ATI PN PHARMACOLOGY PROCTORED EXAM TEST BANK2023/2024 Latest Updated Examination StudyGuid, Exams of Nursing

Download ATI PN PHARMACOLOGY PROCTORED EXAM TEST BANK2023/2024 Latest Updated Examination StudyGuid and more Exams Nursing in PDF only on Docsity! ATI PN PHARMACOLOGY PROCTORED EXAM TEST BANK 2023/2024 Latest Updated Examination Study Guide 2023/2024 ATI PN PHARMACOLOGY PROCTORED EXAM TEST BANK 2023/2024 Latest Updated Examination Study Guide 2023/2024 ATI ATI PN PHARMACOLOGY PROCTORED EXAM  26 LATEST VERSIONS  2500+ QUESTION AND ANSWERS  100% CORRECT  RATED: 100% GRADE A+ COMPLETE GUIDE FOR ATI PN PHARMACOLOGY PROCTORED EXAM 2023/2024 100% SUCCESS GUARENTEED ATI PN PHARMACOLOGY PROCTORED EXAM TEST BANK 2023/2024 Latest Updated Examination Study Guide 2023/2024 100% Correct Answers! the following findings is a contraindication to administration of diltiazem? hypotension tachycardia decreased level of consciousness history of diuretic use A nurse is administering subcutaneous heparin to a client who is at risk for deep vein thrombosis. Which of the following actions should the nurse take? 1. Administer the medication into the client's abdomen. 2. Inject the medication into a muscle. 3. Massage the site after administering the medication. 4. Use a 22-gauge needle to administer the medication. A nurse is providing teaching to a client who has a urinary tract infection and new prescriptions for phenazopyridine and ciprofloxacin. Which of the following statements by the client indicates the need for further teaching? 1. "If the phenazopyridine upsets my stomach, I can take it with meals." 2. "The phenazopyridine will relieve my discomfort, but the ciprofloxacin will get rid of the infection." 3. "I need to drink 2 liters of fluid per day while I am taking the ciprofloxacin." 4. "I should notify my provider immediately if my urine turns an orange color." A nurse is providing teaching to a group of new parents about medications. The nurse should include that aspirin is contraindicated for children who have a viral infection due to the risk of developing which of the following adverse effects? 1. Reye's syndrome 2. Visual disturbances 3. Diabetes mellitus 4. Wilms' tumor A nurse is preparing to administer lactated Ringer's (LR) 1,000 mL IV to infuse over 8 hr. The drop factor or the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how may gtt/min? (Round the answer to the nearest whole number). 1 hr/60 min = 8 hr/X min X = 480 min 1,000 mL/480 min x 10 gtt/mL = X gtt/min X = 20.833 21 gtt/ min A nurse is caring for a client who has a new prescription for tamoxifen. The nurse should recognize that tamoxifen has which of the following therapeutic effects? ? 1. Antiestrogenic 2. Antimicrobial 3. Androgenic 4. Anti-inflammatory A nurse is preparing to administer furosemide 4 mg/kg/day PO divided into 2 equal doses daily to a toddler who weighs 22 lb. How many mg should the nurse administer per dose? (Round the answer to the nearest whole number) 2.2 lb/1 kg = 22 lb/X kg X = 10 kg 4 mg x 10 kg = 40 mg/day 20mg A nurse is assessing a client who is receiving IV gentamicin three times daily. Which of the following findings indicates that the client is experiencing an adverse effect of this medication? 1. Hypoglycemia 2. Proteinuria 3. Nasal congestion ATI PN PHARMACOLOGY PROCTORED EXAM TEST BANK 2023/2024 Latest Updated Examination Study Guide 2023/2024 100% Correct Answers! a nurse is planning to administer epoetin alfa to a client who has chronic kidney failure. Which of the following data should the nurse plan to review prior to administration of this medication ? blood pressure temperature blood glucose levels total protein levels a nurse is providing discharge teaching to a client who has heart failure and a new prescription for digoxin 0.215 mg PO daily and furosemide 20 mg PO daily. Which of the following statements by the client indicates an understanding of the teaching ? "I know that blurred vision is something I will expect to happen while taking digoxin." "I will measure my urine output each day and document it in my diary." "I will skip a dose of my digoxin if my resting heart rate is below 72 beats per minute." "I will eat fruits and vegetables that have high potassium content every day." a nurse is preparing to administer iron dextran IV to a client. Which of the following actions should the nurse plan to take? administer a small test dose before giving the full dose infuse the medication over 30 seconds monitor client closely for hypertension administer cyanocobalamin as an antidote if toxicity occurs A nurse is administering insulin glulisine 10 units subcutaneously at 0730 to an adolescent client who has type 1 diabetes mellitus. The nurse should anticipate onset of action of the insulin at which of the following times? Insulin glulisine has a very short onset of action of 15 min. The nurse should expect the onset of action around 0745 and ensure the client eats breakfast immediately following administration of the insulin. 0745 A nurse in an outpatient facility is assessing a client who is prescribed furosemide 40mg daily but the client reports she has been taking extra doses to promote weight loss. Which of the following indicates she is dehydrated? urine specific gravity of 1.035 Oliguria, increased urine concentration, and an increase in urine specific gravity greater than 1.030 are expected findings in clients who are dehydrated. A nurse is planning to administer chlorothiazide 20 mg/kg/day PO divided equally ATI PN PHARMACOLOGY PROCTORED EXAM TEST BANK 2023/2024 Latest Updated Examination Study Guide 2023/2024 100% Correct Answers! and administered twice daily for a toddler who weighs 28.6 lb. The amount available is chlorothiazide oral suspension 250 mg/5 mL. How many mL should the nurse administer per dose/ (Round to the nearest tenth) 2.6 mL 2.2 lb/1 kg = 28.6 lb/X kg X = 13 kg 20 mg x 13 kg = 260 mg/day 250 mg/5 mL = 130 mg/X mL ATI PN PHARMACOLOGY PROCTORED EXAM TEST BANK 2023/2024 Latest Updated Examination Study Guide 2023/2024 100% Correct Answers! A nurse is caring for an older adult client who has a prescription for zolpidem at bedtime to promote sleep. The nurse should plan to monitor the client for which of the following adverse effects? 4 1, ecchymosis 2, decrease urine output. 3, increase blood pressure. 4, dizziness A nurse on a medical unit is preparing to administer alendronate 40 mg PO for an older adult client who has Paget's disease of the bone. Which of the following actions should be the nurse's priority? 1, Administer the medication to the client before breakfast in the morning. 2, Ambulate the client to a chair prior to administering the medication. 