ATI Pharm - NUR 402

A nurse is teaching a client about the proper placement of a nitroglycerin patch, Which of the following statements by the client indicates an understanding of the teaching? A. I'll apply the patch over areas of my body with little fatty tissue B. I can place the patch on any area of my body without hair C. I'll put the patch on the same site as the previous patch D. I have to apply the patch directly over my heart

B. I can place the patch on any area of my body without hair Should be applied to skin free of hair because hair created a physical barrier to absorption.

A nurse is monitoring a client with pneumonia who has received penicillin G IM. Which of the following findings should the nurse plan to evaluate first? A. Pain at the injection site B. Prolonged motor dysfunction C. Laryngeal edema D. Temperature 37.6 (99.7)

C. Laryngeal edema Priority finding is C. Laryngeal edema b/c the client could be experiencing an allergic or anaphylactic reaction to penicillin.

A nurse is preparing a discharge teaching plan for a client who is scheduled to begin long term oral prednisone for asthma. Which of the following instructions should the nurse include in the plan? A. Stop taking the medication if a rash occurs B. Take the medication on an empty stomach to enhance absorption C. Schedule the medication on alternate days to decrease adverse effects D. Treat shortness of breath with an extra dose of the medication

C. Schedule the medication on alternate days to decrease adverse effects Some adverse effects caused by long-term glucocorticoid therapy can be avoided by using alternate-day therapy.

Anticholinergic Medication Side Effects

Cant see, Cant spit, Cant pee, Cant shit

Test for Warfarin/Coumadin

PT/INR

Test for Heparin

PTT

Antidote for Warfarin

Vitamin K

Antidote for Heparin

protamine sulfate

Anticholinergic Medications

- Inhibit the parasympathetic system - Block the action of ACh

Electrolyte Level: Phosphorus

2.5-4.5

Electrolyte Level: Potassium

3.5-5.0

WBC normal level

4,000-10,000

A nurse is planning to administer epoetin alfa to a client who has chronic kidney failure. Which of the following should the nurse plan to review prior to administering this medication? A. Blood pressure B. Temperature C. Blood glucose levels D. Total protein level

A. Blood pressure Epoetin alfa causes HTN which can lead to stroke or other cardiovascular complications.

A nurse is caring for a client who is receiving IV famotidine. Which of the following adverse effects should the nurse report to the provider immediately? A. Nausea B. Bloody stools C. Drowsiness D. Headache

B. Bloody stools An adverse effect of treatment with famotidine. ight include blood dyscrasias which can lead to bleeding.

A nurse is teaching an assistive personnel (AP) about dietary restrictions for a client who is taking phenelzine to treat depression. The AP's selection of which of the following foods for the client's lunch indicates an understanding of the teaching? A. Bologna on wheat bread B. Chicken salad C. Cheddar cheese and crackers D. Pizza with pepperoni

B. Chicken salad A patient taking MAOIs cannot have tyramine due to drug-food interaction (ex: lunch meats, cheeses)

Cholinergic Agonist

-Stimulate the parasympathetic system - mimics ACh (parasympathetic neurotransmitter)

Electrolyte Level: Magnesium

1.3-2.1

Electrolyte Level: Sodium

135-145

Platelet normal level

150,000-450,000

Electrolyte Level: Calcium

9-10.5

Electrolyte Level: Chloride

95-105

A nurse is planning care for a client who is receiving gentamicin IM and has a new prescription to obtain gentamicin peak and trough levels. At which of the following times should the nurse plan to obtain a blood sample to evaluate the gentamicin peak? A. 1 hour after administering the IM injection B. Just before administering the IM injection C. 12 hours after the last IM injection D. 30 minutes after administering the IM injection

A. 1 hour after administering the IM injection The nurse should obtain blood samples for peak levels 1 hour after administering an IM injection or 30 minutes after completing an IV infusion

A nurse is caring for a client who has asthma and advanced rheumatoid arthritis and deformity of the hands. The nurse should anticipate that the client will receive which of the following medication-delivery devices for the treatment of asthma? A. Dry-powder inhaler (DPI) B.Metered-dose inhaler (MDI) with spacer C. Respimat D. Nebulizer

