NCLEX - ADULT HEALTH Conjugated estrogen (Premarin) is an
estrogen used for hormone
PHARMACOLOGY - 739
Potassium chloride administered
intravenously must always be diluted
in IV fluid and infused via a pump or
controller. The usual concentration of
IV potassium chloride is 20 to 40
mEq/L. Potassium chloride is never
given by bolus (IV push). Giving
potassium chloride by IV push can
result in cardiac arrest. Dilution in
normal saline is recommended, but
dextrose solution is avoided because
this type of solution increases
intracellular potassium shifting. The IV
bag containing the potassium chloride
is always gently agitated before
hanging. The IV site is monitored
closely because potassium chloride is
irritating to the veins and the risk of
phlebitis exists. The nurse monitors
urinary output during administration
and contacts the physician if the
urinary output is less than 30 mL/hr.
After adding a medication to a bag of
intravenous (IV) solution, the nurse
should agitate or rotate the bag gently
to mix the medication evenly in the
solution. The nurse should then attach
a completed medication label. The
nurse can then prime the tubing. The
IV solution should have been checked
for discoloration before the medication
was added to the solution. The tubing
is attached to the client last.
Prednisone is a corticosteroid. With
prolonged use, corticosteroids cause
adrenal atrophy, which reduces the
ability of the body to withstand stress.
When stress is severe, corticosteroids
are essential to life. Before and during
surgery, dosages may be increased
temporarily. Ferrous sulfate is an oral
iron preparation used to treat iron
deficiency anemia. Cyclobenzaprine
(Flexeril) is a skeletal muscle relaxant.
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replacement therapy in
postmenopausal women. These other
three medications may be withheld
before surgery without undue effects
on the client.
Anticoagulants alter normal clotting
factors and increase the risk of
bleeding after surgery. Aspirin has
properties that can alter the clotting
mechanism and should be
discontinued at least 48 hours before
surgery. Options 1, 2, and 3 are
accurate client statements.
Lisinopril is an antihypertensive
angiotensin-converting enzyme
inhibitor. The usual dosage range is 20
to 40 mg daily. Adverse effects include
headache, dizziness, fatigue,
orthostatic hypotension, tachycardia,
and angioedema. Specific client
teaching points include taking one pill
a day, not stopping the medication
without consulting the physician, and
monitoring for side effects and
adverse reactions. The client should
notify the physician if side effects
occur.
Polypharmacy is a concern in the
geriatric population. Duplication of
medications needs to be identified
before drug-drug interactions or
adverse side effects can be
determined. The phone call to the
health care provider is the
intervention after all other information
has been collected.
Asthma is a chronic inflammatory
disease of the airways. Inhaled
aerosolized short-acting β2 agonists
are quick relief medications and
recommended for clients with status
asthmaticus after epinephrine has
been administered. Leukotriene
modifiers, antiallergic medications,
Sunday, October 16, 2011 1
 and nonsteroidal anti-inflammatory
medications are long-term control
medications.
A topical corticosteroid should be
applied sparingly (thin layer) and
rubbed into the area thoroughly. The
affected area should be cleansed
gently before application. A topical
corticosteroid should not be applied
over extensive areas. Systemic
absorption is more likely to occur with
extensive application.
Hemophilia refers to a group of
bleeding disorders resulting from a
deficiency of specific coagulation
proteins. The primary treatment is
replacement of the missing clotting
factor; additional medications, such as
those to relieve pain, may be
prescribed depending on the source of
bleeding from the disorder. A child
with hemophilia A will be at risk for
joint bleeding after a fall. Factor VIII
will be prescribed intravenously to
replace the missing clotting factor and
minimize the bleeding. Desmopressin
(DDAVP) is used to stimulate
production of factor VIII, but it is not
given intravenously. Factor X and
cryoprecipitate are not used for clients
with hemophilia A.
In severe cystic acne, isotretinoin
(Accutane) is used to inhibit
inflammation. Adverse effects include
elevated triglyceride levels, skin
dryness, eye discomfort such as
dryness and burning, and cheilitis (lip
inflammation). Close medical follow-up
is required, and dry skin and cheilitis
can be decreased by the use of
emollients and lip balms. Vitamin A
supplements are stopped during this
treatment.
Salicylic acid is absorbed readily
through the skin, and systemic toxicity
(salicylism) can result. Symptoms
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include tinnitus, dizziness, hyperpnea,
and psychological disturbances.
Constipation and diarrhea are not
associated with salicylism.
Acyclovir is a topical antiviral agent
that inhibits DNA replication in the
virus. Acyclovir has activity against
herpes simplex virus types 1 and 2,
varicella-zoster virus, Epstein-Barr
virus, and cytomegalovirus.
Gentamicin sulfate is an antibacterial
and would not be effective in treating
herpesvirus. Mupirocin calcium is a
topical antibacterial active against
Staphylococcus aureus, beta-
hemolytic streptococci, or
Streptococcus pyogenes. Salicylic acid
is a keratolytic.
Coal tar is used to treat psoriasis and
other chronic disorders of the skin.
Coal tar suppresses DNA synthesis,
mitotic activity, and cell proliferation.
Coal tar has an unpleasant odor,
frequently stains the skin and hair,
and can cause phototoxicity. Systemic
toxicity does not occur.
Sunscreens are most effective when
applied about 30 to 60 minutes before
exposure to the sun so that they can
penetrate the skin. All sunscreens
should be reapplied after swimming or
sweating.
Mafenide acetate is bacteriostatic for
gram-negative and gram-positive
organisms and is used to treat burns
to reduce bacteria present in
avascular tissues. The client should be
informed that the medication will
cause local discomfort and burning.
Mafenide acetate is a carbonic
anhydrase inhibitor and can suppress
renal excretion of acid, thereby
causing acidosis. Clients receiving this
treatment should be monitored for
signs of an acid-base imbalance
Sunday, October 16, 2011 2
 (hyperventilation). If this occurs, the
medication should be discontinued for
1 to 2 days. Options 3 and 4 describe
local rather than systemic effects. An
elevated blood pressure may be
expected from the pain that occurs
with a burn injury.
Sodium hypochlorite is a solution used
for irrigating and cleaning necrotic or
purulent wounds. It cannot be used to
pack purulent wounds because the
solution is inactivated by copious pus.
The solution should not come into
contact with healing or normal tissue
and should be rinsed off immediately
following irrigation. The solution loses
its potency during storage, so fresh
solution should be prepared
frequently.
Tretinoin is applied liberally to the
skin. The hands are washed
thoroughly immediately after applying.
Therapeutic results should be seen
after 2 to 3 weeks but may not be
optimal until after 6 weeks. The skin
needs to be cleansed thoroughly
before applying the medication.
Isotretinoin can elevate triglyceride
levels. Blood triglyceride levels should
be measured before treatment and
periodically thereafter until the effect
on the triglycerides has been
evaluated. Options 1, 3, and 4 do not
need to be monitored specifically
during this treatment.
Isotretinoin is a metabolite of vitamin
A and can produce generalized
intensification of isotretinoin toxicity.
Because of the potential for increased
toxicity, vitamin A supplements should
be discontinued before isotretinoin
therapy. Options 2, 3, and 4 are not
contraindicated with the use of
isotretinoin.
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The instructions for the use of
permethrin include wash, rinse, and
towel-dry hair, apply sufficient volume
to saturate hair and scalp, allow to
remain on hair 10 minutes, and then
rinse with water. Options 1, 2, and 3
are incorrect instructions.
Lindane is applied in a thin layer to the
body below the head. No more than 30
g (1 oz) should be used. The
medication is removed by washing 8
to 12 hours later. In most cases, only
one application is required.
Clients should be advised not to use
occlusive dressings (bandages or
plastic wraps) to cover the affected
site following the application of the
topical corticosteroid, unless the
physician specifically prescribes
wound coverage. Options 1, 2, and 3
are accurate statements related to the
use of this medication.
Topical corticosteroids can be
absorbed into the systemic circulation.
Absorption is higher from regions
where the skin is especially permeable
(scalp, axilla, face, eyelids, neck,
perineum, genitalia), and lower from
regions where permeability is poor
(back, palms, soles).
Dextranomer is a cleansing rather
than a débriding agent that is effective
for wet wounds only. Dextranomer is
not packed tightly into the wound
because maceration of surrounding
tissue may result.
Azelaic acid is a topical medication
used to treat mild to moderate acne.
The acid appears to work by
suppressing the growth of
Propionibacterium acnes and by
decreasing the proliferation of
keratinocytes. Options 2, 3, and 4 are
incorrect.
Sunday, October 16, 2011 3
 Silver sulfadiazine (Silvadene) is an
antibacterial that has a broad
spectrum of activity against gram-
negative bacteria, gram-positive
bacteria, and yeast. It is applied
directly to the wound to assist in
healing. It does not stain the skin.
Fibrinolysin and desoxyribonuclease
(Elase) is used to débride wounds,
including burns, pressure ulcers, and
inflamed or infected lesions.
Dextranomer (Debrisan) is not a
débriding agent but is a cleansing
agent that actually absorbs peptides
and proteins. Nitrofurazone (Furacin)
and silver sulfadiazine (Silvadene) are
antibacterials and are not used for
wound débridement.
The nurse would schedule the next
home care visit in 7 days. Protective
hydrocolloid dressings such as
DuoDerm are designed to be left in
place for 7 days unless leakage occurs
around the dressing.
Bleeding precautions need to be
initiated when the platelet count
decreases. The normal platelet count
is 150,000 to 450,000/mm3. When the
platelets are lower than 50,000 /mm3,
any small trauma can lead to episodes
of prolonged bleeding. The normal
white blood cell count is 5,000 to
10,000/mm3. When the white blood
cell count drops, neutropenic
precautions need to be implemented.
The normal clotting time is 8 to 15
minutes. The normal ammonia value is
15 to 45 mcg/dL.
Hyperuricemia is especially common
following treatment for leukemias and
lymphomas because chemotherapy
results in massive cell kill. Although
options 1, 2, and 4 also may be noted,
an increased uric acid level is related
specifically to cell destruction.
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Busulfan (Myleran, Busulfex) is an
alkylating medication used to treat
acute myelocytic leukemia and in the
palliative treatment of chronic
myelogenous leukemia. Hyperuricemia
can result from the use of this
medication. Allopurinol (Zyloprim), an
antigout medication, is used with
chemotherapy to prevent or treat
hyperuricemia that occurs from the
rapid destruction of cells by the
antineoplastic medication. Allopurinol
is not used to prevent arthritis,
alopecia, or diarrhea.
Hemorrhagic cystitis is a toxic effect
that can occur with the use of
cyclophosphamide (Cytoxan, Neosar).
The client needs to be instructed to
drink copious amounts of fluid during
the administration of this medication.
Clients also should monitor urine
output for hematuria. The medication
should be taken on an empty stomach,
unless gastrointestinal upset occurs.
Hyperkalemia can result from the use
of the medication; therefore, the client
would not be told to increase
potassium intake. The client would not
be instructed to alter sodium intake.
Cardiotoxicity noted by abnormal
electrocardiographic findings or
cardiomyopathy manifested as
congestive heart failure is a toxic
effect of daunorubicin. Bone marrow
depression is also a toxic effect.
Nausea and vomiting is a frequent
side effect associated with the
medication that begins a few hours
after administration and lasts 24 to 48
hours. Fever is a frequent side effect
and diarrhea can occur occasionally.
Options 1, 2, and 3, however, are not
toxic effects.
To ensure that the client receives
optimal doses of chemotherapy,
dosing is usually based on the total
body surface area (BSA), which
Sunday, October 16, 2011 4
 requires a current accurate height and
weight for BSA calculation (before
each medication administration).
Asking the client about his or her
height and weight may lead to
inaccuracies in determining a true BSA
and dosage. Calculating body mass
index and measuring abdominal girth
will not provide the data needed.
Bleomycin (Blenoxane) is an
antineoplastic medication that can
cause interstitial pneumonitis, which
can progress to pulmonary fibrosis.
Pulmonary function studies along with
hematological, hepatic, and renal
function tests need to be monitored.
The nurse needs to monitor lung
sounds for dyspnea and crackles,
which indicate pulmonary toxicity. The
medication needs to be discontinued
immediately if pulmonary toxicity
occurs. Options 1, 2, and 3 are
unrelated to the specific use of this
medication.
Chemotherapy agents are usually
given in combinations (also called
regimens or protocols). The goal of
administering combination
chemotherapy in cycles or specific
sequences is to produce additive or
synergistic therapeutic effects.
Administering combination therapy by
administering several medications
with different mechanisms of action
and different onset of nadirs and
toxicities enhances tumor cell
destruction while minimizing
medication resistance and overlapping
toxicities.
Because antineoplastic medications
lower the resistance of the body,
clients must be informed not to
receive immunizations without a
physician's or health care provider's
approval. Clients also need to avoid
contact with individuals who have
recently received a live virus vaccine.
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Clients need to avoid aspirin and
aspirin-containing products to
minimize the risk of bleeding, and they
need to avoid alcohol to minimize the
risk of toxicity and side effects.
Cyclophosphamide (Cytoxan, Neosar)
is an antineoplastic medication of the
alkylating class. Medications of this
type affect all phases of the
reproductive cell cycle. Cell cycle
phase-specific medications affect cells
only during a certain phase of the
reproductive cycle. Antimetabolite
medications are cell cycle phase-
specific and affect the S phase. Vinca
alkaloids are cell cycle phase-specific
and act on the M phase.
Cisplatin (Platinol) is an alkylating type
of medication and vincristine
(Oncovin, Vincasar PFS) is a vinca
(plant) alkaloid. Alkylating medications
are cell cycle phase-nonspecific. Vinca
alkaloids are cell cycle phase-specific
and act on the M phase. Combinations
of medications are used to enhance
tumoricidal effects and increase the
therapeutic response.
High concentrations of methotrexate
harm and damage normal cells. To
save normal cells, leucovorin is given,
which is known as leucovorin rescue.
Leucovorin bypasses the metabolic
block caused by methotrexate,
thereby permitting normal cells to
synthesize. Note that leucovorin
rescue is potentially hazardous.
Failure to administer leucovorin in the
right dose at the right time can be
fatal.
A side effect specific to vincristine is
peripheral neuropathy, which occurs in
almost every client. Peripheral
neuropathy can be manifested as
numbness and tingling in the fingers
and toes. Depression of the Achilles
tendon reflex may be the first clinical
Sunday, October 16, 2011 5
 sign indicating peripheral neuropathy.
Constipation rather than diarrhea is
most likely to occur with this
medication, although diarrhea may
occur occasionally. Hair loss occurs
with nearly all the antineoplastic
medications. Chest pain is unrelated
to this medication.
Asparaginase (Elspar) is
contraindicated if hypersensitivity
exists, in pancreatitis, or if the client
has a history of pancreatitis. The
medication impairs pancreatic function
and pancreatic function tests should
be performed before therapy begins
and when a week or more has elapsed
between administration of the doses.
The client needs to be monitored for
signs of pancreatitis, which include
nausea, vomiting, and abdominal pain.
The conditions noted in options 2, 3,
and 4 are not contraindicated with this
medication.
Tamoxifen (Nolvadex) is an
antineoplastic medication that
competes with estradiol for binding to
estrogen in tissues containing high
concentrations of receptors.
Tamoxifen is used to treat metastatic
breast carcinoma in women and men.
Tamoxifen is also effective in delaying
the recurrence of cancer following
mastectomy. Tamoxifen reduces DNA
synthesis and estrogen response.
Tamoxifen (Nolvadex) may increase
calcium, cholesterol, and triglyceride
levels. Before the initiation of therapy,
a complete blood count, platelet
count, and serum calcium levels
should be assessed. These blood
levels, along with cholesterol and
triglyceride levels, should be
monitored periodically during therapy.
The nurse should assess for
hypercalcemia while the client is
taking this medication. Signs of
hypercalcemia include increased urine
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volume, excessive thirst, nausea,
vomiting, constipation, hypotonicity of
muscles, deep bone, and flank pain.
Megestrol acetate (Megace)
suppresses the release of luteinizing
hormone from the anterior pituitary by
inhibiting pituitary function and
regressing tumor size. Megestrol is
used with caution if the client has a
history of thrombophlebitis. Options 1,
2, and 4 are not contraindications for
this medication.
Alopecia (hair loss) can occur following
the administration of many
antineoplastic medications. Alopecia is
reversible, but new hair growth may
have a different color and texture.
Stomatitis (ulceration in the mouth)
can result from the administration of
antineoplastic medications. The client
should be instructed to examine her or
his mouth daily and to report any
signs of ulceration. If stomatitis
occurs, the client should be instructed
to rinse the mouth with baking soda or
saline. Food and fluid is important and
should not be restricted. If chewing
and swallowing are painful, the client
may switch to a liquid diet that
includes milk shakes and ice cream.
Instruct the client to avoid spicy foods
and foods with hard crusts or edges.
The client should avoid toothbrushing
and flossing when stomatitis is severe.
Lemon and glycerin swabs may cause
pain and further irritation.
Busulfan (Myleran, Busulfex) can
cause an increase in the uric acid
level. Hyperuricemia can produce uric
acid nephropathy, renal stones, and
acute renal failure. Options 1, 2, and 4
are not specifically related to this
medication.
A side effect specific to etoposide is
orthostatic hypotension. Etoposide
Sunday, October 16, 2011 6
 should be administered slowly over 30
to 60 minutes to avoid hypotension.
The client's blood pressure is
monitored during the infusion. Hair
loss occurs with nearly all the
antineoplastic medications. Chest pain
and pulmonary fibrosis are unrelated
to this medication.
Male and female clients who take
estrogen or progestins are at
increased risk for deep vein
thrombosis (DVT). Women receiving
estrogens or progestins have irregular
but heavy menses, fluid retention, and
breast tenderness. Options 1, 2, and 4
are not specifically associated with
these type of medications.
Redness and swelling and a slowed
infusion indicate signs of
extravasation. If extravasation occurs
during the intravenous administration
of an antineoplastic medication, the
infusion is stopped and the physician
is notified. Ice or heat may be
prescribed for application to the site
and an antidote may be prescribed to
be administered into the site.
Increasing the flow rate can increase
damage to the tissues. Restarting an
IV in the same vein can increase
damage to the site and vein.
Somatrem (Protropin) is a growth
stimulator used in the long-term
treatment of growth failure resulting
from endogenous growth hormone
deficiency. Somatrem stimulates
linear growth and increases the
number and size of muscle cells and
increases red cell mass. Somatrem
affects carbohydrate metabolism by
antagonizing the action of insulin,
increases mobilization of fats, and
increases cellular protein synthesis.
Options 1, 2, and 4 are not actions of
this medication.
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Desmopressin promotes renal
conservation of water. The hormone
carries out this action by acting on the
collecting ducts of the kidney to
increase their permeability to water,
which results in increased water
reabsorption. The therapeutic effect of
this medication would be manifested
by a decreased urine output. Options
1, 3, and 4 are unrelated to the effects
of this medication.
Water intoxication (overhydration) or
hyponatremia is an adverse reaction
to desmopressin. Early signs include
drowsiness, listlessness, and
headache. Decreased urination, rapid
weight gain, confusion, seizures, and
coma also may occur in overhydration.
Because of its powerful
vasoconstrictor actions, vasopressin
can cause adverse cardiovascular
effects. By constricting arteries of the
heart, vasopressin can cause angina
pectoris and even myocardial
infarction, especially if administered to
clients with coronary artery disease. In
addition, vasopressin may cause
vascular problems by decreasing
blood flow in the periphery. Options 1,
2, and 3 are incorrect.
Oral doses of levothyroxine
(Synthroid) should be taken on an
empty stomach to enhance
absorption. Dosing should be done in
the morning before breakfast.
Excessive doses of levothyroxine
(Synthroid) can produce signs and
symptoms of hyperthyroidism. These
include tachycardia, chest pain,
tremors, nervousness, insomnia,
hyperthermia, heat intolerance, and
sweating. The client should be
instructed to notify the physician if
Sunday, October 16, 2011 7
 these occur. Options 1, 3, and 4 are
signs of hypothyroidism.
Propylthiouracil (PTU) inhibits thyroid
hormone synthesis and is used to treat
hyperthyroidism, or Graves' disease.
Myxedema indicates hypothyroidism.
Cushing's syndrome and Addison's
disease are disorders related to
adrenal function.
Desmopressin administered by the
intranasal route can cause a runny or
stuffy nose. Options 1, 2, and 4 are
side effects if the medication is
administered by the intravenous
route.
An adverse effect of somatropin
(Humatrope) is hypothyroidism.
Thyroid function is monitored
throughout therapy. Options 1 and 2
would evaluate pancreatic function,
and option 3 evaluates renal function.
Lugol's solution is administered to
hyperthyroid individuals in preparation
for thyroidectomy to suppress thyroid
function. Initial effects develop within
24 hours; peak effects develop in 10
to 15 days. In most cases, plasma
levels of thyroid hormone are reduced
with propylthiouracil (PTU) before
Lugol's solution therapy is initiated.
Then, Lugol's solution along with
propylthiouracil is administered for the
last 10 days before surgery.
Chronic ingestion of iodine can
produce iodism. The client needs to be
instructed about the symptoms of
iodism, which include a brassy taste,
soreness of gums and teeth, vomiting,
and abdominal pain. The client needs
to be instructed to notify the physician
if these symptoms occur.
Excessive levels of fludrocortisone
acetate (Florinef) cause retention of
sodium and water and excessive
excretion of potassium, resulting in
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expansion of blood volume,
hypertension, cardiac enlargement,
edema, and hypokalemia. The client
needs to be informed about the signs
of sodium and water retention, such
as unusual weight gain or swelling of
the feet or lower legs. If these signs
occur, the physician needs to be
notified.
Calcium carbonate tablets should be
taken with a full glass of water 30 to
60 minutes after meals. Therefore,
options 1, 2, and 3 are incorrect.
The client who is taking an
antihypocalcemic medication should
be instructed to avoid eating too much
spinach, rhubarb, bran, or whole-grain
cereals because they decrease
calcium absorption. Good dietary
sources of calcium are milk products,
dark green, leafy vegetables (although
spinach needs to be avoided), clams,
oysters, sardines, and orange juice
fortified with calcium.
Corticosteroids (glucocorticoids)
should be administered before 9 AM.
Administration at this time helps
minimize adrenal insufficiency and
mimics the burst of glucocorticoids
released naturally by the adrenal
glands each morning. Options 1, 2,
and 4 are incorrect.
Acarbose (Precose) is an alpha-
glucosidase inhibitor. Taken with the
first bite of each major meal, acarbose
delays absorption of ingested
carbohydrates, decreasing
postprandial hyperglycemia.
Abdominal pain and flatulence are the
most common side effects of this
medication. It is not taken at bedtime.
Rotation of insulin injections should be
done within one anatomical site to
maintain consistent absorption of
insulin. Options 1, 3, and 4 are correct
Sunday, October 16, 2011 8
 statements regarding insulin
administration and thus do not
indicate a need for additional client
teaching.
Glucocorticoids can elevate blood
glucose levels. Clients with diabetes
mellitus may need their dosages of
insulin or oral hypoglycemic
medications increased during
glucocorticoid therapy. Therefore,
options 1, 2, and 4 are incorrect.
When preparing a mixture of regular
insulin with another insulin
preparation, the regular insulin is
drawn into the syringe first. This
sequence will avoid contaminating the
vial of regular insulin with insulin of
another type. Options 2, 3, and 4
identify the correct actions for
preparing NPH and regular insulin.
Insulin in unopened vials should be
stored under refrigeration until
needed. Vials should not be frozen.
When stored unopened under
refrigeration, insulin can be used up to
the expiration date on the vial.
Options 1, 3, and 4 are incorrect.
When alcohol is combined with
glimepiride (Amaryl), a disulfiram-like
reaction may occur. This syndrome
includes flushing, palpitations, and
nausea. Alcohol can also potentiate
the hypoglycemic effects of the
medication. Clients need to be
instructed to avoid alcohol
consumption while taking this
medication. The items in options 2, 3,
and 4 do not need to be avoided.
Sildenafil (Viagra) enhances the
vasodilating effect of nitric oxide in
the corpus cavernosum of the penis,
thus sustaining an erection. Because
of the effect of the medication, it is
contraindicated with concurrent use of
organic nitrates and nitroglycerin.
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Sildenafil is not contraindicated with
the use of vitamins. Neuralgia and
insomnia are side effects of the
medication.
Exenatide (Byetta) is an incretin
mimetic used for type 2 diabetes
mellitus only. It is not recommended
for clients taking insulin. Hence, the
nurse should hold the medication and
question the health care provider
regarding this order. Although options
1 and 3 are correct statements about
the medication, in this situation the
medication should not be
administered. The medication is
packaged in prefilled pens ready for
injection without the need for drawing
it up into another syringe.
Repaglinide is a rapid-acting oral
hypoglycemic agent that stimulates
pancreatic insulin secretion that
should be taken before meals, and
that should be held if the client does
not eat. Hypoglycemia is a side effect
of repaglinide and the client should
always be prepared by carrying a
simple at all times. Metformin is an
oral hypoglycemic given in
combination with repaglinide and
works by decreasing hepatic glucose
production. A common side effect of
metformin is diarrhea. Muscle pain
may occur as an adverse effect from
metformin but it might signify a more
serious condition that warrants
physician notification, not the use of
acetaminophen.
Metoclopramide is a gastrointestinal
stimulant and antiemetic. Because it is
a gastrointestinal stimulant, it is
contraindicated with gastrointestinal
obstruction, hemorrhage, or
perforation. It is used in the treatment
of emesis after surgery,
chemotherapy, and radiation.
Sunday, October 16, 2011 9
 Cholestyramine (Questran) is a bile
acid sequestrant used to lower the
cholesterol level and client compliance
is a problem because of its taste and
palatability. The use of flavored
products or fruit juices can improve
the taste. Some side effects of bile
acid sequestrants include constipation
and decreased vitamin absorption.
The principle manifestations of Crohn's
disease are diarrhea and abdominal
pain. Infliximab (Remicade) is an
immunomodulator that reduces the
degree of inflammation in the colon,
thereby reducing the diarrhea. Options
1, 3, and 4 are unrelated to this
medication.
Propantheline bromide is an
antimuscarinic anticholinergic
medication that decreases
gastrointestinal secretions.
Propantheline should be administered
30 minutes before meals. The other
options are incorrect.
Docusate sodium is a stool softener
that promotes absorption of water into
the stool, producing a softer
consistency of stool. The intended
effect is relief or prevention of
constipation. The medication does not
decrease the amount of fat in the
stools, stop gastrointestinal bleeding,
or relieve abdominal pain.
Cascara sagrada is a laxative that
causes nausea and abdominal cramps
as the most frequent side effects.
Other health problems (options 1, 2,
and 3) are not determined based on a
single symptom.
Most rapid results from bisacodyl
occur when it is taken on an empty
stomach. Bisacodyl will not have a
rapid effect if taken with a large meal.
If bisacodyl is taken at bedtime, the
client will have a bowel movement in
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the morning. Taking the medication
with two glasses of juice will not add
to its effect.
Senna works by changing the
transport of water and electrolytes in
the large intestine, which causes
accumulation of water in the mass of
stool and increased peristalsis. The
other options are incorrect.
Loperamide is an antidiarrheal agent.
It is used to manage acute and also
chronic diarrhea in conditions such as
inflammatory bowel disease.
Loperamide also can be used to
reduce the volume of drainage from
an ileostomy. It is not used for the
conditions in options 1, 2, and 4.
The client should not exceed the
recommended dose because it may be
habit-forming. The medication is an
antidiarrheal and therefore should not
be taken with a laxative. Side effects
of the medication include dry mouth
and drowsiness.
Metamucil is a bulk-forming laxative
and should be taken with a full glass of
water or juice, followed by another
glass of liquid. This will help prevent
impaction of the medication in the
stomach or small intestine. The other
options are incorrect.
If the client experiences tardive
dyskinesia (rhythmic movements of
the face or limbs), the client should
stop the medication and call the
physician. These side effects may be
irreversible. Excitability is not a side
effect of this medication. Anxiety,
irritability, and dry mouth are side
effects that are not so harmful to the
client.
Trimethobenzamide (Tigan) is an
antiemetic agent used to treat nausea
and vomiting. The other options are
incorrect.
Sunday, October 16, 2011 10
 Ondansetron is an antiemetic used to
treat postoperative nausea and
vomiting, as well as nausea and
vomiting associated with
chemotherapy. The other options are
incorrect.
Magnesium citrate is available as an
oral solution and is used commonly as
a laxative in preparation for or after
certain studies of the gastrointestinal
tract. Magnesium citrate should be
served chilled and not be allowed to
stand for prolonged periods, which
would reduce the carbonation and
make the solution even less palatable.
