question

Chapter 35

answer

...

question

What finding is a leading AIDS indicator?

answer

CD4 counts of less than 200 cells. Mm3

question

What are the potential benefits of early initiation of antiretroviral therapy in the asymptomatic HIV-infected client? (select all that apply

answer

Control of viral replication Decreased risk of drug toxicity Prevention of progressive immunodeficiency

question

What are the potential risks of early initiation of antiretroviral therapy in clients with asymptomatic HIV infection? Select all that apply

answer

Unknown long-term toxicity reduction in quality of life from adverse effects Earlier development of drug resistance

question

What is the goal of combination antiretroviral therapy?

answer

Increase the CD4 count, decrease the viral load, and have the client clinically well

question

The decision to treat asymptomatic individuals with detectable HIV RNA in plasma should include which information?

answer

Probability of adherence to therapy

question

What is the goal of combination therapy (HAART)?

answer

It targets the enzymes in the HIV lifecycle

question

When did zidovudine receive FDA approval?

answer

1987

question

How frequently is zidovudine generall scheduled to be taken?

answer

Q12h

question

Which is the usual adult dose of zidovudine?

answer

300 mg b.i.d

question

During the time that a client is taking zidovudine, frequent monitoring of which laboratory value is required? (Select all that apply)

answer

CBC Renal function Hepatic function

question

The nurse is assessing a client taking zidovudine. What should the nurse expect to see if the client is experiencing side effects?(select all that apply)

answer

Numbness and pain in lower extremities Headache Difficulty swallowing

question

In what year did efavirenze receive FDA approval

answer

1998

question

Efavirenze is generally initially scheduled to be taken at which intervals?

answer

600 mg q 24 hours

question

During the time that a client is taking efavirenze, periodic monitoring of which laboratory values is required?

answer

Renal function

question

What should the nurse assess in a client taking efavirenze if he appears to be experiencing side effects? (selelct all that apply)

answer

CNS effects diarrhea Rash

question

A client is being discharged on efavirenz. What priority teaching information should be given to this client? (Select al that apply)

answer

"Don't take St. John's wort with this drug as it will decrease its effectiveness." "Avoid alcohol while taking this drug." "This drug can cause convulsions and possibly liver failure."

question

During which year did lopinavir receive FDA approval?

answer

2000

question

At what intervals is lopinavir generally scheduled to be taken?

answer

Twice a day

question

What is the usual adult dose of lopinavir?

answer

800 mg/ day in 2 divided doses

question

What laboratory values are priorities for the nurse to monitor in a patient taking lopinavir? (select all that apply)

answer

Liver function Triglycerides Cholesterol Blood glucose

question

The client is being discharged on lopinavir. What priority teaching information should the client receive? (select all that apply)

answer

"You cannot take St. John's wort while taking this drug." "You should not take this medication with food." "You will need to learn to measure your blood glucose levels." "You may experience an allergic reaction and should contact your health care provider if this occurs."

question

What is the first choice of drugs for prophylaxis for PCP?

answer

Bactrim DS 1 tablet PO daily

question

In the pregnant client, zidovudine monotherapy is begun at how many weeks of gestation?

answer

14

question

What is the dose of prophylactic zidovudine for the pregnant client?

answer

100 mg five times a day

question

What side effects would the nurse expect to see in a client taking lopinavir? (select all that apply)

answer

Vomiting Diarrhea Nausea

question

Which nursing interventions may help to increase adherence to the therapeutic regimen? (select all that apply)

answer

Pill organizers Pill counting Timers/beepers

question

T.L. has been concerned about taking so many medications. What is the nurse's best response?

answer

"This combination of drugs will decrease the RNA HIV levels load and increase your CD4 cells."

question

The nurse is teaching T.L. about his medications. T.L. complains that he has experienced a lot of nausea and diarrhea since starting the medications. What is the nurse's best response?

answer

"This will only last for a few weeks at the beginning of therapy."

question

One of T.L.'s drugs is ritonavir. What is the priority teaching information related to this drug? (select all that apply)

answer

-This medication may cause cardiovascular problems, so T.L may have to make some lifestyle changes. -The GI effects can be irritating. If they get intolerable, T.L should contact his health care provider rather that stopping the drugs. -This medication has a lot of drug-to-drug interactions. T.L. must check with his health care provider before taking any mew medications. Adherence to the drug therapy regimen is important in decreasing the viral load and maintaining health status.

question

What are the nursing interventions that the nurse should perform for T.L.? (select all that apply)

answer

Monitor lab values. Monitor nutritional status. Provide emotional support. Monitor fluid intake/

question

Chapter 37

answer

...

question

The nurse is working with a client receiving combination chemotherapy. The client asks why she has to take more than one agent. What is the nurse's best response?

answer

a. "It has better response rates than single-agent chemotherapy."

question

The nurse is teaching a community group about factors that influence the development of cancer in humans. Which is the best information to be included in the teaching?

answer

d. Human papillomavirus is associated with cancer of the cervix.

question

A client is to receive chemotherapy for the treatment of cancer. What should the nurse know concerning the side effects of chemotherapy?

answer

c. side effects of chemotherapy are caused by toxicities to normal cells.

question

A male client has advanced cancer that has spread to the other areas of the body. He is scheduled to receive palliative chemotherapy. He states that he does not understand why he should have the palliative chemotherapy if it won't kill the cancer cells. What is the best response?

answer

c. "it is done to improve your quality of life."

question

A client is scheduled to receive chemotherapy that will cause a low white blood cell count. Which priority nursing actions should the nurse plan?

answer

a. Assess for a change in temperature.

