Adaptive Quizzes Part 3
When should a nurse obtain blood samples for peak medication levels for an IM injection?
1 hour after administering the IM injection
When should a nurse obtain blood samples for peak medication levels for an IV infusion?
30 minutes after completing the infusion
What drug class does lisinopril belong to?
ACE inhibitors
What is the purpose of enteric-coated tablets?
Less stomach upset
Why can Spironolactone cause adverse endocrine effects and what are they?
Spironolactone is derived from steroids -ADRs: gynecomastia, impotence in men, irregular menses in women, hirsutism in women
A nurse is providing teaching to a client who has RA and an Rx for *LONG-TERM prednisone therapy*. The nurse should instruct the client to monitor for which of the following adverse effects? A. Stress fractures B. Orthostatic Hypotension C. Gingival Ulcers D. Weight loss
Stress fractures
During drug therapy for RA with *etanercept*, what does the client need to be monitored closely for?
TB
What are the potassium SPARING diuretics?
amiloride, spironolactone, triamterene *cause hypERkalemia*
A nurse is caring for a client who is due to receive general anesthesia. The client asks the nurse, "What is the difference between an analgesic and anesthesia?". Which of the following statements should the nurse make? A. "Analgesics can cause a lack of sensation" B. "Anesthesia is specifically for eliminating pain perception" C. "Analgesics treat pain without causing sedation" D. "Anesthesia can cause loss of consciousness"
"Anesthesia can cause loss of consciousness"
A nurse is providing teaching to a client who has HTN and a new prescription for oral *clonidine*. Which of the following instructions should the nurse include in the teaching?
"Avoid driving until the client's reaction to the medication are known" *Rationale*: Clonidine can cause drowsiness, weakness, sedation, and other CNS effects
A nurse is teaching a client who has primary adrenal insufficiency (Addison's disease) and a prescription for hydrocortisone. Which of the following statements should the nurse include in the teaching about. this medication?
"Carry a supply of pills and a single-use injectable preparation with you at all times" *Rationale*: this is to use as an emergency supply to take during times of unexpected stress
A nurse is caring for a client who takes Warfarin to treat chronic atrial fibrillation and has early manifestations of Alzheimer's disease. The client's partner asks the nurse if the client would benefit from taking gingko biloba. Which of the following responses should the nurse make?
"Ginkgo biloba will likely interfere with the effectiveness of his other medications" *Rationale*: Gingko may delay the mental deterioration of Alzheimer's disease if taken in the EARLY stages. *Gingko increases the clients risk of bleeding with warfarin!!*
A nurse is teaching a client about the proper placement of a nitroglycerine patch. Which of the following statements by the client indicates an understanding of the teaching?
"I can place the patch on any area of my body without hair"
A nurse is teaching a client who has a new *ezetimibe* prescription for hyperlipidemia. Which of the following client statements should indicate to the nurse that the teaching was effective?
"I should let my doctor know if I have yellowing of my eyes" *Rationale*: manifestations of hepatitis (jaundice), which is an ADR of this med (hepatotoxicity)
A nurse is providing teaching to a parent of a child who has asthma and a new prescription for cromolyn sodium metered-dose inhaler. Which of the following statements by the parent indicates the need for further teaching?
"I will give my child a dose as soon as soon as wheezing starts" *Rationale*: Cromolyn is a mast cell inhibitor that has a SLOW onset and is given PROPHYLACTICALLY and is *NOT A RESCUE MED*
A nurse is providing teaching for a client who has gout and a prescription for allopurinol. Which of the following statements by the client should indicate to the nurse that the teaching was effective?
"I will increase my fluids to at least 2 liters per day" *Rationale*: this is because an ADR of allopurinol is renal (KIDNEY) injury!
A nurse is providing teaching to a client who has HF and is taking spironolactone. Which of the following statements by the client indicates an understanding?
"I will watch for increased breast tissue growth while taking this medication"
A nurse is teaching a client who has DM about a new prescription for pioglitazone. Which of the following statements should the nurse include in the teaching?
