NCLEX - ADULT HEALTH
PHARMACOLOGY - 739
Potassium chloride administered intravenously must always be diluted in IV fluid and infused via a pump or controller. The usual concentration of IV potassium chloride is 20 to 40 mEq/L. Potassium chloride is never given by bolus (IV push). Giving potassium chloride by IV push can result in cardiac arrest. Dilution in normal saline is recommended, but dextrose solution is avoided because this type of solution increases
intracellular potassium shifting. The IV bag containing the potassium chloride is always gently agitated before
hanging. The IV site is monitored closely because potassium chloride is irritating to the veins and the risk of phlebitis exists. The nurse monitors urinary output during administration and contacts the physician if the urinary output is less than 30 mL/hr. After adding a medication to a bag of intravenous (IV) solution, the nurse should agitate or rotate the bag gently to mix the medication evenly in the solution. The nurse should then attach a completed medication label. The nurse can then prime the tubing. The IV solution should have been checked for discoloration before the medication was added to the solution. The tubing is attached to the client last.
Prednisone is a corticosteroid. With prolonged use, corticosteroids cause adrenal atrophy, which reduces the ability of the body to withstand stress. When stress is severe, corticosteroids are essential to life. Before and during surgery, dosages may be increased temporarily. Ferrous sulfate is an oral iron preparation used to treat iron deficiency anemia. Cyclobenzaprine (Flexeril) is a skeletal muscle relaxant.
Conjugated estrogen (Premarin) is an estrogen used for hormone
replacement therapy in
postmenopausal women. These other three medications may be withheld before surgery without undue effects on the client.
Anticoagulants alter normal clotting factors and increase the risk of bleeding after surgery. Aspirin has properties that can alter the clotting mechanism and should be
discontinued at least 48 hours before surgery. Options 1, 2, and 3 are accurate client statements. Lisinopril is an antihypertensive angiotensin-converting enzyme
inhibitor. The usual dosage range is 20 to 40 mg daily. Adverse effects include headache, dizziness, fatigue,
orthostatic hypotension, tachycardia, and angioedema. Specific client
teaching points include taking one pill a day, not stopping the medication without consulting the physician, and monitoring for side effects and
adverse reactions. The client should notify the physician if side effects occur.
Polypharmacy is a concern in the geriatric population. Duplication of medications needs to be identified before drug-drug interactions or adverse side effects can be
determined. The phone call to the health care provider is the
intervention after all other information has been collected.
Asthma is a chronic inflammatory disease of the airways. Inhaled aerosolized short-acting β2 agonists are quick relief medications and recommended for clients with status asthmaticus after epinephrine has been administered. Leukotriene modifiers, antiallergic medications,
and nonsteroidal anti-inflammatory medications are long-term control medications.
A topical corticosteroid should be applied sparingly (thin layer) and rubbed into the area thoroughly. The affected area should be cleansed gently before application. A topical corticosteroid should not be applied over extensive areas. Systemic
absorption is more likely to occur with extensive application.
Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. The primary treatment is replacement of the missing clotting factor; additional medications, such as those to relieve pain, may be
prescribed depending on the source of bleeding from the disorder. A child with hemophilia A will be at risk for joint bleeding after a fall. Factor VIII will be prescribed intravenously to replace the missing clotting factor and minimize the bleeding. Desmopressin (DDAVP) is used to stimulate
production of factor VIII, but it is not given intravenously. Factor X and cryoprecipitate are not used for clients with hemophilia A.
In severe cystic acne, isotretinoin (Accutane) is used to inhibit
inflammation. Adverse effects include elevated triglyceride levels, skin dryness, eye discomfort such as dryness and burning, and cheilitis (lip inflammation). Close medical follow-up is required, and dry skin and cheilitis can be decreased by the use of emollients and lip balms. Vitamin A supplements are stopped during this treatment.
Salicylic acid is absorbed readily
through the skin, and systemic toxicity (salicylism) can result. Symptoms
include tinnitus, dizziness, hyperpnea, and psychological disturbances.
Constipation and diarrhea are not associated with salicylism.
Acyclovir is a topical antiviral agent that inhibits DNA replication in the virus. Acyclovir has activity against herpes simplex virus types 1 and 2, varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus.
Gentamicin sulfate is an antibacterial and would not be effective in treating herpesvirus. Mupirocin calcium is a topical antibacterial active against Staphylococcus aureus, beta-hemolytic streptococci, or
Streptococcus pyogenes. Salicylic acid is a keratolytic.
Coal tar is used to treat psoriasis and other chronic disorders of the skin. Coal tar suppresses DNA synthesis, mitotic activity, and cell proliferation. Coal tar has an unpleasant odor, frequently stains the skin and hair, and can cause phototoxicity. Systemic toxicity does not occur.
Sunscreens are most effective when applied about 30 to 60 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming or sweating.
Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and is used to treat burns to reduce bacteria present in
avascular tissues. The client should be informed that the medication will cause local discomfort and burning. Mafenide acetate is a carbonic
anhydrase inhibitor and can suppress renal excretion of acid, thereby
causing acidosis. Clients receiving this treatment should be monitored for signs of an acid-base imbalance
(hyperventilation). If this occurs, the medication should be discontinued for 1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs with a burn injury.
Sodium hypochlorite is a solution used for irrigating and cleaning necrotic or purulent wounds. It cannot be used to pack purulent wounds because the solution is inactivated by copious pus. The solution should not come into contact with healing or normal tissue and should be rinsed off immediately following irrigation. The solution loses its potency during storage, so fresh solution should be prepared
frequently.
Tretinoin is applied liberally to the skin. The hands are washed
thoroughly immediately after applying. Therapeutic results should be seen after 2 to 3 weeks but may not be optimal until after 6 weeks. The skin needs to be cleansed thoroughly before applying the medication. Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been
evaluated. Options 1, 3, and 4 do not need to be monitored specifically during this treatment.
Isotretinoin is a metabolite of vitamin A and can produce generalized
intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. Options 2, 3, and 4 are not contraindicated with the use of isotretinoin.
The instructions for the use of permethrin include wash, rinse, and towel-dry hair, apply sufficient volume to saturate hair and scalp, allow to remain on hair 10 minutes, and then rinse with water. Options 1, 2, and 3 are incorrect instructions.
