PHARM HESI PRACTICE QUESTIONS (SAUNDERS)

The client has been taking omeprazole for 4 weeks. The nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptoms? a. diarrhea b. heartburn. c. flatulence d. constipation

Omeprazole is a proton pump inhibitor and antiulcer agent. The intended effect is relief from pain from gastric irritation (heart burn).

The nurse provides instructions to a client who is taking levothyroxine. The nurse should tell the client to take the medication in which way? a. With food b. At lunchtime c. On an empty stomach d. At bedtime with a snack

a. On an empty stomach Oral doses of levothyroxine should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning BEFORE breakfast.

The client with hyperparathyroidism is taking alendronate. Which statements by the client indicate understanding of the proper way to take this medication? a. I should take this medication with food b. I should take this medication at bedtime c. I should sit up for at least 30 minutes after taking this medication d. I should take this medication first thing in the morning on an empty stomach e. I can pick a time to take this medication that best fits my lifestyle as long as I take it at the same time each day.

c and d I should sit up for 30 min after taking thi smed and I should take it in the morning on an empty stomach

Terbutaline is prescribed for a client with bronchitis. The nurse checks the client's medical history for which disorder in which the medication should be used with caution? a. Osteoarthritis b. Hypothyroidism c. Diabetes Mellitus d. Polycystic Disease

c. Diabetes Mellitus Terbutaline is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. It should be used with caution in clients with impaired cardiac function, diabetes mellitus, hypertension, hyperthyroidism, or history of seizures. The medication may increase blood glucose levels.

The nurse is preparing to administer a dose of naloxone intravenously to a client with an opioid overdose. Which supportive medical equipment should the nurse plan to have at the client's bedside if needed? a. Nasogastric Tube b. Paracentesis Tray c. Resuscitation Equipment d. Central line insertion tray.

c. Resuscitation equipment The nurse is administering the naloxone for suspected overdose and should have resuscitation equipment readily available to support naloxone therapy if it is needed. Other adjuncts that may be needed are oxygen, mechanical ventilator and vasopressors.

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 an understanding of the instructions? a. I must take the medication exactly as prescribed b. Once I start the medication I will no longer be contagious c. I will not get any colds or infections while taking this medication d. This medication has minimal side effects and I can return to normal activities.

1. I must take the medication exactly as prescribed. Antiviral medications for influenza must be taken exactly as prescribed. These medications do not prevent the spread of influenza and clients are usually contagious for up to 2 days after the initiation of antiviral medications. Secondary bacterial infections may occur despite antiviral treatment. Side effects occur with these medications and may necessitate a change in activities, especially when driving or operating machinery if dizziness occurs.

The nurse teaches a client about the effects of diphenhydramine, which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction when the client makes which statement? a. I will take the medication with an empty stomach b. I won't drink alcohol while taking this medication c. I won't do activities that require mental alertness while taking this medication d. I will use sugarless gum, cand, or oral rinses to decrease dryness in my mouth.

1. I will take the medication on an empty stomach Diphenhydramine has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative hypnotic. Instructions for use include taking with food or milk to decrease GI upset and using oral rinses, gum, or hard candy ti minimize dry mouth. The medication can cause drowsiness, the client should avoid use of alcohol or operating a car, engaging in other activities that require mental awareness.

A daily dose of prednisone is prescribed for a client. A nurse reinforces instructions to the client regarding administration of the medication and instructs the client that the best time to take this medication is: 1. At noon 2. At bedtime 3. Early morning 4. Anytime, at the same time, each day

3. Early morning Corticosteriods (glucococorticoids) should be administered before 9 am. Administration at this time helps to minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning.

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? a. Withdraws the NPH insulin first b. Withdraws the regular insulin first. c. Injects air into the NPH insulin vial first d. Injects an amount of air equal to the desired dose of insulin into each vial.

A. Withdraws the NPH insulin first When preparing a mixture of short-acting insulin, such as regular insulin, with another insulin preparation, the short-acting insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of short-acting insulin with the insulin of another type.

