Pharmacology A- test 2 with rationales

Instructions of client who has MS and a new prescription for methylprednisolone:

"Blood glucose levels will need to be monitored during therapy." (because this is a corticosteroid) "Avoid contact with persons who have known infections." (because corticosteroids suppress the immune response and mask manifestations of infection) "Grapefruit juice can increase the blood levels of the medication." (increases the absorption of the medication leading to toxicity and adrenal suppression)

"risedronate" for the treatment of osteoporosis, understanding of teaching statement:

"I should sit up for 30 minutes after taking the risedronate." Sitting up will reduce GI effects of esophagitis and dyspepsia

"captopril" understanding of teaching statement:

"I should tell my provider if I develop a sore throat." Client should tell provider because this can indicate neutropenia, a serious adverse effect of captopril.

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

"I will check my HR before I take the medication." This is a calcium channel blocker that has cardio-suppressant effects at the SA and AV nodes, which leads to bradycardia

A nurse is instructing a client on the application of nitroglycerin transdermal patches. Which of the following statements by the client indicates an understanding of the teaching?

"I will take the patch off right after my evening meal." Remove patch for 12 to 14 hours to avoid developing a tolerance to the medication's effects

Client has a gastric ulcer and a new prescription for "ranitidine," what are instructions the nurse should include?

"Report yellowing of the skin." Can be hepatotoxic and cause jaundice.

A nurse is caring for n older adult client. The client received 0.9% sodium chloride 1L over 4 hr instead of over 8hr as prescribed which of the following entries is appropriate documentation of this occurrence in the clients medical record.

0.9% sodium chloride 1L IV infused over 4 hr. Vital signs stable The nurse should only chart factual information without using judgmental language in the medical record

A nurse is preparing to administer hydromorphone for a postoperative client which of the following indicates that the nurse should withhold the next dose of the medication

A clients respiratory rate is eight per minute The clients respiratory rate is below expected reference range there for the nurse should withhold medication

A nurse is teaching a client who is to start a new prescription for verapamil. Which of the following instructions should the nurse plan to include

Change positions slowly Verapamil is given to treat cardiac dysrhythmias, which may cause palpitations. Discontinuing the medication abruptly may cause complications. Instead the client should report this finding to the provider, who may decide to lower or discontinue the medication on a tapered dose.

A nurse Is caring for a client who has just been transferred from the PACU to the medical-surgical unit following colon resection the client reports pain of an eight on a scale from 0 to 10 and has a prescription for morphine sulfate 4 mg IV bolus PRN pain every two hours which of the following actions should the nurse take first

Check the clients PAC you medication record first administering morphine sulfate is an appropriate action but is not the first action the nurse should take you need to know your client

A client who has a history of hypertension tells the nurse that he uses over-the-counter oral decongestants for nasal congestion the nurse should advise the client that decongestants

Constrict blood vessels sympathomimetics work by constricting blood vessels which relieves congestion however this vasoconstrictive effects can also increase blood pressure

A nurse is caring for a client has heart failure and is discharged with a prescription for furosemide. The nurse should plan to instruct the client that which of the following are potential adverse effects for this medication select all that apply

Dizziness: The diuretic action of furosemide can result in A significant drop in blood pressure causing lightheadedness and dizziness hypokalemia: diuretic action of furosemide promotes the excretion of potassium increasing the clients risk for hypokalemia urinary frequency: The diuretic action of furosemide result in urinary frequency

And nurses providing teaching about insulin glargine to a client who has type one diabetes mellitus which of the following should the nurse include in the instructions

Do not mix this medication in a syringe with other insulins insulin glargine does not cause peaks instead it maintains a study blood level over a 24 hour period which reduces the risk of hypoglycemia

A nurse is caring for a client who has pneumonia the client tells nurse she is pregnant but has not told her provider which of the following medication orders should the nurse question

Doxycycline pregnancy is a contraindication for doxycycline, a tetracycline antibiotic, due to the medications adverse affects on developing bones and teeth

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

Dry mouth Due to the blocking of acetylcholine receptors that cause anticholinergic responses

A nurse is administering donepezil to a client who has Alzheimer's disease. Which of the following documented findings should the nurse report to the provider immediately

Dyspnea Using ABC priority setting framework, the greatest risk to the client is dyspnea as a result of bronchoconstriction caused by elevated acetylcholine levels in the lungs.