Lindane is applied in a thin layer to the body below the head. No more than 30 g (1 oz) should be used. The
medication is removed by washing 8 to 12 hours later. In most cases, only one application is required.
Clients should be advised not to use occlusive dressings (bandages or plastic wraps) to cover the affected site following the application of the topical corticosteroid, unless the physician specifically prescribes wound coverage. Options 1, 2, and 3 are accurate statements related to the use of this medication.
Topical corticosteroids can be
absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions where permeability is poor (back, palms, soles).
Dextranomer is a cleansing rather than a débriding agent that is effective for wet wounds only. Dextranomer is not packed tightly into the wound because maceration of surrounding tissue may result.
Azelaic acid is a topical medication used to treat mild to moderate acne. The acid appears to work by
suppressing the growth of
Propionibacterium acnes and by decreasing the proliferation of
keratinocytes. Options 2, 3, and 4 are incorrect.
Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not stain the skin. Fibrinolysin and desoxyribonuclease (Elase) is used to débride wounds, including burns, pressure ulcers, and inflamed or infected lesions.
Dextranomer (Debrisan) is not a débriding agent but is a cleansing agent that actually absorbs peptides and proteins. Nitrofurazone (Furacin) and silver sulfadiazine (Silvadene) are antibacterials and are not used for wound débridement.
The nurse would schedule the next home care visit in 7 days. Protective hydrocolloid dressings such as DuoDerm are designed to be left in place for 7 days unless leakage occurs around the dressing.
Bleeding precautions need to be initiated when the platelet count decreases. The normal platelet count is 150,000 to 450,000/mm3. When the platelets are lower than 50,000 /mm3, any small trauma can lead to episodes of prolonged bleeding. The normal white blood cell count is 5,000 to 10,000/mm3. When the white blood cell count drops, neutropenic
precautions need to be implemented. The normal clotting time is 8 to 15 minutes. The normal ammonia value is 15 to 45 mcg/dL.
Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is related specifically to cell destruction.
Busulfan (Myleran, Busulfex) is an alkylating medication used to treat acute myelocytic leukemia and in the palliative treatment of chronic
myelogenous leukemia. Hyperuricemia can result from the use of this
medication. Allopurinol (Zyloprim), an antigout medication, is used with chemotherapy to prevent or treat hyperuricemia that occurs from the rapid destruction of cells by the antineoplastic medication. Allopurinol is not used to prevent arthritis,
alopecia, or diarrhea.
Hemorrhagic cystitis is a toxic effect that can occur with the use of
cyclophosphamide (Cytoxan, Neosar). The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be told to increase
potassium intake. The client would not be instructed to alter sodium intake. Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as congestive heart failure is a toxic effect of daunorubicin. Bone marrow depression is also a toxic effect. Nausea and vomiting is a frequent side effect associated with the medication that begins a few hours after administration and lasts 24 to 48 hours. Fever is a frequent side effect and diarrhea can occur occasionally. Options 1, 2, and 3, however, are not toxic effects.
To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total body surface area (BSA), which
requires a current accurate height and weight for BSA calculation (before each medication administration). Asking the client about his or her height and weight may lead to
inaccuracies in determining a true BSA and dosage. Calculating body mass index and measuring abdominal girth will not provide the data needed. Bleomycin (Blenoxane) is an
antineoplastic medication that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication.
Chemotherapy agents are usually given in combinations (also called regimens or protocols). The goal of administering combination
chemotherapy in cycles or specific sequences is to produce additive or synergistic therapeutic effects.
Administering combination therapy by administering several medications with different mechanisms of action and different onset of nadirs and toxicities enhances tumor cell destruction while minimizing
medication resistance and overlapping toxicities.
Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without a physician's or health care provider's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine.
Clients need to avoid aspirin and aspirin-containing products to
minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side effects.
Cyclophosphamide (Cytoxan, Neosar) is an antineoplastic medication of the alkylating class. Medications of this type affect all phases of the
reproductive cell cycle. Cell cycle phase-specific medications affect cells only during a certain phase of the reproductive cycle. Antimetabolite medications are cell cycle phase-specific and affect the S phase. Vinca alkaloids are cell cycle phase-specific and act on the M phase.
Cisplatin (Platinol) is an alkylating type of medication and vincristine
(Oncovin, Vincasar PFS) is a vinca (plant) alkaloid. Alkylating medications are cell cycle phase-nonspecific. Vinca alkaloids are cell cycle phase-specific and act on the M phase. Combinations of medications are used to enhance tumoricidal effects and increase the therapeutic response.
High concentrations of methotrexate harm and damage normal cells. To save normal cells, leucovorin is given, which is known as leucovorin rescue. Leucovorin bypasses the metabolic block caused by methotrexate, thereby permitting normal cells to synthesize. Note that leucovorin rescue is potentially hazardous.
Failure to administer leucovorin in the right dose at the right time can be fatal.
A side effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral
neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical
sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this
medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest pain is unrelated to this medication.
Asparaginase (Elspar) is
contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The
medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between administration of the doses. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are not contraindicated with this medication.
Tamoxifen (Nolvadex) is an antineoplastic medication that
competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors.
Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy. Tamoxifen reduces DNA synthesis and estrogen response. Tamoxifen (Nolvadex) may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be
monitored periodically during therapy. The nurse should assess for
hypercalcemia while the client is taking this medication. Signs of
hypercalcemia include increased urine
volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, deep bone, and flank pain. Megestrol acetate (Megace)
suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and
regressing tumor size. Megestrol is used with caution if the client has a history of thrombophlebitis. Options 1, 2, and 4 are not contraindications for this medication.
Alopecia (hair loss) can occur following the administration of many
antineoplastic medications. Alopecia is reversible, but new hair growth may have a different color and texture. Stomatitis (ulceration in the mouth) can result from the administration of antineoplastic medications. The client should be instructed to examine her or his mouth daily and to report any signs of ulceration. If stomatitis
occurs, the client should be instructed to rinse the mouth with baking soda or saline. Food and fluid is important and should not be restricted. If chewing and swallowing are painful, the client may switch to a liquid diet that
includes milk shakes and ice cream. Instruct the client to avoid spicy foods and foods with hard crusts or edges. The client should avoid toothbrushing and flossing when stomatitis is severe. Lemon and glycerin swabs may cause pain and further irritation.