The nurse is monitoring the client who is taking digoxin for adverse effects. Which findings are characteristic of digoxin toxicity? Select all that apply. a. Tremors b. Diarrhea c. Irritability d. Blurred Vision e. Nausea and vomiting

B, D, and E. Diarrhea, Blurred vision and nausea and vomiting. Digoxin is a cardiac glycoside. The risk of toxicity can occur with this medication. Early signs of digoxin toxicity are gastrointestinal manifestations such as anorexia, nausea, vomiting and diarrhea. Subsequent manifestations include headache, visual disturbances such as diplopia and blurred vision or halos and photophobia, drowsiness, fatigue and weakness. Cardiac rhythm abnormalities may occur. Therapeutic range is 0.5-0.8.

A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hour. The nurse determines that the client is receiving the therapeutic effect based on what results? a. Prothrombin time of 12.5 seconds b. Activated partial thromboplastin time of 60 seconds c. Activated partial thromboplastin time of 28 seconds d. Activated partial thromboplastin time longer than 120 seconds.

B. aPTT of 60 seconds. Common lab ranges for aPTT are 30-40 seconds. Because aPTT should be 1.5-2.5 times the normal value, the client's aPTT would be considered therapeutic if it was 60 seconds. Prothrombin time assess response to warfarin therapy.

The nurse should report which finding to the HCP before initiating thrombolytic therapy in a client with pulmonary embolism? a. Adventitious breath sounds b. Temp of 99.4 c. BP of 198/110 c. RR of 28 breaths/minute

C. BP of 198/110 Thrombolytic therapy is contraindicated in severe uncontrolled hypertension because of the risk of cerebral hemorrhage. Adventitious breath sounds, temp of 99.4 and 28 breaths per minute might be present in the client with pulmonary embolism but are not signs that warrant reporting before the thrombolytic therapy is initiated.

A client is diagnosed with an ST segment elevation myocardial infarction (STEMI) and is receiving a tissue plasminogen activator, alteplase. Which action is a priority nursing action? a. Monitor for kidney failure b. Monitor psychosocial status c. Monitor for signs of bleeding d. Have heparin sodium available.

C. Monitor for signs of bleeding Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but not the most critical interventions. Heparin may be administered after thrombolytic therapy, but the question is not asking about follow-up medications. **BLEEDING is a PRIORITY for thrombolytic medications.

A client has a prescription for guaifenesin. The nurse determines that the client understands the proper administration of this medication if the client states that he or she will perform which action? a. Take an extra dose if fever develops b. Take the medication with meals only c. Take the tablet with a full glass of water d. Decrease the amount of daily fluid intake.

C. Take the tablet with a full glass of water. Guaifenesin is an expectorant and should be taken with a full glass of water to decrease the viscosity of secretions. Extra doses should not be taken, the client should contact the HCP if cough lasts longer than 1 week or is accompanied by a rash, fever, sore throat, persistent headache. Fluids are needed to decrease the viscosity of secretions. The medication does not have to be taken with meals.

A client is receiving thrombolytic therapy with a continuous infusion of alteplase suddenly becomes anxious and complains of itching. The nurse hears stridor and notes generalized urticaria and hypotension. Which nursing action is PRIORITY? a. Administer o2 and protamine sulfate b. Cut the infusion rate in half and sit the client up c. Stop infusion and call Rapid response team d. Administer diphenhydramine and epinephrine and continue infusion.

C. stop and call RRT Client is experiencing an anaphylactic reaction. Priority action is to stop the infusion and notify the RRT.

The nurse provides discharge instructions to a client who is taking warfarin sodium. Which statement, by the client, reflects the need for further teaching? a. I will avoid alcohol consumption b. I will take my pills everyday at the same time c. I have called my family to pick up a medic bracelet d. I will take coated aspirin for my headaches because it will coat my stomach.

D. I will take coated aspirin for my headaches because it will coat my stomach. Aspirin containing products must be avoided when a client is taking warfarin sodium. Alcohol consumption should be avoided. Taking the medication at the same time increases compliance. The MedicAlert bracelet provides HCP with emergency information.

