The nurse observes that after administration of a drug the patient has developed itching and a skin rash. The nurse interprets these findings as which of the following?
- A. Toxicity
- B. Allergic reaction
- C. Angioedema
- D. Crystalluria
Correct Answer: B
Rationale: Allergic reactions are manifested by a variety of signs and symptoms including itching, skin rashes, and hives. Swollen eyelids, lips, and mouth are some of the symptoms of angioedema, an allergic drug reaction that may block the airway, causing asphyxia. Toxicity or toxic reactions are caused when blood concentration levels exceed the therapeutic level of drugs. Reduced blood pressure is called hypotension. Crystals in the urine are symptoms of crystalluria.
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The clinic nurse is reviewing a teaching plan for the client receiving an antineoplastic medication. When implementing the plan, the nurse tells the client:
- A. To take aspirin (acetylsalicylic acid) as needed for headache
- B. Drink beverages containing alcohol in moderate amounts each evening
- C. Consult with health care providers (HCPs) before receiving immunizations
- D. That it is not necessary to consult HCPs before receiving a flu vaccine at the local health fair
Correct Answer: C
Rationale: Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without a HCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. 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.
What would the nurse provide when preparing a patient for discharge and home medication self-administration?
- A. Personal contact information to use if the patient has questions
- B. Thorough medication teaching about drugs and the drug regimen
- C. Over-the-counter medications to use to treat potential adverse effects
- D. A sample size package of medication to take home until prescription is filled
Correct Answer: B
Rationale: The nurse is responsible for providing thorough medication teaching about drugs and the drug regimen to ensure the patient knows how to take the medication and when to notify the provider. The nurse never provides personal contact information to a patient. If adverse effects arise, the patient is taught to call the health care provider and should not self-medicate with over-the-counter drugs, which could mask serious symptoms. The nurse never dispenses medication because it must be properly labeled for home use; this is done by the pharmacy.
Ciprofloxacin otic drops are contraindicated in:
- A. Children
- B. Patients with acute otitis externa
- C. Patients with a perforated tympanic membrane
- D. Swimmer's ear
Correct Answer: C
Rationale: Ciprofloxacin otic risks ototoxicity with perforated eardrums; it's safe in kids or swimmer's ear .
Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are:
- A. Slurred speech and insomnia
- B. Bradycardia and confusion
- C. Dizziness and orthostatic hypotension
- D. Insomnia and decreased appetite
Correct Answer: D
Rationale: Insomnia and appetite suppression are common methylphenidate side effects.
A nurse is preparing a client's medications. Which of the following actions should the nurse take in following legal practice guidelines? (Select ONE that does not apply.)
- A. Maintain skill competency.
- B. Determine the dosage.
- C. Monitor for adverse effects.
- D. Safeguard medications.
Correct Answer: B
Rationale: Nurses must maintain competency , monitor effects , and safeguard meds ; determining dosage is the prescriber's role.
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