NCLEX Saunders Pharm Questions

2. A client with squamous cell carcinoma of the larynx is on bleomycin IV. The nurse caring for the client anticipates that which diagnostic study will be prescribed? 1. Echocardiography 2. Electrocardiography 3. Cervical radiography 4. Pulmonary function test

• Bleomycin can cause interstitial pneumonia, pulmonary function test is needed

8. A client is to begin a 6- month course of therapy with Isoniazid the nurse should plan to teach the client to take which action? 1. Use alcohol in small amounts only 2. Report yellow eyes and skin immediately 3. Increase intake of Swiss and aged cheeses 4. Avoid vitamin supplements during therapy

• Isoniazid is hepatotoxic

1. A client with A fib is receiving a continuous heparin infusion at 1000units/ hour. The nurse determines that the client is receiving the therapeutic effect based on which result? 1. PT 12.5 2. aPPT 60 seconds 3. aPPT 28 seconds 4. aPPT longer than 120 seconds

• Ranges for aPPT are 20-36, The therapeutic range is 1.5-2X that. 60 would ne therapeutic

1. The nurse is monitoring a client who is receiving oxytocin to induce labor. Which assessment finding would cause the nurse to immediately discontinue the oxytocin infusion? 1. Fatigue 2. Drowsiness 3. Uterine hyperstimulation 4. Early decelerations of the fetal heart rate

3- Oxytocin stimulates uterine contractions and is a common method to induce labor. Adverse affects are hyperstimulation of uterine contractions and non-reassuring fetal heart rate problems

3. A client is receiving digoxin daily and has a serum K+ level of 3 and is C/O anorexia. The HCP orders a dig level to rule out toxicity. What result is the therapeutic level for digoxin? 1. 0.5- 2 2. 1.2-2.8 3. 3.0-5.0 4. 3.5-5.5

• 1 - therapeutic level is 0.5-2

3. The nurse is monitoring a client in preterm labor who is receiving IV magnesium sulfate. The nurse should monitor for which adverse effects of this medication? SELECT ALL THAT APPLY 1. Flushing 2. HTN 3. Increased urine output 4. Depressed respirations 5. Extreme muscle weakness 6. Hyperactive deep tendon reflexes

• 1, 4,5 - Mag sulfate is a CNS depressant and relaxes smooth muscle, including the uterus. Adverse affects: flushing, depressed respirations, depressed deep tendon reflexes, hypotension, extreme muscle weakness, decreased urine output, pulmonary edema, and elevated magnesium levels

11. A histamine (H2) receptor antagonists will be ordered for a client. The nurse understands that which medication are H2-receptor antagonists? SELECT ALL 1. Nizatidine 2. Ranitidine 3. Famotidine 4. Cimetidine 5. Esomeprazole 6. Lansoprazole

• 1,2,3,4 - H2 end in idine

7. The home health care nurse is visiting a client who was recently diagnosed with type II DM. The client is ordered repaglinide and metformin and asks the nurse to explain these medications. The nurse should provide which instructions to the client? SELECT ALL 1. Diarrhea may occur secondary to the metformin 2. The repaglinide is not taken if a meal is skipped 3. The repaglinide is taken 30 minutes before eating 4. A simple sugar food item is carried and used to treat mild hypoglycemia episodes 5. Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide 6. Muscle pain is an expected effect of metformin and may be treated with acetaminophen

• 1,2,3,4 - Repaglinide is a rapid acting oral hypoglycemic agent that stimulates pancreatic insulin secretion, should be taking 30 minutes before meals and not given if client does not eat. Hypoglycemia is a s/e of repaglinide and a simple sugar should be carried at all times. Metformin decreased hepatic glucose production and may cause diarrhea.

11. The nurse is monitoring the IV infusion of an antineoplastic medication. During the infusion the client C/O pain at the insertion site. On inspection the nurse notes redness and swelling and that the infusion has slowed in rate. The nurse suspects extravasation and should take which action? SELECT ALL 1. Stop the infusion 2. Notify the HCP 3. Prepare to apply ice or heat to the site 4. Restart the IV at a distal part of the same vein 5. Prepare to give a prescribed antidote onto the site 6. Increase the flow rate of the solution to flush the skin and subcutaneous tissue

• 1,2,3,5

13. Rifabutin is prescribed for a client with active mycobacterium avium complex disease and Tb. For which s/e-a/e of the medication should the nurse monitor? SELECT ALL 1. Signs of hepatitis 2. Flulike symptoms 3. Low neutrophil count 4. Vit b6 deficiency 5. Ocular pain or blurred vision 6. Tingling and numbness of the fingers

