ATI Pharmacology 2019 B
A nurse is caring for a client who is refusing to take their scheduled morning furosemide. Which of the following statements should the nurse make? A. By not taking your furosemide, you might retain fluid and develop swelling. B. you can double your dose of furosemide this evening if that would be better for you C. if you do not take your furosemide, we might get in trouble D. I'll go ahead and mix the furosemide into your breakfast cereal
"By not taking your furosemide, you might retain fluid and develop swelling." The nurse should respect the client's right to refuse the medication and inform the client of the risks of not taking the medication, notify the provider, and document the refusal. Furosemide is a loop diuretic given to reduce edema.
Nurse is planning discharge teaching for a client who has prescription for furosemide. The should plan to include which of following statements in teaching? A. "This medication increases your risk for hypertension." B. "Avoid potassium-rich foods in your diet." C. "Take each dose of medication in the evening before bed." D. "Drink a glass of milk with each dose of medication."
"Drink a glass of milk with each dose of medication." Rationale: The client should take furosemide with food or milk to reduce gastric irritation.
A nurse is teaching a client who is to start taking ranitidine for peptic ulcer disease. Which of the following client statements should the nurse identify as understanding of the teaching? A. I will stop taking ranitidine when my stomach pain is gone. B. I know smoking makes ranitidine less effective. C. I will take ranitidine anytime my stomach hurts. D. I know that ranitidine will turn my stools black.
"I know smoking makes ranitidine less effective." The nurse should instruct the client that smoking decreases the effectiveness of ranitidine by exacerbating the ulcer manifestations.
Nurse is teaching pt who is starting to take diltiazem. Which of following statements should nurse identify as indication that pt understands teaching? "I will stop taking the medication if I get dizzy." "I should not drink orange juice while taking this medication." "I should expect to gain weight while taking this medication." "I will check my heart rate before I take the medication."
"I will check my heart rate before I take the medication." Diltiazem, a calcium channel blocker, has cardio-suppressant effects at the SA and AV nodes, which can lead to bradycardia. The client should check their heart rate before taking the medication and notify the provider if it falls below the expected reference range.
A nurse is providing teaching to a client about the use of ethinyl estradiol/norelgestromin. The nurse should identify that which of the following statements by the client indicates an understanding of the teaching? A. I will apply the patch once a week for 2 weeks. B. I will leave the existing patch on for 4 hours after applying the new patch. C. I will fold the sticky sides of the old patch together before disposing of it. D. I will apply the patch within 14 days of menses.
"I will fold the sticky sides of the old patch together before disposing it." The client should fold the sticky sides of the old patch together and then place it in a childproof container to ensure safe disposal of the patch. The client should apply the patch within 7 days of menses to prevent ovulation and the need for another contraceptive method. The client should remove and dispose the old patch before applying a new patch to prevent toxicity by combining the remaining medication on the old patch with the medication on the new patch. The client should apply the patch once a week for 3 weeks and then go without the patch for 1 week to promote menstruation.
A nurse is preparing to administer 0.9% sodium chloride (NaCl) 1,500 mL to infuse over 8 hr to a client who is postoperative. The nurse should set the IV pump to deliver how many ml/hr? (Round to the nearest whole number)
188 ml/hr
A nurse is preparing to administer to a client 0.9% sodium chloride 1,000 mL IV over 8 hours. 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?
31 gtt/min
Nurse is completing incident report for med error. Which of following information should nurse include in report?
Administered propranolol 80 mg PO at 1800 to the client who did not have a prescription for the medication. The incident report should clearly and thoroughly report the facts of the error.
Nurse is preparing newly licensed nurse who is caring for 4 pts. Nurse should complete incident report for which of following actions by newly licensed nurse? A. Administers isosorbide mononitrate to a client who has BP 82/60 mm Hg B. Administers digoxin to a client who has a heart rate of 92/min C. Administers regular insulin to a client who has a blood glucose of 250 mg/dL D. Administers heparin to a client who has an aPTT of 70 seconds
Administers isosorbide mononitrate to a client who has BP 82/60 mm Hg Rationale: Isosorbide mononitrate is a nitrate used for clients with angina. Taking isosorbide mononitrate leads to vasodilation, which can result in hypotension. The nurse should withhold the medication and notify the provider if the client's systolic blood pressure is below the expected reference range of 120/80.
