Download PHARMACOLOGY EVOLVE HESI QUESTIONS WITH 100% ACCURATE ANSWERS and more Exams Public Health in PDF only on Docsity!
PHARMACOLOGY EVOLVE HESI QUESTIONS
WITH 100% ACCURATE ANSWERS
A 19-year-old male client who has sustained a severe head injury is intubated and placed on assisted mechanical ventilation. To facilitate optimal ventilation and prevent the client from "fighting" the ventilator, the health care provider administers pancuronium bromide IV, with adjunctive opioid analgesia. What medication should be immediately accessible for a potential complication with this drug? A. Dantrolene sodium B. Neostigmine bromide C. Succinylcholine bromide D. Epinephrine - Accurate answers B. Neostigmine bromide Neostigmine bromide and atropine sulfate, both anticholinergic drugs, reverse the respiratory muscle paralysis caused by pancuronium bromide. Options A, C, and D are not antagonists to pancuronium bromide and would not be helpful in reversing the effects of the drug compared with the use of anticholinergics. A client with viral influenza is receiving vitamin C, 1000 mg PO daily, and acetaminophen elixir, 650 mg PO every 4 hours PRN. The nurse calls the health care provider to report that the client has developed diarrhea. Which change in prescriptions should the nurse anticipate? A. Change the acetaminophen to ibuprofen. B. Change the elixir to an injectable route. C. Decrease the dose of vitamin C. D. Begin treatment with an antibiotic. - Accurate answers C. Decrease the dose of vitamin C. When providing nursing care for a client receiving pyridostigmine bromide for myasthenia gravis, which nursing intervention has the highest priority? A. Monitor the client frequently for urinary retention. B. Assess respiratory status and breath sounds often. C. Monitor blood pressure each shift to screen for hypertension. D. Administer most medications after meals to decrease gastrointestinal irritation. - Accurate answers B. Assess respiratory status and breath sounds often. A client with a dislocated shoulder is being prepared for a closed manual reduction using conscious sedation. Which medication should the nurse explain as a sedative used during the procedure? A.Inhaled nitrous oxide B.Midazolam IV C.Ketamine IM D.Fentanyl and droperidol IM - Accurate answers B. Midazolam IV
A client is being discharged with a prescription for sulfasalazine to treat ulcerative colitis. Which instruction should the nurse provide to this client prior to discharge? A. Maintain good oral hygiene. B. Take the medication 30 minutes before a meal. C. Discontinue use of the drug gradually. D. Drink at least eight glasses of fluid a day. - Accurate answers D. Drink at least eight glasses of fluid a day. The health care provider prescribes carbamazepine for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. The mother asks why so many blood tests are necessary. Which complication is assessed through frequent laboratory testing that the nurse should explain to this mother? A. Nephrotoxicity B. Ototoxicity C. Myelosuppression D.Hepatotoxicity - Accurate answers C. Myelosuppression Myelosuppression is the highest priority complication that can potentially affect clients managed with carbamazepine therapy. The client requires close monitoring for this condition by weekly laboratory testing. Hepatic function may be altered, but this complication does not have as great a potential for occurrence as option C. Options A and B are not typical complications of carbamazepine therapy. When developing a written nursing care plan for a client receiving chemotherapy for treatment of cancer, the nurse writes, "Assess each voiding for hematuria." The administration of which type of chemotherapeutic agent would prompt the nurse to add this intervention? A. Vincristine B. Bleomycin sulfate C. Chlorambucil D. Cyclophosphamide - Accurate answers D. Cyclophosphamide Hemorrhagic cystitis is the characteristic adverse reaction of cyclophosphamide. Administration of options A, B, and C does not typically cause hemorrhagic cystitis. A client is receiving oral griseofulvin for a persistent tinea corporis infection. Which response by the client indicates an accurate understanding of the drug teaching conducted by the nurse? A. "I'll wear sunscreen whenever I mow the lawn." B. "This is the worse bacterial infection I've ever had." C. "I will need to take the medication for 7 days." D. "My urine will probably turn brown due to this drug." - Accurate answers A. "I'll wear sunscreen whenever I mow the lawn."