Options 2, 3, and 4 are incorrect.
Prochlorperazine is a phenothiazine-
type antiemetic and antipsychotic. The
nurse would assess the client for
blurred vision as a frequent side effect
of prochlorperazine. Other frequent
side effects include dry eyes, dry
mouth, and constipation.
Pancrelipase (Pancrease) is a
pancreatic enzyme used in clients with
pancreatitis as a digestive aid. The
medication should reduce the amount
of fatty stools (steatorrhea). Another
intended effect could be improved
nutritional status. It is not used to
treat abdominal pain or heartburn. Its
use could result in weight gain but
should not result in weight loss if it is
aiding in digestion.
Calcium carbonate antacids should not
be taken with milk, milk products, or
foods or supplements high in vitamin
D because milk-alkali syndrome
(headache, urinary frequency,
anorexia, nausea, vomiting, fatigue)
can occur. The best item to consume
when taking calcium carbonate is
water.
Aluminum hydroxide tablets should be
chewed thoroughly before swallowing.
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This prevents them from entering the
small intestine undissolved. They
should not be swallowed whole.
Antacids should be taken at least 1
hour apart from other medications to
prevent interactive effects.
Constipation is a side effect of the use
of aluminum products, but it is not
correct for the client to take a laxative
with each dose. This promotes laxative
abuse; the client should first try other
means to prevent constipation.
Calcium carbonate can be used as an
antacid for the relief of heartburn and
indigestion. Calcium carbonate also
can be used as a calcium supplement
(option 3) or to bind phosphorus in the
gastrointestinal tract with renal failure
(option 4). Option 2 is incorrect,
although adequate calcium levels are
needed for proper neurological
function.
Sodium bicarbonate is an electrolyte
modifier and antacid, and it would
aggravate metabolic alkalosis, which
is a difficult acid-base imbalance to
correct. The other options are
incorrect.
Cimetidine is a histamine 2 (H2)-
receptor antagonist. Older clients are
especially susceptible to central
nervous system side effects of
cimetidine. The most frequent of these
is confusion. Less common central
nervous system side effects include
headache, dizziness, drowsiness, and
hallucinations.
Sucralfate is a gastric protectant. The
medication should be scheduled for
administration 1 hour before meals
and at bedtime. The medication is
timed to allow it to form a protective
coating over the ulcer before food
intake stimulates gastric acid
production and mechanical irritation.
The other options are incorrect.
Sunday, October 16, 2011 11
 Sucralfate is a gastric protectant. The
medication should be scheduled for
administration 1 hour before meals
and at bedtime. The medication is
timed to allow it to form a protective
coating over the ulcer before food
intake stimulates gastric acid
production and mechanical irritation.
The other options are incorrect.
Ranitidine is a histamine 2 (H2)-
receptor antagonist. A single daily
dose of ranitidine is scheduled to be
given at bedtime. This allows for a
prolonged effect, and the greatest
protection of the gastric mucosa. The
other options are incorrect.
The client with peptic ulcer disease
should avoid taking medications that
are irritating to the stomach lining.
Irritants would include aspirin and
nonsteroidal anti-inflammatory drugs
(NSAIDs). The client should be advised
to take acetaminophen for a
headache.
Omeprazole is a proton pump inhibitor
classified as an antiulcer agent. The
intended effect of the medication is
relief of pain from gastric irritation,
often called heartburn by clients.
Omeprazole is not used to treat the
conditions identified in options 1, 3,
and 4.
Triple therapy for Helicobacter pylori
infection usually includes two
antibacterial drugs and a proton pump
inhibitor. Metronidazole and
clarithromycin are antibacterials.
Omeprazole is a proton pump
inhibitor. These medications will kill
the bacteria and decrease acid
production.
H2-receptor antagonists suppress
secretion of gastric acid, alleviate
symptoms of heartburn, and assist in
preventing complications of peptic
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ulcer disease. These medications also
suppress gastric acid secretions and
are used in active ulcer disease,
erosive esophagitis, and pathological
hypersecretory conditions. The other
medications listed are proton pump
inhibitors.
The medication should be
administered with food such as milk
and crackers to prevent
gastrointestinal irritation. Options 1, 2,
and 4 are appropriate statements
regarding the use of this medication.
Theophylline is a bronchodilator that
directly relaxes the smooth muscles of
the bronchial airway. Options 1, 2, and
3 are not direct actions of this
medication.
Albuterol is a sympathomimetic
bronchodilator. Side effects that can
occur from the use of this medication
include tremors, nausea, nervousness,
palpitations, tachycardia, and dryness
of the mouth or throat.
Isoniazid and rifampin are
contraindicated in clients with acute
liver disease or a history of hepatic
injury. Option 1 is the only option that
addresses hepatic dysfunction. The
medications are not contraindicated in
the disorders noted in options 2, 3,
and 4.
The client needs to be instructed that
the entire year-long course of the
medication needs to be completed.
The preferable method of
administration is for the client to take
the medication 1 hour before or 2
hours after meals. If gastrointestinal
irritation occurs, the medication
should not be discontinued and, in this
situation a small amount of food may
be taken to reduce the irritation.
Increasing fluid intake during this
medication therapy is not necessary.
Sunday, October 16, 2011 12
 Clients diagnosed with active
tuberculosis usually are started on
more than one medication to be
certain that the resistant organisms
are eliminated. The doses of some
medications initially may be large
because the bacilli are difficult to kill.
Options 1, 2, and 3 are inaccurate.
A nonsteroidal anti-inflammatory drug,
which has an analgesic effect, will
relieve pain and allow the client to
cough and deep-breathe more
effectively. Options 1, 3, and 4 are
incorrect.
Benzonatate is a locally acting
antitussive and its effectiveness is
measured by the degree to which it
decreases the intensity and frequency
of cough without eliminating the
cough reflex. Options 1, 2, and 3 are
not effects of this medication.
Pyrazinamide is an antitubercular
medication given with other
antitubercular medications.
Pyrazinamide might not be
discontinued if sputum cultures
continue to be positive. Options 1, 2,
and 4 are not related directly to the
use of this medication.
Salmeterol (Serevent) is an adrenergic
type of bronchodilator and
beclomethasone dipropionate is a
glucocorticoid. Bronchodilators are
always administered before
glucocorticoids when both are to be
given on the same time schedule. This
allows for widening of the air passages
by the bronchodilator, which then
makes the glucocorticoid more
effective.
Theophylline is a xanthine
bronchodilator. Before drawing of a
serum level of the medication, the
client should avoid taking foods or
beverages that contain xanthine, such
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as colas, coffee, or chocolate. Thus,
the client is told to avoid caffeine
intake before the test.
Antiviral medications for influenza
must be taken exactly as prescribed.
These medications do not prevent the
spread of influenza and clients are
usually contagious for up to 2 days
after the initiation of antiviral
medications. Secondary bacterial
infections may occur despite antiviral
treatment. Side effects occur with
these medications and may
necessitate change in activities,
especially when driving or operating
machinery if dizziness occurs.
Theophylline (Theolair) is a
methylxanthine bronchodilator. The
nurse teaches the client to limit the
intake of xanthine-containing foods
while taking this medication. These
foods include coffee, cola, and
chocolate.
Hypersensitivity reaction can occur in
clients taking salmeterol. Signs and
symptoms include rash, urticaria, and
swelling of the face, lips, or eyelids.
The nurse should call the physician
immediately if any of these occur. The
other options are incorrect.
Omalizumab is an anti-inflammatory
used for long-term control of asthma.
Anaphylactic reactions can occur with
the administration of omalizumab. The
nurse administering the medication
should have medications for the
treatment of severe hypersensitivity
available. Options 1, 2, and 3 are
unnecessary.
Guaifenesin (Humibid) is an
expectorant and should be taken with
a full glass of water to decrease the
viscosity of secretions. Sustained-
release preparations should not be
broken open, crushed, or chewed. The
Sunday, October 16, 2011 13
 medication occasionally may cause
dizziness, headache, or drowsiness as
side effects. The client should contact
the physician if the cough lasts longer
than 1 week or is accompanied by
fever, rash, sore throat, or persistent
headache.
The nurse administering naloxone for
suspected opioid overdose should
have resuscitation equipment readily
available to support naloxone therapy
if it is needed. Other adjuncts that
may be needed include oxygen,
mechanical ventilator, and
vasopressors.
Diphenhydramine (Benadryl) has
several uses, including antihistamine,
antitussive, antidyskinetic, and
sedative-hypnotic. Instructions for use
include to take with food or milk to
decrease gastrointestinal upset and to
use oral rinses or sugarless gum or
hard candy to minimize dry mouth.
Because the medication causes
drowsiness, the client should avoid
use of alcohol or central nervous
system depressants, operating a car,
or engaging in other activities
requiring mental awareness during
use.
The client is taught about side effects
that could occur with the use of
codeine sulfate. The most common
side effects include drowsiness,
confusion, hypotension, nausea and
vomiting, and constipation. Others
include bradycardia, respiratory
depression, and urinary retention.
Cromolyn sodium (Intal) is an inhaled
nonsteroidal antiallergy agent and a
mast cell stabilizer. The most common
undesired side effects associated with
inhalation therapy of cromolyn sodium
are bronchospasm, cough, nasal
congestion, throat irritation, and
wheezing. Clients receiving this
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medication orally may experience
pruritus, nausea, diarrhea, and
myalgia.
Terbutaline (Brethine) is a
bronchodilator and is contraindicated
in clients with hypersensitivity to
sympathomimetics. It should be used
with caution in clients with impaired
cardiac function, diabetes mellitus,
hypertension, or hyperthyroidism, and
a history of seizures. The medication
may increase blood glucose levels.
Zafirlukast (Accolate) is a leukotriene
receptor antagonist used in the
prophylaxis and long-term treatment
of bronchial asthma. Zafirlukast is
used with caution in clients with
impaired hepatic function. Liver
function laboratory tests should be
performed to obtain a baseline, and
the levels should be monitored during
administration of the medication.
Isoniazid (INH) is an antitubercular
medication. A common side effect of
isoniazid is peripheral neuritis,
manifested by numbness, tingling, and
paresthesias in the extremities. This
can be minimized with pyridoxine
(vitamin B6) intake. Options 1, 3, and
4 are incorrect.
Isoniazid (INH) is hepatotoxic, and
therefore the client is taught to report
signs and symptoms of hepatitis
immediately, which include yellow skin
and sclera. For the same reason,
alcohol should be avoided during
therapy. The client should avoid intake
of Swiss cheese, fish such as tuna, and
foods containing tyramine because
they may cause a reaction
characterized by redness and itching
of the skin, flushing, sweating,
tachycardia, headache, or light-
headedness. The client can avoid
developing peripheral neuritis by
increasing the intake of pyridoxine
Sunday, October 16, 2011 14
 (vitamin B6) during the course of
isoniazid therapy.
Rifampin should be taken exactly as
directed. Doses should not be doubled
or skipped. The client should not stop
therapy until directed to do so by a
physician. The medication should be
administered on an empty stomach
unless it causes gastrointestinal upset,
and then it may be taken with food.
Antacids, if prescribed, should be
taken at least 1 hour before the
medication. Rifampin causes orange-
red discoloration of body secretions
and will stain soft contact lenses
permanently.
Ethambutol causes optic neuritis,
which decreases visual acuity and the
ability to discriminate between the
colors red and green. This poses a
potential safety hazard when a client
is driving a motor vehicle. The client is
taught to report this symptom
immediately. The client also is taught
to take the medication with food if
gastrointestinal upset occurs. Impaired
hearing results from antitubercular
therapy with streptomycin. Orange-red
discoloration of secretions occurs with
rifampin (Rifadin).
Cycloserine (Seromycin) is an
antitubercular medication that
requires weekly serum drug level
determinations to monitor for the
potential of neurotoxicity. Serum drug
levels lower than 30 mg/mL reduce
the incidence of neurotoxicity. The
medication needs to be taken after
meals to prevent gastrointestinal
irritation. The client needs to be
instructed to notify the physician if a
skin rash or early signs of central
nervous system toxicity are noted.
Alcohol needs to be avoided because
it increases the risk of seizure activity.
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Isoniazid (INH) therapy can cause an
elevation of hepatic enzyme levels
and hepatitis. Therefore, liver enzyme
levels are monitored when therapy is
initiated and during the first 3 months
of therapy. They may be monitored
longer in the client who is older than
50 or abuses alcohol. The laboratory
tests in options 1, 3, and 4 are not
necessary.
Albuterol is an adrenergic
bronchodilator. The nurse assesses
respiratory pattern, lung sounds,
pulse, and blood pressure before and
during therapy. The nurse also notes
the color, character, and amount of
sputum.
The client taking adrenergic
bronchodilators may experience
paradoxical bronchospasm, which is
evidenced by the client's wheezing.
This can occur with excessive use of
inhalers. Further medication should be
withheld, and the physician should be
notified. Options 1, 3, and 4 are
incorrect interpretations.
Rifabutin (Mycobutin) may be
prescribed for a client with active
Mycobacterium avium complex (MAC)
disease and tuberculosis. It inhibits
mycobacterial DNA-dependent RNA
polymerase and suppresses protein
synthesis. Side effects include rash,
gastrointestinal disturbances,
neutropenia (low neutrophil count),
red-orange–colored body secretions,
uveitis (blurred vision and eye pain),
myositis, arthralgia, hepatitis, chest
pain with dyspnea, and flu-like
syndrome. Vitamin B6 deficiency and
numbness and tingling in the
extremities are associated with the
use of isoniazid (INH). Ethambutol
(Myambutol) also causes peripheral
neuritis.
Sunday, October 16, 2011 15
 Common laboratory ranges for
activated partial thromboplastin time
are 20 to 36 seconds. Because the
activated partial thromboplastin time
should be 1.5 to 2.5 times the normal
value, the client's activated partial
thromboplastin time would be
considered therapeutic if it were 60
seconds.
β-Blockers such as metoprolol slow
conduction of impulses through the AV
node and decrease the heart rate. In
rapid atrial fibrillation, the goal first is
to slow the ventricular rate and
improve the cardiac output and then
attempt to restore normal sinus
rhythm.
Spironolactone is a potassium-sparing
diuretic and competes with
aldosterone at receptor sites in the
distal tubule, resulting in excretion of
sodium, chloride, and water and
retention of potassium and phosphate.
Use of the medications noted in
options 1, 2, and 4 could result in
hypokalemia.
Ecotrin is an aspirin-containing
product and should be avoided.
Excessive alcohol consumption should
be avoided by a client taking warfarin
sodium. Taking prescribed medication
at the same time each day increases
client compliance. The Medic-Alert
bracelet provides health care
personnel emergency information.
Therapeutic levels for digoxin range
from 0.5 to 2 mg/mL. Therefore,
options 2, 3, and 4 are incorrect.
Signs of toxicity from procainamide
include confusion, dizziness,
drowsiness, decreased urination,
nausea, vomiting, and
tachydysrhythmias. If the client
complains of dizziness, the nurse
should assess the vital signs first.
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Although options 2 and 3 may be
interventions, these would be done
after the vital signs are taken.
Nitroglycerin is a vasodilator and will
lower the blood pressure.
Audible expiratory wheezes may
indicate a serious adverse reaction,
bronchospasm. β-blockers may induce
this reaction, particularly in clients
with chronic obstructive pulmonary
disease or asthma. Normal decreases
in blood pressure and heart rate are
expected. Insomnia is a frequent mild
side effect and should be monitored.
Tea and coffee are stimulants and
mild diuretics. These are a poor choice
for hydration. Taking the medication
at the same time each day improves
compliance. Because furosemide is a
diuretic, the morning is the best time
to take the medication so as not to
interrupt sleep. Notification of the
health care provider is appropriate if
edema is noticed in the hands, feet, or
face or if the client is short of breath.
Sitting up slowly prevents postural
hypotension.
The prothrombin time will assess for
the therapeutic effect of warfarin
sodium (Coumadin), and the activated
partial thromboplastin time (aPTT) will
assess the therapeutic effect of
heparin. Hematocrit and hemoglobin
values assess red blood cell
concentrations. Baseline assessment,
including an aPTT value, should be
completed, as well as ongoing daily
aPTT values while the client is taking
heparin. Heparin doses are
determined based on the result of the
aPTT.
To help prevent tolerance, clients
need a 12-hour "no-nitrate" time,
sometimes referred to as a
pharmacological vacation away from
Sunday, October 16, 2011 16
 the medication. Options 1, 3, and 4
are incorrect.
This is a therapeutic, nonjudgmental
response. The statement reflects the
family's concern but remains
nonjudgmental. Option 1 dismisses
the family's concerns and
disempowers the family. Option 3
creates doubt about the physician's
practice without actually knowing the
circumstances. Option 4 is
argumentative and nontherapeutic.
The client receiving dopamine therapy
should be assessed for ineffective
tissue perfusion related to peripheral
vasoconstriction. Options 1, 2, and 4
are not related directly to this
medication therapy.
Thiazide diuretics such as
hydrochlorothiazide are sulfa-based
medications, and a client with a sulfa
allergy is at risk for an allergic
reaction. Also, clients are at risk for
hypokalemia, hyperglycemia,
hypercalcemia, hyperlipidemia, and
hyperuricemia.
Nicotinic acid, even an over-the-
counter form, should be avoided
because it may lead to liver
abnormalities. All lipid-lowering
medications also can cause liver
abnormalities, so a combination of
nicotinic acid and cholestyramine resin
is to be avoided. Constipation and
bloating are the two most common
side effects. Walking and the
reduction of fats in the diet are
therapeutic measures to reduce
cholesterol and triglyceride levels.
Flushing is a side effect of this
medication. Aspirin or a nonsteroidal
anti-inflammatory drug can be taken
30 minutes prior to taking the
medication to decrease flushing.
Alcohol consumption needs to be
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avoided because it will enhance this
side effect. The medication should be
taken with meals but this will decrease
gastrointestinal upset; taking the
medication with meals has no effect
on the flushing. Clay-colored stools are
a sign of hepatic dysfunction and
should be immediately reported to the
physician.
Flushing is a side effect of this
medication. Aspirin or a nonsteroidal
anti-inflammatory drug can be taken
30 minutes prior to taking the
medication to decrease flushing.
Alcohol consumption needs to be
avoided because it will enhance this
side effect. The medication should be
taken with meals but this will decrease
gastrointestinal upset; taking the
medication with meals has no effect
on the flushing. Clay-colored stools are
a sign of hepatic dysfunction and
should be immediately reported to the
physician.
Bumetanide (Bumex) is a diuretic. The
paroxysmal nocturnal dyspnea may be
due to increased venous return when
the client is lying in bed, and the client
needs diuresis. Propranolol is a β
blocker, lidocaine is an antiarrhythmic,
and streptokinase is a thrombolytic.
Denial is the most common reaction
when a client has a myocardial
infarction or anginal pain. Options 2, 3,
and 4 are incorrect.
The nurse is responsible for
administering the correct medication.
When medication orders are vague,
the nurse must call the physician to
clarify the orders before administering
the medication. Waiting for the
physician to make rounds delays
needed treatment.
Double vision, loss of appetite, and
nausea are early signs of digoxin
Sunday, October 16, 2011 17
 toxicity. Additional signs of digoxin
toxicity include bradycardia, difficulty
reading, visual alterations such as
green and yellow vision or seeing
spots or halos, confusion, vomiting,
diarrhea, decreased libido, and
impotence.
Clients on potassium-wasting diuretics
are at high risk for hypokalemia.
Clinical manifestations of hypokalemia
include fatigue, anorexia, nausea,
vomiting, muscle weakness, leg
cramps, decreased bowel motility,
paresthesias, and dysrhythmias.
Most β blockers may be administered
with food or on an empty stomach, but
propranolol is absorbed best if taken
with meals or directly after eating.
Exercise will not prevent orthostatic
hypotension. Hot showers and baths
are not advised. The client needs to be
instructed in how to take the pulse
rate and to notify the physician if the
heart rate falls below 60 beats/min.
Enalapril (Vasotec) is an angiotensin-
converting enzyme inhibitor.
Angioedema is an adverse effect.
Swelling of the tongue and lips can
result in airway occlusion. Nausea,
insomnia, and a cough can occur as
side (not adverse) effects of the
medication.
Nesiritide is a recombinant version of
human B-type natriuretic peptide,
which vasodilates arteries and veins. It
is used for the treatment of
decompensated heart failure,
increases renal glomerular filtration,
and increases urine output. Options 2,
3, and 4 are incorrect.
The usual guidelines for administering
nitroglycerin tablets for chest pain
include administering one tablet every
5 minutes PRN for chest pain, for a
total dose of three tablets. If the client
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does not obtain relief after taking a
third dose of nitroglycerin, the
physician is notified. Because the
client is still complaining of chest pain,
the nurse would administer a second
nitroglycerin tablet. The nurse would
assess the client's pain level and
check the client's blood pressure
before administering each
nitroglycerin dose. There are no data
in the question that indicate the need
to call a Code Blue. Additionally, it is
not necessary to contact the client's
family unless the client has requested
this.
Phosphate-binding agents that contain
aluminum include Alu-Caps, Basaljel,
and Amphojel. These products are
made from aluminum hydroxide. Tums
are made from calcium carbonate and
also bind phosphorus. Tums are
prescribed to avoid the occurrence of
dementia related to high intake of
aluminum. Phosphate-binding agents
are needed by the client in renal
failure because the kidneys cannot
eliminate phosphorus.
Trimethoprim (TMP)-sulfamethoxazole
(SMX) (Bactrim) may be administered
by intravenous infusion but should not
be mixed with any other medications
or solutions. Trimethoprim-
sulfamethoxazole is infused over 60 to
90 minutes, and bolus infusions or
rapid infusions must be avoided.
Nalidixic acid can intensify the effects
of oral anticoagulants by displacing
these agents from binding sites on
plasma protein. When an oral
anticoagulant is combined with
nalidixic acid, a decrease in the
anticoagulant dosage may be needed.
Each dose of sulfisoxazole should be
administered with a full glass of water,
and the client should maintain a high
fluid intake. The medication is more
Sunday, October 16, 2011 18
 soluble in alkaline urine. The client
should not be instructed to taper or
discontinue the dose. Some forms of
sulfisoxazole cause urine to turn dark
brown or red. This does not indicate
the need to notify the physician.
Clients taking trimethoprim (TMP)-
sulfamethoxazole (SMZ) should be
informed about early signs of blood
disorders that can occur from this
medication. These include sore throat,
fever, and pallor, and the client should
be instructed to notify the physician if
these symptoms occur. The other
options do not require physician
notification.
The nurse should instruct the client
that a reddish-orange discoloration of
urine may occur. The nurse also
should instruct the client that this
discoloration can stain fabric. The
medication should be taken after
meals to reduce the possibility of
gastrointestinal upset. A headache is
an occasional side effect of the
medication and does not warrant
discontinuation of the medication.
Bethanechol chloride (Urecholine) can
be hazardous to clients with urinary
tract obstruction or weakness of the
bladder wall. The medication has the
ability to contract the bladder and
thereby increase pressure within the
urinary tract. Elevation of pressure
within the urinary tract could rupture
the bladder in clients with these
conditions.
Toxicity (overdose) produces
manifestations of excessive
muscarinic stimulation such as
salivation, sweating, involuntary
urination and defecation, bradycardia,
and severe hypotension. Treatment
includes supportive measures and the
administration of atropine sulfate
subcutaneously or intravenously.
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Toxicity (overdosage) of this
medication produces central nervous
system excitation, such as
nervousness, restlessness,
hallucinations, and irritability. Other
signs of toxicity include hypotension
or hypertension, confusion,
tachycardia, flushed or red face, and
signs of respiratory depression.
Drowsiness is a frequent side effect of
the medication but does not indicate
overdosage.
Propantheline bromide (Pro-Banthine)
is contraindicated in clients with
narrow-angle glaucoma, obstructive
uropathy, gastrointestinal disease, or
ulcerative colitis. The medication
decreases bladder muscle spasms.
Nephrotoxicity can occur from the use
of cyclosporine (Sandimmune).
Nephrotoxicity is evaluated by
monitoring for elevated blood urea
nitrogen and serum creatinine levels.
Cyclosporine does not depress the
bone marrow.
A compound present in grapefruit juice
inhibits metabolism of cyclosporine. As
a result, consumption of grapefruit
juice can raise cyclosporine levels by
50% to 100%, thereby greatly
increasing the risk of toxicity.
Amphotericin B deoxycholate,
erythromycin, and ketoconazole can
elevate cyclosporine levels. When any
of these medications is combined with
cyclosporine, the dosage of
cyclosporine must be reduced to
prevent accumulation to toxic levels.
To improve palatability, the client
should be taught to mix the
concentrated medication solution with
chocolate milk or orange juice just
before administration. Grapefruit juice
is avoided because it can raise
cyclosporine levels. The client is
Sunday, October 16, 2011 19
 instructed to dilute the concentrate in
a glass (not Styrofoam) to ensure
ingestion of the complete dose.
The most common adverse effects of
cyclosporine are nephrotoxicity,
infection, hypertension, tremors, and
hirsutism. Of these, nephrotoxicity and
infection are the most serious.
Tacrolimus (Prograf) is used with
caution in immunosuppressed clients
and in clients with renal, hepatic, or
pancreatic function impairment.
Tacrolimus is contraindicated in clients
with hypersensitivity to this
medication or hypersensitivity to
cyclosporine.
A blood glucose level of 200 mg/dL is
significantly elevated above the
normal range of 70 to 110 mg/dL and
suggests an adverse reaction. Other
adverse reactions include
neurotoxicity evidenced by headache,
tremor, and insomnia, gastrointestinal
effects such as diarrhea, nausea, and
vomiting, hypertension, and
hyperkalemia.
Mycophenolate mofetil (CellCept)
should be administered on an empty
stomach. The capsules should not be
opened or crushed. The client should
contact the physician if unusual
bleeding or bruising, sore throat,
mouth sores, abdominal pain, or fever
occurs. Antacids containing
magnesium and aluminum may
decrease the absorption of the
medication and therefore should not
be taken with the medication. The
medication is given with
corticosteroids and cyclosporine.
Epoetin alfa is used to reverse anemia
associated with chronic renal failure.
Therapeutic effect is seen when the
hematocrit is between 30% and 33%.
NCLEX– 58826276.doc
Options 2, 3, and 4 are not associated
with the action of this medication.
The client should be instructed not to
shake the bottle. The medication
should be refrigerated at all times. The
medication should not be frozen.
Syringes with a ⅝-inch needle are
used for subcutaneous injection. A 1½-
inch needle may be used for
intramuscular injection.
Cinoxacin should be administered with
caution in clients with renal
impairment. The dosage should be
reduced, and failure to do so could
result in accumulation of cinoxacin to
toxic levels. Therefore, the nurse
would verify the prescription with the
physician if the client had a
documented history of renal
insufficiency. The laboratory and
diagnostic test results are normal
findings. Folic acid (vitamin B6) may
be prescribed for a client with renal
insufficiency to prevent anemia.
Myasthenia gravis often can be
diagnosed based on clinical signs and
symptoms. The diagnosis can be
confirmed by injecting the client with a
dose of edrophonium (Tensilon). This
medication inhibits the breakdown of
an enzyme in the neuromuscular
junction, so more acetylcholine binds
onto receptors. If the muscle is
strengthened for 3 to 5 minutes after
this injection, it confirms a diagnosis of
myasthenia gravis. Another
medication, neostigmine (Prostigmin)
also may be used because the effect
lasts for 1 to 2 hours, giving a better
analysis. For either medication,
atropine sulfate should be available as
the antidote.
An edrophonium injection makes the
client in cholinergic crisis temporarily
worse. This is known as a negative
Tensilon test.
Sunday, October 16, 2011 20
 Edrophonium is administered to
determine whether the client is
reacting to an overdose of a
medication (cholinergic crisis) or an
increasing severity of the disease
(myasthenic crisis). When the
edrophonium injection is given and the
condition improves temporarily, the
client is in myasthenic crisis. This is
known as a positive Tensilon test.
Dyskinesia and impaired voluntary
movement may occur with high
levodopa dosages. Nausea, anorexia,
dizziness, orthostatic hypotension,
bradycardia, and akinesia (the
temporary muscle weakness that lasts
1 minute to 1 hour, also known as "on-
off phenomenon") is a frequent side
effect of the medication.
The therapeutic serum drug level
range for phenytoin is 10 to 20
mcg/mL.
Intravenous infusion of phenytoin
should be administered by injection
into a large vein. The medication may
be diluted in normal saline solution;
however, dextrose solution should be
avoided because of medication
precipitation. The medication is
administered as intermittent doses.
Continuous intravenous infusions
should not be used. Infusion rates of
more than 50 mg/min may cause
hypotension or cardiac dysrhythmias,
especially in older and debilitated
clients.
