal occursCalcium Channel Blockers (verapamil, amlodipine, diltiazem, nifedipine)Reduce electrical conduction within heart decreasing force of contraction and dilate arteriesDilation of arteries increases oxygen to heart while reduced contraction decrease demand foroxygen by heart muscleUses – angina, hypertension, abnormal heart rhythmsSide Effects – edema, impotenceCrestor (rosuvastatin) Evaluate effectsAntilipidemia – used for reducing LDL’s and triglycerides while increasing HDL’sNot for use in pregnant women (Category X)
NurseHero2022Digoxin toxicity signs and symptomsLife-threatening heart rhythms, appetite loss, abdominal discomfort, blurred vision, mentalchanges, hypokalemiaEffient (Prasugrel) and tarry stoolAnticoagulant – causes increased bleedingTarry stool is indicative of internal bleeding and doctor needs to be contacted immediatelyLabetalol (Trandate)Beta adrenergic blocker for hypertensionReduces HR, Force of Contraction and Conduction, BPZipsor (diclofenac potassium) -risksNSAID for acute and chronic RA, OsteoarthritisRisks include CHF, MI, stroke, hepatotoxicity, blood dyscrasias, bronchospasm andanaphylaxisLantus (insulin glargine) – peakLong acting insulin that has no peak.Synthroid overdose signsCardiac dysrhythmias – can be fatalTachycardia, palpitations, angina, tremorsVictoza (Liraglutide) – Type II DiabetesNon-insulin treatment for Type II onlyMay lower blood sugar if used with diet and exercise measuresDaily injection
NurseHero2022Calcitriol (Miacalcin)Synthetic vitamin D for hypocalcemia for patient with chronic renal failure in dialysisAlso used as supplemental vitamin D for hypoparathyroidism, pseudohypoparathyroidism,hypophosphatemia, hypocalcemia infantsAspirin and NSAID cautionDo not take together NSAIDS can decrease antiplatelet effects of aspirin.Always look for signs of GI bleedingLactulose – What to evaluateHyper-osmotic laxative to reduce blood ammonia levelsMonitor serum electrolytesIn diabetics it can raise blood sugarIf there is a liver problem and jaundice, look for signs of improvement as increase level ofconsciousness.Reglan (metoclopramide) and tremorsUsed for GERD for short term therapy.Black box warning for rhythmic involuntary movements (extrapyramidal): Notify MDimmediately as effect can sometime be irreversibleFlu VaccineSingle most important influenza controlEach vaccine contains 3 strains based on recent outbreak dataEffectiveness varies with age, immunocompromised status of patient, and similarity tostrains occurring during seasonAIDS/ Videx (Didanosine) risk of infection
NurseHero2022Immunosuppressant therapy raises risk for infectionPlavix (clopidogrel)- holdAnticoagulation so HOLD prior to surgery to reduce risk of bleeding outEpogen – instructionsAntianemia – raises rate of RBC productionTeach the patients how to take BP, take iron, B12, folic acidNo hazardous activities or drivingGengraf (cyclosporine) and grapefruitIncreases absorption of drug causing toxicityEchinacea -topicalOTC ViraMedxHerbal remedy used for treating cold soresAntiseptic action, does not kill virusActonel (Risedronic acid) AdministrationBisphosphonate for osteoporosis and Paget’sIncreases bone massTake with plain water at least 30 min before firs food or drink of day. Do not lie down for 30minutesCelebrex (Celecoxib) desired effectDecrease pain and inflammation caused by Rheumatoid arthritis and osteoarthritis
NurseHero2022Clonazepam (Klonopin)AnticonvulsantUsed for various seizure types as well as panic disorderMonitor for suicidal thoughts or behavioral changesDuragesic (Fentanyl)OpioidFentanyl patchPain reliefNubain (Nalbuphine) adverse effectsSynthetic opioid agonist analgesicRespiratory depression, bradycardia, sedation, euphoria, hallucinationsToradol (ketorolac) side effectsNSAIDPain and inflammation reduction post-surgeryAdverse Effects -bleeding, hypovolemia seizures, CV thrombolytic events hepatic failure andrenal diseaseAvoid during pregnancySt John’s WortHerbal for mild depression and anxiety, OCDDo Not Take with antidepressants, opioids, liver medications or transplant medicationsZovirax (acyclovir) and STIAntiviral used to treat Herpes and varicella infectionsReduces severity and healing time
NurseHero2022Watch for sore throat, fever, fatigue – could indicate superinfectionViagra (sildenafil)Vasodilation to increase blood flow to certain areasNot recommended for patients with heart issuesCan cause hypotensive effects in patients on nitrates (contraindicated and if the patient is on both,should go to the ER)Antihistamine actionBlocks histamine receptors which prevents the release and actions of histamine. Does not pushoff already attached histamine; therefore, more beneficial if given earlyCross sensitivity for respiratory drugsBeta agonists (non-selective) effect both beta 1 and 2 receptors which causes both bronchioleconstriction and vasoconstrictionNot indicated for asthma patientsLong term glucocorticoidsAdrenal drugs that mimic corticosteroidsLong term use may lead to decreased wound healing, moon face, hyperglycemia, psychosis andCushing’sMydriatics drugsDrugs that dilate pupils.Used for chronic open angle glaucoma and ocular hypertensionSympathomimetic (mimic SNS)
NurseHero2022Accutane (Isotretionin) and sun toxicityTreats severe acne by inhibiting sebaceous glandsSun exposure should be avoided as it can cause toxicityCurrently off market due to suicidesFlagyl (metronidazole) – C diff – teachingAntimicrobial agent used to treat Clostridium difficileAcute interaction with alcohol or alcohol containing products (cough med) causing severevomitingNo alcohol 24 hours before taking or 36 after takingNexium and NSAID therapyNexium (antacid) and NSAIDS cause GI irritationAtivan (lorazepam) for delirium tremensBenzos are #1 choice for alcohol withdrawal and delirium tremensAdderall (amphetamine and dextroamphetamine) and time of dosageFor ADHDShould be timed for periods when symptoms control is needed most. Last dose should be taken4-6 hours before bedtime.Antidepressants and addictionGenerally considered non addictive however some such as Prozac and Xanax can be highlyaddictive