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N-Clex
CCC Unit 3 N-Clex Questions
243
Nursing
08/29/2011

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Cards

Term
A 68-year-old patient with cancer complains of flu-like symptoms after receiving interferon alfa 2. For relief of these symptoms, the nurse teaches the patient to self-medicate with:

Acetaminophen.
Aspirin.
Codeine.
Ibuprofen.
Definition
Acetaminophen
Term
A 25-year-old female is concerned about the possibility of contracting measles after a recent case at the day care center where she is employed. Her immunizations are up to date. The nurse recommends:

Seeking a prescription for prophylactic antibiotics.
Immediate administration of an MMR immunization.
A quarantine for two weeks.
Drawing a measles titer.
Definition
Drawing a measles titer
Term
The nurse administers DPT, polio, Hib and hepatitis B immunizations to a 2-month-old child. Which of the following would be appropriate instructions for this child's mother?

Remain in the clinic 30 minutes after receiving the immunizations for observation.
Administer baby aspirin for fever and discomfort.
Return to the clinic for the next immunizations at 6 months of age.
Call the physician if redness develops at the site of the injections
Definition
Remain in the clinic 30 minutes after receiving the immunizations for observation
Term
Which of the following agents is used to confer passive immunity to a patient?

Poliovirus, oral (Orimune)
Hepatitis B (Engerix-B)
Immune globulin intramuscular (Gamastan)
Measles, mumps, and rubella (MMR II)
Definition
Immune globulin intramuscular (Gamastan)
Term
The nurse would question an order for immunostimulant therapy if the patient had which of the following conditions?

Infection
Pregnancy
Cancer
Immunodeficiency disease
Definition
Pregnancy
Term
With prolonged interferon alfa 2 (Roferon-A, Intron A) therapy, the nurse should be alert to signs of:

Hepatotoxicity.
Nephrotoxicity.
Diabetes.
Hypertension.
Definition
Hepatotoxicity.
Term
A 55-year-old female is receiving cyclosporine after a heart transplant. The patient exhibits a WBC of 12,000 cells/mm3, a sore throat, fatigue, and a low-grade temperature. The nurse suspects:

Infection.
Dehydration.
Transplant rejection.
Heart failure.
Definition
Infection
Term
Which of the following statements by a patient taking cyclosporine would indicate the need for more teaching by the nurse?

"I will wash my hands frequently."
"I will report any reduction in urine output to my physician."
"I will take my cyclosporine at breakfast with a glass of grapefruit juice."
"I will take my BP at home everyday."
Definition
"I will take my cyclosporine at breakfast with a glass of grapefruit juice."
Term
The nurse should monitor a transplant patient for the major adverse effect of cyclosporine therapy by assessing which lab test?

Electrolytes
Liver enzymes
Serum creatinine
Complete blood count (CBC)
Definition
Serum creatinine
Term
Which of the following patient statements would indicate the need for more teaching to a patient taking immunosuppressant therapy?

"I will need regular laboratory testing."
"I can visit my neighbor in the hospital every day."
"I should not visit my neighbor in the hospital every day.”
"I banked egg/sperm prior to beginning this treatment.
Definition
"I can visit my neighbor in the hospital every day."
Term
A patient is taking sirolimus (Rapamune) following a liver transplant. On the most recent CBC, the nurse notes a marked 50% decrease in platelets and leukocytes. During the physical assessment, what signs and symptoms should the nurse look for? What are appropriate nursing interventions?
Definition
Sirolimus (Rapamune) is an immunosuppressant. The nurse should assess for any signs and symptoms of bleeding or jaundice and infection. The nurse should question the patient regarding activities that may cause bleeding. The nurse should also assess for signs and symptoms of liver impairment. The nurse should notify the health care provider of the laboratory findings and educate the patient to report any bleeding to the provider. The patient should also report signs and symptoms of infection.
Term
A patient has been exposed to hepatitis A and has been referred for an injection of gamma globulin. The patient is hesitant to get a “shot” and says that his immune system is fine. How should the nurse respond?
Definition
The patient needs the protection of this passive form of immunity after an exposure to such an illness. The gamma globulin will act as a protective mechanism for 3 weeks while the patient is in the window of opportunity for developing hepatitis A. This drug does not stimulate the patient’s immune system but will help protect the patient from developing the disease. The nurse should inform the patient that the shot is far less debilitating than the disease.
Term
A patient had a renal transplant 6 months ago and is taking cyclosporine (Neoral, Sandimmune) daily. Identify three precautions that the nurse should be aware of when caring for this patient.
Definition
Cyclosporine is a toxic medication with many serious adverse effects. The nurse must understand that this drug cannot be given with grapefruit juice; patients who take this medication need their kidney function assessed regularly (not because of the kidney transplant but because cyclosporine reduces urine output). The nurse also must assess whether this patient is taking steroids, which are often given concurrently with cyclosporine, as the serum glucose needs to be monitored regularly.
Term
A client undergoing cancer chemotherapy asks the nurse why she is taking three different antineoplastics. The best response would be:

"Several drugs are prescribed in order to find the right drug for your cancer."
"Your cancer was very advanced, and therefore requires more medications."
"Each drug attacks the cancer cells in a different way, increasing the effectiveness of the therapy."
"One drug will cancel out the side effects of the other."
Definition
"Each drug attacks the cancer cells in a different way, increasing the effectiveness of the therapy."

Rationale: Effectiveness of chemotherapy is increased by use of multiple drugs from different classes that attack cancer cells at different points in the cell cycle. This also allows lower doses of each individual agent to be used, thus reducing side effects. A third benefit of combination chemotherapy is reduced incidence of drug resistance.
Term
The most effective treatment method for the nausea and vomiting that accompany chemotherapy is to:

Administer an antiemetic prior to the antineoplastic medication.
Administer an oral antiemetic when the client complains of nausea and vomiting.
Push fluids prior to administering the antineoplastic medication.
Administer an antiemetic by intramuscular injection when the client complains of nausea and vomiting.
Definition
Administer an antiemetic prior to the antineoplastic medication.

Rationale: Before starting therapy with agents with high emetic potential, clients may be pretreated with an antiemetic.
Term
In case of extravasation during doxorubicin (Adriamycin) therapy, the nurse should be prepared to administer:

Hyaluronidase.
Sodium bicarbonate and normal saline.
Leucovorin (folinic acid).
Epinephrine (Adrenalin).
Definition
Hyaluronidase.

Rationale: Before administering intravenous antineoplastic agents, the nurse should know the emergency treatment for extravasation. Intradermal hyaluronidase may be prescribed for extravasation of doxorubicin.
Term
A client undergoing antineoplastic therapy is also prescribed filgrastim. He acts concerned, and asks the nurse why he is receiving this new medication. The best response by the nurse is that:

This drug helps bone marrow build new blood cells.
This drug works with chemotherapy to attack cancer cells.
This drug helps reduce nausea during chemotherapy.
This drug will help prevent hair loss during chemotherapy.
Definition
his drug helps bone marrow build new blood cells.

Rationale: Efforts to minimize bone marrow toxicity can include therapy with growth factors or colony-stimulating factors that stimulate bone marrow to increase production of blood cells.
Term
Your client will begin doxorubicin (Adriamycin) therapy in one week. Appropriate anticipatory guidance by the nurse would include:

Encouraging the client to be fitted for a stylish wig.
Encouraging the client to purchase home exercise equipment for strength training.
Encouraging the client to quit her job.
Encouraging the client to push fluid intake.
Definition
Encouraging the client to be fitted for a stylish wig.

Rationale: Alopecia occurs with almost all chemotherapy. To prepare for this event, encourage the client to get a wig before it is necessary.
Term
A 28-year-old client with breast cancer is receiving methotrexate. The nurse should teach this client to:

Limit oral fluid intake during therapy.
Use reliable birth control measures during and after therapy.
Use aspirin or NSAIDs such as ibuprofen for minor discomfort.
Take methotrexate with food to avoid gastric upset.
Definition
Use reliable birth control measures during and after therapy.

Rationale: Many antineoplastics are contraindicated in pregnancy. Methotrexate is pregnancy category X. Pregnancy should be avoided during therapy and for at least six months after therapy.
Term
Which of the following statements by a client undergoing antineoplastic therapy would be of concern to the nurse?

"I am taking my 15-month-old granddaughter to the pediatrician next week for her baby shots."
"My husband and I are planning a short trip, by airplane, next week."
"I am eating six small meals plus two protein shakes a day."
"I have attended a meeting of a cancer support group."
Definition
"I am taking my 15-month-old granddaughter to the pediatrician next week for her baby shots."

Rationale: The client and family members should avoid receiving live virus vaccinations or exposure to chickenpox. The client could have an exacerbation, or have a more pronounced episode of chickenpox.
Term
To monitor for the presence of bone marrow suppression, the nurse evaluates the results of the:

Complete blood count.
Bone scan.
Serum electrolytes.
BUN and serum creatinine.
Definition
Complete blood count.

Rationale: The nurse should monitor for blood dyscrasias resulting from bone marrow suppression. The CBC with differential and platelet count is monitored.
Term
A client taking methotrexate for cancer asks the nurse why a second drug, Leucovorin (folinic acid), has been prescribed. The appropriate response is:

"This is used to protect normal cells from damage by the methotrexate."
"This is to prevent arthritis that often accompanies methotrexate use."
"This is a vitamin to build up your resistance."
"This is a second antineoplastic drug used to attack the cancer cells."
Definition
"This is used to protect normal cells from damage by the methotrexate."

Rationale: Leucovorin is administered with methotrexate to rescue normal cells and protect the client from severe bone marrow damage.
Term
A 2-year-old client is receiving vincristine (Oncovin) for Wilms' tumor. The nurse calculates the absolute neutrophin count to determine amount of depression. This lowest point is called a __________.

Growth fraction
Nadir
Oncology level
Alopecia
Definition
Nadir

Rationale: Each antineoplastic drug has a documented nadir level.
Term
When assessing a client who has a diagnosis of generalized anxiety disorder, the nurse should determine if what symptom is present?

A sense of euphoria when completing tasks
Sense of nervousness that responds to deep-breathing exercises
Inability to concentrate at work and complete usual work assignments
Feelings of terror and impending doom whenever there is a change in the daily routine
Definition
Inability to concentrate at work and complete usual work assignments

Rationale: When generalized anxiety disorder is present, clients experience difficulty focusing or concentrating, sleep disturbances, muscle tension, and fatigue. A sense of nervousness, which responds to deep-breathing exercises, is characteristic of situational anxiety disorder. Euphoria is not seen with anxiety disorders. Impending doom occurs with panic disorder.
Term
Which of these measures, if included in the plan of care for a client who has a diagnosis of situational anxiety order, should the nurse plan to use first?

Administer prazepam (Centrax) as ordered.
Instruct the client on the use of biofeedback techniques.
Instruct the client on the use of over-the-counter herbal complementary therapy to reduce symptoms.
Instruct the client to monitor vital signs at home, especially respirations.
Definition
Instruct the client on the use of biofeedback techniques.

Rationale: Nonpharmacological therapy should be considered first-line management for clients who have a diagnosis of situational anxiety.
Term
A nurse is assessing an elderly client who has been taking zolpidem (Ambien) for three months. Which of these findings would require immediate follow-up by the nurse?

The client's respiratory rate is 12 per minute.
The client reports feeling sleepy within 10 minutes of taking the medication.
The client has an occasional moment of forgetfulness.
The client is agitated and combative.
Definition
he client is agitated and combative.

Rationale: Ambien is indicated only for short-term management (7-10 days) of insomnia. The elderly client who is on long-term therapy for insomnia might experience brain dysfunction as the medication accumulates in the brain. Symptoms of agitation and combative behavior require immediate nursing interventions.
Term
A client has been taking lorazepam (Ativan) for several weeks for treatment of anxiety. The nurse should plan to assess the client for potential development of what side effect?

Ataxia
Euphoria
Tachypnea
Astigmatism
Definition
Ataxia

Rationale: When taken in high doses for a prolonged period of time, side effects for this medication include amnesia, weakness, disorientation, ataxia, blurred vision, diplopia, nausea, and vomiting.
Term
A nurse is planning staff assignments on the mental health unit. Which of these clients would be most appropriate for the nurse to assign to a nursing assistant?

A client with a diagnosis of phobias whose vital signs are stable, and who is receiving diazepam (Valium) intravenously
An elderly client who is difficult to arouse after taking three doses of pentobarbital (Nembutal)
A client who is beginning medication therapy for post-traumatic stress disorder
A client who is receiving nonpharmacological therapy for an anxiety disorder
Definition
A client who is receiving nonpharmacological therapy for an anxiety disorder

Rationale: The nurse can assign only clients who do not require nursing assessments to nursing assistants. Clients receiving medication therapy, who require nursing assessments, must be assigned to a licensed nurse.
Term
A client is receiving temazepam (Restoril). Which of these responses should a nurse expect the client to have if the medication is achieving the desired affect?

The client reports having fewer episodes of panic attacks when stressed.
The client reports feeling less anxiety during activities of daily living.
The client reports sleeping seven hours without awakening.
The client sleeps in three-hour intervals, awakes for a short time, and falls back to sleep.
Definition
The client reports sleeping seven hours without awakening.

Rationale: The nurse should recognize that this medication is ordered for insomnia. Therefore, the client should be experiencing relief from insomnia, and reporting feeling rested when awakening.
Term
A client has been given instructions about the newly prescribed medication alprazolam (Xanax). Which of these statements by the client would indicate that the client needs further instruction?

"I will avoid drinking alcohol with this medication."
"I will take the medication with food if my stomach feels upset."
"I will not drive immediately after I take this medication."
"I will stop the medication as soon as I feel less anxious."
Definition
"I will stop the medication as soon as I feel less anxious."

Rationale: Benzodiazepines should not be stopped abruptly; withdrawal symptoms can occur if benzodiazepines are stopped suddenly after long-term use. The physician should decide when and how to discontinue the medication.
Term
A client has been taking diazepam (Valium) for three months. The nurse determines the outcome of medication therapy has been successful when the client makes which statement?

"I feel like I am able to cope with routine stress at my job."
"I like this medication. I know that I needed it to treat my anxiety, which is now better, but I think it just makes me feel good, so I am planning to stay on it for quite a while."
"I will need to take this medication for the rest of my life."
"I thought this medication would make me think clearly, but I don't feel any change in my feelings."
Definition
"I feel like I am able to cope with routine stress at my job."

Rationale: To answer this question correctly, the statement by the client needs to clearly show that she has experienced the expected benefit of the medication therapy. Diazepam is a benzodiazepine used in the treatment of anxiety, seizure disorders, alcohol withdrawal syndrome, and muscle relaxation.
Term
The nurse is instructing a 32-year-old female client on the use of meprobamate (Equanil). The nurse should give which of the following instructions to the client? Select all that apply.

"Use over-the-counter and herbal medications only after you read the label carefully."
"It is okay to drive while taking this medication."
"Keep the medication in a locked cabinet."
"Notify the physician immediately if you become pregnant."
"You will need to take this medication a few times a day."
Definition
"Keep the medication in a locked cabinet."

"You will need to take this medication a few times a day."

"Notify the physician immediately if you become pregnant."

Rationale: Equanil is given in 3-4 divided doses daily. Since it is a CNS depressant, keeping it locked is safe. It might not be safe to take while pregnant. Until effects of the medication are known, it would be unsafe to drive. Clients should not use alcohol, over-the-counter medication, or herbal therapies without consulting with the physician, since serious side effects can occur if the client ingests any of these products during medication therapy.
Term
A client is prescribed zolpidem (Ambien). Which of these outcomes should the nurse include in a plan of care?

Normal sleep pattern will be restored.
The client will not experience any panic attacks.
Coping behaviors will be effective in reducing anxiety.
The client reports taking the medication on a full stomach.
Definition
Normal sleep pattern will be restored.

Rationale: The medication is used for short-term sleep disorders; therefore, restoration of a normal sleep pattern should be the main outcome of medication therapy.
Term
On the fourth day of hospitalization the patient begins to complain of dizziness, weakness, blurred vision, nausea and anorexia. A physical exam reveals a heart rate of 52 bpm, a significant decrease from her baseline. Based on these assessment findings, what does the nurse suspect is going on?
Definition
The patient's symptoms correlate with those of digoxin toxicity. The additional doses of Lorazepam along with the higher dose of Digoxin have placed the patient at an increased risk for digoxin toxicity. Lorazepam can contribute to digoxin toxicity by increasing the serum digoxin level.
Term
The physician has now placed the patient's Digoxin on hold and has ordered a tapering schedule to discontinue the Lorazepam. A student nurse asks the patient's primary nurse, "Why doesn't the physician simply stop the Lorazepam immediately?" How should the nurse respond?
Definition
Abrupt discontinuation of Lorazepam therapy should be avoided as rebound anxiety and sleeplessness is often associated with abrupt discontinuation after long-term use.
Term
A client asks if convulsions and seizures are the same. The nurse's response is based on the knowledge that:

Seizure activity is more harmful than are convulsions.
Seizures involve muscle spasms on one side only.
Convulsions always involve violent skeletal muscle activity.
The terms can be used interchangeably.
Definition
Convulsions always involve violent skeletal muscle activity.

Objective: Compare and contrast the terms epilepsy, seizures, and convulsions.
Rationale: Convulsions specifically refer to involuntary, violent spasms of the large muscles of the face, neck, arms, and legs. Seizure activity does not always involve these characteristics.
Term
The nurse evaluates teaching related to causes of seizures. Further teaching is needed if the client makes which of the following statements?

"My relative had seizures because of a large tumor growing in his muscles."
"Seizures can be caused by low blood sugar."
"Seizures can be caused by inflammation of the brain."
"Seizures can occur after a head injury."
Definition
"My relative had seizures because of a large tumor growing in his muscles."