A nurse is caring for a client who is receiving haloperidol. The nurse should observe for which of the following findings as an adverse effect of the medication? A. Akathisia B. Paresthesia C. Excess tear production D. Anxiety
Akathisia An adverse effect associated with haloperidol is the development of extrapyramidal manifestations such as dystonia, pseudoparkinsonism, and akathisia.
A nurse is reviewing medical record of a client who has hypertension. The nurse should identify which of following findings as a contraindication for receiving propranolol? A. Cholelithiasis B. Asthma C. Angina pectoris D. Tachycardia
Asthma Rationale: Asthma is a contraindication for receiving propranolol. Propranolol is an adrenergic antagonist which blocks the beta2 receptors in the lungs, causing bronchoconstriction and leading to serious airway resistance and possibly respiratory arrest.
A nurse is caring for a client who is recovering from a deep vein thrombosis and is to start taking warfarin. For which of the following findings should the nurse monitor as an adverse effect of warfarin? A. Hypertension B. Low INR C. Constipation D. Bleeding gums
Bleeding gums The nurse should monitor the client for bleeding gums, which is an adverse effect of warfarin, an anticoagulant. The nurse should monitor for gastrointestinal irritation, which can include diarrhea, nausea, and vomiting. The nurse should monitor the INR daily until it increases to a therapeutic level. The nurse should monitor for hypotension, which can indicate bleeding.
A nurse is assessing a client who has received atropine eye drops during an eye examination. Which of the following findings should the nurse expect as an adverse effect of the medication? A. Difficulty seeing in the dark. B. Pinpoint pupils. C. Blurred vision. D. Excessive tearing.
Blurred vision Blurred vision is an expected finding following the administration of atropine eye drops. This is due to the cycloplegic effects of the medication, which cause distant objects to appear blurry to the client. Dilation of pupils, or mydriasis, is an expected finding following the administration of atropine eye drops. A client who has received atropine eye drops can experience photosensitivity, which causes difficulty seeing in brightly lit areas due to the muscarinic receptors causing mydriasis. Excessive tearing is not an expected finding following the administration of atropine eye drops.
Nurse is caring for pt who has Mg 3.1 mEq/L. Nurse should expect to administer which of following meds? A.Magnesium gluconate B. Cinacalcet C. Calcium gluconate D. Regular insulin
Calcium gluconate Rationale: The nurse should expect to administer IV calcium gluconate to the client and prepare to provide ventilatory support. This client is at risk for respiratory depression and cardiac dysrhythmias because a magnesium level of 3.1 mEq/L is above the expected reference range of 1.3 to 2.1 mEq/L.
A nurse is providing teaching to a client who is to start taking sumatriptan. Which of following adverse effects should nurse instruct the client to monitor for and report to the provider? A. Chest pressure B. White patches on the tongue C. Brusing D. Insomnia
Chest pressure Rationale: Sumatriptan is an antimigraine agent which can cause coronary vasospasms, resulting in angina. The client should report chest pressure or heavy arms to the provider.
The nurse is caring for a pt who has hypocalcemia and is receiving calcium citrate. The nurse should identify that which of following findings indicates therapeutic response to med? A. Client report of decreased paresthesia B. A calcium level of 8.8 mg/dL
Client report of decreased paresthesia Paresthesia is a manifestation of hypocalcemia. A client report of a decrease in paresthesia is an indication of a therapeutic response to calcium citrate. The nurse should also monitor for a decrease in other manifestations of hypocalcemia, including muscle twitching and cardiac dysrhythmias. A calcium level of 8.8 mg/dL is below the reference range of 9.0 to 10.5 mg/dL and does not indicate a therapeutic response to calcium citrate.
Nurse is assessing pt who is taking amitriptyline for depression. Which of following findings should nurse identify as adverse effect of med? A. Tinnitus B. Urinary frequency C. Dry mouth D. Exopthalmos
Dry mouth Rationale: The nurse should expect the client to have a dry mouth due to the blocking of acetylcholine receptors that cause anticholinergic responses.
Nurse is planning to teach about inhalant meds to pt who has new Dx of exercise-indused asthma. Which of following weds should nurse plan to instruct pt to use prior to physical activity? A. Cromolyn B. Beclomethasone C. Budesonide D. Tiotropium
Cromolyn Cromolyn sodium stabilizes mast cells, which inhibit the release of histamine and other inflammatory mediators. The client should use cromolyn 10 to 15 min before planning to exercise to prevent bronchospasms.