Busulfan (Myleran, Busulfex) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute renal failure. Options 1, 2, and 4 are not specifically related to this medication.
A side effect specific to etoposide is orthostatic hypotension. Etoposide
should be administered slowly over 30 to 60 minutes to avoid hypotension. The client's blood pressure is
monitored during the infusion. Hair loss occurs with nearly all the
antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication.
Male and female clients who take estrogen or progestins are at increased risk for deep vein
thrombosis (DVT). Women receiving estrogens or progestins have irregular but heavy menses, fluid retention, and breast tenderness. Options 1, 2, and 4 are not specifically associated with these type of medications.
Redness and swelling and a slowed infusion indicate signs of
extravasation. If extravasation occurs during the intravenous administration of an antineoplastic medication, the infusion is stopped and the physician is notified. Ice or heat may be
prescribed for application to the site and an antidote may be prescribed to be administered into the site.
Increasing the flow rate can increase damage to the tissues. Restarting an IV in the same vein can increase damage to the site and vein. Somatrem (Protropin) is a growth stimulator used in the long-term treatment of growth failure resulting from endogenous growth hormone deficiency. Somatrem stimulates linear growth and increases the number and size of muscle cells and increases red cell mass. Somatrem affects carbohydrate metabolism by antagonizing the action of insulin, increases mobilization of fats, and increases cellular protein synthesis. Options 1, 2, and 4 are not actions of this medication.
Desmopressin promotes renal
conservation of water. The hormone carries out this action by acting on the collecting ducts of the kidney to
increase their permeability to water, which results in increased water
reabsorption. The therapeutic effect of this medication would be manifested by a decreased urine output. Options 1, 3, and 4 are unrelated to the effects of this medication.
Water intoxication (overhydration) or hyponatremia is an adverse reaction to desmopressin. Early signs include drowsiness, listlessness, and
headache. Decreased urination, rapid weight gain, confusion, seizures, and coma also may occur in overhydration.
Because of its powerful
vasoconstrictor actions, vasopressin can cause adverse cardiovascular effects. By constricting arteries of the heart, vasopressin can cause angina pectoris and even myocardial
infarction, especially if administered to clients with coronary artery disease. In addition, vasopressin may cause
vascular problems by decreasing blood flow in the periphery. Options 1, 2, and 3 are incorrect.
Oral doses of levothyroxine
(Synthroid) should be taken on an empty stomach to enhance
absorption. Dosing should be done in the morning before breakfast.
Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, heat intolerance, and sweating. The client should be instructed to notify the physician if
these occur. Options 1, 3, and 4 are signs of hypothyroidism.
Propylthiouracil (PTU) inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves' disease. Myxedema indicates hypothyroidism. Cushing's syndrome and Addison's disease are disorders related to adrenal function.
Desmopressin administered by the intranasal route can cause a runny or stuffy nose. Options 1, 2, and 4 are side effects if the medication is administered by the intravenous route.
An adverse effect of somatropin (Humatrope) is hypothyroidism. Thyroid function is monitored
throughout therapy. Options 1 and 2 would evaluate pancreatic function, and option 3 evaluates renal function. Lugol's solution is administered to hyperthyroid individuals in preparation for thyroidectomy to suppress thyroid function. Initial effects develop within 24 hours; peak effects develop in 10 to 15 days. In most cases, plasma levels of thyroid hormone are reduced with propylthiouracil (PTU) before Lugol's solution therapy is initiated. Then, Lugol's solution along with
propylthiouracil is administered for the last 10 days before surgery.
Chronic ingestion of iodine can
produce iodism. The client needs to be instructed about the symptoms of iodism, which include a brassy taste, soreness of gums and teeth, vomiting, and abdominal pain. The client needs to be instructed to notify the physician if these symptoms occur.
Excessive levels of fludrocortisone acetate (Florinef) cause retention of sodium and water and excessive excretion of potassium, resulting in
expansion of blood volume,
hypertension, cardiac enlargement, edema, and hypokalemia. The client needs to be informed about the signs of sodium and water retention, such as unusual weight gain or swelling of the feet or lower legs. If these signs occur, the physician needs to be notified.
Calcium carbonate tablets should be taken with a full glass of water 30 to 60 minutes after meals. Therefore, options 1, 2, and 3 are incorrect. The client who is taking an
antihypocalcemic medication should be instructed to avoid eating too much spinach, rhubarb, bran, or whole-grain cereals because they decrease
calcium absorption. Good dietary sources of calcium are milk products, dark green, leafy vegetables (although spinach needs to be avoided), clams, oysters, sardines, and orange juice fortified with calcium.
Corticosteroids (glucocorticoids) should be administered before 9 AM. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning. Options 1, 2, and 4 are incorrect.
Acarbose (Precose) is an alpha-glucosidase inhibitor. Taken with the first bite of each major meal, acarbose delays absorption of ingested
carbohydrates, decreasing postprandial hyperglycemia.
Abdominal pain and flatulence are the most common side effects of this medication. It is not taken at bedtime. Rotation of insulin injections should be done within one anatomical site to maintain consistent absorption of insulin. Options 1, 3, and 4 are correct
statements regarding insulin administration and thus do not indicate a need for additional client teaching.
Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus may need their dosages of insulin or oral hypoglycemic
medications increased during glucocorticoid therapy. Therefore, options 1, 2, and 4 are incorrect. When preparing a mixture of regular insulin with another insulin
preparation, the regular insulin is drawn into the syringe first. This
sequence will avoid contaminating the vial of regular insulin with insulin of another type. Options 2, 3, and 4 identify the correct actions for preparing NPH and regular insulin. Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When stored unopened under
refrigeration, insulin can be used up to the expiration date on the vial.
Options 1, 3, and 4 are incorrect. When alcohol is combined with
glimepiride (Amaryl), a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this
medication. The items in options 2, 3, and 4 do not need to be avoided. Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide in the corpus cavernosum of the penis, thus sustaining an erection. Because of the effect of the medication, it is contraindicated with concurrent use of organic nitrates and nitroglycerin.