• 1,2,3,5- s/e are: rash, GI disturbances, neutropenia, red orange color secretions, uveitis (blurred vision & eye pain, hepatitis, flulike symptoms

10. The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? SELECT ALL 1. Insomnia 2. Weight loss 3. Bradycardia 4. Constipation 5. Mild heat intolerance

• 1,2,5- Insomnia, weight loss, and mild heat intolerance are all s/e of levothyroxine sodium

9. A client with hyperthyroidism has been given methimazole. Which nursing considerations are associated with this medication? SELECT ALL 1. Give methimazole with food 2. Place the client on a low calorie, low protein diet 3. Assess the client for unexplained bruising or bleeding 4. Instruct the client to report side/adverse effects such as: sore throat, fever, or HA 5. Use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration

• 1,3,4- common s/e are N, V, & D, this should be taken with food, because the increase in metabolism they should consume high calorie diet. Antithyroid meds can cause agranulocytosis, sore throat, fever, HA, and bleeding may indicate agranulocytosis

6. A client is taking NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? SELECT ALL 1. Hypoglycemia may be experienced at dinner time 2. The insulin dose should be decreased if illness occurs 3. The insulin should be given at room temp 4. The insulin vial needs to be shaken vigorously to break up the precipitates 5. The NPH insulin should be drawn into the syringe first, then the regular insulin

• 1,3- NPH is intermediate acting insulin. The onset if action 1.5, it peaks in 4-12 hours, and its duration of action is 24 hours. Regular insulin is short acting insulin. Hypoglycemic reactions usually occur during peak time

4. A burn client is receiving treatments of mafenide acetate to the site of injury. The nurse monitors the client, knowing that which finding indicates that a systemic effect has occurred? 1. Hyperventilation 2. Local rash a the burn site 3. Elevated BP 4. Local pain at the burn site

• 1- Clients on this should be monitored for acid-base imbalance (Hyperventilation). If occurs med will probably be held for 1-2 days

6. A client with severe acne is seen in the clinic and the HCP orders isotretinoin. The nurse reviews the medication record and would contact the HCP is the client was taking which medication? 1. Vitamin A 2. Digoxin 3. Furosemide 4. Phenytoin

• 1- Isontretinoin is a metabolite of Vit. A and can increase risk of toxicity

5. The HCP orders exenatide for a client with DM type 1 who takes insulin. The nurse should plan to take which most appropriate intervention? 1. Withhold the medication and call the HCP, questioning the prescription for the client 2. Give the med within 60 minutes before morning and evening meals 3. Monitor for GI s/e after giving med 4. Withdraw the insulin from the prefilled pen into the syringe and give

• 1- It is used for type II ONLY, not recommended for those on insulin

16. The nurse is caring for a client with a diagnosis of influenza who first began to experience symptoms yesterday. Antiviral therapy is prescribed and the nurse provides instructions to the client about the therapy. Which statement by the client indicates understanding? 1. I must take the medication exactly as ordered 2. Once I start the medication I will no longer be contagious 3. I will not get any colds or infections while taking this med 4. This med has minimal S/E and I can return to normal activities

• 1- Must be taken as ordered

8. An opioid analgesic is administered to a client in labor. The nurse assigned to care for the client ensures that which medication is readily available if respiratory depression occurs? 1. Naloxone 2. Morphine sulfate 3. Betamethasone 4. Meperidine hydrochloride

• 1- Naloxone reverses the effects of opioids

4. The nursing instructor asks a nursing student to describe the procedure for administering erythromycin ointment to the eyes of a newborn. Which statement indicates that further teaching is needed? 1. I will flush the eyes after instilling the ointment 2. I will clean the eyes before instilling ointment 3. I need to administer ointment within 1 hour after delivery 4. I will instill the eye ointment into conjunctival sacs

• 1- The eyes are not flushed, this would wash the med out

1. The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action if preformed by the client indicates a need for further teaching? 1. Withdraws the NPH first 2. Withdraws the regular first 3. Injects air into the NPH vial first 4. Injects the amount of air equal to the desired dose of insulin into each vial

• 1- The short acting is drawn into the syringe 1st

14. A client has begun therapy with theophylline. The nurse should plan to teach the client to limit intake of which items while taking this medication? 1. Coffee, cola, and chocolate 2. Oysters, lobster and shrimp 3. Melons, oranges, and pineapple 4. Cottage cheese, cream cheese and dairy creamers

• 1- Theophylline is a bronchodilator. Limit Xanthine containing foods: coffee, cola and chocolate

8. The clinic nurse is performing an admission assessment on a client and notes the client is taking azelaic acid. Because this medication prescription, the nurse would suspect that the client id being treated for which condition? 1. Acne 2. Eczema 3. Hair loss 4. Herpes