"This medication can be taken when using insulin" *Rationale*: Pioglitazone increases the cellular response to insulin, and *insulin is needed in order for the medication to be effective*
A nurse is teaching a client who has allergic rhinitis about a new prescription for *brompheniramine*. Which of the following pieces of information should the nurse include in the teaching?
"You might find that you develop a dry mouth" *Rationale*: First generation antihistamine!! This can result in cholinergic blockade that can cause drying of mucous membranes in the mouth, nasal passages, and throat. Take frequent sips of water, suck on hard, sugarless candy to help relieve this
A nurse is providing teaching to client with a new dx of HF who has a prescription for furosemide. Which of the following statements should the nurse include in the teaching?
"You should eat foods that are high in potassium while taking this medication"
What are the ADRs of Zolpidem?
-*Daytime sleepiness* -Dizziness (think CNS) -Abnormal thinking/behavior
What 3 herbal/OTC supplements can affect clotting or can interact with other medications that can affect clotting and increase the risk of bleeding?
-*G*arlic -*G*inger -*G*inkgo biloba
What are the ADRs of sulfasalazine for IBS/Crohn's/UC?
-Blood dycrasias (anemia, agranulocytosis) -GI upset -Rash -HA -Crystalluria -Fever *Can turn urine & skin orange/yellow *Monitor CBC
What needs to be closely monitored when giving oxytocin?
-Closely monitor contractions -Contractions should be 60-90 seconds in duration, every 2-3 minutes -Monitor fetal BP & pulse
What are the ADRs of pioglitazone used to treat type 2 DM?
-FLUID RETENTION (REMEMBER PIG ZONE) -Elevated LDL!! -Hepatotoxicity
What is the therapeutic use of oxytocin?
-Induction or enhancement of labor -Placenta delivery -Postpartum hemorrhage
What are the S/S of lactic acidosis?
-Myalgia -Malaise -Somnolence -Hyperventilation
What are the ADRs of Oxytocin?
-Painful contractions -Uterine rupture -WATER INTOXICATION
A nurse is teaching a client who has a prescription for a transdermal estradiol patch. In which of the following locations should the nurse instruct the client to apply the patch? A. Abdomen B. Breast C. Forearm D. Back of thigh
Abdomen
Where should SUBq heparin be administered?
Abdomen using a 25 gauge or smaller needle to decrease risk of hemorrhage; APPLY firm pressure to injection site after administration
A nurse is reviewing the laboratory data for a client who is receiving cloZapine for schiZophrenia. The nurse should identify which of the following findings as a potential adverse effect of the medication?
Absolute neutrophil count 1,200mm^3 *Rationale*: expected reference range is 2500 to 8000/mm^3, and an adverse effect of cloZapine is agranulocytosis (WBC's, including neutrophils are severely decreased)
A nurse is evaluating how a client who is pregnant is responding to a medication. Which of the following physiological effects of pregnancy should the nurse take into consideration? A. Increased intestinal transit rate B. Accelerated excretion of fluids C. Reduced renal blood flow D. Decreased hepatic metabolism
Accelerated excretion of fluids *Rationale*: to compensate for accelerated excretion, dosages of medications that GFR eliminates must be increased to achieve a comparable therapeutic effect (also INCREASED renal blood flow)
A nurse administered an abx 10 minutes ago to a client who is now reporting wheezing and swelling of the eyelids. Which of the following actions should the nurse perform first? A. Give oral corticosteroids B. Administer dopamine C. Give diphenhydramine IV D. Administer epinephrine SUBq
Administer epinephrine SUBq *Rationale*: this will constrict blood vessels, increase CO, and dilate bronchiole passages and is a first line med for anaphylaxis
A nurse is caring for a client who has asthma and a prescription for zileuton. Which of the following laboratory values should the nurse monitor while the client is taking this medication? A. Alanine aminotransferase (ALT) B. WBC count C. Potassium D. Chloride
Alanine aminotransferase (ALT) *Rationale*: Zileuton is a leukotriene receptor antagonist that can effect the liver, causing an increase ALT
What does the client need to allow for if taking Zolpidem or eszopiclone for sleep?