A. Dry-powder inhaler (DPI) DPIs do not require hand-breath coordination and are easier to use for the clients who have deformities of the hands. DPIs are used to deliver medications in a dry, micronized powder directly to the lungs

A nurse is preparing to administer the varicella vaccine to a 12 month old infant. The nurse asks the infant's guardian if the infant has any allergies. Which of the following allergies is a contraindication to the infant receiving the vaccine? A. Gelatin B. Milk C. Eggs D. Peanuts

A. Gelatin Egg allergy is contraindicated for influenza vaccine.

A nurse is teaching a client about the adverse effects of Omeprazole. Which of the following client statements indicates an understanding of the teaching? A. If I experience severe diarrhea, I will call my doctor B. Pneumonia is associated with long-term use of this medication C. I will need to take this medication with food D. I should take Vitamin B12 while using this medication

A. If I experience severe diarrhea, I will call my doctor Omeprazole and other PPIs are associated with dose-related increase in the risk of inc=fection with C-Diff which can cause severe diarrhea.

A nurse is planning care for a client with thrombophlebitis who has a prescription to receive heparin via continuous IV infusion. Which of the following actions should the nurse include in the plan of care? A. Infuse the heparin using an electronic IV pump B. Administer Vitamin K if the client has indications of hemorrhage C. Adjust the dosage of Heparin based on the client's PT levels D. Inform the client that the heparin will dissolve the thrombus

A. Infuse the heparin using an electronic IV pump Heparin should be administered by an electric IV pump rather than by gravity. PTT needs to be monitored not PT.

A nurse is caring for a client who developed hypoglycemia following an insulin injection. The client is conscious and responds appropriately to verbal stimuli. Which of the following medications should the nurse plan to administer first? A. Oral glucose tablet B. 50% dextrose intravenously C. Glucagon intramuscularly D. Epinephrine intravenously

A. Oral Glucose tablet A client who has mild hypoglycemia and is conscious and able to swallow should receive an oral agent. If the client is unresponsive to the oral glucose tablet, then a more invasive form of treatment can be initiated.

A nurse is caring for a client who received spinal anesthesia 30 minutes ago. The client reports feeling dizzy, and the nurse notes that the client's blood pressure is 84/54 mmHG. Which of the following actions should the nurse take? A. Place the client in the head-down position B. Assess the placement of the catheter C. Prepare to administer an IV reversal agent D. Assist the client in passive range of motion movements

A. Place the client in the head-down position Hypotension is the common adverse effect of spinal anesthesia due to the loss of venous tone and decreased venous return to the heart. Placing the client in the head down position with promote venous return to the heart which will increase the client's blood pressure.

A nurse is providing teaching to a newly licensed nurse about administering morphine via IV bolus to a client. Which of the following pieces of information should the nurse include in the teaching? A. Respiratory depression can occur 7 min after the morphine is administered. B. The morphine will peak in 10 min. C. Withhold the morphine if the client has respiratory rate of <16/min D. Administer the morphine over 2 minutes

A. Respiratory depression can occur 7 minutes after the morphine is administered. IV morphine peaks at 20 minutes. Morphine should be held if the respiratory rate is < 12/min.

A nurse is planning care for a female client who has severe irritable bowel syndrome with diarrhea and a new prescription for alosetron. Which of the following interventions should the nurse include in the plan of care? A. The client must sign an agreement with the provider before beginning alosetron B. The client must stop taking alosetron if diarrhea continues for 1 week after beginning the medication C. The client should expect to have a slower heart rate while taking alosetron D. The client should use a barrier birth control method because alosetron interacts with oral contraceptives

A. The client must sign an agreement with the provider before beginning alosetron Alosetron has potentially fatal adverse effects associated with constipation and bowel obstruction. It is only allowed to be placed on the market if the patient signs and adheres to the risk management program and agreement with the doctor.

A nurse is teaching a client who is using topical lidocaine about preventing systemic toxicity. Which of the following pieces of information should the nurse include about the application of topical lidocaine? A. Apply a dressing after covering the affected areas with topical lidocaine B. Apply topical lidocaine to affected areas that are intact C. Apply topical lidocaine in a thick layer to affected areas D. Apply topical lidocaine frequently to large affected areas.

