A
The emergency department (ED) nurse is caring for a client who is experiencing pulmonary edema. The client is treated with furosemide. What will the nurse monitor most closely?
A) Sodium levels
B) Bone narrow function
C) Calcium levels
D) Potassium levels
D. Furosemide is associated with loss of potassium, so that the client will need to be monitored carefully for low potassium levels, which could cause cardiac arrhythmias and further aggravate pulmonary edema. The nurse would not monitor sodium or calcium levels or bone marrow function because of the effects of the drug during the acute treatment of pulmonary edema.
A 64-year-old client in hypertensive crisis is to receive furosemide 40 mg IV. Furosemide comes in 100 mg/10 mL containers. What is the correct action by the nurse when giving the prescribed medication?
A) Give 4 mL over 1 to 2 minutes IV.
B) Give 4 mL over 10 minutes.
C) Flush the line with normal saline, give 4 mL at 1 mL/min, flush again when finished.
D) Fix 10 mL in an IV piggyback and deliver it over 30 minutes.
A. Administer furosemide 40 mg over 1 to 2 minutes IV. The other options are not correct.
A client with hepatitis C has been experiencing symptoms of gastroesophageal reflux. What H2 antagonist would be most appropriate for this client’s needs?
A) Cimetidine
B) Nizatidine
C) Ranitidine
D) Famotidine
B. Nizatidine differs from the other three drugs in that it is eliminated by the kidneys, with no first-pass metabolism in the liver. It is the drug of choice for clients with liver disease or dysfunction.
A client is undergoing chemotherapy and is experiencing severe nausea. The nurse has administered ondansetron intravenously, with good results. What drug effect has this client experienced?
A) Stimulation of antinausea receptors in the medulla
B) Increased gastric emptying and small bowel peristalsis
C) Blockage of receptors in the CTZ
D) Recalibration of the vestibular apparatus
C. The 5-HT3 receptor blockers block those receptors associated with nausea and vomiting in the CTZ and locally.
The client is a 34 years old and has recently started taking theophylline. The nurse knows that medication teaching has been successful when the client agrees to what activity?
A) Avoiding beverages that contain caffeine
B) Eating foods high in potassium
C) Limiting fluid intake to 1,000 mL a day
D) Taking the medication on an empty stomach
A. Both theophylline and caffeine are xanthenes. Theophylline increases cardiac output and heart rate. Caffeine also stimulates heart rate. This can have an additive effect. Eating foods high in potassium, limiting fluid intake, or taking the medicine on an empty stomach are not indications that the client has understood the nurse’s teaching.
A client has been prescribed furosemide. The nurse should recommend what food in order to prevent adverse effects?
A) Potatoes
B) Brown rice
C) Chicken breast
D) Cheese
A. Potatoes are very high in potassium. Rice, chicken, and cheese are comparatively low.
A client has just been prescribed furosemide. After reviewing the client’s medication history, what drug would cause the nurse concern when taken with furosemide?
A) Acetaminophen
B) Ferrous sulfate
C) Naproxen
D) Ampicillin
C. Naproxen sodium is a nonsteroidal antiinflammatory drug. There may also be a decreased loss of sodium and decreased antihypertensive effects if these drugs are combined with indomethacin, ibuprofen, salicylates, or other nonsteroidal antiinflammatory drugs. The client receiving this combination should be monitored closely and appropriate dosage adjustments should be made. There is no contraindication to the concurrent use of acetaminophen, ferrous sulfate, or ampicillin.
The nurse at a long-term care facility administers proton pump inhibitors to several residents. Which client should the nurse monitor for increased effects of other concurrent medications?
A) A client with atrial fibrillation who takes warfarin
B) A client with type 2 diabetes who takes metformin
C) A client with hypertension who takes furosemide and metoprolol
D) A client with heart failure who takes diltiazem
A. There is a risk of increased serum levels and increased toxicity of benzodiazepines, phenytoin, and warfarin if these are combined with proton pump inhibitors. This is not the case with antidiabetic medications, diuretics, and calcium channel blockers beta blockers.
The nurse has administered a prescribed dose of ondansetron IV to a client. What assessment finding best indicates therapeutic effect?
A) Client’s vital signs are within reference ranges.
B) Client participates in activities.
C) Client requests food.
D) Client denies nausea
D. Nausea is a subjective symptom. The client telling the nurse about a decrease in nausea would be the best indication the drug is working, even though all the listed assessment findings are beneficial.