3. Give the medication to the client with water rather than milk. 4. Teach the client how to take the medication at home. A nurse is caring for a client who has a new prescription for ergotamine. The nurse should recognize that ergotamine is administered to treat which of the following conditions? 2 1. Raynaud's phenomenon 2. Migraine headaches 3. Ulcerative colitis 4. Anemia A nurse is caring for a client who has peptic ulcer disease and reports a headache. Which of the following medications should the nurse plan to administer? 1. Ibuprofen 2. Naproxen 3. Aspirin 4. Acetaminophen A nurse is providing teaching to a parent of a child who has asthma and a new prescription for a cromolyn sodium metered dose inhaler. Which of the following statements by the parent indicates the need for further teaching? 1. "I will give my child a dose as soon as wheezing starts." 2. My child should rinse out his mouth after using the inhaler." 3. "My child should exhale completely before placing the inhaler in his mouth." 4. "If my child has difficulty breathing in the dose, a spacer can be used." ATI PN PHARMACOLOGY PROCTORED EXAM TEST BANK 2023/2024 Latest Updated Examination Study Guide 2023/2024 100% Correct Answers! A nurse is reviewing laboratory values for a client who reports fatigue and cold intolerance. The client has an increased thyroid stimulating hormone (TSH) level and a decreased total T3 and T4 level. The nurse should anticipate a prescription for which of the following medications? 1. Methimazole 2. Somatropin 3. Levothyroxine Nurse is preparing to administer heparin 8,000 units subcutaneously every eight hrs. The amount available is heparin injection 10,000 units/mL. How many milliliters should the nurse administer per dose? (Round the answer to the nearest tenth) 8000/ 10000 = 0.8 mL A nurse is caring for a client who has a new prescription for enalapril. The nurse should monitor the client for which of the following adverse effects of this medication? 1. Ecchymosis 2. Jaundice 3. Hypotension 4. Hypokalemia A nurse is caring for a client who is at 28 weeks of gestation and is experiencing preterm labor. Which of the following medications should the nurse plan to administer? 1. Oxytocin 2. Nifedipine 3. Dinoprostone 4. Misoprostol A nurse is caring for a client who has a new prescription for amphotericin B. The nurse should plan to monitor the client for which of the following adverse effects? 1. Hyperkalemia 2. Hypertension 3. Constipation 4. Nephrotoxicity A nurse is administering subcutaneous epinephrine for a client who is experiencing anaphylaxis. The nurse should monitor the client for which of the following adverse effects? 1. Hypotension 2. Hyperthermia 3. Hypoglycemia 4. Tachycardia A nurse is caring for a client who has a prescription for clopidogrel. The nurse should monitor the client for which of the following adverse effects? 1. Insomnia 2. Hypotension 3. Bleeding 4. Constipation A nurse is caring for an older adult client who has a new prescription for amitriptyline to treat depression. Which of the following diagnostic tests should the nurse plan to perform prior to starting the client on this medication? 1. Hearing examination 2. Glucose tolerance test 3. Electrocardiogram 4. Pulmonary function tests A nurse is providing teaching to a client who has chronic kidney failure which an AV fistula for hemodialysis and a new prescription for epoetin alfa. Which of the following therapeutic effects of epoetin alfa should the nurse include in the teaching? 1. Reduces blood pressure 2. Inhibits clotting of fistula 3. Promotes RBC production 4. Stimulates growth of neutrophils A nurse is preparing to administer an enteral tube feeding through an NG tube at 250 mL over 4 hr. The nurse should set the pump to deliver how many mL/hr? (Round the answer to the nearest whole number) 250 mL/4 hr = X mL/hr X = 62.5 63mL/hr A nurse is providing teaching to a newly licensed nurse about caring for a client who has a prescription for gemfibrozil. The nurse should instruct the newly licensed nurse to monitor which of the following laboratory tests? 1. Platelet count 2. Electrolyte levels 3. Thyroid function 4. Liver function A nurse is caring for a client who has been taking isoniazid and rifampin for 3 weeks for the treatment of active pulmonary tuberculosis (TB). The client reports his urine is an orange color. Which of the following statements should the nurse make? 1. "Stop taking the isoniazid for 3 days and the discoloration should go away." 2. "Rifampin can turn body fluids orange." 3. "I'll make an appointment for you to see the provider this afternoon." 4. Isoniazid can cause bladder irritation." A nurse is preparing to administer prochlorperazine 2.5 mg IV. Available is prochlorperazine injection 5 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth) 5 mg/1 mL = 2.5 mg/X mL X = 0.5 A nurse is reviewing the laboratory results for a client who has a prescription for filgrastim. The nurse should recognize that an increase in which of the following values hr. The drop factor or the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how may gtt/min? (Round the answer to the nearest whole number). 1 hr/60 min = 8 hr/X min X = 480 min 1,000 mL/480 min x 10 gtt/mL = X gtt/min X = 20.833 21 gtt/ min A nurse is caring for a client who has a new prescription for tamoxifen. The nurse should recognize that tamoxifen has which of the following therapeutic effects? ? 1. Antiestrogenic 2. Antimicrobial 3. Androgenic 4. Anti-inflammatory A nurse is preparing to administer furosemide 4 mg/kg/day PO divided into 2 equal doses daily to a toddler who weighs 22 lb. How many mg should the nurse administer per dose? (Round the answer to the nearest whole number) 2.2 lb/1 kg = 22 lb/X kg X = 10 kg 4 mg x 10 kg = 40 mg/day 20mg A nurse is assessing a client who is receiving IV gentamicin three times daily. Which of the following findings indicates that the client is experiencing an adverse effect of this medication? 1. Hypoglycemia 2. Proteinuria 3. Nasal congestion 4. Visual disturbances A nurse is providing teaching to a client who has cirrhosis and a new prescription for lactulose. The nurse should instruct the client that lactulose has which of the following therapeutic effects? 1. Increases blood pressure 2. Prevents esophageal bleeding 3. Decreases heart rate 4. Reduces ammonia levels A nurse is providing teaching to a newly licensed nurse about metoclopramide. The nurse should include in the teaching that which of the following conditions is a contraindication to this medication? 1. Hyperthyroidism 2. Intestinal obstruction 3. Glaucoma 4. Low blood pressure A nurse is teaching a newly licensed nurse about contraindications to ceftriaxone. The nurse should include a severe allergy to which of the following medications is a contraindication to ceftriaxone? 