Phenytoin enhances the rate of
estrogen metabolism, which can
decrease the effectiveness of some
birth control pills. Options 1, 2, and 4
are inappropriate instructions.
The antidote for acetaminophen is
acetylcysteine (Mucomyst). The
normal therapeutic serum level of
acetaminophen is 10 to 20 mcg/mL. A
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toxic level is higher than 50 mcg/mL,
and levels higher than 200 mcg/mL
could indicate hepatotoxicity.
Auranofin (Ridaura) is a gold
preparation used to treat rheumatoid
arthritis. Fludarabine (Fludara) and
pentostatin (Nipent) are antineoplastic
agents.
In adults, overdose of acetaminophen
causes liver damage. Option 3 is an
indicator of liver function and is the
only option that indicates an abnormal
laboratory value. The normal direct
bilirubin level is 0 to 0.3 mg/dL. The
normal platelet count is 150,000 to
400,000/mm3. The normal
prothrombin time is 10 to 13 seconds.
The normal sodium level is 135 to 145
mEq/L.
Edrophonium is a short-acting
acetylcholinesterase inhibitor used as
a diagnostic agent. When a client with
suspected myasthenia gravis is given
2 mg of the medication intravenously,
an increase in muscle strength should
be seen in 30 to 60 seconds. If no
response occurs, another 4 to 10 mg
of edrophonium is given over the next
2 minutes, and muscle strength is
tested again. If no increase in muscle
strength occurs with this higher dose,
the muscle weakness is not caused by
myasthenia gravis. Clients receiving
injections of this medication
commonly demonstrate a drop in
blood pressure, feel faint and dizzy,
and are flushed.
The therapeutic phenytoin level is 10
to 20 mcg/mL. At a level higher than
20 mcg/mL, involuntary movements of
the eyeballs (nystagmus) appears. At
a level higher than 30 mcg/mL, ataxia
and slurred speech occur.
Mannitol is an osmotic diuretic that
induces diuresis by raising the osmotic
pressure of glomerular filtrate, thereby
Sunday, October 16, 2011 21
 inhibiting tubular reabsorption of
water and solutes. Mannitol is used to
reduce intracranial pressure in the
client with head trauma.
Mild intoxication with acetylsalicylic
acid (aspirin) is called salicylism and is
experienced commonly when the daily
dosage is higher than 4 g. Tinnitus
(ringing in the ears) is the most
frequent effect noted with intoxication.
Hyperventilation may occur because
salicylate stimulates the respiratory
center. Fever may result, because
salicylate interferes with the metabolic
pathways coupling oxygen
consumption and heat production.
Options 2, 3, and 4 are not associated
specifically with toxicity.
Adverse effects of carbamazepine
appear as blood dyscrasias, including
aplastic anemia, agranulocytosis,
thrombocytopenia, leukopenia,
cardiovascular disturbances,
thrombophlebitis, dysrhythmias, and
dermatological effects.
Morphine sulfate suppresses the
cough reflex. Clients need to be
encouraged to cough and deep-
breathe to prevent pneumonia.
Options 1, 2, and 3 are not associated
specifically with the use of this
medication.
Side effects of meperidine (Demerol)
include respiratory depression,
orthostatic hypotension, tachycardia,
drowsiness and mental clouding,
constipation, and urinary retention.
While the client is taking codeine
sulfate, the nurse would monitor vital
signs and assess for hypotension. The
nurse also should increase fluid intake,
palpate the bladder for urinary
retention, auscultate bowel sounds,
and monitor the pattern of daily bowel
activity and stool consistency. The
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nurse should monitor respiratory
status and initiate deep-breathing and
coughing exercises. Additionally, the
nurse monitors the effectiveness of
the pain medication.
Meperidine hydrochloride is an opioid
analgesic. Side effects include
respiratory depression, drowsiness,
hypotension, constipation, urinary
retention, nausea, vomiting, and
tremors.
Infection and pancytopenia are side
effects of etanercept (Enbrel).
Laboratory studies are performed prior
to and during drug treatment. The
appearance of abnormal white blood
cell counts and abnormal platelet
counts can alert the nurse to a
potentially life-threatening infection.
Injection site itching and edema are
common occurrences following
administration. A metallic taste and
loss of appetite are not common signs
of side effects of this medication.
Clients taking allopurinol are
encouraged to drink 3000 mL of fluid a
day. A full therapeutic effect may take
1 week or longer. Allopurinol is to be
given with, or immediately after,
meals or milk. A client who develops a
rash, irritation of the eyes, or swelling
of the lips or mouth should contact the
physician because this may indicate
hypersensitivity.
Colchicine is contraindicated in clients
with severe gastrointestinal, renal,
hepatic, or cardiac disorders and in
clients with blood dyscrasias. Clients
with impaired renal function may
exhibit myopathy and neuropathy
manifested as generalized weakness.
This medication should be used with
caution in clients with impaired
hepatic function, the older client, and
the debilitated client.
Sunday, October 16, 2011 22
 Precautions need to be taken with the
administration of alendronate to
prevent gastrointestinal side effects
(especially esophageal irritation) and
to increase absorption of the
medication. The medication needs to
be taken with a full glass of water
after rising in the morning. The client
should not eat or drink anything for 30
minutes following administration and
should not lie down after taking the
medication.
Baclofen is a skeletal muscle relaxant
and acts at the spinal cord level to
decrease the frequency and amplitude
of muscle spasms in clients with spinal
cord injuries or debilitating diseases
such as multiple sclerosis. Options 1,
3, and 4 are not associated effects of
this medication.
Baclofen is a skeletal muscle relaxant
and frequently causes drowsiness,
dizziness, weakness, and fatigue.
Baclofen also can cause nausea,
constipation, and urinary retention.
Clients should be warned about the
possible reactions. Options 1, 2, and 4
are not side effects.
Coal tar is used to treat psoriasis and
other chronic disorders of the skin. It
suppresses DNA synthesis, mitotic
activity, and cell proliferation. It has
an unpleasant odor, frequently can
stain the skin and hair, and can cause
phototoxicity. It does not cause
diarrhea.
The client should be instructed that
symptoms such as drowsiness,
weakness, and fatigue are more
intense in the early phase of therapy
and diminish with continued
medication use. The client should be
instructed never to withdraw abruptly
or stop the medication because abrupt
withdrawal can cause visual
hallucinations, paranoid ideation, and
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seizures. The nurse should inform the
client that these symptoms will
subside and encourage the client that
continuing the use of the medication is
the best option.
Dose-related liver damage is the most
serious adverse effect of dantrolene.
To reduce the risk of liver damage,
tests of liver function should be
performed before treatment and
throughout the treatment interval.
Dantrolene is administered in the
lowest effective dosage for the
shortest time necessary.
Clients with seizure disorders may
have a lowered seizure threshold
when baclofen is administered.
Concurrent therapy may require an
increase in the anticonvulsive
medication. The disorders in options 2,
3, and 4 are not contraindications or
cautions for the use of this medication.
Because cyclobenzaprine (Flexeril) has
anticholinergic effects, it should be
used with caution in clients with a
history of urinary retention, glaucoma,
and increased intraocular pressure.
Cyclobenzaprine should be used only
for a short term (2 to 3 weeks).
The client needs to be told that the
urine may turn brown, black, or green.
Other adverse effects include blurred
vision, nasal congestion, urticaria, and
rash. The client needs to be instructed
that if these adverse effects occur to
notify the physician.
Intravenous administration of
methocarbamol can cause
hypotension and bradycardia. The
nurse needs to monitor for these side
effects. Options 1, 2, and 4 are not a
concern with administration of this
medication.
Sunday, October 16, 2011 23
 Allopurinol is an antigout medication
that decreases uric acid production.
Foods high in purine need to be
avoided. Kidney stones can occur as a
complication of gout and can be
decreased by increasing fluids and
limiting calcium intake.
Gastrointestinal upset is common with
this medication and can be minimized
when taken with food. Unprotected
exposure to ultraviolet light and
sunlight can result in visual changes
and should be avoided. Alcohol and
vitamin C can increase uric acid levels
and need to be avoided.
Because emotional stress frequently
exacerbates the symptoms of
rheumatoid arthritis, the absence of
symptoms is a positive finding.
DMARDs are given to slow progression
of joint degeneration. In addition, the
improvement in the range of motion
after 3 months of therapy with normal
blood work is a positive finding.
Temperature elevation and
inflammation and irritation at the
medication injection site could
indicate signs of infection.
The most common side effects related
to this medication include central
nervous system and gastrointestinal
system dysfunction. Fluoxetine
(Prozac) affects the gastrointestinal
system by causing nausea and
vomiting, cramping, and diarrhea.
Excessive sweating, dry mouth, and
cardiovascular symptoms are not side
effects associated with this
medication.
Buspirone (BuSpar) is not
recommended for the treatment of
drug or alcohol withdrawal, thought
disorders, or schizophrenia. Buspirone
hydrochloride most often is indicated
for the treatment of anxiety.
NCLEX– 58826276.doc
Maintenance serum levels of lithium
are 0.6 to 1.2 mEq/L. Symptoms of
toxicity begin to appear at levels of
1.5 to 2 mEq/L. Lithium toxicity
requires immediate medical attention
with lavage and possible peritoneal
dialysis or hemodialysis.
Chloral hydrate (Somnote) is a
sedative. This medication does not
affect cardiac function. Blood pressure
changes are not significant with the
use of this medication. The client
should call for assistance to the
bathroom at night. Additionally, the
client may experience residual
daytime sedation; therefore, the nurse
also should instruct the client to call
for ambulation assistance during the
daytime hours.
Clomipramine (Anafranil) is a tricyclic
antidepressant used to treat
obsessive-compulsive disorder. Weight
gain and tachycardia are side effects
of this medication. Sedation
sometimes occurs and insomnia is a
seldom side effect.
Amitriptyline hydrochloride is a
tricyclic antidepressant. Depressed
individuals sleep for extended periods,
have a change in appetite, are unable
to go to work, and have difficulty
concentrating. They also may
experience increased fatigue, feelings
of guilt or worthlessness, loss of
interest in activities, and possible
suicidal tendencies. Once they have
had some therapeutic effect from their
medication, they will report resolution
of many of these complaints and
demonstrate an improvement in their
appearance.
Haloperidol (Haldol) is an
antipsychotic used to manage
psychotic disorder. Hallucinations,
delusions, and altered thought
processes are characteristics of a
Sunday, October 16, 2011 24
 psychotic disorder and should
decrease with effective treatment.
Fixed stare (option 1) and dry mouth
(option 4) are side effects of therapy.
Option 3 is unrelated to this
medication.
The nurse monitors for signs of
toxicity. Seizure activity is common in
bupropion dosages higher than 450
mg daily. This medication does not
cause significant orthostatic blood
pressure changes. Weight gain is an
occasional side effect, whereas
constipation is a common side effect
of this medication.
The abrupt withdrawal of alprazolam
(Xanax) could result in seizure activity
from rebound central nervous system
excitation. All clients receiving this
medication should be warned of this
danger. The other options are
incorrect.
Sertraline hydrochloride (Zoloft) is
classified as an antidepressant.
Sertraline generally is administered
once every 24 hours. It may be
administered in the morning or
evening, but evening administration
may be preferable, because
drowsiness is a side effect. The
medication may be administered
without food or with food if
gastrointestinal distress occurs.
Sertraline is not ordered for use as
needed.
The client taking clozapine (Clozaril)
may experience agranulocytosis,
which is monitored by reviewing the
results of the white blood cell count.
Treatment is interrupted if the white
blood cell count drops below
3000/mm3. Agranulocytosis could be
fatal if undetected and untreated. The
other options are not related
specifically to the use of this
medication.
NCLEX– 58826276.doc
Phenobarbital (Luminal) is an
anticonvulsant and hypnotic agent.
The client should avoid taking any
other central nervous system
depressants such as alcohol while
taking this medication. The medication
may be given without regard to meals.
Taking the medication at the same
time each day enhances compliance
and maintains more stable blood
levels of the medication. Using a dose
container or "pillbox" may be helpful
for some clients.
Chlorpromazine hydrochloride
(Thorazine) is an antipsychotic
medication. A side effect of this
medication is that the color of urine
may darken. The client should be
aware that this effect is harmless. The
other options are incorrect.
Dry mouth is a common side effect.
Frequent mouth rinsing with water,
sucking on hard candy, and chewing
sugarless gum will alleviate this
common side effect. Hypotension and
hypertension are rare side effects of
fluphenazine (Prolixin). Mild
leukopenia may occur, but the
temperature does not need to be
taken daily. Weight gain is a common
side effect, and frequent snacks will
worsen the problem.
Oxazepam (Serax) causes
constipation, and the client is
instructed to increase fluid intake and
bulk (high fiber) in the diet. If the
heart begins to beat fast, the
physician is notified, because this
could indicate overdose. Additionally,
diarrhea could indicate an incomplete
intestinal obstruction and, if this
occurs, the physician is notified.
Risperidone (Risperdal) can cause
orthostatic hypotension. Sunlight
should be avoided by the client taking
this medication. Food interaction is not
Sunday, October 16, 2011 25
 a concern. With any psychotropic
medication, caution needs to be taken
until the individual can determine
whether his or her level of alertness is
affected.
The therapeutic serum level of lithium
is 0.6 to 1.2 mEq/L. A serum lithium
level of 1.8 mEq/L indicates moderate
toxicity. Serum lithium concentrations
of 1.5 to 2.5 mEq/L may produce
vomiting, diarrhea, ataxia,
incoordination, muscle twitching, and
slurred speech.
The maximum therapeutic effects of
imipramine hydrochloride (Tofranil)
may not occur for 2 to 3 weeks after
the antidepressant therapy has been
initiated. Therefore, options 1, 3, and
4 are incorrect.
Depressed individuals will sleep for
long periods, are not able to go to
work, and feel as if they cannot "do
anything." Once they have had some
therapeutic effect from their
medication, they will report resolution
of many of these complaints and
demonstrate an improvement in their
appearance.
Benztropine (Cogentin) is an
anticholinergic medication used to
treat drug-induced extrapyramidal
reactions, except tardive dyskinesia.
Options 1, 3, and 4 are antipsychotic
medications. Antipsychotic
medications can cause extrapyramidal
reactions.
Tardive dyskinesia is an adverse
reaction that can occur from
antipsychotic medication. It is
characterized by uncontrollable
involuntary movements of the body
and extremities, particularly the
tongue. Torticollis refers to an
extrapyramidal side effect involving
the upper body. Hypertensive crisis
NCLEX– 58826276.doc
can occur from the use of monoamine
oxidase inhibitors and is characterized
by hypertension, occipital headache
radiating frontally, neck stiffness and
soreness, nausea, and vomiting.
Neuroleptic malignant syndrome is a
potentially fatal syndrome that may
occur at any time during therapy with
neuroleptic (antipsychotic)
medications. It is characterized by
dyspnea or tachypnea, tachycardia or
irregular pulse rate, fever, blood
pressure changes, increased sweating,
loss of bladder control, and skeletal
muscle rigidity.
Phenelzine sulfate (Nardil) is a
monoamine oxidase inhibitor. The
client should avoid taking in foods that
are high in tyramine. Use of these
foods could trigger a potentially fatal
hypertensive crisis. Foods to avoid
include yogurt, aged cheeses, smoked
or processed meats, red wines, and
fruits such as avocados, raisins, or
figs.
An adverse effect of PTU is
agranulocytosis. The client needs to
be informed of the early signs of this
adverse effect, which include fever
and sore throat. Drowsiness is an
occasional side effect of the
medication. Increased urination and
dry mouth are unrelated to this
medication.
Iodine solution can cause iodine
toxicity. Iodine is corrosive and an
overdose will injure the
gastrointestinal tract. Symptoms
include abdominal pain, vomiting, and
diarrhea. Swelling of the glottis may
result in asphyxiation. Treatment
consists of gastric lavage to remove
iodine from the stomach and
administration of sodium thiosulfate to
reduce iodine to iodide. Calcium
gluconate is used for acute
hypocalcemia. Mucomyst is the
Sunday, October 16, 2011 26
 antidote for acetaminophen (Tylenol)
overdose. Vitamin K is the antidote for
warfarin (Coumadin).
Octreotide (Sandostatin) is used to
reduce growth hormone levels in
clients with acromegaly. The most
common side effects of octreotide
include diarrhea, nausea, gallstone
formation, and abdominal discomfort.
Hypertension, although rare, may
occur. Polyuria is not associated with
this medication.
Levothyroxine (Synthroid) accelerates
the degradation of vitamin K-
dependent clotting factors. As a result,
the effects of warfarin (Coumadin) are
enhanced. Therefore, if thyroid
hormone replacement therapy is
instituted in a client who has been
taking warfarin, the dosage of warfarin
should be reduced.
To prevent acute adrenal insufficiency,
glucocorticoids should not be abruptly
discontinued. These medications can
cause sodium and water retention and
the loss of potassium, and clients
should be instructed to limit sodium
intake and consume potassium-rich
foods. Additionally, adequate dietary
intake is important. These medications
can increase the risk of infection and
the client should avoid contact with
persons who are ill.
NPH insulin is an intermediate-acting
insulin. Its onset of action is 3 to 4
hours, it peaks in 4 to 12 hours, and
its duration of action is 16 to 20 hours.
An insulin vial in current use can be
kept at room temperature for up to 1
month without significant loss of
activity. Direct sunlight and heat must
be avoided.
Santyl is used to promote
débridement of dermal lesions and
severe burns. It is applied once daily
NCLEX– 58826276.doc
and covered with a sterile dressing.
Options 1, 3, and 4 are incorrect.
Somatotropin (Humatrope) should not
be administered during or after
epiphyseal closure. Efficacy of therapy
declines as the client grows older and
is usually lost entirely by age 20 to 24
years.
Hyperglycemia can occur from the
administration of growth hormone,
particularly in a client with diabetes
mellitus. Growth hormone therapy is
associated with a decline in thyroid
function. Hypercalciuria can occur,
particularly during the first 2 to 3
months of therapy. Glucose and
thyroid hormone levels should be
monitored.
Lindane can penetrate the intact skin
and can cause seizures if absorbed in
sufficient quantities. Clients at highest
risk for seizures are premature infants,
children, and those with preexisting
seizure disorders. Lindane should not
be used on pediatric clients unless
safer medications have failed to
control infection.
Hydrocolloid gel (DuoDerm) contains
hydroactive particles embedded in a
polymer base, which are softened by
wound moisture and act as a
protective gel over healing tissue. It is
applied directly to the wound and can
be left in place for up to 7 days.
Lypressin is an antidiuretic hormone
used in the treatment of diabetes
insipidus. It promotes renal
conservation of water by acting on the
collecting ducts of the kidney to
increase the permeability to water,
which results in increased water
reabsorption. Options 1, 3, and 4 are
not actions of the medication.
Somatrem is a growth hormone used
in the treatment of dwarfism. When
Sunday, October 16, 2011 27
 treatment is started, height may be
increased by as much as 6 inches. To
monitor treatment, height and weight
should be measured monthly. Options
1, 2, and 4 are incorrect.
The effect of lispro insulin begins
within 10 minutes of subcutaneous
injection, peaks in 1 hour, and has a
duration of action of 3 hours. Lispro
insulin acts more rapidly than Regular
insulin and has a shorter duration of
action. Because of its rapid onset, it
can be administered immediately
before eating. In contrast, Regular
insulin is generally administered 30 to
60 minutes before meals.
Because Regular insulin forms a true
solution and is safe for IV use. It is the
only type of insulin that can be
administered by the IV route.
The most common side effect of
metformin (Glucophage) is GI
disturbances, including decreased
appetite, nausea, and diarrhea. These
generally subside over time. This
medication does not cause weight
gain; in fact, clients lose an average of
7 to 8 lb because the medication
causes nausea and decreased
appetite. Although hypoglycemia can
occur, it is not the most common side
effect.
Sulfonylureas promote insulin
secretion by the pancreas and may
also increase tissue response to
insulin. Biguanides decrease glucose
production by the liver. α-Glucosidase
inhibitors inhibit carbohydrate
digestion. Thiazolidinediones decrease
insulin resistance.
When the client with diabetes mellitus
becomes ill, control is more difficult.
Insulin is not omitted and the client is
encouraged to consume liquid
carbohydrates if unable to eat regular
NCLEX– 58826276.doc
meals. The client is instructed to notify
the physician if vomiting or diarrhea
occurs, or if the illness progresses past
2 days.
Fludrocortisone acetate (Florinef
Acetate) has mineralocorticoid activity
and also has a modest glucocorticoid
effect. It acts primarily on the kidneys
distal tubules, enhancing the
resorption of sodium and chloride ions
and the excretion of potassium and
hydrogen ions. It promotes water
retention.
Laboratory determinations of serum
thyroid stimulating hormone (TSH)
level are an important means of
evaluation. Successful therapy will
cause elevated TSH levels to fall.
These levels will begin their decline
within hours of the onset of therapy
and will continue to drop as plasma
levels of thyroid hormone build up. If
an adequate dosage is administered,
TSH levels will remain suppressed for
the duration of therapy.
Levothyroxine (Synthroid) is used in
the treatment of hypothyroidism.
Although therapy with levothyroxine
may begin with small doses that are
gradually increased, the most
appropriate response is to inform the
client that the full therapeutic effect
may take 1 to 3 weeks.
For most hypothyroid clients,
replacement therapy must be
continued for life. Treatment provides
symptomatic relief but does not
produce a cure. The client should be
told that although therapy will cause
symptoms to improve, these
improvements do not constitute a
reason to interrupt or discontinue the
medication. Options 2 and 3 are
incorrect. Option 1 places the client's
question on hold.
Sunday, October 16, 2011 28
 Isoproterenol is an adrenergic
bronchodilator. Side effects can
include tachycardia, hypertension,
chest pain, dysrhythmias,
nervousness, restlessness, and
headache. The nurse monitors for
these effects during therapy.
Cinoxacin should be administered with
caution in clients with renal
impairment. The dosage should be
reduced, and failure to do so could
result in accumulation of cinoxacin to
toxic levels. It is not contraindicated to
the disorders identified in options 1, 3,
and 4.
Administration of bethanechol
(Urecholine) with food can cause
nausea and vomiting in the client. To
avoid this problem, oral doses should
be administered 1 hour before meals
or 2 hours after meals.
Methenamine (Mandelamine) is
contraindicated in clients with renal or
hepatic disease or clients with severe
dehydration. The nurse would question
the physician's prescription for this
medication in the client with cirrhosis
of the liver. Options 2, 3, and 4 are not
contraindicated with this medication.
Nalidixic acid (NegGram) is used for
acute and chronic urinary tract
infections, especially gram-negative
bacterial infections. The medication is
contraindicated in clients with a
history of seizures. It is used with
caution in clients with liver or renal
disorders. It is not contraindicated in
the disorders in options 1, 3, or 4.
The client needs to be instructed to
dispense the oral liquid into a glass
container using a specially calibrated
pipette. The client should not use any
other type of dropper to calibrate the
amount of prescribed medication.
Options 1, 2, and 4 are correct.
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Hydrocodone is an opioid analgesic
that also has antitussive properties.
Side effects of this medication include
physical and psychological
dependence, bradycardia and
hypotension, respiratory depression,
nausea, vomiting, constipation,
sedation, and confusion.
Cromolyn sodium (Intal) is an
antiasthmatic, antiallergic, and mast
cell stabilizer that inhibits the release
of mediators from mast cells after
exposure to an antigen. It can also
interrupt the migration of eosinophils
into the inflammatory site and
decrease the number of eosinophils.
These actions decrease airway
hyperresponsiveness in some clients
with asthma. It has no bronchodilating
action.
Because acetylcysteine has a
pervasive flavor of rotten eggs, it must
be disguised in a flavored ice drink
and is preferably drunk through a
straw to minimize contact with the
mouth. Acetylcysteine is the antidote
for acetaminophen. It is a solution that
is also used as a mucolytic agent,
administered via nebulization. It is not
administered by the IV, IM, or
subcutaneous route.
Side effects of baclofen include
drowsiness, dizziness, weakness, and
nausea. Occasional side effects
include headache, paresthesias of the
hands and feet, constipation or
diarrhea, anorexia, hypotension,
confusion, and nasal congestion.
Paradoxical central nervous system
excitement and restlessness can
occur, along with slurred speech,
tremor, dry mouth, nocturia, and
impotence.
The TENS unit is portable and the
client controls the system for relieving
pain and reducing the need for
Sunday, October 16, 2011 29
 analgesics. It is attached to the skin of
the body by electrodes. Hospitalization
is not required.
Cinoxacin (Cinobac) is a urinary
antiseptic and is administered with
meals to decrease gastrointestinal
side effects. The normal dosage is 1
g/day administered in two to four
divided doses for a period of 7 to 14
days.
Nitrofurazone (Furacin) is applied
topically to the burn and has a broad
spectrum of antibiotic activity. It is
used for burns in which bacterial
resistance to other agents is a real or
potential problem. A {1/16}-inch film
is applied directly to the burn. Saline-
soaked dressings are not used.
The normal serum calcium level is 8.6
to 10.0 mg/dL. This client is
experiencing hypercalcemia. Calcium
gluconate and calcium chloride are
medications used for the treatment of
tetany that occurs from acute
hypocalcemia. In hypercalcemia, large
doses of vitamin D need to be
avoided. Calcitonin, a thyroid
hormone, decreases the plasma
calcium level by increasing the
incorporation of calcium into the
bones, thus keeping it out of the
serum.
Sodium polystyrene sulfonate
(Kayexalate) is a cation exchange
resin used for the treatment of
hyperkalemia. The resin passes
through the intestine or is retained in
the colon. It releases sodium ions
primarily in exchange for potassium
ions. The therapeutic effect occurs 2
to 12 hours after oral administration
and longer after rectal administration.
When carbamazepine (Tegretol) is
administered, blood levels need to be
tested periodically to check for the
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child's absorption of the medication.
The amount of the medication
prescribed is based on the blood level
achieved. Carbamazepine's
therapeutic serum range is 3 to 14
mcg/mL. The nurse would anticipate
that the physician would continue the
presently prescribed dosage.
Glucagon is used to treat
hypoglycemia resulting from insulin
overdose. The family of the client is
instructed in how to administer the
medication. In an unconscious client,
arousal usually occurs within 20
minutes of glucagon injection. Once
consciousness has been regained, oral
carbohydrates should be given.
Lipoatrophy and lipohypertrophy result
from insulin injections.
Corticosteroid therapy can cause
calcium and potassium depletion,
sodium retention, and glucose
intolerance. The client should be
monitored for hyperglycemia. Clients
should be encouraged to have an
intake of potassium-rich and calcium-
rich foods. Also, an increase in
potassium and a decrease in sodium
are recommended to prevent
potassium depletion and sodium
retention while taking the
corticosteroid. Although increased
fluids are important for the client with
emphysema to maintain thin
respiratory secretions, this action is
not specific to the use of
corticosteroids.
Crystals form in a mannitol solution if
the solution is cooled but will quickly
dissolve if the container is placed in
warm water, then cooled to body
temperature before administration.
Shaking the vial should not be done
and will not dissolve the crystals. The
medication is not returned to the
pharmacy because it is not defective.
Sunday, October 16, 2011 30
 The nurse would not discard the
medication.
Ototoxicity can occur as a result of the
administration of aspirin. Signs and
symptoms of tinnitus, hearing loss,
dizziness, and ataxia reflects damage
to the eighth cranial nerve, the organ
of hearing and balance. Purpura and
ecchymosis are caused by prolonged
bleeding, but not ototoxicity. GI
bleeding and upset may be caused by
acetylsalicylic acid (aspirin) irritation
but are not symptoms of ototoxicity.
BenGay is one of many products that
are used for the temporary relief of
muscular aches, rheumatism, arthritis,
sprains, and neuralgia. These types of
products contain combinations of
analgesics, menthol, local antiseptics,
and counterirritants. Heat or a heating
pad should never be applied because
irritation or burning of the skin could
occur. The medication does not act in
a systemic manner, nor does the
medication produce drowsiness.
Lindane can penetrate intact skin and
can cause convulsions if absorbed in
sufficient quantities. A client with a
preexisting seizure disorder is at high
risk for convulsions. Other clients at
high risk for convulsions include
premature infants and children.
Lindane should not be used on
pediatric clients unless safer
medications have failed to control the
infection. Options 1, 2, and 3 do not
identify contraindications related to
the use of this medication.
Fomepizole is a medication that is
used to treat known or suspected
ethylene glycol (antifreeze)
intoxication. It is administered via the
IV route. Options 1, 2, and 3 are
incorrect.