• 1- Used to treat acne

7. The nurse is reviewing the H&P examination of a client who will be receiving asparaginase, an antineoplastic agent. The nurse contacts the HCP before giving if which disorder is present? 1. Pancreatitis 2. DM 3. MI 4. COPD

• 1- asparaginase is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis

8. The community nurse visits a client at home. Prednisone 10mg orally daily is ordered. The nurse teaches the client about this med. which statement indicates a need for further instruction? 1. I can take aspirin or antihistamine if I need it 2. I need to take the med every day at the same time 3. I need to avoid coffee, tea, cola, and chocolate in my diet 4. If I gain more than 5lbs a week, I will call my HCP

• 1- aspirin and other OTC meds should not be taken unless the client consults HCP

17. A client with DM visits a clinic. The clients DM had been controlled with glyburide daily, but recent fasting glucose level has been 180-200. Which medication if added to the client's regimen may have contributed to the hyperglycemia? 1. Prednisone 2. Phenelzine 3. Atenolol 4. Allopurinol

• 1- prednisone may decrease the effects of oral hypoglycemic, insulin, diuretics and K supplements

3. The nurse teaches a client about the effects of diphenhydramine, which has been ordered as a cough suppressant. The nurse determines that the client needs further instruction if the client makes what statement? 1. I will take medication on empty stomach 2. I won't drink alcohol while taking this 3. I will use sugarless gum, candy, oral rinses to decrease mouth dryness 4. I won't do activities that require mental alertness while taking meds

• 1- take with food or milk to decrease GI upset

1. Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which finding indicates the presence of systemic toxicity from this medication? 1. Tinnitus 2. Diarrhea 3. Constipation 4. Decreased respirations

• 1- tinnitus

3. Glimepiride is prescribed for a client with DM. The nurse instructs the client to avoid consuming which food while taking this med? 1. Alcohol 2. Organ meats 3. Whole grain cereals 4. Carbonated beverages

• 1- when alcohol and glimepiride are combined, a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea.

2. The home care nurse visits a client recently diagnosed with DM who is taking NPH insulin daily. The client asks the nurse how to store unopened vials of the insulin. Which should the nurse instruct the client to do? 1. Freeze the insulin 2. Refrigerate the insulin 3. Store the insulin in a dark, dry place 4. Keep the insulin at room temperature

• 2 -refrigerate the insulin, When stored unopened, the vials are good until the expiration date on them

2. The health education nurse provides instructions to a group of clients regarding measures that will assist in preventing skin cancer. Which instructions should the nurse provide? SELECT ALL THAT APPLY 1. Sunscreen should be applied every 8 hours 2. Use sunscreen with outdoor activities 3. Wear a hat, opaque clothing, and sunglasses when in the sun 4. Avoid sun exposure in the late afternoon and early evening hours 5. Examine your body monthly for any lesions that may be suspicious

• 2,3,5

The nurse is monitoring a client who is taking digoxin for A/E. Which findings are characteristics of dig toxicity? SELECT ALL 1. Tremors 2. Diarrhea 3. Irritability 4. Blurred vision 5. N&V

• 2,4,5- Early signs of toxicity: GI manifestations: Anorexia, N, V, and D, visual disturbances halos and blurred vision

3. A client with acute myelocytic leukemia is being treated with busulfan. Which lab test value would the nurse specifically monitor during treatment with this medication? 1. Clotting time 2. Uric acid level 3. K+ level 4. Blood glucose level

• 2- Busulfan can cause an increase in uric acid levels

. The nurse is providing discharge instructions to a client receiving sulfamethoxazole. Which instruction should be included in the list? 1. Restrict fluid intake 2. Maintain a high fluid intake 3. If urine turns brown call HCP STAT 4. Decrease dose if symptoms are improving

• 2- Each dose should be taken with a full glass of water

13. The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action? 1. Take the medication with food 2. Increase fluid intake to 2000-3000ml daily 3. Decrease Na intake while taking med 4. Decrease K intake while taking the medication

• 2- Hemorrhagic cystitis is an adverse effect that can occur with the use of cyclophosphamide. The client is instructed to drink copious amounts of fluid while taking this

7. A client has been taking Isoniazid for 1.5 months. The client complains to the nurse about numbness, paresthesias, and a tingling in the extremities. The nurse interprets that the client is experiencing which problem? 1. Hypercalcemia 2. Peripheral neuritis 3. Small blood vessel spasm 4. Impaired peripheral circulation

• 2- Isoniazid is an antitubercular medication. Common S/E is peripheral neuritis manifested by numbness, tingling and paresthesia in extremities.

