ATI Pharm Assessment Test A

A nurse is teaching a client about warfarin. The client asks if they can take aspirin while taking the warfarin. Which of the following responses should the nurse make? "It is safe to take an enteric-coated aspirin." "Aspirin will increase the risk of bleeding." "Acetaminophen may be substituted for aspirin." "The INR lab work must be monitored more frequently if aspirin is taken."

"Aspirin will increase the risk of bleeding." Aspirin inhibits platelet aggregation and can potentiate the action of the anticoagulant warfarin. Therefore, the client should avoid taking aspirin because it increases the risk for bleeding.

A nurse at an urgent care clinic is collecting a history from a female client who has a urinary tract infection. The nurse anticipates a prescription for ciprofloxacin. The nurse should identify that which of the following client statements indicates a contraindication for administering this medication? "I have tendonitis, so I haven't been able to exercise." "I take a stool softener for chronic constipation." "I take medicine for my thyroid." "I am allergic to sulfa."

"I have tendonitis, so I haven't been able to exercise." The nurse should identify tendonitis as a contraindication for taking ciprofloxacin due to the risk of tendon rupture.

A nurse is providing discharge instructions to a client who has heart failure and a new prescription for captopril. Which of the following client statements indicates an understanding of the teaching? "I should take the medication with food." "I should take naproxen if I develop joint pain." "I should tell my provider if I develop a sore throat." "I should expect the medication to cause my urine to look orange."

"I should tell my provider if I develop a sore throat." The client should report a sore throat to the provider because this can indicate neutropenia, a serious adverse effect of captopril. Neutropenia can be reversed if it is identified early and the medication is promptly discontinued.

A nurse is instructing a client on the application of nitroglycerin transdermal patches. Which of the following statements by the client indicates an understanding of the teaching? "I should apply a patch every 5 minutes if I develop chest pain." "I will take the patch off right after my evening meal." "I will leave the patch off at least 1 day each week." "I should discard the used patch by flushing it down the toilet."

"I will take the patch off right after my evening meal." Clients should remove the patch each evening for a medication free time of 12 to 14 hr before applying a new patch to avoid developing a tolerance to the medication's effects.

A nurse is teaching a client about cyclobenzaprine. Which of the following client statements should indicate to the nurse that the teaching is effective? "I will have increased saliva production." "I will continue taking the medication until the rash disappears." "I will taper off the medication before discontinuing it." "I will report any urinary incontinence."

"I will taper off the medication before discontinuing it." The client should taper off cyclobenzaprine before discontinuing it to prevent abstinence syndrome or rebound insomnia.

A nurse is providing teaching to a client who has a gastric ulcer and a new prescription for famotidine. Which of the following instructions should the nurse include? "Take the medication on an empty stomach for full effectiveness." "You may discontinue this medication when stomach discomfort subsides." "Report yellowing of the skin." "You will be taking this medication for 2 weeks."

"Report yellowing of the skin." Famotidine can be hepatotoxic and cause jaundice. The nurse should instruct the client to monitor for and report yellowing of the skin or eyes to the provider.

A nurse administers a dose of metformin to a client instead of the prescribed dose of metoclopramide. Which of the following actions should the nurse take first? -Report the incident to the charge nurse. -Notify the provider. -Check the client's blood glucose. -Fill out an incident report.

-Check the client's blood glucose. The first action the nurse should take using the nursing process is to assess the client. The client is at risk for hypoglycemia. The nurse should monitor the client's blood glucose and provide the client with a snack to reduce the risk for hypoglycemia.

A nurse is teaching a client who is to start taking hydrocodone with acetaminophen tablets for pain. Which of the following information should the nurse include in the teaching? -The medication should be taken 1 hr prior to eating. -It takes 48 hr for therapeutic effects to occur. -Tablets should not be crushed or chewed. -Decreased respirations might occur.

-Decreased respirations might occur. The nurse should instruct the client that hydrocodone with acetaminophen might cause respiratory depression, which is an adverse effect of the medication. The client should avoid taking over-the-counter medications or newly prescribed medications without consulting their provider to avoid increased respiratory depression.

