ATI - pharmacology ATI assessment [A]

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? A. "I have tendonitis, so I haven't been able to exercise." B. "I take a stool softener for chronic constipation." C. "I take medicine for my thyroid." D. "I am allergic to sulfa."

"I have tendonitis, so I haven't been able to exercise" = contraindication d/t risk of tendon rupture

A nurse is teaching a client about the use of risedronate for the treatment of osteoporosis. The nurse should identify which of the following statements as an indication that the client understands the teaching? A. "I will drink a glass of milk when I take the risedronate." B. "I will take the risedronate 15 minutes after my evening meal." C. "I should take an antacid with the risedronate to avoid nausea." D. "I should sit up for 30 minutes after taking the risedronate."

"I should sit up for 30 minutes after taking the risedronate." -prevents esophagitis + dyspepsia -risedronate = CONTRAINDICATED for pt who cannot sit up/stand upright for at least 30 min

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. A. "I should take the medication with food." B. "I should take naproxen if I develop joint pain." C. "I should tell my provider if I develop a sore throat." D. "I should expect the medication to cause my urine to look orange."

"I should tell my provider if I develop a sore throat." -indicates NEUTROPENIA; can be reversed if med is d/c early

A nurse is providing teaching to a client who has a gastric ulcer and a new prescription for ranitidine. Which of the following instructions should the nurse include? A. "Take the medication on an empty stomach for full effectiveness." B. "You may discontinue this medication when stomach discomfort subsides." C. "Report yellowing of the skin." D. "Store the medication in the refrigerator."

"Report yellowing of the skin." (or eyes) -famotidine = HEPATOTOXIC

A nurse is providing teaching to a client who is to start treatment for asthma with beclomethasone and albuterol inhalers. Which of the following instructions should the nurse include in the teaching? A. "Take beclomethasone to avoid an acute attack." B. "Use beclomethasone 5 minutes before using albuterol." C. "Limit your calcium and vitamin D intake when taking beclomethasone." D. "Rinse your mouth after inhaling the beclomethasone."

"Rinse your mouth after inhaling the beclomethasone." -prevents oropharyngeal candidiasis & hoarseness

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? A. At birth B. 2 months C. 6 months D. 15 months

2 months DTaP: 5 DOSE SERIES 1) 2 months (0-6 yr. old) 2) 4 months (0-6 yr. old) 3) 6 months (0-6 yr. old) 4) 15 - 18 months (all ages) 5) 4-6 yr. old (all ages)

A nurse is teaching a group of unit nurses about medication reconciliation. Which of the following information should the nurse include in the teaching? A. The client's provider is required to complete medication reconciliation. B. Medication reconciliation at discharge is limited to the medication ordered at the time of discharge. C. A transition in care requires the nurse to conduct medication reconciliation. D. Medical reconciliation is limited to the name of the medications that the client is currently taking.

A transition in care requires the nurse to conduct medication reconciliation. WHEN TO COMPLETE A MEDICATION RECONCILIATION 1) admission 2) transfer (unit) 3) discharge

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.) 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 the medication.

A. Blood glucose levels will be monitored during therapy. -steroids can cause HYPERglycemia B. Avoid contact with people who have known infections. E. Grapefruit juice can increase the effects of the medication.

A nurse is preparing to administer heparin subcutaneously to a client. Which of the following actions should the nurse plan to take? A. Administer the medication outside the 5-cm (2-in) radius of the umbilicus. B. Aspirate for blood return before injecting. C. Rub vigorously after the injection to promote absorption. D. Place a pressure dressing on the injection site to prevent bleeding.

Administer the medication outside the 5-cm (2-in) radius of the umbilicus.