A client is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply a. Hypoglycemia may be experienced before dinner time. b. The insulin dose should be decreased if illness occurs. c. The insulin should be administered at room temperature. d. The insulin vial needs to be shaken vigorously to break up the precipitates. e. The NPH insulin should be drawn into the syringe first, then the regular insulin.

a and c Humulin NPH is an intermediate-acting insulin. The onset of action is 60 - 120 minutes, it peaks in 6-14 hours and its duration of action is 16-24 hours. Regular insulin is short acting and the onset is 30-60 minutes, peak 1-5 hours, and duration is 6-10 hours. Hypoglycemic reactions most likely occur during peak time. Insulin should be at room temp. when administered. Clients may need their insulin dosages increased during times of illness. Insulin vials should NEVER be shaken vigorously. Regular insulin is ALWAYS drawn up before NPH.

The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? a. insomnia b. Weight loss c. bradycardia d. constipation e. mild heat intolerance.

a, b and e Insomnia, weight loss, and mild heat intolerance These are all side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication but are side effects of hypothyroidism.

Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. For which side and adverse effects of the medication should the nurse monitor? (Select all that apply) a. Signs of hepatitis b. Flulike syndrome c. low neutrophil count d. vitamin b6 deficiency. e. ocular pain or blurred vision f. tingling and numbness of the fingers

a, b, c, and e Rifabutin may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side and adverse effects include rash, GI disturbance, neutropenia (low neutrophil count) red-orange bodily secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flulike syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associted with the use of isoniazid.

The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide and metformin. The nurse should provide which instructions to the client? a. Diarrhea may occur secondary to the metformin. b. The repaglinide is not taken if a meal is skipped. c. The repaglinide is taken 30 minutes before eating d. A simple sugar food item is carried and used to treat mild hypoglycemia episodes. e. Muscle pain is an expected effect of metformin and may be treated with acetaminophen. f. Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide.

a, b, c, d Diarrhea may occur, repaglinide is not taken if meals skipped, it's taken 30 minutes before eating, and a simple sugar food item should be carried. Repaglinide, a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion, should be taken before meals (approx. 30 minutes) and should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide and the client should always be prepared by carrying a simple sugar. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect from metformin but it might signify a more serious condition that warrants a HCP notification, not the use of acetaminophen.

The nurse determines the client needs further instruction on cimetidine if which statements were made? a. I will take cimetidine with my meals. b. I'll know the medication is working if my diarrhea stops. c. My episodes of heartburn will decrease if the medication is effective. d. Taking cimetidine with an antacid will increase effectiveness e. I will notify my HCP if I become depressed/anxious f. Some of my blood levels will need to be monitored closely since I also take warfarin for atrial fibrillation.

a, b, d Cimetidine (histamine H2 receptor antagonist) alleviates symptoms of heartburn not diarrhea. It crosses the BBB so anxiety, depression, confusion can occur. Food reduces rate of absorption! Antacids decrease the absorption and need to be taken 1 hour apart! PT and INR must be monitored when taking warfarin and cimetidine.

A client with hyperthyroidism has been given methimazole. Which nursing considerations are associated with this medication? Select all that apply a. Administer methimazole with food b. Place the client on a low-calorie, low-protein diet c. Assess the client for unexplained bruising/bleeding d. Instruct the client to report side and adverse effects such as sore throat, fever, or headaches e. Use special radioactive precautions when handling the client's urine for the first 24 hours of initial administration.

a, c, and d Administer with food, assess for unexplained bruising/bleeding, and report side effects. Common side effects of methimazole include nausea, vomiting and diarrhea. To address these side effects, this medication should be taken with food. Because of the increase in metabolism that occurs with hyperthyroidism, the client should consume a high-calorie diet. Antithyroid medications can cause agranulocytosis with leukopenia and thrombocytopenia. Sore throat, fever, headache, and bleeding may indicate agranulocytosis and the HCP should be notified. Methimazole is not radioactive and should not be stopped abruptly.