question

A client has low platelet counts secondary to the administration of chemotherapy. Which nursing actions would be the most appropriate?

answer

d. Assess for occult bleeding and apply pressure to the injection sites.

question

The nurse is caring for a client who is experiencing diarrhea secondary to chemotherapy. Which important information should be included in client teaching about chemotherapy-related diarrhea?

answer

d. Limit caffeine intake

question

An oncology client is to receive cyclophosphamide (Cytoxan) as part of his chemotherapy protocol. The nurse note on the medical record that the client is taking digoxin (Lanoxin) each morning to treat atrial fibrillation. What should the nurse be aware of when giving these two medications?

answer

a. Cyclophosphamide decreases digoxin levels.

question

31. A client in the outpatient oncology clinic is receiving fluorouracil (5-FU; Adrucil) as part of treatment for colon cancer. The physician prescribes metronidazole (Flagyl) to treat trichomoniasis. What should concern the nurse about this order?

answer

d. Metronidazole may increase 5-FU toxicity

question

A client I to receive doxorubicin (Adriamycin) as part of her chemotherapy protocol. Which assessment finding is the most important for the nurse to assess before administration of Adriamycin?

answer

a. cardiac status

question

A client is receiving cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), and methotrexade (Trexall) (CAM) for the treatment of prostate cancer. During morning rounds, the client complains of feeling short of breath. Physical assessment reveals crackles in both lungs. What is the most likely cause of this clinical manifestation?

answer

a. Adriamycin

question

A client is to receive fluorouracil (5-FU; Adrucil) as part of a treatment protocol for colon cancer. When teaching the client about this drug, what should the nurse say concerning when the nadir usually occurs in the blood counts?

answer

c. 10 to 14 days after administration

question

A client has reached the nadir of his blood counts secondary to chemotherapy. Which nursing diagnoses is the most appropriate?

answer

c. risk for infection

question

Which nursing outcome would be the most appropriate as part of the planning for a client scheduled to receive cyclophosphamide (Cytoxan)?

answer

d. Client will maintain blood counts in the desired range.

question

A client is to receive cyclophosphamide (Cytoxan) as part of her cancer treatment. Which nursing intervention should the nurse expect to complete?

answer

a. Assess for signs of hematuria, urinary frequency, or dysuria.

question

The nurse is teaching a 29-year-old client about cyclophosphamide (Cytoxan), which will be given as part of her treatment protocol for cancer. Which priority information should be included in the teaching?

answer

d. Pregnancy should be prevented during treatment with cyclophosphamide.

question

The nurse is administering IV fluorouracil (5-FU; Adrucil) to a client in the outpatient oncology clinic. Which nursing intervention would be most appropriate?

answer

c. Assess for hyperpigmentation along the vein in which the drug is given.

question

A client receiving cyclophosphamide (Cytoxan), epirubicin (Ellence), and fluorouracil (5-FU; Adrucil) (CEF) has experienced severe nausea, vomiting, and diarrhea over the past week. He has lost 5.5 pounds. Which nursing intervention would be most appropriate?

answer

c. Risk for altered nutrition.

question

The nurse is teaching a client about doxorubicin (Adriamycin), which she will receive as part of her treatment for breast cancer. Which statement made by the client indicates that she needs additional teaching?

answer

d. "This drug may make my urine turn blue."

question

The nurse is administering doxorubicin (Adriamycin) to a client in the outpatient oncology clinic. What is priority information to include in the client teaching?

answer

c. Report any shortness of breath, palpitations, or edema to your doctor.

question

The nurse is administering doxorubicin (Adriamycin) to a client diagnoses with cancer. What should the nurse keep in mind with regard to tissue necrosis associated with this drug?

answer

a. Tissue necrosis may occur 3 to 4 weeks after administration.

question

One week ago in the outpatient oncology clinic, a client received his first cycle of chemotherapy consisting of cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), and fluorouracil (5-FU; Adrucil) (CAF). He returns to the clinic today for follow-up. Which nursing intervention would be most appropriate at this time?

answer

b. Monitor blood counts and laboratory values.

question

The nurse is preparing IV vinblastine (Velban), bleomycin (Blenoxane), and cisplatin (Platinol) (VBP) for administration to a client on the nursing unit. Which precaution should the nurse take when hanging chemotherapy?

answer

d. Wear powder-free gloves.

question

A client is being discharged after receiving IV chemotherapy. Which statement made by the client indicates a need for additional teaching?

answer

b. "I will not need to know how to check my temperature."

question

The nurse is preparing to administer chemotherapy, which can cause severe nausea and vomiting, to a client in the outpatient clinic. Which nursing intervention would be most appropriate?

answer

a. Give an antiemetic before administrating the chemotherapy.

question

A client is admitted to the hospital 1 week after receiving teniposide (VP-16) in the outpatient oncology clinic. On physical assessment, the nurse notes the presence of petechiae, ecchymosis, and bleeding gums. Which nursing diagnosis would be most appropriate

answer

c. Risk for bleeding

question

A client with breast cancer is scheduled to receive anastrozole (Arimidex), an aromatase inhibitor. Which priority information should be included in the client teaching?

answer

a.Aromatase inhibitors block the peripheral conversion of androgens to estrogens.

question

A client is scheduled to receive vincristine (Oncovin) as part of treatment for his cancer. The medication record for the client indicates that he is receiving phenytoin (Dilantin) to control a seizure disorder. What should the nurse monitor in this client?

answer

d. seizures

question

A client is scheduled to receive vincristine as part of her treatment for non-Hodgkin's lymphoma. She reports that she takes bromelain (pineapple extract) at home to prevent constipation. What should the nurse monitor in this client?