A nurse in an emergency department is caring for a client who has myasthenia gravis and is in a cholinergic crisis. Which of the following medications should the nurse plan to administer? A. Potassium iodide B. Glucagon C. Atropine D. Protamine

Atropine = ANTIDOTE (ANTI-cholinergic agent) -cholinergic crisis: caused by excess cholinesterase inhibitor (e.g., neostigmine)

A nurse is reviewing the medication administration record of a client who has hypocalcemia and a new prescription for IV calcium gluconate. The nurse should identify that which of the following medications can interact with calcium gluconate? A. Felodipine B. Guaifenesin C. Digoxin D. Regular insulin

Digoxin -can cause HYPERcalcemia = increases risk of DIGOXIN TOXICITY

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? A. Hot flashes B. Urinary retention C. Constipation D. Bradycardia

Hot flashes -tamoxifen MOA: estrogen receptor blocker

A nurse is assessing a client who has myasthenia gravis and is taking neostigmine. Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect? A. Tachycardia B. Oliguria C. Xerostomia D. Miosis

Miosis (pupillary constriction) -d/t excessive muscarinic stimulation; causes difficulty w/visual accommodation

A nurse on the acute care unit is caring for a client who is receiving gentamicin IV. The nurse should report which of the following findings to the provider as an adverse effect of the medication? A. Constipation B. Tinnitus C. Hypoglycemia D. Joint pain

Tinnitus -drug class: amnioglycoside = OTOTOXIC -report HAs, ringing in ears

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? A. Weight loss B. Increased intraocular pressure C. Auditory hallucinations D. Bibasilar crackles

Bibasilar crackles -crackles = complication -> STOP INFUSION; can precipitate HF & pulmonary edema -mannitol drug class: osmotic diuretic

A nurse is caring for a client who is receiving heparin therapy via continuous IV infusion to treat a pulmonary embolism. Which of the following findings should the nurse identify as an adverse effect of the medication and report to the provider? A. Vomiting B. Blood in the urine C. Positive Chvostek's sign D. Ringing in the ears

Blood in the urine -SS of heparin TOXICITY: bruising, hematomas, HYPOtension, tachycardia

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? A. Carbamazepine B. Sumatriptan C. Atenolol D. Glipizide

Carbamazepine -inactivates oral contraceptives d/t its action on hepatic med-metabolizing enzymes

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? A. Report the incident to the charge nurse. B. Notify the provider. C. Check the client's blood glucose. D. Fill out an incident report.

Check the client's BG -pt @ risk for HYPOglycemia; give snacky snack

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? A. The medication should be taken 1 hr prior to eating. B. It takes 48 hr for therapeutic effects to occur. C. Tablets should not be crushed or chewed. D. Decreased respirations might occur.

Decreased respirations might occur

A nurse is assessing a client after administering a second dose of cefazolin IV. The nurse notes the client has anxiety, hypotension, and dyspnea. Which of the following medication should the nurse administer first? A. Diphenhydramine B. Albuterol inhaler C. Epinephrine D. Prednisone

Epinephrine -induce vasoconstriction + bronchodilation

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? A. Tall, tented T-waves B. Presence of U-waves C. Widened QRS complex D. ST elevation

Presence of U-waves

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? A. "It is safe to take an enteric-coated aspirin." B. "Aspirin will increase the risk of bleeding." C. "Acetaminophen may be substituted for aspirin." D. "The INR lab work must be monitored more frequently if aspirin is taken."

"Aspirin will increase the risk of bleeding."

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

"I will taper off the medication before discontinuing it." -prevents abstinence syndrome OR rebound insomnia

A nurse is providing teaching to a client who has a prescription for ergotamine sublingual to treat migraine headaches. Which of the following information should the nurse include in the instructions? A. "Take one tablet three times a day before meals." B. "Take one tablet at onset of migraine." C. "Take up to eight tablets as needed within a 24-hour period." D. "Take one tablet every 15 minutes until migraine subsides."

"Take one tablet at onset of migraine."

A nurse is caring for a client who received 0.9% sodium chloride 1 L over 4 hr instead of over 8 hr as prescribed. Which of the following information should the nurse enter as a complete documentation of the incident? A. IV fluid infused over 4 hr instead of the prescribed 8 hr. Client tolerated fluids well, provider notified. B. 0.9% sodium chloride 1 L IV infused over 4 hr. Vital signs stable, provider notified. C. 1 L of 0.9% sodium chloride completed at 0900. Client denies shortness of breath. D. IV fluid initiated at 0500. Lungs clear to auscultation.