A client experiencing dysrhythmias is given quinidine, 300 mg PO every 6 hours. The nurse plans to observe this client for which common side effect associated with the use of this medication? A. Diarrhea B. Hypothermia C. Seizures D. Dysphagia - Accurate answers A. Diarrhea The most common side effects associated with quinidine therapy are gastrointestinal complaints, such as diarrhea. Options B, C, and D are not usually associated with quinidine therapy. The health care provider prescribes the H2 antagonist famotidine, 20 mg PO in the morning and at bedtime. Which statement regarding the action of H2 antagonists offers the correct rationale for administering the medication at bedtime? A. Gastric acid secreted at night is buffered, preventing pepsin formation. B. Hydrochloric acid secreted during the night is blocked. C. The drug relaxes stomach muscles at night to reduce acid. D. Ingestion of the medication at night offers a sedative effect, promoting sleep. - Accurate answers B. Hydrochloric acid secreted during the night is blocked. H2 antagonists act on the parietal cells to inhibit gastric secretion. Some gastric secretion occurs all the time, even when the stomach is empty, unless medications are taken to inhibit this action. Options C and D are not actions of famotidine. Option A is the action of antacids. Antacids do not affect healing or prevent the recurrence of ulcers; they merely provide symptomatic relief. Knowing the difference between H2 antagonists and antacids is important when teaching clients. The nurse is preparing to administer the disease-modifying antirheumatic drug (DMARD) methotrexate to a client diagnosed with rheumatoid arthritis. Which intervention is most important to implement prior to administering this medication? A. Assess the client's liver function test results. B. Monitor the client's intake and output. C. Have another nurse check the prescription. D. Assess the client's oral mucosa. - Accurate answers C. Have another nurse check the prescription. Double-checking the prescription is an important intervention because death can occur from an overdose. This medication is administered weekly and in low doses for rheumatoid arthritis and should not be confused with administration of the drug as a chemotherapeutic agent. Options A and B are appropriate interventions for those who are receiving this drug, but they are not the most important interventions. Stomatitis is an expected side effect of this medication. A female client with myasthenia gravis is taking a cholinesterase inhibitor and asks the nurse what can be done to remedy her fatigue and difficulty swallowing. What action should the nurse implement? A. Explore a plan for development of coping strategies for the symptoms with the client.
B. Explain to the client that the dosage is too high, so she should skip every other dose of medication. C. Advise the client to contact her health care provider because of the development of tolerance to the medication. D. Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms.
- Accurate answers D. Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms. Maintaining optimal dosage for cholinesterase inhibitors can be challenging for clients with myasthenia gravis. Clients should be taught to recognize signs of overmedication and undermedication so that they can modify the dosage themselves based on a prescribed sliding scale. Options A, B, and C do not adequately address the client's concerns. A female client is receiving tetracycline for acne. Which client teaching 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. - Accurate answers A. Oral contraceptives may not be effective. Certain antibiotics, such as tetracycline, decrease the effectiveness of oral contraceptives. Options B, C, and D do not convey accurate information related to client teaching about this medication. A client who is experiencing an acute attack of gouty arthritis is prescribed colchicine USP, 1 mg PO daily. Which information is most important for the nurse to provide the client? A. Take the medication with meals. B. Limit fluid intake until the attack subsides. C. Stop the medication when the pain resolves. D. Report any vomiting to the clinic. - Accurate answers D. Report any vomiting to the clinic. The client should be instructed to report signs of colchicine toxicity, such as nausea, diarrhea, vomiting, and/or abdominal pain, to the health care provider. Food inhibits the absorption of colchicine when ingested concurrently. Limited fluid intake decreases the excretion of the uric acid crystals, which contributes to painful attacks. Typically, a client should remain on a daily dose of colchicine to decrease the number and severity of acute attacks, so stopping the medication after the pain resolves is not indicated. Amoxicillin, 500 mg PO every 8 hours, is prescribed for a client with an infection. The drug is available in a suspension of 125 mg/5 mL. How many milliliters should the nurse administer with each dose? A. 10 B. 15 C. 20 D. 25 - Accurate answers C. 20 500 mg/x mL = 125 mg/5 mL 125x = 2500
