pharm nclex 3
A client with myasthenia gravis is being discharged on pyridostigmine bromide (Mestinon). The nurse provides the client with medication instructions and makes which statement to the client? 1. "Take the medication on an empty stomach." 2. "Take the medication before activities such as eating." 3. "Tonic water with quinine and the use of antacids improve the effect of the medication." 4. "It is not important when you take the medication, as long as you take exact amount prescribed."
2. "Take the medication before activities such as eating." Rationale: Pyridostigmine bromide is an anticholinesterase that is used to improve muscle strength in the client with myasthenia gravis. Taking the medication before activities such as eating helps lessen fatigue and dysphagia and improves muscle strength. The medication should be taken with food. Clients should avoid quinine, antacids, magnesium, and morphine sulfate and its derivatives, because these medications can reverse the action of the pyridostigmine bromide and increase weakness. The medication should be taken regularly and on time to prevent fluctuating blood levels, which can cause weakness.
Nalidixic acid (NegGram) is prescribed for the client with a urinary tract infection. Reviewing the client's record, the nurse notes that the client is taking warfarin (Coumadin) on a daily basis. Which of the following prescriptions would the nurse anticipate because the client is taking this oral anticoagulant? 1. An increase in the anticoagulation dosage 2. A reduction in the anticoagulation dosage 3. The need to discontinue the warfarin during therapy 4. The need to administer an alternative medication to treat the urinary tract infection
2. A reduction in the anticoagulation dosage Rationale: Nalidixic acid can intensify the effects of oral anticoagulants. When an oral anticoagulant is combined with nalidixic acid, a reduction in the anticoagulant dosage may be needed.
The client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept (Enbrel), it is most important for the nurse to assess: 1. The injection site for itching and edema 2. The white blood cell counts and platelet counts 3. Whether the client is experiencing fatigue and joint pain 4. A metallic taste in the mouth and a loss of appetite
2. The white blood cell counts and platelet counts Rationale: Infection and pancytopenia are adverse effects of etanercept (Enbrel). Laboratory studies are performed before and during treatment. The appearance of abnormal white blood cell counts and abnormal platelet counts can alert the nurse to a potential life-threatening infection. Injection site itching is a common occurrence following administration of the medication. In early treatment, residual fatigue and joint pain may still be apparent. A metallic taste and loss of appetite are not common signs of side effects of this medication.
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 Rationale: Corticosteroids (glucocorticoids) should be administered before 9:00 AM. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning. The other answer options are incorrect.
A nurse is providing instructions to a client taking ethambutol (Myambutol) about the medication. The nurse instructs the client to contact the health care provider immediately if which of the following occurs? 1. Distressing gastrointestinal (GI) side effects 2. Hearing disturbances 3. Orange urine 4. Visual disturbances
4. Visual disturbances Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a safety hazard when driving a motor vehicle. The client is taught to report this symptom immediately. 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 (Rifadin).
Letrozole (Femara) is prescribed for a postmenopausal client with advanced breast cancer. The nurse provides instructions to the client regarding the medication and tells the client that a frequent side effect is: 1. Skeletal pain 2. Weakness 3. Diarrhea 4. Nervousness
1. Skeletal pain Rationale: Letrozole is an aromatase inhibitor used to treat advanced breast cancer in postmenopausal women whose disease progressed after antiestrogen therapy. The most frequent side effects include skeletal, back, arm, and leg pain. Less frequent side effects include nausea, headache, fatigue, constipation, vomiting, and dyspnea.
A urinary analgesic is prescribed for a client with a urinary tract infection. The nurse tells the client that it is best to take the medication: 1. With meals 2. At bedtime 3. One hour before meals 4. In the morning before breakfast
1. With meals Rationale: A urinary antiseptic is administered with meals to decrease gastrointestinal side effects. Options 2, 3, and 4 are incorrect.
