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1. A client with asthmareceives a prescription for high blood pressure duringa clinic visit. Which pres
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cription should the nurse anticipate the client to receive that is least likely to exacerbate asthma
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ANS The best antihypertensive agent for clients with asthma is metoprolol (Lopressor) (C), a beta2
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blocking agentwhich is also cardioselective and less likely to cause bronchoconstriction.Pindolol
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(A) is a beta2 blocker that can cause bronchoconstriction and increase asthmatic symptoms. Alth
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ough carteolol (B) is a beta blocking agent and an effective an-
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tihypertensive agent used in managing angina, it can increase a client's risk for bronchoconst
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rictionduetoits nonselectivebeta blocker action.Propranolol (D)alsoblocks the beta2 recept
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ors in the lungs, causing bronchoconstriction, and is not indicated in clients with asthma and oth
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er obstructive pulmonary disorders.
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2. A male client who has been taking propranolol (Inderal) for 18 months tellsthe nurse that the heal
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thcare provider discontinued the medication because his bloodpressurehas beennormal for the pa
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stthree months.Whichinstruc-tionshouldthenurseprovide
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,ANSAlthoughthehealthcareproviderdiscontinuedthepropranolol, measures to preventrebound c
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ardiac excitation, such as progressivelyreducing the dose over one to two weeks (C), should be reco
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mmended to prevent rebound tachycardia, hypertension, and ventricular dysrhythmias.Abrupt ce
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ssation(A and B) of the beta- l l l l l l
blocking agent may precipitate tachycardia and rebound hypertension, so gradual weaning shou
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ld be recommended.(D) is not indicated.
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3. A client who is taking clonidine (Catapres, Duraclon) reports drowsiness. Which additional asses
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sment should the nurse make
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ANSHow long has the clientbeen taking the medication?
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Drowsiness can occur in the early weeks of treatment with clonidine and with continued use becomes
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less intense, so the length of time the client has been on the medication(A)provides information to dir
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ectadditional instruction.(B, C, andD)are not relevant.
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4. The nurseis preparing to administer atropine,an anticholinergic,toa clientwho is scheduled for a c
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holecystectomy. The client asks the nurse to explainthe reason for the prescribed medication.What r l l l l l l l l l l l l l l l
esponse is best for the nurseto provide
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,ANSDecrease the risk of bradycardia during surgery.
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5. An 80-year- l
old client is given morphine sulphate for postoperative pain. Which concomitant medication should
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the nurse question that poses a po- tential development of urinary retention in this geriatric client
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ANS Drugs with anticholinergic properties, such as tricyclic antidepressants (C), can exacerbate uri
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nary retention associated with opioids in the older client. Although tricyclic an-
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tidepressants and antihistamines with opioids can exacerbate urinary retention, theconcurrent use
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of (A and B) with opioids do not. Nonsteroidal antiinflammatory
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, agents (D) can increase the risk for bleeding, but do not increase urinary retentionwith opioids (D).
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6. A client with osteoarthritis is given a new prescription for a nonsteroidal antiinflammatorydrug(
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NSAID).Theclientasksthenurse,"Howisthismedica-
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tiondifferent fromtheacetaminophenI havebeentaking?"Whichinformationabout the therapeutic
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l action of NSAIDs should the nurse provide
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l ANS Provide antiinflammatory response.
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7. A client with cancer has a history of alcohol abuse and is taking aceta-
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l minophen (Tylenol) for pain. Which organ function is most important for the nurse to monitor
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l ANS Acetaminophen and alcohol are both metabolized in the liver.This places the client at risk for h
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epatotoxicity, so monitoring liver (A) function is the most important assessment because the combin
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ation of acetaminophen and alcohol, even in moderate amounts, can cause potentially fatal liver d
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amage.Othernon-narcotic analgesics, such as n onsteroidal anti-
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inflammatory drugs (NSAIDs), aremorelikelytopromote adverserenal effects (B).Acetaminophen
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does not placethe client at risk for toxic reactions related to (C or D).
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