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? a. Coffee, cola and chocolate b. Oyster, lobster, shrimp c. Melons, oranges, and pineapple d. Cottage cheese, cream cheese, and dairy creamer

a. Coffee, cola, and chocolate Theophylline is a methylxanthine bronchodilator. The nurse teaches the client ot limit the intake of xanthine-containing foods while taking this medication. These foods include coffee, cola, and chocolate.

The nurse is teaching the client about his prescribed prednisone. Which statement, if made by the client, indicates that further teaching is necessary? a. I can take aspirin or my antihistamine if i need it. b. I need to take the medication every day at the same time. c. I need to avoid coffee, tea, cola and chocolate in my diet. d. If I gain more than 5 pounds, a week, I will call my HCP

a. I can take my aspirin or antihistamine if I need it Aspirin and other over-the-counter medications should not be taken unless the client consults with the HCP. The needs to take the medication at the same time every day and should be instructed not to stop the medication, a slight weight gain as result of improved appetite is expected, but more than 5 pounds weekly should be reported. Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development.

A client with diabetes mellitus visits a health care clinic. The client's diabetes previous had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the client's regimen may have contributed to hyperglycemia? a. Prednisone b. Atenolol c. Phenelzine d. Allopurinol

a. Prednisone Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements.

The HCP prescribes exantide for a client with type 1 diabetes mellitus who takes insulin. The nurse should plan to take which most appropriate action? a. Withhold the medication and call the HCP, questioning the prescription for the client b. Administer the medication within 60 minutes before the morning and evening meal c. Monitor the client for GI side effects after administering the medication. d. Withdraw the insulin from the prefilled pen into an insulin syringe to prepare for administration.

a. Withhold the medication and call the HCP, questioning prescription for the client. Exantide is an incretin mimetic used for type 2 diabetes ONLY. It is not recommended for clients taking insulin. Hence, the nurse should withhold the medication and question the HCP. b and c are correct statements about the medication and the medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.

The nurse teaches the client who is newly diagnosed with diabetes insipidus, about the prescribed intranasal desmopressin. Which statements by the client indicate understanding? a. This medication will turn my urine orange. b. I should decrease my oral fluids when I start this medication. c. The amount of urine I make should increase if this medicine is working d. I need to follow a low-fat diet to avoid pancreatitis when taking this medication e. I should report headache and drowsiness to my health care provider since these symptoms could be related to my desmopressin.

b and e In diabetes insipidus, there is a deficiency in anti-diuretic hormone (ADH) resulting in large urinary losses. Desmopressin is an analog of ADH. Clients with diabetes insipidus drink high volumes of fluid (polydipsia) as a compensatory mechanism to counteract urinary losses and maintain fluid balance. Once desmopressin is started, oral fluids should be decreased to prevent water intoxication. Therefore, clients with diabetes insipidus should decrease their oral fluid intake when they start desmopressin. Headache and drowsiness are signs of water intoxication in the client taking this medication and should be reported to the HCP. It does not turn urine orange. The amount of urine should decrease not increase. It does not cause pancreatitis.

Glimepiride is prescribed for a client with diabetes mellitus. The nurse instructs the client that which food items are most acceptable to consume while taking this medication? a. Alcohol b. Red meats c. Whole-grain cereals d. Low-calorie desserts e. Carbonated beverages.

b, c, and e Red meats, whole-grain cereals and carbonated beverages. When alcohol is combined with glimepiride a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. Avoid low-calorie desserts, carbs and sugar are still probably high.

A patient with Crohn's disease is scheduled to receive an infusion of infliximab. What intervention by the nurse will determine the effectiveness of treatment? a. Monitoring leukocyte count for 2 days after the infusion b. Checking the frequency and consistency of bowel movements. c. Checking serum liver enzyme levels before and after the infusion. d. Carrying out a Hematest on gastric fluids after the infusion is completed.

b. Checking the frequency and consistency of bowel movements. Principle manifestations of Crohn's disease are diarrhea and abdominal pain. Infliximab is an immunomodulator that reduces the degree of inflammation in the colon, reducing diarrhea.

