pharm exam 4

​An older adult client's provider prescribes aspirin, 650 mg/q6h PO to treat rheumatoid arthritis. The nurse should teach the client that a possible adverse effect of aspirin therapy is​

Bleeding.

A nurse is reviewing the medical record of a client who has a prescription for a combination oral contraceptive. The nurse should identify which of the following findings is a contraindication to receiving this medication?

Liver disease- also thrombophlebitis of breast cancer are contraindications

A nurse is monitoring the laboratory values of a male client who has leukemia and is receiving weekly chemotherapy with methotrexate via IV infusion. Which of the following laboratory values should the nurse report to the provider?

Platelets 78,000- methotrexate can cause thrombocytopenia also monitor BUN, HGB, AST ranges

A nurse is providing teaching to a client who has chronic kidney failure with an AV fistula for hemodialysis and a new prescription for epoetin alfa Which of the following therapeutic effects of epoetin alfa should the nurse include in the teaching?

Promotes RBC production

A nurse is reviewing the laboratory values for a client who is receiving a continuous IV heparin infusion and has an aPTT of 90 seconds. Which of the following actions should the nurse prepare to take?

Reduce the infusion rate ( it should be 60-80 seconds)

A nurse is caring for a female adult client who is experiencing menopause and has a prescription for estrogen along with progestin The nurse should identify that the provider has prescribed these medications for which of the following reasons ?

Short term use to control urogenital atrophy

a nurse is assessing a client who comes to the clinic for a seasonal influenza vaccine. The client says he read about an influenza vaccine that is given as a nasal spray and wants to receive it. Which of the following is a contraindication for the client to receiving the live attenuated influenza vaccine ( LAIV)

just turned 62

A nurse is reinforcing medication instruction to a group of clients. Which of the following statements indicates a need for further clarification?

​"I will take aspirin for headaches like I did when I had a stroke."

A nurse is providing discharge teaching to a client who will be taking warfarin (Coumadin) at home. Which of the following statements indicates that the client understands the effects of this medication?

​"I'll use my electric razor for shaving."

A nurse is preparing to administer heparin subcutaneously to a client? Which of the following techniques should the nurse use?

​Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, and observe for bleeding.

A nurse is talking with a group of young women about the use of oral contraceptives. The nurse should point out that taking which of the following herbal preparations reduces the effectiveness of this birth control method?

​St. John's wort

​Whenever a nurse is caring for clients who are receiving warfarin (Coumadin), which of the following medications should the nurse have on hand in the event of an overdose?

​Vitamin K

A nurse is teaching a patient who has rheumatoid arthritis about taking methotrexate (Rheumatrex). The nurse should tell the patient to

​drink 2 to 3 L of water per day to promote its excretion.

A nurse is assessing a client who has AIDS and is taking zidovudine . Which of the following findings is the priority for the nurse to report to the provider?

Decreased hemoglobin- zidovudine can cause severe anemia and neutropenia from bone marrow suppression causing hematologic toxicity

A nurse is caring for a client who takes a combination oral contraceptive (OC). Which of the following findings should indicate to the nurse that the client is experiencing a deficiency of estrogen in the ?

Mild cycle breakthrough bleeding or spotting

A nurse is preparing to administer oxytocin to a client who is at 41 weeks gestation and is experiencing ineffective labor. Which of the following actions should the nurse plan to take?

Increase the dose of oxytocin to obtain uterine contractions that occur every 2-3 min

A nurse is planning care for a client with thrombophlebitis who has a prescription to receive heparin via continuous IV infusion . Which of the following actions should the nurse include in the plan of care?

Infuse the heparin using electronic IV Pump

A nurse is caring for a client diagnosed with thrombophlebitis who has a swollen and inflamed right calf. The client is started on a continuous heparin infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give?

"Heparin does not dissolve clots, it stops new clots from forming."

A nurse is assessing a client who has numerous bruises on his upper extremities. The client reports that he has taken warfarin (Coumadin) daily for the past 3 months. Which of the following statements by the client indicates the client needs further teaching?

"I have started taking ginger root to treat my joint stiffness."

A nurse is caring for a client with multiple sclerosis and neurogenic bladder who is receiving bethanechol. The nurse should identify which of the following client statements indicates a therapeutic action of the medication ?

"Im able to urinate more freely"

A nurse is caring for a client who is hospitalized with deep vein thrombosis and has been on IV heparin for 5 days. The provider prescribes oral warfarin (Coumadin) without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following is an appropriate nursing response?

"The Coumadin takes several days to work, so the IV heparin will be used until the Coumadin reaches a therapeutic level."