B. Apply topical lidocaine to affected areas that are intact Lidocaine should be applied to skin that is intact rather than blistered, broken or irritated to prevent a large amount of medication from being absorbed and to decrease the risk of systemic toxicity.

A nurse is caring for a client who has a positive TB skin test and is beginning a prescription for isoniazid. Which of the following laboratory values should be monitored while the client is taking isoniazid? A. Thyroid Stimulating Hormone level (TSH) B. Aspartate Aminotransferase (AST) C. Potassium D. Sodium

B. Aspartate aminotransferase (AST) Isoniazid can be toxic to the liver. It is important to monitor liver enzymes during therapy and notify provider if jaundice, nausea, dark-colored urine or any other findings occur.

A nurse is admitting a client who has atrial fibrillation with a heart rate of 155/min. The nurse should anticipate a prescription from the provider for which of the following medications? A. Atropine B. Diltiazem C. Epinephrine D. Vasopressin

B. Diltiazem Diltiazem is an antiarrhythmic agent that reduces the ventricular rate in a-fib. Atropine is an anti-arrhythmic that is administered to accelerate the heart rate to treat sinus bradycardia and heart block Epinephrine is a vasopressor and bronchodilator that is administered to treat cardiac arrest and severe allergic reactions that cause anaphylaxis Vasopressin is a vasopressor agent that is administered to treat cardiac arrest and asystole.

A nurse is caring for a client who is receiving cefotetan 1 g via intermittent IV bolus every 12 hours to treat a postoperative infection. Which of the following manifestations should the nurse monitor for as an adverse effect of the medication? A. Disorientation B. Epistaxis C. Constipation D. Jaundice

B. Epistaxis Cefotetan is an antibiotic which affects Vitamin K levels and can result in bleeding and epistaxis. If bleeding occurs the medication should be discontinued.

A nurse is caring for a female client who has been taking clomiphene to treat infertility. Which of the following findings should indicate to the nurse that the medication has been effective? A. Decreased serum luteinizing hormone levels B. Follicular enlargement and conversion to corpus luteum after ovulation C. Increased human chorionic gonadotropin (hCG) levels D. Blocked endogenous release of LH and prevention of premature ovulation

B. Follicular enlargement and conversion to corpus luteum after ovulation Clomiphene promotes follicular maturation. Successful treatment is progressive follicular enlargement and the conversion of follicle to a corpus luteum after ovulation.

A nurse is reviewing the medical record of a client with rheumatoid arthritis who has a prescription for infliximab. Which of the following findings should the nurse identify as a contraindication to the client receiving this medication? A. Psoriatic arthritis B. Hepatitis B virus C. Ulcerative colitis D. Ankylosing spondylitis

B. Hepatitis B virus Infliximab has immunosuppressant properties that can increase the risk of infection and can reactivate Hep B.

A nurse is teaching a client who has a new prescription for amitriptyline to treat depression. Which of the following client statements indicates an understanding of the teaching? A. "I should take this medication when I experience active symptoms" B. "I should take this medication before bedtime" C. "This medication may cause excess salivation" D. "I might experience weight loss while taking this medication".

B. I should take this medication before bedtime An adverse effect of amitriptyline is sedation. The patient should take this med at bedtime to minimize sedation during waking hours.

A nurse is reviewing the medical record for a patient who has a migraine and a prescription for sumatriptan. Which of the following factors in the client's medical history should the nurse identify as a contraindication to receiving sumatriptan? A. Renal impairment B. Ischemic heart disease C. Severe osteoporosis D. Cirrhosis

B. Ischemic heart disease Sumatriptan is a serotonin receptor agonist that can cause vasoconstriction and coronary vasospasm. Do not use with pt w/ hx of CAD, Uncontrolled HTN, or stroke

A nurse is reviewing the laboratory results for a client who has a prescription for filgrastim. An increase in which of the following values indicates a therapeutic effect of this medication? A. Erythrocyte count B. Neutrophil count C. Lymphocyte count D. Thrombocyte count

B. Neutrophil count Filgrastim increases neutrophil production.

A nurse is admitting a client who has unstable angina. Which of the following medications should the nurse anticipate administering to the client? A. Epinephrine B. Nitroglycerin C. Lidocaine D. Atropine

B. Nitroglycerin This medication acts by relaxing or preventing spasms in the coronary arteries along with dilating the arteries which increases oxygenation and blood flow.

