RN Pharmacology BSN 315

Correct Answer: Report the finding to the healthcare provider.

Explanation 

The yellowing of the skin, or jaundice, is a key indication of liver dysfunction or liver damage, which can be a serious side effect of acetaminophen (Tylenol) use, especially in high doses or when taken chronically. The liver processes acetaminophen, and excessive use can lead to hepatic toxicity, which may manifest as jaundice due to a buildup of bilirubin in the blood. Jaundice requires immediate attention, and the nurse should report this finding to the healthcare provider so they can assess the client's liver function and adjust treatment accordingly. This could include testing liver enzymes, adjusting the medication regimen, or considering alternative pain management strategies.

Why the other options are wrong:

 Check the client's capillary glucose level:

While checking glucose levels is important for certain conditions, jaundice is not typically related to glucose levels. The presence of jaundice suggests liver dysfunction rather than an issue with glucose metabolism, so checking glucose is not the priority in this situation.

Use a pulse oximeter to assess oxygen saturation:

A pulse oximeter is used to measure oxygen levels in the blood and assess respiratory function. Jaundice is related to liver function and not oxygenation, so using a pulse oximeter would not provide relevant information in this case. The nurse should instead focus on addressing the liver dysfunction indicated by the jaundice.

Advise the client to reduce the medication dose:

While reducing the dose of acetaminophen might be a consideration in the future if liver damage is confirmed, it is not the nurse's role to independently adjust the medication dose. This decision should be made by the healthcare provider. The nurse's immediate responsibility is to report the jaundice to the provider so that appropriate tests and adjustments can be made based on a thorough assessment of the client’s liver function.

Summary:

The most appropriate action when observing jaundice in a client who takes acetaminophen is to report the finding to the healthcare provider. Jaundice can indicate liver dysfunction, which may be linked to acetaminophen toxicity, and requires professional evaluation. The other options are not directly relevant to the assessment of jaundice or liver function.

Correct Answer: Explore a plan for development of coping strategies for the symptoms with the client.

Explanation 

Explore a plan for development of coping strategies for the symptoms with the client is correct because fatigue and difficulty swallowing are common symptoms of myasthenia gravis (MG), even when on appropriate medication like cholinesterase inhibitors (for example, pyridostigmine). While medication helps manage symptoms, it does not cure MG, and clients often experience fluctuating weakness, especially with prolonged activity or later in the day. Helping the client create a symptom management plan that includes coping strategies can significantly improve quality of life. These strategies may involve:

Planning rest periods throughout the day.

Eating softer foods or small frequent meals to help with swallowing.

Prioritizing important activities when energy levels are higher.

Learning techniques to avoid triggers that worsen symptoms (such as heat or stress).

This collaborative approach empowers the client to manage her condition effectively while recognizing the chronic nature of the disease.

Why the Other Options Are Wrong:

 Explain to the client that the dosage is too high, so she should skip every other dose of medication is incorrect.

Adjusting or skipping doses without medical supervision is dangerous in myasthenia gravis. Skipping doses of cholinesterase inhibitors can lead to increased muscle weakness, worsening symptoms, and potentially life-threatening complications like myasthenic crisis (which involves severe muscle weakness and respiratory failure). Dosage changes should only be made by the health care provider (HCP).

Advise the client to contact her health care provider because of the development of tolerance to the medication is incorrect.

Tolerance is not a common feature of cholinesterase inhibitors in the management of MG. If symptoms worsen, it is more likely due to factors like infection, stress, or natural disease progression rather than "tolerance." Advising the client to focus on coping strategies and symptom management is more appropriate unless there are acute or severe changes that require immediate medical attention.

Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms is incorrect.

It is unsafe and inappropriate for clients with myasthenia gravis to self-adjust their medication doses without direct guidance from their provider. Dosing of cholinesterase inhibitors requires careful titration to avoid underdosing (leading to myasthenic crisis) and overdosing (leading to cholinergic crisis with dangerous symptoms like severe muscle weakness, diarrhea, and respiratory distress).