Objective: Recognize the causes of epilepsy.
Rationale: Rapid-growing, space-occupying lesions in the brain, not muscles, that increase intracranial pressure can cause seizures.
Term
A client receiving phenytoin (Dilantin) has been experiencing fluctuating serum blood levels of the medication. Development of which symptoms in the client should prompt the nurse to notify the primary health care provider immediately? (Select all that apply.)

GI cramping and diarrhea
Double vision and lethargy
Migraine headaches and nausea
Dry skin and constipation
Definition
Migraine headaches and nausea

Double vision and lethargy

Objective: Use the nursing process to care for clients receiving drug therapy for epilepsy.
Rationale: Although all the symptoms should prompt further assessment by the nurse, dizziness, ataxia, diplopia, and lethargy are signs of hydantoin toxicity, and should be reported.
Term
A client receiving digoxin (Lanoxin) therapy is being treated for status epilepticus with diazepam (Valium). The nurse places priority on:

Monitoring the client for nausea and GI cramping.
Keeping the client in a high Fowler's position.
Holding the digoxin until the seizure has subsided.
Instructing the client to eat foods high in potassium.
Definition
Monitoring the client for nausea and GI cramping.

Objective: Explain the importance of client drug compliance in the pharmacotherapy of epilepsy.
Rationale: Valium is a benzodiazepine, which can potentate the action of digoxin and raise blood levels. Nausea, vomiting, GI cramping, blurred vision, and bigeminy are signs of digoxin toxicity. The digoxin should not be held unless symptoms of toxicity are seen. Positioning should protect the client from injury during the seizure-most likely recumbent and on the side, if possible. Potassium is not indicated.
Term
Within the question text below, there is one text entry field where you can enter your answer. The nurse recognizes that several chemicals inhibit neurotransmitter function in the brain. The primary inhibitory transmitter in the brain is
Definition
GABA

Objective: Recognize the causes of epilepsy.
Rationale: GABA drugs mimic GABA by stimulating the influx of chloride ions into the neuron, leading to the suppression of neuron firing.
Term
The nurse should question the use of barbiturates for the treatment of seizure activity if prescribed for which of the following clients?

30-year-old pregnant female
45-year-old male with history of hypertension
24-year-old male with new diagnosis of seizures
55-year-old female with history of diabetes mellitus
Definition
30-year-old pregnant female

Objective: Use the nursing process to care for clients receiving drug therapy for epilepsy.
Rationale: Barbiturates cross the placental barrier and are excreted in breast milk, and are not recommended for women who are pregnant or nursing. Folic acid absorption also is decreased, and congenital malformations can occur if barbiturates are taken during the first trimester.
Term
The client, age 8, is prescribed valproic acid (Depokene) for treatment of a seizure disorder. The nurse should monitor the client closely for:

Vitamin B deficiency.
Respiratory distress.
Restlessness and agitation.
Hyperthermia.
Definition
Restlessness and agitation.

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of drug action, primary actions, and important adverse effects.
Term
The nurse completes a history and physical on a client admitted with exacerbation of a seizure disorder. What datum collected by the nurse requires intervention?

History of asthma
Use of aspirin daily
History of diabetes mellitus
Use of herb Ginkgo biloba
Definition
Use of herb Ginkgo biloba

Objective: Use the nursing process to care for clients receiving drug therapy for epilepsy.
Rationale: Ginkgo biloba decreases the effectiveness of anti-seizure medication.
Term
The client is prescribed clonazepam (Klonopin) for treatment of a seizure disorder. Appropriate nursing action includes:

Administrating with other CNS depressants.
Determining the pregnancy status of the client.
Maintaining available dose for treating status epilepticus.
Assuring the client that a history of glaucoma will not affect treatment.
Definition
Determining the pregnancy status of the client.

Objective: Describe the nurse's role in the pharmacologic management of epilepsy.
Rationale: Benzodiazepines are Category D drugs, and are contraindicated during pregnancy. The question does not indicate that the client has status epilepticus. CNS depressants should not be given with benzodiazepines. The drug could produce changes in intraocular pressure, and is contraindicated in narrow-angle glaucoma.
Term
The nurse giving discharge teaching for a client receiving carbamazepine (Tegretol) should include:

Monitor blood glucose, and report decreased levels.
Report unusual bleeding or bruises to the health care provider immediately.
Expect an orange discoloration of urine.
Expect a discoloration of the contact lenses.
Definition
Report unusual bleeding or bruises to the health care provider immediately.

Objective: Use the nursing process to care for clients receiving drug therapy for epilepsy.
Rationale: Carbamazepine affects vitamin K metabolism, and can lead to blood dyscraisias and bleeding. It does not significantly lower blood sugar or change the color of body fluids.
Term
The nurse practitioner reviews the laboratory results of a 16-year-old patient who presents to the clinic with fatigue and pallor. The patient’s hematocrit is 26%, and the nurse notes multiple small petechiae and bruises over the arms and legs. This patient has a generalized tonic–clonic seizure disorder that has been managed well on carbamazepine (Tegretol). Relate the drug regimen to this patient’s presentation.
Definition
Carbamazepine (Tegretol) is the second most widely prescribed antiepileptic drug in the United States. Common side effects are drowsiness, dizziness, nausea, ataxia, and blurred vision. Serious and sometimes fatal blood dyscrasias secondary to bone marrow suppression have occurred with carbamazepine. The patient’s hematocrit suggests anemia, and the petechiae and bruising suggest thrombocytopenia. The nurse should evaluate the patient for complaints of fever and sore throat that would suggest leukopenia. This patient needs immediate evaluation by the health care provider responsible for monitoring the seizure disorder.
Term
A 24-year-old woman is brought to the emergency department by her husband.He tells the triage nurse that his wife has been treated for seizure disorder secondary to a head injury she received in an automobile accident. She takes phenytoin (Dilantin) 100 mg every 8 hours. He relates a history of increasing drowsiness and lethargy in his wife over the past 24 hours. A phenytoin level is performed, and the nurse notes that the results are 24 mcg/dL. Relate the drug regimen to this patient’s presentation.
Definition
This question requires that the student consult a laboratory reference manual. The therapeutic drug level of phenytoin (Dilantin) is 5 to 20 mg/dL. Patients may become drug toxic and demonstrate signs of CNS depression. Exaggerated effects of phenytoin can be seen if the drug has been combined with alcohol or other agents. Phenytoin also demonstrates dose-dependent metabolism. When hepatic enzymes necessary for metabolism are saturated, any increase in drug concentration results in a disproportionate increase in plasma concentration level.
Term
The nurse is admitting a 17-year-old female patient with a history of seizure disorder. The patient has broken her leg in a car accident, in which she was the driver. The patient states that she hates having to take phenytoin (Dilantin), and that she stopped the drug because she could not drive and it was making her angry. Instead of reassuring the patient, the nurse first considers the possible side effects of long-term phenytoin therapy. Explain possible long-term effects of phenytoin therapy and their impact on patient compliance.
Definition
Long-term phenytoin therapy can produce an androgenic stimulus. Reported skin manifestations include acne, hirsutism, and an increase in subcutaneous facial tissue— changes that have been characterized as “Dilantin facies.” These changes, coupled with the risk for gingival hypertrophy, may be difficult for the adolescent to cope with. In addition, the adolescent with a seizure disorder may be prohibited from operating a motor vehicle at the very age when driving becomes key to achieving young-adult status. The thoughtful nurse will consider the range of possible support groups for this patient once she is discharged and will encourage the patient to discuss her concerns about the drug regimen with her health care provider.
Term
The family member caring for a client with Parkinson's disease at home notifies the nurse that the client is demonstrating extrapyramidal symptoms. The nurse should instruct the caregiver to:

Transport the client to the Emergency Department.
Increase dosage of antiparkinsonism drugs.
Make an appointment with the health care provider for evaluation.
Give diphenhydramine (Benadryl) 25 mg p.o.
Definition
Transport the client to the Emergency Department.

Objective: Explain the neurochemical basis for Parkinson's disease, focusing on the roles of dopamine and acetylcholine in the brain.
Rationale: The symptoms can cause severe muscle spasms, and can be life-threatening without intervention. The client should be transported to the Emergency Department. Diphenhydramine must be given parenterally for effective treatment.
Term
The client asks what can be expected from drug therapy for treatment of parkinsonism. The best response by the nurse would be:

That EPS will be prevented.
That a cure can be expected within six months.
That disease progression will be stopped.
That symptoms can be reduced, and the ability to perform ADLs can be improved.
Definition
That symptoms can be reduced, and the ability to perform ADLs can be improved.

Objective: Describe the nurse's role in the pharmacologic management of Parkinson's disease and Alzheimer's disease.
Rationale: Pharmacotherapy does not cure the disease, but does improve the client's ability to perform normal activities, such as eating, bathing, and walking. The symptoms are often reversed if medications are taken long-term.
Term
Levodopa (Laradopa) is prescribed for a client with Parkinson's disease. The nurse's discharge teaching should include: (Select all that apply.)

Expect the urine color to be orange.
Report to the lab for a follow-up of liver and renal function tests.
Report the development of diarrhea.
Avoid taking the medication with high-protein meals.
Monitor the blood pressure every two hours for the first two weeks.
Definition
eport to the lab for a follow-up of liver and renal function tests.

Avoid taking the medication with high-protein meals.

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects.
Rationale: A decrease in kidney and liver function could slow the metabolism and excretion of the drug, leading to overdose and toxicity. Protein decreases the absorption of levodopa. Blood pressure needs to be closely monitored when the dose is adjusted. It might cause urine and sweat to darken in color. It does not cause diarrhea.
Term
The nurse provides nutritional counseling for a client receiving levodopa. The client should be encouraged to:

Decrease intake of dairy products.
Avoid foods such as ham, sweet potatoes, and oatmeal.
Increase vitamin B6 intake.
Lower the intake of simple carbohydrates.
Definition
Avoid foods such as ham, sweet potatoes, and oatmeal.

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects.
Rationale: Ham, sweet potatoes, and oatmeal are high in pyridoxine (vitamin B6). Pyridoxine reduces the effects of levodopa.
Term
The client receiving an anticholinergic drug for treatment of Parkinson's disease complains of dry mouth. Nursing intervention should include advising the client to:

Take the drug with food or milk.
Rinse mouth with warm water.
Use mouthwash prior to taking the drug.
Chew sugarless gum, and suck on sugarless hard candy.
Definition

Correct Answer:

Chew sugarless gum, and suck on sugarless hard candy.

Objective: Describe the nurse's role in the pharmacologic management of Parkinson's disease and Alzheimer's disease.
Rationale: Frequent drinking of cool liquids, sucking on hard candy or ice chips, and chewing sugarle
Term
A client has been started on benztropine (Cogentin) for relief of parkinsonian symptoms. Which of the following statements made by the client best indicates the drug is producing a therapeutic effect?

"I feel so calm and relaxed."
"That annoying lip smacking is much less frequent."
"I can tie my shoes now without difficulty."
"My hands aren't as shaky as they used to be."
Definition
"My hands aren't as shaky as they used to be."

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects.
Rationale: Cogentin blocks excess cholinergic stimulation, and helps to suppress tremors. It does not affect symptoms of tardive dyskinesia, such as lip smacking. It does not affect mood.
Term
Donepezil (Aricept) is prescribed for a client with Alzheimer's disease. The nurse determines that the medication is having positive effects when what is observed?

Increase in "pin rolling"
Decreased progression of memory loss
Regaining the ability to drive a car
Absence of wandering
Definition
Decreased progression of memory loss

Objective: Explain the goals of pharmacotherapy for Alzheimer's disease, and the efficacy of existing medications.
Rationale: Aricept is effective in the early stages of Alzheimer's disease. It might slow or decrease progression of symptoms, but it will not reverse behaviors that are lost.
Term
The lab results of a client treated for Alzheimer's disease reveals increased liver function tests. The nurse recognizes that the drug most likely to cause this side effect is:

Rivastigmine tartrate (Exelon).
Donepezil (Aricept).
Galantamine (Reminyl).
Tacrine (Cognex).
Definition
Tacrine (Cognex).

Objective: Categorize drugs used in the treatment of Alzheimer's disease and Parkinson's disease based on their classifications and mechanisms of action.
Rationale: Acetylcholinesterase inhibitors used for treatment of Alzheimer's disease cause a variety of side effects. Elevated liver enzymes are specifically associated with tacrine (Cognex) use.
Term
A client with Alzheimer's disease has been receiving medication therapy for several months. The nurse should teach the client and caregiver to report signs of overdose, which include:

Bradycardia and muscle weakness.
Abdominal pain and dry mouth.
Tachycardia and hypertension.
Emotional withdrawal and tachypnea.
Definition
Bradycardia and muscle weakness.

Objective: Use the nursing process to care for clients receiving drug therapy for degenerative diseases of the CNS.
Rationale: An overdose of drugs to treat Alzheimer's disease could occur if they are taken improperly, or if decreased liver or renal function occurs. Symptoms of overdose include severe nausea/vomiting, sweating, salivation, hypotension, bradycardia, convulsions, and increased muscle weakness, including respiratory muscles.
Term
During the initial treatment with levodopa for clients with Parkinson's disease, nursing interventions should include:

Providing safety to prevent falls.
Observing for EPS.
Increasing foods high in vitamin B6, such as bananas and liver.
Monitoring for suicidal ideation.
Definition
Providing safety to prevent falls.

Objective: Categorize drugs used in the treatment of Alzheimer's disease and Parkinson's disease based on their classifications and mechanisms of action.
Rationale: Orthostatic hypotension is likely during early treatment. Clients should be protected from falls. Suicidal ideation is monitored when clients are first started on antidepressants. EPS occurs with some antipsychotic medications. Bananas and liver are high in vitamin B6, an
Term
A 58-year-old Parkinson’s patient is placed on levodopa (Larodopa). In obtaining her health history, the nurse notes that the patient takes Mylanta on a regular basis for mild indigestion, and also takes multivitamins daily (vitamins A, B6, D, and E). She also has a history of diabetes mellitus type 2. What should the nurse include in teaching for this patient?
Definition
The patient should reassess with a health care provider the need for regular Mylanta. This drug contains magnesium, which may cause increased absorption and toxicity. The patient needs teaching on decreasing foods that contain vitamin B6 (for example, bananas, wheat germ, and green vegetables) because vitamin B6 may also cause an increase in the absorption of the medication. Teaching should include information about a potential loss of glycemic control (because this patient is diabetic) and safety issues related to postural hypotension.
Term
A patient is on levodopa and benztropine (Cogentin). During a regular office follow-up, the patient tells the nurse that she is going to Arizona in July to visit her grandchildren. What teaching is important for this patient?
Definition
A patient on benztropin (Cogentin) has a decreased ability to tolerate heat. Arizona in July is hot, so the patient should be taught to avoid hot climates, if at all possible, or to increase rest periods, avoid exertion, and observe for signs of heat intolerance. When symptoms occur, the patient must immediately get out of the heat and rest.
Term
A 67-year-old Alzheimer’s patient is on donepezil (Aricept) and has a history of congestive heart failure, diabetes mellitus type 2, and hypertension. The patient’s wife asks the nurse if this new medicine is appropriate for her husband to take. How should the nurse respond? What teaching should be done?
Definition
The nurse should refer the patient and his wife to a health care provider regarding the appropriateness of this medication (this is not a nursing function). The couple should be educated regarding safety issues such as postural hypotension and bradycardia that may occur with this medication. Anorexia is also a potential problem; this patient has diabetes and thus may have glycemic issues.
Term
A client tells the nurse he plans to use a cayenne-based ointment for occasional muscle spasms in his shoulder. The nurse gives what instructions for use of the cream? (Select all that apply.)

Wash your hands thoroughly after applying the cream.
Use the full strength for no more than two days.
The capsule formulation of this drug is more effective.
Avoid applying the cream to broken skin.
Only apply it to the skin once a day.
Definition
Wash your hands thoroughly after applying the cream.

Use the full strength for no more than two days.

Avoid applying the cream to broken skin.

Objective: Discuss nonpharmacologic therapies used to treat muscle spasms and spasticity.
Rationale: The active ingredient in cayenne is capsaicin. When applied in a cream base, it diminishes the sensation of pain. Use for more than two days can cause skin inflammation, blisters, and ulcers, and it should not be applied to open or broken skin. Thorough hand washing after use prevents accidental exposure of the cream to mucous membranes and the eyes. To be effective, it must be applied regularly, up to four times a day. Oral formulations are used for digestive problems.
Term
Cyclobenzaprine (Clycloflex, Flexeril) is prescribed for a client with muscle spasm of the lower back. Appropriate nursing intervention will include:

Providing for client safety.
Encouraging frequent ambulation.
Assessing the heart rate for bradycardia.
Providing oral suction for excessive oral secretions.
Definition
Providing for client safety.

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drugs, and explain their mechanisms of action, primary actions, and important adverse effects.
Rationale: Adverse reactions to cyclobenzaprine include drowsiness, dry mouth, rash, and tachycardia. Ambulation would be restricted with back muscle spasms.
Term
A client is scheduled to receive botulinum toxin type B (Myoblocare) for treatment of muscle spasticity. When preparing the medication, the nurse informs the client to expect:

A rapid return of energy.
Relief of muscle spasms in several days.
Drowsiness.
Local anesthesia, to decrease the pain of the injection.
Definition
Local anesthesia, to decrease the pain of the injection.

Objective: Describe the nurse’s role in the pharmacological management of muscle spasms.
Rationale: An adverse effect of botulinum is pain. The drug is injected directly into muscle tissue, and pain associated with the injection usually is blocked by a local anesthetic. Relief might not be obtained for several weeks. Drowsiness does not occur, and energy levels are not increased by the drug.
Term
Prior to administration of Cyclobenzaprine (Clycloflex), the nurse notes that the client’s liver enzymes are elevated. The appropriate action for the nurse to take is to:

Place the lab report on the medical record, and await instructions from the health care provider.
Hold the medication, and report lab results to primary health care provider.
Give the medication as ordered.
Give the medication as ordered, and schedule a laboratory blood draw for liver enzymes in six hours.
Definition
Hold the medication, and report lab results to primary health care provider.

