Edmunds: Introduction To Clinical Pharmacology, 8th Edition: Answer Keys - in Text Critical Thinking Questions

Edmunds: Introduction to Clinical Pharmacology, 8th Edition
Answer Keys - In text Critical Thinking Questions
Chapter 1: Pharmacology and the Nursing Process in LPN Practice
1. a. S
b. O
c. The nurse is actually determining that the patient’s oxygen levels have decreased (by means
of objective data). However, concluding that the patient is short of breath is subjective on the
nurse’s part.
d. The nurse is concluding that the patient’s abdomen is tender, but this is subjective on the
nurse’s part. Tenderness and pain are subjective data that can be obtained only from the
patient. For example, “Patient states abdomen is tender to touch.”
e. S
f. O
g. O (If based on previous, observable data.)
h. S
i. S
j. S (This is based on information the patient has provided.)
2. In order to safely administer medications to multiple patients, the nurse must first verify all
medication orders with respect to their accuracy and completeness, according to institutional
policy. All medications ordered for each patient should be related to that patient on the basis of
his or her medical diagnosis. Each patient will also need to be assessed by the nurse for any
changes in status that may have occurred since receiving the last dose of medication. The nurse
should determine and gather whatever special equipment is needed for the patients (such as juice
or applesauce) and the nurse (such as syringes). The appropriate medications should then be
prepared and poured. They should then be administered according to the “Six Rights”: the right
drug at the right time in the right dose by the right route (verified by checking medication
orders), to the right patient (verified by checking ID bands), and documented in the right manner
after administration (according to facility policy). Appropriate documentation also includes
relevant patient data before administering the medication, e.g., fingerstick blood sugar results
before administering insulin or BP/apical rates before administering antihypertensive or cardiac
medications. The nurse may wish to administer medications to those patients requiring less
assistance first and then spend additional time with those patients requiring more assistance (e.g.,
those having difficulty swallowing). The patient also retains the right to decline medications.
3. Pain assessment (S data that is obtained from the patient)

Respiratory assessment (O data that is obtained by counting the patient’s respiratory rate and
noting the respiratory pattern as to rhythm and depth)
Note the time the medication was last given (O data that assesses the length of time since the last
dose was received). Has an appropriate length of time elapsed before another dose can be
administered per current physician orders? If not, the nurse should follow up with the physician
regarding modification of the patient’s pain management.
Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Answer Keys - In text Critical Thinking Questions 2
Assess the effectiveness of morphine as an analgesic for the patient:

• Did the morphine relieve the patient’s pain (S)?
• When did the patient begin to experience pain after the previous dose (S)?
• Is the morphine producing side effects such as drowsiness or respiratory depression (O)?
4. Planning refers to the nurse’s proposed intervention(s) after considering all available patient
data. Evaluation involves analyzing the implemented actions (plan) for their effectiveness.
Nurses revise the plan of care based on their evaluations of previous nursing actions and the
patient’s response (outcome), whether that response is physiologic, psychosocial, or emotional.
In fact, this revision is the planning for further nursing interventions. The following is an
example specific to drug administration.
If a patient is experiencing nausea, a nurse may administer an oral antinausea medication. If the
patient subsequently vomits, the nurse may determine that because the patient’s nausea has now
progressed to vomiting, the patient remains uncomfortable. If the patient states that he still feels
nauseated, the nurse will determine that a different route of administration is indicated for the
medication to be absorbed and effective (rectal suppository).
5. If a patient refuses a medication, the nurse should first assess the patient for pain, discomfort
(for example, nausea), and emotional or mental status or behavioral changes (for example,
confusion, lethargy, irritability). The nurse should then try to ascertain the patient’s reason for
refusing the medication.
A frequent occurrence in facilities is the use of different brand name or generic products than
those with which the patient may be familiar. The oral medication may simply look different, and
the patient may think an error is being made with his medication. In this case, offering the patient
this information may resolve the situation. The nurse should again verify the medication order
and proceed according to the “Six Rights.”
If the patient continues to refuse, the nurse may wish to allow the patient some time to reconsider
and offer the medication again at a later time (according to facility policy and appropriate
administration time frame for the specific medication), if this is realistic for the situation.
Nurses should remember that a “Sixth Right” exists, which is the patient’s right to refuse any
treatment, including medications. If the patient continues to refuse, the occurrence should be
documented according to facility policy.
6. Evaluation of the medication effectiveness, as well as evaluation for side effects or adverse
reactions, is a continual process. Effectiveness and untoward effects can change. Without
continual assessment, the presence or absence of any of these, as well as any changes that may
occur, can be missed.
7. Three essential areas of assessment include the following:

• Any medications the patient is currently taking, including oral contraceptives, hormones,
over-the-counter preparations, vitamins, or complementary therapies.
• Patient history of any allergies, sensitivities, adverse reactions to any medications, foods,
or environmental substances. (For example, many vaccines are chicken egg-derived,
including the influenza vaccine; patients allergic to chicken, eggs, or feathers should not
receive it.)

• The patient’s medical history. Other conditions or disorders can contraindicate the use of
some medications. (For example, many cough syrups are sugar-based and diabetics
should be advised regarding the use of these products.)
Chapter 2: Patient Teaching and Health Literacy
1. The first step in developing any patient teaching plan is to determine the patient’s level of
understanding of his disease process, and the impact he sees it having on his life. The nurse can
then develop a teaching plan addressing educational needs according to the patient’s priorities.
This will increase patient compliance with the prescribed treatment regimen.
2. Use of therapeutic communication techniques can encourage patients to verbalize their

concerns. This is essential for nurses to identify and address patient needs and increase the
likelihood of patient compliance with their treatment and medication regimens.
An example of this would be asking open-ended questions that do not imply a “right” or “wrong”
answer and that cannot easily be answered with a simple “yes” or “no.” (Example, “How did you
sleep last night?” Instead of, “Did you sleep OK?”)
Cautious use of “Why?” questions is also important. These may be perceived as judgmental or
expressing the nurse’s disapproval. (Example: “I see you stopped taking your Lasix. Tell me
about that,” instead of, “Why did you stop taking your Lasix?”)
There are many aspects of patient care that involve the use of therapeutic communication
techniques. As you continue with your nursing education, review the information in your
textbooks and notes about the various techniques nurses use to obtain essential data from
patients. Reflect on your student-patient interactions to determine whether there were things you
might have asked or answered differently. You will find this helpful in order to devise
appropriate nursing care plans for your patients.
3. • a. This can be interpreted as any time(s) throughout the day, as long as the tablets are not
taken at the same time. Offer suggestions of actual times (as appropriate for the specific
medication). Examples would include, “You can take one of these at 10 in the morning, and the
other at 6 in the evening,” or, “As long as you take them at least 6 hours apart, you can pick the
times most convenient for you to take these. Just try to take them at the same times each day.”
• b, c, d, and e are similar: “slices” would be a better term to use; “pieces” assumes the patient
understands standard serving sizes, which is what he needs to learn. “Dish” is a subjective term;
“2 ounces uncooked” is objective. “Glasses” can refer to many things found in a kitchen cabinet;
“8 ounces” is a precise liquid measurement. A “cup of coffee” is rarely 6 ounces. If your patient
uses coffee mugs, “cutting down to two cups” would be an improvement but may still be well
above his recommended intake of either fluids or caffeine for 24 hours.
Think about your conversations with friends and family for other examples of phrases that could
result in different interpretations similar to those discussed above.
4. Student answers will vary.

Chapter 3: Legal Aspects Affecting the Administration of Medications
1. Three levels of regulations include federal, state, and agency or facility.
2. Federal drug legislation is concerned with ensuring the safety of medications, controlling
dangerous drugs, and limiting abuse; it describes the conditions under which certain medications
may be given. State legislation outlines who may prescribe, dispense, and administer
medications, and under which conditions they may do so. Agency regulations further establish
guidelines and policy regarding medication administration, including reporting and
documentation.
3. Schedule I drugs are those drugs for which a high potential for abuse exists; there is also no
recognized or accepted medical use for these drugs in the United States. Examples include
heroin, and LSD. Schedule II drugs also have a high abuse potential and may lead to severe
psychologic or physiologic dependence; they do have recognized medical uses, however.
Examples include meperidine, morphine, and oxycodone. Schedule III drugs have a high
potential for abuse and they may lead to low or moderate physiologic dependence or a high
degree of psychologic dependence. They also have recognized medical use. Examples include
acetaminophen with codeine and aspirin with codeine.
4. Suggestions include researching the levels of educational preparation with regard to nurses
legally able to assume “charge” positions in acute care versus subacute or long-term care
facilities, “impaired nurse” provisions, and practice settings for RNs versus LPN/LVNs.
5. Suggestions include researching policies for (1) administration of medications classified as

“critical care” or “ICU” drugs; (2) situations under which these drugs are to be administered and
by whom; (3) administration of IV “push” versus IV “piggyback” medications; and (4) the time
period within which medications must be administered in order to remain in legal compliance
with established legislation (such as the Public Health Code).
6. A drug order form is written by the physician on the patient’s order sheet, which is located in
the front of a hospitalized patient’s medical record. The nurse forwards this order to the
pharmacy. The pharmacy then fills an appropriate medication order by dispensing the medication
to the nursing care unit (floor) where it will be administered to the patient according to the
original physician’s order. In this case, the medication orders will be included with other patient
care orders, such as diet and activity. A prescription is a medication order written on a
specialized pad, or order form, by a health care provider authorized to prescribe medications
(examples are MDs and dentists). Prescriptions are most often used for hospitalized patients
about to be discharged or for patients in the community. The prescription must be delivered to
the pharmacist (usually done by the patient); the pharmacist will then dispense the appropriate
medication. A verbal order is an unwritten order given by a physician in emergency situations or
in situations in which a patient’s status has changed but the physician is not on site. In this case,
the physician may need to give a nurse additional instructions for patient care (i.e., new orders)
but may be unavailable to write them in the patient’s chart. (If accomplished via telephone, these
are referred to as telephone orders.) Most facilities have policies regarding the nursing staff
members who may accept any type of verbal order, as well as under what circumstances. In

general, verbal orders must be written in the patient’s chart by the nurse receiving them and
cosigned by the ordering physician within 24 hours.
7. A standing order means that the medication is to be administered until it is discontinued by the
physician or the order expires, as per facility policy (“ampicillin 500 mg po qid × 10 d”). A stat
order is a one-time medication that is to be administered immediately (“Give 10 mEq K-Lor po
stat.”). A now or NOW order must be carried out within 1½ hours. A single (or single dose) is a
medication which is to be administered one time, usually at a specified time (“Give @ 10:00 AM
today.”). Prn medications are to be given according to patient need and are based on the nurse’s
assessment of patient safety; pain medication is often ordered in this manner (“Meperidine 50 mg
IM q4h prn for incisional pain; hold for respirations below 12/min.”).
8. Any discrepancy in the narcotic count must be analyzed and explained. All nurses with access
to the narcotics keys must be questioned regarding the narcotics they administered during that
shift; actions must be retraced to ensure that all narcotics given were appropriately documented.
The original shift-to-shift narcotics count must be rechecked against the inventory on hand at the
beginning of the shift in question. The nursing supervisor and the pharmacy must be notified per
your institution’s policy if the discrepancy cannot be resolved at this point.
9. Be sure to assess the patient; notify the physician and the nursing supervisor (according to
individual facility policy); and document the occurrence per your institution’s policy.
10. If any portion of a medication order is unclear to the nurse who will be administering the
medication, the prescribing physician must be contacted so that he or she can be asked directly
what the order should read. If the medication was ordered as “stat” or “NOW,” or if it involves
insulin, heparin, or Coumadin, for example, the physician will have to be contacted much sooner
than if the medication in question is of a routine nature or is to be administered later in the shift
or the next day. Most facilities have written policies addressing this issue. These policies may
also include the LPN/LVN’s need to inform his or her supervising RN before contacting a
physician, due to constraints in some areas regarding the acceptance of telephone orders. The
nurse should never administer a medication based on what the order “looks like.” This can result
in serious consequences for the patient.
Chapter 4: Foundations and Principles of Pharmacology
1.
Generic name Chemical name Official name Brand name
phenobarbital 5-ethyl-5- Phenobarbital Luminal, Solfoton
phenylbarbituric acid
metronidazole 2-methyl-5- Metronidazole Flagyl
nitroimidazole-1-
ethanol
cephalexin HCl 7-(D--amino-- Cephalexin Keflex
phenylacetamido)-3-

methyl-3-cephem-4-
carboxylic
acid, monohydrate
albuterol α1-[(tert- Albuterol Proventil
Butylamino)methyl]-
4-hydroxy-m-xylene-
α,α'-diol sulfate (2:1)
(salt)
diazepam 7-chloro-1,3-dihydro- Diazepam Valium
1-methyl-5-phenyl-
2H-1,4-
benzodiazepin-2-one
2. A generic drug cannot always be substituted for a brand name version. This is because
differences in processing or formulation can result in differences in the body’s absorption,
distribution, or metabolism of the drug. These potential variances can in turn lead to differences
in drug action.
3. Drug selected: warfarin (Coumadin)

a. Adverse reaction: Increased or severe bleeding
Anaphylactic reaction: Onset signaled by fever and rash.
Desired action: Inhibits vitamin K-dependent activation of clotting factors; decreases blood
coagulation by prolonging time necessary to clot
Drug interaction: Several, including NSAIDs and aspirin; concurrent use will increase the risk of
spontaneous or severe bleeding; food-drug interactions also exist that can block the action of
warfarin in the body (intake of excessive amounts of green leafy vegetables, for example, as they
contain large amounts of vitamin K)
Side effects: Anorexia, nausea, vomiting, diarrhea, rash
b. Side effects are unpleasant for patients but are, essentially, expected during the course of
medication therapy. They are not usually serious and are most frequently managed by changing
dosages or frequency of administration. Adverse reactions can pose serious risks to the patient,
are unexpected, and often require discontinuing the medication for the patient’s safety.
4. Drug selected: Heparin IV or SC
Process Definition Action

Absorption The way in which the drug Through the blood in veins or
passes into the body’s tissues subcutaneous tissue
and fluids.
Distribution The way in which the drug is By the blood in veins or
transported to its site of action absorbed by subcutaneous
in the body. tissue
Metabolism The use of the medication by By the liver
the body, usually by the liver.
Excretion Removal of the medication
by-products from the body.