1. Gentamicin 2. Clindamycin administer cyanocobalamin as an antidote if toxicity occurs A nurse is administering insulin glulisine 10 units subcutaneously at 0730 to an adolescent client who has type 1 diabetes mellitus. The nurse should anticipate onset of action of the insulin at which of the following times? Insulin glulisine has a very short onset of action of 15 min. The nurse should expect the onset of action around 0745 and ensure the client eats breakfast immediately following administration of the insulin. 0745 A nurse in an outpatient facility is assessing a client who is prescribed furosemide 40mg daily but the client reports she has been taking extra doses to promote weight loss. Which of the following indicates she is dehydrated? urine specific gravity of 1.035 Oliguria, increased urine concentration, and an increase in urine specific gravity greater than 1.030 are expected findings in clients who are dehydrated. A nurse is planning to administer chlorothiazide 20 mg/kg/day PO divided equally and administered twice daily for a toddler who weighs 28.6 lb. The amount available is chlorothiazide oral suspension 250 mg/5 mL. How many mL should the nurse administer per dose/ (Round to the nearest tenth) 2.6 mL 2.2 lb/1 kg = 28.6 lb/X kg X = 13 kg 20 mg x 13 kg = 260 mg/day 250 mg/5 mL = 130 mg/X mL X = 2.6 mL A nurse is preparing a discharge teaching plan for a client who is to begin long-term oral prednisone for asthma. Which of the following instructions should the nurse include in the plan? Stop taking the medication if a rash occurs. Take the medication on an empty stomach to enhance absorption. Schedule the medication on alternate days to decrease adverse effects. Treat shortness of breath with an extra dose of the medication. A nurse is administering ciprofloxacin and phenazopyridine to a client who has a severe urinary tract infection (UTI). The client asks why both medications are needed. Which of the following responses should the nurse make? "Phenazopyridine decreases adverse effects of ciprofloxacin hydrochloride." "Combining phenazopyridine with ciprofloxacin hydrochloride shortens the course of therapy." "The use of phenazopyridine allows for a lower dosage of ciprofloxacin hydrochloride." "Ciprofloxacin hydrochloride treats the infection, and the phenazopyridine treats pain." A nurse is preparing to administer ampicillin 500 mg in 50 ml of dextrose 5% in water (D5W) to infuse over 15 min. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round to the nearest whole number) 10 gtt/1 mL x 50 mL/15 min = X gtt/min X = 33.3333 33 gtt/min ATI PN PHARMACOLOGY PROCTORED EXAM TEST BANK 2023/2024 Latest Updated Examination Study Guide 2023/2024 100% Correct Answers! A nurse is caring for a client who has congestive heart failure and is taking digoxin. The client reports nausea and refuses to eat breakfast. Which of the following actions should the nurse take first? Encourage the client to eat the toast on the breakfast tray. Administer an antiemetic. Inform the client's provider. Check the client's apical pulse. VERSION 2 Pharmacology ATI 1. A nurse is assessing a client who is receiving chloramphenicol (Chloromycetin). Which of the following findings is an adverse effect of this medication? (adverse affect is thrombocytopenia) o Ecchymos o Ototoxicity o Hypertensi on o Anxiety 2. A nurse is caring for a client who is to receive 1,500 mL of 0.9% sodium chloride IV over 8 hours. The nurse plans to use IV tubing with ATI PN PHARMACOLOGY PROCTORED EXAM TEST BANK 2023/2024 Latest Updated Examination Study Guide 2023/2024 100% Correct Answers! 4. A nurse is caring for a client who is receiving a fentanyl transdermal system (Duragesic). What is important to document in the client’s record? o Fluid intake o Skin integrity o Respiratory rate o Pulse rate 5. A nurse is caring for a client who has acute angina and has a prescription for nitroglycerin. Which of the following is an appropriate intervention for the nurse to take when administering this medication? o Massage the nitroglycerin ointment completely into the skin. o Replace the nitroglycerin transdermal patch every 4 hours. o Administer a sustained nitroglycerin tablet orally. o Administer a nitroglycerin tablet sublingually every 5 minutes. 6. A nurse is preparing to administer infliximab (Remicade) to a client who has rheumatoid arthritis. The nurse should watch the patient for which of the following adverse effects? (Select all that apply.) o Bradycard ia o Jaundice o Polyuri a o Urtipenia o Fever 7. A nurse is providing teaching to a client who was recently diagnosed as HIV positive. The client is beginning medication therapy with zidovudine (Retrovir). Which of the following statements should the nurse include in the teaching. (Select all that apply.) o Must be taken with other retroviral medicines. o Has few adverse effects o Cures an HIV infection o Prevents you from transmitting the HIV infection o Increases CD4+ cell count 8. A nurse is assessing a school age client who is experiencing seizure activity and is prescribed diazepam (Valium) IV. The nurse should should clarify the order if the client is receiving a continuous infusion of which of the following IV: o Lactated Ringers solution o 0.9% Sodium chloride with 100 units of regular insulin o 0.9% sodium chloride o 0.9% Sodium chloride with 20 mEq of potassium chloride 9. A nurse is assessing a client who is taking enalapril (Vasotec) for congestive heart failure. Which of the following indicates an expected finding? o Activity tolerance o Orthostatic hypotension o Loss of strength o Increase in blood pressure 10. A child with cerebral palsy is prescribed Baclofen (Lioresol). Which of the following therapeutic effects should the nurse monitor? o Increased urine output o Increased energy o Decreased anxiety o Decreased spacity 11. Clinical findings of a client who has a prescription for lithium carbonate (Lithobid). For which reasons should the nurse withhold the medication and notify the provider? o Lithium level 1.0 mEq/L o Potassium at 3.7 mEq/L o Sodium at 143 mEq/L o Psuedoephedrine hydrochloride (Sudafed) 17. A nurse administered meperidine (Demerol) intramuscularly to a client with an ankle fracture. Which of the following actions should the nurse take next? o Assess the client’s respiratory status o Document on the clients medication record o Reassess the client's pain level o Check the client's blood pressure 18. A nurse is caring for a client who has an order for clozapine (Clozaril) 350 mg PO daily. The nurse should recognize that which of the following findings is a side effect of this medication? o WBC 8,000 mm3 o Serum sodium 136 mg/dL o Fasting blood glucose of 220 mg/dL o Weight loss of 2.26 kg (5 lb) in 2 weeks 19. A client with diabetes mellitus is admitted to the medical unit. The client has routine before- breakfast prescription for 8 units of regular insulin and 18 units ofNPH. The primary care provider adds an additional dose of Regular insulin based on the following: Blood Glucose Regular Insulin Dose 121 to 150 2 units 151 to 180 4 units 201. 