Nurse is reviewing lab results for pt who is to receive dose of ceftazidime via intermittent IV bolus. Which of following lab findings is priority for nurse to report to provider before administering the medication? A. Total bilirubn 0.4 mg/dL B. Alanine aminotransferase 26 units/L C. Platelet count 360,000/mm^3 D. Creatinine 2.6 mg/dL
Creatinine 2.6 mg/dL Rationale: Ceftazidime is excreted primarily by the renal system. A serum creatinine level above 1.3 mg/dL can indicate a kidney disorder requiring a reduction in the dose administered. The nurse should notify the provider, who is likely to prescribe a lowered dose of medication. a total bilirubin value of 0.4 mg/dL is within the expected reference range. an alanine aminotransferase value of 26 units/L is within the expected reference range. platelet count of 360,000/mm3 is within the expected reference range.
Nurse is caring for a client who is taking atorvastatin for hyperlipidemia. Which of following client laboratory values should the nurse monitor? A. Creatinine kinase B. Erythrocyte sedimentation rate C. International normalized ratio D. Potassium
Creatinine kinase Rationale: The client who is taking atorvastatin can develop an adverse effect called rhabdomyolysis, which causes muscle weakness or pain and can progress to myositis. Creatinine kinase levels rise in response to enzymes released with muscle injury.
Nurse is administering baclofen for pt who has spinal cord injury. Which of following findings should nurse document as therapeutic outcome? A. Increase in seizure threshold B. Decrease in flexor and extensor spasticity C. Increase in cognitive function D. Decrease in paralysis of the extremities
Decrease in flexor and extensor spasticity Rationale: A client who has a spinal cord injury and takes baclofen can experience a decrease in the frequency and severity of muscle spasms and in flexor and extensor spasticity.
Nurse is administering cefotetan via intermittent IV bolus to a client who suddenly develops dyspnea and widespread hives. Which of following actions should nurse take first? A. Administer epinephrine 0.5 mL via IV bolus B. Discontinue the medication IV infusion C. Elevate the client's legs above the level of the heart D. Collect a blood specimen for ABGs
Discontinue the medication IV infusion. Rationale: The greatest risk to the client is respiratory arrest from anaphylaxis. Therefore, the first action the nurse should take is to discontinue the medication IV infusion to prevent the client from receiving more medication. However, the nurse should not remove the IV catheter. Instead, the nurse should change the tubing and administer 0.9% sodium chloride by continuous IV infusion.
Nurse is caring for pt who has developed hypomagnesmia due to long-term therapy w/ lansoprazole. Nurse should monitor pt for which of following manifestations?
Disorientation The nurse should monitor the client for disorientation and confusion as manifestations of hypomagnesemia. The nurse should also assess the client for a positive Chvostek's and Trousseau's signs.
A nurse is teaching a client who is taking allopurinol for the treatment of gout. Which of the following information should the nurse include in the teaching? A. Plan to increase the dosage each week by 200 mg increments. B. Prolonged use of this medication can cause glaucoma. C. Drink 2 L of water daily. D. A fine red rash is transient and can be treated with antihistamines.
Drink 2 L of water daily. The nurse should instruct the client to drink at least 2 L of water each day to prevent renal stone formation and kidney injury, because allopurinol is eliminated through the kidneys.
Nurse is providing teaching to a client who has prescription for trimethoprim/sulfamethoxazole. Which of following instructions should nurse include in teaching? A. Take the medication with food B. Expect a fine, red rash as a transient effect C. Drink 8 to 10 glasses of water daily D. Store the medication in the refrigerator
Drink 8 to 10 glasses of water daily. Rationale: The nurse should instruct the client to increase water intake to 1,920 to 2,400 mL (65 to 81 oz) a day to decrease the chance of kidney damage from crystallization. The nurse should instruct the client to take the medication on an empty stomach either 1 hour before or 2 hours after meals. The nurse should instruct the client to notify the provider if a rash develops, because this can be an indication of Stevens-Johnson syndrome. However, the client should not expect to have a fine, red rash as a transient effect. The nurse should inform the client to store trimethoprim/sulfamethoxazole in a light-resistant container at room temperature.
Nurse is administering diazepam to pt who is having colonoscopy. Which of following actions should nurse take? A. Ensure flumazenil is available to administer for toxicity management. B. Monitor the client for an increase in blood pressure C. Expect the client to become unconscious within 30 seconds D. Measure the capnography level every hour until the client is awake and oriented
Ensure flumazenil is available to administer for toxicity management. Rationale: The nurse should monitor the client for manifestations of diazepam toxicity, such as respiratory depression and hypotension. The nurse should be prepared to administer flumazenil to reverse the effects of diazepam. When diazepam is administered IV for induction of anesthesia, the nurse should expect the client to develop the full effect of the medication in 2 min. The nurse should measure the capnography level every 15 to 30 min until the client is awake and oriented and vital signs have returned to baseline.