5. Absorption can be affected by gastrointestinal (GI) disorders, particularly those of the small
intestine. This is where the majority of nutrients and other substances are absorbed for the body’s
use when taken into the body through the GI tract. Areas of the body with significant edema, as
would occur with congestive heart failure, have limited and uneven distribution of medications
because of the fluid the drug would need to pass through in order to reach the intended tissues.
Metabolism of medications would be affected by any disorder of the organ responsible for
processing and detoxifying the specific drugs, usually the liver or kidneys. If these are impaired,
metabolism of the medication may take more time or may not occur at all. In these cases, drugs
may circulate for longer periods of time and can have longer-lasting effects. Accompanying this
impaired drug metabolism, excretion of medications will be affected by any disorder of the
organs responsible for their elimination. This may be the kidneys or the large intestine, in some
cases. Dysfunction of any of the organs of drug excretion can also lead to prolonged action of the
medication, because it will remain in the body longer than intended.
6. Displacement: Warfarin and phenytoin compete with (displace) each other for the same
binding sites on plasma proteins.
Incompatibility: Tricyclic antidepressants may lead to hypertension and convulsions when used
with MAO inhibitors.
Interference: Antacids will block gastric absorption of iron compounds.
7. This is an undesirable side effect of codeine, but it is not a drug allergy. Although it is
unpleasant for the patient, the resulting constipation is a result of the codeine’s effects on muscle
tissue. It is considered a local effect, unlike allergic reactions, which are systemic (affecting the
whole body).
Chapter 5: Lifespan and Cultural Modifications
1. The recommended dosages for digoxin are as follows:

Infants-2 yrs: 0.01-0.02 mg/kg po qd, divided q12h
2-10 yrs: 0.012 mg/kg po qd, divided q12h
>10 yrs-adult: 0.125-0.5 mg qd
>65 yrs: 0.125 mg qd or qod
Differences in dosages are the result of immature or decreased liver and kidney function and
differences in muscle mass, body surface area, and body fat. All of these considerations vary
among growth and developmental stages.
2. Although this question can be appropriately designated a class discussion issue, it may be
more effective as a small-group discussion exercise, with the instructor acting as facilitator. The
point to be emphasized is that no one group’s beliefs are “best”; all beliefs are to be respected
without judgment by nurses.
3. Recommended resources include cultural nursing texts, medical-surgical nursing texts, and
nursing journals.

4. Treating any individual solely as a member of the ethnic group to which he or she belongs
does not take into account his or her unique needs as an individual; this is not in keeping with
nursing process and individualized care plan formulation. In a broader health care sense, this
perspective is also limiting in its approach and can be dangerous to the patient. “Black,”
especially in the United States, encompasses many diverse cultures, including Haitian, urban
black Americans, Creole, and those patients whose country of origin is any of the African
nations. By remaining unaware of a patient’s cultural background (and also, therefore, of his
values and belief systems), information essential to developing a therapeutic relationship will not
be available to the nurse. Formulation of a realistic and effective plan of care will be unlikely.
5. Some factors to be considered include the following:

• Her cultural and religious beliefs, because they may affect her use of medications in
general, or specifically while she is pregnant
• Her asthma symptoms, if any; when they occur, what are her “triggers”? How her asthmatic
attacks can be detrimental to her baby
• Depending on her specific type of medication, discuss the risks they pose to the health of
her developing baby at this and later stages of her pregnancy.
6. You should explore Ms. Kim’s perception of this “pill.” Asian cultures view pain and pain
management stoically; she may believe that she is appearing “weak” by taking this particular
medication. The need for the preoperative medication must be clarified for Ms. Kim. She may
not understand that this medication is a necessary aspect of her preparation for surgery, not a pain
medication. She may also have taken a similar “pill” in the past with resulting unpleasant side
effects or actual adverse reactions. This possibility must also be explored by the nurse. If,
however, the nurse is not convinced of Ms. Kim’s level of comprehension, the medication should
be withheld until appropriate communication with this patient is possible.
7. No medications are considered completely safe during pregnancy, although some medications
are known to pose risks only at specific stages of fetal development. Medications administered or
recommended to pregnant women are done so on an individual basis, in which the mother’s need
for the medication is weighed against any potential effects it may have on the baby. In general,
pregnant women are cautioned to avoid any over-the-counter (OTC) or prescription medications
during their first trimester of pregnancy without first checking with their obstetric provider. If
diabetes, seizure disorder, or other chronic illnesses are factors, these must be evaluated on an
individualized basis. Medication regimens may be modified or changed for the entire pregnancy,
or only during certain stages. Products pregnant women should avoid altogether include those
that will increase the likelihood of bleeding (aspirin, NSAIDs), abdominal cramping, or any
changes in heart rate or blood pressure (this includes OTC cold preparations). Many herbal
preparations, alcohol, and products containing caffeine (coffees, teas, colas, chocolate) are also
generally restricted during pregnancy. If you are in doubt about the content of any medication, a
pharmacist should be consulted. Whether a particular medication is appropriate during pregnancy
must be discussed with the obstetrical care provider.

8. Note that people often fail to get prescriptions filled because they are costly. They may stop a
treatment or medication because the symptoms “went away” or they “felt better and didn’t need
it anymore.”
9. Patients depend on nurses to be reliable and accessible. During busy hospital or long-term care
shifts, it is often helpful to explain to a patient that you are not as available as you would like to
be right now, but that you will be back in 10 minutes. It is important that the nurse keep that
“appointment” with the patient. Patients benefit from consistency. This is one way of providing
consistency and allowing opportunities for patients to ask questions about issues significant to
them. It is also important that nurses perform whatever skills are necessary in the most
competent manner. In addition to providing safe nursing care, this allows patients to see that they
are the most important component in patient care delivery. All of these behaviors on the nurse’s
part will send the message that the patient’s welfare is the priority. This will be helpful in any
aspect of patient care, but particularly regarding patient teaching. If the nurse is showing genuine
concern that a patient learn about his medication regimen (as opposed to simply handing him a
few pills to swallow), the likelihood of meaningful patient participation will be increased.
10. It would be important to first find out why Mrs. Jones feels this way. Many people are
misinformed about immunizations and are fearful that their children will experience adverse
effects from them. Mrs. Jones should be aware that her child is at serious risk for developing
childhood diseases that often have severe consequences (whooping cough or polio). By not being
immunized, or by being underimmunized, her child may not only contract any of these
devastating diseases but can also infect others with them. In addition, her child will not be
allowed to attend public and private schools in the United States, because they require current
immunization status for admission. This generally includes day care centers, preschools, and
nursery schools in most areas of the country.
11. Answers will vary based on student experiences.
Chapter 6: Self-Care: Over-the-Counter Products, Herbal Therapies, and Drugs for Health
Promotion
1. OTC medications must be considered as part of an overall medication regimen. They have
active ingredients and cause drug reactions, as well as interactions (drug-drug and drug-food) in
the same manner as prescription drugs. In addition, as with prescription drugs, certain OTC
medications are contraindicated in patients with specific medical conditions such as hypertension
and glaucoma. In these cases, the OTC drug can make the preexisting condition worse. For
example, Sudafed can cause this patient’s blood pressure to rise to dangerous levels, even if he
continues to take his antihypertensive medications as prescribed. This man should be encouraged
to always check with his physician and/or pharmacist before using any OTC preparations.
2. Although gingko is considered safe and effective in improving circulation to the brain and
extremities, it potentiates (increases) the effects of anticoagulant medication, which Mrs. Brown
has been receiving. Mrs. Brown and her family need to be aware of her significantly increased
risk for severe and spontaneous bleeding.

3. Your OTC choice should be determined by your specific symptoms, such as sinus congestion,
runny nose (rhinorrhea), or coughing. Many OTC preparations are specific for the symptoms
being experienced; medication for symptoms not currently being experienced is unnecessary and
increases the risks of side effects or adverse reactions.
4. Most children, including those aged under 2 years to 12 years, can be given Tylenol, but the
safe dosage varies greatly with the child’s age (due to differences in development of the liver and
kidneys). Guidelines for administration must be strictly followed (examples would be not to
exceed the maximum number of doses within 24 hours and not to take the medication beyond the
maximum number of days recommended). Also, since the child may be experiencing other
symptoms such as cough, he or she may be receiving other OTC preparations that may be
alcohol based. This further increases the risk of adverse effects.
5. All medications, whether OTC or prescription preparations, are dangerous if taken

inappropriately (too frequently or in excess amounts). Safety measures to prevent this are
especially important when children may have access to any medications, including vitamins
(which are often packaged to be attractive to young children). Products should be stored with
these issues in mind: out of sight (the child should not be watching while the medication is being
put away), out of reach, and in the original, childproof container.
6. Both ginseng and black cohosh (not blue cohosh), among other herbal preparations, have been
found to be safe for the reduction of menopausal symptoms. However, ginseng has been found to
be of questionable effectiveness and may make symptoms worse; blue cohosh has been found to
be toxic and should not be used. Before beginning any medication regimen (this includes use of
herbal preparations), patients should have had a recent physical examination to rule out any other
medical problems that may be contributing to the symptoms. Patients should also check with
their health care providers and pharmacists regarding the safety of or need for any medication in
their specific situation. It is unwise for nurses to recommend any medication or preparation; this
borders on prescriptive ability and is not within nursing’s scope of practice for RNs or
LPN/LVNs.
7. Ascertain if any blood pressure or asthma symptoms begin or increase in relation to drinking
this tea. (Examples include an increased heart rate or “pounding” or any shortness of breath,
headache, anxiety, or chest “tightness.”) Also, try to determine when any prescription drugs are
taken in relation to drinking the tea, to minimize or rule out any potential interactions. If
possible, try to also determine exactly what ingredients are in the tea.
8. There is no significant difference between vitamins according to their manufacturer or brand

name; they are used in the same manner by the body. Health food store or “natural” or “organic”
preparations have not been shown to be of higher quality or greater effectiveness than grocery
store or pharmacy purchased stock, including store brands. It is possible, however, that some
vitamin preparations, if not FDA-regulated, may be of lesser quality, as government standards do
not apply to many “health food” products.