answer

c. CBC

question

A client in the outpatient oncology clinic has developed mucositis secondary to cancer therapy. Which statement made by the client would indicate that she needs additional teaching about mucositis?

answer

c. "I will use a mouthwash that has an alcohol base."

question

A client presents with neutropenia secondary to cancer therapy. Which nursing diagnosis would be the most appropriate?

answer

c. Risk for infection.

question

C.Z. says that she does not believe her cancer therapy is effective and that she would like to start taking garlic and Echinacea because she has heard they help to enhance the immune system. What is the nurse's best response?

answer

C. "Those herbal products can negatively affect the chemotherapeutic agent you are taking and should be avoided."

question

When caring for C.Z., what assessment should always be included?

answer

a. vital signs with temperature

question

Which laboratory values should be monitored in C.Z. on a weekly basis?

answer

c. electrolytes

question

C.Z. is concerned about the side effect of hemorrhagic cystitis. What should she do to decrease the risk of this alteration?

answer

b. Increase fluid intake to 2-3 L/day.

question

The nurse is preparing a teaching plan for C.Z. Which priority information should be included? (Select all that apply.)

answer

a. "Do not take herbal preparations or OTC drugs before consulting your health care provider." b. "Take the medication early in the day to prevent its accumulation in the bladder at night." c. "Avoid pregnancy for 3 to 4 months after completing this medication." d. "Use some form of contraception while taking this medication." e. "Report any elevation in temperature or blood in the urine to your physician immediately."

question

Chapter 38

answer

...

question

What occurs in cancer tumor cells when the EGFR-TK signal is inappropriately turned on?

answer

D. Metastasis

question

During the first dose of trastuzumab (Herceptin), the client complains of shortness of breath and pruritis. What is the best action by the nurse?

answer

B. stop the infusion and manage the reaction

question

What is the rationale for administering bevacizumab in a client with metastatic colon cancer?

answer

D. inhibit formation of blood supply

question

Iressa most frequently causes which toxicities?

answer

A. acneiform rash

question

An oncology client is to begin treatment for NSCLC with administration of gefitinib. The nurse notes on his medical record that the client is also taking warfarin daily for atrial fibrillation. What should concern the nurse about the client taking gefitinib and warfarin?

answer

A. Gefitinib increases the effects of warfarin

question

A client in the outpatient oncology unit is receiving sunitinib as part of his treatment for GIST. The physician prescribes metronidazole to treat trichomoniasis. What should concern the nurse about taking these medications concurrently?

answer

D. Metronidazole may potentiate sunitinib toxicity

question

A client is beginning therapy with the EGFR erlotinib (Tarceva) for NSCLC. Which is the most important status for the nurse to assess before beginning therapy with this targeted agent

answer

C. Lung sounds

question

A client is admitted to the hospital 1 week after receiving teniposide (VP-16) in the outpatient oncology clinic. On physical assessment, the nurse notes the presence of petechiae, ecchymosis, and bleeding gums. Which nursing diagnosis would be most appropriate?

answer

C. Risk for bleeding

question

Which nursing outcomes would be most appropriate as part of the planning for a client about to begin therapy with the oral MKI sorafenib? (select all that apply)

answer

A. Client will be free of symptoms of stomatitis. B. Client will be free of cardiac dysfunction. C. Client will maintain skin integrity. D. Client will maintain adequate fluid balance.

question

Which nursing outcomes would be most appropriate as part of the planning for a client scheduled to being treatment with imatinib (Gleevec)? (select all that apply)

answer

A. Client will maintain adequate nutrition and hydration status C. Client will maintain blood counts in the desired range. D. Client will maintain renal function.

question

The nurse is getting ready to hang the IV infusion. When checking the medication, the nurse notices that the medication is mixed in D5W. What should concern the nurse about this combination?

answer

D. This medication should be combined only with .9% normal saline.

question

Before hanging C.L.'s IV, the nurse draws blood for lab tests. Which tests should the nurse expect to be ordered? (select all that apply)

answer

A. CBC with differential B. BUN and Creatinine D. Liver enzymes

question

The nurse offers C.L. crackers and ginger ale before starting the IV infusion. C.L. asks why she is being offered soda and crackers. What is the best answer?

answer

C. "The soda and crackers should help decrease the nausea you might have during the IV."

question

As the nurse is hanging the medication, C.L. asks how this drug will work against her cancer. What is the best answer?

answer

B. "This drug blocks microvascular growth and inhibits metastatic disease progression."

question

5. Before C.L. is discharged, what priority teaching should she receive? (select all that apply)

answer

A. She should contact her health care provider if she has a fever, chills, persistent sore throat, weight gain, chest pain, or shortness of breath. B. She should contact her health care provider if she has black tarry stools or vomit that looks like coffee grounds. C. She should avoid direct sunlight and tanning beds and wear sunscreen when outside. D. She should avoid taking NSAIDS for any reason.

question

Chapter 39

answer

...

question

What are the primary functions of BRMs? (Select all that apply)

answer

Enhance host immunologic function Destroy tumor activities Promote differentiation of stem cells

question

The client is receiving G-CSF therapy. What is a priority assessment in this client?

answer

Bone pain

question

A client is receiving GM-CSF therapy. The nurse knows that attention is focused on which system both during and after these infusions?

answer

Respiratory system

question

What special preparation and administration of EPO is recommended? (Select all that apply.)

answer

Inject less than 3 mL volume/injection Do not re-enter the vial Discard unused portion; no preservatives

question

What is the dose-limiting side effect of IFN alfa Roferon?