200 6 units 201 to 250 8 units > 250 Call provider The client’s pre-breakfast glucose is 192 mg/dl. Which dosage of insulin should the nurse administer? o 8 units of Regular, 18 units of NPH o 8 units of Regular, 24 units of NPH o 14 units of Regular, 18 units of NPH o 14 units of Regular, 24 units of NPH 20. A nurse is caring for a client who has a new prescription of zolpidem (Ambien) 10 mg by mouth. Which comments by the client indicates understanding regarding this medication? o “I will take my medication at bedtime.” o “I will take this medication with food.” o “I will stop taking this medication in 1 week, so I don’t get addicted.” o “I will take vitamin C to increase the effectiveness of this medication.” 21. A nurse is monitoring a client who is taking fosinopril (Monopril). The nurse should understand that this has a beneficial effect on which of the body systems? o Gastrointesti nal o Cardiovascular o Pulmonary o Reproductive 22. A nurse is assessing a client who is taking naproxen (Naprosyn). Which of o Increased level of consciousness 29. A client is questioning the nurse about why she is receiving frequent doses of IV antibiotics. Which of the following responses by the nurse is appropriate? o It helps to maintain a steady drug level o It helps to prevent the emergence of drug-resistant bacteria o It decreases the risk of an allergic reaction o It decreases the length of necessary treatment 30. A female adult client is scheduled to start a prescription for azathioprine (Imuran) for active Rheumatoid Arthritis. The nurse should inform the client about the need for which of the following diagnostic tests prior medication? o Erythrosedimentation rate o Bone density scan o Electrocardiogr am o Pregnancy Test 31.A nurse is caring for a client who has been taking ferrous sulfate for the past 2 months. Which of the following findings is expected? o Increased energy o Reduced frequency of coughing o Increased vision o Decreased inflammation 32. A nurse is caring for a client who has a prescription for Metformin (Glucophage) twice daily. Which of the following lab results projects the expected outcome? o Hemoglobin A1C 6.4% o Pre-meal plasma glucose 135mg/dl o Bedtime blood glucose 150 mg/dl o Systolic blood pressure 146 mm Hg 33. A nurse is teaching about IV betamethasone (Celestone Soluspan) with a client who is at 31 weeks of gestation and is in premature labor. Which of the following information should the nurse include in the teaching? o Prevents contractions of the uterus to avoid premature birth o Promotes the production of surfactant in the fetal lung o Decreases inflammation associated with an allergic reaction o Suppresses the immune system to prevent fetal respiratory distress. 34.A nurse is providing teaching to a client who had a total gastrectomy. The client has a new prescription for Cyanocobalamin (Vitamin B12). Which of the following client statements indicates understanding of the teaching? o “I will have to take this medication for the rest of my life.” o “After I receive injections for a week, I will be able to 36.A nurse receives a phone call from a client who has heart failure and reports a dry cough for the last week. After reviewing the client’s medical record, the nurse asks the client to come to the provider’s office. The nurse should then instruct the client to stop taking which of the following daily medications until he sees his provider? o Isosorbide (Imdur) o Hydroclorothiazide (Hydrodiuril) o Nifedipine (Procardia) o Lisinopril (Zestril) 37.A nurse is planning discharge teaching for a client who is to start therapy with repaglinide (Prandin). Which of the following should the nurse include in the teaching? o “Take the medication 1 hour before mealtime.” o “Hold the medication if your blood glucose is less than 120 mg/dL.” o “Monitor for irritability and diaphoresis.” o “Increase your protein intake.” 38.A nurse is caring for a client who is receiving anticoagulant therapy with Warfarin (Coumadin). The client is prescribed Cefotetan (Cefotan) by intermittent IV bolus for pneumonia. The nurse should monitor the client for which of the following? o Hemorrhage o Hypoglyce mia o Hyperkalemia o Paresthesias 39. A nurse is assessing a client who has been taking anti-tuberculosis medications for the past 3 months. The nurse should instruct the client to notify the provider if which of the following occurs? o Weight gain o Jaundice o Alopec ia o Polyuria 40. A client who has supraventricular tachycardia (SVT) is receiving procainamide. The nurse recognizes that the primary pharmacological action of this medication is to: o Decrease cardiac preload o Promote systemic vasoconstriction o Decrease sinoatrial node conduction. o Control the rate of cardiac contraction. 41. A client is receiving extended-release morphine sulfate (Avinza) 30mg PO every 12 hr. Three hours after the last dose, the client requests pain medication. Which of the following assessment finding is the best indicator of the patient’s need for more pain medication? o Facial grimacing o Elevated blood pressure o Flushed skin o Increase the dose by 2.5mg o Decrease the dose by 5mg. 47. A nurse is caring for a client who has a new prescription for estrogen- progestin combination (Ortho-Novum). Which of the following medications may interact with this medication and require the use of additional non-hormonal birth control? o Thiamine ( Vitamin B 1) o Dilantin (Phenytoin) o Amalodipine (Norvasc) o Docusate sodium (colace) 48. A nurse is providing teaching to a school-age child and his parents. The child has a new prescription for methylphenidate (Concerta). For which of the following adverse effects should the nurse monitor? (Select all that apply.) o Nose bleed o Oliguria o Weight loss o Palpitation s o Insomnia 49. A nurse is caring for a postoperative client with PCA containing IV morphine. A nurse should recognize which is the following priority assessment? o Hypotensi on o Bradypnea o Drowsine ss o Urticaria 50. A nurse is caring for a client who is receiving therapy with the clonidine (Catapres) transdermal patch. The client reports light-headedness and drowsiness. Which of the following actions should the nurse take? o Administer a prescribed antiemetic o Remove the Patch o Elevate the head of the bed o Measure Blood pressure 51. A nurse is assessing a client who takes