0.9% sodium chloride 1 L IV infused over 4 hr. Vital signs stable, provider notified. -document: type + amount of fluid, infusion time, pt's physical status, & provider notification

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? A. Constipation B. Drowsiness C. Facial flushing D. Itching

Constipation

A nurse is preparing to administer medications to a client who tells the nurse, "I don't want to take my fluid pill until I get home today." Which of the following actions should the nurse take? A. Document the refusal and inform the client's provider. B. File an incident report with the risk manager. C. Contact the pharmacist to pick up the medication. D. Give the client the medication to take at home and document that it was administered.

Document the refusal and inform the client's provider -need to verify pt understands RISKS of refusing med -> pt can make informed decision

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? A. Dyspepsia B. Diarrhea C. Dizziness D. Dyspnea

Dyspnea -drug: donepezil -class: cholinesterase inhibitor -SEs: bronchoconstriction, dyspepsia, diarrhea, & dizziness (d/t INCREASE in acetylcholine levels; Ach) *study hack: the 3 D's of DONEPEZIL*

A nurse is assessing a client's vital signs prior to the administration of PO digoxin. The client's BP is 144/86 mm Hg, heart rate is 55/min, and respiratory rate is 20/min. The nurse should withhold the medication and contact the provider for which of the following findings? A. DBP B. SBP C. HR D. RR

HR -if HR < 55 bpm, HOLD DOSE & notify provider (early SS of TOXICITY) -digoxin SLOWS conduction rate thru SA + AV nodes; decreases HR

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? A. Aspirin B. Ibuprofen C. Ranitidine D. Bisacodyl

Ibuprofen -most NSAIDs INCREASE lithium levels

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? A. Decrease in WBC count B. Decrease in amount of time sleeping C. Increase in appetite D. Increase in ability to focus

Increase in ability to focus -propylthiouracil (PTU): thyroid hormone antagonist that decreases T4 graves' disease = HYPERthyroidism (INCREASED T4 levels) -SS: difficulty focusing, restlessness, manic-type behaviors

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? A. Increased neutrophil count B. Increased RBC count C. Decreased prothrombin time D. Decreased triglycerides

Increased neutrophil count -filgrastim stimulates bone marrow to produce neutrophils -chemo pts: risk of infection = minimal

A nurse is providing teaching to a client who is taking bupropion as an aid to quit smoking. Which of the following findings should the nurse identify as an adverse effect of the medication? A. Cough B. Joint pain C. Alopecia D. Insomnia

Insomnia

A nurse is preparing to administer medication to a client who has gout. The nurse discovers that an error was made during the previous shift and the client received atenolol instead of allopurinol. Which of the following actions should the nurse take first? A. Obtain the client's blood pressure. B. Contact the client's provider. C. Inform the charge nurse. D. Complete an incident report.

Obtain the client's BP -atenolol can cause HYPOtension

A nurse is planning to teach about the use of a spacer to a child who has a new prescription for a fluticasone inhaler to treat chronic asthma. The nurse should include that the spacer decreases the risk for which of the following adverse effects of the medication? A. Oral candidiasis B. Headache C. Joint pain D. Adrenal suppression

Oral candidiasis (& dysphonia; hoarseness)

A nurse is planning care for a client who is prescribed metoclopramide following bowel surgery. For which of the following adverse effects should the nurse monitor? A. Muscle weakness B. Sedation C. Tinnitus D. Peripheral edema

Sedation -other SEs: dizziness, fatigue, sedation

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? A. Tingling toes B. Sexual dysfunction C. Absence of dreams D. Pica

Sexual dysfunction (aka "impotence, anorgasmia")

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? A. "I should apply a patch every 5 minutes if I develop chest pain." B. "I will take the patch off right after my evening meal." C. "I will leave the patch off at least 1 day each week." D. "I should discard the used patch by flushing it down the toilet."