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Fomepizole is used for the treatment
of known or suspected ethylene glycol
(antifreeze) intoxication. It is
administered via the IV route, is not
administered undiluted, and is not
administered by rapid IV infusion. It is
diluted in at least 100 mL of 0.9%
normal saline or 5% dextrose in water
and administered over a 30-minute
period.
Fomepizole is used in the treatment of
known or suspected ethylene glycol
(antifreeze) intoxication. It is
administered via the intravenous (IV)
route. It is not administered undiluted
and is not administered by rapid IV
infusion. It is diluted in at least 100 mL
of 0.9% normal saline or 5% dextrose
in water and administered over a 30-
minute period. If the medication
solidifies in the vial, the nurse should
run the vial under warm water.
Options 1 and 2 are inappropriate
actions and option 3 is unnecessary.
Irbesartan (Avapro) is an angiotensin II
type 1 (AT1) receptor antagonist. It is
used to treat hypertension. This
medication is not used to treat renal
transplant rejection, diabetes mellitus,
or hypothyroidism.
Letrozole is used in the palliative
treatment for advanced breast cancer
in the postmenopausal woman with
disease progression after treatment
with antiestrogen therapy. Options 1,
3, and 4 are incorrect.
Ropinirole hydrochloride is a
medication that is used to treat
idiopathic parkinsonian syndrome. It
normally is administered three times a
day to treat the client. This medication
is not used to treat diabetes mellitus,
coronary artery disease, or
depression.
Sunday, October 16, 2011 31
 Tamsulosin hydrochloride is used to
relieve mild-to-moderate
manifestations that occur in benign
prostatic hypertrophy. The medication
also improves urinary flow rates.
Options 1, 3, and 4 are incorrect.
Tamsulosin hydrochloride is a
medication that will relieve mild to
moderate manifestations of BPH and
improve urinary flow rates. The
medication should be administered 30
minutes after meals because food
decreases the peak plasma
concentration and lengthens the time
to achieve peak plasma medication
concentrations. Options 1, 2, and 3 are
incorrect.
Bladder spasm following
prostatectomy is treated with
antispasmodic medications, such as
B&O suppository or propantheline
bromide (ProBanthine). Opioid
analgesics such as meperidine
hydrochloride, morphine sulfate, and
hydromorphone usually are not
effective in treating pain caused by
spasm.
Epoetin alfa is erythropoietin that has
been manufactured through the use of
recombinant DNA technology. It is
used to treat anemia in the client with
chronic renal failure. The medication
may be administered subcutaneously
or intravenously.
Methyldopa is metabolized by the
kidneys and requires careful dosage
adjustment according to the client's
renal function to prevent hypotension.
Epoetin alfa is an erythropoietin and is
more likely to cause hypertension.
Levothyroxine does not cause
hypotension. Calcium carbonate is
used in the treatment of calcium
deficiency and does not cause
hypotension when administered via
the oral route. Parenteral
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administration of calcium may cause
hypotension.
A subcutaneous injection of enoxaprin
is performed using the same
technique as for a heparin injection.
The client should use a 25- to 27-
gauge, 5/8-inch needle to prevent
hematoma formation at the injection
site. The client should be taught to
bunch the skin, rather than placing it
flat. The client should not aspirate
before injecting the medication and
should not massage the area after
injection.
Isotretinoin is used to inhibit
inflammation in the client with severe
cystic acne. Adverse effects include
elevated triglycerides, skin dryness,
and eye discomfort such as dryness
and burning. Lip inflammation called
cheilitis also can occur. Vitamin A
supplements are stopped during this
treatment because of their additive
effects.
An anticoagulant suppresses
coagulation by inhibiting clotting
factors. A client admitted for elective
surgery should have been instructed
to discontinue the anticoagulant 7 to
10 days preoperatively. Even if this
were unscheduled surgery, the nurse
should notify the physician. Vitamin K
can be given for reversal of its action,
but the client may still have an
increased risk of bleeding. The other
medications listed are commonly
taken and do not constitute an
increased risk for the client.
Thrombolytics such as streptokinase
(Streptase) are most effective when
started within 4 to 6 hours of symptom
onset. Streptokinase (Streptase) acts
to dissolve or lyse existing thrombi
that are causing a blockage. Options
2, 3, and 4 are incorrect.
Sunday, October 16, 2011 32
 Clients receiving heparin are at risk for
bleeding. An electric razor rather than
a straight blade razor is used for
shaving. Options 1 and 3 are
inappropriate and unnecessary
nursing actions. It is not necessary to
monitor laboratory values every 4
hours when the client is taking
subcutaneous heparin. Additionally,
the PT is monitored when the client is
taking warfarin (Coumadin).
Warfarin (Coumadin) is an
anticoagulant, which is used as long-
term prophylaxis of thrombosis.
Clients must receive detailed
instructions regarding the signs of
bleeding. Hematuria is a sign of
bleeding, which the client should
report. Bruising is a common side
effect associated with anticoagulant
therapy and is almost unavoidable.
The client, however, should not stop
the medication if bruising occurs.
Option 2 is unrelated to the use of
warfarin, and option 3 is not
completely accurate regarding
prevention of a stroke.
Generally, a healthy diet provides
adequate sources of iron. Because of
the expansion of maternal blood
volume and the production of fetal red
blood cells, iron requirements increase
in pregnancy. Hemoglobin measures
the amount of oxygen in the blood.
Ferrous sulfate is a common iron
supplement given to pregnant women
to prevent anemia. Prothrombin time,
bleeding time, and clotting time are
tests performed for clients with
bleeding disorders.
Enoxaparin (Lovenox) is a low-
molecular-weight heparin that can be
administered without the usual
activated partial thromboplastin time
(aPTT) testing that is required with the
use of heparin. Option 2 places the
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client's feelings on hold. Options 3 and
4 devalue the client's feelings.
Warfarin (Coumadin) is an oral
anticoagulant. The effects of warfarin
(Coumadin) overdose can be reversed
with phytonadione (vitamin K).
Vitamin K is an antagonist to the
action of warfarin that can reverse
warfarin-induced inhibition of clotting
factor synthesis. For mild bleeding,
vitamin K should be administered
orally; a dose of 10 to 20 mg will
cause prothrombin levels to normalize
within 24 hours. If bleeding is severe,
parenteral vitamin K is indicated.
Protamine sulfate is the antidote for
heparin sulfate. Heparin sulfate is an
anticoagulant and would cause
increased bleeding. The question
presents no data indicating that
potassium supplements are indicated.
Aspirin is an antiplatelet and affects
the platelet for its life, which is 7 to 10
days. For an elective procedure such
as dental surgery, aspirin therapy
should be stopped approximately 10
days before the procedure to prevent
bleeding complications. Options 2 and
3 are incorrect. Option 4 is not an
appropriate response and places the
client's issue on hold.
It is most important that pregnant
clients receive iron supplements
because of the extra demands placed
on maternal circulation by the fetus.
Although option 1 may be true, it is
not the appropriate response
considering the options presented.
Option 3 is an inappropriate and
incorrect response because the iron
does not have to be discontinued.
Option 2 is unnecessary at this time.
Liquid iron preparations will stain the
teeth. The best advice for the client
who needs liquid iron is to dilute the
iron in juice or water, drink it through
Sunday, October 16, 2011 33
 a straw, and rinse the mouth well after
taking. Brushing before taking the
liquid iron would not be of any benefit.
The nurse would not instruct a client
to take more than the prescribed
amount.
Ticlopidine (Ticlid) is an antiplatelet
that is used for the prevention of
thrombotic stroke. Ticlopidine's effects
last for the life of the platelet, 7 to 10
days. Ticlopidine also can cause
neutropenia, which is an abnormally
small number of mature white blood
cell (WBCs). Baseline data from a CBC
are necessary before implementation
of therapy, and the nurse should
monitor for neutropenia during this
medication therapy. If this adverse
effect does occur, therapy should be
ceased. The effects of neutropenia are
reversible within 1 to 3 weeks. Options
1, 2, and 4 are actions that are not
specific to this medication therapy.
Ticlopidine is an antiplatelet that is
used to assist in preventing a
thrombotic stroke. Ticlopidine is best
tolerated when taken with meals. The
most common adverse effects are GI
disturbances. Taking ticlopidine with
meals tends to lessen those effects. It
is not necessary to contact the
physician if GI upset occurs. The
medication is used to prevent strokes
but does not guarantee that a stroke
will not occur. The client should not
skip medications.
Cyanocobalamin is essential for DNA
synthesis. It can take up to 3 years for
the vitamin B12 stores to be depleted
and for symptoms of pernicious
anemia to appear. Symptoms can
include weakness, fatigue, anorexia,
loss of taste, and diarrhea. To correct
deficiencies, a crystalline form of
vitamin B12, cyanocobalamin, can be
given intramuscularly. The client
statements in options 1, 2, and 4 do
NCLEX– 58826276.doc
not identify a therapeutic effect of the
medication.
Option 3 is correct because it validates
the issue that the client has with
income. The nurse offers help in a
nonthreatening manner that will allow
the client to accept or decline. Option
1 is incorrect because the client needs
to consume a proper diet. Options 2
and 4 block the communication
process and are nontherapeutic and
nonhelpful statements.
Heparin is an anticoagulant that
increases the risk of bleeding.
Prolonged pressure over the site of an
intramuscular injection will ensure that
the chances of having an increase of
bleeding into the tissue are lessened.
It is not necessary to apply a pressure
dressing to the IM site of injection. A
5/8-inch needle is not an appropriate-
size needle for an IM injection. The
heparin infusion is not decreased
before an injection and the rate is not
adjusted unless specifically prescribed
by a physician.
Ticlopidine is an antiplatelet that is
used for the prevention of thrombotic
stroke. Ticlopidine is best tolerated
when taken with meals. Blood work is
monitored closely, particularly in early
therapy, because the medication can
cause neutropenia. A client should not
stop medication without the
physician's permission.
Calculate the dosage by dividing the
amount ordered by the amount on
hand. The physician ordered 6,000
units of heparin; therefore, divide
6,000 units by 10,000 units = 0.6.
Then multiply 0.6 × 1 mL = 0.6 mL.
Neutropenia or agranulocytosis is the
most serious adverse effect associated
with the use of ticlopidine. A baseline
complete blood cell count with
Sunday, October 16, 2011 34
 differential will be performed for the
client. Neutropenia occurs most often
within the first 3 months of therapy;
therefore, a complete blood cell count
with differential is recommended
every 2 weeks during the first 3
months. If a diagnosis of neutropenia
is determined, then the client will be
withdrawn from therapy. This
medication is used to prevent a stroke
and is not contraindicated in
hypertension. GI disturbances can
occur as a result of taking the
medication, and the client is instructed
to take the medication with food to
minimize these side effects.
Drowsiness is a common side effect of
phenobarbital. Blurred vision is not an
associated side effect of this
medication. Seizure activity could
occur from abrupt withdrawal of this
medication therapy, or as a toxic
reaction. Hypocalcemia is a rare toxic
reaction.
Regular insulin is always drawn up
before the NPH insulin, and the NPH
insulin can be drawn into the same
syringe as for the Regular insulin.
Insulins usually are administered 15 to
30 minutes before a meal. To mix the
NPH insulin suspension, the vial should
be gently rotated. Shaking introduces
air bubbles into the solution.
Dimenhydrinate is used to prevent
and treat the symptoms of dizziness,
vertigo, nausea, and vomiting that
accompany motion sickness. The other
options are incorrect.
Scopolamine is an anticholinergic
medication that causes frequent side
effects of dry mouth, urinary retention,
decreased sweating, and dilation of
the pupils. The other options are
incorrect.
NCLEX– 58826276.doc
The pain experienced with
pyelonephritis usually resolves as
antibiotic therapy becomes effective.
However, clients may be treated for
urinary tract pain with
phenazopyridine, which is a urinary
analgesic. Bethanechol chloride is a
cholinergic agent used to treat
neurogenic bladder or urinary
retention. Oxybutinin chloride and
propantheline bromide are
antispasmodics that are used to treat
bladder spasm.
Epidural analgesia is used for clients
with expected high levels of
postoperative pain. The nurse
carefully checks the medication, notes
the client's level of sedation, and
makes sure that the head of bed is
elevated 30 degrees, unless
contraindicated. The nurse aspirates
with a syringe to make sure that no
CSF return occurs. If CSF returns with
aspiration, the catheter has migrated
from the epidural space into the
subarachnoid space. The catheter is
not flushed with 6 mL of sterile water.
Narcan should be readily available for
use if respiratory depression should
occur.
Chlorpromazine is used to control
shivering in hyperthermic states. It is a
phenothiazine and has antiemetic and
antipsychotic uses, especially when
psychosis is accompanied by
increased psychomotor activity.
Prochlorperazine is a phenothiazine
that is an antiemetic and
antipsychotic. Fluphenazine is a
phenothiazine that is used as an
antipsychotic. Buspirone is an
anxiolytic.
Dexamethasone is an
adrenocorticosteroid administered
after craniotomy to control cerebral
edema. It is given by IV push, and
single doses are administered over 1
Sunday, October 16, 2011 35
 minute. Dexamethasone IV doses are
changed to the oral route after 24 to
72 hours and are tapered in dose until
discontinued. Additionally, IV fluids are
administered cautiously after
craniotomy to prevent increased
cerebral edema.
Aminocaproic acid is an antifibrinolytic
agent that prevents clot breakdown or
dissolution. It is commonly ordered
after subarachnoid hemorrhage if
surgery is delayed or contraindicated,
to prevent further hemorrhage.
Heparin sodium and warfarin are
anticoagulants, which interfere with
propagation or growth of a clot.
Alteplase is a fibrinolytic, which
actively breaks down clots.
Nimodipine is a calcium channel–
blocking agent that has an affinity for
cerebral blood vessels. It is used to
prevent or control vasospasm in
cerebral blood vessels, thereby
reducing the chance for rebleeding. It
is typically ordered for 3 weeks'
duration.
For subcutaneous heparin sodium
injection, a 25- to 26-gauge, 3/8- to
5/8-inch needle is used, to prevent
tissue trauma and inadvertent
intramuscular injection. A 1-inch
needle would inject the heparin
sodium into the muscle. The
application of heat may affect the
absorption of the heparin and cause
bleeding. Aspiration before injection is
incorrect technique with heparin
administration.
Streptokinase converts plasminogen in
the blood to plasmin. Plasmin is an
enzyme that digests or dissolves fibrin
clots wherever they exist. Options 1,
2, and 4 describe mechanisms of
action of heparin sodium and warfarin
sodium (Coumadin).
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Diltiazem is a calcium channel blocker
that inhibits calcium influx through the
slow channels of the membrane of
smooth muscle cells. These
medications decrease myocardial
oxygen demands and block calcium
channels, thereby decreasing the
force of contraction of the ventricular
tissue.
Paraphrasing is restating the client's
or family member's own words. Option
1 represents a communication block
that denies the person's right to an
opinion. Option 2 is offering a false
reassurance. In option 3, the nurse is
expressing approval, which can be
harmful to the client-nurse or family-
nurse relationship.
It is appropriate to treat atrial
fibrillation with the prescribed and
calculated dose of digoxin as indicated
in the question. The subject of the
question is that the client verbalizes
inaccurate and unsafe knowledge
regarding this medication and the
treatment for chest pain. This client
needs further education regarding the
safe administration of medications for
episodes of chest pain.
Mannitol is an osmotic diuretic. When
used to treat increased ICP, it is given
slowly over 30 to 90 minutes, not
rapidly and not via IV bolus. Mannitol
should not be mixed in solution with
antibiotics, and nothing should be
piggybacked with packed red blood
cells.
Blurred vision and nausea are
common indicators of lidocaine
toxicity. The heart rate and blood
pressure noted in option 2 are normal.
A headache and elevated temperature
are important assessment signs but
are not related to the lidocaine. Urine
output is greater than the minimum
Sunday, October 16, 2011 36
 amount of 30 mL/hr and therefore is
adequate.
The tubing must be pinched above the
injection port so that the medication
does not go back up the tubing. Most
IVP medications should be injected
slowly. Considering the need for and
action of the medication, it is not
diluted unless prescribed.
Reflection of the client's own comment
lets the client know that the nurse
hears the concern without judging.
The nurse cannot understand what the
client is experiencing. Option 3 is
confrontational and unsupportive.
Common GI side effects of benztropine
therapy include constipation and dry
mouth. Other GI side effects include
nausea and ileus. These effects are
the result of the anticholinergic
properties of the medication.
The client should not receive
cyclobenzaprine if the client has taken
monoamine oxidase inhibitors (MAOIs)
such as tranylcypromine or phenelzine
within the last 14 days. Otherwise, the
client could experience hyperpyretic
crisis, convulsions, or death.
The client should remain in bed for at
least 3 hours after a parenteral dose
of diazepam. The medication is a
centrally acting skeletal muscle
relaxant and also has antianxiety,
sedative-hypnotic, and anticonvulsant
properties. Cardiopulmonary side
effects of the medication include
apnea, hypotension, bradycardia, and
cardiac arrest. For this reason,
resuscitative equipment also is kept
nearby.
The recommended rate of infusion of
diazepam is to give each 5 mg of the
medication over at least 1 minute.
This will prevent adverse side effects
including apnea, bradycardia,
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hypotension, and possibly cardiac
arrest.
The nurse monitors the CBC, because
hematological side effects of this
therapy include aplastic anemia,
agranulocytosis, leukopenia, and
thrombocytopenia. Other test results
that warrant monitoring include serum
calcium levels and the results of
urinalysis, hepatic, and thyroid
function tests.
Drowsiness, unsteadiness, and
clumsiness are expected effects of the
medication during early therapy. They
are dose related and usually diminish
or disappear altogether with continued
use of the medication. These
symptoms do not indicate that a
severe side effect is occurring. They
also are unrelated to an interaction
with another medication. The client is
encouraged to take this medication
with food to minimize gastrointestinal
upset.
Clonazepam is a benzodiazepine that
is used as an anticonvulsant. During
initial therapy and during periods of
dosage adjustment, the nurse should
initiate seizure precautions for the
client. Options 1, 3, and 4 are
unrelated to this medication.
Precipitation will occur if phenytoin is
mixed with any solution other than
0.9% (normal) saline. This is especially
true with solutions containing
dextrose. An in-line filter reduces the
chance of precipitants entering the
bloodstream. Phenytoin is very
irritating to the vein wall or other
tissues.
The therapeutic range for serum
phenytoin levels is 10 to 20 mcg/mL in
clients with normal serum albumin
levels and renal function. A level
below this range indicates that the
Sunday, October 16, 2011 37
 client is not receiving sufficient
medication and is at risk for seizure
activity. In this case, the medication
dose should be adjusted upward. A
level above this range indicates that
the client is entering the toxic range
and is at risk for toxic side effects of
the medication. In this case, the dose
should be adjusted downward.
Clorazepate is classified as an
anticonvulsant, an anxiolytic
(antianxiety agent), and a sedative-
hypnotic (benzodiazepine). One of the
nursing implications of clorazepate
therapy is that the medication can
lead to physical or psychological
dependence with prolonged therapy at
high doses. For this reason, the
amount of medication that is readily
available to the client at any one time
is restricted.
Valproic acid is an anticonvulsant that
causes central nervous system (CNS)
depression. For this reason, the side
effects of the medication include
sedation, dizziness, ataxia, and
confusion. When the client is taking
this medication as a single daily dose,
administering it at bedtime negates
the risk of injury from sedation and
enhances client safety. The
medication should be taken at the
same time each day.
Carbamazepine is an anticonvulsant
that should be taken around the clock,
precisely as directed. If a dose is
omitted, the client should take the
dose as soon as it is remembered, so
long as it is not immediately before
the next dose. The medication should
not be double-dosed. If more than one
dose is omitted, the client should call
the physician.
Carbamazepine acts by depressing
synaptic transmission in the central
nervous system (CNS). Because of
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this, the client should avoid driving or
doing other activities that require
mental alertness until the effect of the
medication on the client is known. The
client should use protective clothing
and sunscreen to avoid
photosensitivity reactions. The
medication may cause dry mouth, and
the client should be instructed to
provide good oral hygiene and use
sugarless candy or gum as needed.
The medication should not be abruptly
discontinued, because this could lead
to return of seizures or status
epilepticus. Fever and sore throat
should be reported to the physician
(leukopenia).
Ergotamine produces vasoconstriction
by stimulating α-adrenergic receptors,
which suppresses vascular headaches
when the medication is given in the
therapeutic dose range. The nurse
periodically assesses for hypertension,
cool, numb fingers and toes, muscle
pain, and nausea and vomiting.
Edrophonium commonly is given to
test for myasthenic crisis. If the client
is in myasthenic crisis, muscle
strength improves after administration
of the medication, and the
improvement lasts for about 30
minutes. Options 1, 2, and 4 are
incorrect.
Dextroamphetamine is a central
nervous system (CNS) stimulant that
acts by releasing norepinephrine from
nerve endings. The client should take
the medication at least 6 hours before
going to bed at night to prevent
disturbances with sleep.
Dextroamphetamine is a central
nervous system (CNS) stimulant.
Caffeine is a stimulant also, so intake
should be limited in the client taking
this medication. The client should be
Sunday, October 16, 2011 38
 taught to limit his or her own caffeine
intake as well.
Signs and symptoms of Parkinson's
disease usually begin to resolve within
2 to 3 weeks of starting therapy,
although in some clients marked
improvement may not be seen for up
to 6 months. The client needs to
understand this concept to aid in
compliance with medication therapy.
Trihexyphenidyl is an anticholinergic
medication. Thus, it can cause urinary
hesitancy and retention, constipation,
dry mouth, and decreased sweating.
With carbidopa/levodopa therapy, a
darkening of the urine or sweat may
occur. The client should be reassured
that this is a harmless effect of the
medication, and its use should be
continued. Options 1, 2, and 4 are
incorrect.
Pyridostigmine is a cholinergic
medication used to increase muscle
strength in the client with myasthenia
gravis. For the client who has difficulty
chewing, the medication should be
administered 30 minutes before meals
to enhance the client's ability to eat.
The client should take neostigmine
exactly on time. Taking the medication
early or late could result in myasthenic
or cholinergic crisis. Taking the
medication on time is especially
important for the client with
dysphagia, because the client may not
be able to swallow the medication if it
is given late. These clients are taught
to set a battery alarm clock to remind
them of dosage times. The client
should never skip or double up on
missed doses. The medication should
be administered with food or milk to
minimize side effects.
Amantadine is an antiparkinson agent
that potentiates the action of
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dopamine in the central nervous
system. The expected effect of
therapy is a decrease in akinesia and
rigidity. Leukopenia, urinary retention,
and hypotension all are adverse
effects of the medication.
Client teaching should include taking
the dose exactly as prescribed each
day. If the client misses a dose and
more than 12 hours goes by, that dose
should be omitted and only the next
scheduled dose should be taken; the
client should not double-dose. A daily
pulse check is necessary, and the
client should know the parameters for
which the physician should be called.
Clients are advised not to mix digoxin
in pill boxes with other medications.
The physician should be consulted
before changing brands, because the
bioavailability of another preparation
of the medication may be different.
Paroxetine is an antidepressant used
in the treatment of major depression.
Amitriptyline is a tricyclic
antidepressant (TCA) used to treat
various forms of depression.
Tranylcypromine is a monoamine
oxidase (MAO) inhibitor used in the
symptomatic treatment of severe
depression in hospitalized or closely
supervised clients, and thioridazine is
an antipsychotic medication.
For treatment of spasticity, dantrolene
is administered orally. The initial
dosage in adults is 25 mg once daily.
The usual maintenance dosage is 100
mg two to four times daily. If
beneficial effects do not develop
within 45 days, dantrolene therapy
should be discontinued.
The client being changed from oral to
inhalation glucocorticoids could
experience signs of adrenal
insufficiency. The nurse teaches the
client to report anorexia, nausea,
Sunday, October 16, 2011 39
 weakness, and fatigue. Other signs
that can be detected, which are
objective in nature, include
hypotension and hypoglycemia.
A frequent side effect of
brompheniramine maleate, an
antihistamine, is drowsiness or
sedation. Others include blurred
vision, hypertension (and sometimes
hypotension), dry mouth, constipation,
urinary retention, and sweating.
Signs of opioid withdrawal include
increased temperature and blood
pressure, abdominal cramping,
vomiting, and restlessness. Time of
onset may be anywhere from a few
minutes to a few hours after
administration of naloxone
hydrochloride, depending on the
opioid involved, the degree of
dependence, and the dose of
naloxone. Options 1, 3, and 4 are
incorrect.
Noroxin is administered 1 hour before
or 2 hours after meals because food
may hamper absorption. The normal
dosage is 400 mg orally twice daily for
7 to 10 days for mild infections and for
10 to 21 days for severe infections.
For treatment of acute UTI, the adult
dosage is 50 mg three to four times a
day. For prophylaxis of recurrent UTI,
low doses are used, such as 50 to 100
mg at bedtime for adults.
Methenamine, under acidic conditions,
decomposes into ammonia and
formaldehyde. The formaldehyde
denatures bacterial proteins, causing
death of the organism. Nalidixic acid
(NegGram) is a medication that
inhibits the replication of bacterial
DNA. Antispasmodics relax smooth
muscle of the urinary tract and
decrease bladder muscle spasms.
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Nalidixic acid is dispensed in tablets of
250 mg, 500 mg, and 1 g and in
suspension of 50 mg/mL for oral use.
The adult dosage is 1 g four times a
day for 1 week. It should not be
administered to children younger than
3 years because it may produce
intracranial hypertension in pediatric
clients.
The normal adult dosage of
bethanechol chloride ranges from 10
to 50 mg three to four times daily.
The injectable form of bethanechol
chloride is intended for subcutaneous
administration only. Bethanechol must
never be injected intramuscularly or
intravenously because the resulting
high drug level can cause severe
toxicity, resulting in bloody diarrhea,
bradycardia, profound hypotension,
and cardiovascular collapse.
The nurse should plan for a skin test
dose before IV administration of
antithymocyte globulin to identify
hypersensitivity to the medication.
Options 2 and 4 are not specific to this
medication. The client would not be
premedicated with aspirin.
Premedication with acetaminophen
(Tylenol) or diphenhydramine
(Benadryl), or both, may be prescribed
to prevent reaction to the medication.
Epoetin alfa generally is well tolerated.
The most significant adverse effect is
hypertension. Occasionally, a
tachycardia may occur as a side
effect. This medication also may cause
an improved sense of well-being.
Epoetin alfa stimulates erythropoiesis.
It takes 2 to 6 weeks after initiation of
therapy before a clinically significant
increase in hematocrit is observed.
Therefore, this medication is not
intended for clients who require
immediate correction of severe
Sunday, October 16, 2011 40
 anemia, and it is not a substitute for
emergency blood transfusions.
The client who is receiving aluminum
hydroxide should take the medication
with meals. The phosphate-binding
effect is most effective when it is
taken with food. If tablets are used,
they should be chewed well before
swallowing.
Aluminum-containing antacids are
constipating, so the client should be
instructed to take a stool softener or
additional bulk-type laxatives to
relieve this uncomfortable side effect.
Options 1, 3, and 4 are incorrect.
Feosol is an iron supplement used to
treat anemia. Constipation is a
frequent and uncomfortable side
effect associated with the
administration of oral iron
supplements. Stool softeners often are
prescribed to prevent constipation.
Options 1, 3, and 4 are not associated
with this medication.
Tacrolimus is an alternative
medication to cyclosporine
(Sandimmune) for prevention of organ
rejection in clients after
transplantation. The medication is
more effective than cyclosporine but is
more toxic. Concurrent use of
glucocorticoids is recommended
during administration of this
medication.
Potentially fatal anaphylactic reactions
can occur with this medication.
Manifestations include pulmonary
edema, cardiovascular collapse, and
cardiac or respiratory arrest.
Assessing lung sounds is a priority.
Imuran suppresses cell-mediated and
humoral immune responses by
inhibiting the proliferation of B and T
lymphocytes. It generally is used as an
adjunct to cyclosporine (Sandimmune)
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and glucocorticoids to help suppress
transplant rejection. Options 2, 3, and
4 are incorrect.
Gastrointestinal (GI) effects are the
most frequent adverse reactions to
this medication and can be minimized
by administering the medication with
milk or meals. Pulmonary reactions
manifested as dyspnea, chest pain,
chills, fever, cough, and the presence
of alveolar infiltrates on radiography
would indicate the need to stop the
treatment. These abnormalities
typically resolve in 2 to 4 days after
discontinuation of this medication.
Codeine sulfate is an opioid analgesic
used for clients after craniotomy. It
often is combined with a nonopioid
analgesic such as acetaminophen
(Tylenol) for added effect. It does not
alter the respiratory rate or mask
neurological signs as do other opioids.
Side effects of codeine sulfate include
GI upset and constipation. Chronic use
of the medication can lead to physical
and psychological dependence.