diphenoxylate with atropine (Lomotil) for inflammatory bowel disease. For which of the following should the nurse monitor? o Hearing loss o Increased oral secretions o Bradycardia o Urinary retention 52. A nurse is caring for a client with Parkinson’s disease. The client is taking o A client taking pramipexole (Mirapex) for Parkinson’s disease 58. A nurse is caring for a 4 year old client, who is taking amoxicillin (Amoxil) 50 mg/ kg/day PO in three divided doses. Which of the following resources should the nurse consult to verify that the dose is safe for the client? o Medication administration record o The client’s health history o Physician’s desk reference o The client’s BMI record 59. A nurse is caring for a client who has a new prescription for sucraflate (Carafate). The client also takes several other medications and herbal supplements. Which of the following requires that the nurse provide additional teaching for this client? o Phentoin (Dilantin) o Burpropion (Wellbutrin) o Ginko biloba o Valerian root 60. A nurse is caring for a client who has a prescription for levadopa carbidopa (Sinemet-CR). Which of the following should the nurse recognize as an adverse effect of this medication? o Constipati on o Weight gain o Hirsultism o Dyskinesia 61.A nurse is caring for a client who has received acetaminophen (Tylenol) 650 mg and Hydrocodone (Vicodin) 5 mg every 4 hr for the past 24 hr. Which of the following is an appropriate action for the nurse to take? o Complete an incident report o Stagger the medications every 2 hr o Suggest a time with the pharmacy. o Decrease acetaminophen to 325 mg every 4 hr. 62. A nurse is caring for a client who has a new prescription for buproion (Welbutrin). What should the nurse recognize as a contraindication for the use of this medication? o Xerostomia o GERD o Seizure o Bradycardia 63. A nurse is caring for a client with a urinary tract infection. Her past history reveals an allergy to thiazide diuretics. Which of the following medications is contraindicated? o Nitrofurantoin (Macrodantin) o Ciprofloxacin (Cipro) o Amoxicillin/ clavulanate (Augmentin) o Trimethoprim/ sulfamethoxazole (Bactrim) 64.A nurse is providing instruction to four clients regarding medication self- administration. Which of the following actions by a client indicates a need for 66. A nurse is preparing to administer insulin to a client with diabetes mellitus. The client is to receive insulin aspart (NovoLog) 5 units and NPH insulin (Humulin N) 15 units subcutaneously in the morning. Which of the following actions should the nurse take first? o Inject 5 units of air into the insulin aspart vial. o Inject 15 units of air into the NPH insulin vial. o Draw up 5 units of insulin aspart from the vial. o Draw up 15 units of NPH insulin from the vial. 67. A nurse is providing care to a client who has heart failure. While verifying the orders with the medication administration record the nurse notes that the prescription for digoxin (Lanoxin) was transcribed incorrectly. As a result, the client received an extra dose of the medication yesterday. Which of the following actions should the nurse take first? o Complete an incident report. o Notify the charge nurse. o Obtain a set of vital signs. o Withhold the next dose. 68. A nurse is caring for a client who is receiving haloperidol (Haldol). The nurse should document which of the following findings are dystonia? o Neck spasms o Lip smacking o Tremors o Pacing 69. A nurse is completing discharge teaching for a client who has hypertension. The client has a new prescription for spironolactone (aldactone). Which of the following statements by the client indicates an understanding of the teaching? o “I’ll increase my dietary fiber, because this medication causes constipation.” o “I’m aware that his medication can cause heart palpitations.” o “I’ll take aspirin every day, because it makes this medication more effective.” o “I realize that I should use sugar substitutes when taking this medication.” 70.A nurse is caring for a school age child who has been prescribed diphenhydramine (Benadryl). Which of the following adverse effects has highest priority? o Sedation o Dry mucous membranes o Ataxia o Diarrhea VERSION 3 ATI Pharmacology IMPORTANT LAB VALUES  Sodium (Na): 136-145 mEq/L  Calcium: 9.0-10 mg/dL  Chloride: 98-106 mEq/L  Bicarb HCO3: 21-28 mEq/L  Potassium: 3.5-5.0 mg/L  Phosphorus PO4 : 3.0-4.5 mg/dL  Magnesium: 1.3- 2.1 mEq/L  Cholesterol: o Total <200mg/dL o LDL ("bad") <100 o HDL ("good) >40 o Triglycerides <150mg/dL  Liver enzymes o ALT/SGPT 8-20 units/L o AST/SGOT 5-40 units/L o ALP 42-128 units/L o Total protein 6-8 gm/dL  Pancreatic enzymes o Amylase 56-90 IU/L o Lipase 0-110 units/L o Prothrombin time 0.8-1.2  Glucose: Preprandial (fasting) 70-110 mg/dL Postprandial 70-140 mg/dL  RBC: Females 4.2-5.4 million/uL; Males 4.7-6.1 million /uL  WBC: 5000 -10,000  Iron: Females 60-160 mcg/dL; Males 80-180 mcg/dL  Platelets: 150,000-450,000  Hemoglobin (Hgb): Females 12-16 g/dL; Males 14-18 g/dL  Hematocrit (Hct): Females 37-47%;Males 42-52%  Prothrombin Time (PT): 11-14 seconds: therapeutic range 1.5-2x normal or control value  Urine specific gravity: 1.015-1.030  Urine pH: average 6.0; range 4.6-8.0 6) Interference with vitamin K-dependent clotting factors causing bleeding in newborns. - Miscellaneous Central Nervous System Medications: Treating Malignant Hyperthermia (Active Learning Template - Medication, RM Pharm RN 7.0 Ch. 15) 1) Depolarizing neuromuscular blockers: Succinylcholine 2) Manifestations include muscle rigidity accompanied by increased temperature, as high as 43°C (109.4°) 3) Administer oxygen at 100%. 4) Initiate cooling measures including administration of iced 0.9% sodium chloride, applying a cooling blanket, and placing ice bags in groin and other areas 5) Administer dantrolene to decrease metabolic activity of skeletal muscle. - Airflow Disorders: Therapeutic Action of Montelukast (Active Learning Template - Medication, RM Pharm RN 7.0 Ch. 17) 1) Leukotriene modifiers: suppress the effects of leukotrienes, thereby reducing inflammation, bronchoconstriction, airway edema, and mucus production. 2) Long-term therapy of asthma in adults and children, and to prevent exercise-induced bronchospasm 3) Depending on therapeutic intent, effectiveness is evidenced by long-term control of asthma 4) Advise clients to take montelukast once daily at bedtime. 