saunders rationales

Pyridostigmine is a cholinergic medication used to increase muscle strength for the client with myasthenia gravis. For the client who has difficulty chewing, the medication should be administered 30 minutes before meals to enhance the client’s ability to eat.

Senna works by changing the transport of water and electrolytes in the large intestine, which causes the accumulation of water in the mass of stool and increased peristalsis.

Heparin sodium is an anticoagulant. The client who receives heparin sodium is at risk for bleeding. The nurse monitors for signs of bleeding, which includes bleeding from the gums, ecchymoses on the skin, cloudy or pink-tinged urine, tarry stools, and body fluids that test positive for occult blood.

The main function of digoxin is inotropic. It produces increased myocardial contractility that is associated with an increased cardiac output. This causes a rise in the BP in a client with CHF. Digoxin also has a negative chronotropic effect (decreases heart rate) and will therefore cause a slowing of the heart rate. As cardiac output improves, there should be an improvement in respirations as well.

Valium, a benzodiazepine, can cause motor incoordination and ataxia and safety precautions should be instituted for clients taking this medication.

Pitocin produces uterine contractions. Uterine contractions can cause fetal anoxia. The nurse monitors the fetal heart rate and notifies the physician of any significant changes.

Nateglinide (Starlix) is an antidiabetic medication used to treat type 2 diabetes mellitus in clients whose disease cannot be adequately controlled with diet and exercise. It stimulates the release of insulin from beta cells of the pancreas by depolarizing beta cells, leading to an opening of calcium channels. Resulting calcium influx induces insulin secretion.

Rifampin (Rifadin) is an antitubercular medication used in conjunction with at least one other antitubercular agent for initial treatment or retreatment of tuberculosis. Urine, feces, sputum, sweat, and tears may become red-orange in color. The client should also be told that soft contact lenses may become permanently stained as a result of this harmless side effect. There is no useful reason for the client to provide a urine sample. The client is not told to stop a medication. Antacids are not usually taken with a medication because of interactive effects.

Vancomycin hydrochloride (Vancocin) is an antibiotic. Adverse and toxic effects include nephrotoxicity characterized by a change in the amount or frequency of urination, anorexia, nausea, vomiting, and increased thirst; ototoxicity characterized by hearing loss due to damage to the auditory branch of the eight cranial nerve; and red-neck syndrome from too rapid injection of the medication characterized by chills, fever, fast heartbeat,
nausea, vomiting, itching, rash and redness on the face, neck, arms, and back. When this medication is administered to a client, nursing responsibilities include monitoring renal function laboratory results, intake and output, and hearing acuity.

Tamoxifen citrate is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentration of receptors such as the breasts, uterus, and vagina. Frequent side effects include hot flashes, nausea, vomiting, vaginal bleeding or discharge, pruritus, and skin rash. Adverse or toxic effects include retinopathy, corneal opacity, and decreased visual acuity.

Diphenoxylate with atropine (Lomotil) is an antidiarrheal. The client should not exceed the recommended dose of this medication because it may be habit-forming. Since this medication is an antidiarrheal, it should not be taken with a laxative. Side effects of the medication include dry mouth and drowsiness.

Tolterodine tartrate is an antispasmodic used to treat overactive bladder and symptoms of urinary frequency, urgency, or urge incontinence. It is contraindicated in urinary retention and uncontrolled narrow-angle glaucoma. It is used with caution in renal function impairment, bladder outflow obstruction, and gastrointestinal obstructive disease such as pyloric stenosis.

Metamucil is a bulk-forming laxative. It should be taken with a full glass of water or juice, and followed by another glass of liquid. This will help prevent impaction of the medication in the stomach or small intestine. The other options are incorrect.

Cyclosporine is an immunosuppressant medication used to prevent transplant rejection. The client should be especially alert for signs and symptoms of infection while taking this medication, and report them to the physician if experienced. The client is also taught about other side effects of the medication, including hypertension, increased facial hair, tremors, gingival hyperplasia, and gastrointestinal complaints.

Aldactone is a potassium-sparing diuretic and the client needs to avoid foods high in potassium, such as whole grain cereals, legumes, meat, bananas, apricots, orange juice, potatoes, and raisins. Option c provides the highest source of potassium and should be avoided.

Lactulose retains ammonia in the colon, promotes increased peristalsis and bowel evacuation, expelling ammonia from the colon. It should be taken with water or juice to aid in softening the stool. An increased fluid intake and a high-fiber diet will promote defecation. If nausea occurs, the client should be instructed to drink cola, eat unsalted crackers, or dry toast. It is not necessary to notify the physician.

Digoxin is an antidysrhythmic. The most common early manifestations of toxicity are gastrointestinal (GI) disturbances such as anorexia, nausea, and vomiting. If these manifestations occur, the physician needs to be notified. Digoxin blood levels need to be obtained as prescribed to monitor for therapeutic plasma levels (0.5 to 2.0 ng/mL). The client is instructed to take the pulse, hold the medication if the pulse is below 60 beats per minute, and notify the physician. The client is instructed to wear or carry an ID bracelet or card.