The anticonvulsant medications
carbamazepine and phenytoin help
relieve the pain in many clients with
trigeminal neuralgia. They act by
inhibiting the reactivity of neurons in
the trigeminal nerve. Opioid
analgesics (meperidine hydrochloride,
codeine sulfate, oxycodone) are not
very effective in controlling pain due
to trigeminal neuralgia.
Methylprednisolone or
adrenocorticotropic hormone may be
prescribed to be administered
intravenously to accelerate recovery
from an exacerbation of multiple
sclerosis. Carbamazepine may be
prescribed for trigeminal neuralgia,
and phenytoin may be prescribed to
control seizures. Lioresal and
Sunday, October 16, 2011 41
 diazepam are used to treat muscle
spasticity.
Rifampin in combination with isoniazid
prevents the emergence of drug-
resistant organisms. This combination
taken together daily eliminates the
tubercle bacilli from the sputum and
improves clinical status. Rifampin
produces a harmless red-orange color
in all body fluids and should be taken
along with the isoniazid 1 hour before
or 2 hours after eating to maximize
absorption. The treatment regimen is
maintained for at least 6 months for
effectiveness and the therapeutic
effect may be evident in 2 to 3 weeks.
Lactulose is a hyperosmotic laxative
agent that has the adjunct benefit of
lowering serum ammonia levels. This
occurs because the medication lowers
bowel pH and aids in the conversion of
ammonia in the gut to the ammonium
ion, which is poorly absorbed.
Magnesium hydroxide is a saline
laxative. Phenolphthalein is a
stimulant laxative. Psyllium
hydrophilic mucilloid is a bulk laxative.
Itraconazole is an antifungal
medication. The client should be
instructed to take the medication with
food because it increases the
absorption of the medication. Fluid
should be increased to prevent
constipation, which can occur as a
side effect. Hepatitis is an adverse
reaction associated with the
medication, and if anorexia of any
degree, abdominal pain, unusual
tiredness or weakness, or jaundice
develops, the physician should be
notified.
Adverse reactions associated with
kanamycin sulfate include
nephrotoxicity evidenced by an
increased BUN and creatinine.
Irreversible ototoxicity as evidenced
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by tinnitus, dizziness, ringing in the
ears, and reduced hearing and
neurotoxicity manifested by headache,
dizziness, lethargy, and visual
disturbances can occur.
Gastrointestinal disturbances can
occur as a frequent side effect of the
medication. The WBC count may be
elevated as a result of the respiratory
infection.
Intermittent IV infusion of phenytoin is
administered by injection into a large
vein using normal saline solution.
Dextrose solutions are avoided
because the medication will
precipitate in these solutions. Options
1, 3, and 4 identify incorrect solutions
for IV administration with this
medication.
Adverse effects of carbamazepine
appear as blood dyscrasias, including
aplastic anemia, agranulocytosis,
thrombocytopenia, and leukopenia;
cardiovascular disturbances;
thrombophlebitis; dysrhythmias; and
dermatological effects. The incorrect
options identify laboratory values that
are within normal range.
Morphine sulfate depresses
respirations. The nurse monitors the
client's respiratory status closely.
Although the incorrect options may be
components of the plan of care, option
3 identifies the priority nursing action.
Side effects of meperidine
hydrochloride include respiratory
depression, orthostatic hypotension,
tachycardia, drowsiness and mental
clouding, constipation, and urinary
retention.
Codeine sulfate can cause
constipation, so the client is instructed
to increase fluid intake to prevent this
occurrence. A high-fiber diet and stool
softeners may be prescribed to
Sunday, October 16, 2011 42
 prevent constipation. All exercise is
not avoided.
Dantrolene can cause liver damage;
therefore, the nurse should monitor
the results of liver function studies.
They should be done before therapy
starts and periodically throughout
therapy. Dantrolene is discontinued if
no relief of spasticity is achieved in 6
weeks. The incorrect options are not
specifically related to the
administration of this medication.
Mannitol is an osmotic diuretic that
induces diuresis by raising the osmotic
pressure of glomerular filtrate, thereby
inhibiting tubular reabsorption of
water and solutes. It is used to reduce
intracranial pressure in the client with
head trauma. Option 2 would cause
fluid retention, thereby increasing the
intracranial pressure.
Dexamethasone may be given by
direct IV injection or IV infusion. For IV
infusion, it may be mixed with 50 to
100 mL of 0.9% sodium chloride or 5%
dextrose in water. It is not mixed with
lactated Ringer's solution or 10%
dextrose in water.
Because tetracycline can cause
permanent staining of the teeth, a
straw should be used and the mouth
should be rinsed after administration.
The medication should be
administered 1 hour before or 2 hours
after consumption of milk. Diluting the
medication with water is unnecessary.
Pitocin is a synthetic hormone that
stimulates uterine contractions and
commonly is used to induce labor. A
major danger associated with oxytocin
induction of labor is hyperstimulation
of uterine contractions, which can
cause fetal distress as a result of
decreased placental perfusion.
Therefore, oxytocin infusion must be
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stopped when any signs of uterine
hyperstimulation are observed. Early
decelerations of the fetal heart rate
are a reassuring sign and do not
indicate fetal distress. Options 3 and 4
do not indicate a need to discontinue
the infusion.
Clients taking allopurinol are
encouraged to drink 3000 mL of fluid a
day to prevent formations of crystals
in the urine. Allopurinol is given with
or immediately after meals or milk. If
the client notes development of a
rash, irritation of the eyes, or swelling
of the lips or mouth, the physician
should be notified because this may
indicate hypersensitivity.
Probenecid inhibits the reabsorption of
uric acid by the kidney and promotes
excretion of uric acid in the urine.
Clients taking this medication are
instructed to limit excessive purine
intake. High-purine foods to avoid or
limit include organ meats, roe,
sardines, scallops, anchovies, broth,
mincemeat, herring, shrimp, mackerel,
gravy, and yeast.
Auranofin is the one gold preparation
that is given orally, rather than by
injection. Gastrointestinal (GI)
reactions including diarrhea,
abdominal pain, nausea, and loss of
appetite are common early in therapy
but usually subside in the first 3
months. Early signs and symptoms of
toxic reactions include a rash, purple
blotches, pruritus, mouth lesions, and
a metallic taste in the mouth. Signs
and symptoms of toxic reactions are
reported to the physician.
For acute or chronic rheumatoid
arthritis or osteoarthritis, the normal
oral adult dose for an older client is
400 to 800 mg three to four times
daily. The other options are incorrect.
Sunday, October 16, 2011 43
 Baclofen is a skeletal muscle relaxant
and acts at the spinal cord level to
decrease the frequency and amplitude
of muscle spasms in clients with spinal
cord injuries or diseases or with
multiple sclerosis. Options 2 and 3 are
not directly related to the effects of
this medication. Option 4 is incorrect.
Baclofen, a skeletal muscle relaxant,
also is a central nervous system (CNS)
depressant, which can cause urinary
retention. The client should not restrict
fluid intake. Constipation, rather than
diarrhea, is an adverse effect of
baclofen. Fatigue is a CNS effect that
is most intense during the early phase
of therapy and diminishes with
continued medication use. It is not
necessary to notify the physician if
fatigue occurs.
Syrup of ipecac is the medication used
for induction of emesis after ingestion
of many poisons, although its use is
contraindicated after ingestion of
strong acids or bases and in clients
who are comatose, delirious, or
experiencing convulsions. The dose for
children younger than 1 year of age is
5 to 10 mL, followed by one-half to
one glass of water. Diarrhea and
sedation are expected side effects of
the medication. Options 1 and 2 are
incorrect.
Asparaginase can cause severe
adverse effects; however, they often
are different from those of other
antineoplastic medications. By
inhibiting protein synthesis, the
medication can cause coagulation
deficiencies and injury to the liver,
pancreas, and kidneys. Signs and
symptoms of central nervous system
depression ranging from confusion to
coma can occur. Nausea and vomiting
can be intense and may limit the dose
that can be tolerated. In contrast with
most antineoplastic medications,
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asparaginase does not depress the
bone marrow, nor does it cause
alopecia, oral ulceration, or intestinal
ulceration.
Cisplatin is a medication that kills cells
primarily by forming cross-links
between and within strands of DNA. Its
principal use is in the treatment of
testicular cancer, although it also can
be used to treat carcinomas of the
ovary, bladder, head, and neck. It can
cause neurotoxicity, nephrotoxicity,
bone marrow depression, and
ototoxicity, which manifests as tinnitus
and high-frequency hearing loss.
Nausea and vomiting are expected
effects, which can be severe and begin
1 hour after administration, persisting
for 1 to 2 days.
Ifosfamide is used to treat refractory
germ cell cancer of the testes.
Concurrent therapy with mesna and at
least 2 L of oral or intravenous fluid
daily will limit the toxicity of this
medication, evidenced by bone
marrow depression and hemorrhagic
cystitis. Mesna is a detoxifying agent
used to inhibit the hemorrhagic
cystitis induced by ifosfamide. The
medications in options 1, 2, and 4 are
not routinely administered with
ifosfamide.
The medication is massaged into the
skin of the entire body, starting with
the chin and working downward. The
head and face are treated only if
needed. Special attention should be
given to skin folds and creases.
Contact with eyes, mucous
membranes, and any region of
inflammation should be avoided. A
second application is made 24 hours
after the first. A cleansing bath should
be taken 48 hours after the second
application; if needed, treatment can
be repeated in 7 days.
Sunday, October 16, 2011 44
 Metronidazole can produce a variety of
side effects, but they rarely require
termination of treatment. Harmless
darkening of the urine may occur and
the client should be told of this effect.
It is not necessary to discontinue the
medication or call the physician.
Increasing fluid intake is a good health
measure but will not prevent this side
effect from occurring.
Pancreatitis, which can be fatal, is the
major dose-limiting toxicity associated
with the administration of didanosine.
Clients should be monitored for
indications of developing pancreatitis,
which include increased serum
amylase in association with increased
serum triglycerides, decreased serum
calcium, and nausea, vomiting, or
abdominal pain. If evolving
pancreatitis is diagnosed, the
medication should be discontinued.
The client should be seen by the
health care physician.
Peripheral neuropathy is an adverse
effect associated with the use of
zalcitabine, which manifests initially as
numbness and burning sensations in
the extremities. It may progress to
sharp shooting pains or severe
continuous burning if the medication is
not withdrawn. Pain of severe
neuropathy requires opioid analgesics
for control. Clients should be informed
about the early symptoms of
neuropathy and instructed to report
them immediately. Neuropathic
changes will reverse slowly if the
medication is withdrawn early but may
become irreversible if the medication
is continued. The other options are not
associated with use of this medication.
Ribavirin is active against RSV,
influenza virus types A and B, and
herpes simplex virus. It is
administered by oral inhalation. The
medication is absorbed from the lungs
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and achieves high concentrations in
respiratory tract secretions and
erythrocytes. It is not administered by
the routes identified in options 1, 3,
and 4.
Amphotericin B exerts direct toxicity
on cells of the kidneys and causes
renal impairment in most clients. To
evaluate renal injury, tests of kidney
function should be performed weekly,
and intake and output should be
monitored. If the serum creatinine
level rises above 3.5 mg/dL, the dose
of amphotericin B should be reduced.
Options 2, 3, and 4 are unrelated to
the use of this medication.
The major form of dose-limiting
toxicity with bleomycin is injury to the
lungs. It manifests initially as
pneumonitis but can progress to
severe pulmonary fibrosis and death.
In addition to auscultation of lung
sounds, pulmonary function studies
should be monitored. Bleomycin is
discontinued at the first sign of these
adverse changes. Nausea and
vomiting usually are mild with the use
of this medication, and unlike most
other anticancer agents, bleomycin
exerts minimal toxicity to bone
marrow. It does not directly affect the
blood pressure.
Peripheral neuropathy is the major
dose-limiting toxicity associated with
vincristine. Nearly all clients exhibit
signs and symptoms of sensory or
motor nerve injury such as decreased
reflexes, weakness, paresthesia, and
sensory loss. In contrast with most
anticancer medications, vincristine
causes little toxicity to bone marrow.
Nausea and vomiting are rare with the
use of this medication.
Oral erythromycin should be
administered on an empty stomach
with a full glass of water. Some
Sunday, October 16, 2011 45
 preparations may be administered
with food if gastrointestinal upset
occurs, but it is best to administer on
an empty stomach.
Azithromycin should be taken 1 hour
before or 2 hours after meals. It is not
administered with meals, and it should
not be taken with either aluminum- or
magnesium-containing antacids.
Bethanechol chloride is a direct-acting
muscarinic agonist (cholinergic
medication). It can cause hypotension
secondary to vasodilation and
bradycardia. It also can cause
excessive salivation, increased
secretion of gastric acid, abdominal
cramps, and diarrhea. Higher doses
can cause involuntary defecation.
Bethanechol chloride is a cholinergic
medication, which is associated with a
high incidence of side effects when
given subcutaneously instead of
orally. The medication can produce a
cholinergic reaction, and the antidote
for this type of reaction is atropine
sulfate. The other options are
incorrect.
Atropine sulfate can cause a blockade
of muscarinic receptors on the iris
sphincter, producing mydriasis
(dilation of the pupils). It also
produces cycloplegia (relaxation of the
ciliary muscles). It is contraindicated in
clients with narrow-angle glaucoma.
The other options are therapeutic
reasons for using the medication.
A Tensilon test is performed to
distinguish between myasthenic and
cholinergic crisis. After administration
of the Tensilon, if symptoms intensify,
the crisis is cholinergic. Because the
symptoms of cholinergic crisis will
worsen with the administration of
Tensilon, atropine sulfate should be
available because it is the antidote.
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Phentolamine is an α-adrenergic
blocking agent that prevents dermal
necrosis and sloughing after
infiltration of norepinephrine or
dopamine. Vitamin K is the antidote
for warfarin (Coumadin). Atropine
sulfate is the antidote for cholinergic
crisis. Protamine sulfate is the antidote
for heparin.
Phentolamine is an α-adrenergic
blocking agent that prevents dermal
necrosis and sloughing after
infiltration of norepinephrine or
dopamine. Vitamin K is the antidote
for warfarin (Coumadin). Atropine
sulfate is the antidote for cholinergic
crisis. Protamine sulfate is the antidote
for heparin.
Clonidine is an antihypertensive
medication that is applied to a hairless
intact skin area of the upper arm or
torso every 7 days. Options 2, 3, and 4
are correct statements.
The target range for a therapeutic
serum level of phenytoin is between
10 and 20 mcg/mL. Levels below 10
mcg/mL are too low to control
seizures. At levels above 20 mcg/mL,
signs of toxicity begin to appear. This
client has a low serum level, and the
dosage is likely to be increased.
Intravenous administration of
phenytoin is performed slowly (no
faster than 50 mg/min) because rapid
administration can cause
cardiovascular collapse. It should not
be added to any existing IV infusion
because this is likely to produce a
precipitate in the solution. Solutions
are highly alkaline and can cause local
venous irritation.
Gastrointestinal effects from valproic
acid are common and typically mild,
but hepatotoxicity, although rare, is
serious. To minimize the risk of fatal
Sunday, October 16, 2011 46
 liver injury, liver function is evaluated
before initiation of treatment and
periodically thereafter. The other
options are unrelated to the use of this
medication.
Carbamazepine can cause leukopenia,
anemia, thrombocytopenia, and, very
rarely, fatal aplastic anemia. To
reduce the risk of serious
hematological effects, a complete
blood cell count should be done before
treatment and periodically thereafter.
This medication should be avoided in
clients with pre-existing hematological
abnormalities. The client also is told to
report the occurrence of fever, sore
throat, pallor, weakness, infection,
easy bruising, and petechiae. Options
1, 2, and 3 are not associated with the
use of this medication.
Dantrium is hepatotoxic. The nurse
observes for indications of liver
dysfunction, which include jaundice,
abdominal pain, and malaise. The
nurse notifies the physician if these
occur. The items in options 1, 3, and 4
are expected side effects due to the
central nervous system (CNS)
depressant effects of the medication.
Naloxone is an opioid antagonist that
is used to treat opioid overdose.
Promethazine is an antiemetic
medication, and protamine sulfate is
the antidote for heparin. Atropine
sulfate is an anticholinergic.
Before an opioid is administered,
respiratory rate, blood pressure, and
pulse rate should be assessed.
Morphine sulfate should be withheld
and the physician notified if the
respiratory rate is at or below 12
breaths/min, if the blood pressure is
significantly below the pretreatment
value, or if the pulse rate is
significantly above or below
pretreatment value. A temperature of
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99.1° F is not associated with the use
of morphine sulfate.
Ergotamine tartrate is used to stop an
ongoing migraine attack and also is
used to treat cluster headaches. The
other options are unrelated to the use
of this medication.
Spironolactone is a potassium-sparing
diuretic that causes hyperkalemia as
the principal adverse effect. Clients
are instructed to restrict their intake of
potassium-rich foods, such as citrus
fruits and bananas. The other foods
listed are appropriate to include in the
diet.
Moexipril is an angiotensin-converting
enzyme (ACE) inhibitor. The client
should be instructed to take the
medication at least 1 hour before
meals. The other ACE inhibitor that
should be taken 1 hour before meals is
captopril (Capoten). The other options
are incorrect instructions to the client.
Sodium nitroprusside can be degraded
by light and should be protected with
an opaque material. It is dispensed in
powdered form and must be dissolved
and diluted for the IV solution. A fresh
solution may have a faint brown
coloration, but solutions that are
deeply colored, such as blue green or
dark red, should be discarded. No
other medication should be mixed with
the infusion solution. During the
infusion, the blood pressure should be
monitored continuously either through
an arterial line or with an electronic
monitoring device.
The client should be instructed about
symptoms of iodism that can occur
with the administration of potassium
iodide solution. These symptoms
include a brassy taste, burning
sensation in the mouth, and soreness
of the gums and teeth. The client
Sunday, October 16, 2011 47
 should be instructed to withhold the
medication and notify the physician if
these symptoms are noted.
Intravenous ritodrine can cause
pulmonary edema, and the client
should be monitored for fluid overload.
If pulmonary edema develops, the
infusion should be discontinued and
standard treatment implemented. The
client also is at risk for hypotension
and hyperglycemia during infusion of
this medication.
Peak serum drug levels should be
monitored to ensure that the dosage is
appropriate and should be drawn 1.5
to 2.5 hours after the IV infusion is
completed. Peak levels of 30 to 40
mcg/mL generally are acceptable.
Options 1, 3, and 4 are incorrect.
Abacavir is used to treat HIV infection,
in combination with other agents. It is
not used to treat the conditions noted
in options 1, 3, and 4.
The normal WBC is 5,000 to
10,000/mm3. When the WBC count
drops, neutropenic precautions should
be implemented to protect the client
from infection. Bleeding precautions
should be initiated when the platelet
count drops and will include avoiding
trauma such as from rectal
temperatures or injections. The normal
platelet count is 150,000 to 450,000
cells/mm3. The normal clotting time is
8 to 15 minutes. The normal ammonia
value is 15 to 45 mcg/dL.
Warfarin is an anticoagulant. Bleeding
is a concern while the client is taking
this medication. Orange-colored urine
indicates blood in the urine from an
overdose of the medication. Bleeding
also may be identified by urine that
turns red, smoky, or black. The
prothrombin time is determined to
monitor the clotting mechanism. The
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half-life of the medication is 2 days,
the peak effect is between 1 and 3
days, and the anticoagulation effect
extends 4 to 5 days after
discontinuation. Aspirin is an
antiplatelet agent and would increase
the risk of bleeding.
Hydralazine is an antihypertensive
medication used for moderate to
severe hypertension. Because the
blood pressure and pulse should be
monitored frequently after
administration, a noninvasive blood
pressure cuff should be obtained. The
other options are not priority items
specific to the use of this medication.
Opioids are used for epidural
analgesia, which can lead to delayed
respiratory depression. For this
reason, respirations are monitored for
24 hours after administration of
epidural analgesia. Naloxone is a
narcotic antagonist, which reverses
the effects of opioids and is given if
the respiratory rate falls below 6 to 8
breaths/min. Morphine sulfate and
meperidine hydrochloride are opioids
and would further compromise the
respiratory rate. Bethamethasone is a
corticosteroid administered to
enhance fetal lung maturity.
Amphotericin B can cause adverse
effects such as chills, fever, headache,
vomiting, and impaired renal function.
The nurse monitors for these adverse
effects and also carefully assesses the
IV site because of the irritating effects
of the medication.
Bethamethasone, a steroidal anti-
inflammatory, increases the surfactant
level and promotes lung maturation,
thereby reducing the risk of
respiratory distress syndrome in the
newborn infant. Surfactant production
does not become stable until after 32
weeks of gestation, and if adequate
Sunday, October 16, 2011 48
 amounts of lung surfactant are not
present, respiratory distress and death
of the newborn infant could result.
Delivery should be delayed for at least
48 hours after administration of
bethamethasone to allow time for the
lungs to mature. The other options are
incorrect.
The infant should be turned on the
side with the affected ear uppermost.
With the wrist of the nondominant
hand resting on the infant's head, the
mother pulls down and back on the
earlobe and aims the solution at the
wall of the canal, rather than directly
onto the eardrum. In the adult, the
auricle is pulled up and back to
straighten the auditory canal.
Mild intoxication with acetylsalicylic
acid, called salicylism, commonly
occurs when the daily dosage is more
than 4 g. Tinnitus (ringing in the ears)
is the most frequent effect noted with
intoxication. Hyperventilation also
may occur because salicylate
stimulates the respiratory center.
Fever may result because salicylate
interferes with the metabolic
pathways coupling oxygen
consumption and heat production.
Options 2, 3, and 4 are not signs of
aspirin toxicity.
Scopolamine is an anticholinergic
medication that causes the frequent
side effects of dry mouth, urinary
retention, decreased sweating, and
dilation of the pupils. The other
options are incorrect.
Sucralfate is prescribed to treat gastric
ulcers. It should be scheduled for
administration 1 hour before meals
and at bedtime to allow it to form a
protective coating over the gastric
ulcer to prevent irritation by food,
gastric acid, and mechanical
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movement of the stomach. The other
options are incorrect.
Metamucil is a bulk-forming laxative
that should be taken with a full glass
of water or juice (not applesauce),
followed by another glass of liquid.
This will help prevent impaction of the
medication in the stomach or small
intestine. Both fiber in the diet and
fluid intake should not be decreased
unless specifically prescribed by the
physician.
Metoclopramide is a gastrointestinal
stimulant. Administration should be
scheduled 30 minutes before meals
and at bedtime to allow the
medication time to begin working
before food intake and digestion. The
other options are incorrect.
Auranofin is a gold preparation used to
manage rheumatoid arthritis in clients
with insufficient therapeutic response
to nonsteroidal anti-inflammatory
drugs (NSAIDs). Prednisone is a
corticosteroid. Fludarabine and
pentostatin are antineoplastic agents.
Cycloserine is an antituberculosis
medication that requires weekly
serum drug level determinations to
monitor for neurotoxicity and other
adverse effects. Peak concentrations
are measured 2 hours after dosing and
should be between 25 and 35 mcg/mL.
The therapeutic serum drug level
range for phenytoin is 10 to 20
mcg/mL. A laboratory value of 8
mcg/mL is below the therapeutic
range, indicating an inadequate drug
level.
If the injectable solution is not clear or
if precipitate is present, the
medication should not be used and
should be discarded. The nurse may
have to call the pharmacy department
to obtain another vial of the
Sunday, October 16, 2011 49
 medication. Options 2, 3, and 4 are
inaccurate actions.
Because INH therapy can cause
elevated hepatic enzymes and
hepatitis, liver enzymes are monitored
when therapy is initiated and during
the first 3 months of therapy. They
may be monitored longer in the client
who is older than 50 years of age or
who abuses alcohol. The other options
are incorrect.
Rifampin causes orange-red
discoloration of body secretions and
will permanently stain soft contact
lenses. Rifampin should be taken
exactly as directed, and doses should
not be doubled or skipped. The
medication should be taken on an
empty stomach unless it causes
gastrointestinal upset, and then it may
be taken with food. Antacids, if
prescribed, should be taken at least 1
hour before the medication. The client
should not stop therapy until directed
to do so by a physician.
Ethambutol causes optic neuritis,
which decreases visual acuity and
impairs the ability to discriminate
between the colors red and green.
This form of color blindness poses a
potential safety hazard in driving a
motor vehicle. The client is taught to
report this symptom immediately. The
client also is taught to take the
medication with food if GI upset
occurs. Impaired hearing results from
antituberculosis therapy with
streptomycin. Orange-red
discoloration of secretions occurs with
rifampin (Rifadin).
Side effects of chlorpromazine can
include hypotension, dizziness, and
fainting, especially with parenteral
use. Additional side effects include
drowsiness, blurred vision, dry mouth,
lethargy, constipation or diarrhea,
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nasal congestion, peripheral edema,
and urinary retention.
The most common side effects of
cyclobenzaprine are drowsiness,
dizziness, and dry mouth. This
medication is a centrally acting
skeletal muscle relaxant used in the
management of muscle spasm due to
a variety of conditions. Fatigue,
nervousness, and confusion are less
frequent central nervous system
effects of cyclobenzaprine.
Diphenhydramine reduces the
symptoms of allergic reaction, such as
itching or urticaria, when used as a
topical agent on the skin. When taken
orally, it may provide mild nighttime
sedation. It is not used to treat burns
or ecchymoses.
Tolbutamide is an oral hypoglycemic
agent. It is not used to enhance
weight loss, treat infection, or
decrease blood pressure.
Ganciclovir causes neutropenia and
thrombocytopenia, and these are the
most frequent side effects. For this
reason, the nurse implements the
same precautions that are used for a
client receiving anticoagulant therapy.
These include providing a soft
toothbrush and an electric razor to
minimize risk of trauma that could
result in bleeding. Pressure on
venipuncture sites should be held for
approximately 10 minutes. The
medication may cause hypoglycemia,
but not hyperglycemia. The
medication does not have to be taken
on an empty stomach.
Benzonatate is a locally acting
antitussive that decreases the
intensity and frequency of cough
without eliminating the cough reflex.
The other options are incorrect.
Sunday, October 16, 2011 50
 Foscarnet, an antiviral medication
used to treat cytomegalovirus (CMV)
retinitis in clients with AIDS, should be
administered with a controlled infusion
device because of its potential
toxicity. The items described in each
of the other options are unnecessary.
A PT of 28 seconds represents an
elevated value. The therapeutic PT for
a client receiving warfarin is 1.5 times
the normal PT (9.5 to 11.5 seconds).
The nurse should withhold the next
dose and notify the physician. A
medication dose should not be
changed without a specific order
(options 1 and 4).
Akathisia is restlessness or a desire to
keep moving. It may appear within 6
hours of administration of the first
dose and may be difficult to
distinguish from psychotic agitation.
The other options describe tardive
dyskinesia, which is manifested by
uncontrolled rhythmic movements of
the mouth, face, and extremities.
These movements can include lip
smacking or puckering, puffing of the
cheeks, uncontrolled chewing, and the
presence of rapid or undulating
(worm-like) movements of the tongue.
The client should be instructed to take
a single daily dose of the medication
at bedtime, not in the morning,
because of the side effects. The client
should take the medication exactly as
directed and, if a dose is missed,
should take it as soon as possible
unless it is almost time for another
dose. The medication effects may not
be noticed for at least 2 weeks, and
the client should avoid alcohol or other
central nervous system depressants
during therapy.
At lithium levels of 2.0 to 2.5 mEq/L,
the client will experience blurred
vision, muscle twitching, severe
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hypotension, and persistent nausea
and vomiting. With levels between 1.5
and 2.0 mEq/L, the client experiences
vomiting, diarrhea, muscle weakness,
ataxia, dizziness, slurred speech, and
confusion. At lithium levels of 2.5 to
3.0 mEq/L or higher, urinary and fecal
incontinence occurs, as well as
seizures, cardiac dysrhythmias,
peripheral vascular collapse, and
death.
Lorazepam is contraindicated in
hypersensitivity, cross-sensitivity with
other benzodiazepines, comatose
state, preexisting central nervous
system depression, uncontrolled
severe pain, and narrow angle
glaucoma. It also is contraindicated in
pregnancy and in women who are
breast-feeding.
Methylphenidate is best taken shortly
before meals and no later than 1:00
PM for children or after 6:00 PM for
adults because the stimulating effect
of the medication may keep the client
awake. The other options are
incorrect.
Etanercept (Enbrel) is an antiarthritic
medication that is administered via
the subcutaneous route. Adverse
effects include heart failure (noted by
manifestations of dyspnea and
congested lung sounds on
auscultation), hypertension or
hypotension, pancreatitis, or
gastrointestinal hemorrhage.