A client is in the clinic to have blood drawn to assess theophylline levels. The client appears to being responding well to the medication and is not experiencing any adverse effects. What serum level will the nurse expect the client to have?
A) Between 0.5 and 5 mcg/mL
B) Between 10 and 20 mcg/mL
C) Between 25 and 35 mcg/mL
D) Between 40 and 50 mcg/mL
B. Therapeutic theophylline levels should be between 10 and 20 mcg/mL. A level between 0.5 and 5 mcg/mL would be low and would not produce a therapeutic effect. Levels between 25 and 50 mcg/mL would be too high and could cause serious adverse effects.
A 10-year-old child has edema caused by a heart defect. The client is taking furosemide. The dosage is 3 mg/kg/d. The child weighs 76 lbs. How many milligrams does the child receive each day?
A) 20 mg
B) 50 mg
C) 105 mg
D) 210 mg
C. The nurse will administer 105 mg/dose of the drug (76 lbs divided by 2.2 = 34.5 kg, 35 kg times 3 mg = 105 mg).
A client has just begun therapy with furosemide, and the nurse is instructing the client about the need to include foods high in potassium in the diet. What foods should the nurse recommend? Select all that apply.
A) Prunes
B) Whole milk
C) Watermelon
D) Lima beans
E) Rice
A, C, D. Foods high in potassium include avocados, bananas, broccoli, cantaloupe, dried fruits, grapefruit, lima beans, nuts, navy beans, oranges, peaches, potatoes, prunes, rhubarb, Sanka coffee, sunflower seeds, spinach, tomatoes, and watermelon. Milk and rice are not potassium-rich foods.
A client who is taking metoclopramide has present to the clinic for a follow-up visit. The nurse will be most concerned about a drug–drug interaction when learning the client is taking what other medication?
A) Albuterol
B) Digoxin
C) Furosemide
D) Acetylsalicylic acid
B. Metoclopramide has been associated with decreased absorption of digoxin from the gastrointestinal (GI) tract. The nurse should monitor clients taking this combination carefully. The other options do not pose a concern about drug–drug interactions.
The nurse is caring for a client who is receiving ondansetron for nausea associated with chemotherapy. The nurse would teach the client that what adverse effect may occur with this medication?
A) Weakness and rash
B) Urinary incontinence and photosensitivity
C) Headache and dizziness
D) Fever and diarrhea
C. Clients receiving ondansetron most commonly experience headache, dizziness, and myalgia. Rash, fever, diarrhea, and incontinence are unlikely.
A 70-year-old client is being treated for chronic obstructive pulmonary disease (COPD) with theophylline. What will be a priority assessment by the nurse?
A) Intake of fatty foods
B) Weight
C) Activity level
D) Use of nicotine
D. Nutritional status, weight, and activity level would be important for a nurse to know about a COPD client. However, it would be most important for the nurse to know whether the client smokes or uses tobacco in other ways or smoking cessation methods that involve nicotine. Nicotine increases the metabolism of theophyllines; the dosage may need to be increased to produce a therapeutic effect.
The client is at an increased risk for hearing loss if taking furosemide with what medication?
A) Codeine
B) Ciprofloxacin
C) Digoxin
D) Gentamicin
D. The risk of ototoxicity increases if loop diuretics are combined with aminoglycoside antibiotics (gentamicin) or cisplatin. No known increased risk of ototoxicity exists when furosemide is taken with codeine, ciprofloxacin, or digoxin.
A resident of a long-term care facility has been prescribed furosemide 40 mg PO daily. When beginning this drug therapy, what are appropriate nursing actions? Select all that apply.
A) Ensure the resident has easy access to a toilet or commode.
B) Remove foods that are high in potassium from the resident’s meal trays.
C) Limit the resident’s fluid intake to 1 L/d, unless contraindicated.
D) Have the kitchen provide a low-sodium diet until the resident’s response is known.
E) Monitor the resident’s blood pressure frequently.
A, E. The resident is likely to need to void frequently; the nurse should facilitate this so that incontinent episodes or falls are prevented. As well, the resident risks hypotension, so blood pressure monitoring is necessary. Increasing potassium intake is beneficial, not harmful, and there is no direct need for a low-sodium diet. Fluid restriction is potentially dangerous and should not be used as a strategy for managing increased voiding.
For what action would the nurse administer magnesium citrate?
A) Block absorption of fats.
