PHARMACOLOGY _2

20 of 24 A nurse is preparing to administer that hepatitis B vaccine to an adult who has not previously received it. When reviewing the clients history, the nurse should identify an anaphylactic reaction to which of the following foods as a contraindication for receiving this vaccine? A. Eggs B. Yeast C. Neomycin D. Gelatin

An anaphylactic reaction to eggs is a contraindication for receiving the influenza vaccine, not the hepatitis B vaccine ✓Correct An anaphylactic reaction to baker's yeast is a contraindication for receiving the hepatitis B vaccine An anaphylactic reaction to neomycin requires cation when administering the measles, mumps, and rubella vaccine and is a contraindication for receiving the varicella vaccine, not the hepatitis B vaccine An anaphylactic reaction to gelatin requires caution when administering the measles, mumps, and rubella vaccine and is a contraindication for receiving the varicella vaccine, not the hepatitis B vaccine

17 of 24 A nurse is assessing a client who has been taking ferrous sulfate to treat iron-definecy anemia. Which of the following finding should the nurse document as an adverse effect of supplemental iron therapy? A. Dental caries B. Heartburn C. Steatorrhea D. Diplopia

Ferrous sulfate can cause a temporary discoloration of the teeth ✓Correct Heartburn, nausea and bloating car common adverse effects of ferrous sulfate Ferrous sulfate can cause black to red, tarry stools Ferrous sulfate can cause it headaches not diplopia

"I will limit my fluid intake "I may continue to take my antihistamines "I should eat less fiber "I need to avoid jogging on warm day

The client should increase fluid The client shound not take antihistamines, antidepressants, or phenothiazine when taking oxybutynin The client should increase fiber ✓Correct The client should avoid vigorous exercise in warm environments because the suppression of sweating caused by anticholingic effects of can result in hypothermia

22 of 50 A nurse is planning care for a client who has neutropenia. Which of the following medication should the nurse expect to administer? Epoetin Fligrastim Enox Oprelvekin

✓

23 of 50 A nurse is providing teaching to a client who has a new prescription for montelukast. Which of the following statements by the client indicates an understanding of the teaching? I will take an extra dose of the medication I can take up to four tablets I will take this medication every day to control my I should always keeps this medication

✓

1 of 24 A nurse is assessing a client who stated a prescription for phenytoin 3 weeks ago. What of the following assessment finding should the nurse identify as an indication of a hypersensitivity reaction to the phenytoin? a. Enlargement of the cervical lymph nodes b. Diarrhea c. Ringing in the ears d. Alopecia

✓Correct Lymphadenopthy, or enlargement of the lymph nodes, is an indication of a hypersensitivity reaction to phenytoin that usually manifest 3 to 12 weeks after beginning to take the medication Constipation, rather than diarrhea, is an adverse effects of phenytoin Tinnitus, or ringing in the ears, is not associated with phenytoin Hair loss, or alopecia, is not associated with phenytoin. However, the client can develop hirsutism

30 of 50 A nurse is reviewing the laboratory findings for a client who is taking zidovudine to treat HIV. Which of the following finding should the nurse report to the provider? Platelets 165,ooo/mm3 Neutrophil count 650/mm3 Hgb 15 g/dL Albumin 4 g/dL

A platelet count of 165,000/mm3 within the expected reference range and does not need to be reported to the provider ✓Correct A client who is taking zidovudine is at risk for neutropenia and anemia. A neutrophil count of 650/mm3 is below the expected reference range and should be reported to the provider. The provider might need to discontinue the medication or reduce the dosage until the client's neutrophil count increases An Hgb of 15 g/dL within the expected reference range and does not need to be reported to the provider An albumin of 4 g/dL is within the expected reference range and does not need to be reported to the provider

24 or 24 A nurse in a provider office is reviewing the laboratory reports for a client who has been taking allopurinol. Which of the following results indicates a therapeutic response to the medication? A.Decreased triglyceride level B. Increases hematocrit level C. Decreased uric acid level D. Increased albumin level

Allopurinol has no therapeutic effect on triglyceride level Allopurinol has no therapeutic effect on hematocrit level ✓Correct The nurse should identity that a decreased uric acid level is a therapeutic response for the client taking allopurinol Allopurinol has no therapeutic effect on on albumin level

9 of 50 A nurse is caring for a client who is experiencing respiratory depression after taking an excessive does of oxycodone/ Which of the following medication should the nurse expect to administer? Bisacodyl Naloxone Flumazenil Pentazocine

Bisacodyl is used to teach constipation ✓Correct The nurse should identify that naloxone is an opioid antagonist that is used to treat respiratory depression in client who have oxycodone toxicity. Naloxone works by blocking the body's opioid receptors to decease the effects Flumazenil is an antidote used in the treatment of benzodiazepine Pentazocine is an opioid agonist-antagonist used for relief of mild to moderate pain

9 of 24 A nurse is assessing a client who has been taking levothyroxine for 3 months to treat hypothyroidism. Which of the following findings should the nurse expect as an indication that the medication is effective? A. Cool skin B. Weight loss C. Thick nail D. Decreased heart rate

Cool skin is a manifestation of hypothyroidism. With effective therapy, the client's skin should be warmer ✓correct Levothyroxine is a thyroid hormone. The client is taking this medication to reverse the manifestation of hypothyroidism, so the client should lose weight with this medication Thick, brittle nails are a manifestation of hypothyroidism, when levothyroxine should help to revers A decrease heart rate is a manifestation of hypothyroidism. The nurse should expect th clients heart rate to increase when taking levothyroxine

18 of 24 A nurse is assessing a client who is taking cyclosporine to treat rheumatoid arthritis. The client tells the nurse that they are also taking naproxen to relieve joint pain. The nurse should monitor the client for which of the following complication due to the interaction between these two medications? A. Hypotension B. Thrombophlebitis C. Renal impairment D. Coronary vasospasm