Sildenafil is not contraindicated with the use of vitamins. Neuralgia and insomnia are side effects of the medication.
Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It is not recommended for clients taking insulin. Hence, the nurse should hold the medication and question the health care provider regarding this order. Although options 1 and 3 are correct statements about the medication, in this situation the medication should not be
administered. The medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.
Repaglinide is a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion that should be taken before meals, and that should be held if the client does not eat. Hypoglycemia is a side effect of repaglinide and the client should always be prepared by carrying a simple at all times. Metformin is an oral hypoglycemic given in
combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect from metformin but it might signify a more serious condition that warrants
physician notification, not the use of acetaminophen.
Metoclopramide is a gastrointestinal stimulant and antiemetic. Because it is a gastrointestinal stimulant, it is
contraindicated with gastrointestinal obstruction, hemorrhage, or
perforation. It is used in the treatment of emesis after surgery,
Cholestyramine (Questran) is a bile acid sequestrant used to lower the cholesterol level and client compliance is a problem because of its taste and palatability. The use of flavored products or fruit juices can improve the taste. Some side effects of bile acid sequestrants include constipation and decreased vitamin absorption. The principle manifestations of Crohn's disease are diarrhea and abdominal pain. Infliximab (Remicade) is an immunomodulator that reduces the degree of inflammation in the colon, thereby reducing the diarrhea. Options 1, 3, and 4 are unrelated to this
medication.
Propantheline bromide is an antimuscarinic anticholinergic medication that decreases gastrointestinal secretions.
Propantheline should be administered 30 minutes before meals. The other options are incorrect.
Docusate sodium is a stool softener that promotes absorption of water into the stool, producing a softer
consistency of stool. The intended effect is relief or prevention of
constipation. The medication does not decrease the amount of fat in the stools, stop gastrointestinal bleeding, or relieve abdominal pain.
Cascara sagrada is a laxative that causes nausea and abdominal cramps as the most frequent side effects. Other health problems (options 1, 2, and 3) are not determined based on a single symptom.
Most rapid results from bisacodyl occur when it is taken on an empty stomach. Bisacodyl will not have a rapid effect if taken with a large meal. If bisacodyl is taken at bedtime, the client will have a bowel movement in
the morning. Taking the medication with two glasses of juice will not add to its effect.
Senna works by changing the
transport of water and electrolytes in the large intestine, which causes accumulation of water in the mass of stool and increased peristalsis. The other options are incorrect.
Loperamide is an antidiarrheal agent. It is used to manage acute and also chronic diarrhea in conditions such as inflammatory bowel disease.
Loperamide also can be used to reduce the volume of drainage from an ileostomy. It is not used for the conditions in options 1, 2, and 4. The client should not exceed the
recommended dose because it may be habit-forming. The medication is an antidiarrheal and therefore should not be taken with a laxative. Side effects of the medication include dry mouth and drowsiness.
Metamucil is a bulk-forming laxative and should be taken with a full glass of water or juice, followed by another glass of liquid. This will help prevent impaction of the medication in the stomach or small intestine. The other options are incorrect.
If the client experiences tardive dyskinesia (rhythmic movements of the face or limbs), the client should stop the medication and call the physician. These side effects may be irreversible. Excitability is not a side effect of this medication. Anxiety, irritability, and dry mouth are side effects that are not so harmful to the client.
Trimethobenzamide (Tigan) is an antiemetic agent used to treat nausea and vomiting. The other options are incorrect.
Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with
chemotherapy. The other options are incorrect.
Magnesium citrate is available as an oral solution and is used commonly as a laxative in preparation for or after certain studies of the gastrointestinal tract. Magnesium citrate should be served chilled and not be allowed to stand for prolonged periods, which would reduce the carbonation and make the solution even less palatable. Options 2, 3, and 4 are incorrect.
Prochlorperazine is a phenothiazine-type antiemetic and antipsychotic. The nurse would assess the client for
blurred vision as a frequent side effect of prochlorperazine. Other frequent side effects include dry eyes, dry mouth, and constipation.
Pancrelipase (Pancrease) is a
pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. Its use could result in weight gain but should not result in weight loss if it is aiding in digestion.
Calcium carbonate antacids should not be taken with milk, milk products, or foods or supplements high in vitamin D because milk-alkali syndrome (headache, urinary frequency, anorexia, nausea, vomiting, fatigue) can occur. The best item to consume when taking calcium carbonate is water.
Aluminum hydroxide tablets should be chewed thoroughly before swallowing.
This prevents them from entering the small intestine undissolved. They should not be swallowed whole. Antacids should be taken at least 1 hour apart from other medications to prevent interactive effects.
Constipation is a side effect of the use of aluminum products, but it is not correct for the client to take a laxative with each dose. This promotes laxative abuse; the client should first try other means to prevent constipation.
Calcium carbonate can be used as an antacid for the relief of heartburn and indigestion. Calcium carbonate also can be used as a calcium supplement (option 3) or to bind phosphorus in the gastrointestinal tract with renal failure (option 4). Option 2 is incorrect,
although adequate calcium levels are needed for proper neurological
function.
Sodium bicarbonate is an electrolyte modifier and antacid, and it would aggravate metabolic alkalosis, which is a difficult acid-base imbalance to correct. The other options are incorrect.
Cimetidine is a histamine 2 (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of
cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.
Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid
production and mechanical irritation. The other options are incorrect.
Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid
production and mechanical irritation. The other options are incorrect. Ranitidine is a histamine 2 (H2)-receptor antagonist. A single daily dose of ranitidine is scheduled to be given at bedtime. This allows for a prolonged effect, and the greatest protection of the gastric mucosa. The other options are incorrect.
The client with peptic ulcer disease should avoid taking medications that are irritating to the stomach lining. Irritants would include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). The client should be advised to take acetaminophen for a
headache.
Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4.
Triple therapy for Helicobacter pylori infection usually includes two
antibacterial drugs and a proton pump inhibitor. Metronidazole and
clarithromycin are antibacterials. Omeprazole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production.
H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist in preventing complications of peptic
ulcer disease. These medications also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions. The other medications listed are proton pump inhibitors.