Headache, abdominal discomfort, and
dizziness are not side effects of the
medication.
Olanzapine is an antipsychotic
medication that targets both the
positive and the negative symptoms of
schizophrenia. The other options listed
are not indications for use of this
medication.
Sunday, October 16, 2011 51
 Etanercept (Enbrel) is an antiarthritic
medication that is administered via
the subcutaneous route. Adverse
effects include heart failure (noted by
manifestations of dyspnea and
congested lung sounds on
auscultation), hypertension or
hypotension, pancreatitis, or
gastrointestinal hemorrhage.
Headache, abdominal discomfort, and
dizziness are not side effects of the
medication.
Baseline assessment of renal and liver
function should be done before the
initiation of therapy with risperidone.
The medication is used with caution in
clients with renal or hepatic
impairment, in those with underlying
cardiovascular disorders, and in
geriatric or debilitated clients. These
clients are started on the medication
at a reduced dosage level.
Potentially fatal reactions may occur if
sertraline is administered concurrently
with phenelzine, a monoamine oxidase
inhibitor (MAOI). MAOIs should be
stopped at least 14 days before
initiation of sertraline therapy.
Likewise, sertraline should be stopped
at least 14 days before initiation of
MAOI therapy. The other options are
incorrect.
The caregiver is instructed to notify
the physician if nausea, vomiting,
diarrhea, rash, jaundice, or changes in
the color of the stool occur, because
these signs could indicate the
development of hepatitis. Tacrine is
administered between meals on an
empty stomach but may be
administered with food if
gastrointestinal (GI) upset occurs. Flu-
like symptoms without fever and GI
symptoms are frequent side effects
that may occur with use of this
medication. The client or spouse
NCLEX– 58826276.doc
should never double the dose of the
medication.
The client should be instructed to take
the medication at bedtime and to
swallow the medication whole with a
full glass of water. For faster onset of
sleep, the client should be instructed
not to take the medication with food
or immediately after a meal. Antacids
affect the absorption of the
medication.
After heparin sodium is drawn up from
the vial, the needle is changed before
injection to prevent contact of the
medication with tissue along the
needle tract. Heparin sodium
administered subcutaneously does not
require an infusion device and is
injected at least 2 inches from the
umbilicus or any scar tissue. The
needle is withdrawn rapidly, and the
site is not massaged (although
pressure is applied).
A frequent side effect of therapy with
any angiotensin-converting enzyme
(ACE) inhibitor, including quinapril, is a
persistent, dry cough. In general, the
cough does not resolve during the
course of medication therapy, so
clients should be advised to notify the
physician if the cough becomes very
troublesome. The other options are
incorrect.
Nitroglycerin is a coronary vasodilator
used for coronary artery disease. The
client should apply a new patch each
morning and leave it in place for 12 to
14 hours in accordance with physician
directions. This prevents the client
from developing tolerance (as
happens with 24-hour use). The client
should avoid placing the patch in skin
folds or excoriated areas. The client
does not need to wait to apply a new
patch if it falls off because the
Sunday, October 16, 2011 52
 medication is released continuously in
small amounts through the skin.
Activase is a thrombolytic medication
that dissolves thrombi or emboli.
Bleeding is a frequent and potentially
severe adverse effect of therapy. The
nurse assesses for signs of bleeding in
clients receiving this therapy using
occult blood test strips to test urine,
stool, or nasogastric drainage. Pulse
oximeter and suction equipment
would be needed if the client had
evidence of oxygenation or respiratory
problems. A flashlight is used for pupil
assessment as part of the neurological
examination in the client who is
neurologically impaired.
Headache is a frequent side effect of
nitroglycerin, resulting from its
vasodilator action. It often subsides as
the client becomes accustomed to the
medication and is effectively treated
with acetaminophen (Tylenol). The
other options are incorrect
interpretations.
Betaxolol is a β-adrenergic blocking
agent used to lower blood pressure,
relieve angina, or decrease the
occurrence of dysrhythmias. Side
effects include bradycardia and signs
and symptoms of congestive heart
failure, such as weight gain and
increased edema.
Verapamil is a calcium channel–
blocking agent that may be used to
treat rapid-rate supraventricular
tachydysrhythmias such as atrial
flutter or atrial fibrillation. A cardiac
monitor is used to determine the
client's response to the medication. A
noninvasive blood pressure monitor
also is helpful, but is not as essential
or critical as the cardiac monitor. A
pulse oximeter and oxygen are related
to respiratory care and may be other
useful adjuncts to care, but they are
NCLEX– 58826276.doc
not directly related to the use of this
medication.
Cola, coffee, and chocolate contain
xanthine and should be avoided by the
client taking a xanthine
bronchodilator. The additional
xanthine could lead to increased
incidence of cardiovascular and
central nervous system side effects.
Options 1, 2, and 4 identify fluids that
are allowed.
A client should drink increased fluids
(2000 to 3000 mL/day) to decrease
viscosity and increase expectoration
of secretions. This is standard advice
for clients receiving any of the
adrenergic bronchodilators, unless the
client has another health problem that
contraindicates an increased fluid
intake. A dehumidifier will dry
secretions, making the situation
worse. The client should not take
additional medication. Additional
exercise will not effectively clear
bronchial secretions.
The client taking a potassium-wasting
diuretic such as chlorothiazide should
be monitored for decreased potassium
levels. Other possible fluid and
electrolyte imbalances that occur with
use of this medication include
hyponatremia, hypercalcemia,
hypomagnesemia, and
hypophosphatemia.
Amiloride is a potassium-sparing
diuretic used to treat edema or
hypertension. The daily dose should
be taken in the morning to avoid
nocturia, and the medication should
be taken with food to increase
bioavailability. Sodium should be
restricted or limited as prescribed.
Increased blood pressure is not a
reason to withhold the medication;
rather, it may be an indication for its
use.
Sunday, October 16, 2011 53
 Diazepam is a sedative-hypnotic that
also has anticonvulsant and skeletal
muscle relaxant properties. The nurse
should institute safety measures
before leaving the client's room to
prevent injury as a result of
medication side effects, which include
dizziness, drowsiness, and lethargy.
The other options listed are useful but
not essential to the client's safety in
this situation.
Because therapeutic and toxic dosage
ranges are narrow, lithium blood levels
must be monitored closely. They are
measured more frequently when the
client begins the medication and then
once every several months after the
levels stabilize. The client should be
instructed to stop taking the
medication and call the physician if
excessive diarrhea, vomiting, or
diaphoresis occurs. Lithium is irritating
to the gastric mucosa and should be
taken with meals. A normal diet and
normal salt and fluid intake (1500 to
3000 mL per day) should be
maintained because lithium decreases
sodium reabsorption by the renal
tubules, leading to sodium depletion.
A low sodium intake causes a relative
increase in lithium retention and could
lead to toxicity.
Toxic effects include marked
drowsiness and lethargy, excessive
salivation, a fixed stare, akathisia,
acute dystonia, and tardive
dyskinesia. Hypotension, nausea, and
blurred vision are occasional side
effects.
With immediate-release preparations,
oral theophylline should be
administered 4 to 6 hours after
discontinuing the IV form of the
medication. If the sustained-release
form is used, the first oral dose should
be administered immediately on
discontinuation of the IV infusion.
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Because urinary retention is a side
effect of benztropine mesylate, the
nurse must assess for dysuria,
distended abdomen, infrequent
voiding in small amounts, and
overflow incontinence. Monitoring of
the other options is not necessary with
this medication.
Lisinopril is an angiotensin-converting
enzyme (ACE) inhibitor used in the
treatment of hypertension. The client
should be instructed to rise slowly
from a reclining to a sitting position,
and to dangle the legs from the bed
for a few moments before standing to
reduce the hypotensive effect. It is not
necessary to take the medication with
food. If nausea occurs, the client
should drink a non-cola carbonated
beverage and eat salted crackers or
dry toast. A full therapeutic effect may
be achieved in 1 to 2 weeks.
Quinidine gluconate is an
antidysrhythmic medication used to
maintain normal sinus rhythm after
conversion of atrial fibrillation or atrial
flutter. It is contraindicated in
complete AV block, intraventricular
conduction defects, and abnormal
impulses and rhythms due to escape
mechanisms, and with myasthenia
gravis. It is used with caution in clients
with preexisting asthma, muscle
weakness, infection with fever, and
hepatic or renal insufficiency.
Quinupristin-dalfopristin is an
antimicrobial medication used to treat
endocarditis, bacteremia, and
infections of the skin. It also is used to
treat infections of the urinary tract,
central catheter infections, and bone,
joint, and respiratory system
infections. For intermittent IV infusion
(piggyback), the medication should be
infused over a 1-hour period.
Sunday, October 16, 2011 54
 Diarrhea, nausea, vomiting, loss of
appetite, and dizziness all are
common side effects of quinidine
gluconate. If any of these occur, the
physician or the nurse should be
notified; however, the medication
should never be discontinued abruptly.
Rapid decrease in medication levels of
antidysrhythmics could precipitate
dysrhythmia. The other options
indicate correct information.
Diltiazem hydrochloride is a calcium
channel blocker used in the treatment
of atrial flutter and fibrillation. It
decreases myocardial contractility and
workload, thereby decreasing the
need for oxygen. A bolus of 0.25
mg/kg is given slowly over 2 minutes,
and a continuous infusion of 5 to 10
mg/hour may be continued for up to
24 hours.
Vasopressin is a vasopressor and an
antidiuretic. It increases reabsorption
of water by the renal tubules, resulting
in a decreased urinary flow rate. It
also directly stimulates contraction of
smooth muscle, causing
vasoconstriction, and stimulating
peristalsis.
Corticosteroids, thiazide diuretics, and
lithium may decrease the effect of
glyburide, thus causing
hyperglycemia. The medications listed
in the incorrect options increase the
effect of glyburide, leading to
hypoglycemia.
Methylergonovine, an oxytocic, is an
agent that is used to prevent or
control postpartum hemorrhage by
contracting the uterus. The immediate
dose usually is given intramuscularly,
and then if addition medication is
needed, it is given by mouth. It
increases the strength and frequency
of contractions and may elevate the
blood pressure. A priority assessment
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component before the administration
of methylergonovine is blood pressure.
No relationship exists between the
action of this medication and lochial
drainage.
The client taking benztropine mesylate
may have decreased tolerance to heat
as a result of diminished ability to
sweat and should plan rest periods in
cool places during the day. The client
also is instructed to avoid driving or
operating hazardous equipment if
drowsy or dizzy. The client should be
instructed to stop taking the
medication if difficulty swallowing or
speaking develops or if vomiting
occurs; to inform the physician if
central nervous system effects occur;
and to monitor urinary output and
watch for signs of constipation.
Dizziness, nausea, headaches,
nervousness, lightheadedness, and
excitement, which generally are not
major problems, are side effects of
buspirone hydrochloride. Buspirone
hydrochloride is not sedating,
tolerance does not develop, and it is
not addicting.
Bromocriptine, an antiparkinsonian
prolactin inhibitor, is used in the
treatment of neuroleptic malignant
syndrome. Enalapril maleate is an
angiotensin-converting enzyme (ACE)
inhibitor used to treat hypertension.
Phytonadione is the antidote for
warfarin (Coumadin) overdose.
Protamine sulfate is the antidote for
heparin overdose.
Prozac is administered in the early
morning. The other options are
incorrect.
Haloperidol acts by blocking the
binding of dopamine to the
postsynaptic dopamine receptors in
the brain. Donepezil hydrochloride
Sunday, October 16, 2011 55
 (Aricept) inhibits the breakdown of
released acetylcholine. Fluoxetine
hydrochloride (Prozac) is a potent
serotonin reuptake blocker.
Imipramine hydrochloride (Tofranil)
blocks the reuptake of norepinephrine
and serotonin.
Before mixing different types of
insulin, the NPH bottle should be
rotated for at least 1 minute between
both hands to resuspend the insulin
and warm the medication. Insulin can
be stored at room temperature.
Additional bottles of insulin for future
use should be stored in the
refrigerator. Regular insulin is drawn
up before NPH insulin. Air does not
have to be removed from the insulin
bottle.
Dimenhydrinate is used to treat and
prevent the symptoms and signs of
dizziness, vertigo, and nausea and
vomiting that accompany motion
sickness. The other options are
incorrect.
Omeprazole is a proton pump inhibitor
and is classified as an antiulcer agent.
The medication relieves pain from
gastric irritation, which often is
experienced as "heartburn" by clients.
The medication does not relieve the
symptoms identified in options 1, 3,
and 4.
Zollinger-Ellison syndrome is a
hypersecretory condition of the
stomach, associated with increased
risk of problems from irritation of the
stomach lining. Aspirin and
nonsteroidal anti-inflammatory
medications (NSAIDs), such as
naprosyn and ibuprofen, should be
avoided as potential irritants. The
client should take acetaminophen for
pain relief.
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Ranitidine should be taken at bedtime,
when it is given as a single daily dose.
This allows for prolonged effect and
provides the greatest protection of the
gastric mucosa both during sleep and
around the clock. The other options
are incorrect.
A client who chronically uses aspirin is
prone to gastric mucosal injury, which
causes epigastric pain as a symptom.
Misoprostol is specifically given to
prevent this occurrence. Diarrhea can
be a side effect of the medication but
is not an intended effect. Bleeding and
joint aches are not relieved by
misoprostol.
Side effects of scopolamine, an
anticholinergic medication, are dry
mouth, urinary retention, decreased
sweating, and dilation of the pupils.
Each of the incorrect options state the
opposite of a side effect of this
medication.
Droperidol may be administered by
the intramuscular or the intravenous
(IV) route. The IV route is the route
used when relief of nausea is needed.
The other options are incorrect.
Propantheline decreases
gastrointestinal (GI) secretions
because it is an antimuscarinic
anticholinergic medication. It should
be administered 30 minutes before
meals. The other options are incorrect.
Docusate is a stool softener that
relieves constipation because it
promotes absorption of water into the
stool, producing a softer consistency
of stool. The other options are not
effects of this medication.
Cascara sagrada is a laxative that
causes nausea and abdominal cramps
as the most frequent side effects. The
incorrect options represent health
Sunday, October 16, 2011 56
 problems that are not caused by this
medication.
Most rapid results from bisacodyl
occur when it is taken on an empty
stomach. It will not have a rapid effect
if taken with a large meal or with two
glasses of milk. If it is taken at
bedtime, the client will have a bowel
movement in the morning.
Senna works by altering the transport
of water and electrolytes in the large
intestine, which causes accumulation
of water in the mass of stool and
increased peristalsis. The other
options are incorrect actions for this
medication.
Loperamide is an antidiarrheal agent
commonly administered after the
client experiences loose stools. It is
used to treat both acute diarrhea and
chronic diarrhea from disorders such
as inflammatory bowel disease. It also
can be used to reduce the volume of
drainage from an ileostomy.
The client should understand that this
medication may be habit-forming, so
careful adherence to proper dose is
important. The medication is an
antidiarrheal and therefore should not
be taken with a laxative (cathartic).
Side effects of the medication include
dry mouth and drowsiness. Drooling
and irritability are not associated with
the use of this medication.
Metamucil is a bulk-forming laxative
that should be taken with a full glass
of water or juice, followed by another
glass of liquid. This will help prevent
impaction of the medication in the
stomach or small intestine. The other
options are incorrect.
Trimethobenzamide is an antiemetic
agent used for relief of nausea and
vomiting. Each of the other options is
incorrect. The medication is not used
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to treat heartburn, constipation, or
abdominal pain.
Ondansetron is an antiemetic used for
relief of postoperative nausea and
vomiting, as well as nausea and
vomiting associated with
chemotherapy. This medication is not
used to treat the other problems
identified in options 1, 2, and 4.
Magnesium citrate is available as an
oral solution and should be served
chilled to make it more palatable. The
other options are incorrect.
Prochlorperazine is a phenothiazine-
type antiemetic and antipsychotic
agent. A frequent side effect is blurred
vision. Other frequent side effects of
this medication are dry eyes, dry
mouth, and constipation.
Pancrelipase is a pancreatic enzyme
used as a digestive aid for clients with
pancreatitis. It should reduce the
amount of fatty stools (steatorrhea).
Another recognized beneficial effect is
improved nutritional status. It is not
used to treat abdominal pain or
heartburn and does not regulate blood
glucose.
Aluminum hydroxide tablets should be
chewed thoroughly before swallowing,
to prevent them from entering the
small intestine undissolved. An antacid
should not be taken with the
medication, to prevent interactive
effects. Constipation is a side effect of
the use of aluminum products, but the
client should not take a laxative with
each dose. This would promote
laxative abuse and should be avoided
if less habit-forming means can be
used.
Calcium carbonate can be used as an
antacid for the relief of heartburn and
indigestion. It also can be used as a
calcium supplement or to bind
Sunday, October 16, 2011 57
 phosphorus in the gastrointestinal (GI)
tract in clients with renal failure. The
other options are incorrect and are not
indications for the use of calcium
carbonate.
Sodium bicarbonate is an electrolyte
modifier and antacid. With large doses
or long-term use, it can cause
metabolic alkalosis. The other options
are incorrect.
Simethicone is an antiflatulent used in
the relief of pain due to excessive gas
in the gastrointestinal (GI) tract.
Magnesium hydroxide is an antacid
and laxative, and droperidol relieves
postoperative nausea and vomiting.
Acetaminophen is a non-opioid
analgesic.
Older clients are especially susceptible
to the CNS effects of cimetidine, of
which confusion is most frequent. Less
common CNS side effects include
headache, dizziness, drowsiness, and
hallucinations.
The medication should be taken 1
hour before meals and at bedtime to
allow it to form a protective coating
over the ulcer to prevent irritation
from food, gastric acid, and
mechanical movement. The other
options are incorrect.
The blood pressure is monitored
frequently during administration
because pentamidine can cause
severe and sudden hypotension, even
with a single dose. The client should
be supine while receiving the
medication, and resuscitation
equipment should be available.
Pyrazinamide is an antituberculosis
medication that is given in conjunction
with other antituberculosis
medications. Its use may be
discontinued by the prescriber if
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sputum cultures become negative.
Options 1, 3, and 4 are incorrect.
The client who receives a continuous
IV infusion of heparin is at risk for
bleeding. The nurse assesses for signs
of bleeding, which include bleeding
from the gums, ecchymoses on the
skin, cloudy or pink-tinged urine, tarry
stools, and body fluids that test
positive for occult blood. The other
options are not side effects related to
this medication.
Procainamide is an antidysrhythmic
medication used to treat ventricular
dysrhythmias unresponsive to
lidocaine. The other options are not
indications for giving this medication.
Colchicine is classified as an antigout
agent that interferes with the ability of
the white blood cells to initiate and
maintain an inflammatory response to
monosodium urate crystals. The client
should report a decrease in pain and
inflammation in the affected joints, as
well as a decrease in number of gout
attacks. The other options are
incorrect.
Enoxaparin is an anticoagulant that is
administered to prevent deep vein
thrombosis and thromboembolism in
clients at risk. It is not used to treat
the conditions listed in options 1, 2, or
3.
Because of the antacid's aluminum
base, aluminum hydroxide causes
constipation as a side effect. The other
side effect is hypophosphatemia,
which is noted by monitoring serum
laboratory studies. The other options
are not side effects of this medication.
A common side effect of β-adrenergic
blocking agents such as pindolol is
impotence. Other common side effects
include fatigue and weakness. Central
nervous system side effects are rarer
Sunday, October 16, 2011 58
 and include mental status changes,
nervousness, depression, and
insomnia. Increased appetite, difficulty
swallowing, and mood swings are not
side effects of this medication.
Clotrimazole is a topical antifungal
agent used in the treatment of
cutaneous fungal infections. It is not
used for sneezing, fever, or pain.
Azithromycin is a macrolide antibiotic
used to treat infection. It is not used to
treat pain, joint inflammation, or blood
pressure.
Cyclopentolate is a rapidly acting
mydriatic and cycloplegic medication
that is used preoperatively to dilate
the eye. It is effective in 25 to 75
minutes, and accommodation returns
in 6 to 24 hours. The statements in the
other options are incorrect.
Atropine sulfate must be available in
the event of systemic toxicity from
pilocarpine hydrochloride. Pilocarpine
toxicity is manifested by vertigo,
bradycardia, tremors, hypotension,
syncope, cardiac dysrhythmias, and
seizures. Disulfiram is an alcohol
deterrent used in the management of
alcoholism in selected clients.
Naloxone hydrochloride is an opioid
antagonist used to reverse narcotic-
induced respiratory depression.
Cyclopentolate is a rapidly acting
mydriatic and cycloplegic medication
used preoperatively for surgical
procedures on the eye.
Betaxolol is an antiglaucoma
medication and a β-adrenergic
blocker. Systemic effects of this
medication are hypotension, dizziness,
nausea, diaphoresis, headache,
fatigue, constipation, and diarrhea.
The client should have the blood
pressure monitored for hypotension
and the pulse assessed for strength,
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weakness, irregular rate, and
bradycardia. Bowel activity and
evidence of congestive heart failure
also should be assessed. The other
options are incorrect.
Ringing in the ears and vertigo are two
symptoms of ototoxicity that may
indicate dysfunction of the eighth
cranial nerve. This is a frequent
adverse effect of therapy with the use
of aminoglycosides and could result in
permanent hearing loss. In clients with
these symptoms, the nurse should
withhold the dose of the medication
and notify the physician. Nausea,
vomiting, and hypotension are rare
side effects of the medication.
Amiodarone is an antiarrhythmic used
to treat life-threatening ventricular
arrhythmias that do not respond to
first-line agents. The client requires
continuous cardiac monitoring, with
infusion of the medication by an
intravenous pump. Although the other
assessments are not incorrect,
monitoring of cardiac rhythm is the
priority nursing action.
Mild intoxication with aspirin is called
salicylism and can be experienced by
the client when the daily dosage of
aspirin is more than 4 g. Tinnitus
(ringing in the ears) is the most
frequent effect noted with intoxication.
Hyperventilation may occur because
salicylates stimulate the respiratory
center. Fever may result because
salicylates interfere with the metabolic
pathways coupling oxygen
consumption and heat reduction.
Options 1, 2, and 4 are not signs of
aspirin intoxication.
Sucralfate forms a protective coating
over the gastric ulcer. It should be
taken 1 hour before meals because
food intake will stimulate gastric acid
production and mechanical irritation
Sunday, October 16, 2011 59
 causing irritation to the gastric ulcer. It
also is taken at bedtime to provide a
protective coating over the gastric
ulcer during the nighttime hours.
Options 1, 2, and 3 are incorrect.
Hemorrhagic cystitis is a toxic effect
that can occur with the use of this
medication. The client who is taking
cyclophosphamide needs to be
instructed to drink copious amounts of
fluids during the administration of this
medication. The medication should be
taken on an empty stomach, but if the
client complains of gastrointestinal
(GI) upset, it can be taken with food.
Orange juice probably would cause
and increase the GI upset. Option 3
will not assist in relieving the
discomfort experienced by the client.
Bleomycin is an antineoplastic
medication that can cause interstitial
pneumonitis, which can progress to
pulmonary fibrosis. The highest
priority is to monitor lung sounds for
the presence of crackles, which may
indicate pulmonary toxicity.
Pulmonary function studies along with
hematologic, hepatic, and renal
function tests are required in
monitoring for toxic effects of this
agent. If pulmonary toxicity develops,
the medication would be discontinued.
Although options 1, 2, and 4 may be a
component of the nurse's assessment,
option 3 is of the highest priority in
administering this medication.
Acetylcysteine can be given orally or
by nasogastric tube to treat
acetaminophen overdose. It is
administered by inhalation for use as a
mucolytic. Before administration of the
medication as an antidote, the nurse
would ensure that the client's stomach
is empty through emesis or gastric
lavage. The solution is diluted in cola,
water, or juice to make the solution
more palatable. It is not administered
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via nebulizer, intravenously, or
subcutaneously for the client
experiencing acetaminophen
overdose.
Codeine sulfate is an opioid analgesic
and can cause constipation. The client
is instructed to increase fluid intake to
prevent constipation. The client also
should consume foods high in fiber
and should take a stool softener.
Dantrolene can cause liver damage,
and the nurse should monitor results
of the client's liver function studies.
Baseline liver function studies are
done before therapy starts, and
regular liver function studies are
performed throughout therapy.
Dantrolene is discontinued if no relief
of spasticity is achieved in 6 weeks.
Options 1, 2, and 3 are not related to
the administration of this medication.
The normal PT is 12 to 14 seconds. A
prolonged PT may be considered
therapeutic for the client on
anticoagulant therapy such as
warfarin sodium. For the client on
anticoagulant therapy, a PT of 1.5 to
2.5 times the normal value may be
considered appropriate, putting option
4 within the therapeutic range.
Filgrastim is a granulocyte colony-
stimulating factor produced by human
recombinant DNA. It is administered to
clients with agranulocytosis to
promote the growth of neutrophils and
enhance the function of mature
neutrophils. Options 1, 3, and 4 are
not actions of this medication.
Filgrastim is a granulocyte colony-
stimulating factor produced by human
recombinant DNA technology. It is
given by subcutaneous injection,
continuous subcutaneous infusion, or
continuous intravenous infusion.
Sunday, October 16, 2011 60
 Filgrastim is used to promote the
growth of neutrophils and enhance the
function of mature neutrophils.
Treatment is continued until the
absolute neutrophil count reaches
10,000/mm3. Options 1, 3, and 4 are
unrelated to the action of this
medication.
Filgrastim may be administered by
continuous IV infusion. It should be
stored in a refrigerator and should be
discarded if it has been exposed to
room temperature for more than 6
hours. The solution should not be
shaken. It is diluted only with D5W
when administered by the IV route.
Fexofenadine is an antihistamine used
to relieve symptoms associated with
seasonal allergic rhinitis. The nurse
would evaluate for a therapeutic
response to the medication by
determining if the client has obtained
relief of symptoms of red, watery, and
itchy eyes and sneezing. Options 2, 3,
and 4 are unrelated to the use of this
medication.
Acetic acid solution is used for
irrigating, cleansing, and packing
wounds infected by P. aeruginosa.
Glycerin is an emollient that is used
for dry, cracked, and irritated skin.
Aspercreme and Myoflex are used to
treat muscular aches.
The instructions for the use of
malathion are as follows: Sprinkle
lotion on dry hair and rub gently until
the scalp is moistened; allow to dry
naturally; after 8 to 12 hours, wash
the hair with a nonmedicated
shampoo; rinse and use a fine-toothed
comb to remove lice; and repeat in 7
to 9 days if needed.
Lindane shampoo is worked into dry
hair in the affected area and left in
place for 4 minutes. Then the
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shampoo is rinsed off with warm
water. Dead nits can be removed with
a comb or tweezers. Although one
treatment usually is sufficient, a
second application in 7 days may be
required.
BenGay is one of many products used
for the temporary relief of muscular
aches, rheumatism, arthritis, sprains,
and neuralgia. These types of products
contain combinations of antiseptics,
local anesthetics, analgesics, and
counterirritants. A heating pad should
not be applied because irritation or
burning of the skin may occur. The
medication is not addicting, does not
act in a systemic manner, and does
not cause sleepiness.
Lithium is an antimanic medication
and is used to treat the manic phase
of a manic-depressive disorder.
Options 1, 3, and 4 are incorrect.
Lindane can penetrate the intact skin
and can cause convulsions if absorbed
in sufficient quantities. Clients at
highest risk for convulsions are
premature infants, children, and
clients with preexisting seizure
disorders. Lindane should not be used
in pediatric clients unless safer
medications have failed to control the
infection.
Topical glucocorticoids can be
absorbed into the systemic circulation.
Absorption is higher from regions
where the skin is especially permeable
(scalp, axilla, face, eyelids, neck,
perineum, genitalia) and lower from
regions where penetrability is poor
(back, palms, soles).
A topical glucocorticoid will relieve
inflammation. The mother should be
advised not to apply a tight-fitting
diaper or plastic pants after applying
the medication because these items
Sunday, October 16, 2011 61
 will act as an occlusive dressing. The
use of occlusive dressings (bandages
or plastic wraps) over the affected site
is avoided after application of the
topical glucocorticoid, unless the
physician specifically prescribes this
wound coverage. The medication is
gently rubbed into the skin after a thin
layer is applied.
Topical glucocorticoids can be
absorbed in sufficient amounts to
produce systemic toxicity. Principal
concerns are growth retardation (in
children) and adrenal suppression in
all age groups. Systemic toxicity is
more likely under extreme conditions
of use such as with prolonged therapy
in which extensive surfaces are
treated with high doses of high-
potency agents in conjunction with
occlusive dressings.
Salicylic acid is readily absorbed
through the skin, and systemic toxicity
(salicylism) can result. Symptoms
include tinnitus, hyperpnea, dizziness,
and psychological disturbances. Lower
leg pains, constipation, and diarrhea
are not associated with salicylism.