Summary

The correct answer is Explore a plan for development of coping strategies for the symptoms with the client because managing myasthenia gravis involves balancing medication with lifestyle adjustments to reduce fatigue and improve swallowing. The other options are incorrect because altering medication doses without medical oversight is unsafe, "tolerance" is not a typical concern with cholinesterase inhibitors, and self-adjusting doses is never appropriate in MG management. Helping the client build a symptom management plan is the safest and most effective intervention.

Correct Answer: Involuntary movements.

Explanation 

Involuntary movements 

Metoclopramide (Reglan) is a dopamine antagonist that increases gastrointestinal motility and is commonly used to treat chemotherapy-induced nausea. However, it carries a risk of extrapyramidal symptoms (EPS), which include tardive dyskinesia, dystonia, and akathisia. Involuntary movements, such as lip smacking, tongue protrusion, facial grimacing, or jerky limb movements, are signs of tardive dyskinesia (TD), which can become irreversible if not addressed promptly. Therefore, the nurse must report this adverse effect immediately to the healthcare provider.

Explanation of Incorrect Answers:

Diarrhea

 While diarrhea can occur as a side effect of metoclopramide due to its prokinetic effects, it is not as critical as involuntary movements. Diarrhea can usually be managed with supportive care, fluid replacement, and dose adjustments.

Unusual irritability 

Metoclopramide can cause CNS effects such as restlessness, drowsiness, or irritability, but these effects are typically mild and reversible. They do not require immediate intervention unless they become severe.

Nausea

Nausea is the reason the medication was prescribed, so its presence does not indicate an adverse effect requiring urgent attention. Persistent nausea might suggest ineffectiveness of the medication, but it is not as serious as EPS.

Summary:

The correct answer is Involuntary movements because these are signs of tardive dyskinesia, a serious and potentially irreversible side effect that requires immediate intervention. The other options represent less critical or expected side effects of the medication.

Correct Answer:"You can begin taking the Sinemet this evening, but do not take any more levodopa."

Explanation:

Levodopa/carbidopa (Sinemet) is often prescribed to treat Parkinson's disease. In this case, the client has been on regular levodopa therapy and is transitioning to sustained-release levodopa/carbidopa (Sinemet). The timing of the transition is important to ensure effective symptom control without causing excessive dosing. Since the client already took their regular levodopa at 0800, they can begin taking Sinemet in the evening for their next dose. It is important that the client does not take additional levodopa because the Sinemet contains both levodopa and carbidopa, and double dosing would lead to excessive levels of levodopa, increasing the risk of side effects.

Why Other Options Are Incorrect:

"Take the first dose of Sinemet today, as soon as your prescription is filled.": This is incorrect because it suggests that the client should take both levodopa and Sinemet on the same day, which could result in double dosing. The proper course is to start Sinemet in the evening after the morning dose of levodopa.

"Since you already took your levodopa, wait until tomorrow to take the Sinemet.": This is incorrect because it would delay the start of the new medication regimen unnecessarily. The Sinemet should be started that evening, and the levodopa dose from the morning is sufficient to last until then.

 "Take both drugs for the first week, then switch to taking only the Sinemet.": This is incorrect because there is no need to continue taking levodopa separately while starting the Sinemet. The transition from regular levodopa to Sinemet typically involves discontinuing the regular levodopa once the new combination medication is started

Summary:

The nurse should instruct the client to begin taking the Sinemet in the evening but not to take any more levodopa to avoid excessive dosing. This will help the client transition smoothly to the new medication regimen while preventing side effects from taking too much levodopa.

Correct Answer: Increasing growth.

Increasing growth

 Somatropin (Humatrope) is a recombinant human growth hormone (GH) used to treat growth hormone deficiency in children. The primary therapeutic effect of this medication is to stimulate linear growth by promoting the proliferation of growth plates in bones. It also helps with overall body development and metabolism regulation, making increased growth the expected outcome.

Explanation of Incorrect Answers:

Slowing down growth 

Somatropin is used specifically to promote growth, not slow it down. If growth is slowing, this may indicate an issue with dosage, administration, or an underlying medical condition that needs to be assessed.

