RN Pharmacology BSN 315

Correct Answer: Hold the next scheduled dose of Imdur 60 mg and administer a PRN dose of acetaminophen (Tylenol).

Explanation:

Headache is a common side effect of isosorbide dinitrate (Imdur) due to its vasodilatory effects. When the dose is increased, the likelihood of experiencing side effects such as headaches can increase. In this case, the client reports a headache prior to the next dose, which indicates that the headache may be related to the recent increase in the medication dose. The appropriate action is to hold the next scheduled dose of Imdur to prevent further exacerbation of side effects and to administer a PRN dose of acetaminophen to manage the headache. Acetaminophen is commonly used to relieve mild to moderate headaches and does not interact negatively with isosorbide dinitrate. However, the nurse should monitor the client closely for any worsening of symptoms and notify the healthcare provider if necessary.

Why Other Options Are Incorrect:

Administer the 40 mg of Imdur and then contact the healthcare provider: Reducing the dose to 40 mg is not indicated here unless the healthcare provider specifically orders a reduction. The nurse should hold the dose rather than administer a smaller dose without provider guidance. The focus should be on managing the headache first, with notification to the healthcare provider for further guidance.

Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol). Do not administer the next dose of Imdur or any acetaminophen until notifying the healthcare provider: Administering the next 60 mg dose of Imdur when the client already has a headache might exacerbate the headache or worsen other side effects, and the nurse should first assess whether holding the dose is needed. Additionally, acetaminophen can be given for headache relief, but it should be done cautiously while waiting for provider guidance, rather than delaying communication with the healthcare provider.

Summary:

The correct action is to hold the next dose of isosorbide dinitrate and give acetaminophen to relieve the client's headache. The nurse should monitor the client's response and notify the healthcare provider for further recommendations. This helps prevent further medication-related issues while managing the headache symptomatically.

Correct Answer: Notify the healthcare provider of the client's confusion and hallucinations.

Explanation:

The client is displaying signs of meperidine (Demerol) toxicity, which can occur with prolonged use or overdose. Meperidine has a toxic metabolite (normeperidine) that can accumulate in the body, especially in patients receiving it continuously or at high doses. Symptoms of toxicity can include restlessness, irritability, confusion, hallucinations, and seizures. These symptoms are not typical effects of meperidine but are rather indicative of an overdose or toxicity, which is a medical emergency. The nurse's first action should be to notify the healthcare provider so that the client can receive immediate intervention, which may include discontinuation of the drug, adjusting the dosage, or administering an alternative treatment to reverse the toxicity.

Why Other Options Are Incorrect:

Administer a PRN dose of the PO meperidine (Demerol)

Administering more meperidine when the client is already showing signs of toxicity would worsen the situation. More meperidine could increase the risk of overdose and exacerbate the confusion and hallucinations.

Administer naloxone (Narcan) IV per PRN protocol

While naloxone is the antidote for opioid overdose, meperidine toxicity is typically not due to opioid overdose alone. The primary concern here is meperidine toxicity due to prolonged use and not an acute overdose. Naloxone could be used if an opioid overdose is suspected, but the first priority is notifying the healthcare provider for a thorough evaluation.

Decrease the IV infusion rate of the meperidine (Demerol) per protocol

Decreasing the IV infusion rate might help prevent further accumulation of the drug, but the client is already showing signs of toxicity. The first priority should be to notify the healthcare provider so appropriate action, such as stopping the medication or administering an antidote, can be taken.

Summary:

The most appropriate action is to notify the healthcare provider because the client’s confusion and hallucinations are indicative of meperidine toxicity. Prompt evaluation and intervention are necessary to manage the situation. Administering more meperidine, naloxone, or simply adjusting the infusion rate without further consultation would not address the underlying issue of toxicity.

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: Client states chest pain is relieved.

Explanation:

Client states chest pain is relieved:

The primary desired effect of sublingual nitroglycerin in an acute anginal attack is the relief of chest pain. Nitroglycerin works by relaxing the coronary arteries and increasing blood flow to the heart muscle, which reduces the myocardial oxygen demand and relieves pain associated with angina. The client reporting relief of chest pain indicates the desired therapeutic effect of the medication.

Why Other Options are Incorrect

Client's pulse decreases from 120 to 90:

While a reduction in heart rate may occur with nitroglycerin due to its vasodilatory effects, this is not the primary indicator of therapeutic success. The primary goal is the relief of chest pain. Changes in heart rate are not as directly linked to the relief of angina.