Cyclosporine and naproxen can cause hypertension, not hypotension ✓Correct Both cyclosporine and naproxen are nephrotoxic. The nurse should monitor the client's creatinine and BUN levels carefully and discourage. The client from using NSAIDs, such as naproxen, to manage joint pain. Cyclosporine does not affect clot formation. Naproxen can increase clotting times, making bleeding more likely Neither cyclosporine or naproxen causes coronary vasospasm, However, naproxen can cause tachycardia and palpitation

46 of 50 The nurse in the PACU is caring for a client who has received general anesthesia and has manifestation of malignant hyperthermia. Which of the following medication should the nurse expect to administer? Diazepam Dantrolene Cyclobenzaprine Metaxalone

Diazpam acts on CNS to produce sedative effects and depress spasticity of muscles Diazepman is administer to teat muscle spasm related to muscle injury ✓Correct Dabtrolene is used to treat malignant hyperthermia. Manifestations of malignant hyperthermia include propound hyperthermia and muscle rigidity Cyclobenzaprine act in the CNS to depress spasticity of muscles Cyclobenzaprine is administer to teat muscle spasm related to muscle injury Metaxalone depresses the CNS to cause skeletal muscle relaxation. Metaxalone is administered to teat muscle spasm related to muscle injury

10 or 50 A nurse is caring for a client who has recurrent lower urinary tract infection. Which of the following should the nurse expect to administer? Ganciclovir Amphotericin B Azithromycin Nitrofurantoin

Ganciclovir is an antiviral medication administer to treat cytomegalovirus Amphotericin B is an antifungal medication administer to treat systemic fungal infections Azithromycin is a macrolide antibiotic administer to teat disorder such as respiratory tract infections ✓Correct Nitrofurantoin to a client who has recurrent lower UTI. Nitrofurantoin is an antibiotic administer to treat actue lower UTIs, as well as prophlyasxis for recurrent lower UTI

8 of 24 A nurse is assessing a client who began taking verapamil 3 days ago. Which of the following finding should the nurse identify as an adverse effect of the medication A. Hypertension B. Constipation C. Gingivitis D. Facial edema

Hypotension, not hypertension is an adverse reaction of verapamil ✓Correct Constipation is the most commonly reported adverse effect of verapail Gingival hyperplasia, not gingivitis, is and adverse effect of verapamil Rash and flushing, not facial edema, are adverse effects of verapamil

3 of 50 A nurse is caring for a client who has osteoporosis and a new prescription for raloxifene. Which of the following should the nurse assess prior to initiation therapy? Family history of colon cancer Pregnancy status CBC results Thyroid function

Is is not necessary to assess family history of colon cancer prior to starting therapy with raloxifene. Raloxifene ✓Raloxifene is a selective estrogen receptor modulator that is used to treat postmenopausal osteoporosis and protect against breast cancer. The medication is classified as an FDA pregenacy risk teratogenic medication. Therefore should be discontinued Raloxifene can cause the clients platelet count to decrease slightly. However, it I not necessary to obtain CBC levels prior to starting Raloxifene can increase thyroxine-binding globulin and cause increased blood concentration of thryoid hormones

33 of 50 A nurse is reviewing laboratory results prior to administering ketorolac to a client. Which of the following finding should the nurses report to the provider prior to administration? Sodium 140 mEq/L Creatinine 1.6 mg/dL Aspartate aminotransferase (AST) 33 units Lactic acid 6 mg/dL

Ketorolac has no know effects on sodium levels, and this sodium level is within the expected range of 135 to 145 mEq/L. However, ketorolac can cause increased potassium levels ✓Correct The nurse should report this finding to the provider because it is greater than the expected reference range of 0.5 to 1.2 mg/dL. Ketorolac can cause an Increase in creatinine and should be used with caution in clients who have renal impairments While ketorolac can cause increase in AST and other liver function values, this laboratory value is withing expected reference range of 0 to 35 units/L Ketorolac had no known effect on lactic acid levels and this level is withing the expected reference range of 5 to 20 mg/dL. Ketorolac can cause drowsiness and dizziness

7 of 24 A nurse in an emergency department is caring for a client who sustained multiple fractures in a motor-vehicle crash. The client rates their pain a an 8 of 10 pain scale. Which of the following pain medication should the nurse expect to administer? A. Ibuprofen PO B. Pentazocine IM C. Morphine IV D. Fentanyl transdermal

The nurse can administer ibuprofen to the client who is experiencing mild to moderate pain The nurse can administer pentazocine to a client who is administer mild to moderate pain ✓Correct The nurse can administer morphine to a client who is experiencing moderate to severe pain The nurse can administer transdermal fentanyl to a client who is opioid tolerant and is experiencing severe pain, however this system of delivery will not reach therapeutic results for 24 hr

28 or 50 A nurse is preparing to administer mannitol IV to a client. The nurse should monitor the client for which of the following manifestations as an expected outcome of the medication? Decreased thyroxine levels Correction of atrial flutter Reduced intracranial pressure Increased hemoglobin level

Treat oliguric kidney failure only ✓Correct Mannitol is an osmotic diuretic. It increases pressure of the glomerular filtrate and increases blood flow to the kidney. An expected outcome of the treatment is a reduction in intracanal pressure that occurs as result of mobilizing water and electrolytes and decreasing cerebral edema The nurse should administer epoetin for decreased hemoglobin -

18 of 50 A nurse is preparing to administer VERAPAMIL to a client who is 2 days post MI. The nurse should monitor the client for which of the following outcomes as a therapeutic response to the medication? Increased heart rate Increased blood pressure Decreased pulmonary congestion Decreased anginal pain

✓

19 of 50 A nurse is teaching the partner of a client who has diabetes mellitus how to manage episodes of severe hypoglycemia when the client is unresponsive? Administer glucagon IM to the client Call emergency medical services Check the client's blood glucose level Transport the client to the ED

✓

27 of 50 A nurse is providing teaching to a client who has Parkinson's disease and has a new prescription for carbidopa/levadopa. Which of the following instructions should the nurse including in the teaching? Stop taking the medication if your urine becomes dark Move slowly when you stand up Take this medication at the first sign of tremors Increase you intake of foods high in protein