A client with a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hour and the warfarin sodium 7.5 mg at 5:00 pm daily. The morning lab results are as follows: aPTT 32 seconds, INR 1.3. The nurse should take which action based on the lab results? a. Collaborate with HCP to discontinue heparin and still administer warfarin b. Collaborate with the HCP to increase the heparin and administer warfarin as prescribed c. Collaborate with the HCP to withhold the warfarin since the client is receiving heparin infusion and the aPTT is within the therapeutic range d. Collaborate with the HCP to continue the heparin infusion at the same rate and discuss a replacement for warfarin.

b. Collaborate with the HCP to increase the heparin and administer the warfarin as prescribed. When a patient is receiving warfarin for clot prevention due to atrial fibrillation, an INR of 2-3 is appropriate for most clients. Until the INR has achieved a therapeutic range, the patient should be maintained on a continuous heparin infusion with the aPTT ranging between 60 and 80 seconds. The nurse should collaborate with the HCP to obtain a prescription to increase the heparin and administer warfarin as prescribed.

The nurse is providing discharge teaching for a client newly diagnosed with type 2 diabetes mellitus who has been prescribed metformin. Which client statement indicates the need for further teaching? a. It is okay if I skip meals now and then b. I need to constantly watch for signs of low blood sugar. c. I need to let my health care provider know if I get unusually tired. d. I will be sure to not drink alcohol excessively while on this medication.

b. I need to constantly watch for signs of low blood sugar. Metformin is classified as a biguanide and is the most commonly used medication for type 2 diabetes mellitus initially. It is also often used as a preventative medication for those at high risk for developing diabetes mellitus. When used alone, metformin lowers the blood sugar after meal intake as well as fasting blood glucose levels. Metformin does not stimulate insulin release and therefore poses little risk for hypoglycemia. For this reason, metformin is well suited for clients who skip meals. Unusual somnolence, as well as hyperventilation, myalgia, and malaise are early signs of lactic acidosis, a toxic effect associated with metformin. If any of these signs or symptoms occur, the client should inform the health care provider immediately. While it is best to avoid consumption of alcohol, it is not always realistic or feasible for clients to quit drinking altogether. For this reason, clients should be informed that excessive alcohol intake can cause an adverse reaction with metformin.

A client has been taking isoniazid for 2 months. The client complains to the nurse about numbness, paresthesias, tingling, in the extremities. The nurse interprets that the client is experiencing which problem? a. Hypercalcemia b. Peripheral neuritis c. Small blood vessel spasm d. Impaired peripheral circulation

b. Peripheral neuritis Isoniazid is an anti-tubercular medication. A common side effect is peripheral neuritis, manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized by pyridoxine (Vitamin B6) intake.

IV heparin therapy is prescribed fro a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit? a. Vitamin K b. Protamine Sulfate c. Potassium Chloride d. Aminocaproic Acid

b. Protamine Sulfate Antidote to heparin is Protamine sulfate. Vitamin K is antitode for warfarin, Aminocaproic acid is the antidote for thrombolytic therapy.

The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action? a. Freeze the insulin b. Refrigerate the insulin c. Store the insulin in a dark, dry place d. Keep the insulin at room temperature.

b. Refrigerate the insulin Insulin in unopened vials should be stored under refrigeration until needed. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial.

The client who uses NSAIDS has been taking misoprostol. The nurse determines that the misoprostol is having the intended therapeutic effect if which finding is noted? a. Resolved diarrhea b. Relief of epigastric pain c. Decreased platelet count d. Decreased WBC

b. Relief of epigastric pain The client who uses NSAIDS is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence in clients taking NSAIDS.