Buspirone (BuSpar) may be administered without regard to meals and the tablets may be crushed. It is premature to advise the client to call the physician for a change in medication without first trying alternative interventions. Mixing the tablet uncrushed in custard will not ensure ease in
swallowing. Dissolving the tablet in a cup of coffee is not the best instruction to provide to the client because this measure may not ensure that the client will receive the entire dose.

The medication should not be mixed with food or formula because this method would not ensure that the child receives the entire dose of medication. Options a, b, and c are correct. Additionally, if a dose is missed and is not identified until 4 or more hours later, that dose is not administered. If more than one consecutive dose is missed, the physician needs to be notified.

The client needs to be instructed to use a second birth control method during the first pill cycle. Options a, b, and c are correct. Additionally, the client needs to be instructed that if she misses three pills, she will need to discontinue use for that cycle and use another birth control method.

Drowsiness occurs as a side effect and usually disappears with continued therapy. The client should be instructed that if dizziness occurs to change positions slowly from lying to sitting, before standing. Smoking reduces medication effectiveness. Gastrointestinal disturbances can occur as an occasional side effect and the medication can be given with food if this occurs.

Signs and symptoms of Parkinson’s disease usually begin to resolve within 2 to 3 weeks of starting therapy, although in some clients marked improvement may not be seen for up to 6 months. Clients need to understand this concept to aid in compliance with medication therapy.

The therapeutic range for serum phenytoin levels is 10 to 20 mcg/mL in clients with normal serum albumin levels and renal function. A level below this range indicates that the client is not receiving sufficient medication, and is at risk for seizure activity. In this case, the medication dose should be adjusted upward. A level above this range indicates that the client is entering the toxic range and is at risk for toxic side effects of the medication. In this case, the dose should be adjusted downward.

Amoxicillin is a penicillin. Adverse effects include superinfection, such as potentially fatal antibiotic-associated colitis, that results from altered bacterial balance. Symptoms include abdominal cramps, severe watery diarrhea, and fever. Frequent side effects of the medication include gastrointestinal disturbances (mild diarrhea, nausea, vomiting), headache, and oral or vaginal candidiasis.

Acetazolamide (Diamox) is a carbonic anhydrase inhibitor. Nephrotoxicity and hepatotoxicity can occur and is manifested by dark-colored urine and stools, pain in the lower back, jaundice, dysuria, crystalluria, and renal colic and calculi. Bone marrow depression may also occur.

Amphotericin B is an antifungal medication. Adverse effects include nephrotoxicity evidenced by a decrease in urinary output and the nurse needs to monitor fluid balance and renal function tests for potential signs of this adverse effect. Cardiovascular toxicity, evidenced by hypotension and ventricular fibrillation, can occur but is rare. Anaphylactic reactions are also rare. Vision and hearing alterations, seizures, hepatic failure and coagulation defects may also occur.

Spironolactone (Aldactone) is a potassium-sparing diuretic. The nurse should be alert to the fact that the client taking spironolactone may experience body image changes due to threatened sexual identity. These body image changes are related to decreased libido, gynecomastia in males, and hirsutism in females. Since the medication is a diuretic, edema and weight gain should not occur. Excitability is not associated with the use of this medication; rather, drowsiness may occur.

Calcium channel blocking agents, such as diltiazem hydrochloride (Cardizem), are used cautiously in clients with conditions that could be worsened by the medication. These conditions include aortic stenosis, bradycardia, heart failure, acute myocardial infarction, and hypotension. The nurse would assess for signs and symptoms that indicate worsening of these underlying disorders. In this question, the nurse assesses for signs and symptoms indicating heart failure.

Silver sulfadiazine (Silvadene) is a cream used for extensive burn wounds. Significant systemic absorption may occur if applied to extensive burns. Side effects of the medication include pain, burning, itching and a localized rash. Systemic side effects include anorexia, nausea, vomiting, headache, diarrhea, dizziness, photosensitivity, and joint pain.

Sulindac (Clinoril) is a nonsteroidal antiinflammatory medication (NSAID). Frequent side effects include gastrointestinal (GI) disturbances including constipation or diarrhea, indigestion, and nausea. Dermatitis, a rash, dizziness, and a headache are also frequent side effects.

Filgrastim is a biologic modifier that stimulates production, maturation, and activation of neutrophils. Therefore the nurse would monitor the client’s neutrophil count. The platelet count measures the amount of platelets; a decreased level places the client at risk for bleeding. The blood urea nitrogen and creatinine level measures renal function.

Blood dyscrasias can occur as an adverse effect of fluphenazine decanoate. Leukopenia is indicative of a low white blood cell count and places the client at risk for infection. The nurse would monitor the client for signs of infection such as a sore mouth, gums, or throat. Blurred vision, dry mouth, and constipation are occasional side effects of the medication but are not indicative of leukopenia.

Life-threatening hypokalemia can occur with the administration of amphotericin B. Therefore, the nurse monitors the results of serum potassium levels, which should be prescribed at least biweekly during therapy. Magnesium levels should also be monitored.