answer

fatigue

question

A 64-year-old client has hairy cell leukemia that is being treated with the IFN alfa Roferon. The client reports all of the following gastrointestinal side effects. Which side effect is considered the dose-limiting toxicity for the gastrointestinal system?

answer

anorexia

question

A 64-year-old client has hairy cell leukemia that is being treated with the IFN alfa Roferon. The client reports neurologic side effects. What is most appropriate response to the client's questions?

answer

"These side effects are reversible after the drug is stopped."

question

When is the best time to administer a BRM?

answer

At bedtime

question

Which laboratory values should be monitored specific to concerns related to assessing renal and hepatic function? (Select all that apply.)

answer

BUN Creatinine Transaminase

question

What dermatologic effects should the nurse assess for in a client taking alfa IFNs? (Select all that apply.)

answer

Vesicle formation Alopecia Irritation at injection site

question

What is priority health teaching information for a 64-year-old client who has hairy cell leukemia that is being treated with IFN alfa Roferon and her significant others? (Select all that apply.)

answer

-That most BRM side effects disappear within 72-96 hours after discontinuation of therapy -That the client may return for another demonstration of drug administration techniques -Information on the effect of BRM-related fatigue on ADLs, including sexual activity

question

For what conditions should GM-CSF be administered to clients? (Select all that apply.)

answer

ANC <500mm3 Autologous BMT recipient 2 weeks after high-dose chemotherapy administration

question

Chapter 34

answer

...

question

What may occur when methenamine is given with sulfonamides?

answer

Crystalluria

question

Which substances can be taken to decrease urine pH? (Select all that apply)

answer

- Ammonium chloride - Cranberry juice - Ascorbic acid

question

Which is the correct dosage for long-term use of nalidixic acid?

answer

- 1 g b.i.d.

question

The nurse is planning health teaching for a 53-year-old client receiving nalidixic acid for a chronic urinary tract infection. What priority information should be included? (Select all that apply)

answer

- Protection against photosensitivity is necessary when taking this medication - Increase fluid intake - Avoid operating hazardous machinery

question

5. Which are urinary antiseptic drug-drug interactions? (Select all that apply)

answer

-Nalidixic acid increases effects of warfarin -Antiseptics cause false-positive Clinitest results - Sodium bicarbonate inhibits action of methanmine

question

Clients taking nitrofurantoin should report which alterations to the health care provider?

answer

Fever

question

Which alteration is an adverse effect from nitrofurantoin?

answer

Peripheral neuropathy

question

For which alteration should the nurse expect to see urinary analgesics prescribed? (Select all that apply)

answer

- Burning sensation - Frequency - Urgency

question

Which drug is commonly prescribed urinary analgesic?

answer

- Phenazopyridine hydrochloride (Pyridium)

question

What are priority nursing interventions when administering urinary analgesics? (Select all that apply)

answer

- Administering the drug with food or with milk - Instructing that chewable tablets must be chewed, never swallowed whole - Observing the client for any side effects

question

Which drug is commonly used to treat urinary tract spasms?

answer

- Flavoxate (Urispas)

question

The client has overactive bladder. If she also has narrow-angle glaucoma, which drug should not be prescribed:

answer

- Tolterodine tartrate (Detrol)

question

Which drugs are considered to be urinary antiseptics? (Select all that apply)

answer

- Aztreonam - Methenamine - Quinolones - Nitrofurantoin

question

What priority assessment information should the nurse obtain if the client is taking a fluoroquinolone? (Select all that apply)

answer

- Headache and rash - Syncope and visual disturbance - Peripheral neuritis

question

Clients taking bethanechol should report which alterations to the health care provider? (Select all that apply)

answer

- Abdominal discomfort - Increased salivation - Urgency - Abdominal cramps

question

Chapter 22

answer

...

question

The client has not responded to other anticonvulsant drug therapy. Which drug would expect to be prescribed for this client?

answer

carbamazepine

question

The client has just found out she is pregnant and is in need of seizure medications. Which medication has been shown to be teratogenic and should not be given to a pregnant client?

answer

a. Phenytoin

question

The client is receiving phenytoin and asks how this medication works in the body. What is the nurse's best response?

answer

"It suppress the entry of sodium into the cell."

question

A 24 y/o who has a seizure disorder is going to start taking phenytoin, the drug of choice, to control her seizure activity. The client will initially receive IV phenytoin. What should the nurse check before going this medication?

answer

c. patency of the client's IV

question

A client's initial order is to receive phenytoin for a seizure disorder. The nurse is getting ready to administer the next dose and notices that the medication is mixed with dextrose solution. What is the nurse's best action?

answer

c. Send the medication back to the pharmacy and request the drug be mixed in a saline solution.

question

A client is receiving phenytoin intravenously for a seizure disorder. After several days of IV medication, the nurse notices that the client's IV insertion site is red and swollen. What is the best action by the nurse?

answer

d. DC this IV infusion, restart the IV in another site and restart the infusion

question

A client who has been receiving phenytoin intravenously for a seizure disorder has been changed to an oral medication. Which order for oral administration should the nurse question?

answer

a. 100mg, PO, daily

question

A client who is to begin taking oral phenytoin for a seizure disorder asks how long she will need these medications. What is the nurse's best response to this question?

answer

a. "You will need to take this medication for a lifetime."

question

When a client is taking phenytoin for a seizure disorder, serum phenytoin levels should be monitored to determine if the blood serum level is within the therapeutic range, thus avoiding toxic levels. Which result is within the therapeutic range?