✓

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2 of 50 A nurse is planning a staff education session about adverse effect of medications. Which of the following information should the nurse give when discussing the adverse effects of anticholinergic medications? Blurred vision Polyuria Productive cough Tachycardia Constipation

✓Blurred vision is correct Polyuria is incorrect Productive cough is incorrect ✓Tachycardia is correct ✓Constipation is correct

49 of 50 A nurse is caring for a client who has open-angle glaucoma and a new prescription of acetazolamide. Prior to administering the first dose, the nurse should ask the patient of they allergy to which of the following medication classification? Nitrates Sulf-based medications Antilipemic agents Proton-pump inhibitors

An allergy to nitrates is not a contraindication for taking acetazolamide ✓Correct Carbonic anhydrase inhibitors, such as acetazolamide, are sulfa-based medications. A hypersensitivity to sulfonamides can result in an allergic reaction to acetazolamide. Therefore, the nurse should ask the client about allergies to sulfonamides An allergy to antilipemic agents is not a contraindication for taking acetazolamide An allergy to proton pump inhibitors is not a contraindication for taking acetazolamide

36 of 50 A nurse is preparing to administer a second unit of packed RBCs to a client who is experiencing hemorrhagic shock. The nurse should monitor the client for which of the following manifestations as an indication of circulatory overload? Chills Wheezing Dyspnea Flushing

Chills are a manifestation of a febrile acute intravascular hemolytic, or bacterial reaction to a blood transfusion. Other manifestation of these reactions include tachycardia, fever, and hypotension Wheezing is a manifestation of an anaphylactic reaction to a blood transfusion. Other manifestation of an anaphylactic reaction includes hypotension, urticaria, and itching ✓Correct The nurse should monitor the client for indication of circulatory overload including dyspnea, cough, rales, tachycardia, JVD. Administering the blood product at a slower rate can reduce the risk of circulatory overload Flushing is a manifestation of an allergic or acute intravascular hemolytic reaction to a blood transfusion. Other manifestations of an allergic reaction include itching and urticaria. Other manifestation of an acute intravascular hemolytic reaction include hypotension, fever, and low back pain

A nurse is providing teaching to a client who has a new prescription for famotidine for the treatment of Zollinger-Ellison syndrome. The nurse should explain to the client that famotidine treats ulcer through which of the following actions It decreases stomach motility It reduces gastric acid production If forms a protective It neutralizes gastric acid

Famotidine does not decrease stomach motility. Antidiarrheal medication, such as diphenoxylate (plus atropine), work by decreasing gastric motility. Diphenoxylate is a non-specific antidiarrheal medication because it does not treat the underlying cause of diarrhea. ✓Correct The nurse should explain that the client that famotidine treats ulcers by suppressing gastric acid production. Histamine (H2) receptor antagonists work by selectively blocking H2 receptor sites in the parietal cells to reduce acid production Famotidine does not form a protection barrier in the stomach lining. Gastrointestinal protectant medications, such as sucralfate, create a thick substance that will coat the ulcer to protect it from acidic environment Antacids, rather than famotidine, neutralize acid produced in the stomach. Antacids can be aluminum-,magnesium-,sodium-, or calcium-bases

A nurse is providing teaching to a client who has a new prescription for folic acid. The client states, " I thought that was only given during pregnancy' Which of the following statement should the nurse make? "Folic acid is important for stimulating the immune system" "Folic acid is given to increase the absorption of other medication" "Folic acid is administered to minimize the manifestation of Bening Prostatic Hyperplasia "Folic acid is important for the building of blood cells

Folic acid is prescribed for the treatment of megaloblastic and macrocytic anemias in adults and children. It does not stimulate the immune system Certain medication such as phenytoin, interfere with the absorption of folic acid. May also decrease phenytoin levels Folic acid can be administered to client who have malnutrition due to alcohol use disorder. However, it is not administered to clients who have benign prostatic hyperplasia ✓Correct Folic acid, a B vitamin, is essential in the production of blood cells and is prescribed for the treatment of megaloblastic and macrocytic anemias. In addition, clients of childbearing potential need adequate folate level to prevent neural tube defects, which occur early in pregnancy as the neural tube of the fetus develops. For this reason, supplementary folic acid is recommended for clients who might become pregnant.

42 of 50 A nurse in an emergency. Department is caring for a client who has a new prescription for acetylcysteine. For which of the following conditions should the nurse expect to administer the medication? Gastrointestinal bleed Acute bronchospasm Morphoine toxicity Acetaminophen toxicity

For an upper gastrointestinal bleed, the nurse should expect to administer acid suppression medication such as H2-receptor antagonist, proton pump inhibitor, or antacids. The nurse should expect to administer a short acting beta 2 agonist, such as albuterol, for acute bronchospasm. Furthermore, bronchospasm is an adverse effect of acetylcysteine. Acetylcysteine can help break up thick secretion when taken as an inhalation The nurse should expect to administer an opioid agonist to reverse the adverse effects of an opioid toxicity ✓Correct The nurse should expect to administer acetylcysteine to reverse the adverse effect of acetaminophen toxicity. Acetylcysteine is also administered to reduce the risk of renal damage due to contract dye

21 of 24 A nurse is assessing a client who has been taking hydrocodone for 4 weeks to relieve chronic pain. The nurse should evaluate the client for which of the following finding as a common adverse effect of this medication? A. Mydriasis B. Insomnia C. Constipation D. Urinary frequency

Hydrocodone causes miosis, or pupillary construction Hydrocodone produces sedation, not insomnia ✓Correct Constipation is a common adverse effect of hydrocodone. The client's usual bowel elimination patterns should have been documented to make it easier to asses for changes at a later day. The nurse should asses for soft stool every 1- 2 days and encourage the client to drink water, exercise, and consume adequate fiber. The client might also need to take a stool softener Hydrocodone can cause urinary retention not frequency

12 of 24 A nurse is teaching a client to self-administer NPH insulin and regular insulin in the same syringe. Which of the following instruction should the nurse include? A. Discard any NPH insulin that is cloudy B. Shake the vial of NPH insulin to mix it C. Draw up the regular insulin into the syringe first D. Inject air into the regular insulin vial first