A registered nurse has administered a dose of naloxone intravenously to a client with intravenous opioid overdose. The licensed practical nurse assigned to assist in monitoring the client ensures that which of the following equipment is available in the immediate vicinity of the client? 1. Central line insertion kit 2. Resuscitation equipment 3. Nasogastric tube 4. Thoracentesis tray
2. Resuscitation equipment Rationale: Naloxone is used to treat respiratory depression. The client who receives naloxone for suspected opioid overdose should have resuscitation equipment readily available to support naloxone therapy if it is needed. Other items that may be needed include oxygen, a mechanical ventilator, and medications such as vasopressors.
A nurse is providing instructions to the spouse of a client who is taking tacrine (Cognex) for the management of moderate dementia associated with Alzheimer's disease. The nurse should tell the spouse which of the following? 1. If flulike symptoms occur, it is necessary to notify the health care provider immediately. 2. If a dose is missed, double up on the next dose. 3. If a change in the color of the stools occurs, notify the health care provider. 4. Do not administer food with the medication.
3. If a change in the color of the stools occurs, notify the health care provider. Rationale: Tacrine may be administered between meals on an empty stomach, and if gastrointestinal upset occurs, it may be administered with meals. Flulike symptoms without fever and gastrointestinal symptoms are frequent side effects of the medication. The client or spouse should never be instructed to double the dose of any medication if it was missed, and the client and caregiver are instructed to notify the health care provider if nausea, vomiting, diarrhea, rash, jaundice, or changes in the color of the stool occur. This may be indicative of hepatitis.
A nurse reinforces instructions to a client who is taking levothyroxine (Synthroid). The nurse tells the client to take the medication: 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack
3. On an empty stomach Rationale: Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast. Therefore options 1, 2, and 4 are incorrect times of administration.
A client with trigeminal neuralgia tells the nurse that acetaminophen (Tylenol) is taken on a frequent daily basis for relief of generalized discomfort. The nurse reviews the client's laboratory results and determines that which of the following indicates toxicity associated with the medication? 1. Sodium of 140 mEq/L 2. Prothrombin time of 12 seconds 3. Platelet count of 400,000 cells/mm3 4. A direct bilirubin level of 2 mg/dL
4. A direct bilirubin level of 2 mg/dL Rationale: In adults, overdose of acetaminophen (Tylenol) causes liver damage. Option 4 is an indicator of liver function and is the only option that indicates an abnormal laboratory value. The normal direct bilirubin is 0 to 0.4 mg/dL. The normal platelet count is 150,000 to 400,000 cells/mm3. The normal prothrombin time is 10 to 13 seconds. The normal sodium level is 135 to 145 mEq/L.
The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied: 1. Immediately before swimming 2. 15 minutes before exposure to the sun 3. Immediately before exposure to the sun 4. At least 30 minutes before exposure to the sun
4. At least 30 minutes before exposure to the sun Rationale: Sunscreens are most effective when applied at least 30 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming or sweating.
A nurse is collecting medication information from a client, and the client states that she is taking garlic as an herbal supplement. The nurse understands that the client is most likely treating which of the following conditions? 1. Eczema 2. Insomnia 3. Migraines 4. Hyperlipidemia
4. Hyperlipidemia Rationale: Garlic is an herbal supplement that is used to treat hyperlipidemia and hypertension. An herbal supplement that may be used to treat eczema is evening primrose. Insomnia has been treated with both valerian root and chamomile. Migraines have been treated with feverfew.
A client taking phenytoin (Dilantin) has a serum phenytoin level of 30 mcg/mL. The nurse would expect to note which signs and symptoms on data collection of the client? Select all that apply. 1. Ataxia 2. Nausea 3. Tinnitus 4. Diplopia 5. Nystagmus 6. Hyperactive reflexes
1. Ataxia 2. Nausea 4. Diplopia 5. Nystagmus Rationale: The therapeutic serum range of phenytoin should be 10 to 20 mcg/mL. A level of 30 mcg/mL indicates toxicity. Central nervous system (CNS) depression, lethargy, ataxia, and nausea are all signs of phenytoin toxicity. Nystagmus and diplopia also occur. Phenytoin toxicity depresses the CNS, thus hyperactive reflexes would not be present. Tinnitus is not associated with phenytoin toxicity; rather, it is associated with acetylsalicylic acid (aspirin) toxicity.