Azelaic acid is a topical medication
used to treat mild to moderate acne. It
appears to work by suppressing
growth of Propionibacterium acnes
and by decreasing proliferation of
keratinocytes. Options 2, 3, and 4 are
accurate statements regarding the use
of this medication.
A 2% minoxidil solution is used for
topical treatment of baldness. The
usual dosage is 1 mL applied twice a
day. Options 2, 3, and 4 are incorrect.
Clotrimazole is a topical antifungal
agent used in the treatment of
cutaneous fungal infections. The nurse
monitors the effectiveness of this
medication by noting the presence or
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absence of a skin rash, characteristic
of this infection. Options 1, 3, and 4
are unrelated to the use of this
medication.
Tolbutamide is an oral hypoglycemic
agent and is taken in the morning with
breakfast to minimize gastric irritation
and to enhance diabetic control. It
stimulates the pancreas to produce
the insulin that is needed during the
day.
If the tubing is removed from an IV
pump and the tubing is not clamped,
the client will receive a bolus of the
solution and the medication contained
in the solution. The client who receives
a bolus dose of heparin is at risk for
bleeding. If the results of the next PTT
are extremely high, a dose of
protamine sulfate, the antidote for
heparin, may be prescribed.
Aminocaproic acid is an
antithrombinolytic (inhibits clot
breakdown). Enoxaparin is an
anticoagulant. Vitamin K is the
antidote for warfarin sodium
(Coumadin).
Procainamide is an antiarrhythmic
medication often used to treat
ventricular arrhythmias that do not
adequately respond to lidocaine
(Xylocaine). The effectiveness of this
medication is best determined by
evaluating the client's cardiac rhythm.
Thus, a cardiac monitor would be the
most appropriate device for
determining the client's response,
although the blood pressure cuff and
the pulse oximeter would provide
general information about the client's
cardiovascular status. A glucometer is
not needed for this client with the
information presented.
Inamrinone is an inotropic agent used
to relieve the manifestations of heart
failure. Therapeutic effects include a
Sunday, October 16, 2011 62
 decrease in edema, weight (fluid),
dyspnea, and lung crackles. Blood
pressure should remain stable or
increase (if the client is hypotensive).
Hypotension is a cardiovascular
adverse effect of the medication.
Hypokalemia can result from long-
term use of cascara sagrada, a
laxative. The medication stimulates
peristalsis and alters fluid and
electrolyte transport, thus helping fluid
to accumulate in the colon. Options 2,
3, and 4 are not specifically associated
with the use of this medication.
Drowsiness, dizziness, and dry mouth
are the most common side effects of
cyclobenzaprine. This medication is a
centrally acting skeletal muscle
relaxant used in the management of
muscle spasm that accompanies a
variety of conditions. Options 1, 3, and
4 are incorrect.
Levofloxacin should be administered
with water. Antacids, zinc, and iron
supplements decrease absorption and
should be taken at least 4 hours
before or 2 hours after the medication.
If nausea occurs, it is not necessary to
notify the physician. The client should
be instructed to consume
noncaffeinated carbonated beverages,
unsalted crackers, or dry toast to
alleviate the nausea. To reduce the
hypotensive effect of this medication,
the client is instructed to rise slowly
from a lying to a sitting position and to
permit the legs to dangle from the bed
momentarily before standing. The
client should report signs of a sore
throat or fever to the physician
because these may indicate infection.
The client should be notified that
several weeks may be needed for the
full therapeutic effect of blood
pressure reduction. The client also
should be instructed not to skip doses
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or discontinue the medication,
because severe rebound hypertension
can occur.
Enoxaparin sodium is an
anticoagulant. Accidental overdose of
this medication may lead to bleeding
complications. The antidote is
protamine sulfate. Vitamin K is the
antidote for warfarin sodium
(Coumadin). Adrenalin is a
trademarked preparation of
epinephrine, which normally is used to
treat hypersensitivity reactions or
acute bronchial asthma attacks and
bronchospasms.
Insulin dosages are verified by another
nurse before administration. When two
types of insulins are mixed, the doses
must be verified after each is drawn
up in order to verify the dosage for
each one. The Regular insulin is drawn
into the syringe first.
Gemfibrozil is a lipid-lowering agent. It
is given as part of a therapeutic
regimen that also includes dietary
counseling—specifically, the limitation
of saturated and other fats in the diet.
In atrial fibrillation, the walls of the
atria fibrillate. The physician may
prescribe a daily aspirin. This will
prevent embolus secondary to clot
formation along the walls of the atria.
Atrial fibrillation puts the client at risk
for mural thrombi because of the
sluggish blood flow through the atria
that occurs as a result of loss of the
atrial kick. Although aspirin does have
anti-inflammatory properties, it cannot
prevent any inflammation from
occurring, as stated in option 2.
Options 3 and 4 also are incorrect.
Anaphylactic shock is a possible
reaction to penicillin therapy, and the
onset of anaphylaxis nearly always
occurs within 10 minutes. The client
Sunday, October 16, 2011 63
 should be observed for 30 minutes
after intramuscular injection so that if
anaphylaxis develops, treatment is
immediately available. Options 1 and
4 are inaccurate interventions. Option
3 is unnecessary.
Cardiotoxicity can occur with the use
of doxorubicin. The medication can
produce irreversible toxicity to the
heart, including ECG changes and
congestive heart failure. Elevated
values on renal function tests (options
1 and 2) are not associated with the
use of this medication. A red
coloration of the urine may occur with
the use of this medication, but this
effect is harmless.
Mupirocin is a topical antibacterial
agent active against impetigo caused
by staphylococci or streptococci.
Acyclovir is a topical antiviral agent
that inhibits DNA replication in the
virus. It inhibits the activity of herpes
simplex types 1 and 2, varicella-
zoster, Epstein-Barr virus, and
cytomegalovirus. Triple antibiotic
would not be effective in treating
impetigo. Benzoyl peroxide is a
keratolytic.
Sunscreens are most effective when
applied about 30 minutes to 1 hour
before exposure to the sun, so that
they can penetrate the skin. All
sunscreens should be reapplied after
swimming or sweating.
Fenofibrate (Tricor) is a fibric acid
derivative that is used to treat
hyperlipidemia. Contraindications to
the use of fibrates include known
medication allergy, severe liver or
kidney disease, cirrhosis, and
gallbladder disease.
Nitrofurazone is applied topically to
the burn and has a broad spectrum of
antibiotic activity. It is used in second-
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or third-degree burns when bacterial
resistance to other agents is a
potential problem. A film of 1/16 inch
is applied directly to the burn using a
sterile gloved hand. The burn site is
washed daily. Saline-soaked dressings
are not used.
Mafenide acetate is bacteriostatic for
both gram-negative and gram-positive
organisms and is used to treat second-
and third-degree burns to reduce the
number of bacteria present in
avascular tissues. The client should be
informed that the medication will
cause local discomfort, stinging, and
burning.
Mafenide acetate is a carbonic
anhydrase inhibitor and can suppress
renal excretion of acid, thereby
causing acidosis. Clients receiving this
treatment should be monitored for
acidosis and if the acidosis becomes
severe, the medication should be
discontinued for 1 to 2 days. An
elevated blood pressure may be
expected in the client with pain.
Hypotension is not associated with the
use of this medication.
A Vigilon dressing is used to clean
small partial-thickness burns. It is a
colloidal suspension on a polyethylene
mesh support, is permeable to gases
and water vapor, and provides a moist
environment. It is secured over the
wound with gauze or tape and is
changed daily. Option 4 is incorrect.
Sodium hypochlorite is a solution that
is used for irrigating and cleaning
necrotic or purulent wounds. It can be
used for packing necrotic wounds but
cannot be used to pack purulent
wounds, because the solution is
inactivated by copious pus. It should
not come in contact with healing or
normal tissue, and it should be rinsed
off immediately if used for irrigation.
Sunday, October 16, 2011 64
 Solutions are unstable and must be
prepared fresh for each use.
Tretinoin decreases cohesiveness of
the epithelial cells, increasing cell
mitosis and turnover. It is potentially
irritating, particularly when used
correctly. Within 48 hours of use, the
skin generally becomes red and
begins to peel. It is not necessary to
notify the physician if this occurs.
Options 1, 2, and 4 are correct client
statements.
Tretinoin is applied liberally to the
skin. The hands are washed
thoroughly immediately after applying.
Therapeutic results should be seen
after 2 to 3 weeks but may not be
optimal until after 6 weeks. The client
may use cosmetics, but the skin needs
to be cleansed thoroughly before
applying the medication.
Isotretinoin is administered two times
daily for 15 to 20 weeks. The usual
adult dosage is 0.5 to 1 mg/kg/day. If
needed, a second course may be
given, but not until 2 months have
elapsed after completing the first
course. The medication needs to be
taken with food to facilitate
absorption. The tablets should be
administered whole and not crushed.
Isotretinoin can elevate triglyceride
levels. Blood triglyceride levels should
be measured before treatment and
periodically thereafter until the effects
on the triglycerides have been
determined. The client needs to be
instructed about the importance of
follow-up to evaluate the triglyceride
level. Options 2, 3, and 4 are not
necessary to monitor while taking this
medication.
Doxycycline is a tetracycline. Adverse
effects of isotretinoin can be increased
by the use of tetracyclines.
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Tetracyclines increase the risk of
pseudotumor cerebri and papilledema.
Because of the potential for increased
toxicity, tetracyclines should be
discontinued before isotretinoin
therapy. The medications identified in
options 1, 3, and 4 are not
contraindicated.
The wound should be cleansed with a
sterile solution and gently patted dry.
A thin layer of Elase is applied and
covered with a petrolatum gauze. If a
dry powder is used, for best effects
the solution should be prepared just
before use.
Azithromycin (Zithromax) is a
macrolide antibiotic that has excellent
tissue penetration properties and can
reach high concentrations in infected
tissues. It has a long duration of
action, which allows it to be dosed
once daily. Taking the medication with
food or an antacid decreases both the
rate and extent of gastrointestinal
absorption. Therefore, it is best to take
the medication with water on an
empty stomach.
Colchicine is classified as an antigout
agent. It interferes with the ability of
the white blood cells to initiate and
maintain an inflammatory response to
monosodium urate crystals. The client
should report a decrease in pain and
inflammation in the affected joints, as
well as a decrease in the number of
gout attacks. Options 1, 2, and 4 are
not associated with the use of this
medication.
Enoxaparin is an anticoagulant that is
administered by the subcutaneous
route. It is used in preventing
thromboembolism in selected clients
at risk. It also may be be administered
by the client at home after hospital
discharge with follow-up assessments
by a home health nurse.
Sunday, October 16, 2011 65
 Zidovudine effectively interferes with
HIV replication but can cause bone
marrow suppression. Anemia occurs
most commonly after 4 to 6 weeks of
therapy. Hematology studies need to
be monitored for anemia and
granulocytopenia. Renal and liver
function tests also should be
monitored. Options 1, 2, and 3 are not
associated with the use of zidovudine.
Hair regrowth with the use of minoxidil
is most likely to occur when baldness
has developed recently and has been
limited to a small area. On
discontinuation of the medication,
newly gained hair is lost in 3 to 4
months, and the natural progression of
hair loss resumes. Options 1 and 4 are
incorrect. Option 3 places the client's
question on hold and is inappropriate.
Trolamine salicylate is one of many
products used for the temporary relief
of muscular aches, rheumatism,
arthritis, sprains, and neuralgia. These
products contain combinations of
antiseptics, local anesthetics,
analgesics, and counterirritants. A
heating pad should not be applied
because irritation or burning of the
skin may occur. The medication does
not act in a systemic manner (option
2). They are not prescribed to cause
the skin to peel, so if this kind of
reaction occurs, the physician should
be notified.
Simethicone is an antiflatulent used to
relieve pain caused by excessive gas
in the gastrointestinal tract.
Magnesium hydroxide is an antacid
and laxative. Droperidol is used to
treat postoperative nausea and
vomiting. Acetaminophen is a
nonopioid analgesic.
Sulfonamides can intensify the effects
of warfarin sodium (Coumadin),
phenytoin (Dilantin), and orally
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administered hypoglycemics such as
tolbutamide (Orinase). When
combined with sulfonamides, these
medications may require a reduction
in dosage.
Phenytoin is an anticonvulsant.
Gingival hyperplasia, bleeding,
swelling, and tenderness of the gums
can occur with the use of this
medication. The client needs to be
taught good oral hygiene, gum
massage, and the need for regular
dentist visits. The client should not
skip medication doses because
inadequate blood levels could
precipitate a seizure. Capsules should
not be chewed or broken, and they
must be swallowed. The client needs
to be instructed to report a sore
throat, fever, glandular swelling, or
any skin reaction because such
findings may indicate hematological
toxicity.
Dexamethasone may be given by
direct intravenous injection or
intravenous infusion. Dexamethasone
may be mixed with 0.9% sodium
chloride or 5% dextrose. If
administered as an infusion, a
minimum amount of diluting solution
is needed.
Dantrolene can cause liver damage,
and the nurse should monitor results
of liver function studies. Liver function
studies are done before therapy starts
to obtain baseline values and then are
performed regularly throughout
therapy. Dantrolene is discontinued if
no relief of spasticity is achieved in 6
weeks.
Incoordination and drowsiness are
common side effects of diazepam.
Options 1, 3, and 4 are unrelated to
the use of this medication.
Sunday, October 16, 2011 66
 Permethrin rinse is an over-the-
counter scabicide that kills lice and
eggs with one application and has
residual activity for 10 days. It is
applied to the hair after shampooing
and left for 10 minutes before rinsing
out. The hair should not be
shampooed for 24 hours after the
treatment.
Thioridazine hydrochloride, an
antipsychotic, can cause postural
hypotension. The client needs to be
taught to get out of bed slowly and to
rise from a sitting position slowly
because of this untoward effect of the
medication. Options 1, 2, and 3 are
not related to this medication.
Lisinopril (Zestril) is an angiotensin-
converting enzyme (ACE) inhibitor that
is used to treat hypertension or heart
failure. It is not used to treat
gastroesophageal reflux disorder,
venous insufficiency, or immune
disorder.
An ACE inhibitor is used to treat
hypertension or heart failure. An
adverse effect of ACE inhibitors is a
characteristic dry, nonproductive
cough. This can be quite bothersome
to a client, and the medication may
need to be changed. The cough is
reversible with discontinuation of
therapy. Options 2, 3, and 4 are
incorrect.
Uric acid is produced when purine is
catabolized. Probenecid is a
medication used for clients with gout
to inhibit the reabsorption of uric acid
by the kidney and promote excretion
of uric acid in the urine. Clients are
instructed to modify their diets to limit
excessive purine intake. High-purine
foods to avoid or limit include organ
meats, roe, sardines, scallops,
anchovies, broth, mincemeat, herring,
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shrimp, mackerel, gravy, yeast, wine,
and alcohol.
Medications known to lower
cyclosporine levels include phenytoin,
phenobarbital, rifampin, and
trimethoprim-sulfamethoxazole.
Cyclosporine levels should be
monitored and the dosage adjusted in
clients taking these medications.
For IV administration of cyclosporine,
1 mL of concentrate is diluted in 20 to
100 mL of 0.9% sodium chloride or 5%
dextrose. The initial dose is 5 to 6
mg/kg (one-third the oral dose)
administered over 2 to 6 hours. The
solution should be protected from
light.
Muromonab-CD3 is a monoclonal
antibody. On binding to the CD3 site,
the antibody blocks all T-cell functions.
Options 2, 3, and 4 are not actions of
this medication.
Because of the risk of anaphylaxis
during the administration of
cyclosporine by the IV route,
epinephrine and oxygen must be
immediately available for use. An oral
airway or a suction machine is not the
priority item, and it is not necessary to
have a code cart at the bedside.
An antihistamine provides relief of
symptoms caused by allergy.
Antihistamines should be discontinued
for at least 3 days (72 hours) before
allergy skin testing to avoid false-
negative readings. This client should
have the appointment rescheduled for
3 days after discontinuing the
medication.
Acetylcystine can be given orally or by
nasogastric tube to treat
acetaminophen overdose, or it may be
given by inhalation for use as a
mucolytic. Before giving the
medication as an antidote to
Sunday, October 16, 2011 67
 acetaminophen, the nurse ensures
that the client's stomach is empty
through emesis or gastric lavage. The
solution is diluted in cola, water, or
juice to make the solution more
palatable. It is then administered
orally or by nasogastric tube.
Naloxone hydrochloride is an antidote
to opioids, and it also may be given to
the postoperative client to treat
respiratory depression. When given
postoperatively for respiratory
depression, it also may reverse the
effects of analgesics. Therefore, the
nurse must assess the client for a
sudden increase in level of
postoperative pain.
The client taking a single daily dose of
theophylline, a xanthine
bronchodilator, should take the
medication early in the morning. This
enables the client to have maximal
benefit from the medication during
daytime activities. Additionally, this
medication causes insomnia. The
client should take in at least 2 L of
fluid per day to decrease viscosity of
secretions. The client should check
with the physician before changing
brands of the medication because
levels of bioavailability may vary for
different preparations. The client also
should check with the physician before
taking over-the-counter cough, cold,
or other respiratory preparations
because they could have interactive
effects, increasing the side effects of
theophylline and causing
dysrhythmias.
Epoetin alfa is administered
parenterally either by the intravenous
or the subcutaneous route. It cannot
be given orally because it is a
glycoprotein and would be degraded
in the gastrointestinal tract.
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Acetylsalicylic acid (aspirin) may be
used to reduce the risk of recurrent
transient ischemic attacks (TIAs) or
stroke, or reduce the risk of MI in
clients with unstable angina or with a
history of a previous MI. The normal
dose for clients being treated with
acetylsalicylic acid (aspirin) to
decrease thrombosis and MI is 300 to
325 mg daily, and some physicians
may prescribe even a lower dose.
Clients taking aspirin to prevent TIAs
usually are prescribed 1.3 g daily in
two to four divided doses. Clients with
rheumatoid arthritis are treated with
3.2 to 6 g daily in divided doses.
Diclofenac is a nonsteroidal anti-
inflammatory drug (NSAID).
Interactions may occur with the use of
anticoagulants, and the nurse should
consult with the physician about a
potential medication interaction if an
anticoagulant is prescribed. Primidone
and phenytoin are anticonvulsant
medications. Acetaminophen is a
nonopioid analgesic. These
medications are not contraindicated
with diclofenac.
Clients taking antihypocalcemic
medications should be instructed to
avoid the use of mineral oil as a
laxative because it decreases vitamin
D absorption, and vitamin D is needed
to assist in the absorption of calcium.
Options 1, 3, and 4 are basic
measures to alleviate constipation.
The normal maintenance dose of
levothyroxine in an adult is 0.1 to 0.2
mg daily. Maintenance dose for infants
0 to 6 months of age is 0.025 to 0.05
mg daily; for children 1 to 5 years of
age, 0.075 to 0.1 mg daily; and for
children 6 to 12 months of age, 0.05
to 0.075 mg daily.
Abacavir is an antiretroviral agent that
inhibits activity of HIV-1 reverse
Sunday, October 16, 2011 68
 transcriptase and inhibits viral DNA
growth. Options 2, 3, and 4 are not
actions of this medication.
Abacavir is an antiretroviral agent that
may increase liver enzymes,
triglycerides, and the blood glucose
level. Baseline liver function studies
will be done at the initiation of therapy
and at periodic intervals during
therapy. The tests identified in the
other options are unnecessary.
Abacavir (Ziagen) is an antiretroviral
agent that is used to treat human
immunodeficiency virus infection in
combination with other medications.
Frequent side effects include nausea,
vomiting, diarrhea, decreased
appetite, and insomnia. Options 2, 3,
and 4 are not side effects of this
medication.
Abacavir (Ziagen) is an antiretroviral
agent that is used to treat human
immunodeficiency virus infection in
combination with other medications.
Adverse effects include
hypersensitivity, hypotension, lactic
acidosis, and severe hepatomegaly.
Options 1, 2, and 3 are not adverse
effects of this medication; rather, they
are side effects of the medication.
Abacavir is an antiretroviral agent that
is used to treat human
immunodeficiency virus (HIV) infection
in combination with other medications.
It will not cure HIV infection, nor will it
reduce the risk of transmitting the
infection to others. Eating small
frequent meals will help offset the
nausea. The client taking this
medication should check with the
physician before taking any over-the-
counter medications.
Zidovudine is a nucleoside reverse
transcriptase inhibitor used to treat
HIV infection in combination with other
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antiretroviral agents. It is not used to
treat the conditions noted in options 2,
3, and 4.
Zidovudine is a nucleoside reverse
transcriptase inhibitor used to treat
HIV infection in combination with other
antiretroviral agents. It interferes with
viral RNA-dependent DNA polymerase,
an enzyme necessary for viral HIV
replication. It slows HIV replication,
reducing the progression of HIV
infection. Options 1, 2, and 4 are not
actions of this medication.
Mydriatic eyedrops cause pupillary
dilation. The nurse would expect to
note dilated pupils if an effective
response occurred. Option 1 identifies
oval pupils, which sometimes are seen
with head injuries or increased
intracranial pressure. Option 2
identifies constricted pupils. Option 3
identifies a unilateral dilated pupil,
indicating cranial nerve III damage.
Zidovudine is a nucleoside reverse
transcriptase inhibitor used to treat
human immunodeficiency virus (HIV)
infection in combination with other
antiretroviral agents. A
contraindication to the medication is a
client history of hypersensitivity to this
medication. Cautions include bone
marrow suppression, renal and hepatic
dysfunction, and conditions that cause
decreased hepatic blood flow. The
items noted in options 2, 3, and 4 are
not contraindications or cautions
related to this medication.
Zidovudine is a nucleoside reverse
transcriptase inhibitor used to treat
human immunodeficiency virus (HIV)
infection in combination with other
antiretroviral agents. Because anemia
and granulocytopenia can occur with
this medication, a CBC will be done
periodically. The tests identified in
options 1, 3, and 4 are unnecessary.
Sunday, October 16, 2011 69
 Zidovudine is a nucleoside reverse
transcriptase inhibitor used to treat
human immunodeficiency virus (HIV)
infection in combination with other
antiretroviral agents. Common side
effects include nausea and a
headache. Options 1, 2, and 3 are not
side effects of this medication.
Zidovudine is a nucleoside reverse
transcriptase inhibitor used to treat
human immunodeficiency virus (HIV)
infection in combination with other
antiretroviral agents. Adverse effects
include anemia and granulocytopenia,
and neurotoxicity as evidenced by
ataxia, fatigue, lethargy, and
nystagmus. Seizures can also occur.
Options 1, 2, and 4 are not adverse
effects of this medication.
Zidovudine is a nucleoside reverse
transcriptase inhibitor used to treat
human immunodeficiency virus (HIV)
infection in combination with other
antiretroviral agents. Diarrhea is an
occasional side effect of the
medication and does not warrant
physician notification. Options 2, 3,
and 4 are correct client statements.
Capecitabine is an antimetabolite used
to treat metastatic breast cancer that
is resistant to other therapy. It also is
used to treat colon cancer. It is not
used to treat the conditions noted in
options 1, 2, and 4.
Capecitabine is an antimetabolite that
inhibits enzymes necessary for the
synthesis of essential cellular
components. It interferes with DNA
synthesis, RNA processing, and protein
synthesis. Options 2, 3, and 4 are not
actions of this medication.
Capecitabine is an antimetabolite used
to treat metastatic breast cancer that
is resistant to other therapy. A
contraindication to the use of this
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medication is severe renal
impairment. The items noted in
options 1, 2, and 4 are not
contraindications to this medication.
Capecitabine is an antimetabolite used
to treat metastatic breast cancer that
is resistant to other therapy. Bone
marrow depression can occur from the
use of this medication, and a CBC and
blood chemistries should be done
periodically. The tests identified in
options 2, 3, and 4 are unnecessary.
Capecitabine is an antimetabolite used
to treat metastatic breast cancer that
is resistant to other therapy. Bone
marrow depression can occur from the
use of this medication, and a CBC and
blood chemistries should be done
periodically. The tests identified in
options 2, 3, and 4 are unnecessary.
Capecitabine is an antimetabolite used
to treat metastatic breast cancer that
is resistant to other therapy. Adverse
effects include bone marrow
depression, cardiovascular toxicity,
and respiratory toxicity. Options 1, 3,
and 4 are not adverse effects of this
medication.
Capecitabine is an antimetabolite used
to treat metastatic breast cancer that
is resistant to other therapy. Adverse
effects include bone marrow
depression, cardiovascular toxicity,
and respiratory toxicity. The client
should monitor body temperature and
contact the physician if signs of
infection occur. Diarrhea is a frequent
side effect of this medication, but the
client should contact the physician if it
becomes severe. The client is
instructed to obtain physician approval
before receiving immunizations
because the medication lowers the
body's resistance to infection. Options
1, 2, and 3 are correct client
statements.
Sunday, October 16, 2011 70
 A component of therapy for the
treatment of DKA is the administration
of Regular insulin by the intravenous
(IV) route. Regular insulin is the only
type of insulin that can be given by
the IV route.
Propofol is an anesthetic agent that is
used to provide continuous sedation in
a client receiving mechanical
ventilation. It is diluted only with 5%
dextrose (D5W).
Acetylsalicylic acid is a nonsteroidal
agent that is prescribed for its anti-
inflammatory, antipyretic, and
anticoagulant properties. The client
may self-administer acetylsalicylic
acid to treat a headache, backache, or
muscle aches, but a 5-g daily dose
would not be used to treat these
discomforts. A dosage of 3.2 to 6 g
daily in divided doses may be
prescribed for the client with
rheumatoid arthritis.
Acetylsalicylic acid is a nonsteroidal
agent that is prescribed for its anti-
inflammatory, antipyretic, and
anticoagulant properties. All of the
options identify the action of this
medication; however, for the client
with angina, this medication is
prescribed to inhibit platelet
aggregation.
Acetylsalicylic acid is a nonsteroidal
agent that is prescribed for its anti-
inflammatory, antipyretic, and
anticoagulant properties.
Contraindications to the medication
include gastrointestinal bleeding or
ulceration, bleeding disorders, history
of hypersensitivity to aspirin or other
nonsteroidal anti-inflammatory
medications, impaired hepatic
function, and chickenpox or flu in
children or teenagers. The items noted
in options 1, 2, and 3 are not
contraindications to this medication.
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Acetylsalicylic acid is a nonsteroidal
agent that is prescribed for its anti-
inflammatory, antipyretic, and
anticoagulant properties. Serum blood
levels may be determined periodically
to assess for an effective antiarthritic
effect. The therapeutic serum level for
an antiarthritic effect is 20 to 30
mg/dL. Toxicity occurs if levels are
above 30 mg/dL.
Acetylsalicylic acid is a nonsteroidal
agent that is prescribed for its anti-
inflammatory, antipyretic, and
anticoagulant properties. Occasional
side effects include gastrointestinal
distress such as cramping, mild
nausea, heartburn, and abdominal
distention. The client also should self-
monitor for evidence of allergic
reaction such as pruritus, urticaria,
and difficulty breathing. Acetylsalicylic
acid may be used to treat muscle
aches. Burning on urination and
constipation are not side effects of this
medication.
Acetylsalicylic acid is a nonsteroidal
agent that is prescribed for its anti-
inflammatory, antipyretic, and
anticoagulant properties. High doses
can produce gastrointestinal bleeding
or gastric mucosal lesions. Low-grade
toxicity is characterized by ringing in
the ears, generalized pruritus (which
may be severe), headache, dizziness,
flushing, tachycardia,
hyperventilation, sweating, and thirst.
Marked toxicity is manifested by
hyperthermia, restlessness, abnormal
breathing pattern, convulsions,
respiratory failure, and coma. Options
2, 3, and 4 are not related to toxic
effects of this medication.
Acetylsalicylic acid is a nonsteroidal
agent and is prescribed for its anti-
inflammatory, antipyretic, and
anticoagulant properties. The
medication can cause gastrointestinal
Sunday, October 16, 2011 71
 (GI) side effects, and the client is
instructed that the medication can be
taken with milk or meals if GI distress
occurs. If the client develops ringing in
the ears or persistent GI pain, the
physician needs to be notified. The
enteric-coated form or sustained-
released form should not be crushed
or broken. It may take 1 to 3 weeks for
a therapeutic anti-inflammatory effect
to occur.
Atenolol is a β-adrenergic blocker that
is used as an antihypertensive,
antianginal, and antiarrhythmic. It is a
used to treat conditions such as
hypertension and angina pectoris. It is
not used to treat the conditions noted
in options 1, 2, and 4. Additionally, its
use is contraindicated in the client
with heart block greater than first
degree.