5. Isotretinoin is prescribed for a client with severe acne. Before giving this medication, the nurse anticipates that what lab test will be ordered? 1. Platelet count 2. Triglyceride level 3. CBC 4. WBC count

• 2- Isotretinion can elevate triglyceride levels

6. Methylergonovine is prescribed for a woman to treat postpartum hemorrhage. Before administering what is the priority nursing assessment? 1. Uterine tone 2. Blood pressure 3. Amount of lochia 4. Deep tendon reflexes

• 2- Methylergonovine causes continuous uterine contractions and can increase BP

7. A client who chronically uses NSAIDS has been taking misoprostol. The nurse determines that the medication is having the intended effect if which finding is noted? 1. Resolved diarrhea 2. Relief of epigastric pain 3. Decreased platelet count 4. Decreased WBC count

• 2- Misoprostol is a gastric protectant

8. A client has been taking omeprazole for 4 weeks. The ambulatory care nurse notes that the client is receiving the optimal intended effect of this med is the client reports the absence of what? 1. Diarrhea 2. Heartburn 3. Flatulence 4. Constipations

• 2- Omeprazole is a proton pump inhibitor classified as an antiulcer agent. Intended effect is relief of heartburn

13. The nurse preforms an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil is taken daily. The nurse continues to collect data from the client suspecting that the client has a history of which condition? 1. Myxedema 2. Graves disease 3. Addison's disease 4. Cushing's disease

• 2- Propylthiouracil is used to treat Grave's disease

. IV heparin is ordered. While implementing the nurse makes sure what medication is available on the unit? 1. Vitamin K 2. Protamine sulfate 3. Potassium chloride 4. Aminocaproic acid

• 2- Protamine is the antidote for heparin

2. A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which finding is noted on assessment? 1. Proteinuria 3+ 2. Respirations of 10 3. Presence of deep tendon reflexes 4. Serum magnesium level of 6 mEq

• 2- S&S of mag toxicity are respiratory depression, loss of deep tendon reflexes, and sudden decline in FHR and maternal HR and BP • Therapeutic mag levels 4-7.5 mEq

9. A client with metastatic breast cancer is receiving Tamoxifen. The nurse specifically monitors which lab value while the client is taking this medication? 1. Glucose 2. Calcium 3. K+ 4. Prothrombin time

• 2- Tamoxifen may increase calcium, cholesterol, and triglyceride levels

7. The nurse is applying a topical corticosteroid to a client with eczema. The nurse should monitor for the potential for increased systemic absorption of the medication if the medication was being applied to which body area? 1. Back 2. Axilla 3. Soles of feet 4. Palms of hand

• 2- The areas of higher absorption are: scalp, axilla, face, eyelids, neck, perineum and genitalia

The nurse is monitoring a client who is taking propranolol. Which assessment data indicates a potential serious complication associated with this medication? 1. The development of complaints of nausea 2. The development of audible expiratory wheezes 3. Base line b/p of 150/80 followed by b/p 138/72 after 2 doses 4. Base line resting HR of 72 after 2 doses

• 2- audible wheezes indicates possible bronchospasm

5. A client in preterm labor (31 weeks) who is dilated to 4cm has been started on mag sulfate and contractions have stopped. If the client's labor can be inhibited for the next 48 hours, the nurse anticipates a prescription of which medication? 1. Nalbuphine 2. Betamethasone 3. Rh D innune globulin 4. Dinoprostone

• 2- betamethasone is a glucocorticoid, is given to increased production of surfactant to stimulate fetal lung maturity • Given in weeks 28-32 for clients in preterm labor

12. The nurse provides medication instructions to a client taking levothyroxine and should tell the client to call HCP if what problem occurs? 1. Fatigue 2. Tremors 3. Cold intolerance 4. Excessively dry skin

• 2- excessive amounts can produce S&S of hyperthyroidism such as tachycardia, tremors, nervousness, chest pain, insomnia, hyperthermia, extreme heat intolerance and sweating

. A client with A Fib secondary to mitral stenosis is receiving a heparin infusion at 1000U/hour and warfarin 7.5mg at 5pm daily. The AM lab results aPPT- 32 seconds, INR- 1.3, the nurse should plan which action? 1. Collaborate with HCP to D/C heparin and give warfarin as ordered 2. Collaborate with HCP to increase heparin and give warfarin 3. Collaborate with HCP to hold warfarin since the client is receiving a heparin infusion and the aPPT is with in the therapeutic range 4. Collaborate with HCP to continue heparin at same rate and discuss the use of dabigatran etexilate in place of warfarin