B) Directly stimulate the nerve plexus in the intestinal wall.
C) Form a slippery coat on the contents of intestine.
D) Increase motility and the bulk of fecal matter.
D. Magnesium citrate is a rapid-acting, aggressive laxative that causes fecal matter to increase in bulk. It increases the motility of the gastrointestinal (GI) tract by increasing the fluid in the intestinal contents, which enlarges bulk, stimulates local stretch receptors, and activates local activity. It does not block absorption of fats, stimulate the nerve plexus, or form a slippery coat.
The nurse is reviewing the medication regimen of a newly-admitted client. The nurse observes that the client takes sustained-release theophylline. When planning the client’s care, the nurse should address what characteristic of this client’s asthma?
A) The client likely experiences several asthma exacerbations each day.
B) The client likely has asthma symptoms once or twice a day.
C) The client likely experiences asthma symptoms a few times each week, but not every day.
D) The client was likely diagnosed with asthma several months ago.
B. Sustained-release theophylline is used for mild persistent asthma, in which the client has symptoms at least once per week but not every day. There is no way of knowing when the client was first diagnosed.
The nurse is caring for a client who states that he recently been taking dextromethorphan for cough suppression. The nurse should contact the provider promptly if the client also takes which other medication?
A) Verapamil
B) Phenelzine
C) Metoprolol
D) Hydrochlorothiazide
B. Dextromethorphan should not be used in conjunction with MAO inhibitors because hypotension, fever, nausea, myoclonic jerks, and coma could occur. No known drug–drug interaction exists between dextromethorphan and calcium-channel blockers, beta-blockers, and thiazide diuretics.
A client with hypertension has been prescribed spironolactone. The client’s previous diuretic, furosemide, has been discontinued. The nurse should explain what benefits of this change?
A) Potassium losses are lower with spironolactone than with furosemide.
B) Unlike furosemide, spironolactone can be taken on an outpatient basis.
C) The diuretic effect is greater with spironolactone than with furosemide.
D) Sodium losses are greater with spironolactone.
A. Spironolactone is a potassium-sparing diuretic; therefore, it promotes retention of potassium. Furosemide promotes greater water, sodium, and potassium losses than spironolactone. Both medications can be safely taken on an outpatient basis with adequate follow-up.
The nurse is providing care for a 51-year-old client who has been taking cimetidine for several months. When monitoring for adverse effects, the nurse should perform what assessment?
A) Assess the client’s lying, sitting, and standing blood pressures.
B) Inspect the client’s torso for rash.
C) Inspect the client for gynecomastia.
D) Assess the client for insomnia.
C. Cimetidine was the first drug in this class to be developed. It has been associated with antiandrogenic effects, including gynecomastia and galactorrhea. Rashes, insomnia, and orthostatic hypotension are not typical adverse effects.
What drug does the nurse administer that inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall?
A) Bismuth subsalicylate
B) Loperamide
C) Paregoric
D) Magnesium citrate
B. Actions of loperamide include that it inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall, slowing motility and movement of water and electrolytes. Bismuth subsalicylate inhibits local reflexes. Paregoric works through action on CNS centers that cause GI spasm and slowing. Magnesium citrate is a laxative.
A nurse cares for several clients who have asthma. Which client should the nurse monitor most closely because of a heightened risk for asthma-related death?
A) An Asian-American client with a history of cigarette smoking.
B) A 17-year-old client who experiences exercise-induced asthma
C) A 76-year-old client who takes theophylline
D) An African-American client taking salmeterol
D. Salmeterol has a black box warning addressing a small but significant increase in the risk of life-threatening asthma episodes in patients using salmeterol. This is based on a study which showed that African American clients had a greater risk of asthma-related deaths than did other groups. For this reason, an African American client taking salmeterol likely has a higher risk than the other listed clients.
A client presents at the clinic with a dry nonproductive cough. The client is diagnosed with bronchitis, and it has been determined that assistance is needed in thinning the sputum so the cough can become productive. What does the nurse expect the provider will prescribe?
A) Benzonatate
B) Guaifenesin
C) Dextromethorphan
D) Hydrocodone
B. Because this client needs to cough up respiratory secretions, he would likely be prescribed guaifenesin. This drug is an expectorant that liquefies lower respiratory secretions by reducing their viscosity and so making it easier for a client to cough them up. Benzonatate, dextromethorphan, and hydrocodone are antitussives and are given to suppress the cough reflex.