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? a. Use alcohol in small amounts only b. Report yellow eyes or skin immediately. c. Increase intake of swiss or aged cheeses. d. Avoid vitamin supplements during therapy

b. Report yellow eyes or skin immediately Isoniazid is hepatotoxic, and the client should be taught to report signs and symptoms of hepatitis immediately, which include yellow skin and sclera. For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish, tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching, flushing, sweating, tachycardia, headache or lightheadedness. The client can avoid developing peripheral neuritis by increasing intake of B6 during the course of therapy.

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

b. Salmeterol first and then the beclomethasone. Salmeterol is an adrenergic type of bronchodilator and beclamtheasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are given at the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

The nurse is providing instructions to the client newly diagnosed with diabetes mellitus who has been prescribed pramlintide. Which instruction should the nurse include in the discharge teaching? a. Inject the pramlintide at the same time you take your other medications b. Take your prescribed pills 1 hour before or 2 hours after the injection c. Be sure to take the pramlintide with food so you don't upset your stomach d. Make sure you take your pramlintide immediately after you eat so you don't experience a low blood sugar.

b. Take your prescribed pills 1 hour before or 2 hours after the injection Pramlintide is used for clients with types 1 and 2 diabetes who use insulin. It is administered subQ before meals to lower blood glucose levels after meals, leading to less fluctuation during the day and better long-term glucose control. Because pramlintide delays gastric emptying, oral medications should be given 1 hour before or 2 hours after an injection of pramlintide; therefore instructing to take his or her pills before or after is correct. Pramlintide should not be taken at the same time as other meds. It is given before to control postprandial rise in blood glucose.

The nurse is monitoring a client who is taking propranolol. Which assessment finding indicates potential adverse complication associated with this medication? a. The development of complaints of insomnia b. The development of audible expiratory wheezes. c. A baseline BP of 150/80 then a BP of 138/72 after 2 doses of the medication d. A baseline resting HR of 88 bpm followed by a resting HR of 72 BPM.

b. The development of audible expiratory wheezes Audible wheezes may indicate a serious adverse reaction, bronchospasm. Beta blockers may induces this reaction, especially in patients with chronic obstructive pulmonary disease or asthma. Normal decreases in BP and HR are expected. Insomnia is a frequent mild side effect and should be monitored.

A client being treated for heart failure is administered IV bumetanide. Which outcome indicates that the medication has achieved the expected effect? a. Cough becomes productive of frothy pink sputum. b. Urine output increases from 10 - 50 mL/hr c. The serum potassium goes from 3.8-3.1 d. B-type natriuretic peptide (BNP) goes from 200-262

b. The urine output increases from 10 to 50 mL/hr Bumetanide is a diuretic and expected outcomes include increased urine output, decreased crackles, and decreased weight.

The nurse should tell the client, who is taking levothyroxine to notify the HCP if which problem occurs? a. Fatigue b. Tremors c. Cold intolerance d. Excessively dry skin

b. Tremors Excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, and sweating.

A client has an as needed prescription for loperamide hydrochloride. For which condition should the nurse administer this medication? a. Constipation b. Abdominal pain c. An episode of Diarrhea d. Hematest-positive nasogastric tube drainage.

c. An episode of diarrhea. Loperamide is an antidiarrheal agent. It is used to manage acute and chronic diarrhea in conditions such as IBS.

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

c. Causes orange discoloration of sweat, tears, urine, and feces. Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses. Rifampin should be taken exactly as prescribed without missing doses or doubling doses. The client should not stop therapy until directed to do so by a HCP. It is best to take medication on an empty stomach unless it causes GI upset, and it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour prior to this medication.

An older client recently has been taking cimetidine. The nurse monitors the client for which most frequent CNS side effect of this medication? a. tremors b. dizziness. c. confusion d. hallucinations

c. Confusion Cimetidine is a histamine H2 receptor antagonist. Older clients are especially susceptible to CNS side effects of this med, most frequent is confusion.

The nurse is planning to administer hydrochlorothiazide to a client. The nurse should monitor for which adverse effects related to the administration of this medication? a. Hypouricemia, hyperkalmeia b. increased risk of osteoporosis c. Hypokalemia, Hyperglycemia, sulfa allergy d. Hyperkalemia, hypoglycemia, penicillin allergy.

c. Hypokalemia, hyperglycemia and sulfa allergy Thiazide diuretics such as hydroclorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia. -Thiazide diuretics carry a sulfa ring.