Allow for at least 8 hours of sleep to prevent daytime drowsiness
A nurse is assessing a client who has a new Rx for chlorpromazine to treat schizophrenia. The client has a mask-like facial expression and is experiencing involuntary movements and tremors. Which of the following medications should the nurse anticipate administering? A. Amantadine B. Bupropion C. Phenelzine D. Hydroxyzine
Amantadine *Rationale*: Amantadine is an antiparkinsonian med used to treat EPS that can occur with chlorpromazine therapy
What is a fatal ADR of Lisinopril?
Angioedema (swelling of lips, tongue, pharynx)
What is the MOA of Clopidogrel?
Antiplatelet med that inhibits the aggregation of platelets to prevent thrombotic events
A nurse is preparing to administer nitroglycerin topical ointment to a client who has angina. Which of the following actions should the nurse take?
Apply the ointment using a DOSE-measuring applicator
What do patients need to avoid while taking Spironolactone?
Avoid salt substitutes containing potassium!!
What is the major ADR of *Linezolid*?
Bone marrow suppression
A nurse is planning discharge teaching for a client who has MDD and a new Rx for *Phenelzine*. Which of the following foods should the nurse include in the plan as safe for the client to consume while taking this med? A. Broiled beef steak B. Mac&cheese C. Pepperoni pizza D. Smoked salmon
Broiled beef steak *Rationale*: stay away from tyramine rich foods
A nurse is checking a client who is receiving an IV infusion of *telavancin* for Streptococcus pyogenes. Which of the following actions should the nurse include?
Check the client for pruritus *Rationale*: this can occur of the client develops generalized exfoliative dermatitis from infusing the med too rapidly; manifestations= flushing, rash, pruritus, urticaria, tachycardia, hypotension
A nurse is caring for a client who has alcohol use disorder and was admitted with LE fractures following an MVA. A few hours after admission, the client develops restlessness and tremors. Which of the following medications should the nurse anticipate administering to the client first? A. Acamprosate B. Naltrexone C. Chlordiazepoxide D. Disulifram
Chlordiazepoxide
What is the therapeutic use of ezetimibe?
Cholesterol absorption inhibitor for treatment of hypercholesterolemia; inhibits the absorption of cholesterol in the small intestine
A nurse is caring for a client with Alzheimer's disease who has a new prescription for memantine. Which of the following lab results should the nurse identify as increasing the client's risk for decreased clearance of the medication?
Creatinine clearance 35mL/min
A nurse is caring for a client who is taking acarbose to treat type 2 DM. Which of the following adverse effects of this medication should the nurse monitor the client?
Diarrhea *Rationale*: common ADRs from arcarbose are gastrointestinal (diarrhea, abdominal distention, cramping, flatulence)
A nurse is caring for an older adult client who has an Rx for Zolpidem at bedtime to promote sleep. The nurse should plan to monitor the client for which of the following adverse effects? A. Ecchymosis B. Decreased UO C. Increased BP D. Dizziness
Dizziness
A nurse is caring for a client who is receiving *cefotetan* 1g via intermittent IV bolus q12 hours to treat a postoperative infection. Which of the following manifestations should the nurse monitor for as an adverse effect on the medication?
Epistaxis *Rationale*: Cefotetan is an abx that affects vitamin K levels, which can result in bleeding and epistaxis
A nurse is caring for a client who has vitamin K deficiency. Which of the following manifestations should the nurse expect? A. Irregular bone formation B. Abnormal movements C. Blurred vision D. Excessive bruising
Excessive bruising
The nurse should instruct the client to avoid drinking what while using a fentanyl transdermal patch for pain management?