A nurse is caring for a client who has been taking diuretics on a long-term basis. The nurse reviews the medication record, knowing that which of the following medications, if prescribed for this client, would place the client at risk for hypokalemia? 1. Bumetanide 2. Spironolactone (Aldactone) 3. Triamterene (Dyrenium) 4. Amiloride hydrochloride (Midamor)
1. Bumetanide Rationale: Bumetanide is a potassium-losing loop diuretic. The client on this medication would be at risk for hypokalemia. Spironolactone, triamterene, and amiloride hydrochloride are potassium-sparing diuretics.
The nurse is caring for a female client receiving chemotherapy and notes that the client has developed myelosuppression. Which of the following laboratory values would support the client's diagnosis of myelosuppression? 1. Hemoglobin 9.4 g/dL, hematocrit 26% 2. Blood urea nitrogen (BUN) 15 mg/dL, creatinine 0.9 mg/dL 3. Protein 7 g/dL 4. Magnesium 1.8 mg/dL
1. Hemoglobin 9.4 g/dL, hematocrit 26% Rationale: The client has been diagnosed with myelosuppression, which is bone marrow depression. The correct option is the hemoglobin and hematocrit, which is decreased. Hemoglobin is the main component of erythrocytes. Hematocrit represents red blood cell mass and is an important measurement in the identification of blood abnormalities. BUN and creatinine address renal function. Protein levels address the amount of albumin in serum. These other laboratory values are within normal range.
A client who is prescribed metronidazole (Flagyl) calls the clinic nurse to report dark discoloration of the urine. The nurse interprets that the client's report warrants which nursing action at this time? 1. Instruct the client to increase oral fluid intake. 2. Inform the client that this is a common side effect. 3. Arrange for the client to speak with the health care provider. 4. Advise the client to immediately discontinue the medication.
1. Instruct the client to increase oral fluid intake. Rationale: Metronidazole can produce a variety of untoward effects, but they rarely require termination of treatment. Harmless darkening of the urine may occur, and the client should be told of this effect. It is not necessary to discontinue the medication or call the health care provider. Increasing fluid intake is a good health measure but will not prevent this side effect from occurring.
A licensed practical nurse (LPN) is assisting in the care of a pregnant teenaged client with preeclampsia receiving magnesium sulfate. The LPN plans to notify the registered nurse immediately if which sign of magnesium toxicity is noted? 1. Respiratory rate of 10 breaths per minute 2. Serum magnesium level of 5 mEq/L 3. Proteinuria 4. Hyperactive deep tendon reflexes
1. Respiratory rate of 10 breaths per minute Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of magnesium toxicity relate to central nervous system (CNS) depression and include respiratory depression, loss of deep tendon reflexes, sudden drop in fetal heart rate, and/or maternal heart rate and blood pressure. Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can develop very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L.
A nurse is assigned to care for a client with metastatic breast cancer who is taking tamoxifen citrate. The nurse monitors for which of the following trends in laboratory values that could indicate an adverse effect? 1. Rising serum calcium level 2. Prolonged bleeding time 3. Decreasing sodium level 4. Increasing blood glucose level
1. Rising serum calcium level Rationale: Tamoxifen citrate may increase calcium, cholesterol, and triglyceride levels. Before therapy is initiated, blood should be drawn for a complete blood count, platelet count, cholesterol and triglyceride level, and serum calcium level. These blood levels should continue to be monitored periodically during therapy. The nurse should monitor for signs of hypercalcemia while the client is taking this medication, which include increased urine volume, excessive thirst, nausea, vomiting, constipation, decreased muscle tone, and deep bone or flank pain. Options 2, 3, and 4 are not associated specifically with this medication.