A client with tuberculosis is being started on anti-tuberculosis therapy with isoniazid. Before giving the client the first dose, the nurse should ensure that which baseline study has been completed? a. Electrolyte levels b. Coagulation times c. Liver enzyme levels d. Serum creatinine levels

c. Liver enzyme levels. Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years and abuses alcohol.

Zafirlukast is prescribed for a client with bronchial asthma. Which lab test does the nurse expect to be prescribed before the administration of this medication? a. Platelet count b. Neutrophil Count c. Liver function tests. d. Complete blood count

c. Liver function tests Zafirlukast is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Zafirlukast is used with caution in clients with impaired hepatic function. Liver function lab tests should be performed to obtain a baseline and the leves should be monitored during administration of the medication. It is not necessary to perform the other lab tests before administration of this medication.

A client has begun medication therapy with pancrelipase. The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed? a. Weight loss b. Relief of heartburn c. Reduction of steatorrhea d. Absence of abdominal pain

c. Reduction of steatorrhea Pancrelipase is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain/heartburn. It could result in weight gain not weight loss.

A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the meds (clarithromycin, esomeprazole, amoxicillin). Which statement by the client indicates the best understanding? a. My ulcer will heal because these medications kill the bacteria. b. These medications are only taken when I have pain from my ulcer c. The medications will kill the bacteria and stop acid production. d. These medications will coat the ulcer and decrease acid production in my stomach.

c. The medications will kill the bacteria and stop acid production Triple therapy for H. Pylori infection usually includes 2 antibacterials and a proton pump inhibitor. These medications kill the bacteria and stop acid production.

The nurse has given instructions to someone prescribed cholestyramine. Which statement by the client indicates a need for FURTHER teaching? a. I will continue taking vitamin supplements b. This medication will help to lower my cholesterol. c. This medication should only be taken with water. d. A high-fiber diet is important while taking this medication.

c. This medication should only be taken with water Cholestyramine is a bile acid sequestrant used to lower cholesterol levels and the client complience is a problem because of its taste and palatability. Using fruit juice can improve taste.

A client who is receiving digoxin daily has a serum potassium level of 3 mEq/L and is complaining of anorexia. The health care provider prescribes a serum digoxin level to be done. the nurse checks the results and should expect to note which level that is outside the therapeutic range? a. 0.3 ng/mL b. 0.5 ng/mL c. 0.8 ng/mL d.1.0 ng/mL

d. 1.0 ng/mL The optimal therapeutic range for digoxin is 0.5- 0.8 ng/mL. If the client is experiencing symptoms such as anorexia and is experiencing hypokalemia as evidenced by a low potassium level, digoxin toxicity is a concern. Therefore, option d. is correct because it is outside the therapeutic range. EARLY SIGNS OF DIGOXIN TOXICITY present as gastrointestinal manifestations (anorexia, nausea, vomiting, diarrhea) THEN heart rate abnormalities and visual disturbances appear.

A client is being treated with procainamide for cardiac dysrhythmia. Follwing IV administration of the med, the client complains of dizziness. What intervention should the nurse take FIRST? a. Measure the HR on the rhythm strip b. Administer prescribed nitroglycerin tablets. c. Obtain a 12-lead EKG immediately d. Auscultate the client's apical pulse and obtain a blood pressure.

d. Auscultate the client's apical puslse and BP Signs of toxicity from procainamide include confusion, dizziness, drowsiness, decreased urination, nausea, vomitting, and tachydsrhythymias. If the client complains of dizziness, the nurse should assess the vital signs first. Although measuring the heart rate on the strip and a EKG are interventions, these would be done after vital signs. Nitroglycerin is a vasodilator and would lower the BP.

A cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the adverse effects of this medication and should tell the client that which undesirable effect is associated with this medication? a. Insomnia b. Constipation c. Hypotension d. Bronchospasm

d. Bronchospasm Cromolyn sodium is an inhaled non-steroidal anti-allergy agent and a mast cell stabilizer. Undesirable effects associated with inhalation therapy of cromolyn sodium are bronchospasm, cough, nasal congestion, throat irritation, and wheezing. Clients receiving this medication orally may experience pruritus, nausea, diarrhea, and myalgia.

The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states that he or she will immediately report which findings? a. Impaired sense of hearing b. Gastrointestinal side effects c. Orange-red discoloration of body secretions d. Difficulty in discriminating red from green color.

d. Difficulty discriminating red from green color Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is also taught to take the medication with food if GI upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with Rifampin.

The home health care nurse is visiting a client with elevated triglyceride levels and a cholesterol level of 398 mg/dL. The client is taking cholestyramine and the nurse teaches the client about the med. Which statement made by the client indicates the need for further teaching? a. Constipation and bloating might be a problem b. I'll continue to watch my diet and reduce my fats c. Walking a mile each day will help the whole process d. I'll continue my nicotinic acid from the health food store.

d. I will continue my nicotinic acid from the health food store. Nicotinic acid, even the over-the-counter form should be avoided because it may lead to liver abnormalities. All lipid-lowering meds can also cause liver abnormalities so a combination needs to be avoided. Constipation, bloating are 2 COMMON side effects. Walking and reducing fats are therapeutic measures to control cholesterol.

A client is prescribed 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? a. It is not necessary to avoid the use of alcohol b. The medication should be taken with meals to decrease flushing c. Clay-colored stools are a common side effect and not a concern d .Ibuprofen IB taken 30 minutes before the nicotinic acid should decrease the flushing.

d. Ibuprofen IB taken 30 minutes before the nicotinic acid should decrease the flushing. Flushing is an adverse side effect, avoid alcohol consumption (increases flushing). Medication should be taken with meals to decrease GI upset. Clay colored stools are a sign of hepatic dysfunction and should be reported!

Prior to administering the daily dose of digoxin, the nurse notes the lab data: calcium 9.8, mag, 1.0, potassium, 4.1, creatinine, 0.9. Which result should alert the nurse that the client is at risk for dig toxicitiy? a. calcium b. potassium c. creatinine d. magnesium

d. Magnesium An increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function.

The nurse has just administered the first dose of omalizumab to a client. Which statement by the client would alert the nurse that the client may be experiencing a life-threatening effect? a. I have a severe headache b. My feet are quite swollen c. I am nauseated and may vomit d. My lips and tongue are swollen.

d. My lips and tongue are swollen. Omalizumab is an antiinflammatory used for longterm control of asthma. Anaphylactic reactions can occur with the administration of omalizumab. The nurse administering this medication should monitor for adverse reactions of the medication, swelling of the lips and tongue are an indication of an anaphylaxis.

A patient has an as needed prescription for ondansetron. For which condition should the nurse administer this medication? a. Paralytic ileus b. Incisional pain c. Urinary Retention d. Nausea and vomiting

d. Nausea and vomiting Ondansetron is an antiemetic used to treat postoperative nausea and vomiting as well as nausea and vomiting associated with chemo.

A client with a gastric ulcer has a prescription for sucralfate 1 gram by mouth 4 times daily. The nurse should schedule the medication for which times? a. With meals and at bedtime b. Every 6 hours around the clock c. One hour after meals and at bedtime d. One hour before meals and at bedtime

d. One hour before meals and at bedtime Sucralfate is a gastric protectant. The med should be scheduled for administration 1 hour before meals and at bedtime and it's timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation.

A client with a new prescription for metoclopramide. On review of the chart the nurse identifies that this medication can be safely administered with which condition? a. Intestinal obstruction b. Peptic ulcer with melena c. Diverticulitis with perforation d. Vomiting following cancer therapy.

d. Vomiting following chemo Metoclopramide is a GI stimulant and antiemetic. It is contraindicated in GI obstruction, hemorrhage, perforation.