The medication should be
administered with food such as milk and crackers to prevent
gastrointestinal irritation. Options 1, 2, and 4 are appropriate statements regarding the use of this medication. Theophylline is a bronchodilator that directly relaxes the smooth muscles of the bronchial airway. Options 1, 2, and 3 are not direct actions of this
medication.
Albuterol is a sympathomimetic bronchodilator. Side effects that can occur from the use of this medication include tremors, nausea, nervousness, palpitations, tachycardia, and dryness of the mouth or throat.
Isoniazid and rifampin are
contraindicated in clients with acute liver disease or a history of hepatic injury. Option 1 is the only option that addresses hepatic dysfunction. The medications are not contraindicated in the disorders noted in options 2, 3, and 4.
The client needs to be instructed that the entire year-long course of the medication needs to be completed. The preferable method of
administration is for the client to take the medication 1 hour before or 2 hours after meals. If gastrointestinal irritation occurs, the medication
should not be discontinued and, in this situation a small amount of food may be taken to reduce the irritation. Increasing fluid intake during this medication therapy is not necessary.
Clients diagnosed with active tuberculosis usually are started on more than one medication to be certain that the resistant organisms are eliminated. The doses of some medications initially may be large because the bacilli are difficult to kill. Options 1, 2, and 3 are inaccurate. A nonsteroidal anti-inflammatory drug, which has an analgesic effect, will relieve pain and allow the client to cough and deep-breathe more effectively. Options 1, 3, and 4 are incorrect.
Benzonatate is a locally acting antitussive and its effectiveness is measured by the degree to which it decreases the intensity and frequency of cough without eliminating the cough reflex. Options 1, 2, and 3 are not effects of this medication.
Pyrazinamide is an antitubercular medication given with other antitubercular medications. Pyrazinamide might not be discontinued if sputum cultures continue to be positive. Options 1, 2, and 4 are not related directly to the use of this medication.
Salmeterol (Serevent) is an adrenergic type of bronchodilator and
beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before
glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.
Theophylline is a xanthine
bronchodilator. Before drawing of a serum level of the medication, the client should avoid taking foods or beverages that contain xanthine, such
as colas, coffee, or chocolate. Thus, the client is told to avoid caffeine intake before the test.
Antiviral medications for influenza must be taken exactly as prescribed. These medications do not prevent the spread of influenza and clients are usually contagious for up to 2 days after the initiation of antiviral medications. Secondary bacterial infections may occur despite antiviral treatment. Side effects occur with these medications and may
necessitate change in activities, especially when driving or operating machinery if dizziness occurs.
Theophylline (Theolair) is a
methylxanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These foods include coffee, cola, and chocolate.
Hypersensitivity reaction can occur in clients taking salmeterol. Signs and symptoms include rash, urticaria, and swelling of the face, lips, or eyelids. The nurse should call the physician immediately if any of these occur. The other options are incorrect.
Omalizumab is an anti-inflammatory used for long-term control of asthma. Anaphylactic reactions can occur with the administration of omalizumab. The nurse administering the medication should have medications for the treatment of severe hypersensitivity available. Options 1, 2, and 3 are unnecessary.
Guaifenesin (Humibid) is an
expectorant and should be taken with a full glass of water to decrease the viscosity of secretions. Sustained-release preparations should not be broken open, crushed, or chewed. The
medication occasionally may cause dizziness, headache, or drowsiness as side effects. The client should contact the physician if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache.
The nurse administering naloxone for suspected opioid overdose should have resuscitation equipment readily available to support naloxone therapy if it is needed. Other adjuncts that may be needed include oxygen, mechanical ventilator, and vasopressors.
Diphenhydramine (Benadryl) has several uses, including antihistamine, antitussive, antidyskinetic, and
sedative-hypnotic. Instructions for use include to take with food or milk to decrease gastrointestinal upset and to use oral rinses or sugarless gum or hard candy to minimize dry mouth. Because the medication causes drowsiness, the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities
requiring mental awareness during use.
The client is taught about side effects that could occur with the use of codeine sulfate. The most common side effects include drowsiness, confusion, hypotension, nausea and vomiting, and constipation. Others include bradycardia, respiratory depression, and urinary retention. Cromolyn sodium (Intal) is an inhaled nonsteroidal antiallergy agent and a mast cell stabilizer. The most common undesired side effects associated with inhalation therapy of cromolyn sodium are bronchospasm, cough, nasal
congestion, throat irritation, and wheezing. Clients receiving this
medication orally may experience pruritus, nausea, diarrhea, and myalgia.
Terbutaline (Brethine) is a
bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. It should be used with caution in clients with impaired cardiac function, diabetes mellitus, hypertension, or hyperthyroidism, and a history of seizures. The medication may increase blood glucose levels. Zafirlukast (Accolate) is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Zafirlukast is used with caution in clients with impaired hepatic function. Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication. Isoniazid (INH) is an antitubercular medication. A common side effect of isoniazid is peripheral neuritis,
manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized with pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are incorrect.
Isoniazid (INH) is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis
immediately, which include yellow skin and sclera. For the same reason,
alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction
characterized by redness and itching of the skin, flushing, sweating,
tachycardia, headache, or light-headedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine
(vitamin B6) during the course of isoniazid therapy.
Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a physician. The medication should be administered on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses permanently.
Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom
immediately. The client also is taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin (Rifadin).
Cycloserine (Seromycin) is an antitubercular medication that requires weekly serum drug level determinations to monitor for the potential of neurotoxicity. Serum drug levels lower than 30 mg/mL reduce the incidence of neurotoxicity. The medication needs to be taken after meals to prevent gastrointestinal irritation. The client needs to be instructed to notify the physician if a skin rash or early signs of central nervous system toxicity are noted. Alcohol needs to be avoided because it increases the risk of seizure activity.
Isoniazid (INH) therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 or abuses alcohol. The laboratory tests in options 1, 3, and 4 are not necessary.
Albuterol is an adrenergic
bronchodilator. The nurse assesses respiratory pattern, lung sounds, pulse, and blood pressure before and during therapy. The nurse also notes the color, character, and amount of sputum.
