(ANSWERS and RATIONALE) – Pharmacological and Parenteral Therapies

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1. A. Furadantin antimicrobial activity is more potent in an acid urine. Ascorbic acid or vitamin C tablets acidify the urine.

2. A. These signs, in addition to laryngeal edema, are characteristic of an allergic reaction that is, less spe- cifically, a transfusion reaction. Chills, increased temp- erature, and pain in the kidney region are indications of a hemolytic reaction.

3. B. Coumadin therapy is contraindicated in the pregnant woman because it crosses the placenta. The pregnant client should be taught heparin administration with a heparin lock if anticoagulation therapy must be continued. The arthritic client (2) may take aspirin or NSAIDs, which potentiate the effects of Coumadin, and should be watched for gastrointestinal bleed, as should the client with ulcer disease (4).

4. D. Alterations in vital signs could be an indication of side effects of nebulizer medication. The client should be in sitting position, either in the bed or in a chair. Postural drainage would not be done before IPPB therapy. The nurse would not leave the client during this treatment.

5. B. Maintaining neutropenic precautions is the most important implementation for this client. The client is at risk for infection. Low neutrophil and white blood cell counts are often found in clients with aplastic anemia or malignancies or in clients who have received cytotoxic therapy. These low blood counts are most likely due to the Prevacid, trazadone, and Zoloft. Administration of blood (1) is not indicated; frequent vital signs (2) is important, but not the highest priority; continuing the medications that are the most likely cause of the low blood count (4) will only make the situation worse.

6. A. These side effects may be present with this medication, but may be alleviated by taking the drug in the evening. Often, taking one dose in the evening will minimize the sedation. The nurse needs to follow up with this client and report to the physician.

7. B. Short-acting insulin is withdrawn first in order to prevent possible contamination of the short-_acting insulin bottle by the longer-acting insulin.

8. A. A blood transfusion should be started slowly (from 25 to 50 drops per minute) for the first 15 minutes because slow administration allows time to observe for an adverse reaction. Most reactions occur in the first 15 minutes. Continuing rate is 100 mL/hr.

9. B. Aspirin impedes clotting by blocking prosta-glandin synthesis, which can lead to bleeding. A side effect of prednisone is gastric irritation, also leading to bleeding. Tarry stools indicate bleeding in the upper GI system.

10. D. Dicumarol is an anticoagulant drug and one of the dangers involved is bleeding. Using a safety razor can lead to bleeding through cuts. The drug should be given at the same time daily but not related to meals (1). Due to danger of bleeding, missed doses (3) should not be made up.

11. B. If dopamine has a positive effect, it will cause vasoconstriction peripherally, but increase renal perfusion and the blood pressure will rise. The cardiac index will also rise and the PCWP should decrease.

12. C. Dextrose with insulin helps move potassium into cells and is immediate management therapy for hyperkalemia due to acute renal failure. An exchange resin may also be employed. This type of infusion is often administered before cardiac surgery to stabilize irritable cells and prevent arrhythmias; in this case KCl is also added to the infusion.

13. B. Foods high in oxalate include spinach, green and wax beans, beets, and chocolate.

14. B. Mydriatic drugs are used preoperatively so that the pupil is widely dilated. Either atropine sulfate or epinephrine HCl is commonly used. Pilocarpine (3) and carbamylcholine (2) are miotics used for glaucoma and certain types of lens implants. Timolol maleate (4) is a beta blocker used for glaucoma.

15. D. Beta blockers act to decrease heart rate and force of contraction and reduce vasoconstriction by antagonizing Beta receptors in the myocardium and vasculature. Choices (1) and (2) refer to the action of nitrates as well as Calcium Channel Blockers such as Diltiazem. Choice (3) is not applicable.