• 2- if client is on warfarin for clot prevention due to A Fib, an INR of 2-3 is appropriate. Until INR reaches that level the client should be on a continuous heparin infusion with the aPPT ranging between 60-80 seconds

7. The nurse is preparing to administer beractant to a premature infant who has respiratory distress syndrome. The nurse plans to administer the medication by which route? 1. Intradermal 2. Intratracheal 3. Sub Q 4. IM

• 2- intratracheal

1. A client with Crohn's disease is scheduled to receive an infusion of Infliximab. What intervention by the nurse will determine the effectiveness of treatment? 1. Monitoring the leukocyte count for 2 days after the infusion 2. Checking the frequency and consistency of BM's 3. Checking liver enzyme levels before and after infusion 4. Carrying out a hematest on gastric fluids after infusion is done

• 2- principal manifestations of Crohn's is diarrhea and ABD pain. Infliximab reduces the degree of inflammation in colon, reducing diarrhea

12. The nurse has a prescription to give a client salmeterol, 2 puffs and beclomethasone dipropionate, 2 puffs by metered dose inhaler. The nurse should administer the medication using which procedure? 1. Beclomethasone first and then the salmeterol 2. Salmeterol first then the beclomethasone 3. Alternating a single puff of each, beginning with the salmeterol 4. Alternating a single puff of each beginning with the beclomethasone

• 2- salmeterol is a bronchodilator and beclomethasone is a steroid. Bronchodilators are always given before steroids when they are to be given at the same time.

3. Mafenide acetate is prescribed for a client with a burn injury. When applying the medication, the client c/o local discomfort and burning. The nurse should take which most appropriate action? 1. Discontinue the medication 2. Notify the HCP 3. Inform the client that this is expected 4. Apply a thinner film than ordered to the burn site

• 3 - It is a normal reaction

15. The nurse is monitoring the lab results of a client receiving an antineoplastic medication by IV. The nurse plans to initiate bleeding precautions if which lab result is noted? 1. A clotting time of 10 seconds 2. An ammonia level of 20 3. A platelet count of 50,000 4. A WBC of 5000

• 3 Platelets are very low, normal 150,000-450,000

. The nurse should report which assessment finding to the HCP before initiating thrombolytic therapy in a client with PE? 1. Adventitious breath sounds 2. Temp of 99.4 orally 3. B/P 198/110 4. Resp. rate 28

• 3- If the b/p is too high there is an increased risk of bleeding

11. A client with Tb is being started on antituberculosis therapy with Isoniazid. Before giving the client the first dose the nurse should ensure that which baseline study was completed? 1. Electrolytes 2. Coagulation times 3. Liver enzyme levels 4. Creatinine levels

• 3- Isoniazid can cause elevation of hepatic enzyme levels and hepatitis

9. Silver Sulfadiazine is prescribed for a client with a partial thickness burn and the nurse provides teaching about the medication. Which statement made by the client indicates a need for further teaching? 1. The medication is an antibacterial 2. The medication will help heal the burn 3. The medication will permanently stain my skin 4. The medication should be applied directly to the wound

• 3- It does not stain skin

2. A client has a PRN order for loperamide hydrochloride. For which condition should the nurse administer this med? 1. Constipation 2. ABD pain 3. An episode of diarrhea 4. Hematest positive NG drainage

• 3- Loperamide is an antidiarrheal agent

10. Megesterol acetate, an antineoplastic medication is prescribed for a client with metastatic endometrial carcinoma. The nurse reviews the clients history and should contact the HCP if what diagnosis is present? 1. Gout 2. Asthma 3. Thrombophlebitis 4. MI

• 3- Megesterol is contraindicated in a client that has thrombophlebitis

1. A client has a prescription to take guaifenesin. The nurse determines that the client understands the proper administration of this med if the client states that he/she will preform which action? 1. Take an extra dose if a fever develops 2. Take meds with meals only 3. Take tablet with full glass of water 4. Decrease the amount if daily fluid intake

• 3- Mucinex is an expectorant and should be taken with a full glass of water to thin secretions

9. A client has been started on long -term therapy with rifampin. The nurse should provide which information to the client about the medication? 1. Should always be taken with food or antacids 2. Should be double dosed if 1 dose is forgotten 3. Causes orange discoloration of sweat, tears, urine and feces 4. May be discontinued independently if symptoms are gone in 3 months

• 3- Red-orange discoloration is of body secretions will stain soft contacts permanently

4. Sildenafil is prescribed to treat a client with erectile dysfunction. The nurse reviews the medical record and should question the prescription if which is noted in the chart? 1. Insomnia 2. Neuralgia 3. Use of nitroglycerin 4. Use of multivitamins

