Rational: Drug tolerance can develop in a client taking an antihypertensive, which is evident by rising blood pressure levels. The physician should be notified, who may then increase the medication dosage or add a diuretic to the medication regimen. The client is also at risk of developing fluid retention, which would be manifested as dependent edema, intake greater than output, and an increase in weight. This would also warrant adding a diuretic to the course of therapy.
02.Answer C
Rational: Intravenous diazepam is given by IV push directly into a large vein (reduces the risk of thrombophlebitis), at a rate no greater than 1 mg per minute. It should not be mixed with other
medications or solutions and can be diluted only with normal saline.
03.Answer A
Rational: Side effects of chlorpromazine can include hypotension, dizziness and fainting especially with parenteral use, rowsiness, blurred vision, dry mouth, lethargy, constipation or diarrhea,nasal congestion, peripheral edema, and urinary retention. Options B, C, and D are not side effects of chlorpromazine.
04.Answer C
Rational: Adverse reactions or toxic effects of tobramycin sulfate include nephrotoxicity as evidenced by an increased BUN and serum creatinine; irreversible ototoxicity as evidenced by tinnitus,
dizziness, ringing or roaring in the ears, and reduced hearing; and neurotoxicity as evidenced by headaches, dizziness, lethargy, tremors, and visual disturbances. A normal WBC is 4500 to 11,000
cells/mm3. The normal sedimentation rate is 0 to 30 mm/hour. The normal total bilirubin level is less than 1.5 mg/dL. The normal BUN is 5 to 20 mg/dL.
05.Answer D
Rational: Tacrolimus is an immunosuppressant medication used in the prophylaxis of organ rejection in clients receiving allogenic liver transplants. Frequent side effects include headache,tremor, insomnia, paresthesia, diarrhea, nausea, constipation, vomiting, abdominal pain, and hypertension. Adverse reactions and toxic effects include nephrotoxicity and pleural effusion.Nephrotoxicity is characterized by an increasing serum creatinine level and a decrease in urine output.
06.Answer B
Rational: Mestinon is an acetylcholinesterase inhibitor. Muscle cramps and small muscle contractions are side effects and occur as a result of overstimulation of neuromuscular receptors. Options A,C, and D are not associated with this medication.
07.Answer B
Rational: Sotalol is a beta-adrenergic blocking agent. Side effects include bradycardia, palpitations, an irregular heartbeat, difficulty breathing, signs of congestive heart failure, and cold hands and feet. Gastrointestinal disturbances, anxiety and nervousness, and unusual tiredness and weakness can also occur. Options A, C, and D are not side effects of this medication.
8.Answer D
Rational: Cyclosporine is an immunosuppressant medication used in the prophylaxis of organ rejection. Adverse effects include nephrotoxicity, infection, hypertension, tremor, and hirsutism.
Additionally, neurotoxicity, gastrointestinal effects,hyperkalemia, and hyperglycemia can occur.Options A, B, and C are not associated with this medication.
09.Answer B
Rational: Mestinon is an acetylcholinesterase inhibitor. Muscle cramps and small muscle contractions are side effects and occur as a result of overstimulation of neuromuscular receptors. Options A,C, and D are not associated with this medication.
10.Answer D
Rational: Tacrolimus is an immunosuppressant medication used in theprophylaxis of organ rejection in clients receiving allogenic liver transplants. Frequent side effects include headache,tremor, insomnia, paresthesia, diarrhea, nausea, constipation, vomiting, abdominal pain, and hypertension. Adverse reactions and toxic effects include nephrotoxicity and pleural effusion. Nephrotoxicity is characterized by an increasing serum creatinine level and a decrease in urine output.
11.Answer B
Rational: respiratory distress is common in a premature neonates and may be due to lung immaturity as a result of surfactant deficiency. The mainstay of treatment is the administration of exogenous surfactant, which is administered by the intratracheal route.Option A, C, and D are not routes of administration for this medication.
12.Answer D
Rational: the next action is to draw a sample for PT and INR level to determine the client's anticoagulation status and risk for bleeding. These results will provide information as to how to best treat this client if an antidote (vitamin K) or blood transfusion is needed. The aPTT monitors the effects of heparin therapy.
13.Answer C
Rational: oxytocin stimulates uterine contractions and is a common pharmacological method to induce labor. An adverse reaction associated with administration of this medication is hyperstimulation of uterine contractions. Therefore, oxytocin infusion must be stopped when any signs of uterine hyperstimulation are present. Drowsiness and fatigue may be caused by the labor experience. Early decelerations of the fetal heart rate are reassuring sign and do not indicate fetal distress.
14. A
Rational: levodopa relieves tremors and rigidity in clients with Parkinson's disease.
15.Answer C
Rational: Zollinger-Ellison syndrome is characterized by multiple areas of ulcers in the gastrointestinal tract. Omeprazole reduces gastric acid production and help relieve signs and symptoms experienced by the patient.
16.Answer A, B, C, E
Rational: these are health instructions to be given during phenytoin therapy. Dilantin may cause skin rash, constipation, gingival hyperplasia (bleeding, tenderness, swelling of gums), bone marrow depression (pancytopenia), ataxia, nystagmus, double vision,drowsiness. Dental flossing should be avoided because bleeding mayoccur due to gum hyperplasia and blood dyscrasia.
17.Answer A, B, E
Rational: these are possible side effects of Lisinopril, an angiotensin converting enzyme inhibitor.
18.Answer C
Rational: twitching indicates seizure. Therefore dilantin, an anticonvulsant is indicated.
19. Answer C
Rational: ciprofloxacin is a quinolone. It can safely be given if a client has allergy to sulfonamides and penicillin. Ampicillin and cloxacillin are penicillins. Co-trimoxazole is a sulfonamide. If a client has allergy to penicillin, more likely he also, has allergy to cephalosphorin.
20. Answer D
Rational: when a client will receive KCl/slow IV drip, urine output must be adequate to prevent renal damage. "No PEE, No K."
21.Answer A
Rational: alcohol is a CNS depressant. It enhances sedative effect of benzodiazepines like Alprazolam. Therefore, the patient should avoid alcoholic beverages when he is taking benzodiazepines.
22.Answer C
Rational: if a client believes that he is being poisoned, allow him to see that the medications are opened in his presence.
23.Answer B
Rational: heparin is an anticoagulant. Avoid factors that may cause bleeding. Use soft bristled/soft sponge toothbrush to prevent gum bleeding. Ecotrin (ASA) may cause bleeding. Electric razor, and not safety razor is recommended to prevent trauma.
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