Adverse effects of ticarcillin disodium include hypothrombinemia and decreased platelet adhesion, which can result in the presence of petechiae. Options B, C, and D are not adverse effects primarily associated with the administration of ticarcillin disodium. A male client with prostatic carcinoma has arrived for his scheduled dose of docetaxel chemotherapy. What symptom would indicate a need for an immediate response by the nurse prior to implementing another dose of this chemotherapeutic agent? A. A cough that is new and persistent B. Persistent nausea and vomiting C. Fingernail and toenail changes D. Increasing weakness and neuropathy - Accurate answers A. A cough that is new and persistent Option A is an adverse effect that is immediately life threatening. Severe fluid retention can cause pleural effusion (requiring urgent drainage), dyspnea at rest, cardiac tamponade, or pronounced abdominal distention (caused by ascites). Options B, C, and D are all adverse effects from chemotherapy and need to be monitored consistently. A 26-year-old primigravida client is experiencing increasing discomfort and anxiety during the active phase of labor. She requests something for pain. Which analgesic should the nurse anticipate administering? A. Butorphanol B. Hydromorphone C. Morphine sulfate D. Codeine sulfate - Accurate answers A. Butorphanol Butorphanol is a mixed agonist-antagonist analgesic resulting in good analgesia but with less respiratory depression, nausea, and vomiting compared with opioid agonist analgesics. Which question should the nurse ask a client prior to the initiation of treatment with IV infusions of gentamicin sulfate? 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?" - Accurate answers A. "Are you having difficulty hearing?" Complications of gentamicin sulfate therapy include ototoxicity, nephrotoxicity, and neurotoxicity. Determining if the client is hard of hearing prior to initiation of this aminoglycoside will be helpful as the treatment progresses and ototoxicity is identified as a possible complication. Options B, C, and D are important elements of any medical history, but they do not have the priority of option A when assessing for complications of aminoglycoside therapy. Which medication is useful in treating digoxin toxicity? A. Atropine sulfate
B. Isoproterenol C. Xylocaine D. Digoxin immune Fab - Accurate answers D. Digoxin immune Fab Digibind is useful in treating this type of drug toxicity because it is an antibody that binds antigenically to unbound serum digoxin or digitoxin, resulting in renal excretion of the bound complex. Options A, B, and C are not used to treat digitoxin toxicity. The nurse knows that certain antipsychotic drugs cause extrapyramidal symptoms. Which extrapyramidal symptom is a permanent and irreversible adverse effect of long-term phenothiazine administration? A. Dystonia B. Akathisia C. Pseudoparkinsonism D. Tardive dyskinesia - Accurate answers D. Tardive dyskinesia Tardive dyskinesia is a permanent effect of long-term phenothiazine administration. Options A, B, and C are side effects of phenothiazines but do not have the characteristics of being permanent and irreversible. A client receives an antihypertensive agent daily. Which action is most important 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. - Accurate answers B. Obtain the client's blood pressure. To determine the most accurate response to antihypertensive therapy, baseline blood pressures should be obtained before an antihypertensive drug is administered and should be compared with orthostatic vital signs to determine whether any side effects are occurring. Although options A, C, and D are required nursing actions prior to giving any drug, the therapeutic response should be determined before another dose is administered. The health care provider prescribes ipratropium for a client. An allergic reaction to which other medication would cause the nurse to question the prescription for? A. Albuterol B. Theophylline C. Metaproterenol D. Atropine sulfate - Accurate answers D. Atropine sulfate Clients who have experienced allergic reactions to atropine sulfate and belladonna alkaloids may also be allergic to ipratropium, so the prescription for Atrovent should be questioned. Allergies to options A, B, and C would not cause the nurse to question a prescription for ipratropium.