NPH insulin had a cloudy appearance. The nurse should instruct the client to discard any regular insulin that looks cloudy The client should roll the vial of NPH insulin between the palms of their hand to blend it gently. Shaking can alter the solution and interfere with drawing up an accurate dose ✓Correct The client should draw up the regular insulin into the syringe first so that the NPH insulin (the longer-acting insulin) does not contaminate the vial of regular insulin After drawing the about of air equal to the about of NPH insulin the client will withdraw into the syringe; the client should inject air into the NPH vial first

4 of 50 A nurse is monitoring a client who is received an excessive dose of morphine. Which of the following adverse effect should the nurse identify as the priority? Nausea and vomiting Urinary retention Decreased respiration Increased drowsiness

Nausea and vomiting can occur with morphine administration. Therefore, the nurse should plan to administer an antiemetic if necessary Urinary retention can occur with morphine administration. Therefore, the nurse should monitor the clients urine output ✓Correct When using the ABC approach, the nurse should identify that the priority adverse effect is decreasing respiration, which can lead to the respiratory arrest. The nurse should be prepared to administer an opioid antagonist if the clients PR is less than 12 min

15 of 24 A nurse had just administer 2 mg of hydromorphone form a 4-mg vial to treat a clients postoperative pain. Which of the following actions should the nurse take? A. Secure the remainder of the medication in the syringe in a locked drawer for future use B. Discard the vial with the remaining medication in a wastebasket C. Dispose of the syringe with the medication in a secure sharps container D. Have a second nurse witness the disposal of the medication

Securing a partially used does of medication could result in unsafe or illicit usage The nurse mush follow legal guidelines for discarding any portion of a controlled substance ✓Correct When a nurse administers a portion of a dose of a controlled substance, then must discard the remainder safely by injection it out of the syringe into a sink or toilet with a second nurse as a witness The nurse should not dispose the syringe with the remaining medication

31 of 50 A nurse is teaching a client who has a new prescription for brimonidine to treat open-angle glaucoma. Which of the following client statements indicates an understanding of the teaching Its okay to put the drops in my eyes while I'm wearing my contacts I can expect to feel some irritation when I put these drops in my eye I should expect to stop taking the medication after 3 weeks At least these drops will clear up the redness I get in my eyes sometimes

Soft contact lenses can absorb brimonidine. Therefore, the client should wait 15 mins after instillation of the drops before inserting contact lenses ✓Correct Adverse effects of brimonidine topical alpha-2 adrenergic agonist, include the sensation of a foreign body in the eye, along with some itching and stinging of the eyes Brimonidine is used for long-term management of open-angle glaucoma. Apraclonidine is a topical alpha-2 adrenergic agonist used for short-term management of open-angle glaucoma Adverse effects of brimonidine, a topical alpha-2 adrenergic agonist, include ocular hyperemia. It will cause, rather than relieve, redness of the sclerae

23 of 24 A nurse is reviewing the medical record of a client who recently had a MI and has a new prescription for clopidogrel. Which of the following information should the nurse report to the provider? A. The client is if Greek descent B. The client has a history of anxiety C. The client has a prescription of ezetimibe D. The client taking a garlic supplement

Some clients, including 14% of Asians, have the CYP2C19 genotpye, which causes decreased metabolism of clopidogrel not Asian Depression is an adverse reaction to clopidogrel. The client history of anxiety poses no actual potential complication to taking clopidogrel Clopidogrel interacts with NSAID and thrombolytic agents and increases the client risk for bleeding. Ezetimibe is a medication that lowers cholesterol, and does not affect platelet aggregation ✓Correct Garlic has antiplatelet and coagulation properties that can increase the effectiveness of clopidogrel, therefore, increase the risk of bleeding . The nurse should notify the provider that the client take a garlic supplement

19 of 24 A nurse is teaching a client who is about to start taking levodopa/carbidopa orally disintegrating tables to teach Parkinson's disease. Which of the following instruction should the nurse include? A. "You should notify the provider if you symptoms do not improve within 1 week." B. "You should report a darkening of your urine or sweat to the provider." C. "You should not take the medication with high-protein meals." D. "You should drink 8 ounces of water as the table is dissolving."

The client might not notice the therapeutic effects of levodopa/carbidopa for several weeks or months Levodopa/carbidopa can darken urine and sweat, but the nurse should instruct the client that these effects are harmless ✓Correct Meal that are high in protein can decrease the about to levodopa/carbidopa the body absorbs and transport to the brain. The clients does not have to avoided protein altogether, but should space protein consumption evenly across the day It is not necessary to dink any water when taking an orally disintegrating tablet. The nurse should instruct the client to use dry hands when removing the table from the bottle, place the tablet on top of the tongue, allow the tablet to dissolve, and swallow using saliva only

5 of 50 A nurse is providing teaching to a client who has a new prescription for ciprofloxacin. Which of the following client statements indicates an understanding of the teaching? "I will stop taking this medication when I feel better." "I should wear protective clothing when I go outdoors." "I should take my medication daily in the morning with milk." "I should stop taking my birth control pills while I'm taking this medication."