9. All of these patients would most likely have a multivitamin supplement recommended by their
primary health care provider.
• Any smoker is at risk for vitamin B and C deficiencies, due to the decreased absorption of
these vitamins caused by smoking tobacco products. An iron supplement would most likely
be indicated as well, for the same reason.
• A thin 5-year-old boy may be actively growing and may need dietary supplements if his
increased basal metabolic needs are not being met by his diet. (He may also require an
overall calorie increase, according to current RDA guidelines.)
• A 20-year-old female vegetarian may find it difficult to obtain adequate iron and calcium if
animal products are not consumed.
• Caffeine stimulates diuresis (increased urine production) and passage of food through the
GI tract; these actions decrease the absorption time of nutrients. Caffeine also interferes with
the absorption of many nutrients. A 30-year-old man with a significant caffeine intake
combined with an erratic diet is at increased risk for nutritional deficiencies.
• A 40-year-old woman with six children is at high risk for iron-deficiency anemia.
• A 35-year-old homeless man with liver cirrhosis is at severe risk for multiple nutritional
deficiencies. This is due to his lack of availability of an adequate diet and his liver’s impaired
ability to metabolize nutrients into hormones, enzymes, and other proteins that are crucial to
normal physiologic functioning.
• The body’s ability to metabolize nutrients decreases with age, putting a 60-year-old postal
worker at risk for nutritional deficiency. This individual may also require an increased caloric
intake (per current RDA recommendations) in order to accommodate the increased physical
activity requirements of the job.
10. Iron, calcium, and B-complex vitamins are all recommended for women of childbearing age.
Iron promotes proper hemoglobin production; calcium is required for proper bone and tooth
formation; and B-complex vitamins (especially folic acid) are strongly recommended to prevent
development of neural tube defects. All of these nutrients are also necessary for the prospective
mother to meet her metabolic needs during the increased demands of pregnancy.
Chapter 7: Preparing and Administering Medications
1. This is an independent student activity, so answers will vary.
2. This is an independent student activity, so answers will vary.
3.
Dose Form Description Indications
Buccal forms Solid particle held against the Rapid absorption of medication
mucous membrane of the cheek
Elixirs Clear liquid of drugs dissolved in Easier to swallow
water and alcohol
Emulsions Solutions with drops of water and Disguise the bitter taste and

medications dispersed in oil increase the solubility of the drug

Capsules Gelatin containers of medication; Timed-release medications
must be swallowed whole
Lozenges Medication in a hard sugar base; Local relief of discomfort; even
released when preparation is absorption by oral mucosa
sucked
Pills, tablets Dried, powdered, compressed Rapid absorption by GI mucosa
drugs; usually scored and marked
with some form of product
identification; may be coated to
enhance absorption
Suspensions Mixture of liquids with insoluble Easier to swallow for some patients
drug particles; must be shaken
before pouring
Syrups Liquids with a high sugar content Disguise the bitter taste of the
medication for pediatric patients
4. In addition to the nursing considerations relevant to nasogastric tube medication

administration, considerations unique to PEG tube medication administration include the
following: the PEG button should be irrigated with 5 to 10 mL of tap water after administration
of any feeding or medication via the PEG; the button should then be wiped with a cotton-tipped
applicator; the PEG should be flushed with 25 to 50 mL of tap water to maintain tube patency
after administration of any feeding or medication.
5. Nurses should not administer medication that they have not poured (the notable exception
being medication that comes from the manufacturer or the pharmacy already prepared). The
nurse has two choices in this type of situation: (1) the medication may be held (the
appropriateness of this option will depend on the type of medication in question) or (2) the
second nurse may pour and administer new medications for Mr. Johnson. In either case, Lisa
must have that information communicated to her. Proper and timely documentation and verbal
communication are essential in this instance.
6. Most facility policies require ID band identification of patients or residents. In this case, since
the nurse is quite familiar with this patient, identification of the patient would not seem to be the
priority; the patient’s mental status changes (groggy, confused) would require the nurse’s
attention and indicate the need for further and immediate assessment. A prudent course of action
would be to withhold the medication, assess the patient, notify the physician (depending on
assessment findings), and locate a new ID band for Mrs. Davis.
7. Standard precautions for preventing transmission of HIV are similar to those aimed at
preventing the transmission of any other blood-borne pathogen. They include considering all
patients as infected; use of gowns, gloves, masks, and protective eyewear when exposure to
blood or body fluids is likely; use of puncture-resistant sharps and hazardous waste containers;
not recapping needles after use; changing gloves after each contact with a patient; washing skin
surfaces immediately if contaminated and after removal of gloves (even if they remain intact);
and using a mouthpiece or other ventilation device when mouth-to-mouth resuscitation is

necessary. Pregnant health care workers should be especially aware of the risk of HIV
transmission to the infant perinatally.
8. The Z-track technique is a deep IM injection that uses the patient’s skin to seal the medication
into the muscle, preventing it from leaking out and causing irritation. The ventrogluteal site
should be used. A long needle should be selected. After drawing the medication up into the
syringe, 0.5 mL of air should be added (this is to ensure that all medication is expelled from the
syringe and needle, and does not leak into tissues as the needle is being withdrawn). The skin
should be pulled approximately 1” to one side. The nurse should then insert the needle, aspirate,
and inject the medication slowly. After waiting at least 5 seconds, remove the needle and allow
the skin to return to its usual position. The site should not be massaged, and pressure from
constrictive clothing should be avoided. Walking will help increase absorption. This method is
acceptable to use for any intramuscular injection but is generally reserved for medications that
require deep IM injection.
9.
Route Site Absorption Technique
Intradermal Dermis of inner aspect Very slow 15-degree angle, bevel
of forearm, upper chest, up; form bleb; 25g, 3/8-
or scapular area inch needle
SC Connective tissue below Slow; complete 45-degree angle into
dermis of upper skin roll; aspirate if not
arms/back; abdomen heparin; rotate sites; 25-
27g, 5/8-inch needle
IM Deep muscle mass of Rapid; complete Check landmarks;
dorsogluteal, rectus spread skin; 90-degree
femoris, vastus lateralis, angle; aspirate; rotate
ventrogluteal, deltoid sites; 20-22g, 5/8-inch
needle
IV Previously established Direct; immediate Strict aseptic into IV
access into metacarpal, access via venous
dorsal basilic, cephalic circulation
veins; scalp (children)
10. Bubbles can usually be removed from a filled syringe by removing the cap to the syringe or
needle and flicking the barrel of the syringe. This usually forces the air to the top of the syringe
and allows it to escape. If a significant amount of air is contained in the syringe, there will be an
inaccurate amount of medication drawn up and the patient will not receive the full dosage
ordered. In addition, air injected into body tissues can be quite uncomfortable and may impair
proper absorption. In the case of IV medications, air bubbles can be directly injected into the
general circulation with the medication, leading to embolism formation. Emboli can have severe
or life-threatening consequences for the patient if they lodge in areas where circulation or gas
exchange is impaired (i.e., lungs).
11. Forms of percutaneous medications include the following:

• Aerosols: usually administered as metered dose inhalers

• Astringents: wear gloves during administration

• Creams: wear gloves; rub into skin
• Disks or patches: contain timed-release medication for transdermal absorption; usually left
in place for 24 hours; the skin must be cleaned when the old patch is removed; rotate the sites
of application; wear gloves
• Lotions: water-based; need to be shaken before application; wear gloves; apply sparingly;
don’t rub into skin
• Ointments: oil-based; wear gloves; apply sparingly, according to application guide
(provides means of measuring amount applied); often covered with dressings
• Powders: particles in a talc base; wear gloves; spread evenly, but don’t rub in
• Shampoos: water- or alcohol-based; wear gloves; pour onto hair, let stand for designated
time, then rub into hair and scalp before rinsing
• Soaps: wear gloves
• Solutions: medications mixed with water or normal saline; used as washes, baths, or
dressings; directions for mixing solutions must be closely adhered to for proper dosage
administration; wear gloves during application or administration
12. Although the antiemetic is available as a suppository, the dosage may be different because of
differences in absorption rates between the oral and rectal routes. Unless the medication has been
specifically ordered by the physician to be administered by either route, with appropriate dosages
for both routes, the nurse would be administering an unprescribed, potentially dangerous dose of
medication to the patient. If specific orders addressing both routes are not in place, the
appropriate nursing action would be to notify the physician of the patient’s status and request an
order for the alternate route (with corresponding dose).
13-15. Student answers will vary.
Chapter 8: Allergy and Respiratory Medications
1. Signs and symptoms indicating a patient’s need for antihistamines are typically nasal and
ocular. They include sneezing, nasal congestion or rhinorrhea (runny nose), postnasal drip, and
possible increased frontal or maxillary sinus pressure.
2. Development of rebound phenomenon as a result of antihistamine use can be signaled by a

recurrence or increase of the symptoms previously experienced. One way of differentiating
rebound phenomenon from drug tolerance would be to monitor and assess Ms. Allbright after the
physician has changed her medication to another antihistamine, noting whether there is any
decrease in her symptoms. If her symptoms improve, it is likely that Ms. Allbright was
developing a tolerance to her previous antihistamine.
3. The nurse should ask Mr. Tracy how long he has had his cough; if it is it better or worse at
certain times of the day; if it keeps him awake when he is trying to sleep; what he has taken for
the cough (and whether anything has worked); if it is/was productive (if it is productive, what
was the appearance of the sputum); if he experienced any other symptoms; and if he has any
trouble breathing, any shortness of breath, or pain/discomfort. A productive cough should not be

suppressed. Expectoration is one of the respiratory tract’s defenses to rid the body of infection.
Allowing this mucus to remain in the respiratory tract creates an environment conducive to more
bacterial or viral growth.
4. Antitussives are commonly used to relieve coughing. They provide symptomatic relief by
suppressing the cough by various mechanisms. They are used for nonproductive coughs in order
to give the patient some rest from the energy spent coughing. Antitussives are generally not
recommended for productive coughs (refer to answer for Question 3). Symptomatic treatments
focus on relieving the symptoms (in this case, coughing), not treating the cause of the symptom
(which can be chronic irritation or infection).
5. Mr. Tracy should take the medication for the time period ordered and not change the amount
or frequency of medication taken. If his antitussive contains codeine, he should be made aware
of its potential for causing dependence. Mr. Tracy should not drink alcohol while taking this
medication; he should not take any other medication without first checking with his physician
and/or pharmacist. If he experiences nausea within a few minutes after taking his antitussive, he
should lie down. Other side effects to watch for include constipation (increase fluid and fiber
intake), drowsiness (do not drive or operate heavy machinery), dry mouth (increase fluids),
nausea (take with milk or food), and postural hypotension (get up from chairs or bed slowly and
stand for a few seconds before walking). As with all medications, this should be kept away from
anyone for whom it is not prescribed, especially children.
6. The nurse should explain to Ms. Henry that asthma attacks result from increased swelling and
mucus in her main airways, which can make these airways collapse. Air will become trapped
inside, making it difficult for her to “catch her breath.” As an attack progresses, she will hear
wheezing sounds as more air is trapped and forced through the smaller air passages. When an
attack occurs, there are certain medications that can help to relieve the spasms that cause the air
to be trapped inside the air passageways (treatment). It is more important to prevent an attack
from occurring, however, and there are other medications that can do this (prophylaxis). For
these preventive medications to work, Ms. Henry must not be having any symptoms of an
asthmatic attack for two reasons: (1) her closing airways will not allow enough of the medication
to be inhaled to work as they should and (2) these medications do not work on the airways after
the changes (swelling, inflammation, and increased mucus) have begun.
7. To properly use a Spinhaler, Ms. Henry should remove the protective wrapper from one
medication capsule and place the capsule into the inhaler (Spinhaler). She should then suck hard
on the mouthpiece of the Spinhaler. This will cause the medication to spin around in the chamber
and break into small particles that will move down into her air passages when she breathes in.
The Spinhaler should be washed after each use, and used when it is dry. Moisture will cause the
medication capsules to clump and could prevent Ms. Henry from receiving the right dose. This is
also part of the reason Ms. Henry should only breathe in when using the Spinhaler; breathing out
into it will add moisture to the medication. Ms. Henry should have follow-up visits with her
physician after 2 weeks of Spinhaler use and again within 2 weeks after the first visit. She should
experience improvement in her symptoms within 4 weeks. If she does not, or if her symptoms
get worse, she should notify her physician. The capsules should not be swallowed. They should
be protected from light, heat, and moisture (don’t store them in the medicine cabinet in the