A nurse is reviewing the medical record of a client who is scheduled for induction of labor and has a prescription for misoprostol. Which of the following conditions should the nurse identify as a contraindication to administering this medication? A. Gestational diabetes B. Past cesarean delivery C. Preeclampsia D. Genital herpes

B. Past cesarean delivery Misoprostol is used for cervical ripening and induction of labor. It is contraindicated in a patient who had major uterine surgery or c-section because of the risk of uterine rupture.

A nurse is providing teaching to a client who has a new prescription for sertraline. The client asks the nurse if he should continue to take St. John's wort for depression. Which of the following instructions should the nurse give the client? A. Take the medication and herbal supplement together B. Stop taking the herbal supplement while taking the medication C. Take the herbal supplement and the medication at least 2 hr. apart D. Take antacid with both the herbal supplment and the medication

B. Stop taking the herbal supplement while taking the medication. Taking sertraline (antidepressant) and the herbal supplement St. John's wort increases the client's risk of serotonin syndrome.

A nurse is preparing to administer Warfarin to a client who has a new onset of a-fib. The client asks the nurse, "what should this medication do?" Which of the following responses should the nurse make? A. "it helps your heart return to a normal rhythm" B. "it dissolves blood clots" C. "it can reduce your risk of having a stroke" D. "it helps to prevent bleeding in atrial fibrillation"

C. "It can reduce your risk of having a stroke" A-fib increases the risk of having a stroke due to clot formation in the atrium. Warfarin can prevent clot formation when used long-term, which will reduce the client's risk of having a stroke.

A nurse is caring for a client who receives gastrostomy tube feedings and insulin. The client is scheduled to receive a tube feeding at 0700. At which of the following times should the nurse plan to administer insulin lispro subcutaneously? A. 0600 B. 0630 C. 0645 D. 0730

C. 0645 Lispro is rapid-acting insulin with an onset of 15 minutes so the insulin should be administered 15 minutes prior to the feeding.

A nurse is planning care for a client who is postoperative and scheduled to ambulate. At which of the following times should the nurse plan to administer PO morphine to the client for peak analgesic effect during the ambulation? A. 3-4 hours before ambulation B. 10-15 min before ambulation C. 60-90 min before ambulation D. Immediately before ambulation

C. 60-90 min before ambulation PO morphine takes 60-90 minutes to peak while IV morphine takes 5-10 min.

A nurse is caring for a client and realizes after administering the 0900 medications that she administered Digoxin 0.25 mg PO to the client instead of the prescribed Digoxin 0.125 mg PO. Which of the following actions should the nurse take first? A. Notify the provider B. Contact the nursing supervisor C. Assess the client's apical pulse D. Complete an incident report

C. Assess the client's apical pulse An assessment of the patient will provide the nurse with the necessary knowledge to make an appropriate decision.

A nurse is caring for a client with a pseudomonas infection who has a new prescription for ticarcillin-clavulanate. Which of the following data should the nurse collect before administering this medication? A. Indications of superinfection B. Peak and trough medication levels C. Baseline BUN and creatinine D. History of allergy to aminoglycoside antibiotics

C. Baseline BUN and creatinine This penicillin antibiotic is excreted by the kidneys so it is important to assess renal impairment to avoid a resulting toxic level of medication.

A nurse is providing teaching to a client who has postmenopausal osteoporosis and a new prescription for intranasal calcitonin-salmon. Which of the following statements by the client indicates an understanding of the teaching? A. I will administer a spray into each nostril daily B. I should expect nasal bleeding for the first week C. I will need to depress the side arms to activate the pump D. I should expect to take this medication for short term course of treatment.