Slowing down of weight gain 

Growth hormone therapy typically leads to an increase in lean body mass while reducing fat accumulation. It does not directly slow weight gain but instead promotes a healthier body composition.

 Increasing muscle strength 

While somatropin can contribute to improved muscle mass and function, this is not its primary indication. The primary goal of treatment is to increase height and overall growth rather than enhance muscle strength alone.

Summary:

Somatropin (Humatrope) is prescribed to stimulate growth in children with growth hormone deficiency. The correct answer is Increasing growth, as this medication helps promote linear height gain. It does not slow growth, reduce weight gain, or primarily focus on muscle strength. Nurses should monitor growth patterns regularly to ensure the medication is effective.

Correct Answer: "My mouth feels sore."

Explanation 

 "My mouth feels sore."

A sore mouth is a classic symptom of oral thrush, which is a fungal superinfection often caused by Candida albicans. Superinfections occur when normal flora are disrupted by broad-spectrum anti-infective (antibiotic) therapy, allowing overgrowth of resistant organisms like fungi or other bacteria. Common superinfections include:

Oral thrush (white patches, sore mouth)

Vaginal yeast infections

C. difficile colitis

A sore mouth or discomfort, particularly if accompanied by white patches on the tongue or inside the cheeks, is a hallmark sign of oral candidiasis, a superinfection that frequently occurs during or after antibiotic treatment.

Why the Other Options Are Incorrect:

 "I have a headache."

Headaches can happen for many reasons, but they are nonspecific and not directly indicative of a superinfection. They are also not a common or defining symptom of superinfections.

"My ears feel plugged up."

Plugged ears may relate to ear congestion, fluid buildup, or sinus issues but are not associated with superinfections caused by antibiotic use.

"I feel constipated."

Constipation is not a typical sign of a superinfection. More often, antibiotics can cause diarrhea (and in some cases severe diarrhea from C. difficile), not constipation.

Summary:

Superinfections occur when antibiotic therapy disrupts the normal balance of microorganisms, allowing overgrowth of other pathogens, particularly fungi like Candida. Sore mouth complaints raise concern for oral thrush, making "My mouth feels sore" the most appropriate answer. 

Correct Answer: determine the frequency and consistency of bowel movements.

Explanation

This is correct because before giving a laxative, it is essential to assess the client’s bowel pattern, specifically the frequency, consistency, and characteristics of recent bowel movements. This assessment helps the nurse determine:

If the client is actually constipated or in need of a laxative.

The effectiveness of previous bowel management strategies.

Whether the client may be at risk for diarrhea, fecal impaction, or overuse of laxatives.

The most appropriate type of laxative if needed.

Giving a laxative without knowing the client’s bowel history and current status can be harmful. For example, if the client already has diarrhea, administering a laxative could worsen the condition, leading to dehydration and electrolyte imbalance.

 Why the Other Options Are Incorrect:

Observe the skin integrity of the client's rectal and sacral areas.

This is an important assessment in bedfast clients to prevent pressure ulcers and monitor for skin breakdown, especially if there is incontinence. However, this does not directly impact the decision to administer a laxative, making it a secondary priority in this context.

 Assess the client's strength in moving and turning in the bed.

This is relevant to prevent immobility complications and assist with positioning during bowel movements or hygiene care, but it is not the most critical assessment before giving a laxative.

 Evaluate the client's ability to recognize the urge to defecate.

This is useful when planning toileting schedules, particularly with neurogenic bowel issues, but it does not determine if the client needs a laxative at that moment.

Summary:

Before administering a laxative to a bedfast client, the most important assessment is to check the frequency and consistency of bowel movements to ensure the medication is appropriate and safe to give. Skin integrity, strength, and awareness of defecation urges are all valuable assessments but are secondary to the fundamental question of whether the client is constipated or has another bowel elimination issue. 

Correct Answer: Advise the client to take the medication in the morning, rather than at bedtime.