A licensed practical nurse (LPN) is told that baclofen (Lioresal) is prescribed for an assigned client. The LPN questions the registered nurse about the health care provider's prescription if which of the following conditions is noted on the client problem list? 1. Seizure disorder 2. Hyperthyroidism 3. Coronary artery disease 4. Diabetes mellitus
1. Seizure disorder Rationale: Baclofen is a skeletal muscle relaxant. Clients with seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsant medication. The conditions noted in options 2, 3, or 4 are not contraindications or concerns for the client receiving baclofen.
A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which information should the nurse teach when carrying out plans for discharge? Keep insulin vials refrigerated at all times. 2. Rotate the insulin injection sites systematically. 3. Increase the amount of insulin before unusual exercise. 4. Monitor the urine acetone level to determine the insulin dosage.
2. Rotate the insulin injection sites systematically. Rationale: Insulin dosages should not be adjusted or increased before unusual exercise. If acetone is found in the urine, it may possibly indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, the insulin should be administered at room temperature. Injection sites should be systematically rotated from one area to another. The client should be instructed to give injections in one area, about 1 inch apart, until the whole area has been used and then to change to another site. This prevents dramatic changes in daily insulin absorption.
A client has been given a prescription for metoclopramide (Reglan) four times a day. The nurse determines that the client is taking the medication at optimal times if the client reports using the medication: 1. One hour after each meal and at bedtime 2. Every 6 hours spaced evenly around the clock 3. 30 minutes before meals and at bedtime 4. With each meal and at bedtime
3. 30 minutes before meals and at bedtime Rationale: Metoclopramide is a gastrointestinal stimulant. The client should be taught to take this medication 30 minutes before meals and at bedtime. Therefore the other options are incorrect.
The client has a PRN prescription for loperamide hydrochloride (Imodium). The nurse understands that this medication is used for which condition? 1. Constipation 2. Abdominal pain 3. An episode of diarrhea 4. Hematest-positive nasogastric tube drainage
3. An episode of diarrhea Rationale: Loperamide is an antidiarrheal agent. It is used to manage acute and also chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy. It is not used for the conditions in options 1, 2, and 4.
The nurse is reviewing the results of serum laboratory studies drawn on a client with acquired immunodeficiency syndrome who is receiving didanosine (Videx). The nurse interprets that the client may have the medication discontinued by the health care provider if which of the following significantly elevated results is noted? 1. Serum protein 2. Blood glucose 3. Serum amylase 4. Serum creatinine
3. Serum amylase Rationale: Didanosine (Videx) can cause pancreatitis. A serum amylase level that is increased 1.5 to 2 times normal may signify pancreatitis in the client with acquired immunodeficiency syndrome and is potentially fatal. The medication may have to be discontinued. The medication is also hepatotoxic and can result in liver failure.
A nurse is teaching a client with essential hypertension about medication therapy with irbesartan (Avapro). Which client statement would indicate a need for further teaching? 1. "I will take the medication each morning." 2. "I should stop smoking and drinking caffeine." 3. "I will monitor my blood pressure frequently." 4. "The medication reduces my need for exercise."
4. "The medication reduces my need for exercise." Rationale: The medication irbesartan is an antihypertensive, and with any antihypertensive, the client must maintain a healthy lifestyle, which includes dietary modifications and exercise. Antihypertensives should be taken in the morning. Smoking and consuming caffeine must be avoided. The client should be taught how to monitor his own blood pressure.
A client is scheduled for subtotal thyroidectomy. Potassium iodide (Lugol solution) is prescribed. The nurse understands that the therapeutic effect of this medication is to: 1. Replace thyroid hormone. 2. Prevent the oxidation of iodide. 3. Increase thyroid hormone production. 4. Suppress thyroid hormone production.