• 3- Sildenafil enhances vasodilating effect= sustained erection

5. Terbutaline is prescribed for a client with bronchitis. The nurse understands that this medication should be used with caution if which medical condition is present? 1. Osteoarthritis 2. Hypothyroidism 3. DM 4. Polycystic disease

• 3- Terbutaline is a bronchodilator, used in caution with clients with DM, impaired cardiac function, hypertension, hyperthyroidism, or a history of seizures

. The nurse is planning to administer hydrochlorothiazide to a client. The nurse understands that which is a concern related to the administration of this medication? 1. Hypouricemia, hyperkalemia 2. Increased risk of osteoporosis 3. Hypokalemia, hyperglycemia, sulfa allergy 4. Hyperkalemia, hypoglycemia, PCN allergy

• 3- Thiazide diuretics are sulfa based, clients are additionally at risk for hyperglycemia and hypokalemia

A client diagnosed with an ST-segment elevation MI and is receiving tissue plasminogen activator, alteplase. Which action is a PRIORITY nursing intervention? 1. Monitor for kidney failure 2. Monitor psychosocial status 3. Monitor for signs of bleeding 4. Have heparin sodium available

• 3- Tissue plasminogen is a thrombolytic. Hemorrhage is a complication of this medication

6. Zafirlukast is ordered for a client with bronchial asthma. Which lab test does the nurse expect to be prescribed before the administration of this medication? 1. Platelet count 2. Neutrophil count 3. Liver function test 4. CBC

• 3- Zafirlukast is a leukotriene receptor antagonist used in prophylaxis and long -term treatment of bronchial asthma. Used in caution with those with impaired hepatic function

5. A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication. When implementing the plan, the nurse should make which statement to the client? 1. You can take acetylsalicylic acid as needed for a HA 2. You can drink beverages that contain alcohol in moderate amounts each evening 3. You need to consult your HCP before getting vaccinations 4. It is fine to receive the flu shot at the local health fair without HCP approval because the flu is contagious

• 3- because these meds lower the resistance of the body the clients should not get immunizations without consulting the HCP first

A client is receiving thrombolytic therapy with a continuous infusion of alteplase suddenly becomes extremely anxious and C/O itching. The nurse hears stridor and notes generalized urticarial and hypotension. Which action is PRIORITY? 1. Give O2 and protamine sulfate 2. Cut infusion rate in half and sit up in bed 3. Stop infusion and call HCP 4. Give diphenhydramine and continue infusion

• 3- client is having anaphylactic reaction, stopping it is priority

5. An older client is taking cimetidine. The nurse monitors the client for which most frequent CNS s/e of this med? 1. Tremors 2. Dizziness 3. Confusion 4. Hallucinations

• 3- confusion is the most frequent

15. A daily dose of prednisone is ordered for a client. The nurse provides instructions to the client regarding administration of the med and should instruct the client that which is the best time to take the med? 1. At noon 2. At bedtime 3. Early morning 4. Any time, at the same time, every day

• 3- corticosteroids should be given before 9am, this mimics the burst of glucocorticoids released naturally by the adrenal glands each AM

14. The nurse is instructing a client regarding intranasal desmopressin. The nurse should tell the client that which is a s/e of the medication? 1. HA 2. Vulval pain 3. Runny nose 4. Flushed skin

• 3- desmopressin can cause runny or stuffy nose when given intranasal route

12. The nurse is analyzing lab results of a client with leukemia who has received a regimen of chemo. Which lab value would the nurse specifically note as a result of the massive cell destruction that occurs from the chemo? 1. Anemia 2. Decreased platelets 3. Increased uric acid 4. Decreased leukocyte count

• 3- hyperuricemia is especially common following treatment for leukemia's and lymphomas because chemo results in massive cell kill

16. Prednisone is ordered for a client with DM who takes NPH insulin daily. Which prescription change does the nurse anticipate during therapy with the prednisone? 1. An additional dose of prednisone 2. Decrease in NPH 3. Increase in NPH 4. The addition of an oral hypoglycemic med

• 3- prednisone can elevate the glucose levels, dose of insulin may need to be increased

2. The nurse is preparing to give a dose of naloxone hydrochloride IV to a client with an IV opioid overdose. Which supportive medical equipment should the nurse plan to have at bedside? 1. NG tube 2. Paracentesis tray 3. Resuscitation equipment 4. Central line insertion tray

• 3- resuscitation may be needed

11. The nurse provides instructions to a client who is taking levothyroxine. The nurse tells the client to take at which time? 1. With food 2. At lunch 3. On an empty stomach 4. At bedtime with a snack

