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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.
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The nurse is reviewing the client's medication list illustrated, prepared by the client's daughter. The nurse is most concerned about which finding?
- A. Some medication doses are missing.
- B. Some administration routes are missing.
- C. Some medications are being duplicated.
- D. Some medications have drug-drug interactions.
Correct Answer: C
Rationale: A: Missing doses of medication is important to address; however, duplicate medications should be addressed first. B: It is important to address the administration routes, but the duplication of medications is the priority to address. C: Hydrochlorothiazide + captopril (Capozide) is a combination product. The nurse should first determine if the client is taking the combination product along with the individual products due to the potential for overdosing. The client may be clear regarding the dose and the route but may not realize that two medications were replaced with one combination product. D: Drug-drug interactions are important to address and should be addressed, but the duplicate medications are the priority.
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.
Oral ranitidine 2 mg/kg twice daily is prescribed for the infant weighing 16 lb 8 oz. The medication is supplied as 15 mg/mL. How many milliliters should the nurse instruct the parent to withdraw in the syringe provided with the ranitidine to administer one dose?
Correct Answer: 1
Rationale: Use a proportion formula to calculate the dose. First determine the dose for the child's weight: 16 lb 8 ounces = 16.5 lb/ 2.2 lb/kg = 7.5 kg. Next determine the prescribed dose: 7.5 kg x 2 mg = 15 mg. The medication is supplied in 15 mg per 1 mL. The dose to administer is 1 mL of ranitidine (Zantac).
The nurse is assessing the client newly started on benztropine mesylate. Which findings indicate that the client is experiencing the most common side effects of benztropine mesylate?
- A. Dizziness, headache, and insomnia
- B. Weight gain, tremors, and sedation
- C. Blurred vision, dry mouth, and constipation
- D. Headache, dry mouth, and sexual dysfunction
Correct Answer: C
Rationale: Blurred vision, dry mouth, and constipation are common side effects of anticholinergic agents like benztropine mesylate (Cogentin).
The nurse applies a fentanyl transdermal patch to the client for the first time. Shortly after application, the client is experiencing pain. Which nursing action is most appropriate?
- A. Remove the transdermal patch and apply a new one.
- B. Administer a short-acting opioid analgesic medication.
- C. Rub the transdermal patch to enhance drug absorption.
- D. Call the HCP to request a higher-dosed fentanyl patch.
Correct Answer: B
Rationale: A: Removing the patch is unnecessary; effective analgesia may take 12 to 24 hours. B: The nurse should administer a short-acting opioid analgesic. When the first fentanyl (Duragesic) transdermal patch is applied, effective analgesia may take 12 to 24 hours because absorption is slow. C: Transdermal patches should not be rubbed to enhance absorption; it can cause the delivery of the medication to fluctuate. D: It is premature to request a higher dose of fentanyl.