A patient has been taking naltrexone (ReVia) as part of the treatment for addiction to heroin. The nurse expects that the naltrexone will have which therapeutic effect for this patient? Naltrexone prevents the cravings for opioid drugs B.
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Naltrexone works as a safer substitute for the heroin until the patient completes withdrawal C. The patient will experience flushing, sweating, and severe nausea if he takes heroin while on naltrexone D. If opioid drugs are used while taking naltrexone, euphoria is not produced; thus, the drug's effects are lost. The nurse is asked to participate in medication reconciliation for one of the patients for which the nurse is providing care. Medication reconciliation is a new process for the nurse, who seeks guidance from the preceptor before the process begins.
The preceptor provides some written information and reviews the process verbally. Each of the following steps and the nurses role is outlined by the preceptor: A verification, clarification, and reconciliation. What should occur in the verification phase? Is a 60-year-old African-American male who has been recently diagnosed with essential hypertension.
His blood pressure readings before medication therapy had been between 160/110 mm Hg and 150/104 mm Hg. The nurse is seeing J.R. Today for a follow-up blood pressure reading after the patient has been taking hydrochlorothiazide (HydroDIURIL) and diltiazem (Cardizem). His blood pressure is 128/92 mm Hg. The patient asks the nurse about a combination pill that his friend takes called Zestoretic (lisinopril and hydrochlorothiazide). He says, 'I want my doctor to switch me to that drug so that I will only have to take one pill.'
What is one concern that the nurse may have regarding a switch to Zestoretic in this patient? You are caring for a patient who has just been admitted to the surgical unit from the post-anesthesia care unit.
The patient, a 40-year-old man, has had a surgical repair of a small bowel perforation. His medical history includes depression, for which he takes an antidepressant medication, as well as chronic lower back pain. He has taken both opioid and nonopioid pain medications regularly for the past 10 years for his back pain. He also has a history of chronic renal insufficiency. He has a nasogastric (NG) tube connected to suction and is ordered to be NPO (nothing by mouth) at present. He has the following medications prescribed for pain management: OxyContin CR20 mg, crush and administer via NG tube every 12 hours -Hydrocodone/acetaminophen, crush and administer via NG tube every 4 hours as needed for mild to moderate pain -Meperidine IV every 3 hours as needed for severe pain You have reviewed the pain medications that have been prescribed for the patient. What questions might you raise with the prescribing physician?
Which of the following is true regarding meperidine (Demerol)? Meperidine (Demerol) given intravenously (IV) is the preferred choice for severe pain, as it has few adverse effects, and has little addictive potential B.meperidine (Demerol) for severe pain is contraindicated in patients with renal impairment, as a toxic metabolite, normeperidine, may accumulate and cause adverse effects. The patient has a history of renal insufficiency; therefore, this medication is never to be used for severe pain. Since meperidine (Demerol) decreases seizure threshold, it should not be given to this patient. Is a 76-year-old female patient who has been diagnosed with osteoarthritis of the right knee.
She also has a history of hypertension and is taking a diuretic and an ACE inhibitor to manage her blood pressure. She is being seen at the medical clinic with complaints of increasing pain in her knee. She states that she has been researching herbal and dietary supplements and has recently started taking glucosamine, chondroitin, ginkgo, and ginseng for her arthritis. She also takes one aspirin a day 'to keep me from having a heart attack.' During this visit, she is given a prescription for ibuprofen. What potential interactions that may occur when the ibuprofen is added to the other drugs and supplements that Mrs.
Is currently taking. A patient has been prescribed clonidine (Catapres). It is to be applied topically. During the patient teaching, the patient asks why it is given on the skin instead of taking a pill by mouth. What is the nurse's most appropriate response? The use of the medication on the skin will provide greater pain relief.'
The use of the medication on the skin will decrease the risk of tachycardia.' The use of the medication on the skin will prevent migraine headaches. The use of the medication on the skin will provide a longer effect.' A patient is admitted with a fever of 102.8° F (39.3° C), origin unknown.
Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain stat urine and blood cultures and to administer an antibiotic intravenously. The nurse will complete these orders in which sequence?
Blood culture, antibiotic dose, urine culture B. Urine culture, antibiotic dose, blood culture C. Antibiotic dose, blood and urine cultures D. Blood and urine cultures, antibiotic dose. When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs?
The penicillin will cause an enhanced anticoagulant effect of the warfarin B. The penicillin will cause the anticoagulant effect of the warfarin to decrease. The warfarin will reduce the antiinfective action of the penicillin.
The warfarin will increase the effectiveness of the penicillin. The nurse is monitoring a patient who has been on antibiotic therapy for 2 weeks. Today the patient tells the nurse that he has had watery diarrhea since the day before and is having abdominal cramps. His oral temperature is 101° F (38.3° C). Based on these findings, which conclusion will the nurse draw? The patient's original infection has not responded to the antibiotic therapy.