A nurse contacts a client's provider on the telephone to obtain prescription for pain medication. Which of following actions should nurse take? A. Write the order on a prescription pad designated for the client's provider B. Have the provider spell out the unfamiliar medication names C. Read the prescription back to the provider using abbreviations D. Consult with a second nurse for any questions regarding dosage
Have the provider spell out the unfamiliar medication names. Rationale: The nurse should ask the provider to spell out the name of the medication if the stated name is one the nurse is not familiar with.
A nurse is caring for a client who has heart failure and is prescribed enalapril. The nurse should monitor the client for which of the following findings as an adverse effect of the medication? A. Bradycardia B. Hyperkalemia C. Loss of smell D. Hypoglycemia
Hyperkalemia Enalapril improves cardiac functioning in clients who have heart failure and can cause hyperkalemia due to potassium retention by the kidneys. Enalapril is an ACE inhibitor that has several cardiovascular adverse effects including hypotension, tachycardia, and dysrhythmias. Enalapril can cause several sensory adverse effects such as a loss of taste. However, it does not cause a loss of smell.
Nurse in provider's office is assessing pt who has been taking aspirin daily for past year. For which of following findings should nurse notify provider immediately? A. Hyperventilation B. Heartburn C. Anorexia D. Swollen ankles
Hyperventilation Rationale: When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is hyperventilation. This finding indicates the client might have acute salicylate poisoning, which causes respiratory alkalosis in the early stages.
Nurse is assessing a client who is receiving epoetin alfa to treat anemia. Which of following findings should nurse monitor? A. Paresthesia B. Increased blood pressure C. Fever D. Respiratory depression
Increased blood pressure Rationale: The therapeutic effect of epoetin alfa is an increase in hematocrit levels, which can result in an increase in a client's blood pressure. If the client's hematocrit level rises too rapidly, hypertension and seizures can result. The nurse should monitor the client's blood pressure and ensure hypertension is controlled prior to administering the medication.
A nurse is caring for a client who has heart failure and is receiving an IV infusion of dopamine. Which of the following findings indicates that the medication is effective? A. Decreased blood pressure. B. Increased heart rate. C. Increased cardiac output. D. Decreased serum potassium.
Increased cardiac output Dopamine is an adrenergic that causes a receptor specificity effect, which increases cardiac output and improves perfusion. Tachycardia is an adverse effect of dopamine and does not indicate the medication's effectiveness. Dopamine is an adrenergic that causes a receptor specificity effect, which increases blood pressure. Dopamine does not affect serum potassium levels.
A nurse is assessing a client who is taking tamoxifen to treat breast cancer. Which of the following findings is the priority for the nurse report to the provider? A. Hot flashes B. Gastrointestinal irritation C. Vaginal dryness D. Leg tenderness
Leg tenderness The greatest risk to this client is the development of a thromboembolism, which is an adverse effect of tamoxifen. The nurse should also monitor the client for other manifestations of a thromboembolism, including leg tenderness, redness, swelling, and shortness of breath.
A nurse is caring for a client who is to receive treatment for opioid use disorder. Which of following medications should nurse expect to administer? A. Bupropion B. Disulfiram C. Methadone D. Modafinil
Methadone Rationale: The nurse should expect to administer methadone for treatment of opioid use disorder. Methadone can be administered for withdrawal and to assist with maintenance and suppressive therapy. The nurse should administer bupropion to assist the client with smoking cessation. The nurse should administer disulfiram as an aversion therapy to assist with maintaining abstinence from alcohol. The nurse should administer modafinil to assist with the fatigue and prolonged sleep from methamphetamine withdrawal.