A nurse is administering donepezil to a client who has Alzheimer's disease. Which of the following findings should the nurse report to the provider immediately? -Dyspepsia -Diarrhea -Dizziness -Dyspnea

-Dyspnea When using the airway, breathing, circulation approach to client care, the nurse should report the adverse effect of dyspnea, caused by bronchoconstriction, to the provider first. Bronchoconstriction, dyspepsia, diarrhea, and dizziness are caused by the increase in acetylcholine levels, which is a primary effect of donepezil.

A nurse is assessing a client 1 hr after administering morphine for pain. The nurse should identify which of the following findings as the best indication that the morphine has been effective? -The client's vital signs are within normal limits. -The client has not requested additional medication. -The client is resting comfortably with eyes closed. -The client rates pain as 3 on a scale from 0 to 10.

-The client rates pain as 3 on a scale from 0 to 10. The client's description of the pain is the most accurate assessment of pain.

A nurse is caring for a client who is taking acetazolamide for chronic open-angle glaucoma. For which of the following adverse effects should the nurse instruct the client to monitor and report? -Tingling of fingers -Constipation -Weight gain -Oliguria

-Tingling of fingers The nurse should instruct the client to report the adverse effect of paresthesia, a tingling sensation in the extremities, when taking acetazolamide.

A nurse is preparing to administer dextrose 5% in water (D5W) 400 mL IV to infuse over 1 hr. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

100 gtt/min

A nurse is caring for the parent of a newborn. The parent asks the nurse when their newborn should receive the first diphtheria, tetanus, and pertussis vaccine (DTaP). The nurse should instruct the parent that their newborn should receive the immunization at which of the following ages? At birth 2 months 6 months 15 months

2 months The CDC recommends that newborns receive the first dose of the five-dose series of the DTaP immunization at 2 months of age.

A nurse is preparing to administer ciprofloxacin 15 mg/kg PO every 12 hr to a child who weighs 44 lb. How many mg should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

300mg

A nurse is caring for a client who has acute acetaminophen toxicity. The nurse should anticipate administering which of the following medications? Vitamin K Acetylcysteine Benztropine Physostigmine

Acetylcysteine Acetylcysteine is a specific antidote for acetaminophen toxicity. It can prevent severe injury when given orally or by IV infusion within 8 to 10 hr.

A nurse is planning care for a client who is receiving mannitol via continuous IV infusion. The nurse should monitor the client for which of the following adverse effects? Weight loss Increased intraocular pressure Auditory hallucinations Bibasilar crackles

Bibasilar crackles Mannitol, an osmotic diuretic, can precipitate heart failure and pulmonary edema. Therefore, the nurse should recognize lung crackles as an indicator of a potential complication and stop the infusion.

A nurse is providing teaching to a client who has multiple sclerosis and a new prescription for methylprednisolone. Which of the following instructions should the nurse include? (Select all that apply.) Blood glucose levels will be monitored during therapy. Avoid contact with people who have known infections. Take the medication 1 hr before breakfast. Decrease dietary intake of foods containing potassium. Grapefruit juice can increase the effects of the medication.

Blood glucose levels will be monitored during therapy. Avoid contact with people who have known infections. Grapefruit juice can increase the effects of the medication.

A nurse is reviewing the medication list of a client who wants to begin taking oral contraceptives. The nurse should identify that which of the following client medications will interfere with the effectiveness of oral contraceptives? Carbamazepine Sumatriptan Atenolol Glipizide

Carbamazepine Carbamazepine causes an accelerated inactivation of oral contraceptives because of its action on hepatic medication-metabolizing enzymes.

A nurse is caring for a client who has cancer and is taking oral morphine and docusate sodium. The nurse should instruct the client that taking the docusate sodium daily can minimize which of the following adverse effects of morphine? Constipation Drowsiness Facial flushing Itching

Constipation Constipation is a common adverse effect of morphine that can be minimized by taking docusate sodium, a stool softener that promotes easier evacuation of stool by increasing water and fat in the intestine.

