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Exit hesi- Pharm Exam Questions And Answers
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Exit hesi- Pharm Ex am Qu estions And An swers A nurse is assessing the therapeutic action of drugs classified as tumor necrosis factor (TNF) inhibitors. What client response indicates to the nurse that a drug with this classification is effective? Continued remission in a client with ovarian cancer Increased insulin production in a client with diabetes mellitus Reduction of inflammatory joint pain in a client with rheumatoid arthritis Vasodilation of coronary arteries in a client with ischemic heart disease - Answer Reduction of inflammatory joint pain in a client with rheumatoid arthritis TNF is produced mainly by macrophages in synovium; over time, through various mechanisms, the presence of TNF causes inflammation of synovium, destruction o f bone and cartilage, joint stiffness, and pain. TNF inhibitors or blockers neutralize TNF, thereby interrupting the inflammatory cascade; this inhibits the inflammatory response and other mechanisms, thereby slowing tissue damage. TNF inhibitors are not prescribed for clients with ovarian cancer, diabetes mellitus, or ischemic heart disease. The nurse suspects serotonin syndrome in a client prescribed second-generation antidepressants for depression. Which assessment findings observed by the nurse would be beneficial in diagnosing the severity of the syndrome? Delirium Hyperreflexia Hyperthermia Muscle spasms Rhabdomyolysis - Answer Hyperthermia Rhabdomyolysis Serotonin syndrome is a potentially hazardous adverse effect of second-generation antidepressants that are used to treat depression. Hyperthermia and rhabdomyolysis are symptoms observed in severe cases of serotonin syndrome. Delirium, hyperreflexia, and muscle spasms are common symptoms of this syndrome. A healthcare provider prescribes enoxaparin 30 mg subcutaneously daily. Which measure would the nurse take when administering this medication? Push over 2 minutes. Administer in the abdomen. Rub site after administration. Remove air pocket from prepackaged syringe before administration. - Answer Administer in the abdomen. Enoxaparin specifically targets blood clots throughout the body and carries a lo wer risk of hemorrhage than that associated with the drugs heparin and warfarin. Eno xaparin is administered once a day through a subcutaneous injection site around the naval. Enoxaparin should be injected into the fatty tissue only, which is why the ab domen is the recommended injection site. Avoid administering in a muscle. Manufacturer recommendations indicate the air pocket from prepackaged syringes not be remov ed before administration. Rubbing the site is contraindicated, as it can cause bruising. There are no recommendations to push this subcutaneous medication over 2 minute s. A client with cirrhosis of the liver and ascites has been taking chlorothiazide, a thiazide diuretic. Why did the provider add spironolactone to the client's medication regimen? To stimulate sodium excretion To help prevent potassium loss To increase urine specific gravity To reduce arterial blood pressure - Answer To help prevent potassium loss Spironolactone is a potassium-sparing diuretic often used in conjunction with thiazide diuretics. The provider was prompted to add spironolactone to the chlorothiazide to prevent potassium loss. Both medications stimulate sodium excretion. Both medications increase urine specific gravity and reduce arterial blood pressure. A client with myasthenia gravis improves and is discharged from the hospital. The discharge medications include pyridostigmine bromide 10 mg every 6 hours. The nurse evaluates that the drug regimen is understood when the client makes which statement? "I will take the medication on an empty stomach." "I need to set an alarm so I take the medication on time." "It will be important to check my heart rate before taking the medication." "I should monitor for an increase in blood pressure after taking the medication." - Answer "I need to set an alarm so I take the medication on time." Pyridostigmine is a vital drug that must be taken on time; a missed or late dose can result in severe respiratory and neuromuscular consequences or even death. Pyridostigmine should be taken with a small amount of food to prevent gastric irritation . It is unnecessary to take the pulse rate before taking pyridostigmine. Pyridostigmine may cause hypotension, not hypertension, which is a sign of cholinergic crisis. A client has been taking 3 mg of risperidone twice a day for the past 8 days. At th e follow-up appointment, the client reports tremors, shortness of breath, a fever, and sweating. What will the nurse do? Call 911 and have the client transported to the nearest psychiatric unit. Take the client's vital signs and arrange for immediate transfer to a hospital. Check the number of risperidone tablets left in the prescription bottle to see whet her there was an overdose. Request a prescription for 2 mg of intramuscular benztropine stat and assess the client in 10 to 15 minutes for symptom relief. - Answer Take the client's vital signs and arrange for immediate transfer to a hospital. These clinical manifestations signal the presence of neuroleptic malignant syndrome; the cardinal sign of this condition is a high body temperature. Therefore the nurse first should document the hyperthermia and then arrange for immediate hosp italization. Unless the client is experiencing impaired ventilation, it is important to complete a focused assessment before transfer. The care needed can be provided in an emergency department or medical unit, not a psychiatric unit. Neuroleptic malignant syndrome may occur without an overdose; this syndrome can occur when a high-potency antipsychotic drug is prescribed, with typical onset within 3 to 9 days after initiation of the medication. Benztropine will have little or no effect on neuroleptic malignant syndrome. The health care provider prescribes an oral hypoglycemic for the patient with type 2 diabetes. What will the nurse need to consider when developing the teaching plan? Oral hypoglycemics work by decreasing absorption of carbohydrates. Oral hypoglycemics work by stimulating the pancreas to produce insulin. Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control. Clients with type 2 diabetes do not need to be concerned about serious adverse effects from oral hypoglycemics. - Answer Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control. Taking a tablet may give the client a false sense that the disease is under control, and this can lead to dietary indiscretions. Some oral hypoglycemics work by stimulating the pancreas to produce insulin, others work by decreasing carbohydrate absorption, and others work in a variety of other ways; therefore teaching should be specific to the drug prescribed. Oral hypoglycemic drugs can have serious adverse effects. A pregnant client states to the nurse, "I have been advised to take an ove r-the-counter medication for the flu. The drug label says it is a category B drug." How should the nurse respond to these statements? "Because this drug causes fetal abnormalities, you should not take this drug." "This drug causes fetal risks when administered and should not be used in pregnancy." "This drug has been reported to have adverse effects in animal fetuses so this drug should be avoided." "This drug does not show risks to an animal fetus so you can safely take it while pregnant." - Answer "This drug does not show risks to an animal fetus so you can saf ely take it while pregnant." According to the Food and Drug Administration, category B drugs have no risk to an animal fetus. Therefore these medications are safe to take during pregnancy. Stud ies report that category X drugs cause fetal abnormalities and should be avoided. Catego ry D drugs are reported to cause adverse effects in animal fetuses so pregnant clients should avoid these drugs. Category C drugs have been shown to have adverse effects in animal fetuses. A client who has an adenocarcinoma of the descending colon with a partial obstruction is receiving doxorubicin intravenously (IV) to reduce the tumor mass. The nurse
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