The nurse administer digoxin immune Fab to pt who received the incorrect dose of digoxin over a period of 3 days. The Nurse should identify that which of following findings indicates the antidote was effective? A. Normal sinus rhythm B. A digoxin level of 2.5 ng/mL C. A decrease in blood pressure D. A potassium level of 3.2 mEq/L
Normal sinus rhythm Dysrhythmias are a life-threatening adverse effect of digoxin toxicity. The return of the heart to normal sinus rhythm indicates a therapeutic response to the antidote. Digoxin immune Fab is administered to a client who is experiencing severe digoxin toxicity. It binds with digoxin and works to reduce the client's blood digoxin level. A digoxin level of 2.5 ng/mL is above the expected reference range of 0.8 to 2 ng/mL. Therefore, this finding does not indicate a therapeutic response to the antidote. A decrease in blood pressure is not an indication of a therapeutic response to the antidote. A potassium level of 3.2 mEq/L is below the expected reference range of 3.5 to 5.0 mEq/L. A decreased potassium level can lead to toxicity in a client who is taking digoxin. However, digoxin immune Fab is administered only for severe toxicity.
A nurse is caring for a client who reports lethargy and myalgia after taking clozapine for 6 months. Which of the following actions should the nurse plan to take? A. Infuse 0.9% sodium chloride 1,000 mL IV bolus B. Schedule the client for an electroencephalogram C. Obtain WBC with absolute neutrophil count. D. Place the client on a tyramine-free diet.
Obtain WBC with absolute neutrophil count. The client who takes clozapine can develop lethargy and myalgia caused by the adverse effect of agranulocytosis. Therefore, monitoring the WBC with absolute neutrophil count weekly for the first 6 months of treatment is recommended. After 6 months, monitoring can occur every 2 weeks up to 1 year.
Nurse is preparing to administer hydrochlorothiazide (HCTZ) to a client. Which of following actions should nurse take prior to administering the medication? A. Ask the client to drink 8oz of water B. Review the client's most recent Hgb level C. Obtain the client's blood pressure D. Determine if the client is allergic to NSAIDs
Obtain the client's blood pressure. Rationale: HCTZ is a thiazide diuretic administered to promote urine output and reduce blood pressure and edema. The nurse should obtain the client's blood pressure prior to administration of the medication.
Nurse is providing teaching to a client who has new prescription for ferrous sulfate. Nurse should instruct the client to take the medication with which of following to promote absorption? A. Vitamin E B. Orange Juice C. Milk D. Antacids
Orange juice Rationale: The absorption of ferrous sulfate is enhanced by a vitamin C source, such as orange juice.
A nurse is monitoring for adverse effects of hydrochlorothiazide after administering the medication to an older adult client who has heart failure. Which of the following findings should the nurse identify as an adverse effect of the medication? A. Hypoglycemia B. Orthostatic hypotension C. Bradycardia D. Xanthopsia
Orthostatic hypotension The nurse should identify that hydrochlorothiazide is an antihypertensive thiazide diuretic medication, which can cause orthostatic hypotension and light headedness. Therefore, the nurse should instruct the client to rise slowly when moving from a recumbent to a standing position. Hydrochlorothiazide is an antihypertensive thiazide diuretic medication, which can cause hyperglycemia. The nurse should identify palpitations as an adverse effect of hydrochlorothiazide, which is an antihypertensive thiazide diuretic medication. The nurse should identify that hydrochlorothiazide is an antihypertensive thiazide diuretic medication and has an adverse effect of blurred vision. Xanthopsia causes objects to appear yellow and is not an adverse effect of this medication.
Nurse is caring for pt who has DM and is taking glyburide. Pt reports feeling confused and anxious. Which of following actions should nurse take 1st? A. Perform a capillary blood glucose test. B. Provide the client with a protein-rich snack. C. Give the client 120 mL (4 oz) of orange juice. D. Schedule an early meal tray
Perform a capillary blood glucose test. The greatest risk to this client is injury from hypoglycemia. Therefore, the nurse should perform a capillary blood glucose test to determine the client's blood glucose status. Manifestations of hypoglycemia include weakness, anxiety, confusion, sweating, and seizures.
Circulating nurse is planning care for a client who is scheduled for surgery and has latex allergy. Which of following actions should nurse include in plan of care? A. Schedule the client for the last surgery of the day B. Place monitoring cords and tubes in a stockinet C. Choose rubber injection ports for fluid administration D. Ensure phenytoin IV is readily available
Place monitoring cords and tubes in a stockinet. Rationale: The nurse should place monitoring devices in a stockinet to prevent direct contact with the client's skin.
Nurse is preparing to mix and administer dantrolene via IV bolus to a client who has developed malignant hyperthermia during surgery. Which of following actions should nurse take? A. Administer the reconstituted medication slowly over 5 min. B. Store the reconstituted medication in the refrigerator C. Use the reconstituted medication within 12 hr D. Reconstitute the initial dose with 60 mL of sterile water without a bacteriostatic agent
Reconstitute the initial dose with 60 mL of sterile water without a bacteriostatic agent. The nurse should dilute the medication with 60 mL of sterile water without a bacteriostatic agent and inject rapidly.