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drugs, and explain their mechanisms of action, primary actions, and important adverse effects.
Rationale: Since cyclobenzaprine can cause serious liver damage, the elevated enzymes should be reported to the physician, and the drug held. It would not be the nurse’s responsibility to order lab tests in this situation.
Term
The nurse would expect which of the following evaluation data to support effective treatment with cyclobenzaprine (Flexeril)?

Complaints of dry mouth have decreased.
Muscle spasms occur only with exercise.
Ability to ambulate in hallway without complaint of pain
Reports of less dizziness
Definition
Ability to ambulate in hallway without complaint of pain

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drugs, and explain their mechanisms of action, primary actions, and important adverse effects. Rationale: Expected outcomes include relief of pain and spasms, increased range of motion of affected body part, and the ability to demonstrate knowledge of drug therapy and side effects.
Term
A client prescribed dantrolene sodium (Dantrium) reports taking verapamil (Calan) as part of the drug regimen. Appropriate nursing interventions include:

Holding the drug until the physician arrives.
Encouraging client to drink plenty of fluids.
Monitoring closely for cardiac arrhythmias.
Monitoring neurological status.
Definition
Monitoring closely for cardiac arrhythmias.

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drugs, and explain their mechanisms of action, primary actions, and important adverse effects.
Rationale: Verapamil is a calcium channel blocker, and increases the risk for ventricular fibrillations and cardiovascular collapse when taken with dantrolene sodium.
Term
When planning care for a client with muscle spasms, the nurse recognizes that a goal of the treatment is to:

Avoid long-term treatment of the disorder.
Decrease pain and increase range of motion.
Prevent liver and renal damage.
Restrict mobility until symptoms are relieved.
Definition
Restrict mobility until symptoms are relieved.

Objective: Discuss nonpharmacologic therapies used to treat muscle spasms and spasticity. Explain the goals of pharmacotherapy with skeletal muscle relaxants.
Rationale: Pharmacotherapy used for muscle spasms usually includes analgesics, anti-inflammatory agents, or centrally acting antispasmodic drugs. The goals of therapy include minimizing pain and discomfort, increasing range of motion, and improving the client’s ability to function independently. Long-term treatment might be needed, and mobility does not always need to be restricted.
Term
The nurse determines that which of the following statements made by a client prescribed dantrolene sodium (Dantrium) indicates an understanding of the side effects of the drug?

“I will report frequent changes in my blood pressure to my doctor.”
“I will not be concerned if I cannot empty my bladder; it is probably my prostate.”
“I will be able to drive myself home from the hospital.”
“I will be able to do my regular work as soon as I get home.”
Definition
“I will report frequent changes in my blood pressure to my doctor.”

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drugs, and explain their mechanisms of action, primary actions, and important adverse effects.
Rationale: The client should be observed for side effects such as muscle weakness, drowsiness, dry mouth, dizziness, nausea, diarrhea, tachycardia, erratic blood pressure, photosensitivity, and urinary retention. The client should not drive until the full effect of the drug has been established. Activity should be restricted.
Term
Which of the following medication orders should the nurse clarify with the physician prior to administration of the drug to a client?

Cyclobenzaprine (Flexeril) 15 mg t.i.d.
Baclofen (Lioresal) 10 mg b.i.d.
Lorazepam (Ativan) 5mg q.i.d
Carisoprodol (Soma) 350 mg t.i.d.
Definition
Lorazepam (Ativan) 5mg q.i.d

Objective: Compare and contrast the roles of the following drug categories in treating muscle spasms and spasticity: centrally acting skeletal muscle relaxants and direct-acting antispasmodics.
Rationale: The usual dose of lorazepam (Ativan) is ½ mg p.o. b.i.d. to t.i.d. The maximum dosage is 10 mg/day. The other doses are within limits.
Term
The nurse explains to the client that botulinum toxin Type A (Botox) is administered:

By mouth in at least 8 ounces of juice.
By subcutaneous injection in the affected area.
Intravenously over one hour.
Intramuscularly into a target muscle.
Definition
Intramuscularly into a target muscle.

Objective: Compare and contrast the roles of the following drug categories in treating muscle spasms and spasticity: centrally acting skeletal muscle relaxants and direct-acting antispasmodics.
Rationale: Botox is injected into target muscle.
Term
A 46-year-old male quadriplegic patient has been experiencing severe spasticity in the lower extremities, making it difficult for him to maintain position in his electric wheelchair. Prior to the episodes of spasticity, the patient was able to maintain a sitting posture. The risks and benefits of therapy with dantrolene (Dantrium) have been explained to him, and he has decided that the benefits outweigh the risks. What assessments should the nurse make to determine whether the treatment is beneficial?
Definition
The nurse would anticipate a decrease in the patient’s spasticity after 1 week of therapy. If there has been no improvement in 45 days, the medication regimen is usually discontinued. In this case, the nurse should evaluate the patient’s muscle firmness, pain experience, range of motion, and ability to maintain posture and alignment when in a wheelchair. When spasticity is used to maintain posture, dantrolene should not be used. In this case, the patient’s spasticity involved only the lower extremities.
Term
A 52-year-old breast cancer survivor is taking tamoxifen (Nolvadex) and has experienced leg and foot cramps “almost nightly.” She states that these cramps have markedly decreased the quality of her sleep and that she is ready to “just stop taking” the tamoxifen to end the leg cramps. The nurse is aware that tamoxifen is considered important in the chemoprevention of breast cancer. What variety of treatment modalities can be offered this patient to promote her comfort and decrease the chance that she will stop therapy?
Definition
Leg and foot cramps have been anecdotally associated with tamoxifen, an antiestrogenic drug. Tamoxifen, which has been shown to reduce the recurrence of some breast cancers, has been demonstrated to preserve bone density. Tamoxifen has several side effects that affect lifestyle, including the potential for weight gain and leg cramps.
The nurse should assess the following factors before responding to this patient’s concerns:

What is the patient’s activity level? Muscle cramps are associated with muscle fatigue.
Does she take exogenous calcium?
Can she tolerate dietary sources of calcium?
Interventions for leg cramps include the following:
Stretching exercises before sleep
Daily calcium and magnesium supplements
Increasing dietary calcium intake
Drinking a glass of tonic water (containing quinine) at bedtime
This patient needs to relate her concerns to the oncologist. A health care provider may consider starting the patient on quinine 200 to 300 mg at bedtime. This is an off-label use and requires careful patient evaluation.
Term
A 32-year-old cotton farmer injured his lower back while unloading a truck at a farm cooperative. His health care provider started him on cyclobenzaprine (Flexeril) 10 mg tid for 7 days and referred him to outpatient physical therapy. After 4 days, the patient reports back to the office nurse that he is constipated and having trouble emptying his bladder. Discuss the cause of these side effects.
Definition
Cyclobenzaprine (Flexeril) has been demonstrated to produce significant anticholinergic activity. Students should recall that anticholinergics block the action of the neurotransmitter acetylcholine at the muscarinic receptors in the parasympathetic nervous system. This allows the activities of the sympathetic nervous system to dominate. In this case, the result has been a decrease in oral secretions and relaxation of the smooth muscle of the GI tract. Decreased peristalsis and motility can result in constipation. The anticholinergic effect is also responsible for urine retention because of increased constriction of the internal sphincter.
Term
The client exhibits symptoms of depression after an extended period of financial difficulty. The nurse recognizes this type of depression is classified as
Definition
reactive

Objective: Identify the two major categories of mood disorders, and their symptoms.
Rationale: Reactive or situational depression results from challenging circumstances, such as illness, job difficulties, loss of loved ones, divorce, or financial difficulties.
Term
The client admitted with symptoms of depression would require additional evaluation if the nurse collected which of the following data during the history and physical exam?

Vitamin K deficiency
History of diabetes mellitus
History of hypothyroidism
Asthma
Definition
History of hypothyroidism

Objective: Explain the etiology of clinical depression.
Rationale: The symptoms of depression may be attributed to medical and neurological disorders such as hypothyroidism. Diabetes, vitamin K deficiency, and asthma are not typical causes of depression, although chronic illness can contribute to depression.
Term
The client asks the nurse how antidepressants work. The best response by the nurse would be that they work by:

Increasing serotonin uptake.
Enhancing mood.
Breaking down neurotransmitters in the brain.
Increasing the ability to cope.
Definition
Enhancing mood.

Objective: Identify the symptoms of attention-deficit hyperactivity disorder.
Rationale: Antidepressants enhance neurotransmitter action by blocking breakdown of norepinephrine and slowing reuptake of serotonin. This leads to a more balanced chemical state in the brain. The client needs to learn how to develop effective means of coping.
Term
The nurse providing discharge teaching for a client recently started on a tricyclic antidepressant (TCA) must include the importance of:

Increasing fluid intake.
Using sugarless gum for a dry mouth.
Taking medication with meals.
Avoiding driving or operating dangerous equipment.
Definition
Avoiding driving or operating dangerous equipment.

Objective: Use the nursing process to care for clients receiving drug therapy for mood and emotional disorders.
Rationale: Sedation is frequently reported at initiation of therapy, and safety needs are of highest priority. The other options should also be included in the teaching, but are not the most important.
Term
The nurse encourages the client to remain compliant with TCA therapy in spite of the common side effect of:

Weight gain.
Hyperglycemia.
Excessive thirst.
Urinary frequency.
Definition
Weight gain.

Objective: Explain the etiology of clinical depression.
Rationale: Weight gain is a common side effect, and frequently leads to noncompliance with the drug regimen.
Term
Fluoxetine (Prozac) is prescribed for a client with depression. The nurse recognizes the advantage to using this drug rather than tricyclic antidepressants is that fluoxetine:

Does not cause GI distress.
Does not cause sexual dysfunction.
Does not have cardiotoxicity as a side effect.
Can be used for a shorter time.
Definition
Does not have cardiotoxicity as a side effect.

Objective: Categorize drugs used for mood and emotional disorders based on their classification and drug action.
Rationale: Fluoxetine (Prozac) is an SSRI. These drugs are safer than MAOL and TCAs, and they have fewer side effects.
Term
The nurse closely monitors the client beginning SSRI therapy for:

Suicidal ideation.
Contraceptive use.
Excessive exercise.
Weight gain.
Definition
Suicidal ideation.

Objective: Use the nursing process to care for clients receiving drug therapy for mood and emotional disorders.
Rationale: SSRIs take several weeks for full therapeutic benefit. Clients should be monitored closely for suicidal intent until SSRIs reach their maximum therapeutic effect.
Term
Which of the following would be a priority component of the teaching plan for a client prescribed phenelzine (Nardil) for treatment of depression?

Hyperglycemia can occur.
Headache can occur frequently when first started.
Monitor blood pressure for hypotension.
Read labels of food and over-the-counter (OTC) drugs.
Definition
Read labels of food and over-the-counter (OTC) drugs.

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary actions, and important adverse effects.
Rationale: Nardil is an MAOI. This class of drugs has many drug and food interactions that can cause serious reactions, especially with foods containing tyramine. They can lead to a hypertensive crisis.
Term
The nurse reviews the client's lithium serum drug level, noting that it is 0.95 mEq/L. The appropriate nursing action is to:

File the lab result in the medical record.
Hold the next dose of the drug.
Observe the client for signs of toxicity.
Notify the physician immediately.
Definition
File the lab result in the medical record.

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary actions, and important adverse effects.
Rationale: The therapeutic dose range of lithium is 0.6-1.5mEq/L. 0.95 mEq is within normal limits.
Term
The parents of a client receiving methylphenidate (Ritalin) express concern that the health care provider has suggested the child have a "holiday" from the drug. The nurse explains that the drug-free holiday is designed to:

Decrease drug dependence and assess status.
Allow the child's "normal" behavior to return.
Prevent hypertensive crisis.
Reduce the risk of drug toxicity.
Definition
Decrease drug dependence and assess status.

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary actions, and important adverse effects.
Rationale: Methylphenidate (Ritalin) is a Schedule II drug with the potential to cause drug dependence when used over an extended period of time. The drug holiday is to decrease the risk of dependence and to evaluate behavior.
Term
A 12-year-old girl has been diagnosed with ADHD. Her parents have been reluctant to agree with the pediatrician’s recommendation for pharmacologic management; however, the child’s performance in school has deteriorated. A school nurse notes that the child has been placed on amphetamine (Adderall), not methylphenidate (Ritalin). Discuss the developmental considerations that might support the use of amphetamine.
Definition
Methylphenidate (Ritalin) therapy is usually administered twice a day,with one dose before breakfast and one dose before lunch. A child in school would be required to visit a school nurse to receive a dose of Ritalin before lunch. Amphetamine (Adderall) requires once-a-day dosing and may be better accepted by the child and his or her family because treatment can be privately managed at home. Although many children cope effectively with treatment for ADHD, a 12-year-old girl might be concerned about being “singled out” for therapy. She is old enough to realize her problems in performance. The self-esteem of children in this age group is tied to success in school, a characteristic of Erikson’s developmental stage of industry versus inferiority. Children who have difficulty in school perceive themselves as being inferior to peers. Helping the child with ADHD pharmacologically may require the health care provider to be sensitive to social factors such as dosage regimens.
Term
Methylphenidate (Ritalin) therapy is usually administered twice a day,with one dose before breakfast and one dose before lunch. A child in school would be required to visit a school nurse to receive a dose of Ritalin before lunch. Amphetamine (Adderall) requires once-a-day dosing and may be better accepted by the child and his or her family because treatment can be privately managed at home. Although many children cope effectively with treatment for ADHD, a 12-year-old girl might be concerned about being “singled out” for therapy. She is old enough to realize her problems in performance. The self-esteem of children in this age group is tied to success in school, a characteristic of Erikson’s developmental stage of industry versus inferiority. Children who have difficulty in school perceive themselves as being inferior to peers. Helping the child with ADHD pharmacologically may require the health care provider to be sensitive to social factors such as dosage regimens.
Definition
The nurse should teach the patient that it might take 2 to 4 weeks before she begins to notice therapeutic benefit. The nurse should help the patient identify a support person or network to help assist as she works through her grief. The nurse also needs to instruct the patient that both caffeine and nicotine are CNS stimulants and decrease the effectiveness of the medication.
Term
A 26-year-old mother of three children comes to the prenatal clinic suspecting a fourth pregnancy. She tells the nurse that she got “real low” after her third baby and that she was prescribed sertraline (Zoloft). She tells the nurse that she is really afraid of “going crazy” if she has to stop taking the drug because of this pregnancy. What concerns should the nurse have?
Definition
The use of any drug during pregnancy must be carefully evaluated. Sertraline (Zoloft) is a pregnancy category B drug, which means that studies indicate no risk to animal fetuses, although safety in humans has not been established. The health care provider must weigh risks and benefits of any medication during pregnancy. The nurse should recognize this patient’s risk for ineffective coping, as evidenced by her history of depression, and help the patient identify support groups in the community. She may be functioning in some degree of isolation from family or other parenting women, which is typical of women who suffer postpartum depression. Identifying community resources for the patient is one intervention designed to provide more holistic care.
Term
In the administration of an antidiuretic hormone, the nurse would recognize that which medication could be easily self-administered by a client?

Vasopressin
Somatotropin
Glucocorticoids
Desmopressin (DDAVP)
Definition
Desmopressin (DDAVP)

Objective: Explain the pharmacotherapy of diabetes insipidus.
Rationale: Desmopressin (DDAVP) is available as a nasal spray, and can be easily self-administered by a client.
Term
Myxedema, which includes fatigue, general weakness, and muscle cramps, is a symptom of which endocrine disorder treated with levothyroxine (Synthroid)?

Addison's disease
Hyperthyroidism
Cushing's syndrome
Hypothyroidism
Definition
Hypothyroidism

Objective: Identify the signs and symptoms of hypothyroidism and hyperthyroidism.
Rationale: Hypothyroidism is the endocrine disorder that causes myxedema, which includes fatigue, general weakness, and muscle cramps.
Term
Which drug causes increased risk for peptic ulcers, decreased wound healing, and increased capillary fragility?

Growth hormones
Hydrocortisone (Cortef)
Antithyroid hormones
Antidiuretic hormones
Definition
Hydrocortisone (Cortef)

Objective: Explain the pharmacotherapy of adrenal gland disorders.
Rationale: Glucocorticoids can cause increased risk for peptic ulcers, decreased wound healing, and increased capillary fragility. Graves' disease

Objective: Identify the signs and symptoms of hypothyroidism and hyperthyroidism.
Rationale: Graves' disease is characterized by all of the symptoms.
Term
Which disease is characterized by increased body metabolism, tachycardia, increased body temperature, and anxiety, and treated with Prophylthiouracil (PTU)?

Graves' disease
Cushing's syndrome
Addison's disease
Hashimoto's thyroiditis
Definition
Graves' disease

Objective: Identify the signs and symptoms of hypothyroidism and hyperthyroidism.
Rationale: Graves' disease is characterized by all of the symptoms.
Term
In the administration of hydrocortisone (Aeroseb-HC, Alphadern, Cetacort), it is vital that the nurse recognize that this drug might mask which symptoms?

Signs and symptoms of infection
Signs and symptoms of heart failure
Skin infections
Hearing loss
Definition
Signs and symptoms of infection

Objective: Explain the pharmacotherapy of adrenal gland disorders.
Rationale: This drug can mask
Term
When hydrocortisone use is discontinued, the nurse must recognize the possibility of what side effect, if this drug is stopped abruptly?