A. Decreased oral secretions B. Clear speech C. Diminished hand tremors D. Increased ptosis - Accurate answers B. Clear speech Clear speech is the result of increased muscle strength. Muscle weakness characteristic of myasthenia gravis often first appears in the muscles of the neck and face. Options A and D are symptoms of multiple sclerosis that would persist if the medication was ineffective. Hand tremors are not typical symptoms of the disease. A client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCl. Which assessment finding would require immediate intervention by the nurse? A. Reports dizziness when first getting up. B. Describes an unpleasant metallic taste in the mouth. C. Demonstrates Parkinson-like symptoms, such as cogwheel rigidity. D. Refuses to drive after 6 pm because of an inability to see well at night. - Accurate answers C. Demonstrates Parkinson-like symptoms, such as cogwheel rigidity. Metoclopramide HCl blocks dopamine receptors in the brain, which can cause the extrapyramidal symptoms associated with Parkinson disease. Reglan has been associated with hypertension, not option A. Option B is often associated with metronidazole, not metoclopramide HCl. Option D, and other vision problems, have not been associated with metoclopramide HCl. For which clients should the nurse withhold the initial dose of a cyclooxygenase 2 (COX-2) inhibitor until notifying the health care provider? (Select all that apply.) A. A middle-aged adult with a history of tinnitus while taking aspirin B. A middle-aged adult with a history of polycystic ovarian disease C. An older adult with a history of a skin rash while taking glyburide (DiaBeta) D. An adolescent with a history of an anaphylactic reaction to penicillin E. An older adult with a history of gastrointestinal upset while taking naproxen sodium (Naprosyn) F. An adolescent at 34 weeks of gestation experiencing 1+ pitting edema - Accurate answers C, D, F COX-2 inhibitors are contraindicated for those who are allergic to sulfa drugs (C), aspirin, and nonsteroidal antiinflammatory drugs (NSAIDs). Drug safety for adolescents (D and F) is not yet established, and COX-2 inhibitors, as well as NSAIDs, are contraindicated during the third trimester of pregnancy (F) because they can cause a premature closure of the patent ductus arteriosus. Tinnitus, an adverse reaction of aspirin (A), and ovarian disease (B) are not contraindications for the use of COX- inhibitors. Gastrointestinal upset is a common adverse reaction of NSAIDs (E) but is not a contraindication for the use of a COX-2 inhibitor. A client who is hypertensive receives a prescription for hydrochlorothiazide. When teaching about the side effects of this drug, which symptoms are most important for the nurse to instruct the client to report? A. Fatigue and muscle weakness B. Anxiety and heart palpitations
C. Abdominal cramping and diarrhea D. Confusion and personality changes - Accurate answers A. Fatigue and muscle weakness Thiazide diuretics, such as HCTZ, cause potassium wasting in the urine, so the client should be instructed to report fatigue and muscle weakness, which are characteristic of hypokalemia. Although options B, C, and D should be reported, they are not indicative of hypokalemia, which is a side effect of hiazides that can cause cardiac dysrhythmias. A 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous hospitalizations have occurred since the diagnosis because of noncompliance with the prescribed medication regimen. Which drug might work best for this particular client? A. Chlorpromazine HCl B. Lithium carbonate C. Fluphenazine decanoate D. Diazepam - Accurate answers C. Fluphenazine decanoate Fluphenazine, an antipsychotic drug that can be given IM, has a rapid onset (1 to 2 hours) and a long duration of action (up to 3 or 4 weeks), so it would be the drug of choice for a noncompliant psychotic client. Option A is an antipsychotic drug used to treat schizophrenia and is usually administered PO (IM doses are short-acting). The client must be compliant in taking this drug for it to be effective. Option B is most effective with manic and depressive bipolar affective disorders. Option D is an antianxiety drug and would not be effective for a psychotic disorder. The nurse is administering the early morning dose of insulin aspart, 5 units subcutaneously, to a client with diabetes mellitus type 1. The client's fingerstick serum glucose level is 140 mg/dL. Considering the onset of insulin aspart, when should the nurse ensure that the client's breakfast be given? A. 5 minutes after subcutaneous administration B. 30 minutes after subcutaneous administration C. 1 to 2 hours after administration D. At any time because of a flat