bathroom). Clear as much mucus as possible from the airways before using the Spinhaler with
the medication. If Ms. Henry feels an asthma attack coming on, or if she cannot take a deep
breath and hold it, she should not use the medication. Ms. Henry should use the medication at the
same times every day, according to her physician’s order. Suddenly stopping this medication can
cause her to have an acute asthma attack. Decreasing the number of times each day she uses it
should only be done under her physician’s supervision. Ms. Henry may experience throat
irritation, dry mouth, or hoarseness; these can be prevented by rinsing her mouth or gargling after
each use. It is important for her to rinse her mouth and brush her teeth after each use, in any
event, to prevent possible tooth damage from this medication.
8. Nasal steroids are used for long-term management of asthma and are often used to reduce the
need for oral (systemic) corticosteroids. Systemic corticosteroids are generally used for
immediate management of asthma while long-term therapy is begun. They are also used for
management and prevention of asthma exacerbations. Nasal steroids may result in cough,
dysphonia, and oral candidiasis (thrush). Systemic steroids can result in abnormal glucose
metabolism (some patients will need to take insulin during steroid therapy), increased appetite,
fluid retention, weight gain, changes in mood, hypertension, and peptic ulcer development
when used even for a short time (a few weeks). With higher doses, growth suppression and
osteoporosis can develop. Long-term steroid use suppresses adrenal function, leading to even
more serious systemic effects.
9. Because antitussives are meant to suppress the cough reflex, they may seriously impair the
ability of a patient with a chronic pulmonary disease to expectorate secretions. This may lead to
the buildup of secretions inside the lungs and increase the patient’s respiratory difficulty.
10. Antihistamines suppress the release of histamine from body tissues, interfering with the
inflammatory response of the immune system. Both the PPD and skin testing for allergies
depend on this response for skin reactions to antigens or allergens. Taking an antihistamine will
suppress or minimize this reaction and may lead to a “false negative” reading, meaning that
because no skin reaction was visible (because the antihistamines prevented one from occurring),
the patient will be thought to have no reaction to the substance injected.
11. Ms. Harris needs to be made aware that decongestants can interact with her antihypertensive
medication to cause serious effects and may even cause her blood pressure to rise dangerously.
Her patient education should include reading OTC medication labels to look for cautionary
phrases regarding use by patients with high blood pressure. Asking the pharmacist to recommend
safe preparations would also be helpful.
Chapter 9: Antiinfective Medications
1. Because of their weakened immune systems, patients often develop mixed (bacterial and viral)
infections or secondary infections (in addition to the original infection, and caused by other types

of organisms). For this reason, patients with viral infections are often prescribed broad-spectrum
antibiotics.
2. Mrs. Johnson’s “scratchy throat” may have actually been a symptom of an allergic reaction
developing. Since the antibiotic prescribed today is a broad-spectrum antibiotic closely related to
penicillin, the strong possibility of cross-sensitivity or cross-allergy exists. The physician should
be informed before the antibiotic is administered to Mrs. Johnson.
3. Compliance with the medication regimen is crucial to control of tuberculosis. The patient’s
ability to understand and comply with his or her medication regimen must be evaluated at the
beginning of treatment and frequently during the course of tuberculosis chemotherapy. This is
also important to properly assess the patient for side effects from the medications.
4. Mr. Johannsen should be taught that his malaria is an infection caused by a protozoan, which
resulted from his being bitten by a carrier mosquito. The malaria sporozoites will grow and
divide in his red blood cells, where they mature and produce the symptoms of malaria infection.
The antimalarial drugs, such as the chloroquine prescribed for Mr. Johannsen, interfere with the
life cycle of the organism. However, these medications are not without risk and side effects.
They may produce hypotension, ECG changes, mild/transient headaches, urticaria, pruritus,
abdominal cramping, anorexia, diarrhea, nausea, vomiting, blood dyscrasias (especially anemia),
blurred vision, retinopathy, decreased hearing, tinnitus, irritability, and exfoliative dermatitis.
There are certain population groups in which use of antimalarials may cause hemolysis or
thrombocytopenia; this is one reason it is important that Mr. Johannsen return for periodic
evaluation. Other assessments will need to be made of his vision, hearing, and neurologic status.
An initial loading dose will be administered to Mr. Johannsen orally, followed by one half of the
loading dose on each of the next 2 days. He should take all his antimalarial medication as
directed by his physician (weekly, same day of the week for the duration of his treatment), and
should not stop taking his medication when his symptoms disappear. To decrease GI distress, he
can take his medication with food. He should report significant nausea, vomiting, diarrhea,
abdominal cramps, or anorexia. He should also report any muscle weakness or photosensitivity.
Any visual or hearing difficulties must also be reported immediately; his medication may have to
be discontinued. His skin may appear yellow, and he should avoid sun exposure. Because
dizziness and blurred vision may occur, Mr. Johannsen should be cautious about driving. Malaria
may recur. Mr. Johannsen should be educated regarding the life cycle of the causative organism
and the ways in which the various antimalarials work to prevent recurrences. He should be aware
of the signs/symptoms of a recurrent infection (fever, chills, and shaking) and notify his
physician if he experiences any of these.
5. Allergic or hypersensitivity reactions include fever, pruritus (itching), urticaria (hives),

erythema, decreased urination (indicating renal involvement), laryngeal edema, and anaphylaxis.
These reactions may manifest shortly after administration of the medication or they may take
several days to develop.
6. GI side effects are common among some types of penicillin. These are generally not indicative
of a developing sensitivity or allergy.

7. Sulfonamides have a bacteriostatic effect on a wide range of gram-positive and gram-negative

organisms. They are generally used to treat acute and chronic urinary tract infections, especially
those caused by E. coli. Ms. Keaton needs to be educated regarding the need to take all of her
medication as directed by her physician, especially when her symptoms are gone. Stopping her
antiinfective before completing the course of therapy will result in the return of her symptoms
and infection, caused by a drug-resistant strain of organism. Ms. Keaton should inform her
physician of any other medications she is taking and not take any other medications (including
OTC preparations) without checking with her physician and/or pharmacist, because of the risk of
drug interactions. Effects of oral anticoagulants, thiazide diuretics, and phenytoin will be
increased. Antacid use will decrease absorption of the sulfonamide if these drugs are taken
together. She should be made aware of the signs and symptoms of hypersensitivity and allergic
reactions, as well as other adverse and side effects that will have to be reported, such as hearing
difficulty; peripheral neuropathy; anorexia, nausea, vomiting, abdominal pain; any rash or fever;
periorbital edema; or hematuria. She may also need to be evaluated for hypothyroidism and
hypoglycemia.
8. She should not take any medication for her new infection until she is evaluated by her
physician, including the pills “left over.” She should also be prepared to provide another urine
sample so that the physician will be able to determine from a urine culture what medication the
causative organism will be most sensitive to. When devising a teaching plan for this patient, the
nurse should emphasize (1) the need to finish all of the medication prescribed as treatment, even
if Ms. Keaton has no symptoms after a few days; (2) another, stronger infection may develop if
she doesn’t take all of the medication as ordered; and (3) it may be caused by a different
organism that may be more difficult to treat.
9. Some suggested responses include letting the patient know that it will be important to talk to
her sexual partner(s) and have them come in for testing and treatment. It is important for all
exposed to be tested because they remain contagious without treatment and may have long-term
risks to their health if they are not treated.
10. MRSA means that he has an infection with methicillin-resistant streptococcus A, which is
commonly found on athletic mats. He will require special medication to clear up this infection.
It is also important to tell his coach about the infection so that the mats can be disinfected and
other wrestlers treated if they develop infections.
Chapter 10: Antivirals, Antiretrovirals, and Antifungal Medications
1. Many of the medications used in the management of HIV and AIDS are toxic to the kidneys
and liver. Combining these with other drugs significantly increases the risk of liver toxicity, as
well as the development of adverse effects. Many of these drugs also result in development of
peripheral neuropathies and blood dyscrasias. Serious drug interactions often result when these
medications are used concurrently with other medications. Many of these interactions occur with

drugs that do not usually cause drug-drug interactions, requiring careful monitoring and
assessment of patient status.
2. Adverse reactions that may occur with fungicide use include epigastric distress, nausea,
vomiting, and diarrhea; headache and dizziness; oral thrush infection, sore throat, and dry mouth;
black, furry tongue; photosensitivity, rash, and urticaria; angioedema and blurred vision;
arthralgia, malaise, and fever; abdominal pain, gynecomastia, impotence, and oligospermia;
vaginal discharge, proteinuria, bruising, changes in blood cells, and abnormal liver function tests.
In addition to the above, Mr. Delavan should be aware of the signs and symptoms of fungal
infection and overdose of his antifungal medication. He should not use alcohol while he is taking
this medication (he can experience tachycardia, flushing, confusion, and severe nausea and
vomiting). Treatment may have to continue for several weeks. Mr. Delavan should not decrease
or stop his antifungal medication when his symptoms improve or disappear; he should not
decrease or stop taking his medication until directed to do so by his physician. Good hygiene is
important in controlling fungal infections; skin, hair, and nails should be kept clean. Some
antifungals require an acidic environment for proper absorption. Mr. Delavan should wait at least
2 hours between taking antacids, anticholinergics, or H2 blockers and his antifungals. (Patients
with achlorhydria require special instructions.) Some medications are enhanced after ingestion of
a high-fat meal. Mr. Delavan will be evaluated for therapeutic effects of the medication, such as
disappearance of fever, shaking, and chills. He should be monitored for any signs of GI distress
and liver or kidney failure. Nausea, vomiting, or diarrhea can also indicate overdose. Mr.
Delavan may need to decrease his use of local municipal water supplies to limit his exposure to
organisms. Using bottled water for cooking and drinking may be recommended.
3. Mr. Delavan is much more likely to contract unusual or opportunistic infections because of his
immunocompromised status; his immune system cannot fight these organisms. Compliance with
a TB medication regimen is important; noncompliance or undercompliance can result in drug-
resistant strains of organisms. Extensive teaching regarding his additional medication regimen
must be implemented. Mr. Delavan needs to be aware of how susceptible he is to many types of
infection and that it is to his benefit to prevent infection rather than attempting to cure any
infections that he is likely to develop.
4. Mr. Harris may be experiencing side or adverse reactions of his antifungal medication. This is
especially likely if the symptoms he recently developed (nausea, vomiting, diarrhea) were not
originally present with his thrush infection but developed after taking the antifungal medication.
Increasing symptoms may indicate disease progression. Check the patient’s T-cell count, viral
load levels, and ability to adhere to his current anti-HIV medication regimen.
5. Standard precautions should be implemented when cleansing and dressing Mr. Harris’ Kaposi
sarcoma lesion. The precautions in this case should include proper handwashing before gloving
and following removal of gloves, as well as wearing a gown and face shield because the lesion is
weeping. Disposal of used equipment and dressing materials should be in hazardous biologic
waste receptacles. Increasing symptoms may indicate disease progression. Check the patient’s T-
cell count, viral load levels, and ability to adhere to his current anti-HIV medication regimen.

6. The nurse should plan to discuss the potential for HIV transmission during delivery and
breastfeeding; indications for AZT monotherapy for her (if not already initiated) and her
newborn; possible seroconversion of her infant; methods to control or prevent the spread of her
HIV infection; and the need for determining her hepatitis status.
7. Treatment of fungal infections often must be continued for several months. Ms. Lizz can assist
in this process by maintaining good hygiene of the affected areas; continuing to take her
antifungal medication as prescribed; not taking any other medications without checking with her
pharmacist or health care provider; and reporting any signs or symptoms of drug toxicity or
increased infection to her health care provider.
8. It is very likely that Ms. Sorenson has developed a yeast infection from her course of
antibiotics. Antibiotics destroy all bacteria sensitive to them, not only pathogenic ones such as
streptococcus. This includes the normal beneficial flora (bacteria) of the GI and genitourinary
(GU) tracts, which keep yeast and fungi under control. Taking antibiotics often allows yeast and
fungi to overgrow and produce symptoms such as Ms. Sorenson’s. The most common treatment
prescribed in this case is nystatin; various forms are available OTC.
9. Mr. Lopez could have a “cold sore,” which is a form of herpes simplex virus (HSV). Eruptions
are common around the mouth or on the oral mucosa and, like herpes infections in general, are
opportunistic (meaning they occur when someone is already physiologically or emotionally
stressed). Since Mr. Lopez mentioned he was recovering from a cold (which is usually the result
of a viral infection), his immune system was already somewhat compromised, making him
susceptible to HSV. Treatment is generally symptomatic. There are several OTC preparations
available, which work best when used at the first sign or symptom of infection (tingling,
numbness, burning of the area before eruption of the lesion occurs). Mr. Lopez will need patient
education about preventing the spread of the virus, especially if the lesion opens. The drainage is
highly contagious, so he should not share cups, glasses, utensils, towels, etc., or kiss anyone
during this outbreak.
Chapter 11: Antineoplastic Medications
1. All antineoplastic agents slow cell growth in order to delay metastasis; they especially affect
rapidly dividing and growing cells. Different types of antineoplastic agents may be used alone,
but they are generally used in combination with each other and with other treatments, such as
surgery and radiation therapy. The various categories of antineoplastic agents affect different
phases of the cell cycle and can be ineffective at any other phase. Using these agents in
combination therapy allows for greater effectiveness in interfering with the malignant cells at
several points in their replication process. Depending on the size and location of a malignancy, a
patient may have chemotherapy and radiation therapy in order to shrink the tumor and may then
undergo surgery to remove all or part of the tumor. Surgery may be followed by an additional
course of radiation and/or chemotherapy, in an effort to prevent further metastasis.