Development of myxedema
Development of diabetes insipidus
Development of Cushing's syndrome
Circulatory collapse
Definition
Circulatory collapse

Objective: Explain the pharmacotherapy of thyroid disorders.
Rationale: Circulatory collapse can occur if hydrocortisone use is discontinued abruptly.
Term
A client who is taking levothyroxine (Synthroid) begins to develop weight loss, diarrhea, and intolerance. The nurse should be aware that this might be an indication of what hormonal condition?

Development of acromegaly
Cushing's syndrome
Addison's disease
Hyperthyroidism
Definition
Hyperthyroidism

Objective: Explain the pharmacotherapy of thyroid disorders.
Rationale: The client could have the hormonal condition of hyperthyroidism.
Term
Which organ is destroyed when administering radioactive I-131?

Hypothalamus
Parathyroid
Pituitary gland
Adrenals
Definition
Hypothalamus

Objective: Explain the pharmacotherapy of thyroid disorders.
Rationale: The thyroid gland is destroyed in cases of hyperthyroidism treatment using doses of sodium I-131.
Term
Of what precautions should a client receiving radioactive iodine-131 be made aware?

Be aware of the symptoms of tachycardia, increased metabolic rate, and anxiety.
Avoid close contact with children or pregnant women for one week after administration of drug.
Wear a mask if around children or pregnant women.
Drink plenty of fluids, especially those high in calcium.
Definition
Avoid close contact with children or pregnant women for one week after administration of drug.

Objective: Explain the pharmacotherapy of thyroid disorders.
Rationale: The client should avoid close contact with children or pregnant women for one week after administration of the drug.
Term
In the administration of a drug such as levothyroxine (Synthroid), the nurse must teach the client: (Select all that apply.)

Therapy could take three weeks or longer.
Report weight loss, anxiety, insomnia, and palpitations.
Periodic lab tests for T4 levels are required.
Jaundice
Definition
Therapy could take three weeks or longer.

Report weight loss, anxiety, insomnia, and palpitations.

Periodic lab tests for T4 levels are required.

Objective: Explain the pharmacotherapy of thyroid disorders.
Rationale: The nurse needs to be aware the action, uses, and adverse side effects, including the need for periodic T4 lab tests; that therapy might take three weeks or longer for effect; and that the symptoms of anxiety, weight loss, and insomnia indicate hyperthyroidism.
Term
A 5-year-old girl requires treatment for diabetes insipidus acquired following a case of meningitis. The child has suffered serious complications including blindness and mental retardation. Her diabetes insipidus is being treated with intranasal desmopressin, and the child’s mother has been asked to help evaluate the drug’s effectiveness using urine volumes and urine specific gravity. Discuss the changes that would indicate that the drug is effective.
Definition
To answer this question the student should refer to a medical–surgical text or a laboratory manual. A child with diabetes insipidus produces large amounts of pale or colorless urine with a low specific gravity of 1.001 to 1.005. Daily urine volume may be 4 to 10 L or more and result in excessive thirst and rapid dehydration. Desmopressin is a synthetic analog of ADH. It may be administered intranasally and therefore may be better tolerated by a child. With pharmacotherapy, there should be an immediate decrease in urine production and an increase in urine concentration. The child’s mother or caregiver should be taught to use a urine dipstick to check specific gravity during the initiation of therapy. A normal specific gravity would range from 1.005 to 1.030 and would indicate that the kidneys are concentrating urine. The caregiver also should be taught to monitor urine volume, color, and odor until a dosing regimen is established.
Term
A 17-year-old adolescent with a history of severe asthma is admitted to the intensive care unit. He is comatose, appears much younger than his listed age, and has short stature. The nurse notes that the asthma has been managed with prednisone for 15 days, until 3 days ago. The patient’s father is extremely anxious and says that he was unable to refill his son’s prescription for medicine until he got his paycheck. What is the nurse’s role in this situation?
Definition
The nurse must be empathetic with the patient’s father and allow him to express his concerns. He may feel guilty about contributing to his son’s current health crisis. Once the patient’s condition begins to improve, the nurse should assess the father’s understanding of the asthma regimen. The father and the patient should receive instruction about the side effects of glucocorticoid therapy. Glucocorticoids used for anti-inflammatory purposes can suppress the hypothalamic–pituitary axis. Abruptly discontinuing a glucocorticoid after long-term therapy (more than 10 days) can produce cardiovascular collapse. The father needs to be instructed about the dosage regimen for prednisone, which may include an incremental decrease in the drug dosage when discontinuing the drug. The nurse might also be concerned about the family’s economic needs. Referrals to a resource providing financial support for medication is appropriate.
Term
A 9-year-old boy has been diagnosed with growth hormone deficiency. His parents have decided to proceed with a prescribed regimen of somatotropin (Humatrope). Outline the basic information the parents need to know regarding this regimen, side effects, and evaluation of effectiveness.
Definition
The instruction needed by the parents should include the following points:

Drug action: The drug stimulates growth of most body tissues, especially epiphyseal plates; it also increases cellular size.
Instructions for reconstituting the medication, site selection, and technique for IM or subcutaneous injection.
Dosing schedule: Somatropin injections are usually scheduled 48 hours apart.
Pain and swelling at the injection site.
Importance of regular follow-up with the health care provider, including checks on height, weight, and bone age.
A discussion of the cost of the medication and an opportunity for the parents to raise any concerns they may have for appropriate referral to the prescriber or social services department.
Term
Which of the following hormones maintains adequate levels of glucose in the blood between meals?

Cortisol
Insulin
Epinephrine
Glucagon
Definition
Glucagon

Objective: Describe the endocrine and exocrine functions of the pancreas.
Rationale: Glucagon is an antagonist to insu
Term
The client received NPH (isophane) insulin at 0730. Based on an understanding of peak time, the nurse should assess the client for hypoglycemia at which of the following times?

1000
1600
1400
1200
Definition
1600

Objective: Describe the signs and symptoms of insulin overdose and underdose.
Rationale: The onset of NPH is between 1 and 4 hours, and it peaks between 8 and 12 hours.
Term
The client is scheduled to receive 5 units of Humalog and 25 units of glargine (Lantus) insulin prior to bedtime for a blood sugar of 252. What nursing intervention is most appropriate for this client?

Offer the client a high-carbohydrate snack in six hours.
Make sure the client's snack is ready to eat before administering this insulin.
Administer the medications in two separate syringes.
Hold the insulin if the blood glucose level is <100 mg/dl.
Definition
Make sure the client's snack is ready to eat before administering this insulin.

Objective: Describe the nurse's role in the pharmacological management of diabetes mellitus.
Rationale: Hypoglycemic reactions can occur rapidly if Humalog insulin is not supported by sufficient food intake. Lantus is a peakless insulin that is often administered in the evening.
Term
During the assessment, the client states, "My blood glucose levels range between 80-100mg/dl, but my early-morning blood glucose levels are 200 mg/dl." This phenomena is best known as _________.

Hyperosmolarity
Somogyi phenomenon
Insulin resistance
Diabetic ketoacidosis
Definition
Somogyi phenomenon

Objective: Describe the signs and symptoms of insulin overdose and underdose.
Rationale: Somogyi phenomenon occurs when there is a rapid drop in blood glucose levels during the night, which stimulates the release of blood glucose-elevating hormones.
Term
The nurse is initiating discharge teaching with the newly diagnosed diabetic. Which of the following statements indicates that the client needs additional teaching?

"If I am experiencing hypoglycemia, I should drink half a cup of apple juice."
'If my blood glucose levels are greater than 300mg/dl, I must check my urine for ketones."
"I must draw the NPH insulin first if I am mixing it with regular insulin."
"My insulin needs might increase when I have an infection."
Definition
"I must draw the NPH insulin first if I am mixing it with regular insulin."

Objective: Use the nursing process to care for clients receiving drug therapy for diabetes mellitus.
Rationale: Additional teaching is needed, since clients are instructed to draw the clear solution (regular insulin) into the syringe first, followed by the cloudy solution (NPH).
Term
Which of the following medications prescribed for a type 2 diabetic client is needed to optimize the secretion of insulin, slows glucose absorption, and decreases action of glucagons?

Repaglinide (Prandin)
Glucophage (Metformin)
Rosiglitazone (Avandia)
Exenatide (Byetta)
Definition
Exenatide (Byetta)

Objective: Identify drug classes used to treat type 2 diabetes mellitus.
Rationale: Exenatide (Byetta) is an injectable drug that belongs to a class of drugs called incretin hormones. Type 2 diabetics need to secrete some insulin in response to small elevations in blood glucose. This response is diminished at 115 mg/dl.
Term
The client is newly admitted with clinical manifestations of type 1 diabetes ketoacidosis. Which of the following medications would the nurse anticipate administering to this client via IV access immediately?

Regular insulin
Cimetadine (Tagamet)
Glargine (Lantus)
Pancreatin (Viokase)
Definition
Regular insulin

Objective: Identify drug classes used to treat Type 1 diabetes mellitus.
Rationale: The chief complaint of a client experiencing diabetic ketoacidosis, which requires regular insulin to be administered immediately.
Term
The nurse is initiating client education about taking the medication Glucophage (metformin). Which of the following questions is most important to ask the client prior to beginning therapy on metformin?

"Will you have difficulty eating only three main meals per day?"
"Do you have a way to crush your pills prior to mixing with food?"
"Do you have any known liver function abnormalities?"
"Are you able to limit your fluid intake to avoid bloating?"
Definition
"Do you have any known liver function abnormalities?"

Objective: For each of the drug classes listed in Drugs at a Glance, identify representative drug examples, and explain the mechanisms of drug action, primary actions, and important adverse effects.
Rationale: Since metformin works on the liver, its use in people known to have liver disease should be avoided.
Term
What information should the nurse give to the diabetic client who is planning an exercise program?

Withhold insulin prior to engaging in strenuous exercise.
Exercise does not increase insulin needs.
Monitor blood glucose levels before and after exercise.
Eat a complex carbohydrate at the first sign of hypoglycemia.
Definition
"Do you have any known liver function abnormalities?"

Objective: For each of the drug classes listed in Drugs at a Glance, identify representative drug examples, and explain the mechanisms of drug action, primary actions, and important adverse effects.
Rationale: Since metformin works on the liver, its use in people known to have liver disease should be avoided.
Cognitive Level: Analysis
Term
What information should the nurse give to the diabetic client who is starting on glargine (Lantus)?

Stress does not increase insulin needs.
Withhold insulin if you are feeling better.
Eat a complex carbohydrate within 15 minutes of administration to prevent hypoglycemia.
Lantus should not be mixed with any other insulin.
Definition
Lantus should not be mixed with any other insulin.

Objective: Use the nursing process to care for clients receiving drug therapy for diabetes mellitus.
Rationale: Lantus insulin cannot be mixed with other insulin.
Term
A 28-year-old woman who is pregnant with her first child is diagnosed with gestational DM. She is concerned about the fact that she might have to take “shots.” She tells the nurse at the public health clinic that she does not think she can self-administer an injection and asks if there is a pill that will control her blood sugar. She has heard her grandfather talk about his pills to control his “sugar.” What should the nurse explain to this patient?
Definition
The nurse should first explain that management of type 1 diabetes is initiated with diet, exercise, and home blood glucose monitoring. Compliance with prescribed regimens may reduce the patient’s fasting and postprandial blood glucose values to acceptable levels. Mothers with type 1 diabetes must keep their blood glucose level within a very narrow range to prevent the numerous complications that can occur because of elevated blood glucose during pregnancy. These complications can range from fetal deformity to fetal macrosomia and its subsequent sequelae. Some authorities recommend that the fasting blood glucose levels be maintained at or below 100 mg/dL and the postprandial glucose below 120 mg/dL. The nurse should prepare the patient for insulin therapy in case diet and exercise fail to maintain control. Oral hypoglycemic agents cross placental membranes and have been implicated as teratogenic agents. Their use is not recommended during pregnancy.
Term
A type 2 diabetic on metformin (Glucophage) reports that he takes propranolol (Inderal) for his hypertension. What concerns would the nurse have about this combination of medications and what would the nurse teach the patient?
Definition
Beta-blocking drugs such as propranolol have the potential to affect type II diabetics on oral hypoglycemics by altering the way hypoglycemia is perceived. In recent studies, hypoglycemia was perceived differently in patients taking concurrent beta-blocker therapy than patients who were not. Diaphoresis was a common symptom when blood sugar decreased among those patients on beta blockers along with their oral hypoglycemic drug. The nurse should teach the patient to be aware that should his blood sugar begin to decrease, symptoms normally felt (e.g., nervousness, tremors, agitation) may be perceived differently and that should diaphoresis occur, he should check his blood sugar immediately.
Term
The patient has insulin glargine (Lantus) and regular insulin ordered for every morning. Explain the implications of administering these two types of insulins.
Definition
Insulin glargine (Lantus) is a newer agent that is a recombinant human insulin analog. It must not be mixed in the syringe with any other insulin and must be administered subcutaneously. Insulin glargine appears to have a constant long-duration hypoglycemic effect with no defined peak effect. It is prescribed once daily, at bedtime. The nurse should question the order for Lantus to be administered every morning.
Term
Caffeinated beverages and smoking are risk factors to assess for in the development of what condition?

Peptic ulcers
Esophageal reflux
Duodenal ulcers
Helicobacter pylori
Definition
Peptic ulcers

Objective: Identify common causes, signs, and symptoms of peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD).
Rationale: PUD risk factors include family history, blood group O, smoking tobacco, and beverages containing caffeine.
Term
The gram-negative bacterium Helicobacter pylori is the primary cause of what type of ulcer development?

Esophageal ulcers
Duodenal ulcers
Peptic ulcers
Gastric ulcers
Definition
Peptic ulcers

Objective: Identify common causes, signs, and symptoms of peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD).
Rationale: The gram-negative bacterium Helicobacter pylori is the primary cause development of peptic ulcers.
Term
The development of GERD (gastroesophageal reflux disease) is often associated with what medical condition?

Type II diabetes mellitus
Alcohol use
Cigarette smoking
Obesity
Definition
Obesity

Objective: Identify common causes, signs, and symptoms of peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD).
Rationale: Development of GERD (gastroesophageal reflux disease) is often associated with obesity.
Term
The drug of choice in the H2-receptor antagonists, ranitidine (Zantac), is preferable to the use of cimetidine (Tagamet) for what reason?

Zantac (ranitidine) has a higher potency than cimetidine, and can be administered once daily.
Zantac has a lower cost.
Zantac (ranitidine) crosses the blood-brain barrier.
Cimetidine causes less confusion and CNS depression.
Definition
Zantac (ranitidine) has a higher potency than cimetidine, and can be administered once daily.

Objective: Identify common causes, signs, and symptoms of peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD).
Rationale: Development of GERD (gastroesophageal reflux disease) is often associated with obesity.
Term
Mrs. Johnson has been using over the proton pump inhibitors for relief of gastric upset. The nurse should teach Mrs. Johnson that appropriate administration is to:

Crush the medication.
Never crush or chew medication.
Take with antacids.
Take medication 30 minutes after eating.
Definition
Never crush or chew medication.

Objective: Use the nursing process to care for clients who are receiving drug therapy for PUD.
Rationale: Stress the importance of taking medication before meals, and not crushing, breaking, or chewing medication.
Term
In the treatment of Helicobacter pylori, the nurse must recognize that the use of two or more antibiotics is essential for what reason?

They lower the potential for bacterial resistance.
They decrease the chances of development of duodenal ulcers.
They increase the likelihood of eliminating redevelopment of gastric ulcers.
They decrease the cost of future drug therapies.
Definition
They lower the potential for bacterial resistance.

Objective: Explain the pharmacologic strategies for eradicating Helicobacter pylori.
Rationale: Two or more antibiotics are used in order to lower the potential for bacterial resistance.
Term
In addition to the use of multiple antibiotics, what compound may be added to the regimen treatment of Helicobacter pylori?

Antacids
Bismuth compounds
H2-receptor inhibitors
Vitamin E compounds
Definition
Bismuth compounds

Objective: Explain the pharmacologic strategies for eradicating Helicobacter pylori.
Rationale: Bismuth compounds may be added to the regimen treatment of Helicobacter pylori.
Term
Peptic ulcer disease is commonly treated with inexpensive therapy medications called _____.

Sucralfate (Carafate)
Pirenzepine (Gastrozepin)
Misoprostol (Cytotec)
Aluminum hydroxide (antacid)
Definition
Aluminum hydroxide (antacid)

Objective: Identify the classification of drugs used to treat PUD.
Rationale: Antacids are effective at neutralizing stomach acid, and are inexpensive OTC therapy for PUD or GERD.
Term
The nurse must be aware of what natural therapy that many people use to induce a sense of calm, but which in reality could make esophageal reflux more pronounced?

Chocolate
Basil
Ginger
Peppermint
Definition
Peppermint

Objective: Describe the nurse's role in the pharmacologic management of clients with PUD.
Rationale: Peppermint may be used to induce a sense of calm, but in reality, it could make esophageal reflux more pronounced.
Term
What natural therapy should the nurse encourage patients to use to strengthen the upper GI tract?