answer

b. 12 mcg/mL

question

A client is receiving anticonvulsant medication and many other medications. Which type of drug (s) should the nurse question before administration? (Select all that apply)

answer

a. digoxin b. antineoplastics c. sulfonamides

question

In the event that a client taking anticonvulsant medication experiences a seizure, what information should be included in the nurse's documentation? (Select all that apply)

answer

a. type of movements b. time the movements started and ended d. progression of movements

question

A client who has been receiving phenytoin for a seizure disorder will be discharged in a couple of days. The nurse is preparing for discharge teaching. What information about side effects of this medication should the client receive?

answer

c. The client may experience nosebleeds and a sore throat

question

The nurse is conducting an admission assessment for a client who has been taking phenytoin for 20 yrs. The client has not reported any seizure activity while taking the maintenance dose. What would the nurse expect to see if this client is experiencing a common side effect of the drug?

answer

a. gingival hyperplasia

question

As a result of a client's LT use of phenytoin, which lab test would the nurse want ordered for the client?

answer

d. serum blood glucose

question

The client is diagnosed with status epilepticus. Which medication would the nurse expect to be prescribed?

answer

a. diazepam

question

Which statement(s) is/are true about seizures and anticonvulsant use during pregnancy? (select all that apply)

answer

a. seizures increase 25% in epileptic women b. many anticonvulsants have teratogenic properties c. anticonvulsant use increases loss of folic acid

question

The nurse assesses the client for side effects of phenytoin. What clinical manifestations might the nurse see? (select all that apply

answer

a. nausea b. vomiting d. headache

question

What should be included in the health teaching plan for the client taking phenytoin? (Select all that apply)

answer

b. urine may be a harmless pink or reddish-brown color c. alcoholic beverages are not recommended. d. the drug may have teratogenic effect on a fetus e. avoid aspirin while taking phenytoin

question

M.B.'s drug level is 8 mcg/mL. What should concern the nurse about this level?

answer

it is too low

question

M.B.'s medication has been changed to ethotoin. What disadvantage of this medication could be problematic for this client?

answer

this medication has to be taken more frequently than phenytoin

question

M.B. does not like taking ethotoin, so the physician put her back on phenytoin. She has been reporting gastric upset and her physician has put her on cimetidine. What should the nurse be concerned about this combination of medications?

answer

c. the actions of phenytoin will be increased

question

M.B. has become perimenopasual, and she informs the nurse that she is taking evening primrose, an OTC herbal supplement. What should concern the nurse about M.B. taking evening primrose?

answer

c. The phenytoin dosage will need to be increased.

question

Chapter 21

answer

...

question

Because of a high incidence of sleep disorders, which is the most frequently prescribed type of drug?

answer

D) Sedative-Hypnotics

question

Which drugs are frequently prescribed to control seizures?

answer

D) Long-Acting Barbiturates

question

A 48 year-old client returns to the unit after surgery; she has had spinal anesthesia. What are the best actions for the nurse to take to decrease the possibility of a spinal headache?

answer

D) answers B&C B-Position the client flat in bed C-Increase fluid intake

question

What is the reasoning for putting a client in a specific position after spinal anesthesia?

answer

A) To decrease leakage of spinal fluid

question

On the night of postoperative day 4, a client who had spinal anesthesia requests a sleeping pill. Which barbiturate may be used when the client has difficulty falling asleep and nonpharmacologic measures have not been effective?

answer

A) Secobarbital

question

Which type of anesthesia frequently is administered using lidocaine

answer

A)spinal anesthesia

question

What are the primary ingredients in OTC sleep medications?

answer

B) Antihistamines

question

Which drug(s) is/are considered safer than barbiturates in older clients?

answer

D) all of the above (Estazolam (ProSom), Temazepam (Restoril), Triazolam (Halcion))

question

The advantage(s) of balanced anesthesia include(s) which

answer

B) Reduction of drugs to maintain desired state of anesthesia

question

Local anesthesia is indicated for which procedures? (select all that apply)

answer

A) Dental Procedures B)Diagnostic Procedures C) Suturing a skin laceration

question

Balanced anesthesia is comprised of which? (select all that apply)

answer

A)Inhaled gas B)Muscle relaxant D )Hypnotic the night before E) Narcotic analgesic and anticholinergic about 1 hour preoperatively

question

Which are possible complications of spinal anesthesia? (select all that apply)

answer

A) Headache C) Hypertension

question

What questions should the nurse ask B.Z. to determine his sleep patterns? (select all that apply)

answer

A) "Do you have a usual time at which you go to bed?" B) "Do you take naps during the day, and if so, for how long?" C) "How much caffeine do you ingest on a daily basis?" D) "Which medications are you currently taking?" E) "How much fluid do you drink within the 3 hours prior to going to sleep?"

question

B.Z.'s physician ordered secobarbital for sleep, and B.Z. has now taken this medication for one month. What is the best action by the nurse?

answer

C) Question the order given that this client has been taking this drug for at least one month.

question

B.Z. is being discharged with a sleep medication for long-term use. Which medication would the nurse expect to be ordered for the client?

answer

C)Quazepam

question

What priority information should the nurse include in the health teaching for this client? (select all that apply)

answer

A) methods for inducing sleep without using medications B) information on side effects of the medications C) instructions to void prior to taking the sleep medication

question

Chapter 25

answer

...

question

What occurs during the vascular phase of inflammation?

answer

Vasodilation with increased capillary permeability

question

The client who is taking NSAIDs complains of heartburn. What should concern the nurse about this symptom?

answer

Nothing, it is a known side effect of NSAIDs

question

The client asks about how the NSAID he just took works. What is the nurse's best response?

answer

"It inhibits the synthesis of prostaglandins."

