Nokea
The nurse is preparing to administer a pm dose of benztropine to the client with worsening akathisia. The client's medication record lists benztropine 0.5 mg IM q4h pm. The vial contains 1 mg/mL. How many milliliters of the medication should the nurse administer?
Correct Answer: 0.5
Rationale: Calculation: 0.5 mg/ 1 mg/mL = 0.5 mL.
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The nurse is teaching the parent of the 3-year-old being treated with vincristine sulfate for Wilms' tumor. The nurse should inform the parents to immediately notify the HCP of which most significant adverse effect?
- A. The child develops diarrhea.
- B. The child's hair begins to fall out.
- C. The child develops dysphagia and paresthesia.
- D. The child has signs or symptoms of depression.
Correct Answer: C
Rationale: A: Both diarrhea and severe constipation are adverse effects of vincristine, and prophylactic treatment is implemented at the beginning of therapy to decrease the potential of these occurring. B: Hair loss is a common adverse reaction to the medication and is reversible. C: Dysphagia and paresthesia are CNS adverse effects from vincristine sulfate (Oncovin). The nurse should teach the parent to notify the HCP immediately if these occur. D: Three-year-olds may not show signs or symptoms of depression. If present, the signs and symptoms should be distinguished as being associated with the neoplastic disease itself or as side effects of the medication.
Cyclosporine and methotrexate are prescribed for the client with severe rheumatoid arthritis. What information should the nurse address when teaching the client? Select all that apply.
- A. Drink grapefruit juice to enhance the medication effects.
- B. Drink plenty of fluids to prevent becoming dehydrated.
- C. Avoid use of St. John's wort, echinacea, and melatonin.
- D. These medications are administered weekly by injection.
- E. Methotrexate and cyclosporine suppress the immune system.
Correct Answer: B,C,E
Rationale: A: Grapefruit juice should be avoided because it can increase the concentration of cyclosporine. B: Adequate hydration minimizes the risk of adverse effects. C: St. John's wort decreases cyclosporine levels. Echinacea and melatonin interact with cyclosporine to alter immunosuppression. D: Methotrexate and cyclosporine can be taken orally instead of by injection. It is incorrect that both medications are taken weekly. Only methotrexate is taken weekly, whereas cyclosporine is usually taken twice daily. E: Methotrexate and cyclosporine both have immunosuppressive effects.
The client has a new prescription for metoclopramide. The nurse notifies the HCP because the client has a contraindication for metoclopramide use. Which information in the client's medical record most likely prompted the nurse's notification of the HCP?
- A. Use of nasogastric suctioning
- B. History of diabetes mellitus
- C. History of seizure disorders
- D. Chemotherapy treatment for cancer
Correct Answer: C
Rationale: A: The use of NG suctioning alone would not prevent metoclopramide use. Metoclopramide can be administered through the NG tube; the tube is then clamped for an hour after administration until absorption occurs. B: Metoclopramide should be used with caution with DM, but it is not contraindicated. C: The client's history of a seizure disorder would contraindicate the use of metoclopramide. Because metoclopramide (Reglan) blocks dopamine receptors in the chemoreceptor trigger zone of the CNS, it is contraindicated in seizure disorders. D: Metoclopramide is used in the treatment of nausea and vomiting for clients receiving chemotherapy.
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.
The client taking lithium for bipolar disorder participated in a recreational game of basketball in the mental health unit gym. The client is now feeling nauseated and shaky, has blurred vision, and is finding it hard to stand. Considering this information, which action should be taken by the nurse?
- A. Instruct the client to sit and rest for a while in a cool place.
- B. Call the HCP to request an order for a STAT serum lithium level.
- C. Give the prn prescribed antiemetic with a large glass of cold water.
- D. Alert the emergency team for the client's impending cardiac arrest.
Correct Answer: B
Rationale: The client is showing signs of lithium (Lithane) toxicity, especially apparent after high levels of physical activity. The HCP should be notified for a STAT lithium level and corrective action.