peak of action - Accurate answers A. 5 minutes after subcutaneous administration Insulin aspart is a very rapidly acting insulin, with an onset of 5 to 15 minutes. Insulin aspart should be administered when the client's tray is available. Insulin aspart peaks in 45 minutes to 1½ hours and has a duration of 3 to 4 hours. The client should have eaten to ensure absorption of the meal so that serum glucose levels will coincide with the peak. Insulin glargine has a flat peak of action and is usually given at bedtime. A mother brings her 18-month-old child to the community health center because the child has had "bad diarrhea" for the last 3 days. She states, "I bought some of this liquid at the pharmacy and gave my daughter a half-ounce." The nurse sees that the bottle contains loperamide. Which intervention is most important for the nurse to implement initially? A. Tell the mother never to give this drug to her toddler. B. Ask if any other siblings have experienced diarrhea. C. Take the child's oral and tympanic temperatures.
Which statement indicates that client teaching regarding the administration of the chemotherapeutic agent daunorubicin HCl has been effective? A. "I should use an astringent mouthwash after every meal." B. "I will eat high-fiber foods and drink lots of water." C. "I expect my urine to be red for the next few days." D. "I should use sunscreen when I spend time outdoors." - Accurate answers C. "I expect my urine to be red for the next few days." Daunorubicin HCl causes the urine to turn red in color. Option A is not recommended. Options B and D are interventions that promote general good health but are not specific to treatment with daunorubicin HCl. When providing client teaching about the administration of methylphenidate (Ritalin) to a parent of a child diagnosed with ADHD, which instruction should the nurse include in the teaching plan? A. The doses should be given exactly 12 hours apart to sustain a therapeutic serum level. B. Doses should be scheduled at midmorning and midafternoon to achieve optimal benefit. C. Give the medication only on school days and when the child appears to be anxious. D. Offer the child the medication with breakfast and after the child eats lunch. - Accurate answers D. Offer the child the medication with breakfast and after the child eats lunch. Administering the medication at breakfast and after lunch provides the correct spacing of the doses to maximize the child's attention span and helps prevent the appetite suppression associated with the drug. Doses should be spaced at 6-hour intervals, not option A. Option B is likely to increase insomnia. Option C disrupts the normal dosing schedule, resulting in ineffective treatment. Doses should be discontinued only for brief intervals (with the health care provider's approval) when the client's condition is being evaluated or if the client is being weaned from the medication entirely. A client who is HIV-positive is receiving combination therapy with the antiviral medication zidovudine. Which instruction should the nurse include in this client's teaching plan? A. Take the drug as prescribed to cure HIV infections. B. Use the drug to reduce the risk of transmitting HIV to sexual contacts. C. Return to the clinic every 2 weeks for blood counts. D. Report to the health care provider immediately if dizziness is experienced. - Accurate answers C. Return to the clinic every 2 weeks for blood counts. Bone marrow depression with granulocytopenia is a severe but common adverse effect of zidovudine. Careful monitoring of CBCs is indicated. Options A and B are not correct instructions related to use of this medication. Option D is an expected side effect. The client should be instructed to avoid driving until this reaction improves. A client with chronic gouty arthritis is talking allopurinol, 100 mg PO daily. Which laboratory serum level should the nurse report to the health care provider to determine the therapeutic outcome? A. Prothrombin time B. Uric acid level
C. White blood cell count D. Creatinine level - Accurate answers B. Uric acid level The primary therapeutic outcome associated with allopurinol therapy is reduced serum uric acid levels with a lower frequency of acute gouty attacks, so option B should be reported to the health care provider. Options A, C, and D are not related to the effectiveness of allopurinol. A client who is receiving chlorpromazine HCl to control his psychotic behavior also has a prescription for benztropine. When teaching the client and/or significant others about these medications, what should the nurse explain about the use of benztropine in the treatment plan for this client? A. This medication will reduce the side effect of urinary