A nurse is caring for a client who is taking ferrous sulfate (Feosol) tablets twice daily for iron-deficiency anemia. The client asks the nurse why the provider suggested that she take the ferrous sulfate with orange juice. Which of the following is an appropriate response by the nurse?

"The orange juice will help you absorb the medication more efficiently."

​Whenever a nurse is caring for clients who are receiving heparin, which of the following medications should the nurse have on hand in the event of an overdose?

Protamine

A nurse is caring for a client who has a prescription for clopidogrel. The nurse should monitor the client for which of the following adverse effects?

Bleeding- clopidogrel is an antithrombotic medication that inhibits platelet aggregation. Prevents stenosis of the coronary stents, myocardial infarction and strokes. Nurses should monitor for coffee grounds, black tarry stools, ecchymosis, or any indications of bleeding.

A nurse is planning to administer epoetin alfa to a client who has chronic kidney failure . Which of the following should the nurse plan to review prior to administering this medication ?

Blood pressure- epoetin alfa often causes hypertension, ppl taking often require use of antihypertensive medication

​A client provides a nurse with a list of home medications. Which of the following should the nurse recognize as incompatible?

Warfarin sodium (Coumadin) and multivitamins

A client who is postoperative following a transurethral resection of the prostate (TURP) has a new prescription for bethanechol (Urecholine) PRN. The nurse should administer this medication if the client reports?

an inability to void.

A nurse at a family practice clinic receives a call from a client who is taking oral contraceptives but forgot to take one oral contraceptive pill. Which of the following instructions should the nurse give her?

​"Take the missed dose along with the next dose.

A nurse is educating a group of clients about the contraindications of warfarin (Coumadin) therapy. Which of the following statements is appropriate to include in the teaching?

​Clients who are pregnant should not take Coumadin."

A nurse is teaching a client who is about to start therapy with methotrexate (Rheumatrex) to treat rheumatoid arthritis. Which of the following instructions should the nurse include? (Select all that apply.)

​Do not drink alcoholic beverages. ​Report unexplained bruising to the provider. ​Avoid people who have infections.

​A nurse is talking with a client who is about to undergo hip arthroplasty. The nurse explains that the surgeon will prescribe anticoagulant therapy to prevent deep-vein thrombosis postoperatively. The nurse should explain that the client will not require frequent clotting time determinations because the surgeon plans to prescribe which of the following medications?

​Enoxaparin (Lovenox)

​A nurse is caring for a client who has a hip fracture. The nurse should expect the provider to prescribe which of the following medications for prophylactic anticoagulant therapy?

​Heparin

A nurse is administering subcutaneous heparin to a client who is at risk for deep vein thrombosis. Which of the following actions should the nurse take?

Administer the medication into the client's abdomen

A nurse on a medical unit is preparing to administer alendronate 40 mg PO for an older adult client who has Paget's disease of the bone . Which of the following actions should be the nurse's priority?

Ambulate the client prior to administering the medication (ambulate client to chair and sit upright to prevent esophagitis from occurring. Must be able to stand upright for 30 minutes after taking medication, given with water, before breakfast since food reduce absorption)

A nurse is teaching a group of nurses about the manifestations of progestin deficiency for clients who take a combination oral contraceptive (OC). Which of the following findings should the nurse include in the teaching as an indication of progestin deficiency ?

Amenorrhea

A nurse is caring for a client who is HIV positive and is started on zidovudine (AZT). The nurse should monitor the client for which of the following life-threatening side effects of this medication?

Aplastic anemia

A nurse is reviewing the medical record of a client who is requesting a prescription for sildenafil citrate. Which of the following data in the client's record should the nurse identify as a contraindication to the use of this medication?

Current use of isosorbide to treat heart failure ( taking any nitrates such as isosorbide and nitroglycerin are contraindications and can cause life threatening hypotension)

A nurse is providing discharge teaching to a client who has venous thrombosis and a prescription for warfarin. Which of the following instructions should the nurse include in the teaching?

Carry a medical alert ID card ( client taking warfarin has increased risk for bleeding and emergency personnel must be aware)

A nurse is preparing to administer the influenza vaccine to a client. Which of the following allergies should the nurse identify as a contraindication to the client receiving this vaccine?

Chicken eggs- adults with chicken egg allergy can't get the influenza vaccine

A nurse is teaching a client who is premenopausal and has a prescription for a combination oral contraceptive . Which of the following findings should the nurse include as an adverse effect of oral contraceptives ?

Deep vein thrombosis

A nurse is caring for a client who is 12 hours postoperative following a total hip arthroplasty. Which of following medications should the nurse anticipate administering to this client to prevent deep vein thrombosis (DVT) ?