The client should complete the entire course ✓Correct Ciprofloxacin can cause photosensitivity. Therefore, the nurse should instruct the client to wear protective clothing and sunscreen when outdoors to reduce the risk of sunburn Taking ciprofloxacin with milk, aluminum- and magnesium- containing antacids, iron, or sucralfate can reduce The client can continue to take estrogen-containing oral contraceptives. Hormonal contraceptive can interfere with tetracycline and many antiviral medications

14 of 24 A nurse is preparing to insert a peripheral IV catheter to initiate IV fluid therapy for an older adult client. Which of the following veins should nurse choose as the insertion site A. Superficial dorsal vein B. Median vein in the forearm C. Cephalic vein in the wrist D. Great saphenous vein

The nurse should avoid inserting a catheter in the back of the client's hand, because it can interfere with client ability to maintain independence and mobility ✓Correct The median vein on the inner aspect of the forearm is a good choice for this client. The nurse should stabilize the vein during insertion by applying traction just below the site The nurse should avoid site that the client could easily bump into objects, such as at the wrist. Older adults have less support due to minimal subcutaneous tissue. Also, the catheter should not be where the client flexes a joint. The nurse should not use a vein in the foot for adult client, because it increases the risk for thrombophlebitis

13 of 24 A nurse is administering enoxaparin to the client who is at high risk of DVT. Which of the following action should the nurse take? A. Choose a site on the upper thigh B. Spread the injection site C. Expel the air bubble before injecting the mediation D. Inject the medication deeply into subcutaneous tissue

The nurse should choose a site on the left or right side of the clients abdomen, atleast 5 com (2 in) When administering a low-molecular-weight heparin, such as enoxaparin, the nurse should pinch the injection site when inserting the needle to ensure the medication goes into the subcutaneous tissue. The nurse should not expel the air bubble in the prefilled syringe before ✓Correct The nurse should administer enoxaparin subcutaneously, deep into subcutaneous tissue, and inject it slowly

44 of 50 A nurse is caring for a client who refuses prescribed influenza immunizations. Which of the following actions should the nurse take first? Contact the provider who prescribed the immunization Ask the client to describe their outcomes Provide the client with education about immunization Document the client's refusal of the immunization

The nurse should contact the provider if the client refuses a medication However, according to the nursing process there is another action the nurse should take first ✓Correct When using the nursing process, the first action the nurse should take is to assess the client to determine what their concerns are regarding the immunization. This can provide the nurse with an opportunity to correct misconceptions that the client might have. However, the nurse should recognize that the client has the right to refuse any treatments or procedures. The nurse should provide education about the immunization for the client. However, according to the nursing process there is another action the nurse should take first The nurse should document the clients refusal of the immunization. However, according to the nursing process there is another action the nurse should take first

11 of 24 A nurse in a long-term facility is preparing medication for a group of clients. Which of the following actions should the nurse take when following guidelines for safe medication administration? A. Return acetaminophen to the facility's stock bottle after a client refuses a dose B. Crush the clients verapamil extended-release tablet and administer in pudding C. Administer a client cephalexin 30 min before it is scheduled D. Apply an estradiol transdermal patch to a female clients waistline

The nurse should discard medication that are refused by the client rather than returning them to the original contain for the purpose of infection control and client safety Crushing extended-release tablet changes the properties of metabolism and distribution of the medication, negating the extended-release action ✓Correct The nurse should administer an antibiotic, such as cephalexin, withing 30 min of the scheduled administration time to ensure that the client maintains therapeutic medication levels The nurse should apply an estradiol transdermal patch to the clients abdomen or trunk and avoid placing the patch anywhere the skin is sensitivity, where the skin folds, or where clothing can rub against the patch, such as on breast tissue or the waistline.

4 of 24 A nurse is planning to apply testosterone topical solution to the client. Which of the following actions should the nurse take? A. Cover the site with a transparent dressing after application B. Rub the solution is while wearing gloves C. Apply the medication to the clients axilla D. Dry shave the clients skin prior to application

The nurse should have the client cover the site with clothing following application The nurse should avoid rubbing in the solution following application ✓Correct The nurse should apply the prescribed about of testosterone topical solution to the client's axilla The nurse should dry shave the client skin prior to application of the testosterone transdermal patch, but this action is not recommended for the application of the topical solution

5 of 24 A nurse is caring for a client who is noted extravasation of an IV site following infiltration of dopamine. After stopping the dopamine infusion which of the following actions should the nurse take? A. Inject phentolamine into the affected area B .Apply a clod compress to the site C. Aspirate dopamine from the IV cannula D. Photograph the site

The nurse should inject phentolamine into the affected areas to neutralize the dopamine and minimize the tissue damage. however, evidence-bases practice indicates that another action is the priority The nurse should apply a cold compress to the site to minimize discomfort and the extension of extravasation. However, evidence-bases practice indicates that another action is the priority ✓Correct Evidence-bases practice indicated the nurse should first aspirate any remaining dopamine from the IV cannula to prevent injecting additional dopamine into the tissues during treatment and removal of the cannula The nurse should photograph the site to monitor the condition of the injury over time and to guid further treatment. However, evidence-bases practice

47 of 50 A nurse is providing teaching to a client who has type 2 DM and is starting to take immediate-release exenatide. Which of the following client statements indicates an understanding of the teaching? I will discard the open injector pen after two months I will inject the medication into the muscle of my thigh I will store open injector pens in the refrigerator I will take this medication one hour before morning and evening meals

The nurse should instruct the client to discard the open injector pen after 30 days, even if some of the medication remains Exenatide is administered by subcutaneous injection into the abdomen, upper arm, or thigh. The nurse should instruct the client to store open injector pens in the refrigerator. ✓Correct Exenatide should be administer withing 60 min before the morning and evening meals each day. It should not be administered after a meal.

37 of 50 A nurse is providing teaching to a client who has a new prescription for levothyroxine. Which of the following statements by the client indicates an understanding of the teaching? I should take with food I will take three doses each day I might not realize the full effect of the medication for several weeks I might gain weight while taking this medication if I do not exercise

The nurse should instruct the client to take levothyroxine on an empty stomach with a glass of water, preferable first thing after waking up and 30 to 60 min prior to breakfast. The nurse should instruct the client to take levothyroxine once a daily, first thing after waking up to enhance absorption and to prevent sleeplessness at bedtime. The medication should be given at the same time each day to maintain adequate medication levels ✓Correct Levothyroxine is a synthetic thyroid hormone that increases cellular metabolism and is indicated to treat hypothyroidism. Levothyroxine can take weeks to become effective, so that dose should be small with gradual increase until therapeutic levels occur Levothyroxine can cause the client to lose wight

38 of 50 While assessing a client at the beginning of the shift, a nurse notes that the client received a medication in error from the nurse on the previous shift. At which of the following times should the nurse plan to complete an incident report about the error? After the end of the current shift After contacting risk management As soon as the assessment is complete As soon as the nurse from the previous shift has been informed