retention. B. This drug potentiates the effect of chlorpromazine HCl. C. The benztropine is used to control extrapyramidal symptoms. D. The combined effect of these drugs will modify psychotic behavior. - Accurate answers C. The benztropine is used to control extrapyramidal symptoms. Benztropine, an anticholinergic drug, is used to control extrapyramidal symptoms associated with chlorpromazine HCl (Thorazine) use. Options A, B, and D are not accurate statements regarding the use of benztropine for clients who are treated with chlorpromazine HCl for the control of psychosis. A client being treated for an acute myocardial infarction is to receive the tissue plasminogen activator alteplase. The nurse would be correct in providing which explanation to the client regarding the purpose of this drug? A. This drug is a nitrate that promotes vasodilation of the coronary arteries. 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 a new clot. D. This drug is a volume expander that improves myocardial perfusion by increasing output. - Accurate answers B. This drug is a clot buster that dissolves clots within a coronary artery. t-PA, or tissue plasminogen activator, is a coronary-specific fibrinolytic agent that dissolves clots within the coronary arteries. This drug is not a calcium channel blocker or nitrate, which would promote vasodilation of the coronary arteries. This medication is not an anticoagulant, such as warfarin or heparin, which would prevent new clot formation. Volume expansion is not provided by an infusion of t- PA and would not necessarily improve myocardial perfusion caused by an increased cardiac output in a client with coronary artery disease. The nurse has completed diabetic teaching for a client who has been newly diagnosed with diabetes mellitus. Which statement by this client would indicate to the nurse that further teaching is needed? A. "Regular insulin can be stored at room temperature for 30 days." B. "My legs, arms, and abdomen are all good sites to inject my insulin." C. "I will always carry hard candies to treat hypoglycemic reactions." D. "When I exercise, I should plan to increase my insulin dosage." - Accurate answers D. "When I exercise, I should plan to increase my insulin dosage."
Amantadine is a dopamine-releasing agent; therefore, this medication increases the amount of dopamine present in the central nervous system. Although this medication is also an antiviral agent, the antiviral effect is not significant in the treatment of parkinsonism. Options B and D are not affected by amantadine. A client is taking famotidine. Which client statement should the nurse further assess because it may indicate that the client is experiencing a side effect of this drug? A. "I have heartburn whenever I lie down." B. "I am never hungry. I've lost weight in the past 2 weeks." C. "I have a funny metallic taste in my mouth." D. "I seem to be having difficulty thinking clearly." - Accurate answers D. "I seem to be having difficulty thinking clearly." A common side effect of of famotidine is confusion. Options A, B, and C are not side effects of this medication. A client with HIV who was recently diagnosed with tuberculosis (TB) asks the nurse, "Why do I need to take all of these medications for TB?" What information should the nurse provide? 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. - Accurate answers B. Multiple drugs prevent the development of resistant organisms. A multidrug regimen is prescribed for a client with HIV and TB to prevent the development of resistance of the tubercle bacilli. Although antitubercular medications can inhibit some antiretrovirals, a multidrug regimen is needed to inhibit the proliferation of the virulent tubercle bacilli. The duration of antitubercular therapy is typically 6 to 9 months and is not shortened by the use of multiple medications. A client who is receiving HIV and TB therapy is at an increased risk of adverse reactions because of the complex medication regimens and complications secondary to immunosuppression. A 67-year-old client is discharged from the hospital with a prescription for digoxin, 0.25 mg daily. Which instruction should the nurse include in this client's discharge teaching plan? 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. - Accurate answers B. Take and record radial pulse rate daily. Monitoring pulse rate is very important when taking digoxin. The client should be further instructed to report pulse rates <60 or >110 beats/min and to withhold the dosage until consulting with the health care provider in such a case. Options A and D are not necessary. Option C is an indication of drug toxicity, and the client should be instructed to report this immediately.