5) For exercise-induced bronchospasm, take 2 hr. before exercise. Instruct clients taking daily montelukast to not take an additional dose for exercise induced bronchospasm - Upper Respiratory Disorders: Client Teaching Prior to Allergy Testing (Active Learning Template - Medication, RM Pharm RN 7.0 Ch. 18) 1) Medications that can interfere with skin tests include: antihistamines, Tricyclic antidepressants, heartburn medications, asthma medication omalizumab (Xolair) 2) May need to discontinue certain meds 10 days prior 3) If you are running a fever or have an attack of hay fever or asthma, testing should be delayed 4) Do not change your diet before the test. - Medications Affecting Blood Pressure: Titrating Continuous Nitroprusside Infusion (RN QSEN - Safety, Active Learning Template - Medication, RM Pharm RN 7.0 Ch. 20) 1) Nitroprusside (centrally-acting vasodilator) 2) Direct vasodilation of arteries and veins resulting in rapid reduction of blood pressure (decreased preload and after load 3) Used for hypertensive crisis 4) Administer medication slowly because rapid administration will cause blood pressure to go down to rapidly 5) Prepare medication by adding to diluent for IV infusion. 6) Protect IV container and tubing from light & Discard medication after 24 hr. Angina Chapter 22 (pg. 169) Self-administration of nitroglycerine patch (pg. 170) Client teaching for a new prescription of sublingual nitroglycerin PROTOTYPE: Nitroglycerin (NTG) Oral extended-release capsules Sublingual tablet Medications Affecting Coagulation (Chapter 25 page 191) Administering Heparin (pg. 193) Laboratory values to report to the provider Self- Administration of Enoxaparin (pg. 193) Adverse effects of clopidogrel (pg. 197) Monitoring for adverse effects of Warfarin Adverse effects of Heparin Medication safety with Warfarin (pg. 194) Reviewing client data during heparin infusion (pg. 192) PROTOTYPE: Heparin Low Molecular Weight: PROTOTYPE: Enoxaparin Other: Dalteparin Activated factor (Xa) Inhibitors: PROTOTYPE Medication: Fondaparinux Adverse Effects: Hemorrhage secondary to heparin overdose: - Monitor vital signs. - Advise clients to observe for bleeding (increase heart rate, decreased blood pressure, bruising, petechiae, hematomas, black tarry stools). - In the case of overdose, stop heparin, administer protamine, and avoid aspirin. - Monitor activated partial thromboplastin time (aPTT). Keep value at 1.5 to 2 times the baseline. Heparin induced thrombocytopenia Interventions: - Evidenced by low platelet count and increased development of thrombi: mediated by antibody development (white clot syndrome) - Monitor platelet count periodically throughout treatment, especially in the first month. - Stop heparin if platelet count is less than 100,000/mm^3; Nonheparin anticoagulants, such as lepirudin or argatroban, can be used as a substitute if anticoagulation is still needed. Hypersensitivity reaction (chills, fever urticaria): - Administer a small test dose prior to the administration of heparin. Toxicity/overdose: - Administer protamine, which binds with heparin-protamine complex that has no anticoagulant properties. - Protamine should be administered slowly IV, no faster than 20mg/min or 50mg in 10 min. - Do not exceed 100 mg in a 2-hr period. Administer carefully to prevent overdose (anticoagulation). Enoxaparin: Hemorrhage: - Monitor vital sings - Advise clients to observe for bleeding (increased heart rate, decreased blood pressure, bruising, petechiae, hematomas, black tarry stools) - Monitor platelet count. Instruct clients to avoid aspirin. Neurologic damage from hematoma formed during spinal or epidural anesthesia: - In clients who have spinal or epidural anesthesia: Assess insertion site for sings of hematoma formation, such as redness or swelling; Monitor sensation and movement of lower extremities; Notify provider of abnormal findings. Thrombocytopenia Interventions: - Monitor platelets. Discontinue medication for platelet count less than 100,000/mm^3. Toxicity/ Overdose - Administer protamine (heparin antagonist) - Protamine should be administered slowly intravenously, no faster than 20 mg/min or 50 mg in 10 min. Fondaparinux: -Hemorrhage -Neurologic damage from hematoma formed during spinal or epidural anesthesia. -Thrombocytopenia, as evidenced by low platelet count. Contraindications/Precautions: -Parenteral anticoagulants are contraindicated in clients who have low platelet counts (thrombocytopenia) or uncontrollable bleeding. -These medications should not be used during or following surgeries of the eyes, brain, or spinal cord; lumbar puncture; or regional anesthesia. -Use cautiously in clients who have hemophilia, increased capillary permeability, dissecting aneurysm, peptic ulcer disease, severe hypertension, hepatic or renal disease, or threatened abortion. Interactions: - Antiplatelet agents such as aspirin, NSAIDs, and other anticoagulants can increase the risk for bleeding. -Avoid concurrent use when possible -Monitor carefully for evidence of bleeding -Take precautionary measures to avoid injury (limit venipuncture and injections). Nursing Evaluation of Medication Effectiveness: - Heparin: aPTT levels of 60 to 80 seconds. - Heparin, enoxaparin, and fondaparinux sodium: No development or no further development of venous thrombi or emboli. Oral Anticoagulants PROTOTYPE: Warfarin Adverse Effects: Hemorrhage - Monitor VS. - Advise clients to observe for bleeding (increased heart rate, decreased blood pressure, bruising, petechiae, hematomas, black tarry stools). - Obtain baseline PT, and monitor PT levels of PT and INR periodically. - In the case of a warfarin overdose, discontinue administration of warfarin, and administer vitamin K. Hepatitis: - Monitor liver enzymes. Toxicity/ Overdose: - Administer Vitamin K, to promote synthesis of coagulation factors VII, IX, X, and prothrombin. - Administer IV vitamin K, slowly and in a diluted solution to prevent anaphylactoid-type reaction. Adverse effects of Clopidogrel: Bleeding: Prolonged bleeding time, gastric bleed, thrombocytopenia. -Monitor bleeding time. -Monitor for gastric bleed (coffee-ground emesis or bloody, tarry stools). -Monitor for bruising, petechial, and bleeding gums. -Apply pressure to cardiac catheter access. GI effects (diarrhea, dyspepsia, pain): - Teach client to monitor for effects and notify the provider. Growth factors (chapter 26 pg. 201) Evaluating Client response Monitoring adverse effects of Epoetin alfa Effectiveness of oprelvekin therapy PROTOTYPE: Epoetin Alfa, erythropoietin Other: Darbepoetin alfa, long acting erythropoietin Adverse effects: Hypertension: Secondary to elevation in hematocrit level. - Monitor Hgb levels and blood pressure. If elevated administer antihypertensive medications. Risk for a thrombic event: Such as myocardial infraction or stroke if the client has a Hgb of 11/g/dL or higher, or an increase of more than 1g/dL in 2 weeks. Seizures can also occur with a too-rapid rise in the blood counts. - Decrease dosage when these limits are reached. Therapy can be resumed when Hgb drops to acceptable