Enoxaparin

A nurse is preparing to administer the varicella vaccine to a 12 - mon -old infant. The nurse asks the infant's guardian if the infant has any allergies. Which of the following allergies is a contraindication to the infant receiving the vaccine?

Gelatin- an allergy to gelatin is a contraindication to receive the Varicella vaccine

A nurse is teaching a client who has osteoporosis and a new prescription for alendronateWhich of the following client statements indicates that the teaching was effective ?

I will sit upright for 30 min after taking medication

A nurse is caring for a client who is taking warfarin . Which of the following laboratory values should the nurse recognize as an effective response to the medication ?

INR 3.0

A nurse is teaching a client who has a new prescription for warfarin . Which of the following statements should the nurse identify as an indication that the client understands the instructions ?

Ill avoid contact sports like football- high risk injury and on warfarin risk for bleeding

A nurse is caring for a client who has chronic renal disease and is receiving epoetin alfa (Epogen) therapy. The nurse should instruct the client to increase dietary consumption of

Iron

A nurse is reviewing laboratory values for an adult client who has sickle cell anemia and a history of receiving blood transfusions . For which of the following complications should the nurse monitor ?

Iron toxicity ( excessive iron can come from overuse of supplements or from receiving frequent blood transfusions as in sickle cell anemia, also risk for hypocalcemia, hyperkalemia)

A nurse is preparing to administer warfarin to a client who has a new onset of atrial fibrillation. The client asks the nurse, " What should this medication do?" Which of the following responses should the nurse make?

It can reduce your risk of stroke

A nurse is caring for a client who is recovering from surgical placement of an artificial heart valve and is to be started on warfarin (Coumadin) prior to discharge. Which of the following diagnostic tests should the nurse use to monitor the effect of this therapy?

Prothrombin time (PT)

A nurse is reviewing the medical record of a client. The medication administration record shows the client is taking clopidogrel . Which of the following events should the nurse expect in the client's medical history ?

Recent myocardial infarction- bc clopidogrel is an antiplatelet medication that inhibits the aggregation of platelets to prevent thrombotic events

A nurse is providing teaching to a group of new parents about medications. The nurse should include that aspirin is contraindicated for children who have a viral infection due to the risk of developing which of the following adverse effects?

Reye's Syndrome

A nurse is caring for a female client who has osteoporosis and is taking raloxifene. Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect of this medication?

Sudden onset of dyspnea (adverse effects of raloxifene is a increased risk of thromboembolic events such as deep vein thrombosis, pulmonary embolism and stroke)

A nurse in a provider's office is providing teaching to a client with osteoporosis who has a new prescription for alendronate sodium. Which of the following pieces of information should the nurse include?

Take alendronate sodium with a full glass of water on an empty stomach ( needs to be taken with at least 230 mL (8oz) of water 30 min before ingesting food in upright position)

A nurse is preparing to administer an IM injection for a client. Which of the following factors should the nurse identify as a potential contraindication to administering the medication via the IM route

The client is taking an anticoagulant

​A charge nurse is evaluating the care of a newly licensed nurse as he cares for a client who is receiving a transfusion of packed RBC. The nurse suspects a possible hemolytic reaction. After stopping the blood transfusion, which of the following actions by the newly licensed nurse requires intervention by the charge nurse?

The nurse starts the transfusion of another unit of blood product.

A nurse is preparing to administer cisplatin IV to a client who has lung cancer . The nurse should identify which of the following findings is an adverse effect of this medication?

Tinnitus- adverse effect of the med is ototoxicity which can cause tinnitus

A nurse is caring for a client who reports occasionally self-medicating with an over-the-counter calcium carbonate antacid. To avoid the adverse effects of calcium carbonate, the nurse should recommend that the client take this medication with

Water.

A nurse is teaching a client who has a prescription for a combination oral contraceptive (OC) that uses a 28-day cycle. Which of the following instructions should the nurse include in the teaching ?

You can miss up to 7 pills with little risk in getting pregnant as long as you have taken the pills regularly for the previous 3 weeks

A female client who has rheumatoid arthritis asks the nurse if it is safe for her to take aspirin. Which of the following is a contraindication to this medication?

​History of gastric ulcers.

​A nurse is preparing to administer heparin to a client via the deep subcutaneous (intrafat) route. Which of the following is an appropriate action for administering this medication?

​Inject the medication into the abdomen above the level of the iliac crest.

A nurse is teaching a client who is about to start therapy with alendronate (Fosamax) to treat osteoporosis. Which of the following adverse effects should the nurse instruct the client to report? (Select all that apply.)

​Jaw pain ​Blurred vision ​Dysphagia

​A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects?

​Protamine sulfate