2. Antineoplastic agents adversely affect any active, growing cells. They cannot differentiate
between normal metabolic and malignant growth processes. This includes cells of the GI tract,
bone marrow, hair follicles, lymphatic and epithelial tissue (including oral mucosa), and ovaries
or testes. Adverse reactions associated with antineoplastic agents include anorexia, nausea,
vomiting, diarrhea, alopecia, and bone marrow depression.
3. A baseline evaluation of a patient’s status is the foundation by which effectiveness of treatment

can be measured. It is imperative to have accurate assessment information in order to determine
what progress is being made and what adverse effects may be occurring. Some patients respond
so adversely to the various treatments for malignant disorders that treatment must be held or
discontinued. In addition to data regarding the patients’ current physiologic status (including pain
assessment), the nurse also must obtain information regarding the patients’ perceptions of the
following: any changes in status (since last hospitalization, if appropriate); management of their
activities of daily living (ADLs); available support system; and their psychosocial status
(including their financial situation). Oncology nurse specialist, social service, and hospice
referrals may be appropriate at this time or at some time in the future.
4. The nurse’s ultimate responsibility is to always provide the safest and most competent nursing
care to patients. To accomplish this, complete data collection often requires referring to patient
records from previous hospitalizations. Additionally, it is essential that the nurse consult the
literature included with the many chemotherapy agents used in treatment to be aware of the most
current information available. Nurses should be aware that many of these agents may only be
administered by certified chemotherapy nurse specialists or physicians, and that health hazards
for both the practitioner and patient are often created by the use of many of these drugs (as well
as by improper disposal of the equipment used in their administration). Obtaining as much
information as possible from the patient, family, and other support systems is crucial to the
formation of an appropriate, effective nursing care plan. This will include appropriate assessment
and management of any pain the patient may experience; it will also involve the use of narcotics,
at times in higher dosages than many nurses routinely administer. It may also involve the use of a
variety of other medications including antiemetics, antidiarrheals, and skin care preparations.
Body image may also be of concern as hair loss, edema, and dehydration occur. Patient education
is indicated, as well as offering resources for obtaining a wig, if the patient desires. Mastectomy
patients often have serious concerns about their appearance and attractiveness; support groups
are often helpful in these instances. Nurses must be available for support and to offer patients and
families opportunities to discuss their concerns. It is helpful if a few nurses can consistently care
for oncology patients so that the opportunity to develop a therapeutic relationship can be
established. However, nurses often may not be able to provide the intensity of services these
patients require in a hospital setting. Referrals for social service (for financial and other issues)
and counseling (to assist the patient and support system in effectively coping with their
emotional needs) may be indicated in many patient situations. Hospice services may also be
appropriate for cancer patients, in relation to home care and inpatient services as patients’ needs
change.
5. Correct administration of chemotherapeutic agents will vary according to the specific agent
being used, and patient education will also vary accordingly. The following is some general
information. Actively growing body cells will be most affected by these medications, even if

they are not cancer cells. Especially affected will be skin cells, those inside the mouth, and the
hair. Nurses often advise patients to suck on ice chips or wear an icecap (with supervision) while
receiving IV chemotherapy; this has been shown to reduce the discomfort and loss in these body
areas. Also affected will be cells of the GI tract. Patients should be made aware that they may
experience nausea, vomiting, and diarrhea for this reason. They may find that sips of cool liquids
and small, frequent snacks may be easier to tolerate than larger amounts or volumes. Bone
marrow cells are also affected; these provide protection from infection and blood clotting cell
particles. Patients need to be taught to protect themselves from infection (not to visit with people
who have colds; provide neutropenic precaution teaching); to recognize signs and symptoms of
infection in themselves; and when to initiate their own bleeding precautions (a cut that continues
to ooze, bleeding from gums; need for soft toothbrush, no razor blades, no popcorn). Many of the
effects of these drugs (therapeutic or adverse) may be noted within a short period of time;
adverse effects, especially, may be experienced within hours of administration.
However, many of these effects may not surface for several days or weeks; patients need to be
made aware that this is to be expected. It is possible that, due to the development of adverse
reactions (especially neutropenia resulting from bone marrow depression), therapy will be
suspended until the symptoms resolve. The patient should be reassured that (in most cases), it
will be resumed once the affected body system begins to recover. Patients should be educated
regarding symptoms that must be immediately reported to their practitioner. These symptoms
include difficulty breathing; vision problems; hearing problems; skin rash or jaundice; slowed
clotting, easy bruising, or bleeding; signs of infection (temperature increase, not necessarily
fever; drainage from a cut, especially if it has an odor [even if without redness or tenderness];
difficulty or discomfort voiding [including burning on urination]).
6. Because of her disease process and her chemotherapy, she will be at great potential risk for
immunocompromise. This is secondary to her malignancy and the bone marrow suppression
resulting from her chemotherapy. Ms. Reynolds should be cautioned regarding her greatly
increased susceptibility to infection, which may result from any immunizations her daughter may
receive containing live (including attenuated, or weakened) organisms. Recommend that Ms.
Reynolds discuss these issues with her daughter’s health care provider before the scheduled
school physical appointment.
7. Cancer chemotherapy is most effective at certain stages of the malignant cell’s life cycle. The
various classes of chemotherapy affect the cell differently, depending upon where the malignant
cell is in its growth cycle. If the particular form of cancerous tumor is not metabolically active,
chemotherapy will most likely have little effect on it, but healthy cells may still be destroyed.
Additionally, the patient will still be subject to any adverse effects the drugs may cause. Mr.
Sorrento’s oncologist may feel that waiting until the tumor cells become more active (i.e., when
they increase their growth and reproduction, the point at which they are most vulnerable to the
effects of chemotherapy) would be more appropriate treatment for his form and stage of cancer.
8. Evaluations of blood and bone marrow, followed by kidney and liver function tests. A basic
CBC with differential can offer an accurate picture of bone marrow function by evaluating
production and function of blood components. Red and white cell numbers, shape, and size can
indicate bone marrow and immune system function; platelet count can indicate a patient’s bone
marrow and bleeding status. Liver and kidney function tests (AST, ALT, bilirubin; BUN,

creatine) can indicate if the chemotherapy is becoming toxic to either of these organ systems.
These general laboratory evaluations are often the basis for dosage adjustments, or determining if
the chemotherapy should be discontinued for a period of time until the bone marrow, liver, or
kidneys recover function.
Chapter 12: Cardiovascular and Renal Medications
1. Points to address with Ms. Henson include the following:

• Nitroglycerin (NTG) in this form is meant to be placed under the tongue—not chewed or
swallowed.
• Decrease intake of caffeine (increases heart rate), alcohol (potentiates NTG), and nicotine
(causes vasoconstriction).
• NTG must be stored and carried in the original, dark glass container and away from heat,
light, and humidity. Don’t carry NTG mixed with other medications, and replace it every 3
months. NTG is flammable and should not be used around fire or sparks.
• She may experience severe headaches when she begins taking NTG; this should wear off as
she becomes more tolerant of the drug’s vasodilating effects. She should also change
positions slowly after taking any tablets, since NTG can cause a decrease in blood pressure,
and she may experience lightheadedness.
• Persistent headache, vision difficulties (especially blurred vision), or dry mouth should be
reported to the practitioner.
• Her symptoms should improve with NTG therapy: shortness of breath should decrease,
activity tolerance should increase, and chest pain should occur much less frequently (if at
all).
• After taking three SL NTG tablets (5 minutes apart) without relief, 911 should be called.
Ms. Henson may be having a myocardial infarction (MI), and this must be treated or ruled
out immediately.
2. Class I antidysrhythmics (quinidine, procainamide) prolong the time period during which
myocardial cells are not able to discharge their electrical impulses; they slow the action of
sodium on the heart muscle, making it less excitable.
Class II antidysrhythmics (beta blockers) reduce sympathetic stimulation of the heart. Class III
antidysrhythmics (amiodarone) prolong the length of time the electrical impulse is in one cell
(action potential). Class IV antidysrhythmics (verapamil) selectively block calcium ions from
entering the myocardial cells; they prolong the resting phase in the AV node (refractory period).
3. ECG monitoring is essential because most antidysrhythmic medications may also create other
dysrhythmias, particularly if serum electrolytes (notably K+, Na+, and Ca2+) become imbalanced.
Patients should be educated regarding signs and symptoms of electrolyte imbalances, such as
fatigue, visual disturbances, anorexia, nausea, vomiting, diarrhea, and muscle weakness or
twitching. Patients will also need to be educated regarding taking their own radial pulses, as well
as about the side effects and adverse reactions of their specific medications, which may include
palpitations, shortness of breath, chest pain, slowed or rapid pulse, nausea, vomiting, diarrhea or
constipation, dry mucous membranes, rash or itching, increased or decreased blood sugar, and
hypotension.

4. For those patients with types of hyperlipidemia/hypercholesterolemia that respond to dietary

intervention (Types II, III, and IV), nurses should focus their patient education on ways in which
patients can lower their serum cholesterol levels. (Dietary management should always be
attempted before medication therapy is initiated.)
Recommendations can be made that include reducing the intake of whole-fat dairy products
(changing from whole milk to 2% and gradually working down to skim milk); reducing the
intake of butter and cheeses (cheese is also high in sodium; this reduction may also be beneficial
if hypertension management is indicated); and familiarizing patients with appropriate portion
sizes and the need to reduce intake of animal fats (i.e., red meats). Many of the
antihyperlipidemic medications are prescribed to be taken with food or at bedtime. Patients
should be given appropriate information regarding the need to maintain this regimen. The liver
synthesizes cholesterol at night; taking certain of these drugs at that time will have the greatest
effect on cholesterol production. Other medications used in cholesterol-lowering treatment will
have to be taken with meals to enhance their absorption, to affect the liver’s cholesterol
production during mealtime absorption of the dietary fats necessary for cholesterol synthesis, and
to minimize the GI effects of the medications. Because these medications directly affect liver
functioning, patients must know that regular medical follow-up and liver function tests are
necessary. Also, since many of these medications interfere with fat digestion and metabolism,
reducing dietary fat intake in order to lower cholesterol levels will also result in fewer GI side
effects from reduced fat absorption (bloating, increased gas production, abdominal cramping,
foul-smelling stools). For those products that must be reconstituted, mixing them with soups,
juices, or flavored gelatin (fruit can be added also) can make them more convenient and
palatable. High-water-content fruits will aid in dissolution of the powder and also mask the taste
somewhat: for example, pineapple, grapefruit, watermelon, and cantaloupe. Patients should
maintain fluid intake of at least 2 liters per day. Fiber should be encouraged to prevent
constipation. However, because these medications may also cause diarrhea and increased gas
formation, patients should be cautioned to increase their fiber intake gradually and to stop adding
fiber if any of these GI symptoms occur.
5. In addition to being aware of the information included in the answer for Question 4, nurses
should include the following when devising an initial teaching plan for recently diagnosed
hypertension:
• Because diet is generally a significant component of initial hypertension management,
dietary modifications are often recommended. These modifications may include decreasing
caloric intake, as well as decreasing the intake of salt and high-sodium products (e.g., bacon
and ham) and saturated fats (animal and whole milk products such as butter, cheese, and ice
cream).
• Because of the potential for food-drug and drug-drug interactions, patients are also advised
to restrict their caffeine and alcohol intake, as well as their nicotine intake. (These substances
can also cause vasoconstriction, increasing peripheral vascular resistance to circulation and
actually working against antihypertensive drug therapy.)
• Patients can initiate a mild to moderate increase in their activity level. This will have to be
approved by their practitioner but can often be gradually implemented by simple
modifications such as parking farther away from their destination in store parking lots;