level, but dosage should be produced. - Consider placing client on seizure precautions if rapid increase in Hgb or blood pressure occurs. Deep-vein thrombosis: Increased risk in preoperative care. - Prophylactic use of an anticoagulant might be needed for preoperative clients. Headache and body aches: - Report headaches that are frequent or severe to the provider. Hypertension can be the cause. Contraindications/ Precautions: - Pregnancy Risk Category C. - Contraindicated in clients who have uncontrolled hypertension. - Contraindicated in clients who have some cancers due to possible increase in tumor growth. Nursing evaluation of medication effectiveness: - Depending on therapeutic intent, effectiveness can be evidenced by Hgb level of 10 to 11 g/dL and maximum Hct of 33% - Erythropoietic growth factors: Depending on therapeutic intent, effectiveness can be evidenced by Hgb level of 10 to 11 g/dL and maximum Hct of 33% - Leukopoietic growth factors: effectiveness can be evidenced by the following: Absence of infection & Interactions: Cimetidine can inhibit medication-metabolizing enzymes and thus increase the levels of warfarin, phenytoin, theophylline, and lidocaine. - In clients taking warfarin, monitor indications for bleeding. - Monitor INR & PT levels, and adjust warfarin dosages accordingly. - In clients taking phenytoin, theophylline, and lidocaine, monitor serum levels and adjust dosages accordingly. Concurrent use of antacids can decrease absorption of histamine2-receptor antagonists. - Advise clients not to take an antacid 1 hour before or after taking a histamine2-receptor antagonist. Proton pump inhibitor: (-prazole) PROTOTYPE: Omeprazole Other medications: -Pantoprazole -Lansoprazole -Dexlansoprazole -Rabeprazole -Esomeprazole Adverse effects: Minor adverse effects with short-term treatment include headache, diarrhea, nausea, and vomiting. Long- term treatment: Pneumonia - Inform clients of these possible effects and to monitor and report manifestations of a respiratory infection. Osteoporosis and fractures - Advise clients to increase vitamin D and calcium intake. Rebound acid hypersecretion - Advise clients to take low dose if possible and to taper slowly to discontinue. Hypomagnesemia - Advise clients to monitor and report manifestations of hypomagnesemia, such as tremors, muscle cramps, and seizures Contraindications/ Precautions: - These medications are Pregnancy Risk Category B, except for omeprazole, which is Category C. - Contraindicated for clients hypersensitive to medications and during lactation. - Use cautiously in children and with clients who have dysphagia or liver disease. - These medications increase the risk for pneumonia. Use cautiously in clients at high risk for pneumonia, including clients who have COPD. Interactions: Digoxin and phenytoin levels can increase when used concurrently with omeprazole. - Monitor digoxin and phenytoin levels carefully if prescribed concurrently. Absorption of ketoconazole, itraconzale, and antazanvavir is decreased when taken concurrently with protein pump inhibitors. - Avoid concurrent use. If necessary to administer concurrently, separate medication administration concurrently, separate medication by 2 to 12 hr. The beneficial effects of clopidogrel can decrease with concurrent use. - Monitor thrombotic events. Nursing administration: - Do not crush, chew, or break sustained-release capsules. - Do not open capsule and sprinkle contents over food to facilitate swallowing. - Clients should take omeprazole once per day prior to eating in the morning. - Encourage clients to avoid alcohol and irritating medications, such as NSAIDs. - Active ulcers should be treated for 4 to 6 weeks. - Pantoprazole can be administered to clients by IV. In addition to slow incidence of headache and diarrhea, there can be irritation at the injection site leading to thrombophlebitis. Monitor the - IV site for indications of inflammation (redness, swelling, local pain), and change the IV site indicated. - Teach clients to notify the provider for any indication of obvious or occult GI bleeding such as coffee- ground emesis. Mucosal Protectant: PROTOTYPE: Sucrasulfate Adverse effects: Constipation - To prevent constipation, encourage clients to increase dietary fiber and drink at least 1,500 mL/day if fluids are not restricted. Contraindications/ Precautions: -Pregnancy Risk Category B -Contraindicated in clients who are hypersensitive to the medication. -Use cautiously in clients who have kidney disease. Interactions: Sucralfate can interfere with the absorption of phenytoin, digoxin, warfarin, and ciprofloxacin. - Maintain a 2-hr interval between these medications and sucralfate to minimize interaction. Antacids interfere with the absorption of sucraflate. - Take sucralfate 30 min before or after antacids. Nursing administration: - Assist clients with the medication regimen. - Instruct clients that sucralfate should be taken four times a day, 1 hr. before meals, and again at bedtime. - Clients can break or dissolve the medication in water, but should not crush or chew the tablet. - Encourage clients to complete the course of treatment. Antacids: PROTOTYPE: Aluminum hydroxide Other: -Magnesium hydroxide -Calcium carbonate Adverse effects: Constipation, diarrhea - Aluminum and calcium compounds: constipation - Magnesium compounds: diarrhea 2) monitor uric acid levels, CBC, uric acid levels, urinalysis, liver and kidney function tests 3) allopurinol should be well-diluted and administered as an infusion over 30-60 min 4) avoid alcohol and food high in purine (red meat, scallops, cream sauces) 5) Prednisone is used for clients with acute gout who are unable to take or unresponsive to NSAIDS. - Miscellaneous Pain Medications: Adverse Effects of Ergotamine (RN QSEN – Safety, Active Learning Template - Medication, RM Pharm RN 7.0 Ch. 38) 1) GI upset (N/V); Administer an antiemetic, such as metoclopramide 2) Acute or chronic overdose (ergotism): Muscle pain, paresthesia in fingers and toes; peripheral ischemia 3) Physical dependence 4) Fetal harm or abortion 5) Contraindicated in clients who have renal and/or liver dysfunction, sepsis, hypertension, history of myocardial infarction, and CAD, as well as during pregnancy & Pregnancy Risk Category X. - Diabetes Mellitus: Evaluating Understanding of Insulin Self-Administration (RN QSEN - Patient- centered Care, Active Learning Template - Medication, RM Pharm RN 7.0 Ch. 39) 1) When mixing short-acting insulin with longer-acting insulin, draw the short-acting insulin up into the syringe first, then the longer-acting insulin. This prevents the possibility of accidentally injecting some of the longer-acting insulin into the shorter-acting insulin vial. (This can pose a risk for unexpected insulin effects with subsequent uses of the vial. 2) NPH and premixed insulins should appear cloudy. Do not administer other insulins if they are cloudy or any insulins that are discolored or if a precipitate is present 3) Instruct clients to administer subcutaneous insulin in one general area to have consistent rates of absorption. 