The nurse should not wait until the end of the shift to complete because it might cause the nurse to forget some details The risk management department reviews incident report after they are completed to determine if further investigation is needed. Therefore, the nurse should complete the incident report prior to contacting risk management ✓Correct The first step the nurse should take after discovering the error is to assess the client and respond to immediate needs in client care. After notifying the provider, the nurse should complete an incident report as soon as possible so that they are better able to recall details. The nurse should also document factual information in the client's medical record without mentioning an error has occurred. Although the nurse from the pervious shift who made the error should be contacted, the nurse should complete an incident report prior to contacting the previous nurse

41 of 50 A nurse is obtaining vital signs for a client who has been taking propranolol. Which of the following finding should the nurse identify as an adverse effect of the medication? Respiratory rate 20/min Oral temperature 37.8F (100.1 F) Blood pressure 118/78 mm Hg Apical pulse 50/min

The nurse should recognize that propranolol does not affect body temperature. The nurse should monitor the client for fatigue and weakness as adverse effects of propranolol. The nurse should identify that a blood pressure of 118/78 mm Hg is within the expected reference range of less than 120/80 mm Hg. The nurse should monitor the client's blood pressure periodically during therapy and instruct the client to avoid abruptly discontinuing the medication because doing so could a hypertensive crisis ✓Correct The nurse should identify that an apical pulse of 50/min is below the expected reference range of 60 to 100/min. Bradycardia is an adverse effect of propranolol and other beta blockers. Therefore, the nurse should monitor the apical pulse prior to and following administration of a beta blocker medication

6 of 24 A nurse is planning to perform a dressing change on a client peripherally inserted central catheter site. Which of the following action should the nurse take? A. Apply clean gloves when cleaning the site B. Document the next dressing changes is due in 14 days C. Measure the length of the external portion of the catheter D. Cleanse around the site for at least 20 seconds

The nurse should use strict aseptic technique when performing central line care, including the use of sterile gloves and mask to minimize the risk of a catheter-related bloodstream infection Dressing changes for cental line catheter should be completed every 7 days if a transparent dressing is used or every 48 hr if a gauze dressing is used, ✓Correct The nurse should measure the length of the external portion of the catheter and compare this to the documented length to determine if the catheter has become displaced The nurse should use the back-and-forth motion with an approved cleansing agent for a least 30 seconds.

48 of 50 A nurse is caring for a client who has HIV ritonavir and zidovudine. The client asks why they mush take both medication. Which of the following responses should the nurse take? " If you take the two medication together, it will shorten the duration of your antiviral therapy" "Taking the two med" "Taking the two medication together keeps you from developing toxicity from either of them" "Zidovudine will help protect from the possible adverse effects of ritonavir

Treating HIV infection required long-term com therapy. No combination of medications shortens the duration of thearpy ✓Correct Zidovudine, a nucleoside reverse transcriptase inhibitor, is combined with ritonavir a protease inhibitor, to reduce the risk for medication resistance and to increase medication effectiveness. Monotherapy with either medication quickly results on medication resistance Hematological toxicity can develop with zidovudine and can lead to anemia and neutropenia. No combination of medication therapy can prevent toxicity Zidovudine and ritonavir are administered in a combination to prevent resistance. This combination therapy dies not offer protection from adverse effects of either medication

20 or 50 A nurse is discussing adverse effects with a client who has non-Hodgkin lymphoma and is starting to take Methotrexate. Which of the following information should the nurse provide? Methotrexate can cause the risk for bleeding Methotrexate can cause can cause bradycardia Methotrexate can cause arthritic pain Methotrexate can cause insomnia

✓

24 of 50 A nurse is caring for a client who has a new prescription for aldosterone. Which of the following therapeutic effects should the nurse expect the client to experience? A decrease in the amount of gastric acid production A decrease in the frequency defecation An increase in gastric motility An increase in the absorption of water into the intestine

✓

25 of 50 A nurse is caring for a client who is receiving a continuous intravenous infusion of Vitamin K Physostigmine Protamine Calcium gluconate

✓

26 of 50 A nurse is providing teaching to a client who has a new prescription for transdermal nitroglycerin patches to treat angina pectoris. Which of the following instruction should the including in teaching? Remove the patch for two to four hours daily Apply a new patch each day after waking Cover the patch with plastic wrap Replace the existing patch with a new patch

✓

7 of 50 A nurse is caring for a client who refuses a prescribed dose of valproic acid 250 mg PO. The clients states, " I don't want to take that pill because It makes me feel nauseated." Which of the following actions should the nurse take? (Select all) Educate the client about the possible consequences of not taking the medication Suggest to the client that food with the medication to minimize GI effects Document the clients refusal in the medication administration record Offer to administer the medication IM Recommend the client ask the provider to prescribe an enteric-coated medication

✓

29 or 50 A nurse is caring for a client who has varicella-zoster virus. Which of the following medications should the nurse expect to administer? Acyclovir Vancomycin Gentamicin Quinine

✓Correct Acyclovir is an antiviral medication used for the treatment of herpes simplex and varicella-zoster infections (shingles or chickenpox) Acyclovir works by inhibiting the synthesis of viral DNA. Although acyclovir does not cure the viral infection, it can decrease healing time and minimize the severity og varicella-zoster Vancomycin antibiotics Gentamicin is an aminoglycoside antibiotic Quinine is an antimalaria _

40 of 50 A nurse is providing teaching to a client who has neuropathic pain and a new prescription for amitriptyline once per day. Which of the following information should the nurse include in the teaching? Increase fluid while taking the medication Expect an elevation in blood pressure with initial dose of the medication Stop the medication immediately if urine becomes Take the medication in the morning