question

The client is taking large doses of aspirin for an arthritic condition. Which of the following should concern the nurse? (Select all that apply)

answer

- Tinnitus is a common symptom of early toxicity - The half-life of aspirin in large doses is approximately 2-20 hours - Aspirin not taken at mealtime or with food can increase GI distress

question

A father presents to the emergency department with his 4-year-old son. The father explains that his son had a temperature and that he gave him baby aspirin to decrease his fever, but it has not worked. What should concern the nurse about a 4-year-old receiving aspirin?

answer

Aspirin has the potential to cause Reye's syndrome in children

question

A 25 y.o client with asthma has been prescribed aspirin for arthritis. What should concern you about this client taking aspirin?

answer

Aspirin can cause bronchospasms

question

Ibuprofen (Motrin, Advil, Nuprin) is a frequently taken anti-inflammatory, analgesic, and antipyretic agent. What is a positive aspect of this drug in relation to other NSAIDs?

answer

It causes less GI upset

question

Which statement by a client would indicate a need for further education on ibuprofen?

answer

"I will be glad to decrease how much I drink daily"

question

Piroxicam (Feldene) is an NSAID. What advantage does it have over other NSAIDs?

answer

Long half-life

question

What information should the nurse provide to an individual taking NSAIDs? (select all that apply)

answer

- The client should report epigastric distress - The client should observe for tarry stools, bleeding gums, and bruising if taking NSAIDs for an extended time - Those clients with a heavy menstrual flow should take NSAIDs 1 to 2 days before menstruation and not during heavy flow

question

What characteristics are associated with celecoxib (Celebrex)? (select all that apply)

answer

- It is not to be used for cardiac precautions like aspirin - It is to be avoided during the third trimester of pregnancy - It relieves pain and inflammation without causing GI distress

question

Clients receiving gold (a DMARD) therapy for advanced arthritic conditions may receive a corticosteroid as part of the early multiple-dosage regimen. The client may ask about the reason for the combination of a steroid and a DMARD. What would be the nurse's best response

answer

"The gold takes time to achieve its effects; the steroid assists immediately in the alleviation of arthritic symptoms."

question

By which action does colchicine relieve the symptoms of gout?

answer

inhibition of the migration of leukocytes to the inflamed area

question

Uricosuric agents such as probenecid (Benemid) are used in the treatment of gout. What does this medication promote?

answer

uric acid excretion via the kidney

question

What would the nurse assess in an individual experiencing side effects from Benemid?

answer

sore gums and headache

question

A client is taking corticosteroids for an arthritic condition. What information should the nurse include in a health teaching plan? (select all that apply)

answer

- Corticosteroids are used to control arthritic flare-ups in severe cases - Corticosteroid dosage must be tapered when discontinuing therapy

question

When DC steroid therapy, the dosage should be tapered over a period of how many days?

answer

5 to 10

question

Which statements are true regarding ketorolac? (select all that apply)

answer

- It can be administered orally. - It can be administered intramuscularly. - It can be administered intravenously. - It may be given only for 5 days or less.

question

A client should receive what information concerning gold therapy? (select all that apply)

answer

- Desired clinical effect may take 3 to 4 months. - Adherence to scheduled lab tests is essential. - Meticulous dental hygiene is required. - Metallic taste or pruritus should be reported to the health care provider.

question

The nurse is planning teaching related to antigout drugs. Which information should be included? (select all that apply)

answer

- Increase fluid intake. - Avoid alcohol and caffeine. - Avoid foods high in purine. - Take medication with food.

question

M.B.'s serum level for aspirin is 33 ng/dl. What should concern the nurse about the drug blood level?

answer

It is at a mildly toxic level.

question

M.B.'s health care provider places her on potassium supplements. She does not like to take medications and asks the nurse why she now has to take potassium. What is the nurse's best response?

answer

"Aspirin can decrease serum potassium levels."

question

M.B. is talking about her medication and wants to know if she should take her medication next week because she is having a tooth pulled. What is the nurse's best response?

answer

"You should contact your dentist before this appointment to determine what should be done."

question

M.B. also complains of loss of appetite and stomach pains and wonders, "Is there something else wrong with me?" What is the nurse's best response

answer

"These are normal problems experienced in individuals taking aspirin."

question

. M.B. wants to know if there are other things that she should be concerned about while taking aspirin. What other clinical manifestations should the nurse discuss with the client? (select all that apply)

answer

- ringing in the ears - drowsiness - dizziness - headache

question

The nurse is planning discharge teaching for M.B. What information should be included in her teaching plan? (select all that apply)

answer

- Take medication with meals to decrease stomach upset. - Avoid intake of alcohol. - Keep medication out of the reach of children.

question

Chapter 24

answer

...

question

A 62-year-old client is receiving treatment for MG with an acetylcholinesterase inhibitor. The nurse is assessing this client. What clinical manifestations would be noted to determine if the medication is working?

answer

Maintenance of muscle strength

question

The nurse observes changes in a 62-year-old client who is receiving treatment for MG with an acetylcholinesterase inhibitor. She is drooling, and she has increased tearing and sweating. What should concern the nurse about the client's exhibiting these clinical manifestations?

answer

She is having cholinergic crisis

question

What emergency medication should the nurse administer to a client who is receiving treatment for MG with an acetylcholinesterase inhibitor to relieve clinical manifestations such as drooling, tearing, and sweating?

answer

Atropine

question

MS is difficult to diagnose. Which study should the nurse expect to be ordered to diagnose MS and identify new lesions?

answer

Magnetic resonance imaging (MRI)

question

What are the actions of adrenocorticotropic hormone (ACTH) in clients with MS?

answer

Decrease the acute inflammatory process

question

A client was given 80 units of ACTH in 500 mL D5W per day for 5 days. Which medication when ordered by the physician should the nurse question before administering it to the client?

