Chapter 42 Flashcards
What instruction is most important for the nurse to teach a patient who is taking an anticholinergic agent to treat nausea and vomiting?
A) “assess your stools for dark streaks”
B) “do not take more than two doses of this medication”
C) “brush your teeth and gargle to help with dryness in your mouth”
D) “check your heart rate and call the health care provider if it gets below 50 beats/min”
C) “brush your teeth and gargle to help with dryness in your mouth”
Anticholinergic agents block the parasympathetic nervous system, which causes the body to “rest and digest.” Blocking of these effects leads to constipation, urinary retention, and decreased secretions (dry mouth).
The nurse is administering loperamide to a patient with diarrhea. What assessment is essential for the nurse to perform?
A) vascular assessment
B) gastric assessment
C) hourly blood pressure measurements
D) intake and output every shift
B) gastric assessment
Adverse effects associated with loperamide include central nervous system symptoms such as fatigue and dizziness, epigastric pain, abdominal cramps, nausea, dry mouth, vomiting, and anorexia. The nurse should be auscultating bowel sounds on the patient to verify that they are present in each quadrant. There is no evidence to support vascular assessment or hourly blood pressure measurements. Although intake and output are important because the patient is experiencing diarrhea, they do not have the priority that gastric assessment does.
A patient is prescribed scopolamine. What information should the nurse include on the teaching plan for this patient? (Select all that apply)
A) “do not take this medication if you are dizzy”
B) “do not use laxatives while on this medication”
C) “do not use this medication for longer than a day”
D) “after 3 days, switch patch to alternate ear”
E) “apply patch 4 hours before effect is desired”
F) “drowsiness is a concern while on this medication”
A) “do not take this medication if you are dizzy”
D) “after 3 days, switch patch to alternate ear”
E) “apply patch 4 hours before effect is desired”
F) “drowsiness is a concern while on this medication”
This medication is used for motion sickness and has anticholinergic side effects, including dizziness, drowsiness, dry mouth, and constipation. The patient can use it for longer than 3 days, but must switch ears. It should be applied 4 hours before the effect is needed.
The patient is prescribed tetracycline as part of the treatment for acne. Which patient education information takes priority?
A) take with milk
B) drink plenty of water
C) take at bedtime
D) report tinnitus
B) drink plenty of water
For moderate to severe inflammatory acne vulgaris, adding oral tetracycline to topical retinoid and benzoyl peroxide (BP) improves outcomes. The medication is best taken on an empty stomach (1 h before or 2 h after meal/milk). To reduce risk of esophageal irritation or ulceration, take with plenty of water and do not take at bedtime. Tinnitus is not a side effect.
In developing a plan of care for a patient receiving an antihistamine antiemetic agent, which nursing diagnosis is of highest priority?
A) knowledge deficit regarding medication administration
B) fluid volume deficit related to nausea and vomiting
C) risk for injury related to side effects of medication
D) alteration in comfort related to nausea and vomiting
B) fluid volume deficit related to nausea and vomiting
Although all of the options are appropriate nursing diagnoses, fluid volume deficit is the highest priority because it has the highest associated mortality rate.
Which statement by the patient indicates that further teaching is needed about antiemetic medication?
A) “I will not drive while I am taking these medications because they may cause drowsiness”
B) “I may take acetaminophen to treat the headache caused by ondansetron”
C) “I will apply the scopolamine patches to rotating sites on my upper arms”
D) “I should take my prescribed antiemetic before receiving my chemotherapy dose and continue afterward”
C) “I will apply the scopolamine patches to rotating sites on my upper arms”
Transdermal scopolamine patches should be applied to nonirritated areas behind the ear, not on the arms. It is appropriate for the patient to refrain from driving while utilizing antiemetics, to use acetaminophen to treat headaches caused by ondansetron, and to take antiemetics preventatively prior to and after chemotherapy.
Which assessment is most important for the patient who is taking stimulant laxatives?
A) monitor bowel elimination daily
B) monitor intake and output
C) monitor signs and symptoms of fluid and electrolyte imbalance
D) monitor heart rate and blood pressure every 4 hours
C) monitor signs and symptoms of fluid and electrolyte imbalance
Fluid and electrolyte imbalance is a serious complication of the therapy. The patient needs to be monitored for potential problems.
A patient is prescribed lorazepam and a glucocorticoid during chemotherapy treatments. What is the nurse’s best action?
A) call the health care provider and question the order
B) only administer the lorazepam if the patient seems anxious
C) administer the two medications at least 12 h apart
D) administer the medications and assess the patient for relief
D) administer the medications and assess the patient for relief
Drug combination therapy is commonly used to manage chemotherapy-induced nausea and vomiting. Both lorazepam and the glucocorticoids have been found to be effective medications to assist in preventing and managing chemotherapy-induced nausea and vomiting.
What will the nurse teach the patient about the reason for administering multiple medications for relief of nausea and vomiting?
A) combination therapy decreases the risk of constipation
B) combination therapy is more cost-effective
C) combination therapy blocks different vomiting pathways
D) combination therapy decreases side effects due to lower doses of each drug
C) combination therapy blocks different vomiting pathways
Combining antiemetic agents from various categories allows the blocking of the vomiting center and chemoreceptor trigger zone through different pathways, thus enhancing the antiemetic effect.
Which nursing intervention is a priority before administering magnesium hydroxide to a patient?
A) obtain a history of constipation and causes
B) record baseline vital signs
C) assess renal function
D) advise the patient to take the medication with a glass of water
C) assess renal function
Adequate renal function is needed to excrete excess magnesium. This intervention is essential to predict how the patient will handle the therapy. The other interventions are important, but assessing renal function is the priority.
Which outcome assessment is essential to monitor for in the patient taking diphenoxylate with atropine?
A) increase in bowel sounds
B) increase in number of bowel movements
C) decrease in gastric motility
D) decrease in urination
C) decrease in gastric motility
Diphenoxylate with atropine acts on the smooth muscle of the intestinal tract to inhibit gastrointestinal motility and excessive propulsion of the gastrointestinal tract (peristalsis). A decrease in the gastric motility results in a decrease in the number of bowel movements. Bowel movements should not increase; bowel sounds should not increase, and there should be no change in urination.
Ondansetron has been ordered for the patient undergoing cancer chemotherapy to control the severe nausea and vomiting. What side effects should the nurse observe for?
A) headache, dizziness, and fatigue
B) anorexia and hair loss
C) abdominal cramping and irritability
D) psychosis and middle ear disturbances
A) headache, dizziness, and fatigue
Bisacodyl has been ordered for a patient who is constipated. The nurse realizes that bisacodyl:
A) increases peristalsis to produce a bowel movement
B) is incompatible with alcohol consumption
C) should be avoided during pregnancy as it is teratogenic
D) may lead to paralytic ileus
A) increases peristalsis to produce a bowel movement
A patient is ordered a phenothiazine antiemetic for treatment of nausea and vomiting associated with chemotherapy. The drug will be most effective if administered:
A) as requested by the patient
B) 1 hour after chemotherapy administration
C) the night before treatment, the day of treatment, and for 24 hours after treatment
D) the day of treatment
C) the night before treatment, the day of treatment, and for 24 hours after treatment
A toddler ingests a small amount of household cleaning fluid. What is the safest advice for the nurse to provide the caregiver?
A) give the child fluids and proceed to the emergency department
B) call the poison control center and follow directions
C) administer syrup of ipecac and monitor for vomiting
D) have the toddler eat bread to absorb the substance
B) call the poison control center and follow directions