GFJ- this will increase the absorption of the med, placing the client at risk for CNS & respiratory depression
A nurse is administering insulin glulisine 10 units SUBq at 0730 to an adolescent client who has type 1 DM. The nurse should anticipate the onset of action of the insulin at which of the following times?
GLULISINE RHYMES WITH FIFTEEN (onset of action is 15 minutes) Answer: 0745
A nurse is performing a preoperative assessment of a client who is about to undergo an aneurysm clipping. The nurse should identify a risk for increased bleeding when the client reports raking which of the following dietary supplements? A. Soy B. Garlic C. Black cohosh D. Green tea
Garlic
What is creatinine clearance an estimate of?
Glomerular filtration rate, which tells us the rate of the kidneys to filter waste
A nurse is monitoring a client who has DI and was administered desmopressin. Which of the following findings should indicate to the nurse the client is experiencing an ADR of this med? A. Thirst B. Nocturia C. HA D. Heart palpitations
HA *Rationale*: Diabetes Insipidus is rapid diuresis; to concentrate the urine and prevent more fluid loss, we use desmopressin which causes vasoconstriction. This can lead to a HA
A nurse is preparing to administer digoxin for a client. Which of the following findings should the nurse identify as a C/I receiving this medication? A. BP 180/70 B. O2 sats 94% C. HR 51/min D. RR 21/min
HR 51/min *Rationale*: digoxin should be held if <60/min
What are the ADRs of Methylergonovine?
HTN Abdominal pain N/V
What is the therapeutic use of *Clonidine*?
HYPERTENSION (don't confuse with CloZapine which is for schiZophrenia)- centrally acting alpha 2 agonist
A nurse is reviewing the medical record of a client with RA who has a new Rx for *infliximab*. Which of the following findings should the nurse identify as a C/I to the client receiving this med? A. Psoriatic arthritis B. Hepatitis B virus C. Ulcerative colitis D. Ankylosing Spondylitis
Hepatitis B virus *Rationale*: Infliximab has immunosuppressant properties that can increase risk of infection
What are the ADRs of ezetimibe?
Hepatotoxicity Muscle pain
What are the ADRs of Spironolactone?
HypERkalemia Amenorrhea Gynecomastia Impotence
A nurse is caring for a client who has osteoporosis and has been taking a vitamin D supplement. The nurse notes that the client reports also taking a multivitamin daily. Which of the following findings should indicate to the nurse that the client might be experiencing Vitamin D toxicity? A. Hyperkalemia B. Hypermagnesemia C. Hypercalcemia D. Hypernatremia
Hypercalcemia
A nurse is caring for a client who is taking fludrocortisone. Which of the following findings indicates to the nurse that the client is experiencing an adverse effect of the medication? A. Hypotension B. Weight loss C. Hypokalemia D. Anorexia
Hypokalemia *Rationale*- this is due to excessive sodium & water retention, leading to excretion of potassium (RAAS)
A nurse is preparing to administer a SL nitroglycerin tablet to a client who is reporting chest pain. For which of the following ADRs should the nurse monitor after giving this medication? A. Hypotension B. Myalgia C. Diarrhea D. Ototoxicity
Hypotension *Rationale*: NTG is a vasodilator used as an antianginal agent for angina; BP & pulse needs to be monitored before and after administration
What are the therapeutic uses of Sulfasalazine?
IBS Crohn's disease Ulcerative colitis
A nurse is reviewing the laboratory reports of a client who has been taking Warfarin for a-fib. Which of the following results should the nurse report to the provider immediately? A. PT 18 seconds B. Platelet count 160,000/mm^3 C. Hct 43% D. INR 5.5
INR 5.5 *Rationale*: expected is 2-3; always INR for Warfarin!
In which patients is taking pioglitazone C/I?
In patients with HF because it causes fluid retention
In which patients is Spironolactone C/I?
In patients with severe kidney failure
A nurse is planning to administer oxytocin to a client who is 41 weeks gestation and is experiencing ineffective labor. Which of the following actions should the nurse plan to take?