answer

Histamine2 blockers

question

A client has had MS for several years, during which he has had many remissions and exacerbations. He has been prescribed Imuran and Betaseron. The client wants to know how the new medications (biologic response modifiers and immunosuppressors) will help his current physical state. What is the nurse's best response?

answer

They will reduce spasticity and improve muscular movement."

question

A client had an acute attack of MS. Which drug(s) should the nurse be prepared to administer? (Select all that apply)

answer

ACTH, glucocorticoid (prednisone), 6 alpha - methylprednisolone

question

A client with MS is experiencing muscle spasms. How will centrally acting muscle relaxants improve his status?

answer

They can decrease pain and increase range of motion

question

The nurse is assessing a client who is taking carisoprodol. Which assessed clinical manifestations would indicate the client is experiencing side effects? (Select all that apply)

answer

Nausea insomnia weakness

question

The nurse is administering medications to her clients. Which medication order should the nurse question before administration?

answer

Diazepam for a 60-year-old who also has glaucoma

question

The nurse is reviewing G.D.'s medications and health history. What should concern the nurse about G.D. taking carisoprodol?

answer

It can increase asthma attacks

question

G.D. states that he has been depressed since his injury and sometimes drinks too much alcohol when taking the Soma. What is a priority concern for the nurse with this combination?

answer

It can increase CNS depression

question

The nurse is passing out 2 PM medications for several people, including G.D. Which client should receive medication first?

answer

25-year-ol with MG taking neostigmine bromide

question

Which medication, if ordered for G.D., should be questioned by the nurse?

answer

Antihistamine

question

G.D. is being discharged. What information is a priority to be included in his discharge teaching? (Select all that apply)

answer

Avoid use of alcohol and CNS depressants Do not abruptly stop taking the muscle relaxant Follow up with the health care provider for required lab tests

question

Chapter 19

answer

...

question

Which receptor stimulates smooth muscle and slows the heart rate?

answer

b. muscarinic

question

Which cholinergic drug is used primarily to increase urination?

answer

a. bethanechol chloride (Urecholine)

question

Anticholinesterases are used to produce which type of pupillary changes?

answer

b. constriction

question

The client has glaucoma and is prescribed an anticholinergic drug. What is the nurse's priority action?

answer

c. Hold the dose and contact the physician about the client's diagnosis of glaucoma.

question

Bethanechol is what type of medication?

answer

a. cholinergic agonist

question

How does bethanechol work in the body?

answer

b. It stimulates muscarinic receptors.

question

How does bethanechol correct a client's clinical problem of urinary retention?

answer

a. It promotes contraction of the bladder.

question

How does the body tissue respond to large doses of cholinergic drugs?

answer

a. increased bronchial secretions

question

A client taking bethanechol is experiencing decreased urinary output. What is the nurse's priority action?

answer

c. Notify the physician as it may be related to the client's medications.

question

A client who takes bethanechol is experiencing flushing, sweating, nausea, and abdominal cramps. What is the nurse's best action?

answer

a. Prepare to give the client IV atropine sulfate.

question

Which drug treats myasthenia gravis by increasing muscle strength?

answer

c. neostigmine bromide (Prostugmin)

question

For which situations is atropine frequently prescribed? (All that apply)

answer

a. as a preoperative medications b. as an antispasmodic c. to treat bradycardia

question

Which client should not receive any atropine-like drugs?

answer

c. A 60-year-old with glaucoma

question

A 70-year-old client is admitted for evaluation of peptic ulcers. She is taking propantheline (Pro-Banthine) three times a day. The nurse is teaching this client about her medications. The priority teaching point is that the client should eat which types of foods?

answer

a. those high in fiber

question

Which information is important to include in the teaching plan for a 70-year-old client who is admitted for evaluation of peptic ulcers and who is taking propantheline (Pro-Banthine) three times daily? (Select all that apply.)

answer

a. Avoid alcohol. b. Use artificial tears. c. Decreased fluid intake.

question

Anticholinergic drugs are contraindicated in clients with which disease process?

answer

d. heart block

question

A specific group of anticholinergics may be prescribed in the early treatment of which neuromuscular disorders?

answer

b. parkinsonism

question

Which drug is used to treat an overdose of organophosphate pesticides that causes paralysis?

answer

c. pralidoxime chloride

question

What advise should the nurse give the client taking anticholinergic drugs?

answer

b. Increase intake of fluids and foods high in fiber.

question

Which clinical manifestations are effects of anticholinergics? (Select all that apply.)

answer

b. increase heart rate c. decrease salivation e. decrease muscle rigidity f. relax bladder detrusor muscle

question

Which clinical manifestations would the nurse possibly assess in a client experiencing side effects/ adverse effects of atropine? (Select all that apply.)

answer

b. flushing c. headache d. dry mouth e. blurred vision

question

What should the nurse monitor closely in this client?

answer

d. blood pressure a. heart rate

question

Q.T. informs the nurse that she was diagnosed with asthma several years ago and since she started on bethanechol her asthma attacks have become more frequent. What is the nurse's best action

answer

c. Notify her physician about this information given the medication she is taking.

question

The nurse is teaching Q.T. how to take her medications. Which statement by Q.T. indicates she requires more teaching? (Select all that apply.)

answer

a. I should take the medication at the same time with my other medications. b. I should increase my fluid intake while taking this medication. c. I am so glad I can take this medication with my breakfast.

question

. Which clinical manifestation should the nurse be concerned about following administration of atropine?

answer

a. tachycardia

question

While doing the postoperative assessment. The nurse notes that Q.T. has decreased bowel sounds. What should the nurse suspect may be occurring in this client?

