HESI Pharm and Parenteral - Questions, Answers and Rationales Shortly after birth the nurse instills erythromycin ophthalmic ointment in the newborn's
... [Show More] eyes. The father asks why an antibiotic is needed. The nurse explains it is routinely administered to prevent which type of infection? - Gonorrhea - Toxoplasmosis - Rubella - Cytomegalovirus The antibiotic ointment is administered prophylactically to prevent the development of ophthalmia neonatorum, which may be contracted during a vaginal birth to a mother with gonorrhea, chlamydia, or both infections. Cytomegalovirus, toxoplasmosis, and rubella are contracted by the fetus in utero during various stages of pregnancy, not during birth. Erythromycin ophthalmic ointment would be an ineffective treatment for these conditions. A client who takes four 325-mg tablets of buffered aspirin four times a day for severe arthritis complains of dizziness and ringing in the ears. Which complication would the nurse conclude that the client probably is experiencing? - Salicylate toxicity - Allergic reaction - Withdrawal symptoms - Aspirin tolerance Aspirin is a salicylate; excessive aspirin ingestion can influence the vestibulocochlear nerve (cranial nerve VIII), causing tinnitus and dizziness. The client is experiencing symptoms of toxicity, not an allergic response. Withdrawal symptoms occur when a medication is no longer being administered. Tolerance describes a condition in which additional medication is needed to achieve an effect; it is not associated with the development of new symptoms. In which category of fluids would the nurse classify an intravenous solution of 0.45% sodium chloride? - Isotonic - Isomeric - Hypotonic - Hypertonic Hypotonic solutions are less concentrated (contain less than 0.85 g of sodium chloride in each 100 mL) than body fluids. Isotonic solutions are those that cause no change in the cellular volume or pressure because their concentration is equivalent to that of body fluid. This relates to two compounds that possess the same molecular formula but that differ in their properties or in the position of atoms in the molecules (isomers). Hypertonic solutions contain more than 0.85 g of solute in each 100 mL. The nurse is caring for a child receiving furosemide for pulmonary edema. Which nursing intervention(s) would the nurse implement? Select all that apply. One, some, or all responses may be correct. - Checking the child's weight every day - Administering the medication on an empty stomach - Calculating the dose of medication as carefully as possible - Exposing the child to sunlight for increasing periods - Assessing the child regularly to help prevent electrolyte loss The child's weight should be checked and recorded daily to aid in the assessment of therapeutic and adverse effects. Pediatric doses should be calculated carefully to prevent an accidental overdose. Pediatric clients are at greater risk of electrolyte loss; therefore they require closer and more cautious assessment to help prevent hypertension and stroke. Furosemide may cause stomach upset if it is taken on an empty stomach; the child should be given the medication with food to help prevent gastric upset. A child taking diuretics should not be exposed to sunlight for long periods, because this action may precipitate fluid volume loss and heatstroke. A client visited the primary health care provider complaining of inflammatory lesions on the face and is diagnosed with an inflammatory disorder of the sebaceous glands. Which medications would the nurse anticipate being prescribed for this client? Select all that apply. One, some, or all responses may be correct. - Bacitracin - Mupirocin - Clindamycin - Erythromycin - Metronidazole Clindamycin and erythromycin are topical antibiotics used in the treatment of acne vulgaris, which occurs due to inflammation of the sebaceous glands. Bacitracin is an over-the-counter topical antibiotic used in the treatment of dermatological problems. Mupirocin is used in the treatment of superficial Staphylococcus infections such as impetigo. Topical metronidazole is used in the treatment of rosacea and bacterial vaginosis. An adolescent with leukemia is receiving vincristine. The mother reports that the child is complaining of feeling "tingles" all over. Which response by the nurse is mostappropriate regarding the effect of this medication? - "It is a neurological side effect." - "It is caused by an autoimmune reaction." - "The skin becomes sensitive with chemotherapy." - "The central nervous system has become hyperactive." Neurotoxicity is an anticipated side effect of vincristine sulfate. Some children report it as "tingles" or feeling "funny all over." It is not usually permanent. Vincristine causes leukopenia, which increases susceptibility to infection; it does not cause an autoimmune reaction. Skin sensitivity is not the reason that the child feels tingly. Hyperactivity of the central nervous system is not a factor in the development of this neurological finding. The nurse recalls that the blockage of dopamine by antipsychotic medications can cause extrapyramidal side effects such as akathisia. Which client behaviors reflect the presence of akathisia? - Acute muscle spasms and torticollis - Bizarre facial and tongue movements - Motor restlessness, foot tapping, and pacing - Tremor, shuffling gait, drooling, and rigidity Motor restlessness, foot tapping, and pacing are signs of akathisia, which is an involuntary movement disorder characterized by an inability to sit still. Muscle spasms and pulling of the head to the side by the neck muscles (torticollis) are related to acute dystonia. Bizarre facial and tongue movements are associated with tardive dyskinesia. A tremor, shuffling gait, drooling, and rigidity are signs of pseudoparkinsonism. For which therapeutic effect will the nurse monitor the client who is prescribed alprazolam? - Pain relief - Decreased anxiety - Reduction in dysrhythmias - Reduced blood pressure Alprazolam, an anxiolytic, promotes muscle relaxation, reduces anxiety, and facilitates rest. Possible adverse reactions to alprazolam are anger and hostility. Although drowsiness is a side effect of alprazolam caused by depression of central nervous system activity, it is not a hypnotic. Transient hypotension is a side effect of alprazolam, but this is not why it is given to an anxious client. For the client receiving total parenteral nutrition (TPN), which action will the nurse take to prevent a major complication? - Flush the line if extravasation occurs. - Administer the infusion over 12 to 24 hours. - Change the site every 24 hours. - Discontinue the infusion immediately if elevation of hepatic enzymes occurs. TPN should be infused at a slow, constant rate; this will prevent both hyperglycemia and cellular dehydration from too rapid infusion of a hypertonic solution. The intravenous (IV) line should not be flushed if extravasation occurs. Generally, a major vein is selected for administration of TPN; the site is not changed every 24 hours. Abruptly discontinuing the infusion can lead to rebound hypoglycemia; elevation of hepatic enzymes is an anticipated adverse effect in 1% to 2% of clients. Carbidopa-levodopa is prescribed for a client with Parkinson's disease. The nurse monitors the client for which side effects of the medication? Select all that apply. One, some, or all responses may be correct. - Vomiting - Involuntary movements - Slow heart rate - Changes in mood - Peripheral edema Nausea and vomiting may occur, which reflect a central emetic reaction to levodopa. About 80% of clients develop involuntary movements. Changes in affect, mood, and behavior are related to toxic effects of the medication. Tachycardia and palpitations, not bradycardia, occur. Peripheral edema is not a side effect of carbidopa-levodopa. Which medication is a teratogen that may cause masculinization of a female fetus? - Lithium - Danazol - Nitrofurantoin - Carbamazepine Danazol is a teratogen that may cause masculinization of a female fetus. Lithium may cause cardiac defects. Nitrofurantoin may cause cleft lips with cleft palates. Carbamazepine may cause neural tube defects. The nurse recognizes which statements are true regarding the pharmacokinetic changes observed in infants? Select all that apply. One, some, or all responses may be correct. - An infant's fat content is higher. - An infant's gastric pH is less acidic. - An infant's gastric emptying is slow. - An infant's first-pass metabolism is slow. - An infant's transdermal absorption is rapid. [Show Less]