4. Suppress thyroid hormone production. Rationale: Lugol solution is administered to hyperthyroid individuals in preparation for thyroidectomy to suppress thyroid function. Initial effects develop within 24 hours; peak effects develop in 10 to 15 days. Options 1, 2, and 3 are incorrect.
A nurse provides instructions to a client who has been prescribed betaxolol (Betoptic) eye drops for the treatment of glaucoma. The nurse instructs the client regarding the administration of the medication and about the importance of returning to the clinic for monitoring of the: 1. Temperature 2. Blood pressure and apical pulse 3. Pupil dilation 4. Presence of Trousseau's sign
2. Blood pressure and apical pulse Rationale: Betaxolol is an antiglaucoma medication and a β-adrenergic blocker. Hypotension manifested as dizziness, nausea, diaphoresis, headache, fatigue, constipation, and diarrhea are systemic effects of the medication. Nursing interventions include monitoring the blood pressure for hypotension and assessing the pulse for strength, weakness, irregular rate, and bradycardia. For the client taking this medication, the nurse also monitors bowel activity and monitors for the evidence of congestive heart failure (CHF) as manifested by dizziness, night cough, peripheral edema, and distended neck veins. Monitoring intake and output and for an increase in weight and a decrease in urine output may also be indicative of CHF. Pupil dilation and monitoring temperature are unrelated to the use of this medication. A positive Trousseau's sign indicates a calcium imbalance.
A client who has begun taking fosinopril (Monopril) is very distressed, telling the nurse that he cannot taste food normally since beginning the medication 2 weeks ago. The nurse provides the best support to the client by: 1. Telling the client not to take the medication with food 2. Suggesting that the client taper the dose until taste returns to normal 3. Informing the client that impaired taste is expected and generally disappears in 2 to 3 months 4. Requesting that the health care provider (HCP) change the prescription to another brand of angiotensin-converting enzyme (ACE) inhibitor
3. Informing the client that impaired taste is expected and generally disappears in 2 to 3 months Rationale: ACE inhibitors, such as fosinopril, cause temporary impairment of taste (dysgeusia). The nurse can tell the client that this effect usually disappears in 2 to 3 months, even with continued therapy, and provide nutritional counseling if appropriate to avoid weight loss. Options 1, 2, and 4 are inappropriate actions. Taking this medication with or without food does not affect absorption and action. The dosage should never be tapered without HCP approval and the medication should never be stopped abruptly.
A nurse is caring for a hospitalized client who has been taking clozapine (Clozaril) for the treatment of a schizophrenic disorder. Which laboratory study prescribed for the client will the nurse specifically review to monitor for an adverse effect associated with the use of this medication? 1. Platelet count 2. Cholesterol level 3. White blood cell count 4. Blood urea nitrogen level
3. White blood cell count Rationale: Hematological reactions can occur in the client taking clozapine and include agranulocytosis and mild leukopenia. The white blood cell count should be checked before initiating treatment and should be monitored closely during the use of this medication. The client should also be monitored for signs indicating agranulocytosis, which may include sore throat, malaise, and fever. Options 1, 2, and 4 are unrelated to this medication.
A nurse is providing medication instruction to a client who has been prescribed simvastatin (Zocor). The nurse explains the action of the medication to the client based on the fact that simvastatin: 1. Inhibits hepatic synthesis of cholesterol 2. Increases lipid metabolism of cholesterol 3. Sequesters fat in the colon promoting fecal excretion of cholesterol 4. Increases glomerular filtration promoting renal excretion of cholesterol
1. Inhibits hepatic synthesis of cholesterol Rationale: The process of cholesterol reduction begins with inhibition of hepatic HMG-CoA reductase, the rate-limiting enzyme in cholesterol biosynthesis. In response to decreased cholesterol production, hepatocytes synthesize more HMG-CoA reductase. As a result, cholesterol synthesis is restored. However, for reasons that are not fully understood, inhibition of cholesterol synthesis causes hepatocytes to synthesize more low-density lipoproteins (LDL) receptors. Therefore options 2, 3, and 4 are incorrect.