✓Correct Amitriptyline is a tricyclic antidepressant used to treat neuropathic pain and migraine headaches. The adverse effects of amitriptyline are anticholinergic in nature, causing dry mouth, constipation, and urinary retention. The nurse should instruct the client to increase fluids and fiber to reduce constipation, and to use sugarless candy or gum to reduce dry mouth Orthostatic hypotension is an adverse effect of early treatment with amitriptyline. The nurse should instruct the client to change positions slowly Amitriptyline can turn the urine a blue-green color. The nurse should instruct the client to stopping the medication immediately. It can result in adverse effects in the gastrointestinal system, headaches, and trouble sleeping Sedation is an adverse effect of amitriptyline. Therefore, the nurse should instruct the client to take the medication at bedtime

10 of 24 A nurse is teaching a client about how to use a nitroglycerin transdermal patch. Which of the following instruction should the nurse include? A. Apply the patch to a hairless area of skin B. Replace the patch twice a day C. Leave the patch off for 4 hr daily D. Apply the patch to the same area each day

✓Correct Body hair can interfere with the distribution of the medication of the skin, so the nurse shold instruct the client to apply the patch to a hairless area of skin The client should apply a new patch once daily The client should remove the patch and wait about 12 hr before applying a new patch The client should rotate application sites to prevent irritation of the skin

35 of 50 A nurse is reviewing medical record for a group of clients. Which of the following finding should the nurse report to the provider? A client who is taking citalopram has a prolonged Q-T interval A client who is taking duloxetine and has an alanine transaminase (ALT) of 32 units/L A client who is taking fluoxetine and had gained 1 kg (2.2 lb) over 12 weeks A client who is taking carbamazepine and has a platelet count of 320,000/mm3

✓Correct Citalopram, an SSRI antidepressant, can result in an adverse effect of a prolonged Q-T interval, would could lead to serious life-threatening cardiac dysrhythmias, such as Torsades de pointes. Therefore, the nurse should report this finding to the provider Duloxetine, an SSRI antidepressant, can cause hepatotoxicity. However, the client's ALT is within the expected reference range of 4 to 36 units/L Weight fluctional is and expected adverse effect of fluoxetine. Therefore, the nurse does not need to report this finding to the provider Carbamazepine, is a mood stabilizer and anticonvulsant, can cause thrombocytopenia. However, the client's platelet count is within expected range of the reference 150,000 to 400,000/mm3. Therefor, the nurse does not need to report

3 of 24 A nurse is reviewing the laboratory results of a client who has been receiving injection of epoetin alfa for the past 3 weeks. Which of the following Labortory finding should the nurse identify as an indication that the treatment is effective? A. Increased reticulocyte count B. Decreased hemoglobin C. Increased neutrophils D. Decreased triglycerides

✓Correct Epoetin alfa increases the rate of red blood cell production in clients who have anemia, A reticulocyte is an immature red blood cell. An increase in reticulocytes indicated the treatment is effective Effective treatment with epoetin alfa should increase clients hemoglobin level Epoetin alfa should increase the rate of red blood cell production in client who have anemia. However, this medication has no effects on white blood cells, such as neutrophils Epoetin alfa should increase the rate of red blood cell production in client who have anemia. However, this medication has no effect on triglycerides

34 of 50 A nurse is teaching a client who has asthma about using a beclomethasone inhaler along with an albuterol inhaler. Which of the following instruction should the nurse include about the beclomethasone inhaler? You should gargle with water after each use of this inhaler There is no need to use a spacer for this inhaler You should use this inhaler for any acute incident of shortness of breath Use the beclomethasone inhaler before using you albuterol inhaler to increase absorption

✓Correct Garling with water after using the beclomethasone inhaler will reduce the risk of a candidiasis infection and will reduce hoarseness. The client can also use mouthwash instead of water for gargling A spacer will reduce residual medication from being deposited int the clients mouth and will reduce hoarseness Beclomethasone is used for long-term prophylaxis of asthma, not as a rescue medication. The client should take beclomethasone on a regular schedule, even if rescue medication are used near the scheduled time for beclomethasone administration The client should first use a bronchodilator, such as albuterol, to open the airways and promote absorption of the beclomethasone

8 of 50 A nurse is teaching a client who is starting subcutaneous leuprolide for the treatment of prostate cancer. Which of the following instructions should the nurse include in the teaching? Increase calcium Keep the solution cold for administration Monitor for low blood glucose levels The medication can cause constipation

✓Correct Leuprolide, a gonadotropin-releasing hormone agonist, suppresses hormone production and can cause bone loss. To minimize this adverse effect, the client should consume adequate calcium and vitamin D and preform weight-barding exercises

6 or 50 A nurse is caring for four clients who have peptic ulcer disease. The nurse should recognize that misoprostol is contraindicated for which of the following clients A client that is pregnant A client is is experiencing diarrhea A client who is receiving long-term NSAIDs therapy A client who has a gastrointestinal bleed

✓Correct Misoprostol is an FDA Pregnancy risk teratogenic medication that should not be administer for the treatment of peptic ulcer disease in clients who are pregnant. This medication can results in spontaneous abortion. Clients should have the potential to bear children should have a negative pregnancy test before starting Diarrhea is and adverse effect of misoprostol that might require a dosage reduction. However, diarrhea is not a contraindication Misoprostol is a prostaglandin E analog and acts as an endogenous prostaglandin in the gastrointestinal tract to decrease acid secretion, increase the secretion of bicarbonate and protective mucus, and promote vasodilation to maintain submucosal blood flow. These actions all serve to prevent gastric ulcer, especially in a client who is talking long-term NSAID therapy Gastrointestinal bleeding is not a contraindication for receiving misoprostol, nor is it an adverse effect of the medication. Misoprostol treats peptic ulcer disease, which can cause GI bleeding

43 of 50. A nurse is caring for a client who has a prescription for a hypotonic IV fluid. Which of the following solution should the nurse expect to administer? 0.45% sodium chloride 0.9% sodium chloride 3% sodium chloride Lactated Ringer's

✓Correct The nurse should identify that 0.45% sodium chloride is a hypotonic solution The nurse should identify that 0.9% is an isotonic solution The nurse should identify that 3% sodium chloride is a hypertonic solution The nurse should identify that lactated Ringer's is an isotonic solution

2 of 24 A nurse is caring for a client who has a radical facture and a new prescription for butorphanol. The nurse should identify that which of the following statements by the client indicated a contraindication for the administration of butorphanol? A. " I've been taking methadone to treat a heroin use disorder." B. "My pain rating is at 7 on a 0 to 10 scale." C. "My fingers are number" D. "I am allergic to peanuts."