walking up one flight of stairs instead of taking an elevator; taking walks and increasing their
briskness and duration over several weeks.
• Any new or increased symptoms (shortness of breath, chest pain, edema, weight gain) must
be reported to the patient’s health care provider.
• Patients must also be educated regarding the generally asymptomatic nature of
hypertension. For this reason, it is important that they continue their medication and
adjunctive (diet and lifestyle modification) treatment regimens, even if they are feeling well
or begin to feel better.
• Patients will benefit most from their antihypertensive regimen if medications are taken at
the same time(s) each day, and with orange juice (if tolerated and allowed) as a potassium
source (especially important if also taking a potassium-wasting diuretic). Additional
potassium sources should be recommended in these cases.
• Doses should not be doubled if forgotten; if remembered within an hour or two of the
scheduled time, the missed dose can be taken.
• Many antihypertensive drugs can cause rebound (higher than present at diagnosis)
hypertension if they are abruptly discontinued; this is another reason medications must be
taken as prescribed. Regular medical follow-up and eye exams should be maintained because
of the changes that can occur in the retina as a result of uncontrolled hypertension.
• Male patients may experience impotence and need to be aware that many options for
antihypertensive medications exist. Their current medication can be adjusted. They should
inform their practitioner so that a change to a more suitable medication can be made, but they
should not self-discontinue their drug therapy.
• OTC preparations are particularly dangerous for a patient on antihypertensive medications.
Checking with the pharmacist before using any OTC preparations, especially those used to
decrease cold and allergy symptoms, is recommended.
• Although essential hypertension cannot be cured, it can be controlled and well-managed.
Patients should know that they can have a great deal of control over their hypertensive
management.
6. A dysrhythmia can lead to CHF because it can cause the heart to be an ineffective pump. If it
is severe enough, a dysrhythmia can allow circulation to either side of the heart to slow down
and back up. If this happens on the right side of the heart, the heart cannot effectively pump the
blood to the lungs for reoxygenation; it will back up into the right ventricle, right atrium, and
then back into the systemic circulation. If this happens on the left side of the heart, the blood will
back up into the lungs, causing pulmonary edema, and will also eventually back up into the right
ventricle. The heart will also become enlarged as the myocardium works harder to pump blood
against increasing vascular resistance.
7. Patients should be taught that their digoxin will make their heart beat stronger, but more
slowly; to take their radial pulse for a full minute (to do this they can turn their arm so the palm
is facing upward, place their fingers lightly on their wrist, and not use the thumb); and that they
need to take the digoxin exactly as prescribed in order to maintain an even level of it in their
blood. If patients forget to take their digoxin, they should be instructed to take it as soon as they
remember, if it is within a few hours of their regular time (if they take it once a day). If it is
several hours after their usual time, and they normally take it daily, they should contact their
provider for direction. (If a dose is forgotten for several hours and they normally take it every

other day, most providers will direct the patient to take the missed dose as soon as it is
remembered, but this will need to be clarified.) They should never “double-dose” a missed dose.
Follow-up medical and laboratory appointments should be kept, in order to ensure proper dosage
and effects, and to monitor for toxicity.
8. The most commonly exhibited signs and symptoms of digitalis toxicity, especially among
elderly clients, are anorexia and nausea, onset of new dysrhythmia, and potassium imbalances. A
patient receiving any digitalis preparation should be taught to take his or her own radial pulse for
a full minute at the same time each day. Nurses should follow these same guidelines, but check
the patient’s apical rate. Nurses should be aware that any GI symptoms may indicate toxicity, and
the patient should be educated regarding these symptoms and their possible significance. The
health care provider should be notified, and arrangements made for the appropriate digitalis and
electrolyte levels to be obtained as soon as possible. If digitalis toxicity is strongly suspected,
further doses should be withheld until the health care provider is made aware of the situation.
9. Phenazopyridine (Pyridium) is used for symptomatic treatment of discomfort associated with

urinary tract infections. Although Pyridium is an OTC preparation and appears to cause no
significant drug interactions, patients for whom it is recommended should be made aware that it
may cause side effects such as headache, rash, vertigo, GI disturbances, and symptoms like those
of anaphylaxis. Jaundice (of skin or sclerae) should be reported to the health care provider. In
addition, this medication changes the color of urine to orange or red and may also stain fabrics
and clothing.
10. When obtaining a nursing history from a patient taking a newly prescribed diuretic, nurses
should gather data relevant to effectiveness of the medication, as well as signs and symptoms of
fluid and electrolyte imbalance (especially potassium). Patients should be asked regarding weight
gain, fit of clothing and rings, irregular pulse, any shortness of breath, unusual thirst, anorexia,
and any productive cough. If the patient is taking a potassium-wasting diuretic, he should also be
taking a potassium supplement and offered diet education about dietary potassium sources.
11. The nurse should first ascertain if the patient has any renal problems. If not, and the patient’s
diuretic is potassium-wasting (for example, furosemide/Lasix), which is the class of diuretic
most commonly prescribed, the patient should be taking a daily potassium supplement and be
aware of potassium-containing food sources (baked potato, orange juice, bananas, cantaloupe,
broccoli).
The patient should also be made aware of signs and symptoms of hypo- and hyperkalemia
(hypokalemia symptoms include dysrhythmias, decreased GI motility/constipation, nausea,
vomiting, fatigue; hyperkalemia symptoms include dysrhythmias, muscle irritability/twitching).
Patients should weigh themselves daily or every other day (per their health care provider) at the
same time, on the same scale, and wearing roughly the same clothing. Any weight gain or loss of
more than 1 to 2 lb/day or 5 lb/week should be reported. Along with this, the patient should be
aware of other signs/symptoms of increasing edema: productive cough; shortness of breath;
belts, shoes, rings, watches feeling tighter; ankles swelling; needing to use more pillows when
lying down or needing to sleep up in a recliner, etc.

12. Dehydration is most likely to occur in the elderly and very young children (those under 2 to 3
years of age). Dehydration may also occur when (1) environmental conditions predispose to the
loss of fluid and electrolytes as a result of increased perspiration; (2) oral intake is inadequate
(deficient intake or increased metabolic demands, such as fever, acidosis, or burns, or following
activity without fluid and electrolyte replacement); and, (3) when fluid loss is excessive (nausea,
vomiting, diarrhea, intestinal obstruction, and burns).
13. Fluid and electrolyte replacement or supplementation is indicated to correct or prevent

dehydration and its accompanying electrolyte imbalances. Fluid and electrolyte solutions may be
given orally or parenterally. They generally contain calories (in the form of glucose), as well.
Uncorrected fluid and electrolyte imbalances (deficiencies or excesses) can lead to cardiac
dysrhythmias, disruptions in nerve impulse transmission, and muscle spasticity or flaccidity.
Fluid excess, which can occur from intake of water without minerals (distilled water), can lead to
water intoxication and fluid overload. It is possible for one or two electrolytes to become
imbalanced; in this case, only those requiring correction will be replaced. Ms. Falk needs to be
educated regarding the most likely causes of fluid and electrolyte imbalance (dehydration, often
from vomiting or diarrhea), its early signs and symptoms, and the importance of correcting any
imbalance for optimal cardiac, nerve, and muscle function.
Chapter 13: Central and Peripheral Nervous System Medications
1. Antimigraine agents are beta-adrenergic blocking agents; they dilate the veins in smooth
muscle, reducing cerebral blood flow and arterial pulsation. Since migraine headaches are
thought in part to be the result of local cranial vasodilation, this action can directly prevent or
relieve their occurrence. Unlike more traditional non-narcotic analgesics, antimigraine agents do
not affect perception, or block transmission, of pain impulses.
2. Adverse reactions often mimic symptoms of anxiety, including agitation, excitement,

irritability, anger, hostility, and depression. Drowsiness and fatigue may also occur.
Overdosage generally produces significantly decreased mental status: confusion, somnolence,
and diminished reflexes. It is often accompanied by hypotension. Coma can result. Baseline
patient data are essential. Interviewing individuals accompanying the patient (if appropriate), in
addition to the patient, would be most helpful. Close observation and monitoring of the patient
for any vital sign and mental status changes is indicated.
3. Traditional recommendations for treatment of insomnia have included warm baths,

noncaffeinated warm drinks (notably some herbal tea preparations), and decreasing overall
caffeine intake. Complementary methods of increasing relaxation include stress reduction
techniques such as aromatherapy, meditation, and deep-breathing exercises.
4. The most likely effect of oversedation is respiratory depression. The patient’s respiratory
status should be monitored for rate, rhythm, and depth of respirations. A respiratory rate of 12 to
20 breaths/minute is considered appropriate for an adult; below 10 respirations/minute is grounds
for concern. The nurse should also anticipate that an antidote counteracting this should be

immediately available. The most commonly used narcotic analgesic is naloxone (Narcan), which
reverses respiratory depression almost immediately after IV, IM, or SC administration.
Chapter 14: Medications for Pain Management and Anesthesia
1. Current recommended doses for geriatric patients are one quarter to one half the usual adult
dose, to be increased cautiously, as needed, depending on analgesic effect and patient tolerance.
Because liver and kidney function decrease naturally with aging, drugs are metabolized and
excreted less efficiently by the liver and kidneys. They last longer in the older patient’s
circulation (extended half-life), where they can continue to exert analgesic and sedative effects.
Older patients must be closely monitored for symptoms of oversedation, especially respiratory
depression.
2. You can best assist her by first assessing her pain thoroughly for location, intensity, triggers,
etc. In this situation, asking the physician to assess this patient or to increase the dosage or
frequency of pain medication may be indicated after relevant data are obtained (including vital
signs and oxygen saturation). It should never be assumed that the patient’s complaints of pain are
from the same source as previously (i.e., surgical incision site), since postoperative pain can
indicate the development of postoperative complications such as pneumonia, pulmonary
embolism, myocardial infarction, or deep vein thrombosis (DVT).
3. The nurse’s assessment of the patient’s pain, and the effect of the pain medication, is missing
from the entry.
4. The most appropriate pain management plan would be to administer analgesia on a regularly
scheduled basis, not to wait until he requests it. This will also require patient education
concerning the most effective use of his analgesia, which is for him to receive the medication
before his pain level becomes intense.
5. Refer to your text for patient teaching points regarding narcotic agonist-antagonist analgesics.
6. You should contact the nursing office in the different hospitals to find out what their specific
policy says about this.
7. Consequences may vary but may include investigation, counseling, suspension, or termination
of job.
Chapter 15: Antiinflammatory, Musculoskeletal, and Antiarthritis Medications
1. Salicylates are used for their various effects in the treatment of a number of different medical
problems. Many of the desired therapeutic effects of salicylates (most commonly aspirin) depend
on drug dosage, not body weight or size. Although used for the inflammation that accompanies

arthritis and lupus, aspirin (ASA) is also used for its antiplatelet effects. These effects are
achieved with low doses (80 to 325 mg po qd) of aspirin, regardless of the patient’s mass. Higher
dosages (600 to 650 mg q4h) are useful for achieving aspirin’s antipyretic and analgesic effects.
Lower dosages generally will not result in these therapeutic benefits.
2. Refer to your text for information on occult blood and how to test for it.
3. You must first ascertain what medications Mr. Franklin has been prescribed, what medications
he has been taking, and what his interpretation of his medication regimen has been. It is essential
that Mr. Franklin is aware of the difference between prophylactic and acute treatment of gout
symptoms and that the individual medications generally prescribed are not intended to treat both
aspects. (Those used for treatment of acute attacks primarily relieve pain and inflammation;
those intended for prophylaxis affect the body’s metabolism of uric acid.) Taking his uricosuric
agent (allopurinol) during an acute attack will not relieve his symptoms and may actually
precipitate worse symptoms. Taking his colchicine may help during an acute gouty attack but
will not prevent further episodes.
4. NSAIDs are often preferred over ASA for treatment of inflammatory processes. This is due to
the rapidity of onset of ASA’s effects, which are not always desirable for certain patients. For
example, although NSAIDs will have similar effects, the GI distress and antiplatelet activity will
take longer to develop and require higher dosages than with aspirin. (The changes in platelet
agglutination occurring with ASA therapy will begin with the patient’s first dose.) Patients
should be made aware, however, that although these undesirable effects may take longer to
develop with NSAIDs than with aspirin, they will still eventually develop. Patients still need to
be taught signs and symptoms of bleeding (spontaneous bleeding or oozing from gums, nose, or
rectum and unexplained bruising) and developing GI problems (stomach or abdominal pain or
discomfort) and when to notify their health care provider.
5. Although oral forms of skeletal muscle relaxants may not be as effective as the parenteral
forms and larger oral dosages are required for therapeutic effects than with the injectable forms,
an oral skeletal muscle relaxant may be prescribed in certain circumstances. If the patient’s
ability to comply with safe and appropriate parenteral administration is questionable, an oral
form may be more realistic. If short-term use is anticipated, oral administration may also be
considered, since the risk of toxicity developing is significantly increased with a longer duration
of treatment.
6. This is an individual student activity, so answers will vary. Use Chapter 16 in your text to help
prepare your teaching plan, particularly the discussions of adverse reactions and patient and
family teaching.
7. See your text for information on the etiologies of high uric acid levels, including common
signs and symptoms of each.
8. After the physician has assessed the patient, heat and/or cold treatments are often used with
analgesics to control edema and lessen discomfort (this is usually most appropriate during the
first 48 hours after injury). If the injury is to an upper or lower extremity and not contraindicated,