Client's systolic blood pressure decreases from 180 to 90:

Nitroglycerin can cause a decrease in blood pressure due to its vasodilatory effects. However, a significant drop in blood pressure (e.g., from 180 to 90 mmHg) is not the goal of therapy and could potentially lead to hypotension. The desired effect is pain relief, not a dramatic reduction in blood pressure.

Client's SaO2 level increases from 92% to 96%:

Although nitroglycerin may improve oxygenation by increasing blood flow, an increase in SaO2 is not a primary indicator of the effectiveness of nitroglycerin. The main therapeutic goal is the relief of chest pain, not necessarily an increase in oxygen saturation.

Summary:

The most important indicator that the desired effect of sublingual nitroglycerin has been achieved is the relief of chest pain, as this directly reflects the medication's ability to alleviate the symptoms of angina.

Correct Answer: Maintain a gastric pH of 3.5 or above.

Explanation:

Maalox is an antacid, which works by neutralizing stomach acid. Its primary purpose is to increase the gastric pH, typically maintaining it above 3.5. This helps reduce the symptoms of acid reflux and peptic ulcer disease by neutralizing excess acid in the stomach, providing relief from pain and irritation caused by the ulcers. Maintaining an appropriate gastric pH helps prevent further damage to the stomach lining and promotes healing of existing ulcers.

Why Other Options Are Incorrect:

 Decrease production of gastric secretions: Antacids like Maalox do not directly decrease the production of gastric secretions; rather, they neutralize the existing acid. Medications like H2 blockers (e.g., ranitidine) or proton pump inhibitors (PPIs, e.g., omeprazole) are typically used to decrease acid production in the stomach.

Produce an adherent barrier over the ulcer: This action is typically associated with sucralfate (Carafate), not antacids. Sucralfate works by forming a protective layer over the ulcer to help it heal, whereas Maalox neutralizes acid.

Decrease gastric motor activity: Antacids do not significantly affect gastric motility or motor activity. Prokinetic agents such as metoclopramide (Reglan) are used to enhance gastric motility in certain conditions like gastroparesis, but antacids focus on neutralizing acid.

Summary:

The purpose of Maalox (an antacid) in treating peptic ulcer disease is to maintain a gastric pH of 3.5 or above by neutralizing stomach acid. This helps relieve symptoms and promotes ulcer healing.

Correct Answer:  Thirty minutes after the dose is administered

Explanation 

For IV gentamicin, which is an aminoglycoside antibiotic, peak and trough levels are essential to monitor to ensure therapeutic effectiveness while minimizing the risk of toxicity (such as nephrotoxicity and ototoxicity). The peak level reflects the highest concentration of the drug in the blood. For IV gentamicin, the peak is typically drawn thirty minutes after the infusion is complete. This timing allows for the medication to distribute fully in the bloodstream and gives an accurate measurement of the maximum drug level. The goal of the peak level is to ensure the drug concentration is high enough to kill bacteria effectively.

Why the other options are incorrect:

Immediately before giving the next dose

This describes the correct timing for a trough level, which measures the lowest concentration of the drug in the bloodstream. The trough ensures the drug level does not fall below the minimum effective concentration and helps assess the risk of drug accumulation and toxicity.

When the next electrolyte levels are drawn

This option is incorrect because drawing peak levels should be specifically timed based on the completion of the infusion, not based on convenience with other lab draws like electrolytes, unless they happen to coincide perfectly.

 Sixty minutes after the dose is administered

This timing is too late for an accurate peak for IV gentamicin. After sixty minutes, the drug levels may already begin to decline from their peak, leading to inaccurate results.

Summary:

For clients receiving IV gentamicin, the nurse should draw the peak level thirty minutes after the infusion finishes to accurately measure the maximum drug concentration. Trough levels are drawn immediately before the next dose, but peak levels must be precisely timed to prevent ineffective treatment or toxicity.

Correct Answer: Immediately before the next antibiotic dose is given.

Explanation:

The trough level is the lowest concentration of the antibiotic in the blood, which is typically drawn just before the next dose is administered, to ensure the drug's levels are within the therapeutic range. This helps prevent toxicity while maintaining the drug's effectiveness.

Why Other Options are Incorrect

Sixty minutes after the antibiotic dose is administered:

 This is the time to obtain the peak level, not the trough level. The peak level measures the highest concentration of the antibiotic in the blood, which is typically drawn after the dose is administered, usually about 30 to 60 minutes after administration.

When the next blood glucose level is to be checked:

 This is unrelated to the timing for obtaining trough levels. Blood glucose monitoring is not associated with the timing of antibiotic trough levels

Thirty minutes before the next antibiotic dose is given

 The trough level should be drawn immediately before the next dose, not 30 minutes before. Waiting until just before the dose helps ensure an accurate reading of the lowest concentration of the drug.