"I will take the patch off right after my evening meal." -remove patch qpm (12-14 hr) BEFORE applying new patch (to avoid developing a tolerance)

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.) A. Dry mouth B. Tinnitus C. Blurred vision D. Bradycardia E. Dry eyes

A. Dry mouth C. Blurred vision (d/t increased IOP) E. Dry eyes (and mydriasis; pupil dilation) oxybutynin = anticholinergic (can't see, spit, pee, poop); it DRYS you out!

A nurse is developing a teaching plan for a client who has a new prescription for simvastatin. Which of the following instructions should the nurse include in the teaching plan? (Select all that apply.) A. Report muscle pain to the provider. B. Avoid taking the medication with grapefruit juice. C. Take the medication in the early morning. D. Expect a flushing of the skin as a reaction to the medication. E. Expect therapy with this medication to be lifelong.

A. Report muscle pain to the provider. -myopathy can lead to rhabdomyolysis B. Avoid taking the medication with grapefruit juice. -increases risk of muscle injury from elevations in creatine kinase (CK) -lab test: CMP E. Expect therapy with this medication to be lifelong.

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

Acetylcysteine = ANTIDOTE (give within 8 to 10 hrs to prevent severe injury)

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? A. Ondansetron B. Magnesium sulfate C. Flumazenil D. Protamine sulfate

Flumazenil = ANTIDOTE

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? A. Decreases stomach acid secretion B. Neutralizes acids in the stomach C. Forms a protective barrier over ulcers D. Treats ulcers by eradicating H. pylori

Forms a protective barrier over ulcers ("bandaid" or mucosal protectant) -forms gel like substance + coats ulcer = barrier to HCI & pepsin (irritators)

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)? A. MSO4 5 mg subcut every 4 hr PRN severe pain B. Morphine 5 mg subcut every 4 hr PRN severe pain C. MSO4 5 mg SQ every 4 hr PRN severe pain D. Morphine 5.0 mg subcutaneously every 4 hr PRN severe pain

Morphine 5 mg subcut every 4 hr PRN severe pain -do NOT use "MSO4" or "SQ"

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 medication should the nurse plan to administer? A. Methadone B. Naloxone C. Diazepam D. Bupropion

Naloxone = ANTIDOTE

A nurse is caring for a client who is in labor. The client is receiving oxytocin by continuous IV infusion with a maintenance IV solution. The external FHR monitor indicates late decelerations. Which of the following actions should the nurse take first? A. Turn the client to a side-lying position. B. Disconnect the client's oxytocin from the maintenance IV. C. Apply oxygen to the client by face mask. D. Increase the client's maintenance IV infusion rate.

PRIORITY intervention: turn the client to a side-lying position -experiencing late decelerations, which is d/t uteroplacental insufficiency

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? A. Potassium 5.0 mEq/ L B. aPTT 2 times the control C. Hemoglobin 15 g/dL D. Platelets 96,000/mm3

Platelets 96,000/mm3 -BELOW range -indicates heparin-induced thrombocytopenia (HIT); fatal -PRIORITY intervention: STOP INFUSION! PLT range: 150k/mm^3 to 400k/mm^3

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? A. Chew on the medication stick to release the medication. B. Leave the medication stick in one location of the mouth until melted. C. Allow the medication 1 hr for analgesia effects to begin. D. Store unused medication sticks in a storage container.

Store unused medication sticks in a storage container.

A nurse is assessing a client who has schizophrenia and is taking haloperidol. The nurse should report which of the following findings to the provider as a manifestation of neuroleptic malignant syndrome (NMS)? A. Temperature of 39.7° C (103.5° F) B. Urinary retention C. Heart rate 56/min D. Muscle flaccidity

Temperature of 39.7° C (103.5° F) -other SS of NMS: resp. distress, diaphoresis, HYPER/HYPOtension

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? A. The client's vital signs are within normal limits. B. The client has not requested additional medication. C. The client is resting comfortably with eyes closed. D. 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.