Nurse is caring for a client who is receiving end-of-life care and has a prescription for fentanyl patches. Which of the following information regarding the adverse effects of fentanyl should the nurse plan to give to the client and family? A. The provider will prescribe naloxone at home for respiratory depression B. Remove the patch to reverse the adverse effects immediately C. Expect an increase in urinary output D. Take a stool softener on a daily basis
Take a stool softener on a daily basis. Rationale: Constipation is an adverse effect of opioid use. Stool softeners can decrease the severity of this adverse effect.
Nurse administers ceftazidime to a client who has a severe penicillin allergy. The nurse should identify which of following client findings as an indication that she should complete incident report? A. The client reports shortness of breath B. The client is also taking lisinopril C. The client's pulse rate is 60/min/. D. The client's WBC count is 14,000/mm^3
The client reports shortness of breath. Rationale: A severe penicillin allergy is a contraindication for taking ceftazidime, a cephalosporin antibiotic, due to the potential for cross-sensitivity. Shortness of breath can indicate the client is developing anaphylaxis.
Nurse in clinic is caring who is taking aspirin for the treatment of arthritis. The nurse should identify which of following findings as indication that the client is beginning to exhibit salicylism? A. Gastric distress B. Oliguria C. Excessive bruising D. Tinnitus
Tinnitus Rationale: Tinnitus is a manifestation of aspirin toxicity, also called salicylism. Other manifestations include sweating, headache, and dizziness.
A nurse is reviewing the medical record of a client who has schizophrenia and a prescription for clozapine. Which of the following laboratory tests should the nurse review before administering the medication? A. Troponin B. Total cholesterol C. Creatinine D. Thyroid stimulating hormone
Total cholesterol The nurse should review the client's total cholesterol before administering clozapine, because this medication can cause hyperlipidemia.
A nurse is teaching a client who is starting to take amitriptyline. Which of the following findings should the nurse include in the teaching as an adverse effect of the medication? A. Diarrhea B. Cough C. Urinary retention D. Increased libido
Urinary retention The nurse should instruct the client that amitriptyline causes the anticholinergic effect of urinary retention. A decrease in libido is an adverse effect of amitriptyline. Constipation is an adverse effect of amitriptyline.
Nurse is providing teaching to a client who is to start therapy with digoxin. For which of following adverse effects should nurse instruct client to monitor and report to provider? A. Dry cough B. Pedal edema C. Bruising D. Yellow-tinged vision
Yellow-tinged vision The nurse should instruct the client to monitor for and report yellow-tinged vision, which is a sign of digoxin toxicity. Other manifestations of digoxin toxicity include nausea, vomiting, loss of appetite, and fatigue. As the digoxin levels increase, the client can experience cardiac dysrhythmias.
The nurse is reviewing lab results of pt who is taking carbamazepine for seizure disorder. Which of following findings should nurse report to provider? A. WBC 3,500/mm3 B. A carbamazepine level of 7 mcg/mL C. A 24-hour urine glucose of 300 mg/day D. A potassium level of 4.1 mEq/L
WBC 3,500/mm3 A WBC count of 3,500/mm3 is below the expected reference range of 5,000 to 10,000/mm3. Leukopenia is an adverse effect of carbamazepine. The nurse should report this finding to the provider and monitor the client for manifestations of infection. A carbamazepine level of 7 mcg/mL is within the expected reference range of 5 to 12 mcg/mL and is an expected finding. A 24-hour urine glucose of 300 mg/day is within the expected reference range of 50 to 300 mg/day. The nurse should continue to monitor this value because carbamazepine can cause an elevation in urine glucose levels. A potassium level of 4.1 mEq/L is within the expected reference range of 3.5 to 5 mEq/L. The nurse does not need to monitor potassium levels for a client taking carbamazepine; however, the nurse should monitor sodium levels due to the potential adverse effect of hyponatremia.
A nurse is preparing to administer a new prescription of amoxicillin/clavulanic to a client. The client tells the nurse that he is allergic to penicillin. Which of the following actions should the nurse take first? A. Update the client's medical record. B. Notify the provider. C. Withhold the medication. D. Inform the pharmacist of the client's allergy to penicillin.
