Nokea
The client with CRF receives a sodium polystyrene sulfonate enema. Which finding indicates that the medication is achieving the desired therapeutic effect?
- A. Returns of dark-colored stool
- B. Able to retain solution for 1 hour
- C. Verbalizes relief of constipation
- D. Serum potassium level 4.0 mEq/L
Correct Answer: D
Rationale: A: Although sodium polystyrene sulfonate may be administered as an enema and stool may return, the purpose of the medication is to lower serum potassium levels and not to empty the bowel. B: The client should be encouraged to retain the enema solution for as long as possible so that sodium ions can be exchanged for potassium ions in the intestine, but its retention for this length of time does not indicate its effectiveness in lowering the serum potassium level. C: The client may be constipated prior to receiving the enema, but this is not the purpose of a sodium polystyrene sulfonate enema. D: Sodium polystyrene sulfonate exchanges sodium ions for potassium ions in the intestine and is administered when the client has hyperkalemia. A normal serum potassium level of 4.0 mEq/L indicates that the medication is achieving its desired therapeutic effect.
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Which of the following medications is a serotonin antagonist that might be used to relieve nausea and vomiting?
- A. metoclopramide (Reglan)
- B. onedansetron (Zofran)
- C. hydroxyzine (Vistaril)
- D. prochlorperazine (Compazine)
Correct Answer: B
Rationale: Zofran is a serotonin antagonist that can be used to relieve nausea and vomiting. The other medications can be used for nausea and vomiting, but they have different mechanisms of action.
What is the therapeutic range for carbamazepine (Tegretol)?
- A. 7-12 mcg/mL
- B. 4-10 mcg/mL
- C. 10-14 mcg/mL
- D. 1-5 mcg/mL
Correct Answer: B
Rationale: The therapeutic range for carbamazepine (Tegretol) is 4-10 mcg/mL.
The nurse is preparing to administer Azithromycin, and the pharmacy has provided the drug in a powder form that requires reconstitution connected to a saline piggyback. Which of the following is least concerning when preparing the medication?
- A. The expiration date on the powder vial is the same as the current date.
- B. The brand/trade name is not listed on the vial.
- C. The storage instructions on the vial says 'store at room temperature', and the vial is very cold to the touch indicating it has been taken out of a freezer.
- D. The bag of saline is leaking.
Correct Answer: B
Rationale: The brand or trade name is not required to be on the medication label if the generic name is present. The nurse should check that the medication is not expired and that it has been stored according to the storage instructions. If the saline bag is leaking, it may indicate that the container is damaged and the fluid may not be sterile.
The nurse is assessing the client with herpes zoster. The nurse determines that acyclovir is an effective treatment when which finding is noted?
- A. Drying and crusting of genital lesions
- B. Crusting and healing of vesicular skin lesions
- C. Urticaria decreased and pruritus relieved
- D. Decrease in intensity of chicken pox lesions
Correct Answer: B
Rationale: A: Drying and crusting of genital lesions would indicate acyclovir's effectiveness for treating genital herpes, not herpes zoster. B: Herpes zoster produces painful vesicular skin eruptions along the course of a nerve. Crusting and healing of the vesicular skin lesions indicate that acyclovir (Zovirax) is effective. C: Urticaria (swollen, raised areas) and pruritus (itching) are not symptoms of herpes zoster. D: The lesions of chicken pox are generalized, whereas herpes zoster lesions occur along the course of a nerve. Herpes zoster occurs when the chicken pox (varicella zoster) virus that has incorporated itself into nerve cells is reactivated years after the initial infection, but it is not chicken pox.
The nurse is caring for the client taking atorvastatin. The nurse should assess for which adverse effects?
- A. Constipation and hemorrhoids
- B. Muscle pain and weakness
- C. Fatigue and dysrhythmias
- D. Flushing and postural hypotension
Correct Answer: B
Rationale: A: Bile acid sequestrants act by inhibiting bile acids from absorption by the small intestine. This results in fewer bile acids in the small intestine, which may lead to constipation and hemorrhoids. B: Atorvastatin (Lipitor) is a 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor (statin) used to lower lipid levels. Statins can cause muscle tissue injury manifested by muscle ache or weakness. Muscle injury can progress to myositis (muscle inflammation) or rhabdomyolysis (muscle disintegration). C: Diarrhea, not constipation, has been found to be a side effect of statin medications. D: Side effects of niacin, a lipid-lowering agent, include flushing, dysrhythmias, and postural hypotension.