The client taking adrenergic bronchodilators may experience paradoxical bronchospasm, which is evidenced by the client's wheezing. This can occur with excessive use of inhalers. Further medication should be withheld, and the physician should be notified. Options 1, 3, and 4 are
incorrect interpretations. Rifabutin (Mycobutin) may be prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count), red-orange–colored body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flu-like
syndrome. Vitamin B6 deficiency and numbness and tingling in the
extremities are associated with the use of isoniazid (INH). Ethambutol (Myambutol) also causes peripheral neuritis.
Common laboratory ranges for
activated partial thromboplastin time are 20 to 36 seconds. Because the activated partial thromboplastin time should be 1.5 to 2.5 times the normal value, the client's activated partial thromboplastin time would be considered therapeutic if it were 60 seconds.
β-Blockers such as metoprolol slow conduction of impulses through the AV node and decrease the heart rate. In rapid atrial fibrillation, the goal first is to slow the ventricular rate and
improve the cardiac output and then attempt to restore normal sinus rhythm.
Spironolactone is a potassium-sparing diuretic and competes with
aldosterone at receptor sites in the distal tubule, resulting in excretion of sodium, chloride, and water and
retention of potassium and phosphate. Use of the medications noted in
options 1, 2, and 4 could result in hypokalemia.
Ecotrin is an aspirin-containing product and should be avoided.
Excessive alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information. Therapeutic levels for digoxin range from 0.5 to 2 mg/mL. Therefore, options 2, 3, and 4 are incorrect. Signs of toxicity from procainamide include confusion, dizziness,
drowsiness, decreased urination, nausea, vomiting, and
tachydysrhythmias. If the client complains of dizziness, the nurse should assess the vital signs first.
Although options 2 and 3 may be interventions, these would be done after the vital signs are taken.
Nitroglycerin is a vasodilator and will lower the blood pressure.
Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. β-blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored. Tea and coffee are stimulants and mild diuretics. These are a poor choice for hydration. Taking the medication at the same time each day improves compliance. Because furosemide is a diuretic, the morning is the best time to take the medication so as not to interrupt sleep. Notification of the health care provider is appropriate if edema is noticed in the hands, feet, or face or if the client is short of breath. Sitting up slowly prevents postural hypotension.
The prothrombin time will assess for the therapeutic effect of warfarin sodium (Coumadin), and the activated partial thromboplastin time (aPTT) will assess the therapeutic effect of
heparin. Hematocrit and hemoglobin values assess red blood cell
concentrations. Baseline assessment, including an aPTT value, should be completed, as well as ongoing daily aPTT values while the client is taking heparin. Heparin doses are
determined based on the result of the aPTT.
To help prevent tolerance, clients need a 12-hour "no-nitrate" time, sometimes referred to as a
the medication. Options 1, 3, and 4 are incorrect.
This is a therapeutic, nonjudgmental response. The statement reflects the family's concern but remains
nonjudgmental. Option 1 dismisses the family's concerns and
disempowers the family. Option 3 creates doubt about the physician's practice without actually knowing the circumstances. Option 4 is
argumentative and nontherapeutic. The client receiving dopamine therapy should be assessed for ineffective tissue perfusion related to peripheral vasoconstriction. Options 1, 2, and 4 are not related directly to this
medication therapy.
Thiazide diuretics such as
hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic
reaction. Also, clients are at risk for hypokalemia, hyperglycemia,
hypercalcemia, hyperlipidemia, and hyperuricemia.
Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin is to be avoided. Constipation and bloating are the two most common side effects. Walking and the
reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels. Flushing is a side effect of this
medication. Aspirin or a nonsteroidal anti-inflammatory drug can be taken 30 minutes prior to taking the
medication to decrease flushing. Alcohol consumption needs to be
avoided because it will enhance this side effect. The medication should be taken with meals but this will decrease gastrointestinal upset; taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be immediately reported to the physician.
Flushing is a side effect of this
medication. Aspirin or a nonsteroidal anti-inflammatory drug can be taken 30 minutes prior to taking the
medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this side effect. The medication should be taken with meals but this will decrease gastrointestinal upset; taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be immediately reported to the physician.
Bumetanide (Bumex) is a diuretic. The paroxysmal nocturnal dyspnea may be due to increased venous return when the client is lying in bed, and the client needs diuresis. Propranolol is a β blocker, lidocaine is an antiarrhythmic, and streptokinase is a thrombolytic. Denial is the most common reaction when a client has a myocardial
infarction or anginal pain. Options 2, 3, and 4 are incorrect.
The nurse is responsible for
administering the correct medication. When medication orders are vague, the nurse must call the physician to clarify the orders before administering the medication. Waiting for the
physician to make rounds delays needed treatment.
Double vision, loss of appetite, and nausea are early signs of digoxin
toxicity. Additional signs of digoxin toxicity include bradycardia, difficulty reading, visual alterations such as green and yellow vision or seeing spots or halos, confusion, vomiting, diarrhea, decreased libido, and impotence.
Clients on potassium-wasting diuretics are at high risk for hypokalemia.
Clinical manifestations of hypokalemia include fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps, decreased bowel motility, paresthesias, and dysrhythmias. Most β blockers may be administered with food or on an empty stomach, but propranolol is absorbed best if taken with meals or directly after eating. Exercise will not prevent orthostatic hypotension. Hot showers and baths are not advised. The client needs to be instructed in how to take the pulse rate and to notify the physician if the heart rate falls below 60 beats/min. Enalapril (Vasotec) is an angiotensin-converting enzyme inhibitor.
Angioedema is an adverse effect. Swelling of the tongue and lips can result in airway occlusion. Nausea, insomnia, and a cough can occur as side (not adverse) effects of the medication.
Nesiritide is a recombinant version of human B-type natriuretic peptide, which vasodilates arteries and veins. It is used for the treatment of
decompensated heart failure,
increases renal glomerular filtration, and increases urine output. Options 2, 3, and 4 are incorrect.
The usual guidelines for administering nitroglycerin tablets for chest pain include administering one tablet every 5 minutes PRN for chest pain, for a total dose of three tablets. If the client
does not obtain relief after taking a third dose of nitroglycerin, the physician is notified. Because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would assess the client's pain level and check the client's blood pressure before administering each
nitroglycerin dose. There are no data in the question that indicate the need to call a Code Blue. Additionally, it is not necessary to contact the client's family unless the client has requested this.