A client is prescribed a cholinesterase inhibitor, and a family member asks the nurse how this medication works. Which pharmacophysiologic explanation should the nurse use to describe this class of drug? A. Promotes excretion of neurotoxins. B. Slows nerve cell degeneration. C. Improves nerve impulse transmission. D. Stimulates nerve cell regeneration. - Accurate answers C. Improves nerve impulse transmission. Cholinesterase inhibitors work to increase the availability of acetylcholine at cholinergic synapses, which aids in neuronal transmission and assists in memory formation. Basing an explanation on this concept, option C should provide an accurate explanation that the family can understand. Options A, B, and D are incorrect. In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, the nurse writes a nursing diagnosis of alteration in nutrition: less than body requirements, related to inadequate digestion of nutrients. Which intervention would best meet this child's needs? A. Give aluminum hydroxide and magnesium hydroxide after meals. B. Give pancrelipase capsule mixed with applesauce before each meal. C. Administer cholestyramine resin before each meal and at bedtime. D. Administer omeprazole for gastroesophageal reflux. - Accurate answers B. Give pancrelipase capsule mixed with applesauce before each meal. Pancreatic enzyme replacement with pancrelipase is a major component of cystic fibrosis nutritional management. Aluminum hydroxide and magnesium hydroxide may be given before meals with enzymes to reduce gastric acidity and prevent enzyme destruction but are ineffective when used alone to promote enzyme replacement. Options C and D are used to treat steatorrhea in cystic fibrosis. The nurse is preparing a teaching plan for a client who has received a new prescription for levothyroxine sodium. Which instruction should be included? A. "Take this medication with a high-protein snack at bedtime." B. "You may change at any time to a less expensive generic brand." C. "Take your pulse daily, and if it exceeds 100 beats/min, contact the health care provider." D. "Return to the clinic weekly for serum blood glucose testing." - Accurate answers C. "Take your pulse daily, and if it exceeds 100 beats/min, contact the health care provider." Levothyroxine sodium should be withheld if the pulse is over 100 beats/min. To prevent insomnia, the daily dose should be taken early in the morning before breakfast, not at bedtime. Product brands should not be changed without consulting the health care provider because the intended effects and side effects of different formulations of the medication can vary. The serum glucose level is not affected by thyroid preparations, so option D is not required. Dopamine is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response? A. Gain in weight
Photosensitivity is a common adverse effect of haloperidol (Haldol); therefore, the use of sunglasses and sunscreen should be included in the discharge teaching for this client. Options A, C, and D are not pertinent to client teaching regarding the use of haloperidol (Haldol). The nurse is reviewing prescribed medications with a female client who is preparing for discharge. The client asks the nurse why the oral dose of an opioid analgesic is higher than the IV dose that she received during hospitalization. Which response is best for the nurse to provide? A. A higher dose of analgesic medication may be needed after discharge. B. An error in the dose calculation may have occurred when the prescribed dose was converted. C. The doses should be the same unless the pain is not well controlled. D. Oral forms of drugs must pass through the liver first, where more of the dose is metabolized. - Accurate answers D. Oral forms of drugs must pass through the liver first, where more of the dose is metabolized. Oral doses of medication are usually larger than parenteral doses to compensate for the first-pass effect in the liver after oral administration, which metabolizes more of the drug's dose before affecting its therapeutic response. Although recommended dose ranges for adults should be individualized, a client's pain should be controlled at discharge, not option A or C. Option B is inaccurate information to convey to the client. The nurse is scheduling a client's antibiotic peak and trough levels with the laboratory personnel. What is the best schedule for drawing the trough level? A. Give