Pharm ATI practice B

A nurse is providing teaching for a client who has multiple sclerosis and a new prescription for methylprednisone. Which of the following instructions should the nurse include?

1. Blood glucose levels will need to be monitored during therapy 2. Avoid contact with persons with known infections 3. Grapefruit juice can increase blood levels of this medication Why? Corticosteroids raise blood glucose levels; Corticosteroids suppress immune response; Grapefruit juice increases absorption, which can lead to toxicity and adrenal suppression.

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?

1. Dangle your legs from the side of the bed before standing 2. Monitor for muscle weakness 3. Increase intake of potassium-rich foods Why? Loop diuretics can reduce vascular tone which decreases blood return to the heart and can manifest as dizziness and lightheadedness when changing positions; Furosemide causes a loss of potassium, which can result in manifestations of hypokalemia such as shallow respirations, difficulty concentrating, hyporeflexia, and muscle weakness; Loop diuretics act by blocking the resorption of sodium, water, and potassium. An adverse effect of the drug is development of electrolyte imbalances.

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?

1. Hemoglobin 7 2. Platelets 75,000 3. Potassium 5.2 Why? A Hgb of 7 indicates hydroxyurea toxicity, it is below the expected range of 14-19 for a male and 12-16 for a female; Platelet level of 75,000 indicates hydroxyurea toxicity, it is below the expected range of 150,000-400,000; Potassium level of 5.2 indicates tumor lysis syndrome.

A nurse is preparing to teach a client who is to start a new prescription for extended release verapamil. Which of the following instruction should the nurse plan to include?

Change positions slowly. Why? To prevent orthostatic hypotension and syncope.

A nurse is reviewing the medical record of a client who has hypertension. The nurse should identify which of the following findings as a contraindication for receiving propranolol?

Asthma. Why? Propranolol is an adrenergic antagonist which blocks beta2 receptors in the lungs, causing bronchoconstriction and leading to serious airway resistance and possibly airway arrest.

A nurse is caring for a client who is recovering from 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?

Bleeding gums Why? This is an adverse effect of warfarin, an anticoagulant.

A nurse is caring for a client who has magnesium level of 3.1 mEq/L. The nurse should expect to administer which of the following medications?

Calcium gluconate Why? Give IV calcium gluconate and prepare to provide ventilatory support. Patient is at risk for respiratory depression and cardiac dysrhythmias because a magnesium level of 3.1 is above the expected range of 1.3-2.1.

A nurse is providing teaching to a client who is to start taking sumatriptan. Which of the following adverse effects should the nurse instruct the client to monitor for and report to the provider?

Chest pressure Why? Sumatriptan is an anti-migraine agent that can cause coronary vasospasms which results in angina.

A nurse is caring for a client who is taking atrovastatin for hyperlipidemia. Which of the following client laboratory values should the nurse monitor? creatinine kinase

Creatinine kinase Why? Patient's taking atorvastatin can develop rhabdomyolysis, which causes muscle weakness or pain and can progress to myositis. Creatinine kinase levels rise in response to enzymes released with muscle injury.

A nurse is reviewing laboratory results for a client who is to receive a dose of cefiazidime via intermittent IV bolus. Which of the following laboratory findings is the priority for the nurse to report to the provider before administering the medication?

Creatinine 2.6 mg/dL Why? Ceftazidime is excreted primarily by the renal system. Serum creatinine greater than 1.e mg/dL can indicate kidney disorder.

A nurse is planning to teach about inhalant medications to a client who has a new diagnosis of exercise-induced asthma. Which of the following medications should the nurse plan to instruct the client to use prior to physical activity?

Cromolyn Why? Cromolyn sodium stabilizes mast cells, which inhibit release of histamine and other inflammatory mediators. The patient should use cromolyn 10-15 min before planning to exercise to prevent bronchospasms.

A nurse is administering baclofen for a client who has a spinal cord injury. Which of the following findings should the nurse document as a therapeutic outcome?

Decrease in flexor and extensor spasticity. Why? Patient can experience a decrease in the frequency and severity of muscle spasms and in flexor and extensor spasticity.

A nurse is caring for a client who has hypocalcemia and is receiving calcium citrate. The nurse should identify that which of the following findings indicates a therapeutic response to the medication?

Decreased parasthesia. Why? Paresthesia is a manifestation of hypocalcemia. Other manifestations of hypocalcemia include muscle twitching and cardiac dysrhythmias.