elevation of the limb above the level of the heart can also reduce edema by encouraging venous
and lymphatic return.
9. The two causes of high uric acid levels are that the patient produces too much uric acid or that
they underexcrete the uric acid. High uric acid levels in the blood lead to production of sharp uric
acid crystals, which tear and bruise the tissues and cause swelling or increased tissue edema,
heat, inflammation, and severe pain. Overproducers have high serum uric acid levels.
Underexcreters have low urine uric acid levels.
10. Some nursing interventions for orthopedic injuries include elevation of the affected area,
compression of swollen soft tissue with an Ace bandage, rest of the affected area, and ice or
alternating ice and heat as the injury heals.
Chapter 16: Gastrointestinal Medications
1. Patient teaching for Ms. McKelvey should stress the major difference in action between
antacids (which neutralize stomach acids that have already formed) and H2-receptor antagonists
(which prevent the formation of stomach acids). The nurse might add that many H2-receptor
antagonists, like the antacids, are OTC preparations. This might reassure Ms. McKelvey that she
may be able to keep her medical costs down, increasing the likelihood of her compliance.
2. Anticholinergics work directly on the CNS and require high dosages for effectiveness in
treatment of GI disorders. Both of these characteristics of this drug classification increase the
risk of associated side effects. Antidiarrheals exert their effects locally (reduction of fluid content
of stool and a decrease in peristalsis and motility of the GI tract), as opposed to the systemic
effects of anticholinergics. This decreases the risk of associated adverse reactions.
3. Signs and symptoms of fluid and electrolyte imbalance (in this instance, deficit) include poor
skin turgor (“tenting” when the forearm skin is lightly pinched that takes longer than a few
seconds to resolve); increased pulse rate; hot, dry skin; elevated body temperature (but usually
below 101° F); thirst; decreased urinary output; dark, concentrated urine with a strong odor;
muscle twitching (this may manifest as dysrhythmia development and is especially indicative of
potassium depletion in older adults); abdominal discomfort, distention, and a possible functional
small bowel obstruction (from loss of GI muscle tone). Development of and/or increasing
confusion or other changes in mental status are particularly relevant to development of fluid and
electrolyte imbalance in older adults. This patient population is especially sensitive to
hypokalemia. Development of physical dependence to these agents is also a concern.
4. Relevant nursing interventions for Mrs. Harris would include increasing and encouraging fluid
intake. This may initially be accomplished by encouraging sips (5 mL) of fluids every 5 to 10
minutes, unless diarrhea is restimulated. Any fluids or foods (other than dairy products, which
can stimulate diarrhea) tolerated are generally allowed. Intravenous fluids for rehydration and
hydration maintenance will most likely be ordered by her physician; the specific fluid will be

determined by her current fluid and electrolyte status. She will need to be monitored for signs
and symptoms of fluid overload (lung sounds, weight gain, peripheral edema). Rehydration
performed too rapidly can result in congestive heart failure, especially in an older adult patient.
Evaluation of Mrs. Harris’ response to treatment will include signs of improving fluid and
electrolyte deficit (increased urine output, decreased concentration of urine, return of pulse rate
to baseline range) without signs of fluid overload (lungs clear, no abrupt or excessive weight
gain, no peripheral or dependent edema). Precipitating factors for her diarrhea must be explored
as well. Significant information to obtain will include onset, medications taken (including OTC
preparations and laxatives), dietary habits (including anything new or any recent changes), and
any signs or symptoms suspicious of GI infection or irritability.
5. Mr. Weigand should be educated regarding the difference between the actions of his stool
softener (which increases the fluid content of stool) and the recommended lubricant laxative
(which will ease the passage of stool through the colon). However, further exploration of the
patient’s noted “discomfort” with the use of a lubricant laxative is indicated. Is the patient simply
uncomfortable with a change in his treatment plan, or is he frightened that something may be
seriously wrong? Is he concerned about possibly decreasing or loss of bowel control? Also,
dietary assessment may be helpful. Diet modifications (increasing fiber or fluids; adding warm
prune juice, for example) may help and may give him a feeling of some control over this new
development.
6. See Table 16-5 in your text for information about digestive enzymes.
7. Children with cystic fibrosis need supplemental pancreatic enzymes because their disease
process causes the production of very viscous, sticky secretions that block naturally produced
pancreatic enzymes from exiting the pancreas and reaching the duodenum. Eventually, they will
be unable to produce any digestive enzymes; enzyme replacement will be part of their lifelong
therapy.
8. See your text for information about disulfiram reactions.
Chapter 17: Hematologic Products
1. Anticoagulants prevent the formation and extension of existing clots and are indicated in
patient situations in which clot formation is likely, such as immobility. They may also be used in
situations in which clots have already formed, such as pulmonary embolism (PE), in an attempt
to prevent additional or extended clots until the body’s natural anticoagulants and thrombolytics
can degrade the emboli. Thrombolytics are used to rapidly degrade (lyse) clots that have formed,
usually to prevent tissue ischemia (as with myocardial infarction) resulting from the clot’s
location. Both of these types of drugs affect the coagulation process by interfering with clotting
factor activity. Antiplatelet agents work on platelets, preventing agglutination and thereby
preventing the earliest stage of the clotting process. These are often used to prevent clot
formation in patients at high risk for thrombus development, including those with a heart valve

replacement, history of stroke (cerebrovascular accident, CVA) or transient ischemic attack

(TIA), and MI.
2. The nurse should explain to Mrs. Gardner that a thrombus is a stationary clot that has formed
in an undesirable location, and that an embolus is a clot (usually) that has gotten into the
circulation and has moved. Although the differentiation between clot and embolus may affect the
treatment plan, much of the intervention will be determined by the location of the clot and the
risk posed to the patient. DVTs and PEs are often treated with bed rest and heparinization;
emergency interventions and thrombolytics are generally not indicated unless the patient is at
risk for respiratory distress or circulatory instability. More common treatment involves
Coumadin therapy after heparinization and evidence that the thrombus is resolving.
3. Patients receiving anticoagulants are generally placed on bleeding precautions on the nursing
unit. This involves observing for bruising; bleeding from the mouth, nose, gums, and GI and GU
tracts, and patient complaints of abdominal fullness; limiting venipunctures; using soft (or no)
toothbrushes; no razor blades; no foods irritating to the GI tract such as nuts and popcorn; and
monitoring PT/aPTT values, as well as platelet counts. Laboratory values are essential in closely
monitoring a patient’s anticoagulant status. Many patients are unusually responsive to heparin
and/or Coumadin, and may reach therapeutic levels of these medications sooner than expected.
In these cases, patients would be at risk for overdosage and hemorrhage if not monitored
appropriately. Other individuals may take longer to reach therapeutic anticoagulant blood levels.
These patients need to be monitored closely so that their dosages can be adjusted accordingly for
the anticoagulant to be effective in preventing further clot formation or extension.
4. The list of drugs that can interact with anticoagulants is extensive; therefore, it is imperative
that nurses research any medications their patient is receiving to determine the potential effects
on the patient. Many medications enhance the effects of anticoagulants; common examples are
NSAIDs, but there are many others. Many drugs (and foods, such as green leafy vegetables
because of their high vitamin K content) will antagonize anticoagulants (especially Coumadin);
nurses need to be aware of these potential interactions as well.
5. If immediate anticoagulant effect is indicated, heparin is the drug of choice because of its
rapid IV action (several minutes).
6. Refer to the answer for Question 3 for signs and symptoms of bleeding (in this case, as a result
of heparin overdosage). Additional signs might also include changes in mental status and
shortness of breath (from the decreased oxygen supply to the brain and lungs). If severe, changes
in vital signs indicating circulatory shock (increased heart rate and respirations, decreasing blood
pressure with a narrowing pulse pressure, decreasing oxygen saturation/pulse oximetry) would
also generally be noted. Pharmacologic interventions would consist of administration of
protamine sulfate. Nursing interventions would include assessing for response (including
rebound effect) to protamine sulfate and hemodynamic stability (improved vital signs). The
effects of protamine sulfate are extremely rapid. The physician (if not present during
administration) should be notified of the patient’s status at frequent intervals or immediately if
signs of stabilization are not apparent or signs of rebounding are noted.

7. The activated partial thromboplastin time (aPTT) is the accepted laboratory value for
monitoring heparin therapy. This is because it measures the effects of heparin on the specific
clotting factors with which heparin interferes (as opposed to whole blood values).
8. Pain at injection sites can be managed by local application of ice to the areas. Nurses should
be especially careful to rotate injection sites for a patient receiving heparin. Do not aspirate
during heparin injection and do not massage the injection sites following administration of
heparin.
9. Green leafy vegetables, such as lettuce, contain vitamin K, which is the antidote to Coumadin.
If Mrs. Martinez were to eat a great deal of salads containing green leafy vegetables, it could
affect her anticoagulant therapy by blocking the effects of her Coumadin. The Coumadin would
have limited or no therapeutic effect, and she would continue to clot normally. Other vitamin K-
containing foods she should be aware of include tomatoes, bananas, and cantaloupe.
10. Platelets do cause blood to clot, but separately from the substances in blood that also make
blood clot. It is these specialized substances, called clotting factors, that Coumadin affects.
Taking drugs such as aspirin would affect platelets; Coumadin does not. Different blood tests are
used to check how well Coumadin is working; these are the PT and INR.
Chapter 18: Hormones and Steroids
1. Patient and family teaching about diabetes is essentially the same regardless of the specific
medication prescribed. Diet and nutrition, exercise, blood glucose monitoring, foot care, and
signs and symptoms of infection must be discussed at length (at the appropriate times and levels
of comprehension). The obvious difference is whether the patient will need to be instructed
regarding self-administration of insulin.
2. Multiple injections of synthetic regular human insulin via pump or subcutaneous insulin
delivery device is the most likely treatment of choice in Jessica’s case. The newer rapid-onset,
short-acting insulin preparations such as Lispro provide an even closer physiologic insulin
action. Therefore, these are becoming more commonly used in management of type 1 diabetes.
3. Improvement of a patient’s symptoms may require several weeks or months; any new
symptoms must be reported to his practitioner, such as swelling of the feet or hands; enlargement
of the breasts; shortness of breath; yellowing of the skin or eyes; prolonged, painful erection or
excessive sexual stimulation; or urinary retention. Also, if his medication is to be taken orally,
mouth care will be important. He should rinse his mouth and brush his teeth after taking each
dose. He will need to wait until the medication has been completely absorbed (if buccal or
sublingual) before performing mouth care or eating or drinking anything.
4. With the exception of abstinence, no method of contraception is 100% effective. If she

suspects she may be pregnant, Ms. Marra should contact her practitioner; these preparations are
not considered safe during pregnancy. Oral contraceptives should be taken at about the same
time each day. Ms. Marra should be able to explain the prescribed use and schedule for taking

her birth control pills. A backup plan for missed doses should be thoroughly explained and
described. She should also indicate her understanding that many medications, including
penicillin, oral hypoglycemics, and OTC preparations, may interfere with the action of her oral
contraceptives. She should check with her practitioner before taking other preparations, as well.
Ms. Marra’s smoking history will also need to be determined. Vaginal bleeding will occur during
the “rest” phase of her oral contraceptive cycle; she will continue to have cyclical menstrual
bleeding. Ms. Marra should indicate her understanding of signs and symptoms of potentially
serious vascular side effects: slurred speech, shortness of breath, chest or extremity pain, visual
changes.
5. This will be long-term maintenance therapy. Therapeutic results are generally not achieved
before 2 weeks to 3 months. It is extremely important that Mr. Moore not modify his dosage and
that he take his thyroid preparation exactly as prescribed.
6. Thiazide diuretics oppose beta cell secretion of insulin and decrease effectiveness of
sulfonylureas, resulting in hyperglycemia. Many of the oral hypoglycemics can decrease the
effectiveness of oral contraceptives, increasing the risk of an unplanned pregnancy. In effect,
both of these classes of medications can antagonize each other.
7. Your patient should be aware that increased body temperature (fever), like redness, may be an
unreliable sign of infection. She should be aware of any breaks in her skin and any developing
swelling, discomfort, pain, or drainage (there may be no odor to the drainage). Any general
malaise, chest tightness, or increased cough (with or without sputum production) may also be
significant. Urinary frequency or difficulty voiding should also be considered as early symptoms
of a potential problem. Any of these signs or symptoms should be reported. In addition, she
needs to be made aware that she should receive no immunizations (including pneumonia,
influenza, and hepatitis) without first checking with her practitioner.
8. Because corticosteroids (glucocorticoids) can cause stomach ulcers, it is usually recommended

for patients to take stomach acid reducers as prophylaxis to prevent ulcers from occurring.
Patients should also be informed that alcohol intake will increase the risks of ulcer formation and
should be avoided while they are receiving steroids.
9. The patient taking oral steroids should also be receiving an H2-receptor antagonist because
oral steroids are very erosive to the GI tract and the histamine H2-recptor antagonists help protect
the gastric mucosa and decrease episodes of bleeding.
Chapter 19: Immunologic Medications
1. When evaluating the benefits versus the risks involved in immunizations (including adverse
reactions), consider the following factors:
• The children’s ages and developmental stages
• Each child’s current health status (including allergies)
• Each child’s current immunization status
• The likelihood of regular return visits