A nurse is preparing to administer a scheduled antibiotic at 0800 to a client and discovers the antibiotic is not present in the client's medication drawer. The nurse should identify that administration of the medication can occur at which of the following time periods without requiring an incident report? A. 1000 B. 0900 C. 0830 D. 1200

0830 -ABX can be administered 30 min BEFORE or AFTER scheduled time to maintain therapeutic blood levels WITHOUT an incident report

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? A. Weigh the client weekly. B. Determine apical pulse prior to administering. C. Administer the medication 30 min prior to breakfast. D. Monitor the client for jaundice.

Determine apical pulse prior to administering -can cause life-threatening BRADYCARDIA -HOLD dose + notify md if HR < 60 bpm

A nurse is preparing to administer PO sodium polystyrene sulfonate to a client who has HYPERkalemia. Which of the following actions should the nurse plan to take? A. Hold the client's other oral medications for 8 hr post administration. B. Inform the client that this medication can turn stool a light tan color. C. Keep the client's solution in the refrigerator for up to 72 hr. D. Monitor the client for constipation.

Monitor the client for constipation -can lead to fecal impaction

A nurse is reviewing the laboratory results of a client who is taking digoxin for heart failure. Which of the following results should the nurse report to the provider? A. Calcium level 9.2 mg/dL B. Magnesium level 1.6 mEq/L C. Digoxin level 1.1 ng/mL D. Potassium level 2.8 mEq/L

Potassium level 2.8 mEq/L -HYPOkalemia -> cardiac dysrhythmias = hold dose/notify md

A nurse is caring for a client who is experiencing acute alcohol withdrawal. For which of the following client outcomes should the nurse administer chlordiazepoxide? A. Minimize diaphoresis B. Maintain abstinence C. Lessen craving D. Prevent delirium tremens

Prevent delirium tremens

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? A. The client's capnography has returned to baseline. B. The client can respond to their name when called. C. The client is passing flatus. D. The client is requesting oral intake.

The client's capnography has returned to baseline (aka gas exchange = adequate)

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)

Answer: 100 gtt/min Step 1: What is the unit of measurement the nurse should calculate? (Place the unit of measure being calculated on the left side of the equation.) Step 2: Determine the ratio that contains the same unit as the unit being calculated. (Place the ratio on the right side of the equation, ensuring that the unit in the numerator matches the unit being calculated.) Step 3: Place any remaining ratios that are relevant to the item on the right side of the equation, along with any needed conversion factors, to cancel out unwanted units of measurement. Step 4: Solve for X. Step 5: Round if necessary. Step 6: Determine whether the amount to administer makes sense. If the prescription reads D5W 400 mL IV to infuse over 60 min with a drop factor of 15 gtt/mL, it makes sense to administer 100 gtt/min. The nurse should set the manual IV infusion to deliver D5W IV at 100 gtt/min.

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)

Answer: 300 mg Step 1: What is the unit of measurement the nurse should calculate? (Place the unit of measure being calculated on the left side of the equation.) Step 2: Determine the ratio that contains the same unit as the unit being calculated. (Place the ratio on the right side of the equation, ensuring that the unit in the numerator matches the unit being calculated.) Step 3: Place any remaining ratios that are relevant to the item on the right side of the equation, along with any needed conversion factors, to cancel out unwanted units of measurement. Step 4: Solve for X. Step 5: Round if necessary. Step 6: Determine whether the amount to administer makes sense. If the prescription reads 15 mg/kg every 12 hr and the child weighs 20 kg, it makes sense to give 300 mg/dose every 12 hr.

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? A. Serum calcium B. Pregnancy test C. 24-hr urine collection for protein D. Aspartate aminotransferase level

Pregnancy test -initial rx: 2 negative pregnancy tests -every refill: 1 negative pregnancy test

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? A. Tingling of fingers B. Constipation C. Weight gain D. Oliguria

Tingling of fingers (paresthesia)