A nurse is caring for a client who has developed hypomagnesemia due to long-term therapy with lansoprazole. The nurse should monitor the client for which of the following manifestations?

Disorientation. Why? Disorientation is a manifestation of hypomagnesemia. Other manifestations include positive Chvostek's and Trousseau's signs.

A nurse is caring for a client who has pneumonia. The client tells the nurse she is pregnant and that she has not told her provider yet. The nurse should identify that pregnancy is a contraindication for receiving which of the following medications?

Doxycycline Why? This is a tetracycline antibiotic. Doxycycline can cause teratogenic effects such as staining the infant's teeth.

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?

Drink 2 L of water a day. Why? To prevent renal stone formation and kidney injury, because allopurinol is eliminated through the kidneys.

A nurse is assessing a client who is taking amitriptyline for depression. Which of the following findings should the nurse identify as an adverse effect of the medication?

Dry mouth Why? Tricyclic antidepressants block acetylcholine receptors that cause anticholinergic responses.

A nurse is administering diazepam to a client who is having a colonoscopy. Which of the following actions should the nurse take?

Ensure flumazenil is available to administer for toxicity management. Why? Monitor for manifestations of diazepam toxicity, such as respiratory depression and hypotension. Be prepared to administer flumazenil to reverse the effects of diazepam.

A nurse is caring for a client who has heart failure and a prescription for enalapril. The nurse should monitor the client for which of the following findings as an adverse effect of the medication?

Hyperkalemia Why? Enalapril improves cardiac functioning in patients who have heart failure and can cause hyperkalemia due to potassium retention by the kidneys.

A nurse is providing teaching to a client who has depression and a new prescription for fluoxetine. Which of the following statements by the client indicates an understanding of the teaching?

I should take acetaminophen instead of ibuprofen for my headaches while taking this medication. Why? Fluoxetine suppresses platelet aggregation, which increases risk of bleeding when used with NSAIDS and anticoagulants.

A nurse is teaching a client who is starting to take diltiazem. Which of the following statements should the nurse identify as an indication that the client understand the teaching?

I will check my heart rate before I take the medication. Why? Diltiazem is a calcium channel blocker, and has cardio-suppressant effects at the SA and AV nodes, which can lead to bradycardia.

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 the following statements by the client indicated an understanding of the teaching?

I will remove the patch after 14 hours. Why? Patch should be removed after 12-14 hours to prevent tolerance to the medication.

A nurse is teaching about zolpidem to a client who has insomnia. The nurse should identify that which of the following client statements indicates an understanding of the teaching?

I will use this medication for a short period of time. Why? Zolpidem is used for short-term treatment of insomnia.

A nurse is assessing a client who is receiving epoetin alfa to treat anemia. Which of the following findings should the nurse monitor?

Increased blood pressure. Why? The therapeutic effect of epoetin alfa is an increase in hematocrit levels, which can result in an increase in blood pressure. If the hct level rises too rapidly, hypertension and seizures can result.

A nurse is caring for a client who has heart failure and is receiving an IV infusion of dopamine. Which of the following findings indicated that the medication is effective?

Increased cardiac output. Why? Dopamine is an adrenergic that causes receptor specificity effect, which increases cardiac output and improves perfusion.

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?

Leg tenderness Why? Greatest risk to the patient is development of thromboembolism, which is an adverse effect of tamoxifen. Also monitor patient for other manifestations of thromboembolism including redness, swelling, and shortness of breath.

A nurse is caring for a client who is to receive treatment for opioid use disorder. Which of the following medications should the nurse expect to administer?

Methadone. Why? Can be administered for withdrawal and to assist with maintenance and suppressive therapy.

A nurse administered digoxin immune Fab to a client who received the incorrect dose of digoxin over a period of 3 days. The nurse should identify that which of the following findings indicates the antidote was effective?

Normal sinus rhythm. Why? Dysrhythmias are a life-threatening adverse effect of digoxin 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? Obtain WBC with absolute neutrophil count

Obtain WBC and absolute neutrophil count. Why? Clozapine has an adverse effect of agranulocytosis, which can lead to lethargy and myalgia. It is recommended to monitor the WBC and absolute neutrophil count weekly for the first 6 months of treatment.

A nurse is preparing to administer hydrochlorothiazide to a client. Which of the following actions should the nurse take prior to administering the medication?