• 3- should take on empty stomach to enhance absorption

12. The nurse is given instructions to a client who has just been prescribed cholestyramine. Which statement by the client indicates a need for further teaching? 1. I will continue taking vitamin supplements 2. This will help lower my cholesterol 3. This should only be taken with water 4. A high fiber diet is important while in this medication

• 3- tastes bad, can mix with fruit juice to help with taste

9. A client with a peptic ulcer is diagnosed with helicobacter pylori infection. The nurse is teaching the client about the meds ordered including clarithromycin, esomeprazole, and amoxicillin. Which statement by the client indicates the best understanding of the medication regimen? 1. My ulcer will heal because these meds will kill the bacteria 2. These meds are only taken when I have pain from my ulcer 3. The meds will kill the bacteria and stop acid production 4. These meds will coat the ulcer and decrease acid production in my stomach

• 3- triple therapy is usually done, 2 antibacterial meds and a PPI. These will kill the bacteria and decrease acid production

4. A client has begun medication therapy with pancrelipase. The nurse evaluates that the med is having an optimal intended benefit if which is observed? 1. Weight loss 2. Relief of heart burn 3. Reduction in steatorrhea 4. Absence of ABD pain

• 3- used as a digestive aid, the absence of fat in stools indicates that it is working

10. The camp nurse reminds kids that chemical sunscreens are most effective when applied? 1. Immediately before swimming 2. 5 minutes before exposure to the sun 3. Immediately before expose to the sun 4. At least 30 minutes before sun exposure

• 4- 30 minutes before sun exposure

2. The nurse provides discharge instructions to a client who is on warfarin. What statement reflects the need for further teaching? 1. I will avoid alcohol 2. I will take my pills every day at the same time 3. I have already called my family to pick up my medic- alert bracelet 4. I will take Ecotrin for my HA c=because it is coated

• 4- ASA should be avoided

A client who has a cold is seen in the ER with an inability to void. The client has a history of BPH; the nurse determines that the client should be questioned about the use of which medication? 1. Diuretics 2. ATB 3. Antitussives 4. Decongestants

• 4- Clients with BPH, episodes of urinary retention can be triggered by decongestants

10. Methylergonovine is prescribed for a client with postpartum hemorrhage. Before giving the med, the nurse contacts the HCP who prescribed the medication if which condition is in the client's medical history? 1. Hypotension 2. Hypothyroidism 3. DM 4. Peripheral vascular disease

• 4- Contraindicated in peripheral vascular because it can worsen vasoconstriction effects

10. The nurse has given a client taking ethambutol information about this medication. The nurse determines that the client understands the instructions if the client states he will immediately report which finding? 1. Impaired sense of hearing 2. GI S/E 3. Orange-red discoloration of body secretions 4. Difficulty in discriminating the color from red and green

• 4- Ethambutol causes optic neuritis

9. Rh (D) immune globulin is prescribed for a client after delivery and the nurse provides information to the client about the purpose of the medication. The nurse determines that the woman understands the purpose if the woman states that it will protect her next baby from which condition? 1. Having Rh-positive blood 2. Developing a rubella infection 3. Developing physiological jaundice 4. Being affected by Rh incompatibility

• 4- It prevents the mom from developing antibodies against Rh positive blood

The home health care nurse is visiting a client with elevated triglyceride level and cholesterol of 398. The client is taking cholestyramine. Which statement by the client indicates further teaching is needed? 1. Constipation and bloating could be a problem 2. I'll continue to watch my diet and reduce fats 3. Walking a mile each day will help the whole process 4. I'll continue my nicotinic acid from the health store

• 4- Nicotinic should be avoided because it may lead to liver abnormalities. All lipid lowering meds can cause liver abnormalities, so a combination of then needs to be avoided

Nitrofurantoin is ordered for a client with UTI. The client complains of cough, chills, fever, and dyspnea. The nurse should make which interpretation about the client's complaints? 1. The client may have contacted the flu 2. The client is experiencing anaphylaxis 3. The client is having expected effects of the med 4. The client is having a pulmonary reaction requiring cessation of the medication

• 4- Nitrofurantoin can induce pulmonary reactions, the symptoms resolve 2-4 days after stopping med

Prior to giving digoxin the nurse reviews labs. Calcium 9.8, Mag 1.2, potassium 4.1, Creatinine 0.9. Which would alert the nurse to dig toxicity? 1. Calcium level 2. Potassium level 3. Creatinine level 4. Mag level

• 4- Normal range for magnesium is 1.6- 2.6, a client with hypomagnesiumia is at an increased risk for dig toxicity

3. A client has a PRN order for ondansetron. For which condition should the nurse give this to the postop client? 1. Paralytic ileus 2. Incisional pain 3. Urinary retention 4. N&V