Increase the dose of oxytocin to obtain uterine contractions that occur *every 2-3 minutes*
What is the MOA of Sulfasalazine?
Inhibits prostaglandin synthesis to decrease inflammation in the colon (anti-inflammatory)
What is the MOA of Zolpidem & eszopiclone for sleep?
Is a hypnotic/sedative that increases GABA (major inhibitory NT) in the CNS, promoting sedation/sleep
A charge nurse is teaching a newly licensed nurse about a client who has severe allergy-related asthma and a new prescription for *omalizumab*. Which of the following pieces of information should the charge nurse include to describe the medications MOA?
It reduces the number of immunoglobulin E (IgE) molecules on mast cells; this limits the ability of allergens to trigger immune mediators that cause bronchospasm
A nurse is providing teaching to a client who has ulcerative colitis and a new prescription for sulfasalazine. The nurse should instruct the client to monitor for which of the following adverse effects of this medication? A. Jaundice B. Constipation C. Oral candidiasis D. Sedation
Jaundice *Rationale*: this med can cause orange/yellow discoloration of both the urine & the skin
What electrolyte imbalances does furosemide cause?
LOOP diuretic Causes: hypOkalemia, hypOnatremia, hypOchloremia, hypOmagnesemia, and low water
A nurse is reviewing the MAR of a client who has impaired swallowing. The nurse should crush the medication when administering which of the following prescriptions? A. Aspirin EC 80mg PO daily B. Levothyroxine 75mcg PO qam before breakfast C. Metformin XR 500mg PO daily D. Nitroglycerin 0.3mg SL PRN chest pain, may repeat q 5 minutes for 2 additional doses
Levothyroxine 75mcg PO qam before breakfast *Rationale: Levothyroxine can be crushed because it is not extended release, sublingual, or enteric coated*. If crushed, the medication should be mixed with 5-10mL of water
What needs to be monitored in a patient taking ezetimibe for hypercholesterolemia?
Liver function & CK levels (muscle breakdown)
Besides Staphylococcus infection, what else can Linezolid be used to treat?
MRSA UTI's VRE
When administering oxytocin to stimulate contractions, which medication can be used to RELAX the uterus?
Magnesium sulfate
A nurse is monitoring a client who is receiving *terbutaline* to suppress pre-term labor. Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect of the medication?
Maternal HEART RATE >120 (tachycardia)
A. nurse is caring for a client who has a prescription for chlorothiazide to treat HTN. The nurse should plan to monitor the client for which of the following adverse effects? A. Thrombophlebitis B. Hyperactive reflexes C. Muscle weakness D. Hypoglycemia
Muscle weakness *Rationale*: Chlorothiazide is a thiazide diuretic that promotes excretion of sodium and water and potassium, which can cause hypokalemia; the physical manifestations of hypokalemia include muscle weakness (also muscle cramps & dysrhythmias)
A nurse is providing teaching to a client who has type 2 DM and a new Rx for *metformin*. Which of the following adverse effects should the nurse instruct the client to watch for and report to the provider? A. Weight gain B. Myalgia C. Hypoglycemia D. Severe constipation
Myalgia *Rationale*: this is a manifestation of lactic acidosis
Where should transdermal estradiol patches NEVER be applied?
NEVER to the breasts
When should patients take pioglitazone for the treatment of Type 2 DM?
Once daily, with OR without food
A nurse is caring for a client who has schizophrenia and a prescription for chlorpromazine. For which of the following adverse effects should the nurse monitor?
Orthostatic hypotension
A nurse is assessing a client who was recently admitted and has a history of alcohol use disorder. The client displays ataxia, altered LOC, and nystagmus. Which of the following medications should the nurse anticipate administering to the client? A. Parenteral thiamine B. Niacin ER capsules C. Parenteral pyridoxine D. Riboflavin tablets
Parenteral thiamine *Rationale*: these are manifestations of Wernicke-Korsakoff syndrome due to thiamine deficiency
A nurse is assessing a client who has been taking *linezolid* to treat a Staphylococcus infection. Which of the following findings should the nurse report to the provider? A. Nausea B. HA's C. Paresthesias D. Insomnia
Paresthesias
What is the therapeutic use of Methylergonovine?