the dose of medication, and call the laboratory to draw the trough STAT. B. Arrange for the laboratory to draw the trough 1 hour after the dose is given. C. Instruct the laboratory to draw the trough immediately before the next scheduled dose. D. Give the first dose of medication after the laboratory reports that the trough has been drawn. - Accurate answers C. Instruct the laboratory to draw the trough immediately before the next scheduled dose. The best time to draw a trough is the closest time to the next administration. Option A will provide a peak level. Option B will not provide the most accurate trough level. The medication is given before peak and trough levels are obtained. A male client asks the nurse why condoms should not be lubricated with the spermicide nonoxynol-9. Which response is best for the nurse to provide? A. The risk of female infertility and spontaneous abortion is linked with nonoxynol-9. B. Partners can develop intermittent interstitial cystitis if the spermicide is used after the expiration date. C. The spermicide decreases the amount of vaginal and penile sensitivity for up to 8 to 12 hours. D. Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of HIV. - Accurate answers D. Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of HIV. The use of condoms and a water-based spermicide is recommended because nonoxynol-9 can cause a rash that allows viruses a portal of entry if the condom breaks, which increases the risk of transmission
of sexually transmitted diseases (STDs), such as human immunodeficiency virus (HIV), herpes, human papillomavirus (HPV), or hepatitis B virus (HBV). Options A and B are inaccurate. Nonoxynol-9 may cause vaginal irritation, not option C. Which intervention is most important for a nurse to implement prior to administering atropine PO? A. Determine the presence of 5 to 35 bowel sounds/min. B. Provide oral care prior to administration. C. Verify that the client's tendon reflexes are 2+. D. Have the client rate his or her pain on a 0 to10 scale. - Accurate answers A. Determine the presence of 5 to 35 bowel sounds/min. Anticholinergic drugs, such as atropine, have antispasmodic and antisecretory properties, which relax the gastrointestinal tract, and are therefore contraindicated in a client with intestinal atony. Oral care may be required after administration since atropine can dry secretions. Option B (used to determine dehydration) or (C). Atropine itself has no analgesic effect; it is used with opioids to potentiate their effect. A chemotherapeutic regimen with doxorubicin HCl is being planned for a client recently diagnosed with cancer. What diagnostic test results should the nurse review prior to initiating this treatment? A. Electrocardiogram (ECG) B. Arterial blood gases (ABGs) C. Serum cholesterol level D. Pelvic ultrasound - Accurate answers A. Electrocardiogram (ECG) Baseline cardiac function studies are required to monitor the irreversible cardiotoxic effects of doxorubicin HCl. Option B assesses disturbances of acid-base balance. Option C is not affected by this chemotherapeutic agent. Option D is used to detect pelvic abnormalities such as tumors but is not specific for the administration of doxorubicin HCl. The nurse is preparing to administer a secondary infusion of a dobutamine solution to a client. The nurse notes that the solution is brown in color. Which action should the nurse implement? A. Verify the prescribed dose with the health care provider. B. Discard the solution and reorder from the pharmacy. C. Dilute the solution with more normal saline until it becomes lighter in color. D. Administer the drug if the solution's reconstitution time is <24 hours. - Accurate answers D. Administer the drug if the solution's reconstitution time is <24 hours. The color of the dobutamine solution is normal, and the solution should be administered within 24 hours after reconstitution, so the time of reconstitution should be verified before administering the solution of medication. Option A is not indicated. Option B is not necessary. Additional dilution of a drug in solution is stated in the manufacturer's reconstitution instructions, but option C is not needed. An older client who had a colon resection yesterday is receiving a constant dose of hydromorphone via a patient-controlled analgesia (PCA) pump. Which assessment finding is most significant and requires that the nurse intervene?