• 4- Ondansetron is an antiemetic used to treat N&V

Trimethoprim-sulfamethoxazole is ordered. The nurse should instruct the client to report which symptom is it develops? 1. Nausea 2. Diarrhea 3. HA 4. Sore throat

• 4- Sore throat, fever and pallor can indicate a blood disorder

6. A client with a gastric ulcer has an order for sucralfate 1g by mouth 4X daily. The nurse should schedule the med for which times 1. With meals and at bedtime 2. Every 6 hours around the clock 3. 1 hour after meals and at bedtime 4. 1 hour before meals and at bedtime

• 4- Sucralfate is a gastric protectant and should be given 1 hour before meals and at HS

8. Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The nurse giving the med understands that this is a primary action of this med? 1. IT increases DNA and RNA synthesis 2. It promotes the biosynthesis of nucleic acids 3. It increases estrogen concentration and estrogen response 4. It competitively binds to estrogen receptors on tumors and other tissue targets

• 4- Tamoxifen competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors

1. Chemo dosage is frequently based on total body surface area, so it is important for the nurse to preform which assessment before giving chemo? 1. Measure the clients ABD girth 2. Calculate the clients body mass index 3. Ask the client about his or her body weight and height 4. Measure the clients current weight and height

• 4- This requires an accurate height and weight for BSA calculation

6. A client with ovarian cancer is being treated with vincristine. The nurse monitors the client knowing that which manifestation indicates an adverse effect to this medication? 1. Diarrhea 2. Hair loss 3. Chest pain 4. Peripheral neuropathy

• 4- adverse effect is peripheral neuropathy, which occurs in almost every client

A client is being treated for HF is given bumetanide IV. Which outcome indicates the med is effective? 1. Cough becomes productive of frothy pink sputum 2. Potassium changes for 3.8 to 3.1 3. B-natriuretic peptide factor increases from 200 to 262 4. Urine output increases 10ml per hour to greater than 50 ml and hour

• 4- bumetanide is a diuretic and expected outcomes are increased output, decreased crackles and decreased weight

14. A client with non-Hodgkin's lymphoma is receiving daunorubicin. Which finding would indicate to the nurse that the client is experiencing an adverse effect related to the medication? 1. Fever 2. Sores in the mouth and throat 3. C/O N&V 4. Crackles on auscultation of the lungs

• 4- cardio-toxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as HF (crackles in lungs) is an adverse effect

A client is ordered nicotinic acid for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? 1. It is not necessary to avoid alcohol 2. The medication should be taken with meals to decrease flushing 3. Clay colored stools are a common side effect and should not be of concern 4. Ibuprofen taken 30 minutes before the nicotinic acid should decrease flushing

• 4- flushing is a side effect and can be decreased when ibuprofen is taken 30 minutes prior

10. A client has a new prescription for metoclopramide. On review of the chart, the nurse identifies that this medication can be safely given with what condition? 1. Intestinal obstruction 2. Peptic ulcer with melena 3. Diverticulitis with perforation 4. Vomiting following cancer chemo

• 4- metroclopramide is a GI stimulant and antiemetic

4. A client with small cell lung caner is being treated with etoposide. The nurse monitors during administration, knowing that which adverse effect is associated with this medication? 1. Alopecia 2. Chest pain 3. Pulmonary fibrosis 4. Orthostatic hypotension

• 4- orthostatic hypotension is an adverse effect. It should be given slowly over 30-60 minutes to avoid hypotension

4. A client is being treated with procainamide for a cardiac dysrhythmia. Following IV administration of the med, the client C/O dizziness. What intervention should the nurse to take first? 1. Measure the HR on the strip 2. Give ordered nitro tablets 3. Get a 12 lead EKG stat 4. Auscultate the apical pulse and get a b/p

• 4- signs of toxicity form procainamide include confusion, dizziness, drowsiness, decreased urination, N&V

15. The nurse has just given the first dose of Omalizumab to a client. Which statement by the client would alert the nurse that the client might be experiencing a life threatening effect? 1. I have a severe HA 2. My feet are quite swollen 3. I am nauseated and may vomit 4. My lips and tongue are swollen

• 4-Omalizumab is an anti-inflammatory used in asthma. Anaphylactic reactions may occur with this medication

4. A cromolyn sodium inhaler is ordered for a client with allergic asthma. The nurse provides instructions regarding the S/E and A/E of this medication and should tell the client that what undesirable effect is associated with this medication? 1. Insomnia 2. Constipation 3. Hypotension 4. Bronchospasm

• Undesirable effects are: bronchospasm, cough, nasal congestion, throat irritation and wheezing