Atenolol is a β-adrenergic blocker that
is used as an antihypertensive,
antianginal, and antiarrhythmic. It
blocks β-adrenergic receptors in
cardiac tissue and produces the
therapeutic effects of slowing the
heart rate, decreasing cardiac output,
decreasing blood pressure, and
decreasing myocardial oxygen
demand.
Atenolol is a β-adrenergic blocker that
is used as an antihypertensive,
antianginal, and antiarrhythmic. It
blocks β-adrenergic receptors in
cardiac tissue and produces the
therapeutic effects of slowing the
heart rate, decreasing cardiac output,
decreasing blood pressure, and
decreasing myocardial oxygen
demand. Contraindications to the
medication include severe
bradycardia, cardiac failure,
cardiogenic shock, and heart block
greater than first-degree. Options 1, 3,
and 4 are not contraindications to this
medication (option 4 is a normal
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finding). The medication is used to
lower the blood pressure (option 1).
Although the temperature indicated in
option 3 is slightly above normal, it is
unrelated to the use of this
medication.
Atenolol is a β-adrenergic blocker that
is used as an antihypertensive,
antianginal, and antiarrhythmic. It
blocks β-adrenergic receptors in
cardiac tissue and produces the
therapeutic effects of slowing the
heart rate, decreasing cardiac output,
decreasing blood pressure, and
decreasing myocardial oxygen
demand. The nurse would check the
client's apical heart rate and blood
pressure immediately before
administering the medication. If the
heart rate is 60 beats/min or lower or
if the systolic blood pressure is less
than 90 mm Hg, the medication is
withheld and the physician is
contacted. Options 1, 2, and 3 are
unrelated to the administration of this
medication.
Atenolol is a β-adrenergic blocker that
is used as an antihypertensive,
antianginal, and antiarrhythmic. It
blocks β-adrenergic receptors in
cardiac tissue and produces the
therapeutic effects of slowing the
heart rate, decreasing cardiac output,
decreasing blood pressure, and
decreasing myocardial oxygen
demand. Frequent side effects include
hypotension manifested as dizziness,
nausea, diaphoresis, headache, cold
extremities, fatigue, and constipation
or diarrhea. Occasional side effects
include insomnia, flatulence, urinary
frequency, and impotence or
decreased libido. Options 2, 3, and 4
are not side effects of this medication.
Atenolol is a β-adrenergic blocker that
is used as an antihypertensive,
antianginal, and antiarrhythmic. It
Sunday, October 16, 2011 72
 blocks β-adrenergic receptors in
cardiac tissue and produces the
therapeutic effects of slowing the
heart rate, decreasing cardiac output,
decreasing blood pressure, and
decreasing myocardial oxygen
demand. Adverse effects include
profound bradycardia or hypotension.
Options 1, 2, and 4 are not adverse
effects of this medication. Nausea and
diaphoresis are side effects of the
medication.
Atenolol is a β-adrenergic blocker that
is used as an antihypertensive,
antianginal, and antiarrhythmic. It
blocks β-adrenergic receptors in
cardiac tissue and produces the
therapeutic effects of slowing the
heart rate, decreasing cardiac output,
decreasing blood pressure, and
decreasing myocardial oxygen
demand. Abrupt withdrawal may result
in sweating, palpitations, headache,
and tremulousness and may
precipitate congestive heart failure or
myocardial infarction in a client with
cardiac disease. Abrupt withdrawal
can also cause rebound hypertension.
Options 1, 3, and 4 are correct client
statements.
Atorvastatin is a 3-hydroxymethyl-3-
glutaryl–coenzyme A (HMG-CoA)
reductase inhibitor used to treat
hypercholesterolemia and
hypertriglyceridemia. It is not used to
specifically treat the conditions noted
in options 1, 2, and 4.
Atorvastatin is a 3-hydroxymethyl-3-
glutaryl–coenzyme A (HMG-CoA)
reductase inhibitor used to treat
hypercholesterolemia and
hypertriglyceridemia. It decreases LDL
cholesterol and plasma triglycerides
and increases HDL cholesterol.
Options 2, 3, and 4 are not actions of
this medication.
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Atorvastatin is a 3-hydroxymethyl-3-
glutaryl–coenzyme A (HMG-CoA)
reductase inhibitor used to treat
hypercholesterolemia and
hypertriglyceridemia.
Contraindications to the medication
include active liver disease,
unexplained elevated liver function
tests, pregnancy, and lactation. The
items noted in options 1, 2, and 3 are
not contraindications to this
medication.
Atorvastatin is a 3-hydroxymethyl-3-
glutaryl–coenzyme A (HMG-CoA)
reductase inhibitor used to treat
hypercholesterolemia and
hypertriglyceridemia. Because the
medication is metabolized in the liver,
baseline and periodic liver function
tests, as well as cholesterol and
triglyceride levels, should be done
periodically. The tests identified in
options 1, 3, and 4 are unnecessary.
Atorvastatin is a 3-hydroxymethyl-3-
glutaryl–coenzyme A (HMG-CoA)
reductase inhibitor used to treat
hypercholesterolemia and
hypertriglyceridemia. A frequent side
effect is headache. Occasional side
effects include myalgia, rash or
pruritus (signs of an allergic reaction),
flatulence, and dyspepsia. Options 1,
2, and 4 are not side effects of this
medication.
Atorvastatin is a 3-hydroxymethyl-3-
glutaryl–coenzyme A (HMG-CoA)
reductase inhibitor used to treat
hypercholesterolemia and
hypertriglyceridemia. Adverse effects
include photosensitivity and the
potential for developing cataracts.
Options 1, 3, and 4 are not adverse
effects of this medication.
Atorvastatin is a 3-hydroxymethyl-3-
glutaryl–coenzyme A (HMG-CoA)
reductase inhibitor used to treat
Sunday, October 16, 2011 73
 hypercholesterolemia and
hypertriglyceridemia. The client is
instructed to follow the recommended
diet as an important component of
therapy. Liver function tests and
cholesterol and triglyceride level
determinations will be performed
periodically while the client is taking
the medication. The client needs to be
instructed to consult with the
physician before taking any over-the-
counter medications.
Carbamazepine is classified as an
iminostilbene derivative and is used as
an anticonvulsant, antineuralgic,
antimanic, and antipsychotic. It is not
used to treat any of the conditions
noted in options 1, 3, and 4.
Carbamazepine is classified as an
iminostilbene derivative and is used as
an anticonvulsant, as well as an
antineuralgic, antimanic, and
antipsychotic. Options 2, 3, and 4 are
not actions of this medication.
Carbamazepine is classified as an
iminostilbene derivative and is used as
an anticonvulsant, antineuralgic,
antimanic, and antipsychotic. It is
used to treat seizure disorders,
trigeminal neuralgia, and diabetic
neuropathy. The medication can cause
blood dyscrasias as a toxic reaction
and is contraindicated if the client has
a history of bone marrow depression
or of hypersensitivity to tricyclic
antidepressants, and with concurrent
use of monoamine oxidase inhibitors.
Carbamazepine is classified as an
iminostilbene derivative and is used as
an anticonvulsant, antineuralgic,
antimanic, and antipsychotic. The
medication can cause blood dyscrasias
as a toxic reaction and the client
should have a CBC done before
therapy and periodically during
therapy. Additional laboratory tests
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that should be done include a serum
iron determination, urinalysis, and
blood urea nitrogen determination.
The tests identified in options 1, 2, and
4 are unnecessary.
Warfarin sodium is an anticoagulant
that prevents further extension of
formed existing clots and also
prevents new clot formation and
secondary thromboembolic
complications. The medication should
be taken exactly as prescribed and at
the same time daily. Because the
medication places the client at risk for
bleeding, the client is instructed to
avoid alcohol and salicylates
(acetylsalicylic acid, or aspirin). The
client needs to avoid all over-the-
counter medications and needs to
consult with the physician before
taking any other medications because
of the risk for medication interactions.
Digoxin (Lanoxin) is a cardiac
glycoside that is used to treat
dysrhythmias such as atrial fibrillation
in the client with heart failure. Digoxin
blood levels need to be checked while
the client is taking this medication to
monitor for toxicity. The therapeutic
blood serum level of digoxin ranges
from 0.8 to 2 ng/mL. Therefore, a
blood level of 2.1 ng/mL is just above
the high end of the therapeutic range.
Additionally, a low K+ level increases
the risk of digoxin toxicity. The normal
K+ level is 3.5 to 5.1 mEq/L.
Thrombolytic medications are used to
treat acute thrombolytic disorders.
These medications dissolve clots.
Because these medications alter the
hemostatic capability of the client, if
bleeding occurs it can be difficult to
control. Options 2, 3 and 4 are not
actions of this medication.
Streptokinase is a thrombolytic
medication that is used to manage
Sunday, October 16, 2011 74
 acute myocardial infarction. It lyses
thrombi that are obstructing the
coronary arteries, decreases infarct
size, improves ventricular function,
decreases the risk of congestive heart
failure, and limits the risk of death
associated with myocardial infarction.
Options 1, 3, and 4 are not actions of
this medication.
Diltiazem is a calcium channel blocker
that inhibits calcium movement across
cell membranes of cardiac and smooth
muscle. It dilates coronary arteries
and peripheral arteries and arterioles.
Diltiazem decreases the heart rate and
slows SA and AV conduction.
Propranolol is a β-adrenergic blocker
used as an antihypertensive,
antianginal, antidysrhythmic, and
antimigraine medication. It may
precipitate congestive heart failure
(CHF) or myocardial infarction in
persons with cardiac disease. Signs of
CHF include dyspnea (particularly on
exertion or lying down), night cough,
peripheral edema, and distended neck
veins. If signs of CHF occur, the
physician needs to be notified. Options
1, 3, and 4 identify side effects of this
medication and do not warrant
physician notification if they occur.
Hydrochlorothiazide is a diuretic and
antihypertensive medication used to
treat mild to moderate hypertension,
edema associated with heart failure,
and nephrotic syndrome. The
medication is a sulfonamide
derivative. A contraindication to the
use of this medication is a history of
hypersensitivity to sulfonamides.
The most common early
manifestations of digoxin toxicity are
gastrointestinal disturbances such as
anorexia, nausea, and vomiting and
neurological disturbances as fatigue,
headache, weakness, drowsiness,
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confusion, and nightmares. Visual
disturbances such as photophobia,
light flashes, halos around bright
objects, and yellow or green color
perception also may be noted.
In agranulocytosis, the WBC count
decreases as a result of bone marrow
suppression, and the deficiency
causes the affected person to become
susceptible to serious infection. Some
antipsychotic medications, such as
clozapine, can produce this adverse
effect, and a baseline WBC count and
periodic evaluation of the WBC count
are done during therapy with this
medication. A BUN and creatinine
above normal may indicate renal
disease. Although a basophil count is a
component of the WBC differential
count, it does not provide adequate
data to determine the presence of
agranulocytosis.
Ringing in the ears and vertigo are two
symptoms that may indicate
dysfunction of the eighth cranial
nerve. Ototoxicity is a toxic effect of
therapy with the aminoglycosides and
could result in permanent hearing
loss. The nurse should withhold the
dose and notify the physician. Options
1, 2, and 4 are inappropriate nursing
actions.
Hydralazine is an antihypertensive
medication used in the management
of moderate to severe hypertension.
The blood pressure and pulse should
be monitored frequently after
administration, so a blood pressure
cuff and a stethoscope are the items
to have in place. Options 1, 2, and 3
are not necessary.
The client who receives an opioid
analgesic should immediately have
the siderails raised on the bed, to
prevent injury once the medication
has taken effect. Dimming the light in
Sunday, October 16, 2011 75
 the room is the next most helpful
action. The name bracelet should have
been checked before administering
the medication. It is unnecessary to do
ROM at the site of injection.
The nurse should always inspect the
vial of insulin before use for changes
that may signify loss of potency. NPH
insulin normally is uniformly cloudy.
Clumping, frosting, and precipitates
are signs of insulin damage. In this
situation, because potency is
questionable, it is safer to discard the
vial and draw up the dose from a new
vial.
Valproic acid is an anticonvulsant that
causes central nervous system (CNS)
depression. For this reason, the side
effects include sedation, dizziness,
ataxia, and confusion. When the client
is taking this medication as a single
daily dose, administering it at bedtime
negates the risk of injury from
sedation and enhances client safety.
The medication also should be
administered at the same time each
day.
Clients with Parkinson's disease are at
risk for postural (orthostatic)
hypotension from the disease. This
problem is exacerbated with the
introduction of levodopa, which also
can cause postural hypotension and
increase the client's risk for falls.
Although knowledge of the client's use
of assistive devices and history of falls
is helpful, neither of these options is
the most important element of the
assessment based on the wording of
this question. Clients with Parkinson's
disease generally have resting tremor,
not intention tremor.
Sotalol is a β-adrenergic blocking
agent. Side effects include
bradycardia, palpitations, difficulty
breathing, irregular heart beat, signs
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of congestive heart failure, and cold
hands and feet. Gastrointestinal
disturbances, anxiety and
nervousness, and unusual tiredness
and weakness also can occur.
Torsemide is a loop diuretic. The
medication can produce acute and
profound water loss, volume and
electrolyte depletion, dehydration,
decreased blood volume, and
circulatory collapse. Option 4 is the
only option that indicates an
electrolyte depletion, because the
normal potassium level is 3.5 to 5.1
mEq/L. The normal sodium level is 135
to 145 mEq/L. The normal chloride
level is 98 to 107 mEq/L. The normal
blood BUN is 5 to 20 mg/dL.
Adverse reactions to or toxic effects of
tobramycin sulfate include
nephrotoxicity as evidenced by an
increased BUN and serum creatinine;
irreversible ototoxicity as evidenced
by tinnitus, dizziness, ringing or
roaring in the ears, and reduced
hearing; and neurotoxicity as
evidenced by headaches, dizziness,
lethargy, tremors, and visual
disturbances. A normal white blood
cell count is 4500 to 11,000
cells/mm3. The normal sedimentation
rate is 0 to 30 mm/hr. The normal total
bilirubin level is less than 1.5 mg/dL.
The normal BUN concentration is 8 to
25 mg/dL.
Clients who are taking antabuse must
be taught that substances containing
alcohol can trigger an adverse
reaction. Sources of hidden alcohol
include foods (soups, sauces,
vinegars), medicine (cold medicine),
mouthwashes, and skin preparations
(alcohol rubs, aftershave lotions).
Nitroglycerin may be self-administered
sublingually 5 to 10 minutes before an
activity that triggers chest pain.
Sunday, October 16, 2011 76
 Tablets should be discarded 6 to 9
months after opening the bottle, and a
new bottle of pills should be obtained
from the pharmacy. Nitroglycerin is
very unstable and is affected by heat
and cold, so it should not be kept close
to the body (warmth) in a shirt pocket;
rather, it should be kept in a jacket
pocket or purse. Headache often
occurs with early use and diminishes
in time. Acetaminophen (Tylenol),
rather than aspirin (acetylsalicylic
acid), may be used to treat headache.
Glyburide is a second-generation
sulfonylurea used to treat diabetes
mellitus. The client is instructed to
take a single daily dose 15 to 30
minutes before breakfast. Cholestatic
jaundice is a potential adverse
reaction, and if the client exhibits
signs of jaundice (skin color changes
or pale-colored stools), the physician
needs to be notified. The medication is
not used to prevent foot infections.
Altered taste sensation is a frequent
side effect and does not warrant
physician notification.
Fosphenytoin sodium (Cerebyx) is
used for short-term parenteral
(intravenous [IV]) infusion. A child who
is not tolerating medications by mouth
and has a seizure disorder would need
an anticonvulsant administered by the
parenteral route. Phenobarbital
(Luminal) is an antiseizure medication
that is given by mouth or parenterally,
but because the child has been on
phenytoin (Dilantin), the medication of
choice in this case would be
fosphenytoin. Valproic acid
(Depakene) and clonazepam
(Klonopin) usually are given by mouth.
An urticarial reaction is characterized
by a rash accompanied by pruritus.
This type of transfusion reaction is
prevented by pretreating the client
with an antihistamine such as
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diphenhydramine. Acetaminophen and
acetylsalicylic acid are analgesics, and
ibuprofen is a nonsteroidal anti-
inflammatory drug.
Raloxifene (Evista) is an estrogen
receptor modulator. It was developed
to limit the side effects of estrogen
while producing beneficial effects. The
purpose of this medication is to
increase bone mineral density, which
makes option 2 correct. Option 1 is
incorrect because leg tenderness or
cramps can indicate deep vein
thrombosis, which is an adverse
effect. The modulating effects of this
medication can lead to hot flashes and
vaginal bleeding.
Dantrolene (Dantrium) acts directly on
skeletal muscle to relieve muscle
spasticity. The primary action is the
suppression of calcium release from
the sarcoplasmic reticulum. This in
turn decreases the ability of the
skeletal muscle to contract.
Baclofen is the only skeletal muscle
relaxant that can be administered
intrathecally within the spinal column.
Therefore, options 1, 2, and 3 are
incorrect.
The normal adult dosage for
carisoprodol (Soma) is 350 mg orally
three to four times daily.
Pyridoxine reverses the therapeutic
effects of levodopa. Dietary
restrictions are not necessary, but
ingredients of multivitamins should be
considered. Many multivitamins
contain pyridoxine and should be
avoided. Careful reading of over-the-
counter vitamin labeling is necessary
to avoid increasing pyridoxine in the
diet. The statements in options 2, 3,
and 4 are incorrect.
A complication of head injury is
diabetes insipidus, which can occur
Sunday, October 16, 2011 77
 with insult to the hypothalamus, the
antidiuretic hormone storage vesicles,
or the posterior pituitary gland. Urine
output that exceeds 9 L per day
generally requires treatment with
desmopressin. Dexamethasone, a
glucocorticoid, is administered to treat
cerebral edema. This medication may
already be ordered for the head-
injured client. Ethacrynic acid and
mannitol are diuretics, which would be
contraindicated.
Naoloxone hydrochloride (Narcan)
should be titrated every 2 to 5
minutes according to client response.
Therefore, options 1, 2, and 4 are
incorrect.
Leukocytosis and a slight temperature
elevation can indicate an infection in a
client on a biological response
modifier. These findings warrant
physician notification and possible
discontinuation of the medication.
Irritation and erythema are common
and can be decreased by rotating the
injection sites. Arthritic symptoms
often do not lessen early in the
treatment, and arthritic medications
often are given other medications,
such as a tumor necrosis factor
inhibitor.
Dolobid may be given with water, milk,
or meals. The tablets should not be
crushed or broken open. This situation
does not warrant physician notification
at this time.
Baclofen is dispensed in tablets of 10
and 20 mg for oral use. Dosages are
low initially and then are increased
gradually. Maintenance doses range
from 15 to 20 mg administered three
to four times a day.
Influenza vaccinations are
recommended yearly and developed
according to predicted strain for
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persons at high risk. Influenza
immunization is recommended for
high-risk clients. Anyone in close
contact with persons with a chronic
respiratory or other chronic disorder
should receive the vaccine. Adults
with chronic metabolic disease such as
diabetes mellitus are in the high-risk
population. Residents of chronic care
facilities are at risk for influenza.
Health care workers are in the high-
risk population. The influenza vaccine
does not treat an active infection with
the virus. Healthy children are not in
the high-risk population.
Ramipril (Altace) is an angiotensin-
converting enzyme (ACE) inhibitor,
and a serious side effect is profound
hypotension. The client's blood
pressure should be checked before
administration of this medication. The
medication does not cause weight
gain or loss, bradycardia, or depletion
of potassium.
Urinary retention is a side effect of
benztropine mesylate. The nurse
needs to observe for dysuria,
distended abdomen, infrequent
voiding of small amounts, and
overflow incontinence. Options 1, 2,
and 4 are unrelated to the side effects
of this medication.
Enoxaparin is an anticoagulant. A
common side effect of anticoagulant
therapy is bleeding. Accordingly, the
nurse questions the client about signs
and symptoms that could indicate
bleeding, such as bleeding gums,
bruising, hematuria, or dark tarry
stools.
The client who has been prescribed
sulfasalazine should be checked for
history of allergy to either
sulfonamides or salicylates because
Sunday, October 16, 2011 78
 the chemical composition of
sulfasalazine and that of these
medications are similar. The other
options are incorrect.
Glucocorticoids have three primary
uses: replacement therapy for adrenal
insufficiency, immunosuppressive
therapy, and anti-inflammatory
therapy. Exogenous glucocorticoids
cause the same effects on cellular
activity as those of the naturally
produced glucocorticoids; however,
exogenous glucocorticoids also may
have undesired effects. The
glucocorticoids stimulate appetite and
increase caloric intake. They also
increase the availability of glucose for
energy. These combined effects cause
the blood glucose levels to rise,
making the client prone to
hyperglycemia. Options 1, 2, and 4 are
not expected effects of the use of
glucocorticoids.
Soft contact lenses may be
permanently damaged by the orange
discoloration in body fluids caused by
rifampin. Any sign of possible jaundice
(yellow-colored skin) should always be
reported. If rifampin is not tolerated on
an empty stomach, it may be taken
with food. The client may be on the
medication for 12 months even if
cultures give negative results.
Tambocor is an antidysrhythmic
medication that slows conduction and
decreases excitability, conduction
velocity, and automaticity. The nurse
needs to monitor for the development
of a new or a worsening arrhythmia.
Options 1, 3, and 4 are components of
standard care.
Intravenous nitroprusside is a potent
vasodilator that reduces preload and
afterload. It is the medication of
choice for the client with pulmonary
edema. Digoxin is a cardiac glycoside
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that increases cardiac contractility.
Morphine sulfate is an opioid
analgesic. Furosemide is a loop
diuretic and can reduce preload by
enhancing the renal excretion of
sodium and water, which reduces
circulating blood volume.
Headache, hypertension, tachycardia,
nausea, and vomiting are precursors
to hypertensive crisis brought about
by the ingestion of foods rich in
tyramine and tryptophan while the
client is taking MAOIs. These
medications act by decreasing the
amount of MAO in the liver, which is
necessary for the breakdown and
utilization of tyramine and tryptophan.
Hypertensive crisis may lead to
circulatory collapse, intracranial
hemorrhage, and death.
Bumetanide is a loop diuretic that is
not potassium sparing. The value
given for potassium is below the
therapeutic range of 3.5 to 5.1 mEq/L
for this electrolyte. The nurse should
notify the physician before giving the
dose so that potassium
supplementation may be ordered.
Options 1, 3, and 4 identify normal
values.
Hydralazine is an antihypertensive
medication used in the management
of moderate-to-severe hypertension. It
is a vasodilator medication that
decreases afterload. The blood
pressure needs to be monitored.
Options 2, 3, and 4 are unrelated to
the use of this medication.
Ketorolac is a nonopioid analgesic and
nonsteroidal anti-inflammatory agent
(NSAID). It acts by inhibiting
prostaglandin synthesis and produces
analgesia that is peripherally
mediated. The nurse evaluates the
effectiveness of this medication by
using the pain rating scale with the
Sunday, October 16, 2011 79
 client. Options 1, 2, and 3 are
unrelated to the use of this
medication.
The client is experiencing signs and
symptoms of what is called "red neck
syndrome." This is a response due to
histamine release that occurs with
rapid or bolus injection of this
medication. The client may experience
chills, fever, flushing of the face or
trunk, tachycardia, syncope, tingling,
and an unpleasant taste in the mouth.
The corrective action is to administer
the medication more slowly. An
antihistamine such as
diphenhydramine (Benadryl) may be
administered as well.
Atropine sulfate is an anticholinergic
medication that causes tachycardia,
drowsiness, blurred vision, dry mouth,
constipation, and urinary retention.
The nurse monitors the client for any
of these effects in the immediate
postoperative period.
Tobramycin is an antibiotic
(aminoglycoside) that causes
nephrotoxicity and ototoxicity. The
medication is working if the WBC
count drops back into the normal
range and kidney function remains
normal. Option 2 indicates an
abnormal WBC count, and options 3
and 4 are unrelated to the use of this
medication.
Lithium is used to treat manic
disorders, not depression. Side effects
of lithium are nausea, tremors,
polyuria, and polydypsia. Serum
lithium concentration is assessed
approximately every 2 to 4 days
during initial therapy, and at longer
intervals thereafter. Toxic levels of
lithium may induce electrocardiogram
changes; however, performing weekly
ECGs is unnecessary if therapeutic
levels are maintained.
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Hyperpyrexia with body temperatures
up to 107° F may be present in NMS.
Signs and symptoms develop suddenly
and may include respiratory distress
and muscle rigidity. As the condition
progresses, evidence of tachycardia,
hypertension, increasing respiratory
distress, confusion, and delirium may
appear. The frequency and severity of
symptoms are compounded when two
or more antipsychotics are taken
concomitantly.
Phenelzine sulfate is in the
monoamine oxidase inhibitor (MAOI)
class of antidepressant medications. A
person taking an MAOI must avoid
aged cheeses, alcoholic beverages,
avocados, bananas, and caffeine
drinks. Other food items to avoid
include chocolate, meat tenderizers,
pickled herring, raisins, sour cream,
yogurt, and soy sauce. Medications
that should be avoided include
amphetamines, antiasthmatics, and
certain antidepressants. Clients taking
MAOI medications also should avoid
antihistamines, antihypertensive
medications, levodopa, and
meperidine (Demerol).
Aspirin is irritating to the
gastrointestinal (GI) tract of the client
with a history of gastritis. The client
should be advised to take analgesics
that do not contain aspirin, such as
acetaminophen. The other
medications listed have aspirin in
them. Another category of
medications that is irritating to the GI
tract is that of the nonsteroidal anti-
inflammatory drugs (NSAIDs).
The client taking an angiotensin-
converting enzyme (ACE) inhibitor is
instructed to take the medication
exactly as prescribed, to monitor
blood pressure weekly, and to
continue with other lifestyle changes
to control hypertension. The client
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 should change positions slowly to
avoid orthostatic hypotension, should
report fever, mouth sores, or sore
throat to the physician (neutropenia),
and needs to avoid salt substitutes
and high-potassium foods. Salt
substitutes contain potassium, as do
high-potassium foods, placing the
client at risk for hyperkalemia.
Lovastatin is a reductase inhibitor. It
results in an increase in high-density
lipoprotein (HDL) cholesterol and a
decrease in the triglycerides and low-
density lipoprotein (LDL) cholesterol.
This medication is converted by the
liver to active metabolites and
therefore is not used in clients with
active hepatic disease or elevated
transaminase levels. Because it is
metabolized by the liver, clients are
recommended to have periodic liver
function studies. Periodic cholesterol
levels also are needed to monitor the
effectiveness of therapy.
Lovastatin is a reductase inhibitor. It
results in an increase in high-density
lipoprotein (HDL) cholesterol and a
decrease in the triglycerides and low-
density lipoprotein (LDL) cholesterol.
This medication is converted by the
liver to active metabolites and
therefore is not used in clients with
active hepatic disease or elevated
transaminase levels. Because it is
metabolized by the liver, clients are
recommended to have periodic liver
function studies. Periodic cholesterol
levels also are needed to monitor the
effectiveness of therapy.
Persantine combined with warfarin
sodium (Coumadin) is prescribed to
protect the client's artificial heart
valves. Persantine does not prevent
heart attacks, strokes, or
hypertension.
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Aspirin can interact with the
anticoagulant medication to increase
clotting time beyond therapeutic
ranges. Avoiding aspirin is a priority.
Not all activities need to be avoided.
Walking and climbing stairs are
acceptable activities. The client does
not need to avoid brushing the teeth;
however, the client should be
instructed to use a soft toothbrush.
The client should be taught that
ketoconazole is an antifungal
medication. It should be taken with
food or milk. Antacids should be
avoided for 2 hours after it is taken
because gastric acid is needed to
activate the medication. The client
should avoid concurrent use of
alcohol, because the medication is
hepatotoxic. The client should also
avoid exposure to sunlight, because
the medication increases
photosensitivity.
BuSpar may be administered without
regard to meals, and the tablets may
be crushed. This medication is not
available in liquid form. It is premature
to advise the client to call the
physician for a change in medication
without first trying alternative
interventions. Mixing the tablet
uncrushed in apple sauce will not
ensure ease in swallowing.
Baclofen is a skeletal muscle relaxant.
The client should be cautioned against
the use of alcohol and other central
nervous system (CNS) depressants
because baclofen potentiates the
depressant activity of these agents.
Constipation rather than diarrhea is an
adverse effect. Restriction of fluids is
not necessary, but the client should be
warned that urinary retention can
occur. Fatigue is related to a CNS
effect that is most intense during the
early phase of therapy and diminishes
with continued medication use. The
Sunday, October 16, 2011 81
 client does not need to notify the
physician about fatigue.

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