4) Vials of premixed insulins can be stored for up to 3months under refrigeration. 5) Store the vial that is in use at room temperature, avoiding proximity to sunlight and intense heat. Discard after 1 month. - Endocrine Disorders: Client Teaching About Antidiuretic Hormones (RN QSEN - Patient-centered Care, Active Learning Template - Medication, RM Pharm RN 7.0 Ch. 40) 1) Antidiuretic hormone (ADH), produced by the hypothalamus and stored in the posterior pituitary, promotes reabsorption of water within the kidney 2) In general, clients should reduce fluid intake during therapy 3) Monitor ECG and blood pressure. Advise clients to notify the provider of chest pain, tightness, or diaphoresis 4) Monitor vital signs, central venous pressure, I&O, specific gravity, and laboratory studies (potassium, sodium, BUN, creatinine, specific gravity, osmolality), BP & HR 5) Intranasal desmopressin starts with a bedtime dose. I&O is monitored. When nocturia is controlled, doses are given twice daily 6) Reduction in the large volumes of urine output associated with diabetes insipidus to normal levels of urine output. - Endocrine Disorders: Adverse Effects of Thyroid Hormone (Active Learning Template - Medication, RM Pharm RN 7.0 Ch. 40) 1) Overmedication can result in indications of hyperthyroidism (anxiety, tachycardia, palpitations, altered appetite, abdominal cramping, heat intolerance, fever, diaphoresis, weight loss, menstrual irregularities) 2) Chronic overtreatment can cause atrial fibrillation and an increased risk of fractures from bone loss, especially in older adults. 3) TSH levels should be monitored at least once a year 4) Use cautiously in obese patients, older adults and those with cardiovascular problems (hypertension, Adverse effects: Allergies/ Anaphylaxis: - Interview clients for prior allergy. - Advise clients to wear an allergy identification bracelet. - Observe for allergic reactions for 30 min following parenteral administration of penicillin. Renal impairment - Monitor kidney function & I&O. Hyperkalemia, dysrhythmias (high doses of penicillin G potassium) Hypernatremia (IV ticarcillin-clavulante) - Monitor cardiac status and electrolyte levels. Contraindications/Precautions: - A history of severe allergic reactions to penicillins, cephalosporin, or imipenem is a contraindication for penicillins. - Use cautiously for clients who have or are at risk for kidney dysfunction (clients who are acutely ill, older adults, or young children). - Clients who are allergic to one penicillin are cross-allergic to other penicillins and are at risk for cross-sensitivity to cephalosporins. Interactions: - Penicillin in the same IV solution as aminoglycosides inactivates the aminoglycoside. Do not mix penicillin and aminoglycosides in the same IV solution. - Probenecid (treats Gout) delays the excretion of penicillin. Providers sometimes add probenecid to prolong the action of penicillin therapy. Nursing Administration: - Instruct clients to take penicillin V, amoxicillin, and amoxicillin-clavulanate with meals. Tell them to take all others with 8 oz. of water 1 hr. before or 2 hr. after meals. - Instruct clients to report any signs of an allergic response such as dyspnea, a skin rash, itching, and hives. - Give IM injections cautiously to avoid injecting into a nerve or an artery. - Advise clients to complete the entire course of therapy, even if symptoms resolve. - Advise client to use an additional contraceptive method when taking penicillins. Cephalosporins: PROTOTYPE: Cephalexin, first generation First generation: Cefazolin (IM/IV) Second generation: Cefaclor, cefotetan (PO) Third generation: Ceftriaxone, cefotaxime (IM/IV) Fourth generation: Cefepime (IM/IV) Adverse effects: - Allergy, hypersensitivity, anaphylaxis, possible cross-sensitivity to penicillin. - If indications of allergy appear (urticaria, rash, hypotension, dyspnea), stop the cephalosporin immediately, and notify the provider. - Question clients carefully about a history of allergy to a penicillin or another cephalosporin, and notify the provider if present. - Bleeding tendencies from cefotetan and ceftriaxone - Avoid use for clients who have bleeding disorders and for clients taking anticoagulants. - Observe clients for bleeding. - Monitor prothrombin and bleeding times. Delays in clotting can require discontinuation of the - medication. - Administer parenteral vitamin K. - Thrombophlebitis with IV infusion - Rotate injection sites. - Administer as a dilute intermittent infusion or slowly over 3 to 5 min and in a dilute solution for bolus dosing. - Renal Insufficiency - Giver lower dosage of most cephalosporin to prevent accumulation to toxic levels. - Pain with IM injection - Administer IM injections deep into a large muscle mass such as into the ventrogluteal site. - Antibiotic-associated pseudomembranous colitis - Observe for diarrhea, and notify the provider if present. - Stop the medication. Contraindications/Precautions: - Do not give cephalosporins to clients who have a history of severe allergic reactions to penicillins. - Use cautiously with clients who have renal impairment or bleeding tendencies. Interactions: - Disulfiram reaction (intolerance to alcohol) occurs with simultaneous use of alcohol and either cefotetan or cefazolin. Instruct clients not to consume alcohol while taking these cephalosporins. - Probenecid (gout) delays renal excretion. Monitor I&O. Nursing Administration: - Instruct clients to complete the entire course of therapy, even if symptoms resolve. - Advise clients to take oral cephalosporins with food. - Instruct clients to store oral cephalosporin suspensions in a refrigerator. Carbapenems: PROTOTYPE: Imipenenem-cilastaton (IM/IV), Meropenem (IV) Adverse Effects: - Allergy, hypersensitivity, possible cross-sensitivity to penicillin or cephalosporins - Monitor for indications of allergic reactions, such as dyspnea, rashes, and pruritus. - Question clients carefully about their history of allergy to a penicillin or other cephalosporin, and notify the provider if present. - Gastrointestinal upset (nausea, vomiting, diarrhea) - Observe for manifestations, and notify the provider if they occur. - Monitor I&O. - Suprainfection - Monitor for indications of colitis (diarrhea), oral thrush, and vaginal yeast infection. Contraindications/ Precautions: - Imipenem-cilastatin is a Pregnancy Risk Category C medication.