answer

b. paralytic ileus

question

Q.T. is being discharged from the hospital. What should the nurse tell her to decrease the potential for constipation? (Select all that apply.)

answer

a. Increase fiber in her diet. b. Increase fluid intake. c. Increase exercise as allowed.

question

Chapter 26

answer

...

question

A 53-year-old client has just returned to the unit from OR for the placement of a pin to stabilize her fractured hip, For the first 48 hours postoperative, medperidine (Demerol) is order for pain control. During the time the client is taking Demerol, frequent monitoring of what is required?

answer

d. blood pressure

question

The nurse assesses for toxic effects of medperidine (dermerol). What would the nurse expect to find if the client is experiencing toxic effects?

answer

d. constricted pupils

question

Which nursing assessment would be least important when monitoring a client who is receiving meperidine (demerol)?

answer

a. fluid intake

question

What should the nurse include in a teaching plan for a client who is taking meperidine for pain control after surgery? (select all that apply)

answer

a. instruction not to use alcohol and central nervous system depressants while taking meperidine b. instruction to report side effects c. information on how to prevent constipation

question

Which factor is most relevant to the relief of chronic pain?

answer

d. use of drugs with long half-lives

question

Mixed opioid agonist-antagonists were developed in hopes of decreasing which problem?

answer

c. opioid abuse

question

Withdrawal symptoms usually occur how many hours after the last opioid dose?

answer

b. 24-38 hrs

question

Methadone treatment programs can be effective in helping with opioid-addicted person withdraw. Which is the recommended maintenance dose of methadone?

answer

b. 15-120 mg/day

question

What is the benefit of methadone over other opioids?

answer

d. both a & c a. reduced dependency c. daily dosing

question

Older clients frequently require a reduction in opioid dosage to avoid severe side effects. What changes occur that require a reduction in opioid dosage? (select all that apply)

answer

a. decreased excretion of the drug b. decreased metabolism of the drug c. poly pharmacy

question

The 70 year old client is 12 hours post surgery and is reporting severe discomfort. The physician has ordered Demerol for relief of pain. What should concern the nurse about giving this medication to the client?

answer

b. Demerol tends to be more toxic in older clients

question

It may be difficult to assess pain in children. What should the nurse do to be more successful in assessing pain in children? (select all that apply)

answer

a. use age-appropriate communication skills b. use the "ouch" scale c. discuss the child's response with parents

question

The nurse is reading the client's medication administration record and notes that she is taking acetaminophen. Which type of drug or drugs should the client not receive when taking this drug?

answer

a. cholestyramine

question

The nurse is concerned about that the client is experiencing side effects of opioid analgesics/agonists. What might the nurse assess if this client is experiencing side effects? (select all that apply)

answer

a. sedation b. constipation e. nausea and vomiting f. respiratory depression

question

The client is taking morphine for pain after a procedure. He has asked for pain medication. This will be his fourth dose of morphine. The nurse goes into his room to administer the drug. His respiratory rate is 12. What is the best action by the nurse?

answer

a. Give the medication and contact the client's health care provider about his pain

question

The client is taking morphine for her postoperative pain. What should the nurse assess in this client to determine if she is experiencing side effects of the medication?

answer

d. urinary retention

question

What statement made by a client taking morphine for pain indicates a need for more teaching?

answer

c. "Having a few beers on the weekends will help me to relax."

question

The client is taking morphine and reports she is having dizzy spells when she changes positions. What is the nurse's best response to this concern?

answer

b. "You should move slowly when changing positions and it will decrease the incidence of this."

question

The nurse is working in the post anesthesia care unit. and the client has received morphine for pain and subsequently is breathing at a rate less than 8 breath/min. What medication should the nurse give to increase the client's respiratory rate?

answer

c. naloxone

question

The nurse has administered 10 mg of morphine IV. What is a priority to assess in this client? (select all that apply)

answer

a. blood pressure d. respiratory rate

question

E.K. says, as the nurse is giving the medication, that she takes kava kava daily and took it this morning. Given this combination, what should the nurse monitor in this client?

answer

b. increased sleepiness

question

E.K.'s chest discomfort is relieved and she is transferred to the ICU on morphine for pain. What should the nurse continue to monitor in this client? (select all that apply)

answer

a. blood pressure c. urinary output d. respiratory rate

question

What, if anything, should concern the nurse about the BP finding?

answer

b. Nothing, because the client is sitting up and diastolic reading will be low.

question

Given that the client is not able to "pass water," what is the first action that should be taken by the nurse?

answer

b. Assess for bladder distention

question

The nurse takes E.K. to the bathroom, and she is able to void but complains of being light-headed and dizzy when standing up. She wants to know why this is happening. What is the nurse's best response?

answer

b. "Your blood pressure drops when changing positions; we need to move slowly."

question

E.K.'s lab results show that she is experiencing noncardiac pain. Her physician has changed her order to oral morphine. What priority teaching information should be given to this client? (select all that apply)

answer

a. Do not continue to take your kava kava until approved by your physician. b. Be sure to monitor your bowel movements as this medication may cause constipation. c. Do not drink any alcohol when taking this medication

question

E.K. knows that this medication is addictive. She wants to know how long she can take it without becoming addicted. What is the nurse's best response?

answer

a. "Each individual is different. Make sure you take the medication as needed to relieve pain."

question

The nurse is reviewing discharge teaching with E.K. What statement(s) by her indicate she has an understanding of her pain medications? (select all that apply)

answer

b. "I will not take my kava kava until directed by my physician." d. "I will not drink alcohol while taking this medication. Even a small drink can cause problems."

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