A nurse is planning care for a client who has hypertension and is to start taking metoprolol. Which of the following interventions should the nurse include in the plan of care? Weigh the client weekly. Determine apical pulse prior to administering. Administer the medication 30 min prior to breakfast. Monitor the client for jaundice.

Determine apical pulse prior to administering. Life-threatening bradycardia is an adverse effect that might affect this client. Therefore, the nurse should assess the client's apical pulse prior to administering the medication. If the client's pulse rate is less than 60/min, the nurse should withhold the medication and notify the provider.

A nurse is providing teaching to a client who is to begin taking oxybutynin for urinary incontinence. Which of the following adverse effects should the nurse include in the teaching? (Select all that apply.) Dry mouth Tinnitus Blurred vision Bradycardia Dry eyes

Dry mouth Blurred vision Dry eyes Oxybutynin is an anticholinergic agent "can't see, cant pee, cant spit and cant sH*t."

A nurse in an emergency department is caring for a client whose family reports the client has taken large amounts of diazepam. Which of the following medications should the nurse anticipate administering? Ondansetron Magnesium sulfate Flumazenil Protamine sulfate

Flumazenil The nurse should anticipate administering flumazenil, an antidote used to reverse benzodiazepines such as diazepam.

A nurse is providing teaching to a client who has peptic ulcer disease and is to start a new prescription for sucralfate. Which of the following actions of sucralfate should the nurse include in the teaching? Decreases stomach acid secretion Neutralizes acids in the stomach Forms a protective barrier over ulcers Treats ulcers by eradicating H. pylori

Forms a protective barrier over ulcers Secretions by the parietal and chief cells, hydrochloric acid and pepsin, can further irritate the ulcerated areas. Sucralfate, a mucosal protectant, forms a gel-like substance that coats the ulcer, creating a barrier to hydrochloric acid and pepsin.

A nurse is teaching a client who is to begin taking tamoxifen for the treatment of breast cancer. Which of the following adverse effects should the nurse include in the teaching? Hot flashes Urinary retention Constipation Bradycardia

Hot flashes The estrogen receptor blocking action of tamoxifen commonly results in the adverse effect of hot flashes. TAMHOTcifen

A nurse is collecting a medication history from a client who has a new prescription for lithium. The nurse should identify that the client should discontinue which of the following over-the-counter medications? Aspirin Ibuprofen Famotidine Bisacodyl

Ibuprofen Most NSAIDs can significantly increase lithium levels. Therefore, the client should not take ibuprofen and lithium concurrently.

A nurse is assessing a client who is taking propylthiouracil for the treatment of Graves' disease. Which of the following findings should the nurse identify as an indication that the medication has been effective? Decrease in WBC count Decrease in amount of time sleeping Increase in appetite Increase in ability to focus

Increase in ability to focus A client who has Graves' disease can experience psychological manifestations such as difficulty focusing, restlessness, and manic-type behaviors. Propylthiouracil is a thyroid hormone antagonist that decreases the circulating T4 hormone, reducing the manifestations of hyperthyroidism. An increased ability to focus indicates that the medication has been effective.

A nurse is caring for a client who is receiving filgrastim. Which of the following findings should the nurse document to indicate the effectiveness of the therapy? Increased neutrophil count Increased RBC count Decreased prothrombin time Decreased triglycerides

Increased neutrophil count Filgrastim stimulates the bone marrow to produce neutrophils. For clients receiving chemotherapy, the risk of infection is minimized.

Carbamazepine causes an accelerated inactivation of oral contraceptives because of its action on hepatic medication-metabolizing enzymes. Tachycardia Oliguria Xerostomia Miosis

Miosis Miosis, which is pupillary constriction, is a common adverse effect of neostigmine due to the excessive muscarinic stimulation that causes difficulty with visual accommodation.