C. I will need to depress the side arms to activate the pump Activate the pump by depressing both white side arms towards the bottle 6 times

A nurse is teaching a client who has a new prescription for warfarin. Which of the following statements should the nurse identify as an indication that the client understands the instructions? A. Ill use a safety razor to shave each day B. Ill be sure to eat lots of spinach C. Ill avoid contact sports like football D. Ill take ibuprofen if I get a headache

C. Ill avoid contact sports like football The most common adverse effect of taking anticoagulants is bleeding.

A nurse is teaching the guardian of a school-aged child about growth hormone therapy. Which of the following statements should the nurse include in the teaching? A. "your child will grow an extra 4-6 inches while receiving hormone therapy" B. "Hormone injection therapy will occur for 2-3 years" C. "Your child will receive hormone injections no more often than 1-2 times each week" D. "The hormone injections are administered subcutaneously"

D. "The hormone injections are administered subcutaneously" Subcutaneously is the preferred route of administration since the injections are more painful when administered IM.

A nurse is providing teaching to a client who has multiple sclerosis and a new prescription for baclofen PO. Which of the following pieces of information should the nurse include? A. "you should take the medication on an empty stomach to increase absorption" B. "You can stop taking the medication once your back spasms disappear" C. "You can expect to experience urinary frequency when you first start taking this medication" D. "You should change positions slowly while taking this medication".

D. "You should change positions slowly while taking this medication". Dizziness and hypotension are adverse effects of this medication.

A nurse is administering a medication parenterally to a client. Which of the following techniques should the nurse use to reduce fluctuations in plasma medication levels? A. Gradually increasing the dose with the dosing interval B. Administering a single loading IM dose C. Using a large fluid-volume IV dose D. Administering a continuous infusion of the dose

D. Administering a continuous infusion of the dose

A nurse is providing teaching to the parents of a school-age child with asthma about medications for bronchospasm. Which of the following inhaled medications should the nurse instruct the parents to use to relieve an acute asthma attack? A. Salmeterol B. Cromolyn C. Fluticasone D. Albuterol

D. Albuterol Beta 2 adrenergic agonist which provides immediate relief for an acute asthma attack.

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? A. Discontinue the medication if a rash develops B. Expect increased salivation during the first few weeks of therapy C. Minimize fiber intake to prevent diarrhea D. Avoid driving until the client's reaction to the medication is known

D. Avoid driving until the client's reaction to the medication is known Clonidine is a sedative and can cause drowsiness, weakness and other CNS effects.

A nurse is providing teaching to a client with asthma who has a new prescription for short-acting beta-2 agonist (SABA) bronchodilator. Which of the following pieces of information should the nurse share? A. The SABA will provide prolonged control of asthma atttacks B. SABA are also available in an oral form C. The SABA will have to be taken with an inhaled glucocorticoid D. Notify the provider if the SABA is needed more than twice per week.

D. Notify the provider if the SABA is needed more than twice per week. SABA are used PRN as rescue medications to stop an ongoing asthma attack. If it is needed more than 2x a week the provider may need to prescribe a long-acting beta 2 agonist

A nurse is providing teaching to a client who has cirrhosis and a new prescription for lactulose. The nurse should instruct the client that lactulose has which of the following therapeutic effects? A. Increases blood pressure B. Prevent esophageal bleeding C. Decreases heart rate D. Reduces ammonia levels

D. Reduces ammonia levels Lactulose is a laxative that promotes the excretion of ammonia in a client who has hepatic encephalopathy from cirrhosis of the liver.

A nurse is caring for a female adult patient who is experiencing menopause and has a prescription for estrogen along with progestin. The nurse should identify that the provider has prescribed these medications for which of the following reasons? A. Long-term use to reduce the risk of breast cancer B. Short-term use to stimulate the endometrium C. Long-term use to prevent osteoporosis D. Short-term use to control urogenital atrophy

D. Short-term use to control urogenital atrophy This is prescribed for menopause for hormonal therapy and can assist with managing the manifestations of menopause like urogenital atrophy.

A nurse is assessing a client who is receiving a continuous morphine IV infusion and finds the client's respiratory rate has decreased from 20/min to 12/min. Which of the following actions should the nurse take? A. Flush the IV line with saline B. Administer flumazenil C. Lower the head of the bed D. Slow the rate of the infusion

D. Slow the rate of the infusion Decreasing the infusion rate will reduce the amount of morphine the client receives and limits the risk of respiratory depression.