✓Correct The nurse should identify that methadone, an opioid analgesic, is a contraindication for the administration of butorphanol, which if administered will result in manifestation of opioid withdrawal Butorphanol is mixed opioid antagonist used to treat moderate to severe pain The nurse should identify that a loss of feeling in the extremity distal to the fracture site might indicate never damage. However, this is not a contraindication for the administration for butorphanol. The nurse should document any allergies on the clients medication record. However, an allergy to peanuts is not a contraindication for the administration of butorphanol.

39 of 50 A nurse is providing teaching to a client who has a new prescription for oral extended-release potassium chloride tablets. Which of the following instructions should the nurse include in the teaching? Do not crush this medication Dissolve the table in your mouth Take this medication on an empty stomach Take this medication every other day

✓Correct The nurse should instruct the client not to chew or crush extended-release potassium chloride tablets because this can cause an immediate release of the medication instead of extended release and can result in injury to the client The nurse should instruct the client not to allow potassium chloride tablets to dissolve in the mouth to prevent the occurrence of oral ulcerations The nurse should instruct the client to take potassium chloride with food or right after meals to decrease gastrointestinal irritation Potassium chloride is prescribed to replace potassium in clients who have potassium deficiency. The nurse should instruct the client to take this medication one or two times daily, according to the provider's prescription

22 of 24 A nurse is teaching a client who is experiencing postoperative pain about the use of a PCA pump to deliver morphine. Which of the following statement by the client indicates an understanding of the teaching A. "I'll push the button about 10 min before I get out of bed." B. "I'll ask my son to push the dose button when I am asleep for the night." C. "I won't push the button that often, so I don't overdose." D. "I shouldn't experience any adverse effects when using a PCA pump with morphine."

✓Correct The nurse should instruct the client to activate the PCA device about 10 min before potentially painful activities The nurse should instruct the family member that the client is the only one who should operate the PCA pump. The pump is programmed to deliver a larger bolus dosing at night to prolong sleep when the client is not awake to active self-administration The nurse should instruct the client that morphine, an opioid medication, can cause adverse effect such as constipation, hypotension, and urinary retention, Using the PCA pump will not prevent or reduce these adverse effects

16 or 50 A nurse is assessing a client who had heart failure and is taking digoxin. Which of the following manifestations should the nurse report to the provider as an indication of digoxin toxicity? Vomiting Dilated pupils Brusing Peripheral edema

✓Correct The nurse should monitor the client foe nausea, vomiting, anorexia, and indication of digoxin toxicity. The nurse should withhold the medication and contact the provider if any of these manifestations occur The nurse should monitor the client for blurred vision and yellow and green vision, which can be an adverse effect of digoxin. However, dilated pupils are not an indication of digoxin toxicity The nurse should monitor laboratory results for thrombocytopenia, which can be an adverse effect of digoxin. However, bruising is not an indication of digoxin toxicity The nurse should monitor the client who has heart failure by recording intake and output rations, daily weights, and assessing for edema. However, peripheral edema is not an indication of digoxin toxicity

16 of 24 A nurse is teaching a client who is to start taking gemfibrozil to lower their triglyceride levels. The nurse instruct the client to report which of the following adverse effects to the provider immediately A. Upper abdominal discomfort B. Blurred vision C. Headache D. Dizziness

✓Correct When using the urgent vs nonurgent approach the client care, the nurse should instruct the client that the priority finding to report is discomfort in the upper abdomen. This finding, along with bloating and intolerance of fatty foods, could indicate gallbladder disease, a potential consequence of gemfibrozil therapy. Reporting blurred vision is nonurgent because it is an expected finding Reporting headache is nonurgent because it is an expected finding Reporting dizziness is nonurgent because it is an expected finding

45 of 50 A nurse is reviewing the medical record of a client who received medication 1 hr ago and reports have chest pain. The nurse should recognize that chest pain can be an adverse effect of which of the following medications? Albuterol Furosemide Digoxin Atenolol

✓Correct albuterol Albuterol is a beta2-agonist used to control bronchospasm associated with asthma. Cardiovascular adverse effects associated with beta2 agonists can include chest pain, tachycardia, and dysrhythmia Furosemide is a loop diuretic used for client who have heart failure of edema. Hypotension is a cardiovascular adverse effects of this medication Digoxin is a cardiac glycoside used for clients who have atrial fibrillation and heart failure. Cardiovascular adverse effects of this medications include dysrhythmia and ECG changes Atenolol is a selective beta blocker used for clients who have hypertension, agina, and who have experienced a myocardial infraction. Cardiovascular adverse effects of this medication include hypotension and bradycardia

17 of 50 A nurse is caring for a client who has a prescription for terazosin. The nurse should identify that is medication is indicated for which of the following disorders? Hypertension Heart failure Male pattern baldness Benign prostatic hypertrophy Erectile dysfunction

✓Hypertension is correct Terazosin is a non-selective alpha1-adrenegic antagonist that works on the alpha1 receptors in the smooth muscle of the periphery, resulting in a decreased in blood pressure Heart failure is incorrect. This medication is not used to treat heart failure. However, peripheral edema, is an adverse effect of terazosin Male pattern baldness is incorrect. This medication is not used to teat make pattern baldness. Finasteride is a 5-alha reductase inhibitor that can be used. ✓Benign prostatic hypertrophy is correct. This medication is used to treat manifestation of benign prostatic hypertrophy, such as urinary hesitancy. Terazosin is a non-selective alpha1-adrenegic antagonist that works on the smooth muscle tissue surrounding the bladder neck and prostate. Erectile dysfunction is incorrect. This medication is not used, Tadalfil is a phosphodiesterase type-5 inhibitor that is used for ED