Conclusion:

Immediately before the next antibiotic dose is given is the correct time to obtain a trough level, which ensures that the drug concentration is at its lowest point, helping to assess the adequacy of the dosage and avoid potential toxicity.

Correct Answer: give PRN dose of diphenhydramine (Benadryl).

Explanation 

This is correct because the client is showing signs of an extrapyramidal side effect (EPS) known as acute dystonia, which is a potential adverse reaction to haloperidol (Haldol), a typical antipsychotic medication.

Acute dystonia involves sudden, severe muscle contractions, often affecting the jaw, neck, and face. Jaw tightness and a stiff neck are classic early symptoms.

Treatment for acute dystonia includes the prompt administration of anticholinergic medications, such as:

Diphenhydramine (Benadryl).

Benztropine (Cogentin).

These medications help reverse the muscle rigidity and discomfort by restoring the balance between dopamine and acetylcholine in the central nervous system. Diphenhydramine is commonly given as a PRN (as-needed) medication in such cases to relieve the symptoms quickly.

Why the Other Options Are Incorrect:

 assess client's other sensory hallucinations.

This is incorrect. While assessing for hallucinations may be appropriate in monitoring psychosis, it does not address the immediate physical symptoms of muscle rigidity and dystonia, which require urgent medication intervention.

massage neck until muscles begin to relax.

This is incorrect and potentially harmful. Muscle contractions from dystonia are not relieved by massage. Without appropriate medication, the dystonia can worsen and even involve the airway muscles, leading to a medical emergency such as laryngospasm.

obtain a 12-lead EKG.

This is not appropriate for these symptoms. While haloperidol can affect the heart (such as prolonging the QT interval), jaw tightness and neck stiffness are neurologic/muscular symptoms, not cardiac-related in this context. The priority is treating the acute dystonic reaction.

Summary:

The client receiving Haldol who reports jaw tightness and neck stiffness is likely experiencing an acute dystonic reaction, an extrapyramidal side effect. The priority intervention is to administer a PRN dose of diphenhydramine (Benadryl) to relieve the muscle stiffness and prevent worsening symptoms. 

Correct Answer: The medication is used to protect the gastrointestinal mucosa

Explanation

Sucralfate (Carafate) is a medication that primarily acts as a mucosal protectant. It forms a protective barrier over ulcers and the gastrointestinal (GI) lining by binding to proteins in damaged tissues, such as fibrinogen and albumin, to create a gel-like coating. This coating protects the ulcerated area from further damage caused by gastric acid, bile salts, and digestive enzymes, allowing for healing. Sucralfate does not have systemic effects because it is minimally absorbed into the bloodstream. Instead, it works locally in the stomach and duodenum. Due to its protective function, it is commonly used to treat conditions such as peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD).

Why the Other Options Are Incorrect

The medication helps reduce bacteria levels in the stomach 

Sucralfate does not have antibacterial properties and does not reduce bacterial levels in the stomach. Some medications, such as antibiotics (e.g., amoxicillin, clarithromycin, or metronidazole), are prescribed to treat infections like Helicobacter pylori, which is associated with peptic ulcers. However, sucralfate works purely as a mechanical barrier to protect the stomach lining and does not act against bacteria.

The medication helps neutralize gastric acid in the stomach 

Sucralfate does not function as an antacid. Unlike medications such as calcium carbonate (Tums), magnesium hydroxide (Milk of Magnesia), or aluminum hydroxide, which neutralize gastric acid, sucralfate does not alter stomach acidity. Instead, it provides a protective coating to shield the gastric mucosa from the harmful effects of acid but does not affect acid secretion or pH levels.

The medication can reduce the patient’s constipation 

Sucralfate is not used to relieve constipation. In fact, one of its common side effects is constipation due to its aluminum content. Medications used to treat constipation include laxatives, stool softeners, or fiber supplements, such as psyllium (Metamucil) or docusate sodium (Colace). Because sucralfate does not have a laxative effect, this statement is incorrect.

Summary

The correct answer is The medication is used to protect the gastrointestinal mucosa because sucralfate forms a protective coating over ulcers and damaged areas in the stomach and intestines, shielding them from gastric acid and allowing them to heal. The other options are incorrect because sucralfate does not have antibacterial properties, does not neutralize acid, and does not relieve constipation. Instead, it serves as a mucosal protectant and is commonly prescribed for peptic ulcer disease and GERD.