Sulfonylureas are hypoglycemic agents that lower the blood glucose. Acetohexamide (Dymelor), chlorpropamide (Diabinese), glyburide (DiaBeta), and tolbutamide (Orinase) are sulfonylureas. If a sulfonylureas is administered with a sulfonamide (option a), increased glycemic effects can occur.

Synercid is an antimicrobial agent. One adverse effect of the medication is superinfection, including antibiotic-associated colitis, which may result from bacterial imbalance. If the client develops diarrhea, the medication should be withheld, and the physician is notified. The nurse would not discontinue the medication. The nurse would not administer an antidiarrheal unless specifically prescribed by the physician.

Monopril is an angiotensin-converting enzyme (ACE) inhibitor that lowers blood pressure. It can cause tachycardia as a side effect of therapy, making option b incorrect. Other side effects of the medication are neutropenia and agranulocytopenia, making options c and d incorrect.

Impotence is a common side effect of labetalol and may be distressing to the client. Other side effects of this medication are bradycardia, weakness, and fatigue. Night blindness is unrelated to this medication, although this medication can cause blurred vision and dry eyes.

Hypokalemia can result from long-term use of casanthrol (cascara sagrada), which is a laxative. The medication stimulates peristalsis and alters fluid and electrolyte transport, thus helping fluid to accumulate in the colon. The normal range for potassium is 3.5 to 5.1 mEq/L. The normal range for sodium is 135 to 145 mEq/L.

Enoxaparin is an anticoagulant that is administered to prevent deep vein thrombosis and thromboembolism in selected clients at risk. It is not used to treat urinary calculi, migraine headaches, or multiple sclerosis.

Quinidine gluconate is an antidysrhythmic medication used as prophylactic therapy to maintain normal sinus rhythm after conversion of atrial fibrillation and/or atrial flutter. It is contraindicated in complete AV block, intraventricular conduction defects, abnormal impulses and rhythms caused by escape mechanisms, and in myasthenia gravis. It is used with caution in clients with preexisting asthma, muscle weakness, infection with fever, and hepatic or renal insufficiency.

Benzonatate is a locally acting antitussive. Its effectiveness is measured by the degree to which it decreases the intensity and frequency of cough, without eliminating the cough reflex.

Auranofin (Ridaura) is a gold preparation that is used as an antirheumatic. Gold toxicity is an adverse effect and is evidenced by decreased hemoglobin, leukopenia, reduced granulocyte counts, proteinuria, hematuria, stomatitis,
glomerulonephritis, nephrotic syndrome, or cholestatic jaundice. Anorexia, nausea, and diarrhea are frequent side effects of the medication.

Accupril is an angiotensin-converting enzyme (ACE) inhibitor. It is used in the treatment of hypertension. The client should be instructed to rise slowly from a lying to sitting position and to permit the legs to dangle from the bed momentarily before standing to reduce the hypotensive effect. The medication does not need to be taken with meals. It may be given without regard to food. If nausea occurs, the client should be instructed to take a noncola carbonated beverage and salted crackers or dry toast. A full therapeutic effect may be noted in 1 to 2 weeks.

Glycerin is an emollient that is used for dry, cracked, and irritated skin. Aspercreame and Myoflex are used to treat muscular aches. Acetic acid solution is used for irrigating, cleansing, and packing wounds infected by Pseudomonas aeruginosa.

The client with cirrhosis has impaired ability to metabolize protein because of liver dysfunction. Administration of lactulose aids in the clearance of ammonia via the gastrointestinal (GI) tract. Ethacrynic acid is a diuretic. Folic
acid and thiamine are vitamins, which may be used in clients with liver disease as supplemental therapy.

Triamterene is a potassium-sparing diuretic, and clients taking this medication should be cautioned against eating foods that are high in potassium, including many vegetables, fruits, and fresh meats. Because potassium is very water-soluble, foods that are prepared in water are often lower in potassium.

The client is taking famotidine, a histamine receptor antagonist. This implies that the client has a disorder characterized by gastrointestinal (GI) irritation. The only medication of the ones listed in the options that is not irritating to the GI tract is acetaminophen. The other medications could aggravate an already existing GI problem.

Cola, coffee, and chocolate contain xanthine and should be avoided by the client taking a xanthine bronchodilator. This could lead to an increased incidence of cardiovascular and central nervous system side effects that can occur with the use of these types of bronchodilators.

The client should be taught that ketoconazole is an antifungal medication. It should be taken with food or milk. Antacids should be avoided for 2 hours after it is taken because gastric acid is needed to activate the medication. The client should avoid concurrent use of alcohol, because the medication is hepatotoxic. The client should also avoid exposure to sunlight, because the medication increases photosensitivity.

The nurse should always inspect the vial of insulin before use for solution changes that may signify loss of potency. NPH insulin is normally uniformly cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In this situation, because potency is questionable, it is safer to discard the vial and draw up the dose from a new vial.