A nurse receives a verbal order from the provider to administer morphine five milligrams every 4 hours subcutaneously for severe pain as needed. The nurse should identify which of the following entries as the correct format for the medication administration record (MAR)? MSO4 5 mg subcut every 4 hr PRN severe pain Morphine 5 mg subcut every 4 hr PRN severe pain MSO4 5 mg SQ every 4 hr PRN severe pain Morphine 5.0 mg subcutaneously every 4 hr PRN severe pain

Morphine 5 mg subcut every 4 hr PRN severe pain The nurse should identify this entry as the correct format for the MAR. The medication name is spelled out and there are not any abbreviations from The Joint Commission's "Do Not Use" list included in the transcription.

A nurse in an emergency department is caring for a client who has heroin toxicity. The client is unresponsive with pinpoint pupils and a respiratory rate of 6/min. Which of the following medications should the nurse plan to administer? Methadone Naloxone Diazepam Bupropion

Naloxone The nurse should administer naloxone, an opioid antagonist, to a client who has heroin toxicity to reverse the respiratory depressive effects of the heroin. However, the nurse should not administer naloxone too quickly because naloxone can cause hypertension, tachycardia, nausea, vomiting, and might cause the client to enter a state of opioid withdrawal.

A nurse is reviewing the laboratory results for a client who is receiving heparin via continuous IV infusion for deep-vein thrombosis. The nurse should discontinue the medication infusion for which of the following client findings? Potassium 5.0 mEq/ L aPTT 2 times the control Hemoglobin 15 g/dL Platelets 96,000/mm3

Platelets 96,000/mm3 A platelet count of 96,000/mm3 is below the expected range of 150,000 to 400,000/mm3. A platelet count less than 100,000/mm3 while receiving heparin can indicate heparin-induced thrombocytopenia, a potentially fatal condition that requires stopping the infusion. K+ (3.5 - 5 mEq/L) Hgb (14 - 18 g/dL)M Hgb (12 - 16 g/dL)F

A nurse is caring for a 20-year-old female client who has a prescription for isotretinoin for severe nodulocystic acne vulgaris. Before the client can obtain a refill, the nurse should advise the client that which of the following tests is required? Serum calcium Pregnancy test 24-hr urine collection for protein Aspartate aminotransferase level

Pregnancy test The nurse should instruct the client that isotretinoin has teratogenic effects; therefore, pregnancy must be ruled out before the client can obtain a refill. The client must provide two negative pregnancy tests for the initial prescription and one negative test before monthly refills.

A nurse is reviewing the ECG of a client who is receiving IV furosemide for heart failure. The nurse should identify which of the following findings as an indication of hypokalemia? Tall, tented T-waves Presence of U-waves Widened QRS complex ST elevation

Presence of U-waves The nurse should identify the presence of U-waves as a manifestation of hypokalemia, an adverse effect of furosemide.

A nurse at a clinic is providing follow-up care to a client who is taking fluoxetine for depression. Which of the following findings should the nurse identify as an adverse effect of the medication? Tingling toes Sexual dysfunction Absence of dreams Pica

Sexual dysfunction Sexual dysfunction, including a decreased libido, impotence, and delayed orgasm, or anorgasmia, is a common adverse effect of fluoxetine and occurs in about 70% of clients who take this SSRI antidepressant.

A nurse is providing discharge teaching about handling medication to a client who is to continue taking oral transmucosal fentanyl raspberry-flavored lozenges on a stick. Which of the following information should the nurse include in the teaching? Chew on the medication stick to release the medication. Leave the medication stick in one location of the mouth until melted. Allow the medication 1 hr for analgesia effects to begin. Store unused medication sticks in a storage container.

Store unused medication sticks in a storage container. The nurse should instruct the client to store unused, used, or partially used medication sticks in the safe storage container that comes in the kit when the medication is initially prescribed.

A nurse is assessing a client who is postoperative following an outpatient endoscopy procedure using midazolam. The nurse should monitor for which of the following findings as an indication that the client is ready for discharge? The client's capnography has returned to baseline. The client can respond to their name when called. The client is passing flatus. The client is requesting oral intake.

The client's capnography has returned to baseline. The nurse should identify that the client is ready for discharge when the capnography level indicates that gas exchange is adequate.