Postpartum hemorrhage and acts as a uterine stimulant
A nurse is providing teaching to a female client who has a new prescription for *pravastatin* to treat hyperlipidemia. Which of the following pieces of information should the nurse include in the teaching?
Pravastatin can be taken with grapefruit juice
A nurse is providing teaching to a client who has chronic kidney failure with an AV fistula for hemodialysis and a new prescription for epoetin alfa. Which of the following therapeutic effects on epoetin alfa should the nurse include in the teaching?
Promotes RBC production (for anemia)
A nurse is reviewing the medical record of a client. The MAR shows the client is taking Clopidogrel. Which of the following events should the nurse expect in the client's medical history? A. Recent MI B. H/o hemorrhagic stroke C. Current outbreak of psoriasis D. H/o HTN
Recent MI *Rationale*: might expect an atherosclerotic event, such as ischemic stroke, PVD, or MI
A nurse is caring for a client who has cancer involving the lumbar vertebrae and has been prescribed *gabapentin*. Which of the following therapeutic effects should the nurse identify for the client when taking this medication?
Reduced cramping, aching, and burning neuropathic pain
A nurse is caring for a client who has RA and a new Rx for etanercept. Which of the following values should the nurse review prior to the administration of the medication? A. Ability to swallow B. Results of last purified protein derivative (PPD) test C. Serum creatinine level D. Blood glucose level
Results of last purified protein derivative (PPD) test *Rationale*: a client taking this med is at risk for infections such as TB. To reduce the risk, the client needs to be tested for latent TB;
A nurse is caring for a client who has asthma and requires long term treatment. The nurse should identify that which of the following places the client at an increased risk of asthma related death? A. Salmeterol B. Fluticasone C. Budesonide D. Theophylline
Salmeterol *Rationale*: this is a long acting beta 2 agonist, which should ALWAYS be prescribed with an inhaled corticosteroid to reduce the risk of asthma related death
A nurse is caring for a client who has a prescription for subdermal etonogestrel. The nurse should alert the provider about which of the following findings in the client's medical history?
Takes St. John's wort *Rationale*: St. John's wort can reduce the effects of subdermal etonogestrel because it stimulates hepatic drug metabolizing enzymes
A nurse is evaluating a 20 month old client who received a hepatitis A immunization 3 days ago. The parent reports that the child has exhibited a loss of appetite following the immunization. Which of the following actions should the nurse take?
Tell the parent that this reaction should only last for a couple of days
What are the ADRs of *Clonidine* used for HTN?
The 3 D's: Dizziness, Drowsiness, Dry mouth (suck on hard candy)
A nurse is assessing an infant who is scheduled to receive the rotavirus vaccine. Which of the following criteria should the nurse identify as a potential C/I for administering this vaccine?
The infant has a h/o intussusception
A nurse is providing teaching to a client who has a new prescription for lisinopril. Which of the following should the nurse include in the teaching as an ADR of lisinopril? A. Tongue swelling B. Low potassium level C. Runny nose D. Bruising
Tongue swelling
Why do some clients take the herbal supplement *feverfew*?
Used for the prophylaxis of migraine headaches and can reduce the frequency of migraines an decrease the severity of accompanying manifestations such as nausea & photophobia
A nurse is caring for a client who has severe asthma and allergic rhinitis. The client is taking theophylline. Which of the following medications should the nurse identify as being incompatible with theophylline? A. Cromolyn B. Albuterol C. Zafirlukast D. Methyprednisone
Zafirlukast *Rationale*: Zafirlukast is a leukotriene receptor antagonist prescribed for asthma maintenance; concurrent use of theophylline with zafirlukast suppresses the metabolism of theophylline, which can lead to toxicity