Chocolate
Peppermint
Basil
Ginger
Definition
Ginger

Objective: Describe the nurse's role in the pharmacologic management of clients with PUD.
Rationale: Ginger should be used to strengthen the upper GI tract.
Term
A patient with chronic hyperacidity of the stomach takes aluminum hydroxide (Amphojel) on a regular basis. The patient presents to the clinic with complaints of increasing weakness. What may be the cause of this increasing weakness?
Definition
Regular use of aluminum hydroxide (Amphojel) may cause hypercalcemia because calcium and phosphorus have a reciprocal relationship; that is, if the calcium goes up, the phosphorus goes down. A patient with low serum phosphorus often exhibits signs of increasing weakness. The treatment is to replace the aluminum hydroxide with a different antacid and take oral phosphorus supplements until serum phosphorus returns to a normal level.
Term
Identify why nurses who work at night are at higher risk for developing PUD.
Definition
The stomach is empty during the sleep cycle, the time when the protective protein peptide TFF2 is most effective at repairing the mucoprotective lining of the stomach. For the TFF2 protein to reach its maximum effectiveness, the person needs a minimum of 6 hours of uninterrupted sleep, which is uncommon in people who sleep during the daytime.
Term
A patient who is on ranitidine (Zantac) for PUD smokes and drinks alcohol daily. What education will the nurse provide to this patient?
Definition
This patient has a history of PUD; therefore, alcohol and smoking are contraindicated because they will exacerbate the condition. This patient is on ranitidine (Zantac), and smoking decreases the effectiveness of the medication. Alcohol is a depressant and can cause increased drowsiness in combination with ranitidine. This patient should be advised to stop smoking and drinking alcohol if PUD is to be resolved.
Term
The nurse is caring for a patient preparing to undergo a colonoscopy. She should be prepared to give what drug?

Antihypertensive
Diuretic
Laxative
Cathartic
Definition
Cathartic

Objective: Describe the nurse's role in the pharmacologic management of bowel disorders, nausea and vomiting, and other GI conditions.
Rationale: A cathartic drug is used for a client preparing to undergo a colonoscopy.
Term
What is one of the major precipitating factors in the development of irritable bowel syndrome (IBS)?

Peptic ulcers
Helicobacter pylori
Stress
GERD (gastroesophageal reflux disease)
Definition
Stress

Objective: Discuss conditions where the pharmacotherapy of bowel disorders is indicated.
Rationale: Stress is one of the major factors for developing irritable bowel syndrome (IBS), along with dietary factors.
Term
Mrs. Smith has had intractable diarrhea for two weeks. The nurse would expect to administer what type of drug for the treatment of this condition?

Opioids
Cathartics
Laxatives
Bulk-forming agents
Definition
Opioids

Objective: Describe the nurse's role in the pharmacologic management of bowel disorders, nausea and vomiting, and other GI conditions.
Rationale: The nurse would expect to administer opioids, such as atropine (Lomotil), for intractable diarrhea.
Term
With a prolonged episode of vomiting, the patient could be at risk for the development of what problem?

Hypoventilation
Intractable diarrhea
Acid-base disturbances
Esophageal tears
Definition
Acid-base disturbances

Objective: Discuss conditions where the pharmacotherapy of bowel disorders is indicated.
Rationale: After a prolonged episode of vomiting, the patient could be at risk for acid-base disturbances.
Term
When treating a nauseated patient with antiemetics, it is essential that the nurse understand what principle?

There are no known side effects of antiemetics.
Sports drinks replace the essential ingredients lost by dehydration.
Sports drinks are an excellent substitute for antiemetics.
Patient safety is a concern, as drowsiness is a frequent side effect.
Definition
Patient safety is a concern, as drowsiness is a frequent side effect.

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drugs, and explain the mechanisms of drug action, describe primary actions, and identify important adverse effects.
Rationale: The medication could cause drowsiness, and the patient should avoid driving or performing hazardous tasks. Vomiting could be a serious disorder, and should not be treated with OTC medications for a long period of time.
Term
What dietary information is it helpful to record when treating diarrhea in children? (Select all that apply.).

Record hours of sleep.
Measure the fluid intake, including popsicles and ice chips.
Weigh the client daily.
Measure the percentage of additional high fiber in the diet.
Definition
Weigh the client daily.

Measure the fluid intake, including popsicles and ice chips.

Objective: Use the nursing process to care for clients who are receiving drug therapy for bowel disorders, nausea and vomiting, and other GI conditions.
Rationale: Recording the frequency of stools, noting blood, and reporting any abdominal pain would be helpful in treating diarrhea in children. Measure weight to determine dehydration, and record fluid intake.
Term
Mrs. James has been given a drug for treatment of nausea and vomiting. She is now complaining of dry mouth, constipation, and a rapid heart rate. What drug would cause these side effects?

Peppermint
Diphenoxylate (Lomotil)
Prochlorperazine (Compazine)
Loperamide (Imodium, Kaopectate)
Definition
Prochlorperazine (Compazine)

Objective: Categorize drugs used in the treatment of bowel disorders, nausea, and vomiting based on their classifications and mechanisms of action.
Rationale: Prochlorperazine (Compazine) can cause dry mouth, constipation, and a rapid heart rate.
Term
In giving hydroxyzine (Vistaril), the nurse must be careful to deliver what type of injection?

Subcutaneous
Deep IM, using the Z-track method
Intramuscular in the deltoid muscle
In the umbilical, being careful not to aspirate
Definition
Deep IM, using the Z-track method

Objective: Describe the nurse's role in the pharmacologic management of bowel disorders, nausea and vomiting, and other GI conditions.
Rationale: The nurse must be careful to deliver a deep IM, using the Z-track method.
Term
Mr. Howard has been diagnosed with constipation after surgery. What drug should the nurse have prepared to administer?

Docusate sodium (Colace)
Loperamide (Imodium)
Prochlorperazine (Compazine)
Promethazine (Phenergan)
Definition
Docusate sodium (Colace)

Objective: Describe the nurse's role in the pharmacologic management of bowel disorders, nausea and vomiting, and other GI conditions.
Rationale: A stool softener such as docusate sodium (Colace) should be administered.
Term
Mr. Howard should be urged to take diphenhydrinate (Dramamine) how long before he plans to board a fishing boat for an overnight trip?

2 hours
20-60 minutes
6 hours
15 minutes
Definition
20-60 minutes

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drugs, and explain the mechanisms of drug action, describe primary actions, and identify important adverse effects.
Rationale: Dramamine should be taken at least 20-60 minutes before anticipated need.
Term
The patient has been taking diphenoxylate with atropine (Lomotil) for diarrhea for the past 3 days. The patient has had diarrhea five times today. Identify the priorities of nursing care.
Definition
A priority for the nurse is to assess the potential for dehydration. The nurse should assess the patient for possible hypotension and tachycardia. The cause of this ongoing diarrhea needs to be investigated by the health care provider.
Term
The health care provider has ordered morphine and prochlorperazine (Compazine) for a patient with postoperative pain. The patient insists that she is “needle phobic” and wants all the medication in one syringe. What is the nurse’s response?
Definition
The patient needs to be informed that prochlorperazine (Compazine) is administered in its own syringe and must not be mixed with any other drug. The nurse could notify the health care provider that the patient wants a change of antiemetic to one that can be combined with an analgesic and given in the same syringe.
Term
A patient comes to the clinic complaining of no bowel movement for 4 days (other than small amounts of liquid stool). The patient has been taking psyllium mucilloid (Metamucil) for his constipation and wants to know why this is not working. What is the nurse’s response?
Definition
This patient needs to take a contact laxative to stimulate the nerve endings and facilitate a bowel movement. A bulk-forming laxative promotes bowel regularity. The liquid stool may be a result of fecal impaction, in which only liquid seeps out. If this patient has ongoing bowel irregularity problems, the bulk-forming laxative may be helpful later. The nurse should assess the abdomen for bowel sounds and educate the patient to drink plenty of fluids when taking bulk-forming laxatives.
Term
Erythropoietin regulates the process of red blood cell formation. The nurse understands that this mechanism is activated by a reduction of oxygen reaching the:

Kidneys.
Lungs.
Heart.
Brain.
Definition
Kidneys.

Objective: Explain how hematopoiesis is regulated.
Rationale: Secreted by the kidney, erythropoietin travels to the bone marrow, where it interacts with receptors on hematopoietic stem cells with the message to increase erythrocyte production. The primary signal for the increased secretion of erythropoietin is a reduction in oxygen reaching the kidney.
Term
A client with a diagnosis of cancer is receiving epoetin alfa (Epogen, Procrit) as part of the treatment regimen. The nurse evaluates the effectiveness of this drug by:

Monitoring the client's blood pressure.
Assessing the client's level of consciousness.
Monitoring the hematocrit and hemoglobin levels.
Assessing the client's energy level.
Definition
Monitoring the hematocrit and hemoglobin levels.

Objective: Use the nursing process to care for patients who are receiving drug therapy for hematopoietic disorders.
Rationale: This medication does not cure the primary disease condition; however, it helps reduce the anemia that dramatically affects the client's ability to function. The hematocrit and hemoglobin levels will provide reference for evaluating the drug's effectiveness.
Term
The nursing care plan for a client receiving epoetin alfa (Epogen, Procrit) should include careful monitoring for symptoms of:

Severe hypotension.
Impaired liver function.
Severe diarrhea.
Angina, or a change in level of consciousness.
Definition
Angina, or a change in level of consciousness.

Objective: Categorize drugs used in the treatment of hematopoietic disorders based on their classifications and mechanisms of action.
Rationale: This drug increases the risk of thromboembolic disease. The client should be monitored for early signs of stroke or heart attack.
Term
The nurse administers filgrastim (Neupogen) to the client. The nurse explains that this drug is used in the treatment of:

Clients with Hodgkin's disease who are having bone marrow transplants.
Acute lymphoblastic leukemia.
Neutropenia, or neutropenia secondary to chemotherapy.
Hodgkin's lymphoma.
Definition
Neutropenia, or neutropenia secondary to chemotherapy.

Objective: Describe the nurse's role in the pharmacologic management of hematopoietic disorders.
Rationale: Filgrastim is a colony-stimulating factor used primarily for chronic neutropenia, or neutropenia secondary to chemotherapy.
Term
The client receiving filgrastim (Neupogen) should be monitored for common adverse effects, which include:

Elevated liver enzymes.
Hypertension and skeletal pain.
Hypotension and hypoglycemia.
Elevated BUN and creatinine.
Definition
Hypertension and skeletal pain.

Objective: Describe the nurse's role in the pharmacologic management of hematopoietic disorders.
Rationale: The nurse should assess for both hypertension and skeletal pain, which are adverse effects of filgrastim therapy.
Term
Prior to the administration of sargramostim (Leukine), the nurse should assess:

Blood pressure.
CBC.
Bowel sounds.
Level of consciousness.
Definition
CBC.

Objective: Describe the nurse's role in the pharmacologic management of hematopoietic disorders.
Rationale: The CBC should be assessed prior to administration, because this drug is contraindicated when excessive leukemic myeloid blasts are present in blood or bone marrow.
Term
The client receiving chemotherapy is prescribed oprelvekin (Neumega) as part of the treatment regimen. The nurse explains that the function of this drug is to:

Reverse bone marrow suppression.
Stimulate platelet production.
Stimulate white blood cell production.
Reduce excessive immature white cells.
Definition
Stimulate platelet production.

Objective: Categorize drugs used in the treatment of hematopoietic disorders based on their classifications and mechanisms of action.
Rationale: Oprelvekin (Neumega) is a medication, produced through recombinant DNA technology, that stimulates the production of megakaryocytes and thrombopoietin. The drug is used to stimulate the production of platelets in clients who are at risk for thrombocytopenia caused by cancer chemotherapy.
Term
The nurse teaches the client and caregivers to immediately report to the health care provider which of the following symptoms of adverse reaction to oprelvekin (Neumega)?

Muscle pain
Thirst
Nausea
Cough; difficulty breathing
Definition
Cough; difficulty breathing

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drugs, and explain their mechanisms of drug action, primary actions, and important adverse effects.
Rationale: Fluid retention is a common side effect of oprelvekin therapy. The client should be assessed for the symptoms of pleural effusion, HF, and dysrhythmias.
Term
The nurse explains to the client that the development of pernicious anemia is caused by:

Bone marrow depression.
Blood loss.
Lack of intrinsic factor; vitamin B12 deficiency.
Iron deficiency.
Definition
Blood loss.

Objective: Classify types of anemia based on their causes.
Rationale: Intrinsic factor is required for Vitamin B12 to be absorbed from the intestine. The most profound consequence of B12 deficiency is pernicious anemia, or megaloblastic anemia.
Term
The nurse prepares nutritional teaching for a group of clients. The nurse recognizes that the client most at risk for ____________ anemia is the client diagnosed with Insufficient Dietary Intake.

Folate-deficiency
Aplastic
Hemolytic
Sickle-cell
Definition
Folate-deficiency

Objective: Classify types of anemia based on their causes.
Rationale: The most common cause of folate deficiency is insufficient dietary intake. This is most commonly observed with chronic alcoholism, although other absorption diseases of the small intestine can result in folate anemia.
Term
A patient newly diagnosed with renal failure asks the nurse why he must receive injections of epoetin alfa (Epogen, Procrit). Develop teaching points to describe the indications for this drug.
Definition
Patients with chronic renal failure often have decreased secretion of endogenous erythropoietin and therefore require a medication such as epoetin alfa (Epogen) to stimulate RBC production and reduce the potential of becoming anemic (or to decrease the effects of anemia). Teaching points should include the importance of monitoring blood pressure for hypertension. Side effects such as nausea, vomiting, constipation, redness/pain at the injection site, confusion, numbness, chest pain, and difficulty breathing should be reported to the health care provider. The patient should also be instructed to maintain a healthy diet and follow any dietary restrictions necessary because of renal failure.
Term
A patient is receiving filgrastim (Neupogen). What nursing interventions are appropriate to safely administer this drug and provide patient safety throughout therapy?
Definition
Patients who are receiving filgrastim (Neupogen) should have their vital signs assessed every 4 hours (especially pulse and temperature) to monitor for signs of infection related to a low WBC count. Other nursing interventions include assessing for signs and symptoms of myocardial infarction, dysrhythmias, and hepatic dysfunction during treatment.
Term
A patient is receiving ferrous sulfate (Feosol, others). What teaching should the nurse provide to this patient?
Definition
Patients taking this drug need to be educated about the GI distress that may occur while on iron supplements. This medication may be taken with food to reduce the potential for GI upset. Constipation is a common complaint of patients on this medication, so preventive measures need to be taken. The patient needs to ensure that this medication has a child-resistant cap and is safely secured, because overdose of iron supplements is a common toxicology emergency for children.
Term
The client asks how too much calcium could be dangerous. The nurse explains that hypercalcemia could cause:

Muscle spasms.
Cardiac dysrhythmias.
Osteomalacia.
Convulsions.
Definition
Cardiac dysrhythmias.

Objective: Identify major disorders, signs and symptoms associated with an imbalance of calcium, vitamin D, parathyroid hormone, and calcitonin.
Rationale: Calcium ions influence the excitability of all neurons. Whenever calcium concentrations are too high, sodium permeability decreases across cell membranes. This is a dangerous state because nerve conduction depends on the proper influx of sodium into cells.
Term
The nurse completing a physical exam on a child diagnosed with osteomalacia would expect to find:

Deformities of the fingers and toes.
Shortness of breath.
The use of crutches for walking.
Bowlegs and a pigeon breast.
Definition
Bowlegs and a pigeon breast.

Objective: Identify important disorders characterized by weak, fragile bones and abnormal joints.
Rationale: Osteomalacia, referred to as rickets in children, is a disorder characterized by softening of bones without alteration of basic bone structure. Classic signs of rickets in children include bowlegs and a pigeon breast.
Term
The client's calcium level is reported as 5.6 mg/dL. The nurse should assess the client for:

Muscle spasms.
Headache.
Drowsiness.
Anorexia.
Definition
Muscle spasms.

Objective: Identify major disorders, signs, and symptoms associated with an imbalance of calcium, vitamin D, parathyroid hormone, and calcitonin.
Rationale: Normal serum calcium level is 8.5-11.5 mg/dL. Signs of hypocalcemia include seizures, muscle spasms, facial twitching, and paresthesias.
Term
The nurse cautions the client receiving calcium gluconate to avoid adding foods such as nuts, legumes, and tofu to the diet. The rationale for this instruction is that:

These foods can cause hypercalcemia.
These foods are high in fat.
These foods cause GI distress.
These foods, rich in zinc, can decrease calcium absorption.
Definition
These foods, rich in zinc, can decrease calcium absorption.

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drugs, and explain their mechanisms of action, primary actions, and important adverse effects.
Rationale: Consuming food rich in zinc can decrease calcium absorption. Teach clients to avoid zinc-rich foods such as nuts, legumes, seeds, sprouts, and tofu.
Term
An explanation of the disease process of osteoporosis is included in the discharge teaching for a client. The nurse explains that the most common risk factor for this disorder is:

Onset of menopause.
Limited exercise.
Alcohol consumption.
Smoking.
Definition
Onset of menopause.

Objective: Identify important disorders characterized by weak, fragile bones and abnormal joints.
Rationale: The most common risk factor associated with the development of osteoporosis is the onset of menopause. When women reach menopause, estrogen levels decline in the bloodstream. When estrogen levels are low, bones become weak and fragile.
Term
The nurse explains that the action of alendronate (Fosamax) is to:

Increase bone density.
Increase calcium absorption.
Inhibit bone resorption.
Increase calcium production.
Definition
Inhibit bone resorption.

Objective: Describe the nurse's role in the pharmacological management of disorders caused by calcium and vitamin D deficiency.
Rationale: Alendronate (Fosamax) is classified as a bisphosphonate drug. Bisphosphonates block bone resorption by inhibiting osteoclast activity. These drugs strengthen bones with continued use.
Term
The nurse explains to a client that an advantage of using tamoxifen (Nolvadex) for increasing bone density instead of estrogen replacement therapy (ERT) is that:

There is increased absorption of calcium.
The risk of uterine cancer is reduced.
There is increased development of bone density.
Vaginal bleeding does not occur.
Definition
The risk of uterine cancer is reduced.

Objective: Describe the nurse's role in the pharmacological management of disorders caused by calcium and vitamin D deficiency.
Rationale: Tamoxifen (Nolvadex) provides the benefit of increasing bone density without the risk of uterine cancer. It mimics the effect of estrogen, reducing the risk of bone fracture. The incidence of blood clots is less than with other drugs.
Term
Sodium hyaluronate (Hyalgan) is prescribed for a client with osteoarthritis. The nurse explains this drug will be administered by which method?