Obtain the patient's blood pressure. Why? HCTZ is a diuretic used to promote urine excretion and reduce blood pressure and edema.

A nurse is caring for a client who has diabetes mellitus and is taking glyburide. The client reports feeling confused and anxious. Which of the following actions should the nurse take first?

Perform a capillary blood glucose test. Why? Greatest risk for this patient is hypoglycemia. Manifestations of hypoglycemia include weakness, anxiety, confusion, sweating, and seizures.

A nurse is preparing to mix and administer dantrolene via IV bolus to a client who has developed malignant hyperthermia during surgery. Which of the following actions should the nurse take?

Reconstitute the initial dose with 60 mL of sterile water without a bacteriostatic agent Why? Cause that just what you do and also inject RAPIDLY.

A 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?

Take a stool softener on a daily basis. Why? Fentanyl is an opioid, and constipation is an adverse effect of opioid use.

A circulating nurse is planning care for a client who is scheduled for surgery and has a latex allergy. Which of the following actions should the nurse include in the plan of care?

The nurse should place monitoring devices in a stockinet. Why? To prevent direct contact with the client's skin.

A nurse administers ceftazidime to a client who has severe penicillin allergy. The nurse should identify which of the following client findings as an indication that she should complete an incident report?

The patient reports shortness of breath. Why? A severe penicillin allergy is a contraindication for taking ceftazidime, a cephalosporin antibiotic. Shortness of breath can indicate the patient is developing anaphylaxis.

A nurse in a clinic is caring for a client who is taking aspirin for the treatment of arthritis. The nurse should identify which of the following findings as an indication that the client is beginning to exhibit salicylism?

Tinnitus Why? Tinnitus is a manifestation of aspirin toxicity, AKA salicylism. Other manifestations include sweating, headache, and dizziness.

A nurse is reviewing the laboratory results of a client who is taking carbamazepine for a seizure disorder. Which of the following findings should the nurse report to the provider?

WBC 3,500/mm3 Why? This is below the expected WBC range of 5,000 - 10,000/mm3. Leukopenia is an adverse effect of carbamazepine.

A nurse is providing teaching to a client who is to start therapy with digoxin. For which of the following effects should the nurse instruct the client to monitor and report to the provider?

Yellow-tinged vision. Why? Yellow-tinged vision is a sign of digoxin toxicity. Other manifestations of digoxin toxicity include N/V, loss of appetite, fatigue, and possible cardiac dysrhythmias.

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?

Blurred vision Why? Cycloplegic effects of the medication cause near objects to appear blurry to the patient.

A nurse is providing teaching to a client who has a prescription for trimethoprim/sulfamethoxazole. Which of the following instructions should the nurse include in the teaching?

Drink 8-10 glasses of water a day. Why? To decrease risk of kidney damage from crystallization. The patient should drink 1,920-2,400 mL/day.

A nurse is planning discharge teaching for a client who has prescription for furosemide. The nurse should plan to include which of the following statements in the teaching?

Drink a glass of milk with each dose of medication. Why? To reduce gastric irritation.

A nurse in a provider's office is assessing a client who has been taking aspirin daily for the past year. For which of the following findings should the nurse notify the provider immediately?

Hyperventilation. Why? Hyperventilation may indicate acute salicylate poisoning, which causes respiratory alkalosis in the early stages. THINK ABC'S.

A nurse is teaching a client who is to start taking famotidine for peptic ulcer disease. Which of the following client statements should the nurse identify as understand of the teaching?

I know smoking makes famotidine less effective. Why? Smoking decreases effectiveness by exacerbating the ulcer manifestations.

A nurse is teaching about a new prescription for ciprofloxacin to a client who has a urinary tract infection. The nurse should identify which of the following statements as an indication that the client understands the teaching?

I will report any signs of tendon pain or swelling. Why? Ciprofloxacin, a fluoroquinolone, is associated with a risk of tendon rupture.

A nurse is providing teaching to a client who has a new prescription for ferrous sulfate. The nurse should instruct the client to take the medication with which of the following to promote absorption?

Orange juice Why? 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?

Orthostatic Hypotension Why? HCTZ a an antihypertensive thiazide diuretic which can case orthostatic hypotension and light headedness.

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?

Total cholesterol. Why? Clozapine can cause hyperlipidemia.