Withhold the medication. When using the urgent vs nonurgent approach to client care, the nurse should determine that the priority action is to withhold the medication to prevent injury to the client.
A nurse is preparing to teach a client who is to start a new prescription for extended-release verapamil. Which of the following instructions should the nurse plan to include? A. Take the medication on an empty stomach. B. Avoid crowds. C. Discontinue the medication if palpitations occur. D. Change positions slowly.
Change positions slowly. The nurse should instruct the client to change positions gradually to prevent orthostatic hypotension and syncope.
A nurse is providing teaching to a client who has depression and has a new prescription for fluoxetine. Which of the following statements by the client indicates an understanding of the teaching? A. I should start to feel better within 24 hours of starting this medication. B. I will be sure to follow a strict diet to avoid foods with tyramine. C. I will continue to take St. John's Wort to increase the effects of the medication. D. I should take acetaminophen instead of ibuprofen for my headaches while taking this medication.
"I should take acetaminophen instead of ibuprofen for my headaches while taking this medication." Fluoxetine suppresses platelet aggregation, which increases the risk of bleeding when used concurrently with NSAIDs and anticoagulants. Therefore, clients who are taking fluoxetine should take acetaminophen for headaches or pain, since acetaminophen does not suppress platelet aggregation. Concurrent use of St. John's Wort and fluoxetine can increase the client's risk for serotonin syndrome, a potentially life-threatening complication. Manifestations of serotonin syndrome include confusion, hallucinations, hyperreflexia, excessive sweating, and fever. Clients taking fluoxetine, a selective serotonin reuptake inhibitor, are not required to restrict their dietary intake of tyramine. A client who is taking an MAOI, such as selegiline, should avoid products containing tyramine. The nurse should inform the client that the therapeutic levels of fluoxetine can take between 1 and 4 weeks to achieve desired effects. The client should take the medication as prescribed and use other strategies to manage depression in the interim.
A nurse is teaching about self-administration of transdermal medication with a male client who has a new prescription for nitroglycerin. The nurse should identify that which of following statements by the client indicates an understanding of the teaching? A. "I can apply the patch to a chest area that has hair." B. "I can take this medication while using an erectile dysfunction product." C. "I will remove the patch after 14 hours." D. "I need to apply a new patch to the same area every day."
"I will remove the patch after 14 hours." Rationale: The client should remove the patch after 12 to 14 hours to prevent tolerance of the medication.
Nurse is teaching about new prescription to a client who has new urinary tract infection. The nurse should identify which of the following statements as an indication that the client understands the teaching? A. "I will take this medication with an antacid to prevent gastrointestinal upset." B. "I will stop taking this medication when I no longer have pain upon urination C. "I will report any signs of tendon pain or swelling D. "I will take this medication with milk."
"I will report any signs of tendon pain or swelling." Rationale: Ciprofloxacin, a fluoroquinolone, is associated with a risk of tendon rupture. This risk is increased in older adult clients, so the client should notify the provider at the onset of tendon pain or swelling.
A nurse is providing discharge instruction to a client who is to self-administer insulin at home. Which of the following client statements should indicate to the nurse that the teaching is effective? A. I should avoid getting rid of the air bubble in the syringe. B. I should inject the insulin into my thigh for the fastest absorption. C. I will store my unopened bottles of insulin in the refrigerator. D. I need to shake the insulin before using it to make sure it is well mixed.
"I will store my unopened bottles of insulin in the refrigerator." The client should store unopened vials of insulin in the refrigerator to maintain medication viability. Once opened, the insulin can remain at room temperature for up to 1 month.
Nurse is teaching about zolpidem to a client who has insomnia. The nurse should identify that which of following client statements indicates an understanding of teaching? A. "I will need to get laboratory testing prior to a refill of this medication." B. "I will use this medication for a short period of time." C. "I will need to take this medication for 1 week before results are seen." D. "I will need to change the medications to prevent building up a tolerance."
"I will use this medication for a short period of time." Rationale: Zolpidem is used for short-term treatment of insomnia. Therefore, the provider should reassess the client before refilling the prescription.
A nurse is providing teaching for a client who has multiple sclerosis and a new prescription for methylprednisolone. Which of the following instructions should the nurse include? (SATA) A. Blood glucose levels will be monitored during therapy. B. Avoid contact with people who have known infections. C. Take the medication 1 hr before breakfast. D. Decrease dietary intake of foods containing potassium. E. Grapefruit juice can increase the effects of this medication.