Directly into the joint
Subcutaneously
Intravenously
Intramuscularly
Definition
Directly into the joint

Objective: Describe the nurse's role in the pharmacological management of disorders caused by calcium and vitamin D deficiency.
Rationale: Hyalgan is administered by injection directly into the knee joint. This medication replaces or supplements the body's natural hyaluronic acid, which deteriorates due to the inflammation of osteoarthritis.
Term
The client admitted with a diagnosis of gout complains of red, swollen, and inflamed tissues of the big toes, heels, and ankles. The nurse recognizes this type of gout is most likely classified as:

Secondary gout.
Acute gouty arthritis.
Primary gout.
Tertiary gout.
Definition
Acute gouty arthritis.

Objective: Identify important disorders characterized by weak, fragile bones and abnormal joints.
Rationale: Acute gouty arthritis occurs when needle-shaped uric acid crystals accumulate in the joints of the toes, heels, ankles, wrists, fingers, knees, and elbows. The joints become red, swollen, and inflamed.
Term
The client receiving allopurinol (Lopurin) for treatment of gout asks why he should avoid consumption of _____________.

Alcohol
Fat intake
Carbohydrates
Definition
Alcohol

Objective: Describe the nurse’s role in the pharmacological management of disorders caused by uric acid.
Rationale: Gout is a metabolic disorder characterized by the accumulation of uric acid in the blood stream or joint cavities. Alcohol increases uric acid levels.

A young woman calls the triage nurse in her health care provider’s office with questions concerning her mother’s medication. The mother, age 76, has been taking alendronate (Fosamax) after a bone-density study revealed a decrease in bone mass. The daughter is worried that her mother may not be taking the drug correctly and asks for information to minimize the potential for drug adverse effects. What information should the triage nurse incorporate in a teaching plan regarding the oral administration of alendronate?
Term
A young woman calls the triage nurse in her health care provider’s office with questions concerning her mother’s medication. The mother, age 76, has been taking alendronate (Fosamax) after a bone-density study revealed a decrease in bone mass. The daughter is worried that her mother may not be taking the drug correctly and asks for information to minimize the potential for drug adverse effects. What information should the triage nurse incorporate in a teaching plan regarding the oral administration of alendronate?
Definition
Alendronate (Fosamax) is poorly absorbed after oral administration and can produce significant GI irritation. It is important that the patient be educated regarding several elements of drug administration. To promote absorption, the drug should be taken first thing in the morning with 8 oz of water before food or beverages are ingested or any other medications are taken. It has been shown that certain beverages, such as orange juice and coffee, interfere with drug absorption. By delaying eating for 30 minutes or more, the patient is promoting absorption of the drug. Additionally, the patient should be taught to sit upright after taking the drug to reduce the risk of esophageal irritation. Alendronate must be used carefully in patients with esophagitis or gastric ulcer. If the patient misses a dose, she should be told to skip it and not to double the next dose. Alendronate has a long halflife, and missing an occasional dose will do little to interfere with the therapeutic effect of the drug.
Term
A community health nurse has decided to discuss the benefits of oral calcium supplements with an 82-year-old female patient. The patient had a stroke 6 years ago and requires help with most activities of daily living. Since her husband’s death 18 months ago, she rarely leaves home. She has lost 25 lb because she“just can’t get interested”in her meals. She refuses to drink milk. What considerations must the nurse make before recommending calcium supplementation?
Definition
Frail elderly patients may be susceptible to hypocalcemia caused by dietary deficiencies of calcium and vitamin D or decreased physical activity and lack of exposure to sunshine. This patient has all these risk factors. She is uninterested in eating, has physical limitations, and is not able to get out of the house into the sunshine without assistance. Orally administered calcium requires vitamin D for absorption to take place. Because this patient does not consume milk, the most recognizable source of vitamin D, she needs to be encouraged to increase her intake of other dietary sources of this vitamin. Foods rich in vitamin D include canned salmon, cereals, lean meats, beans, and potatoes. To promote the effectiveness of calcium supplementation, the nurse must remember the importance of drug–nutrient interactions.
Term
A 36-year-old man comes to the emergency department complaining of severe pain in the first joint of his right big toe. The triage nurse inspects the toe and notes that the joint is red, swollen, and extremely tender. Recognizing this as a typical presentation for acute gouty arthritis, what historical data should the nurse obtain relevant to this disease process?
Definition
The triage nurse should obtain information about the onset of symptoms, degree of discomfort, and frequency of attacks. A familial history of gout can be predictive, because primary gout is inherited as an X-linked trait. A past medical history of renal calculi may also be predictive of acute gouty arthritis. The nurse should ask the patient questions about his diet and fluid intake. An attack of gout can be precipitated by alcohol intake (particularly beer and wine), starvation diets, and insufficient fluid intake. In addition, the nurse should obtain information about prescribed drugs and the use of OTC drugs containing salicylates. Thiazide diuretics and salicylates can precipitate an attack. The nurse should also ask about recent lifestyle events. Stress, illness, trauma, or strenuous exercise can precipitate an attack of gouty arthritis.
Term
The client is treated for head lice with lindane (Kwell). Following treatment, the nurse reinforces instructions to:

Wash linens with cold water and bleach.
Inspect hair shafts, checking for nits daily, for one week following treatment.
Shampoo with Kwell three times per week.
Remain isolated for 48 hours.
Definition
Inspect hair shafts, checking for nits daily, for one week following treatment.

Objective: Identify important drug therapies for bacterial, fungal, or viral infections; mite and lice infestations; sunburn; acne vulgaris; rosacea; dermatitis; and psoriasis.
Rationale: In order to ensure the effectiveness of drug therapy, clients should inspect hair shafts after treatment, checking for nits by combing with a fine-toothed comb after the hair is dry. This must be conducted daily for at least a week after treatment.
Term
Careful attention to directions for application of lindane (Kwell) is emphasized by the nurse. Signs of over application include:

Diaphoresis.
Drowsiness.
Eye irritation.
Nausea and vomiting.
Definition
Nausea and vomiting.

Objective: For each of the classes listed in Drugs at a Glance, know representative drugs, and explain their mechanisms of drug action, primary actions, and important adverse effects.
Rationale: The directions for scabicides and pediculicides must be followed carefully. If overapplied, wrongly applied, or accidentally ingested, the client could experience headaches; nausea or vomiting; irritation of the nose, ears, or throat; dizziness; tremors; restlessness; or convulsions.
Term
The nurse evaluates the client's understanding of the procedure for application of lindane (Kwell). Which of the following statements requires intervention by the nurse?

"The cream should be left on 8-12 hours before rinsing."
"I will leave the lotion on for about 30 minutes before rinsing."
"I will leave the shampoo on for five minutes before rinsing."
"The lotion takes longer to work."
Definition
"I will leave the lotion on for about 30 minutes before rinsing."

Objective: Use the nursing process to care for clients who are receiving drug therapy for skin disorders.
Rationale: Creams or lotions take longer to produce their effect; therefore, they are usually left on the body for about 8-12 hours before rinsing. Lindane shampoo is applied and left on for at least five minutes before rinsing.
Term
The client reports using benzoyl peroxide (Fostex) for treatment of acne. The action of this drug is:

Antimicrobial.
Skin-abrading.
Sebum suppression.
A keratolytic effect.
Definition
A keratolytic effect.

Objective: For each of the classes listed in Drugs at a Glance, know representative drugs, and explain their mechanisms of drug action, primary actions, and important adverse effects.
Rationale: Benzoyl peroxide (Fostex) is the main OTC medication used to treat acne-related disorders. Benzoyl peroxide has a keratolytic effect, which helps dry out and shed the outer layer of epidermis.
Term
The teaching plan for a 24-year-old female receiving isotretinoin (Accutane) for treatment of acne must include:

Washing the face with cool water only.
Avoiding the use of oral contraceptives while taking this drug.
Avoiding using makeup until the treatment is completed.
Avoiding pregnancy while taking this drug.
Definition
Avoiding pregnancy while taking this drug.

Objective: Describe the nurse's role in the pharmacological management of skin disorders.
Rationale: Isotretinoin (Accutane) is a vitamin A metabolite that aids in reducing the size of sebaceous glands, thereby decreasing oil production and the occurrence of clogged pores. Isotretinoin is not recommended during pregnancy, due to potential harmful effects to the fetus.
Term
A priority nursing diagnosis for a 16-year-old client with severe acne is:

Anger related to disfigurement.
Body Image, Disturbed related to facial lesions.
Self-Care Deficit related to medication regimen.
Health Maintenance, Ineffective related to drug therapy.
Definition
Body Image, Disturbed related to facial lesions.

Objective: Use the nursing process to care for clients who are receiving drug therapy for skin disorders.
Rationale: The nurse working with teenagers with acne should establish rapport, as many clients with acne might be embarrassed, or have an altered body image or self-esteem disturbance because of their acne.
Term
Nutritional counseling for a client experiencing acne includes:

Limiting spicy and fried foods.
Avoiding concentrated-carbohydrate foods.
Avoiding foods that make acne worse.
Avoiding chocolate and caffeine.
Definition
Avoiding foods that make acne worse.

Objective: Use the nursing process to care for clients who are receiving drug therapy for skin disorders.
Rationale: No special diet is required, but foods that seem to make the acne worse should be avoided. Clients should be encouraged to keep a food log to determine which foods tend to worsen the condition.
Term
A client with a history of diabetes mellitus is receiving isotretinoin for treatment of acne. Which of the following assessments might indicate a side effect of the drug?

Jaundice
Blood pressure 148/88
Dyspnea
Blood glucose 268 mg/dl
Definition
Blood glucose 268 mg/dl

Objective: For each of the classes listed in Drugs at a Glance, know representative drugs, and explain their mechanisms of drug action, primary actions, and important adverse effects.
Rationale: Encourage clients to disclose their health history and medications. Concurrent use of isotretinoin and hypoglycemic agents could lead to loss of glycemic control, as well as increased triglycerides levels.
Term
Methotrexate (Amethopterin) is prescribed for a client with psoriasis vulgaris. During the physical examination, the nurse expects to find the lesions on the client's:

Fingers and toes at distal interphalangeal joints.
Scalp, elbows, and knees.
Upper trunk and extremities.
Palms of the hands and soles of the feet.
Definition
Scalp, elbows, and knees.

Objective: Use the nursing process to care for clients who are receiving drug therapy for skin disorders.
Rationale: Lesions of psoriasis vulgaris are papules that form into erythematosus plaques that are thick silver or grey, which bleed when removed. The lesions are found primarily over the scalp, elbows, and knees.
Cognitive Level: Application
Term
A 3-month-old infant is treated for eczema. The nurse expects to discover that _________.

The mother experienced gestational diabetes
The infant was premature
The infant was formula-fed
The infant was breastfed
Definition
The infant was formula-fed

Objective: Use the nursing process to care for clients who are receiving drug therapy for skin disorders.
Rationale: About three-fourths of clients with atopic dermatitis will have had an initial onset before 1 year of age. In those infants predisposed to eczema, breastfeeding seems to offer a protection, as it is very rare for a breastfed child to develop eczema before the introduction of other foods.
Term
A senior nursing student is participating in well-baby screenings at a public health clinic. While examining a 4- month-old infant, the student notes an extensive, confluent diaper rash. The baby’s mother is upset and asks the student nurse about the use of OTC corticosteroid ointment and wonders how she should apply the cream. How should the student nurse respond?
Definition
To establish a rapport with the baby’s mother, the nurse should first respond to the mother’s anxiety. She should validate that the baby’s condition is cause for concern and commend the mother for seeking medical guidance. The nursing student should recognize that the availability of OTC preparations can be a temptation to a young mother who only wants to see her infant more comfortable and relieved of symptoms. However, the student nurse must also recognize that topical use of corticosteroid ointments can be potentially harmful, especially for young children. Corticosteroids, when absorbed by the skin in large enough quantities over a long period can result in adrenal suppression and skin atrophy. Children have an increased risk of toxicity from topically applied drugs because of their greater ratio of skin surface area to weight compared with that of adults. The student nurse should ensure that the health care provider at the public health clinic sees this patient. Once a drug treatment modality is prescribed, the student nurse should make sure that the baby’s mother understands the correct method for drug administration.
Term
A 14-year-old girl has been placed on oral doxycycline (Doxy-Caps) for acne vulgaris because she has not responded to topical antibiotic therapy. After 3 weeks of therapy, the patient returns to the dermatologist’s office complaining about episodes of nausea and epigastric pain. The nurse learns that the patient is “so busy with school activities” that she often forgets a morning dose and “doubles up” on the drug before bedtime. Devise a teaching plan relevant to drug therapy that takes into consideration the major side effects of this drug and the cognitive abilities of this patient.
Definition
According to Piaget, this 14-year-old patient is capable of formal operations, the highest level of cognitive development. A young person in this age group is able to think logically and make decisions regarding health care problems and take control of a treatment regimen. To safely self-medicate, the teenager needs information about the medication, its administration, and side effects. Teenagers need clear instructions and often respond to a caregiver outside the family as a resource for information. The nurse should recognize that this patient is experiencing GI side effects that are common in doxycycline and all tetracycline treatment. Recent studies have demonstrated cases of esophagitis in teenage patients. To develop an effective teaching plan, the nurse will need to assess the patient’s dosing regimen and current dietary patterns. A teaching plan would include the following:

Encouraging oral fluids to maintain hydration even if nausea occurs.
Drinking a full glass of water with the medication to reduce gastric irritation.
Sitting up for 30 minutes after the night-time dose to reduce gastric irritation and reflux.
Consuming small frequent meals to ensure adequate nutrition.
Taking the drug 1 hour before or 2 hours after meals to promote its absorption and effectiveness (if nausea persists, however, the patient should be encouraged to take the doxycycline with food).
Taking doxycycline with milk products or antacids decreases the absorption of the drug; therefore, other remedies for GI irritation will need to be discussed with the health care provider.
Term
A 37-year-old woman is referred to a dermatologist for increasing redness and painful “acne” lesions. The patient is frustrated with her attempts to camouflage her “teenage face” with makeup. She relates to the nurse that she had acne as a teen but had no further problem until the last 11 months. After consultation, the dermatologist suggests a 3-month trial of isotretinoin (Accutane). What are the specific reproductive considerations for this patient? What information should this patient be provided in relation to reproductive concerns?
Definition
This patient’s presentation is typical of rosacea. To prevent long-term changes in the skin, therapy should be aggressive despite the fact that this patient is also of child-bearing age. Isotretinoin (Accutane) is a pregnancy category X drug and has a picture of a fetus overlaid by the “No” symbol on the package. Reported teratogenic effects include severe CNS abnormalities such as hydrocephalus, microcephalus, cranial nerve deficits, and compromised intelligence scores. This patient needs to understand that she must use contraception while receiving drug therapy and for up to 6 months after therapy is discontinued. She should not begin therapy unless she first demonstrates a negative pregnancy test. In addition, she should be taught to begin therapy on the second or third day of her normal menstrual cycle. Teenagers who are on isotretinoin should anticipate monthly pregnancy tests.
Term
The nurse suspects a client is experiencing extrapyramidal symptoms (EPS) from long-term treatment with antipsychotic medications when which of the following behaviors are observed? (Select all that apply.)

The client walks with a shuffling gait and stooped posture.
The client refuses to participate in group activities.
The client has frequent angry outbursts.
The client frequently paces in the room.
The client hoards food in the bedside stand.
Definition
The client frequently paces in the room.

The client walks with a shuffling gait and stooped posture.

Objective: Explain the symptoms associated with extrapyramidal side effects of antipsychotic drugs.
Rationale: Pacing in the room reflects an inability to relax or rest, also called akathisia, a common EPS. The shuffling, stooped gait reflects Parkinsonism, another EPS. Hoarding food, refusal to participate, and angry outbursts might reflect other psychotic behaviors, but are not EPS.
Term
The client states that he has not taken his antipsychotic drug for the past two weeks because it was causing sexual dysfunction. The nurse explains that continuing the medication as prescribed is important because:

Parkinson-like symptoms will occur.
Hypertensive crisis could occur with abrupt withdrawal.
Symptoms of psychosis are likely to return.
Muscle twitching could occur.
Definition
Symptoms of psychosis are likely to return.

Objective: Explain the importance of client drug compliance in the pharmacotherapy of schizophrenia.
Rationale: Symptoms of psychosis are likely to return, exhibited by agitation, distrust, and frustration.
Term
The client with schizophrenia asks how long she will have to take chlorpromazine (Thorazine). The nurse's response is based on the understanding that:

Therapy will be long-term or lifetime.
A cure can be expected in 3-6 weeks.
Pharmacotherapy for several months should be expected.
The drug should be taken until serum levels reach therapeutic range.
Definition
Therapy will be long-term or lifetime.

Objective: Describe the nurse's role in the pharmacologic management of schizophrenia.
Rationale: Because of the increased rate of recurrence of psychotic episodes, treatment is long-term or lifetime. There is no cure for schizophrenia.
Term
Prior to discharge, the nurse provides teaching related to side effects of phenothiazines to the client and caregivers. Which of the following should be included?

Medications should be taken as prescribed to prevent side effects.
The client might experience withdrawal and slowed activity.
Severe muscle spasms can occur early in therapy.
Tardive dyskinesia is likely early in therapy.
Definition
Severe muscle spasms can occur early in therapy.

Objective: Use the nursing process to care for clients receiving drug therapy for psychoses.
Rationale: Acute dystonias occur early in the course of therapy. These are severe muscle spasms, particularly of the back, neck, tongue, and face.
Term
The client experiences extrapyramidal symptoms (EPS) during therapy with phenothiazines. The nurse expects which of the following drugs to be prescribed?