The patient is showing typical adverse effects of antibiotic therapy. The patient needs to be tested for Clostridium difficile infection. The patient will need to take a different antibiotic. A patient has been receiving isosorbide mononitrate for Angina. Today, the provider changed the order to ranolazine (Ranexa) The patient questions the nurse, 'What is the difference in these drugs?' Which response by the nurse is correct?
There is no difference in these two drugs.' Ranolazine (Ranexa) works faster than than isosorbide mononitrate.' Ranolazine (Ranexa) improves your myocardial oxygen exchange along with ejection fraction. Ranolazine (Ranexa) often works well for those who have angina that is not responsive to nitrates. The nurse is reviewing new medication orders for a patient who has an epidural catheter for pain relief. One of the orders is for the patient to recieve 40 mg enoxaparin (Lovenox) SC q 12h. The treatment teams plans include discontinueing the epidural later in the day since the patient is doing well on po pain medication.
Which of the following should be part of the nurse's priority action? Give the LMWH as ordered. Double-check the enoxaparin order with another nurse, and then administer as ordered. Stop the epidural pain medication, and then administer the enoxaparin as ordered. Contact the prescriber to clarify the enoxaparin dose/schedule obtaining a time when epidural catheter will be discontinued. A patient is in an urgent care center and is receiving treatment for mild hyponatremia (Na+ 130) after spending several hours doing gardening work in the heat of the day.
The patient states, I drink alot of H20 and alwyas seem to have calf cramping during the summer months. The nurse anticipates which of the following? Encouragement of patient to increase H20 to avoid dehydration. Intravenous bolus of 1 liter of D5W solution, to replenish electrolytes C.
Normal saline infusion at 75ml/hr IV for 24 hours D. Administration of sodium chloride tablets. A patient is receiving low-molecular-weight heparin to prevent thromboembolic complications.
The nursing student asks her instructor the reason why this treatment is given instead of heparin. What is the instructor's best explanation of the rationale for LMWH over heparin? LWMH is associated with stronger anticoagulant effects than standard heparin.'
'LWMH is given to patients who have a history of blood dyscrasia.' 'LWMH is more effective than standard heparin for patients with hypertension.' 'LMWH is associated with less thrombocytopenia than standard heparin.' The nurse is reviewing new medication orders for a patient who has an epidural catheter for pain relief.
One of the orders is for enoxaparin (Lovenox), a low-molecular-weight heparin (LMWH). Plans include to discontinue the epidural later in the day.
What is the nurse's priority action? Give the LMWH as ordered. Double-check the LMWH order with another nurse, and then administer as ordered. Stop the epidural pain medication, and then administer the LMWH.
Contact the prescriber because the LMWH should be held for at least 12 hours before epidural catheter is discontinued. A patient is being administered heparin IV and has been started on warfarin (Coumadin). The patient asks the nurse why she is taking both medications. What is the nurse's most accurate response? 'Warfarin cannot be given without heparin due to the amount of clotting you need.' 'You will need both warfarin and heparin for several days.'
Warfarin takes 3-5 days to develop anticoagulant effects, and you still need heparin.' 'After a certain period of time, you must start warfarin and heparin together.'
A patient is admitted to the surgical division after a mastectomy. The patient has a PCA pump and states to you that she is fearful she will overdose on morphine.
Which of the following interventions is most appropriate to teach the patient? 'The device will give you a placebo when you press it often.' 'If you follow the instructions, that won't happen to you.' 'The device is preset, so you cannot receive more than you need.' 'The pump will administer all of the doses, so you don't have to worry.' A patient has been prescribed ropinirole (Requip). She states, 'I don't know why they are giving me this medicine.
I don't have restless leg syndrome.' What is the nurse's best response in teaching this patient with newly diagnosed Parkinson's disease about ropinirole (Requip)? 'Your doctor must have written the prescription wrong. I will call her.' 'You are mistaken; ropinirole is not used for restless leg syndrome.' Ropinirole is used for restless leg syndrome and migraines, not parkinsonism.'
You are right about ropinirole, but it is also used in early Parkinson's disease.'
Course Information Course: Ultrasound - Image Interpretation Series Module: Abdominal Ultrasound: Miscellaneous Module Description: Audience: Sonographers Prerequisites: It is suggested that you complete 'Image Interpretation - Abdmominal Ultrasound: Introduction and Image Optimisation. This session considers the sonographic appearance of bowel, abdominal lymphadenopathy and ascites. It will provide a basic overview and discuss common pitfalls to avoid. Tips on reporting will be offered. Bulk CEU Sales Discontinued As of April 1, 2017, the Philips Online Learning Center no longer offers Online Education Accounts for the advance purchase of bulk continuing education units (CEUs). We will, however, continue to offer CEUs with the purchase of individual courses.
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