Phosphate-binding agents that contain aluminum include Alu-Caps, Basaljel, and Amphojel. These products are made from aluminum hydroxide. Tums are made from calcium carbonate and also bind phosphorus. Tums are
prescribed to avoid the occurrence of dementia related to high intake of aluminum. Phosphate-binding agents are needed by the client in renal failure because the kidneys cannot eliminate phosphorus.
Trimethoprim (TMP)-sulfamethoxazole (SMX) (Bactrim) may be administered by intravenous infusion but should not be mixed with any other medications or solutions.
Trimethoprim-sulfamethoxazole is infused over 60 to 90 minutes, and bolus infusions or rapid infusions must be avoided. Nalidixic acid can intensify the effects of oral anticoagulants by displacing these agents from binding sites on plasma protein. When an oral anticoagulant is combined with nalidixic acid, a decrease in the
anticoagulant dosage may be needed. Each dose of sulfisoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more
soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfisoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the physician. Clients taking trimethoprim (TMP)-sulfamethoxazole (SMZ) should be informed about early signs of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client should be instructed to notify the physician if these symptoms occur. The other options do not require physician notification.
The nurse should instruct the client that a reddish-orange discoloration of urine may occur. The nurse also should instruct the client that this discoloration can stain fabric. The medication should be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication. Bethanechol chloride (Urecholine) can be hazardous to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions.
Toxicity (overdose) produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Treatment includes supportive measures and the administration of atropine sulfate subcutaneously or intravenously.
Toxicity (overdosage) of this
medication produces central nervous system excitation, such as
nervousness, restlessness,
hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion,
tachycardia, flushed or red face, and signs of respiratory depression.
Drowsiness is a frequent side effect of the medication but does not indicate overdosage.
Propantheline bromide (Pro-Banthine) is contraindicated in clients with narrow-angle glaucoma, obstructive uropathy, gastrointestinal disease, or ulcerative colitis. The medication decreases bladder muscle spasms. Nephrotoxicity can occur from the use of cyclosporine (Sandimmune).
Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels. Cyclosporine does not depress the bone marrow.
A compound present in grapefruit juice inhibits metabolism of cyclosporine. As a result, consumption of grapefruit juice can raise cyclosporine levels by 50% to 100%, thereby greatly
increasing the risk of toxicity. Amphotericin B deoxycholate,
erythromycin, and ketoconazole can elevate cyclosporine levels. When any of these medications is combined with cyclosporine, the dosage of
cyclosporine must be reduced to prevent accumulation to toxic levels. To improve palatability, the client should be taught to mix the
concentrated medication solution with chocolate milk or orange juice just before administration. Grapefruit juice is avoided because it can raise
instructed to dilute the concentrate in a glass (not Styrofoam) to ensure ingestion of the complete dose.
The most common adverse effects of cyclosporine are nephrotoxicity, infection, hypertension, tremors, and hirsutism. Of these, nephrotoxicity and infection are the most serious.
Tacrolimus (Prograf) is used with caution in immunosuppressed clients and in clients with renal, hepatic, or pancreatic function impairment.
Tacrolimus is contraindicated in clients with hypersensitivity to this
medication or hypersensitivity to cyclosporine.
A blood glucose level of 200 mg/dL is significantly elevated above the normal range of 70 to 110 mg/dL and suggests an adverse reaction. Other adverse reactions include
neurotoxicity evidenced by headache, tremor, and insomnia, gastrointestinal effects such as diarrhea, nausea, and vomiting, hypertension, and
hyperkalemia.
Mycophenolate mofetil (CellCept) should be administered on an empty stomach. The capsules should not be opened or crushed. The client should contact the physician if unusual bleeding or bruising, sore throat, mouth sores, abdominal pain, or fever occurs. Antacids containing
magnesium and aluminum may decrease the absorption of the medication and therefore should not be taken with the medication. The medication is given with
corticosteroids and cyclosporine.
Epoetin alfa is used to reverse anemia associated with chronic renal failure. Therapeutic effect is seen when the hematocrit is between 30% and 33%.
Options 2, 3, and 4 are not associated with the action of this medication. The client should be instructed not to shake the bottle. The medication should be refrigerated at all times. The medication should not be frozen. Syringes with a ⅝-inch needle are used for subcutaneous injection. A 1½-inch needle may be used for
intramuscular injection.
Cinoxacin should be administered with caution in clients with renal
impairment. The dosage should be reduced, and failure to do so could result in accumulation of cinoxacin to toxic levels. Therefore, the nurse would verify the prescription with the physician if the client had a
documented history of renal insufficiency. The laboratory and diagnostic test results are normal findings. Folic acid (vitamin B6) may be prescribed for a client with renal insufficiency to prevent anemia. Myasthenia gravis often can be
diagnosed based on clinical signs and symptoms. The diagnosis can be
confirmed by injecting the client with a dose of edrophonium (Tensilon). This medication inhibits the breakdown of an enzyme in the neuromuscular junction, so more acetylcholine binds onto receptors. If the muscle is
strengthened for 3 to 5 minutes after this injection, it confirms a diagnosis of myasthenia gravis. Another
medication, neostigmine (Prostigmin) also may be used because the effect lasts for 1 to 2 hours, giving a better analysis. For either medication,
atropine sulfate should be available as the antidote.
An edrophonium injection makes the client in cholinergic crisis temporarily worse. This is known as a negative Tensilon test.
Edrophonium is administered to determine whether the client is reacting to an overdose of a
medication (cholinergic crisis) or an increasing severity of the disease (myasthenic crisis). When the
edrophonium injection is given and the condition improves temporarily, the client is in myasthenic crisis. This is known as a positive Tensilon test. Dyskinesia and impaired voluntary movement may occur with high levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia (the
temporary muscle weakness that lasts 1 minute to 1 hour, also known as "on-off phenomenon") is a frequent side effect of the medication.
The therapeutic serum drug level range for phenytoin is 10 to 20 mcg/mL.
Intravenous infusion of phenytoin should be administered by injection into a large vein. The medication may be diluted in normal saline solution; however, dextrose solution should be avoided because of medication
precipitation. The medication is administered as intermittent doses. Continuous intravenous infusions should not be used. Infusion rates of more than 50 mg/min may cause hypotension or cardiac dysrhythmias, especially in older and debilitated clients.
Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, and 4 are inappropriate instructions.
The antidote for acetaminophen is acetylcysteine (Mucomyst). The normal therapeutic serum level of acetaminophen is 10 to 20 mcg/mL. A
toxic level is higher than 50 mcg/mL, and levels higher than 200 mcg/mL could indicate hepatotoxicity. Auranofin (Ridaura) is a gold
preparation used to treat rheumatoid arthritis. Fludarabine (Fludara) and pentostatin (Nipent) are antineoplastic agents.
In adults, overdose of acetaminophen causes liver damage. Option 3 is an indicator of liver function and is the only option that indicates an abnormal laboratory value. The normal direct bilirubin level is 0 to 0.3 mg/dL. The normal platelet count is 150,000 to 400,000/mm3. The normal
prothrombin time is 10 to 13 seconds. The normal sodium level is 135 to 145 mEq/L.
Edrophonium is a short-acting
acetylcholinesterase inhibitor used as a diagnostic agent. When a client with suspected myasthenia gravis is given 2 mg of the medication intravenously, an increase in muscle strength should be seen in 30 to 60 seconds. If no response occurs, another 4 to 10 mg of edrophonium is given over the next 2 minutes, and muscle strength is tested again. If no increase in muscle strength occurs with this higher dose, the muscle weakness is not caused by myasthenia gravis. Clients receiving injections of this medication
commonly demonstrate a drop in blood pressure, feel faint and dizzy, and are flushed.
The therapeutic phenytoin level is 10 to 20 mcg/mL. At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) appears. At a level higher than 30 mcg/mL, ataxia and slurred speech occur.
Mannitol is an osmotic diuretic that induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby
inhibiting tubular reabsorption of water and solutes. Mannitol is used to reduce intracranial pressure in the client with head trauma.
Mild intoxication with acetylsalicylic acid (aspirin) is called salicylism and is experienced commonly when the daily dosage is higher than 4 g. Tinnitus (ringing in the ears) is the most
frequent effect noted with intoxication. Hyperventilation may occur because salicylate stimulates the respiratory center. Fever may result, because salicylate interferes with the metabolic pathways coupling oxygen
consumption and heat production. Options 2, 3, and 4 are not associated specifically with toxicity.
Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular disturbances,
thrombophlebitis, dysrhythmias, and dermatological effects.
Morphine sulfate suppresses the cough reflex. Clients need to be encouraged to cough and deep-breathe to prevent pneumonia.
Options 1, 2, and 3 are not associated specifically with the use of this
medication.
Side effects of meperidine (Demerol) include respiratory depression,
orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention. While the client is taking codeine sulfate, the nurse would monitor vital signs and assess for hypotension. The nurse also should increase fluid intake, palpate the bladder for urinary
retention, auscultate bowel sounds, and monitor the pattern of daily bowel activity and stool consistency. The
nurse should monitor respiratory status and initiate deep-breathing and coughing exercises. Additionally, the nurse monitors the effectiveness of the pain medication.
Meperidine hydrochloride is an opioid analgesic. Side effects include
respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors.
Infection and pancytopenia are side effects of etanercept (Enbrel).
Laboratory studies are performed prior to and during drug treatment. The appearance of abnormal white blood cell counts and abnormal platelet counts can alert the nurse to a potentially life-threatening infection. Injection site itching and edema are common occurrences following administration. A metallic taste and loss of appetite are not common signs of side effects of this medication. Clients taking allopurinol are
encouraged to drink 3000 mL of fluid a day. A full therapeutic effect may take 1 week or longer. Allopurinol is to be given with, or immediately after, meals or milk. A client who develops a rash, irritation of the eyes, or swelling of the lips or mouth should contact the physician because this may indicate hypersensitivity.
Colchicine is contraindicated in clients with severe gastrointestinal, renal, hepatic, or cardiac disorders and in clients with blood dyscrasias. Clients with impaired renal function may exhibit myopathy and neuropathy manifested as generalized weakness. This medication should be used with caution in clients with impaired
hepatic function, the older client, and the debilitated client.
Precautions need to be taken with the administration of alendronate to prevent gastrointestinal side effects (especially esophageal irritation) and to increase absorption of the
medication. The medication needs to be taken with a full glass of water after rising in the morning. The client should not eat or drink anything for 30 minutes following administration and should not lie down after taking the medication.
Baclofen is a skeletal muscle relaxant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or debilitating diseases such as multiple sclerosis. Options 1, 3, and 4 are not associated effects of this medication.
Baclofen is a skeletal muscle relaxant and frequently causes drowsiness, dizziness, weakness, and fatigue. Baclofen also can cause nausea, constipation, and urinary retention. Clients should be warned about the possible reactions. Options 1, 2, and 4 are not side effects.
Coal tar is used to treat psoriasis and other chronic disorders of the skin. It suppresses DNA synthesis, mitotic activity, and cell proliferation. It has an unpleasant odor, frequently can stain the skin and hair, and can cause phototoxicity. It does not cause
diarrhea.
The client should be instructed that symptoms such as drowsiness, weakness, and fatigue are more intense in the early phase of therapy and diminish with continued
medication use. The client should be instructed never to withdraw abruptly or stop the medication because abrupt withdrawal can cause visual
hallucinations, paranoid ideation, and
seizures. The nurse should inform the client that these symptoms will
subside and encourage the client that continuing the use of the medication is the best option.
Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, tests of liver function should be performed before treatment and throughout the treatment interval. Dantrolene is administered in the lowest effective dosage for the shortest time necessary.
Clients with seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsive
medication. The disorders in options 2, 3, and 4 are not contraindications or cautions for the use of this medication. Because cyclobenzaprine (Flexeril) has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, glaucoma, and increased intraocular pressure. Cyclobenzaprine should be used only for a short term (2 to 3 weeks).
The client needs to be told that the urine may turn brown, black, or green. Other adverse effects include blurred vision, nasal congestion, urticaria, and rash. The client needs to be instructed that if these adverse effects occur to notify the physician.
Intravenous administration of methocarbamol can cause
hypotension and bradycardia. The nurse needs to monitor for these side effects. Options 1, 2, and 4 are not a concern with administration of this medication.