Haloperidol (Haldol)
Benztropine (Cogentin)
Diazepam (Valium)
Ativan
Definition
Benztropine (Cogentin)

Objective: Categorize drugs used for psychoses based on their classifications and drug actions.
Rationale: Concurrent therapy with anticholinergic Parkinson's medications, such as Cogentin, reduces EPS.
Term
Which of the following data collected by the nurse during the history and physical is a contraindication for a client to receive fluphenazine (Prolixin)?

Elderly client
Bone marrow depression
Diabetes mellitus
Hypertension
Definition
Elderly client

Objective: Describe the nurse's role in the pharmacologic management of schizophrenia.
Rationale: Fluphenazine (Prolixin) is a phenothiazine drug. Use is contraindicated for clients with CNS depression, bone marrow depression, and alcohol withdrawal.
Term
Nursing assessment of a client receiving promazine (Prozene) reveals T 104°F, BP 90/50-160/100, and urinary incontinence. The appropriate nursing intervention is to:

Administer acetaminophen for fever.
Document the findings; reassess in two hours.
Notify the physician immediately.
Keep the client on bedrest, and monitor closely.
Definition
Notify the physician immediately.

Objective: Describe the nurse's role in the pharmacologic management of schizophrenia.
Rationale: These are symptoms of neuroleptic malignant syndrome (NMS). This is a toxic reaction to a therapeutic dose of the drug, and immediate attention/treatment is needed.
Term
The nurse gives what advice to a client who reports experiencing side effects related to risperidine (Risperdal).

Continue the drug, and notify the health care provider.
Decrease the dose to once per day.
Discontinue the drug immediately.
Report to the Emergency Department immediately.
Definition
Continue the drug, and notify the health care provider.

Objective: Use the nursing process to care for clients receiving drug therapy for psychoses.
Rationale: Notify the health care provider; however, continue taking the drug. Avoid abrupt cessation of drug without medical attention, as this can cause serious side effects.
Term
The nurse providing nutritional counseling for a client receiving thiothixene HCl (Navane) should include:

Avoid taking medication with citrus juice.
Increase carbohydrates.
Avoidance of caffeine.
Fatty foods slow absorption.
Definition
Avoidance of caffeine.

Objective: Use the nursing process to care for clients receiving drug therapy for psychoses.
Rationale: Caffeine in any form increases anxiety when used with Navane.
Term
Nursing implications when administrating oral haloperidol (Haldol) to a client include which of the following?

Take with a glass of milk.
Take on an empty stomach.
Take with a full glass of water.
Take one hour before or two hours after antacids.
Definition
Take one hour before or two hours after antacids.

Objective: For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary actions, and important adverse effects.
Rationale: Aluminum- and magnesium-based antacids decrease absorption of haloperidol (Haldol).
Term
A 22-year-old male patient has been on haloperidol (Haldol LA) for 2 weeks for the treatment of schizophrenia. During a follow-up assessment, the nurse notices that the patient keeps rubbing his neck and is complaining of neck spasms. What is the nurse’s initial action? What is the potential cause of the sore neck and what would be the potential treatment? What teaching is appropriate for this patient?
Definition
The patient is exhibiting signs of EPS. Initially, the nurse would assess the patient to ensure he had sustained no recent neck injury or trauma, but if the neck spasms started spontaneously, the nurse would then assess for the possibility of EPS. The patient probably needs to be on a medication such as benztropine (Cogentin) to decrease the EPS effects. The patient should be taught to recognize the symptoms of EPS and to seek medical evaluation when the symptoms occur.
Term
A 68-year-old patient has been put on olanzapine (Zyprexa) for treatment of acute psychoses. What is a priority of care for this patient? What teaching is important for this patient?
Definition
The patient is elderly; thus, safety is a priority when administering this medication. Postural hypotension and dizziness are common; therefore, the patient needs to move and change position slowly. Constipation is also a concern for a patient on this medication, especially elderly patients.
Term
A 20-year-old, newly diagnosed patient with schizophrenia has been on chlorpromazine (Thorazine) and is doing well. Today the nurse notices that the patient appears more anxious and is demonstrating increased paranoia. What is the nurse’s initial action? What is the potential problem? What patient teaching is important?
Definition
The nurse should initially assess whether the patient has been taking the medication as ordered or has altered the dose in any way. It is not uncommon for a young person to “cheek” the medication or attempt to cut back on the dose because of the lack of desire to take the medication on a continual basis—especially when the patient begins to feel better. It is important that the patient understand the necessity of being on this medication for a lifetime, and that the dose is not to be adjusted without consulting a health care provider.
Term
Which of the following actions is dependent upon proper functioning of the kidneys or the administration of Epogen?

Stimulates the production of RBCs.
Detoxifies drugs in the bloodstream.
Secretes the hormone cortisol.
Inhibits the release of renin.
Definition
Stimulates the production of RBCs.

Rationale: The kidney is responsible for the hormone erythropoietin, which stimulates the production of RBCs.
Term
Which of the following is the most important baseline value prior to initiation of diuretic therapy?

Amino acids
Sodium bicarbonate
Water
Glucose level
Definition
Water

Objective: Use the nursing process to care for patients receiving drug therapy for renal failure and diuretic therapy.
Rationale: Although many baseline values are important, blood pressure (sitting and supine) can indicate excessive diuresis, which can result in dehydration and hypovolemia.

Objective: Explain the initial treatment for a patient in shock.
Rationale: Lactated Ringer's is a crystalloid solution that contains electrolytes and concentration similar to plasma. It leaves the blood and enters the cells, replacing fluids and promoting urinary output.
Term
Which of the following is an important point of emphasis the nurse should include when teaching a client with diabetes regarding thiazides?

Anemia
Hyperglycemia
Urinary tract infections
Hypocalcemia
Definition
Hyperglycemia

Objective: Use the nursing process to care for patients receiving drug therapy for renal failure and diuretic therapy.
Rationale: Some thiazide diuretics can cause hyperglycemia and glycosuria in diabetic patients.
Term
Which of the following actions by the nurse is most important when caring for a client with renal disease?

Encourage the client to void every four hours.
Identify medications that have the potential for nephrotoxicity.
Check the specific gravity of the urine daily.
Eliminate potassium-rich foods from the diet.
Definition
Identify medications that have the potential for nephrotoxicity.

Objective: Use the nursing process to care for patients receiving drug therapy for renal failure and diuretic therapy.
Rationale: Since the kidneys excrete most drugs, clients with renal failure will need a significantly lower dosage in order to avoid fatal consequences.
Term
Which of the following medications acts by blocking the reabsorption of sodium and chloride in Henle's loop?

Furosemide (Lasix)
Spironolactone (Aldactone)
Chlorothiazide (Diuril)
Metolazone (Mykrox)
Definition
Furosemide (Lasix)

Objective: For each of the classes shown in Drugs at a Glance, identify representative drugs, and explain the mechanisms of drug action, primary actions, and important adverse effects.
Rationale: Furosemide (Lasix) is a loop diuretic that blocks the reabsorption of sodium and chloride in Henle's loop.
Term
Which of the following clinical manifestations might indicate that the client has excessive potassium loss?

Excessive thirst; urination
Pitting edema; weight gain
Low blood pressure; cardiac arrhythmias
Hypertension; angina
Definition
Low blood pressure; cardiac arrhythmias

Objective: Identify the general side effects expected during pharmacotherapy with diuretics.
Rationale: Rapid excretion of large amounts of fluid predisposes the client to potassium deficits, and is manifested by hypotension, dizziness, cardiac arrhythmias, and fainting.
Term
Administration of potassium supplements is contraindicated in clients taking which of the following diuretics?

Chlorothiazide (Diuril)
Furosemide (Lasix)
Bumetanide (Bumex)
Spironolactone (Aldactone)
Definition
Spironolactone (Aldactone)

Objective: Compare and contrast loop, thiazide, and potassium-sparing diuretics.
Rationale: Unlike with loop and thiazide diuretics, clients taking potassium-sparing diuretics should not take potassium supplements, due to the increased risk of hyperkalemia.
Term
For which of the following disorders should the nurse assess prior to administration of chlorothiazide (Diuril)?

Congenital malformations
Chronic urinary tract infections
Hyperkalemia
Low blood pressure
Definition
Low blood pressure

Objective: Identify the general side effects expected during pharmacotherapy with diuretics.
Rationale: Thiazide diuretics reduce circulating blood volume, which can cause orthostatic hypotension.
Term
The client admitted for congestive heart failure (CHF) is receiving digoxin (Lanoxin) and furosemide (Lasix.) Which of the following laboratory findings should the nurse carefully monitor?

Potassium
Calcium
Sodium
Creatinine
Definition
Potassium

Objective: Describe the nurse's role in the pharmacologic management of renal disorders, and in diuretic therapy.
Rationale: Potassium loss is a serious side effect of loop diuretics, and this is a serious concern to clients being treated with digoxin (Lanoxin).
Term
Client education as relates to loop diuretics should include goals of therapy, and should include which of the following points? (Select all that apply.)

Take potassium supplements, if ordered, and eat potassium-rich foods.
Report any change in hearing (deafness).
Check weight daily, and report a weight gain of 2 pounds or greater in 24 hours.
Expect decreased urine output.
Take in the morning to avoid nighttime urination that could result in increased risk of injury.
Definition
Report any change in hearing (deafness).

Take potassium supplements, if ordered, and eat potassium-rich foods.

Take in the morning to avoid nighttime urination that could result in increased risk of injury.

Check weight daily, and report a weight gain of 2 pounds or greater in 24 hours.

Objective: Use the nursing process to care for patients receiving drug therapy for renal failure and diuretic therapy.
Rationale: Client education should include reasons for obtaining baseline data such as vital signs and tests for renal disorders, and possible side effects.
Term
A 43-year-old man is diagnosed with hypertension following an annual physical examination. The patient is thin and states that he engages in fairly regular exercise, but he describes his job as highly stressful. He also has a positive family history for hypertension and stroke. The health care provider initiates therapy with losartan (Cozaar). After 2 months, the patient has noted no appreciable difference in blood pressure values. The health care provider switches the patient to combination losartan and hydrochlorothiazide (Hyzaar), which proves to be very effective. Why is the new therapy more effective?
Definition
Losartan (Cozaar) is an angiotensin II receptor antagonist commonly prescribed for hypertension. Because some patients do not respond adequately to monotherapy, a drug that offers combined therapy, Hyzaar, is added. Hyzaar combines losartan with hydrochlorothiazide, a diuretic. This combination decreases blood pressure initially by reducing blood volume and arterial resistance. Over time, the diuretic is effective in maintaining the desired change in sodium balance with a resultant decrease in the sensitivity of vessels to norepinephrine. Angiotensin II–receptor antagonists appear to prevent the hypokalemia associated with thiazide therapy.
Term
A 78-year-old woman is admitted to the intensive care unit with a diagnosis of heart failure. The nurse administers furosemide (Lasix) 40 mg IV push. What assessments should the nurse make to determine the effectiveness of this therapy?
Definition
The nurse should carefully monitor fluid status. Because the primary concern is cardiopulmonary, the nurse should assess and document lung sounds, vital signs, and urine output. Depending on the patient’s condition, a Foley catheter may be inserted to permit the measurement of hourly outputs. Daily weights should be obtained. Edema should be evaluated and documented, as well as status of mucous membranes and skin turgor. Because furosemide (Lasix) is a loop diuretic, the nurse would anticipate rapid and profound diuresis. Therefore, the nurse should also observe for signs of dehydration and potassium depletion over the course of therapy.
Term
A 17-year-old male patient is admitted to the ICU following a car–train collision. The patient sustained a depressed skull fracture and is on a ventilator. Two days after surgery, there are obvious signs of increasing intracranial pressure. The nurse administers 32 g of a 15% solution of mannitol (Osmitrol) per IV over 30 minutes. The patient’s mother asks the nurse to explain why her son needs this drug. What explanation should the nurse offer?
Definition
Cerebral edema occurs as a result of the body’s response to an initial head trauma. In this case, the patient sustained a skull fracture and underwent the trauma of required surgery. The nurse should explain to the mother that mannitol (Osmitrol) helps reduce swelling or cerebral edema at the site of her son’s injury. The nurse might explain that the drug helps “pull” water from the site of injury and carry it to the kidneys, where it is eliminated. The patient’s mother should understand that the goal of decreasing swelling is to promote tissue recovery. Nurses must be sensitive to the fact that family members may have severe emotional reactions to a patient’s injury and need help to focus on short-term goals for recovery when the long-term prognosis is not known. For additional information on the action or administration of mannitol, students should consult a drug handbook.
Term
Which of the following solutes is the greatest contributor to the osmolality of a fluid?

Potassium
Sodium
Calcium
Water
Definition
Sodium

Objective: Explain how changes in the osmolality or tonicity of a fluid can cause water to move to a different compartment.
Rationale: Solutes found in the osmolality of a fluid include sodium, glucose, and urea. Sodium comprises the major part of the osmolality of a fluid.
Term
Which of the following solutions has a greater concentration of solutes than blood has?

Hypertonic
Hyposmolar
Isotonic
Hypotonic
Definition
Hypertonic

Objective: Compare and contrast colloids and crystalloids used in IV therapy.
Rationale: Normal plasma is isotonic. Hypertonic solutions have a greater concentration of solutes than plasma does.
Term
Which of the following mechanisms is the most important regulator of fluid intake?

Renin-angiotensin
Thirst
Kidneys
Electrolytes
Definition
Thirst

Objective: Explain the importance of electrolyte balance in the body.
Rationale: Thirst is the most important regulator of fluid intake.
Term
Which of the following solutions is used to correct hypovolemic shock secondary to severe burns?

Dextran 40
Plasma protein
Lactated Ringer's
Albumin
Definition
Dextran 40

Objective: Compare and contrast the use of colloids and crystalloids in IV therapy.
Rationale: Dextran, a synthetic polysaccharide, doubles the plasma volume within hours and acts as a volume expander.
Term
Which of the following nursing interventions is most important when caring for a client receiving a plasma volume expander?

Observe for signs of hypersensitivity.
Encourage fluid intake.
Assess the client for a deep vein thrombosis.
Monitor arterial blood gases.
Definition
Observe for signs of hypersensitivity.

Objective: Describe the nurse's role in the pharmacological management of fluid balance, electrolyte, and acid-base disorders.
Rationale: Dextran 40, a plasma volume expander, can cause a hypersensitivity reaction in some clients. Also, the nurse should understand that fluid moves rapidly from the tissues to vascular spaces, which places the client at risk for fluid overload.
Term
The client's serum sodium value is 149 mEq/L. Which of the following nursing interventions is most appropriate for this client?

Administer a 0.45% NaCl intravenous solution.
Advise that the sodium values are within normal limits.
Hold all doses of glucocorticoids.
Encourage the client to eat a low-salt diet.
Definition
Encourage the client to eat a low-salt diet.

Objective: Describe the nurse's role in the pharmacological management of fluid balance, electrolyte, and acid-base disorders.
Rationale: Hypernatremia is defined as serum sodium levels > 148 mEq/L. A slight increase in sodium can be managed by diet.
Term
Which of the following solutions would be administered intravenously to manage a client with a serum sodium level of 130mEq/L?

Lactated Ringer's
5% D5W
0.9% NaCl
D5W with KCl
Definition
0.9% NaCl

Objective: Explain the pharmacotherapy of sodium and potassium imbalances.
Rationale: Hyponatremia is defined as serum sodium levels < 136 mEq/L. Mild hyponatremia usually is treated with intravenous infusions of NaCl.
Term
The client complains of muscle cramping in the calves, paresthesias of the toes, and the sensation of the heart skipping a beat. These symptoms can be symptoms of which of the following imbalances?

Hyperkalemia
Hypoglycemia
Hypercalcemia
Hypernatremia
Definition
Hyperkalemia

Objective: Describe conditions for which IV fluid therapy might be indicated.
Rationale: Hyperkalemia, serum potassium level > 5mEq/L, predisposes the client to cardiac and muscle irregularities.
Term
The client's arterial blood gases (ABG) reveal metabolic acidosis. Which of the following medications is indicated?

Potassium chloride
Ammonium chloride
Sodium bicarbonate
Sodium chloride
Definition
Sodium bicarbonate

Objective: Discuss common causes of alkalosis and acidosis, and the medications used to treat these disorders.
Rationale: Sodium bicarbonate acts by directly raising the pH of body fluids. It is the drug of choice to restore the pH of the plasma to normal limits.
Term
The client's arterial blood gases (ABG) reveal respiratory acidosis. Which of the following are causes? (Select all that apply.)