Explanation

Advise the client to take the medication in the morning, rather than at bedtime is correct because long-term corticosteroid therapy (such as prednisone or similar steroids) should ideally be taken in the morning, preferably with food. This recommendation is based on the body's natural circadian rhythm of cortisol production, which peaks in the early morning and decreases throughout the day. By taking corticosteroids in the morning, the medication better mimics the body's natural cortisol release, which:

Reduces the risk of adrenal suppression.

Minimizes side effects like insomnia, nighttime restlessness, and mood disturbances.

Decreases long-term complications from disrupting the body’s hormonal cycles.

Taking corticosteroids at bedtime can lead to difficulty sleeping and may interfere with the body's ability to maintain a normal hormone rhythm. Therefore, the nurse's best response is to educate the client to switch the timing of the dose to the morning with food (such as crackers and milk), which also helps reduce the risk of gastrointestinal upset.

 Why the Other Options Are Wrong:

Teach the client that dairy products should not be taken with her medication is incorrect.

Dairy products are not contraindicated with corticosteroids. In fact, taking corticosteroids with food, including dairy, can help protect the stomach lining and reduce the risk of gastric irritation or ulcers, which are common with long-term steroid use. Therefore, there is no need to avoid crackers and milk.

Tell the client that absorption is improved when taken on an empty stomach is incorrect.

Corticosteroids do not need to be taken on an empty stomach. In fact, they are often recommended to be taken with food to help prevent gastrointestinal irritation, nausea, and ulcer formation. So, taking the medication with a snack is appropriate, just at the wrong time of day.

Affirm that the client has a safe and effective routine for taking the medication is incorrect.

While it is good that the client takes the medication with food, taking corticosteroids at bedtime is not recommended due to the risk of disrupting natural cortisol cycles and causing insomnia or other side effects. Therefore, affirming the current bedtime routine would reinforce incorrect practice.

Summary:

The correct answer is Advise the client to take the medication in the morning, rather than at bedtime because corticosteroids should follow the body's natural cortisol cycle to minimize side effects and hormonal disruption. The other options are incorrect because dairy products are acceptable with corticosteroids, the medication does not need to be taken on an empty stomach, and the client’s current bedtime dosing routine is not safe or best practice. Proper education on timing is essential to protect the client from complications of long-term corticosteroid therapy.

Correct Answer: 75-year-old woman with liver disease.

Explanation

Seventy-five-year-old woman with liver disease.

This client is at the greatest risk for adverse drug reactions because both advanced age and liver disease significantly impair drug metabolism. The liver is the primary organ responsible for metabolizing many medications. When liver function is reduced, drugs are not broken down or cleared effectively, leading to accumulation of the medication in the body, which increases the risk of toxicity and adverse effects. Additionally, older adults often have multiple comorbidities, take multiple medications, and experience age-related changes in renal function, body fat distribution, and protein levels, all of which increase the chance of drug interactions and side effects. Therefore, this client’s age combined with liver impairment puts her at the highest risk.

Why the Other Options Are Incorrect:

Thirty-year-old man with a fracture.

This client is relatively young and likely healthy apart from the acute injury. His liver and kidney functions are expected to be normal, which reduces his risk for adverse drug reactions compared to older adults or those with organ dysfunction.

 Seven-year-old child with an ear infection.

While children require careful dosing due to their developing organ systems, they typically have intact liver and kidney functions unless otherwise compromised. Pediatric dosages are often adjusted appropriately based on weight and age, and children generally have a lower overall risk of adverse drug reactions than elderly adults with organ impairment.

Fifty-year-old man with an upper respiratory tract infection.

While middle-aged adults may start to develop chronic conditions, at fifty years old, unless there is underlying organ dysfunction or polypharmacy, this client has less risk than a seventy-five-year-old with liver disease. His infection is likely being treated with standard antibiotics, and unless there are complicating factors, his risk for adverse drug reactions is moderate to low.

Summary:

The seventy-five-year-old woman with liver disease is at the greatest risk for adverse drug reactions because her age and impaired liver function significantly affect how drugs are metabolized and eliminated. These factors greatly increase the chance of drug accumulation and toxicity. The other clients are either younger or do not have organ dysfunction, which lowers their risk in comparison.