A, B, E "Blood glucose levels will be monitored during therapy" : The nurse should instruct the client that their blood glucose levels will be monitored during therapy because corticosteroids, such as methylprednisolone, can raise blood glucose levels. "Avoid contact with persons who have known infections": The nurse should instruct the client to avoid contact with persons who have known infections because corticosteroids, such as methylprednisolone, suppress the immune response and mask manifestations of infection. "Grapefruit juice can increase the blood levels of the medication": The nurse should instruct the client that grapefruit juice increases the absorption of the medication, which can lead to toxicity and adrenal suppression.
A nurse is caring for a client who has sickle cell anemia and is taking hydroxyurea. Which of the following findings should the nurse report to the provider? (SATA) A. Hemoglobin 7.0 B. Creatinine 1 C. RBC 4.7 million D. Platelets 75,000 E. Potassium 5.2
A, D, E Hemoglobin 7.0 g/dL: A hemoglobin level of 7.0 g/dL indicates hydroxyurea toxicity. This hemoglobin level is below the expected reference range of 14 to 19 g/dL for a male client and 12 to 16 g/dL for a female client. Therefore, the nurse should report this finding to the provider. Platelets 75,000/mm3: A platelet level of 75,000/mm3 indicates hydroxyurea toxicity. This platelet level is below the expected reference range of 150,00 to 400,000/mm3. Therefore, the nurse should report this finding to the provider. Potassium 5.2 mEq/L: A potassium level of 5.2 mEq/L indicates tumor lysis syndrome. This potassium level is above the expected reference range of 3.5 to 5 mEq/L. Therefore, the nurse should report this finding to the provider.
A nurse is providing discharge teaching to a client who has a new prescription for furosemide twice daily. The nurse should include which of the following instructions in the teaching? (Select all that apply) A. Take the second dose at bedtime B. Increase intake of potassium-rich foods. C. Obtain your weight weekly. D. Monitor for muscle weakness. E. Dangle your legs from the side of the bed before standing.
B, D, E "Increase intake of potassium-rich foods": Loop diuretics, such as furosemide, act at the loop of Henle by blocking the resorption of sodium, water, and potassium. An adverse effect of the medication is the development of electrolyte imbalances such as hyponatremia, hypochloremia, and hypokalemia. To prevent hypokalemia, the client should increase intake of potassium-rich foods, such as potatoes, spinach, dried fruit, and nuts. "Monitor for muscle weakness": Furosemide, a loop diuretic, causes a loss of potassium, which can result in manifestations of hypokalemia such as difficulty concentrating, shallow respirations, hyporeflexia, and muscle weakness. The nurse should instruct the client to monitor for these manifestations and report them to the provider. "Dangle your legs from the side of the bed before standing": Loop diuretics, such as furosemide, reduce vascular tone and increase fluid excretion. These effects decrease blood return to the heart and can manifest as dizziness and lightheadedness when going from a lying to a standing position. The client should change positions slowly to minimize orthostatic hypotension.
A nurse is caring for a client who has pneumonia. The client tells the nurse she is pregnant and that she hasn't told provider yet. The nurse should identify that pregnancy is a contraindication for receiving which of following medications? A. Acetaminophen B. Ipatropium C. Benzonatate D. Doxycycline
Doxycycline Rationale: Doxycycline is a tetracycline antibiotic. The nurse should identify that doxycycline can cause teratogenic effects such as staining of the infant's teeth when exposed to this medication. Therefore, this medication is contraindicated for the client.
Nurse is teaching pt who has new prescription for docusate sodium about med's MOA. Which of following information should the nurse include in the teaching? A. Docusate sodium reduces the surface tension of the stools to change their consistency. B. Docusate sodium causes rectal contractions C. Docusate sodium acts as a fiber agent, increasing bulk in the intestines D. Docusate sodium the motility of the intestines
Docusate sodium reduces the surface tension of the stools to change their consistency. Rationale: Docusate sodium is a surfactant that softens stool by reducing surface tension, allowing water to penetrate more easily into the stool. Osmotic laxatives, such as glycerin suppositories, act by lubricating the lower colon and initiating reflex contractions of the rectum. Bulk-forming laxatives, such as methylcellulose, mimic the action of dietary fiber, forming a viscous compound that softens the fecal mass and increases its bulk, which stimulates peristalsis. Stimulant laxatives, such as bisacodyl, stimulate the intestinal wall to cause peristalsis by pulling water into the intestines.