• The caregiver’s level of understanding and compliance
2. Obtaining health histories for four children will necessarily have to be prioritized and concise
and will depend on the nurse’s assessments of the above areas. Patient and family education will
also need to be prioritized, because an otherwise overwhelming amount of information will
likely not be processed or retained by the caregiver. After obtaining some basic data (age;
height/weight and percentiles; developmental milestones; basic health status), perhaps the most
realistic way to obtain further information is to ask the caregiver what concerns there may be
about any of the children. This allows the caregiver an opportunity for input and also allows the
nurse to determine what is seen as significant by the family. The actual immunization should be
done at the end of the visit, ideally starting with the oldest child (unless it is obvious that this
would be inappropriate from an anxiety or behavioral perspective). It is not considered
appropriate to have the caregiver restrain the children during injections, but they should be
encouraged to hold them and offer comfort.
3. Patients should be aware of the need to contact their practitioner if any of the following
develop after receiving any immunizations: rash, pruritus, urticaria, edema, difficulty swallowing
or breathing, or shortness of breath. Antihistamines may be recommended to suppress sensitivity
reactions. Many pediatric practitioners recommend giving children appropriate doses of
acetaminophen prophylactically for discomfort after immunization. (Children are not given ASA
due to the risk of Reye syndrome, but ibuprofen may be allowed.) This will decrease discomfort
from fever and myalgia that may develop but will not mask a high fever, which should be
reported.
4. a. Artificially acquired active immunity: develops as a result of immunization (exposure to a

less virulent form of a pathogen)
b. Artificially acquired passive immunity: develops as a result of immune/gamma globulin
injection
c. Naturally acquired active immunity: direct exposure to the pathogen (e.g., “catching”
chickenpox)
d. Naturally acquired passive immunity: only occurs by passing of maternal antibodies to the
baby in utero and/or during breastfeeding
5. Refer to your text for information on how to counteract the most common side effects of
immunologic agents.
6. A booster is an additional dose of an immunization administered at intervals (specific to the

agent) as a reinforcement or reminder to the immune system to maintain antibody production.
Many immunizing agents, such as tetanus, do not continue to stimulate the immune system’s
production of antibodies to the tetanus toxoid over time; reimmunization is recommended for
adults every 5 to 10 years. However, boosters serve as a reminder; an individual’s immune
system will remember that it has been previously exposed to the substance and will increase
antibody production to it accordingly. This differs from initial immunization, during which time
the individual’s immune system is exposed to a new invader and must develop new antibodies to
the invader for the first time. This takes longer and (as with tetanus toxoid) often requires an
initial series of immunizations to stimulate the immune system appropriately.

7. A patient may exhibit unusual sensitivity to an immunologic agent when multiple

immunizations are received at the same time; when previous sensitivity reactions have occurred
in the past or sensitivity has recently developed; during an acute illness; if the patient is
immunocompromised because of medications or chronic disease; or if the patient has recently
received immune globulin (the patient may not have acquired sufficient immunity to defend
against immunizing agents).
8. Because many immunizations are cultured or prepared using chick embryos, an individual
sensitive or allergic to eggs or feathers may develop a severe allergic reaction to the similar
proteins in the intended vaccine as well. A thorough patient history must always be obtained or
updated, including any immunizations received (and any reactions to them) since the last visit.
9. People with cancer are immunocompromised because of the effects the disease process has on
the immune system and the nutritional status of the individual. They are further
immunocompromised if they are receiving chemotherapy because of the effects the medication
has on the bone marrow. Since many immunizations are live or attenuated, they can cause the
immunocompromised individual to develop the actual disease, which their weakened immune
system may not be able to fight. (The oral polio virus is an example of this.) Alicia’s mother
should be made aware of this situation and given guidelines for Alicia to avoid close contact with
her grandmother until the time period for possible disease transmission is past.
Chapter 20: Topical Medications
1. The main precaution with administration of any eye preparation is to ensure the medication is
instilled for local, not systemic, absorption. This becomes especially important when
administering steroid and beta blocker preparations to the eye. To that end, the nurse must ensure
that the medication is instilled into the eye while avoiding and obstructing the lacrimal ducts
(light pressure to the inner canthus during administration generally accomplishes this). See
Chapter 7 for information about the actual procedure of administration of eye drops.
2. See Table 20-3 in your text for information about glaucoma and OTC products to control mild
glaucoma.
3. See Table 20-3 in your text for information about the prescription drugs used to control mild
glaucoma.
4. See Table 20-3 in your text for information about teaching patients how to administer eye
drops. Also see Chapter 7, including Procedure 6.
5. When administering eye drops, it is important for the patient to be instructed to open and close
the eyes slowly (to distribute the medication evenly in the pocket) and not to squeeze the eyes
closed (as this may force the medication out of place). Eye drops are generally administered with
the lower lid pulled slightly downward and the medications administered centrally (away from
the inner canthus and lacrimal duct). Ophthalmic ointments should be administered to the same

area, but as a thin, continuous ribbon along the lining of the sac or pocket from the inner to the
outer canthus (also avoiding the systemic absorption of the lacrimal duct). Another point that
should be reinforced with the patient is slow opening and closing of the eyes, as with
eye drop instillation.
6. There are several pediatric considerations to note. The differences in administration of ear
drops exist because of the differences that generally occur between pediatric and adult dosages
and because of the anatomic differences in the ear canal between adults and young children. (For
specific information, refer to an anatomy and physiology or nursing fundamentals text.) Note
that most ear drops for any age or developmental stage are administered for their effects on the
middle ear (e.g., otitis media). “Swimmer’s ear” is an inflammation of the external ear canal.
7. See Table 20-4 in your text for information about medications used to remove earwax
accumulations.
8. This is an individual student activity, so answers will vary.
9. Firstly, transmission of pediculosis occurs very easily, and is not an indicator that their home is
not clean. Head lice are transmitted from sharing towels, clothing (especially hats), combs and
brushes, etc. Daniel will need to be treated with a specialized shampoo, available OTC under a
variety of brand names. (The best recommendation would be to ask a pharmacist which would be
best for someone Daniel’s age.) Additionally, the entire family will need to be treated; all sheets
and towels and clothing must be washed and dried at the hottest temperature the fabrics can
tolerate. Because of the life cycle of pediculosis nits, if the first round of treatment is not
completely successful, everyone will need to be treated again to prevent further transmission.
Chapter 21: Vitamins and Minerals
1. See the Section One Overview in your text for information on the two types of vitamins and
how each type reacts within the body.
2. Malabsorption or metabolic disorders can inhibit absorption of nutrients, including vitamins,

even if sufficient amounts are ingested. This is especially true of fat malabsorption syndromes,
which will impair absorption and use of the fat-soluble vitamins as well as of dietary fats.
3. Vitamins are found naturally in plant and animal tissues and are essential to normal
metabolism. Minerals are inorganic substances that act as catalysts to speed up biochemical
reactions.
4. It is difficult to explain that if a little is good, more is not necessarily better for the human
body. Mr. Baker needs to understand that the human body functions best within narrow limits.
Excessive intake of water-soluble vitamins will, at best, cause more to be excreted in his urine,
be of no benefit to his body, and may actually cause him harm. Fat-soluble vitamins will be
stored to toxic levels, which are not significantly higher than maintenance levels for the body.
These toxic levels will result in visual, motor, and cardiac disturbances, as well as skin lesions

and kidney problems (including calculi). These same dysfunctions will occur if the excesses are
the result of high levels of mineral intake (especially cardiac dysrhythmias, which can prove
lethal with potassium imbalance). An effective way to explain these potential risks to Mr. Baker
is to compare vitamins and minerals to any other medication. Adhering to the prescribed dosage
is therapeutic; taking more than is prescribed is taking an overdose and will have adverse effects
on his body.
5. Refer to Chapter 21 in your text for help in creating the nutrition chart. To counteract Mr.
Baker’s claim that “A vitamin is a vitamin,” refer to the sections listing special considerations for
various vitamins.
6. The three minerals most often deficient in U.S. diets are calcium, iron, and iodine; this is
usually the result of inadequate ingestion. Absorption and proper use of calcium by the body is
dependent on vitamin D, appropriate proportions of phosphorus (phosphate), and an acidic pH of
the GI tract. An inadequate intake of dairy products and/or green leafy vegetables, or an
excessive intake of spinach and related vegetables, can result in actual or bioavailable calcium
deficiency. Iron also requires an acidic pH in the GI tract for proper absorption. Under usual
circumstances, even with adequate intake and absorption, 10% of dietary iron is absorbed. The
body can increase the amount of iron absorbed during periods of physiologic stress (i.e.,
pregnancy and acute illness), but because the body’s metabolic need for iron will also have
increased, this may not result in a sufficient increase of available iron. Iodine may be of limited
availability in areas where fresh seafood, the richest source of this mineral, is not regularly
available. There are currently many foods to which iodine has been added in order to prevent the
goiter formation and thyroid dysfunction caused by iodine deficiency; the most commonly
known food is iodized table salt.
7. Ms. Mariani has pernicious anemia, or vitamin B12 deficiency, not iron-deficiency anemia.
Dietary therapy is not helpful in this case. Her injections are IM or subcutaneous vitamin B12,
but she may be able to switch to a nasal spray form of B12 if she goes into remission. She will
need to remain on some form of B12 therapy as lifetime treatment, however. Severe, irreversible
neurologic damage will occur if her pernicious anemia is not successfully treated, or if she does
not adhere to her treatment regimen.

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Edmunds: Introduction To Clinical Pharmacology, 8th Edition: Answer Keys - in Text Critical Thinking Questions

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Edmunds: Introduction to Clinical Pharmacology, 8th Edition

Answer Keys - In text Critical Thinking Questions

Chapter 1: Pharmacology and the Nursing Process in LPN Practice

3. Pain assessment (S data that is obtained from the patient)

Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Assess the effectiveness of morphine as an analgesic for the patient:

7. Three essential areas of assessment include the following:

Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Chapter 2: Patient Teaching and Health Literacy

2. Use of therapeutic communication techniques can encourage patients to verbalize their

4. Student answers will vary.

Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Chapter 3: Legal Aspects Affecting the Administration of Medications

1. Three levels of regulations include federal, state, and agency or facility.

5. Suggestions include researching policies for (1) administration of medications classified as

Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

11. Student answers will vary.

Chapter 4: Foundations and Principles of Pharmacology

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3. Drug selected: warfarin (Coumadin)

4. Drug selected: Heparin IV or SC

Process Definition Action

Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Chapter 5: Lifespan and Cultural Modifications

1. The recommended dosages for digoxin are as follows:

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5. Some factors to be considered include the following:

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11. Answers will vary based on student experiences.

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5. All medications, whether OTC or prescription preparations, are dangerous if taken

8. There is no significant difference between vitamins according to their manufacturer or brand

Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

11. Student answers will vary.

Chapter 7: Preparing and Administering Medications

1. This is an independent student activity, so answers will vary.

2. This is an independent student activity, so answers will vary.

Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

medications dispersed in oil increase the solubility of the drug

4. In addition to the nursing considerations relevant to nasogastric tube medication

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11. Forms of percutaneous medications include the following:

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• Astringents: wear gloves during administration

13-15. Student answers will vary.

Chapter 8: Allergy and Respiratory Medications

2. Development of rebound phenomenon as a result of antihistamine use can be signaled by a

Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

12. Student answers will vary.

Chapter 9: Antiinfective Medications

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5. Allergic or hypersensitivity reactions include fever, pruritus (itching), urticaria (hives),

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7. Sulfonamides have a bacteriostatic effect on a wide range of gram-positive and gram-negative

11-12. Student answers will vary.

Chapter 10: Antivirals, Antiretrovirals, and Antifungal Medications

Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Copyright © 2016 by Mosby, an imprint of Elsevier Inc.