Excess alcohol ingestion
Starvation
Airway obstruction
Hypoventilation or shallow breathing
Damage to the medulla
Definition
Hypoventilation or shallow breathing

Damage to the medulla

Airway obstruction

Objective: Discuss common causes of alkalosis and acidosis, and the medications used to treat these disorders.
Rationale: Origins of acidosis related to respiratory involve conditions that affect airway and breathing.
Term
A 72-year-old man with a history of heart failure presents to the emergency department complaining of weakness and palpitations. The patient has been taking furosemide (Lasix) and digoxin (Lanoxin) at home. His current ECG reveals atrial fibrillation, and serum electrolyte testing reveals a potassium level of 2.5 mEq/L. The physician orders an IV solution of 1,000 mL of lactated Ringer’s with 40 mEq KCl to infuse over 8 hours. What are the issues the nurse must consider to safely administer this drug?
Definition
Aggressive treatment with loop diuretics is a common cause of hypokalemia. As in this example, hypokalemia can produce a myriad of sequelae including dysrhythmias. KCl is indicated for patients with low potassium levels and is preferred over other potassium salts because chloride is simultaneously replaced. The nurse administering KCl must keep in mind several critical concerns to safeguard the patient. The primary concern is the risk of potassium intoxication. High plasma concentrations of potassium may cause death through cardiac depression, arrhythmias, or arrest. The signs and symptoms of potassium overdose include mental confusion, weakness, listlessness, hypotension, and ECG abnormalities. In a patient with heart disease, cardiac monitoring may be indicated during potassium infusion. Students should consult their drug handbooks and look up the maximum rates for infusing KCl in adults and children. To prevent potassium intoxication, the nurse should carefully regulate the infusion of IV fluids. Most institutions require that any solution containing KCl be administered using an infusion pump. Prior to beginning and throughout the infusion, the nurse should assess the patient’s renal function (BUN and creatinine levels). A patient with diminished renal function is more likely to develop hyperkalemia.
Term
An 18-year-old woman is admitted to the labor and delivery unit for observation with a blood pressure of 186/108 mmHg. She has 3–4 pitting edema of the lower extremities and states that her hands and face are “swollen.” The CBC reveals an elevated hemoglobin and hematocrit. The certified nurse midwife diagnoses the patient with pregnancy-induced hypertension and orders an IV of D5W. In addition, she requests that the nurse “push oral fluids.” The nurse considers whether the midwife’s order should be questioned. Discuss the appropriateness of this order.
Definition
The patient may be considered dehydrated despite her appearance as indicated by her elevated hematocrit and hemoglobin (“hemoconcentration”). Most pregnant women present with normal or slightly decreased hemoglobin and hematocrit levels related to the increase in intravascular volume during pregnancy. The midwife recognizes the need to increase the intravascular fluid compartment to promote renal and uterine perfusion. Careful monitoring of the patient’s blood pressure, pulse, and weight should be maintained.
Term
An 84-year-old woman has recently returned home after being admitted to the hospital for persistent nausea and vomiting and dehydration. Her past medical history includes gastric reflux, hiatal hernia, GI bleeding, anemia, and coronary artery disease. Her current medication regimen is metoprolol (Lopressor), 50 mg PO bid; pantoprazole (Protonix), 40 mg PO daily; furosemide (Lasix), 20 mg PO daily; and lactulose, 20 g/30 mL PO at bedtime. Although this patient’s nausea and vomiting has resolved, she is still at risk for fluid and electrolyte imbalances secondary to her medication regimen. Which drug in particular places her at risk for fluid volume deficit, and which electrolyte must be monitored? What assessments should the nurse include?
Definition
Excessive renal fluid loss due to diuretic therapy, such as with furosemide (Lasix), can contribute to fluid volume deficits in patients taking these medications. Because pharmacotherapy with thiazide or loop diuretics such as furosemide is the most common cause of potassium loss, patients taking these diuretics are usually instructed to take oral potassium supplements to prevent hypokalemia.
Term
The client receives antihistamine treatment for a respiratory condition through intranasal route therapy. The nurse explains that the major medication of this type is _______________.

Cromolyn (Intal)
Zileuton (Zyflo)
Azelastine (Astelin)
Triamcinolone (Azmacort)
Definition
Azelastine (Astelin)

Objective: Compare and contrast the oral and intranasal decongestants.
Rationale: The medication used is azelastine (Astelin), an intranasal antihistamine.
Term
The nurse teaches the client that the major disadvantage of antitussive therapy on Robitussin A-C is that:

The medication is very expensive.
The medication is irritating to the bronchial tree.
The dose of the medication the client receives could cause drowsiness.
The client may use the medication for 14 days.
Definition
The dose of the medication the client receives could cause drowsiness.

Objective: For each of the classes listed in Drugs at a Glance, know representative drugs, and explain their mechanisms of drug action, primary actions on the respiratory system, and important adverse effects.
Rationale: The major disadvantage to administering antitussive therapy with codeine or other opioids is drowsiness.
Term
The client is using intranasal sympathomimetics for treatment of nasal congestion. The nurse teaches that the use of this drug:

Reduces mucus production.
Reduces cough.
Is limited to 3-5 days for nasal congestion.
Liquefies mucus.
Definition
Is limited to 3-5 days for nasal congestion.

Objective: Categorize drugs used in the treatment of allergic rhinitis and the common cold based on their classifications and mechanisms of action.
Rationale: Beta-adrenergic agonists (sympathomimetics) act by relaxing bronchial smooth muscle, resulting in a bronchodilation that lowers airway resistance and makes breathing easier for the client. Limit the use of intranasal treatment to 3-5 days.
Term
Client teaching for clients on dextromethorphan (Benylin) should include:

Reducing the dosage of the drug if insomnia occurs.
Continuing the drug at higher doses if the cough is not relieved after several days.
Notifying the physician if the drug no longer seems effective.
Monitoring intake and output.
Definition
Notifying the physician if the drug no longer seems effective.

Objective: Categorize drugs used in the treatment of allergic rhinitis and the common cold based on their classifications and mechanisms of action.
Rationale: Benylin is a drug included in most severe cold and flu preparations; therefore, the client must be instructed to seek medical attention should the drug become less effective with continued use.
Term
The client is receiving an antitussive with codeine for treatment of a cough. Nursing intervention is required if the client makes which of the following statements?

"I will notify my doctor if my breathing changes."
"I will keep this medication away from my children."
"I will avoid driving."
"I will take my medicine with red wine, to help me sleep."
Definition
"I will take my medicine with red wine, to help me sleep."

Objective: Use the nursing process to care for clients who are receiving pharmacotherapy for allergic rhinitis and the common cold.
Rationale: The codeine antitussive medications should not be combined with alcohol, which can cause increased CNS depression.
Term
An elderly male client is complaining of sneezing, running nose, and watery eyes when he is around cats. His condition is known as _____________.

Emphysema
Allergic rhinitis
Asthma
Chronic obstructive pulmonary disease
Definition
Allergic rhinitis

Objective: Describe common causes and symptoms of allergic rhinitis.
Rationale: Allergic rhinitis is inflammation of the nasal mucosa due to exposure to allergens.
Term
The client is using a H1 receptor antagonist. Which of the following statements indicates the client understands drug therapy?

"This is the only drug I will need to treat my asthma attacks."
"I will use this drug only when I feel an attack coming on."
"I will report fever, blurred vision, or eye pain."
"I will use my bronchodilator if my wheezing increases."
Definition
"I will report fever, blurred vision, or eye pain."

Objective: Use the nursing process to care for clients who are receiving pharmacotherapy for allergic rhinitis and the common cold.
Rationale: Clients should be informed that their adverse effects.

Assessing for signs of increased sputum production.

Objective: Discuss the pharmacotherapy of cough.
Rationale: Expectorants act by reducing the thickness of bronchial secretions. Therefore, increased sputum production from a client would be expected, and should be recorded.
Term
Nursing intervention for a client on an expectorant includes:

Assessing liver function tests.
Assessing of cardiac dysrhythmias.
Monitoring blood glucose for hypoglycemia.
Assessing for signs of increased sputum production.
Definition
Assessing for signs of increased sputum production.

Objective: Discuss the pharmacotherapy of cough.
Rationale: Expectorants act by reducing the thickness of bronchial secretions. Therefore, increased sputum production from a client would be expected, and should be recorded.
Term
The nurse teaches the client that the primary purpose of mucolytics is to:

Aid in the ability to cough up mucous.
Achieve bronchodilation.
Relax bronchial smooth muscles.
Loosen thick, viscous bronchial secretions.
Definition
Loosen thick, viscous bronchial secretions.

Objective: Discuss the pharmacotherapy of cough.
Rationale: The primary purpose of mucolytics is to loosen thick, viscous bronchial secretions causing respiratory distress.
Term
The client is prescribed dextromethorphan (Benylin) for treatment of a cold. The nurse teaches that the action of this drug:

Is an opioid.
Is an anti-inflammatory.
Is an anti-infective.
Is a non-opioid.
Definition
Is a non-opioid.

Objective: Use the Nursing Process to care for clients who are receiving pharmacotherapy for allergic rhinitis and the common cold.
Rationale: Dextromethorphan (Benylin) is classified as a non-opioid cold medication.
Term
A 74-year-old male patient informs the nurse that he is taking diphendydramine (Benadryl) to reduce seasonal allergy symptoms. This patient has a history of an enlarged prostate and mild glaucoma (controlled by medication). What is the nurse’s response?
Definition
The nurse needs to ensure that the patient understands the potential side effects related to the anticholinergic effects of this medication. The patient (based on age) is at higher risk for urine retention, glaucoma (or other visual changes), and constipation.
Term
A 65-year-old patient has bronchitis and has been coughing for several days. Of the two antitussive medications, dextromethorphan and codeine, which is the drug of choice for this patient? Why?
Definition
Although codeine is a more powerful antitussive, it can cause dependence and constipation. Dextromethorphan is a more appropriate choice for this patient initially, with codeine syrup as a potential later choice for more severe cough symptoms.
Term
A 67-year-old patient has allergic rhinitis and always carries a handkerchief in his pocket because he has nasal discharge nearly every day. Sometimes his nose is stuffy and dry. The health care provider prescribes fluticasone (Flonase). He is to take one spray intranasally at bedtime. The patient starts to take fluticasone and a week later calls the provider’s office and talks to the nurse. He says, “This Flonase is not helping me.” What is the nurse’s best response?
Definition
Intranasal glucocorticoids, such as Flonase, may take as long as 2 to 4 weeks to work. The medication should not be discontinued prematurely. If a decongestant spray is being used along with the Flonase, the decongestant should always be administered first to clear the nasal passages, which will facilitate adequate application of the glucocorticoid mist.
Term
The client receives treatment for a respiratory condition through aerosol therapy. The nurse explains that the major advantage of this type if therapy is that:

It delivers the medication to the site of action.
The client requires no skill to use it.
It has no systemic side effects.
It is safe for all clients.
Definition
It delivers the medication to the site of action.

Objective: Compare the advantages and disadvantages of using the inhalation route of drug administration for pulmonary drugs.
Rationale: An aerosol is a suspension of minute liquid droplets or fine solid particles in a gas. Aerosol therapy can give immediate relief for bronchospasm, or can loosen thick mucous. The major advantage of aerosol therapy is that it delivers medications to their immediate site of action, reducing systemic side effects.
Term
The nurse teaches the client that the major disadvantage of aerosol therapy is that:

The precise dose of the medication the client receives cannot be measured.
The medication is very expensive.
The medication is irritating to the bronchial tree.
The client cannot use the equipment unless supervised by medical personnel.
Definition
The precise dose of the medication the client receives cannot be measured.

Objective: Compare the advantages and disadvantages of using the inhalation route of drug administration for pulmonary drugs.
Rationale: The major disadvantage to administering aerosol therapy is that the precise dose received by the client is difficult to measure, because it depends upon the client's breathing pattern and correct use of the aerosol device.
Term
The client is using a beta-adrenergic agonist for treatment of asthma. The nurse teaches that the action of this drug is:

Reducing cough.
Liquefying mucus.
Relaxing smooth muscle, causing bronchodilation.
Reducing mucus production.
Definition
Relaxing smooth muscle, causing bronchodilation.

Objective: For each of the classes listed in Drugs at a Glance, know representative drugs, and explain their mechanisms of drug action, primary actions on the respiratory system, and important adverse effects.
Rationale: Beta-adrenergic agonists (sympathomimetics) act by relaxing bronchial smooth muscle, resulting in a bronchodilation that lowers airway resistance and makes breathing easier for the client.
Term
Client teaching for clients on long-term therapy with beta-adrenergic agonists for treatment of asthma should include:

Reducing the dosage of the drug if insomnia occurs.
Discontinuing the drug if the heart rate increases.
Monitoring intake and output.
Notifying the physician if the drug no longer seems effective.
Definition
Notifying the physician if the drug no longer seems effective.

Objective: For each of the classes listed in Drugs at a Glance, know representative drugs, and explain their mechanisms of drug action, primary actions on the respiratory system, and important adverse effects.
Notifying the physician if the drug no longer seems effective.

Objective: For each of the classes listed in Drugs at a Glance, know representative drugs, and explain their mechanisms of drug action, primary actions on the respiratory system, and important adverse effects.
Rationale: Tolerance can develop to the therapeutic effects of the beta-agonists; therefore, the client must be instructed to seek medical attention should the drugs become less effective with continued use.
Term
The client is receiving theophylline (Theo-Dur) for treatment of asthma. Nursing intervention is required if the client makes which of the following statements?

"I will use my inhaler if I am wheezing."
"I will check my heart rate each day."
"I will notify my doctor if my vision changes."
"I will take my medicine with my coffee each morning."
Definition
"I will take my medicine with my coffee each morning."

Objective: Describe the nurse's role in the pharmacologic treatment of lower respiratory tract disorders.
Rationale: The methylxanthines comprise a group of bronchodilators chemically related to caffeine. Because of the drugs' chemical similarities, clients should avoid foods and beverages containing caffeine when taking these drugs.
Term
An elderly male client is prescribed ipratropium (Atrovent) for the treatment of asthma. Appropriate nursing intervention includes:

Teaching the client to avoid caffeine in the diet.
Assessing for enlarged liver.
Teaching the client to report inability to urinate.
Monitoring for development of diarrhea.
Definition
Teaching the client to report inability to urinate.

Objective: Compare and contrast the pharmacotherapy of acute and chronic asthma.
Rationale: Anticholinergic bronchodilators should be used cautiously in elderly men with benign prostatic hypertrophy, and in all clients with glaucoma.
Term
The client is using beclomethasone (Beclovent) for treatment of chronic asthma. Which of the following statements indicates that the client understands drug therapy?

"This is the only drug I will need to treat my asthma attacks."
"I will use my bronchodilator if my wheezing increases."
"I will not need a flu shot now that I'm taking this medicine."
"I will use this drug only when I feel an attack coming on."
Definition
"I will use my bronchodilator if my wheezing increases."

Objective: Use the nursing process to care for clients who are receiving pharmacotherapy for lower respiratory tract disorders.
Rationale: Clients should be informed that inhaled glucocorticoids must be taken daily to produce their therapeutic effect, and that these medications are not effective at terminating episodes in progress.
Term
Nursing intervention for a client on long-term oral glucocorticoids includes:

Assessing cardiac dysrhythmias.
Monitoring blood glucose for hypoglycemia.
Assessing liver function tests.
Assessing for signs of GI bleeding.
Definition
Assessing for signs of GI bleeding.

Objective: Use the nursing process to care for clients who are receiving pharmacotherapy for lower respiratory tract disorders.
Rationale: If taken for longer than 10 days, oral glucocorticoids can produce significant adverse effects, including adrenal gland atrophy, peptic ulcers, and hyperglycemia.
Term
The nurse teaches the client that the primary purpose of inhaled glucocorticoids is to:

Relax bronchial smooth muscles.
Aid in the ability to cough up mucus.
Achieve bronchodilation.
Prevent respiratory distress.
Definition
Prevent respiratory distress.

Objective: Describe the types of devices used to deliver aerosol therapies via the inhalation route.
Rationale: The primary purpose of inhaled glucocorticoids is to prevent respiratory distress. The client should be advised that this medication should not be used during an acute asthma attack.
Term
The client is prescribed cromolyn (Intal) for treatment of asthma. The nurse teaches the action of this drug is _________________.

Mucolytic.
Anti-infective.
Bronchodilation.
Anti-inflammatory.
Definition
Anti-inflammatory.

Objective: Categorize drugs used in the treatment of lower respiratory tract disorders based on their classifications and mechanisms of action.
Rationale: Cromolyn (Intal) is classified as a mast cell stabilizer, since its action serves to inhibit mast cells from releasing histamine and other chemical mediators of inflammation. This drug should be taken on a daily basis, and is not effective at terminating acute asthma attacks.
Term
A 72-year-old male patient has recently been started on an ipratropium (Atrovent) inhaler. What teaching is important for the nurse to provide?
Definition
The nurse needs to ensure that the patient understands the potential side effects related to anticholinergic effects of this medication. The patient (based on age) is at higher risk for urine retention, glaucoma (or other visual changes), and constipation. These are also common problems for patients who are taking this medication.
Term
A 45-year-old patient with chronic asthma is on corticosteroids. What must the nurse monitor when caring for this patient?
Definition
Once the patient’s condition begins to improve, the nurse should assess the patient’s understanding of the asthma regimen. The patient should receive instruction on the side effects of glucocorticoid therapy. Glucocorticoids can suppress the hypothalamic–pituitary axis. Abruptly discontinuing a glucocorticoid after long-term therapy (greater than 10 days) can produce cardiovascular collapse. The patient needs to be instructed on the dosage regimen for prednisone, which may include an incremental decrease in the drug dosage when discontinuing the drug. The patient should be monitored for hyperglycemia, peptic ulcer disease, signs and symptoms of GI bleeding, poor wound healing, infections, and mood changes.
Term
A 7-year-old boy with a history of asthma goes to the health room at his elementary school and states that he has increased shortness of breath and chest tightness. On assessment, the school nurse notes scattered expiratory wheezes throughout his upper and middle lung fields and a decreased peak meter flow. The current therapeutic regimen for this child includes salmeterol (Serevent) two puffs every 12 h, montelukast (Singulair) 5 mg/day PO in the evening, triamcinolone (Azmacort) two puffs tid, and albuterol (Proventil) two puffs every 4 h prn. After observing the child’s technique in using the metered-dose inhaler (MDI), the school nurse wishes to reinforce the child’s education as it relates to the administration technique of his inhalants. What areas should be emphasized?
Definition
Key patient education points of emphasis regarding administering medications via an inhaler include the following:

Shake the canister well immediately before each use.
Exhale completely to the end of a normal breath.
With the inhaler in the upright position, place the mouthpiece just inside the mouth and use the lips to form a tight seal.
While pressing down on the inhaler, take a slow, deep breath and hold for approximately 10 seconds.
Wait approximately 2 minutes before taking a second inhalation of the drug.
Rinse the mouth with water after each use (especially after using steroid inhalers, because the drug may cause fungal infections of the mouth and throat).