Nurse is caring for a client who is candidiasis which of the following medications to the nurse expect to administer

Fluconasole Is an antifungal medication effective for treating oral pharyngeal and systemic candidiasis

A nurse is caring for a client to his heart failure and is prescribe enalapril the nurse should monitor the client for which of the following

Hyperkalemia a client taking enalapril can develop hyperkalemia due to potassium retention by the kidneys

A nurse is assessing a client who is taking propylthiouracil for treatment of. Graves' disease which of the following findings indicate the fact of this of this medication

Increase in ability to focus a client who has Graves' disease has difficulty focusing and increased ability to focus indicates effectiveness of the medication

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

Increased blood pressure The therapeutic effect of epoetin alfa is an increase in hematocrit levels which can result in an increase in BP

A nurse is caring for a client who is taking tamoxifen for the treatment of breast cancer the nurse informed the client that which of the following side effects can develop select all that apply

Menstrual irregularities hot flashes bruising Tamoxifen is an anti-estrogen medication

A nurse is planning to teach about the use of a spacer to a child who has a new prescription for a fluticasone inhaler to treat chronic asthma. The nurse should include hat the spacer decreases the risk for which of the following adverse effects of the medication?

Oral candidiasis Adverse effects of inhaled corticosteroids can include dysphonia and oral candidiasis. Teach pt. to use spacer then rinse mouth after

A nurse is providing follow-up care to a client who is taking lisinopril. Which of the following manifestations should the nurse instruct the client to report as an adverse effect of lisinopril?

Persistent cough This is an ACE inhibitor that can cause persistent cough from an excessive buildup of bradykinin

A nurse is assessing laboratory results for client to use prescribe oprelvekin for management of adverse effects of chemotherapy which of the following findings by the nurse indicates a therapeutic effect of the medication

Platelet count is 350,000 mm oprelvekin is a thrombopoietic Factor in there for a platelet count within the expected reference range indicates the medication is effective

A client is receiving a heparin infusion for deep vein thrombosis the nurse should discontinue the medication infusion for which of the following client findings

Platelets 96,000 per millimeter cube A platelet count less than 100,000 mm cube while receiving heparin may indicate heparin-induced thrombocytopenia this would require stopping in fusion

A nurse is caring for a client is experiencing acute alcohol withdrawal for which of the following is a client prescribed chlordiazepoxide

Prevent delirium tremens the client should take chlordiazepoxide to prevent delirium tremens for client experiencing acute alcohol withdrawal A treatment of the benzodiazepine group used to treat anxiety and alcohol withdrawal

Nurse is caring for a client who recently began taking oral amoxicillin and clavulanate potassium and reports urticaria which of the following intervention should the nurse take

Request a change in the type of antibiotic Manifestations of urticaria after taking a penicillin-based medication indicate a mild allergic reaction. Therefore, it is appropriate for the nurse to request a change in the type of antibiotic

And nurses providing teaching to a client who is taking tetracycline PO and reports gastrointestinal distress which of the following should the nurse include in the teaching

Take the medication with applesauce to reduce gastrointestinal distress the client should take the medication with food such as applesauce

A nurses providing teaching to a client regarding the administration of Ferrous sulfate which of the following instruction should the nurse include in the teaching

Take the tablet on an empty stomach black stools are a common and harmless side effect of oral iron administration

A nurse administers ceftazidime to a client who has severe penicillin allergy which of the following client findings requires an incident report

The client reports shortness of breath Severe penicillin allergy is a contraindication for ceftazidime, a cephalosporin antibiotic, due to the potential for cross sensitivity shortness of breath can indicate the development of anaphylaxis

A nurse administers ceftazidime to a client who has a sever penicillin allergy. Which of the following requires and incident report

The client reports shortness of breath Severe penicillin allergy is a contraindication for ceftazidime, a cephalosporin antibiotic, due to the potential for cross sensitivity. Shortness of breath can indicate anaphylaxis

A nurse has administered 2 doses of betamethasone to a client in preterm labor. After delivery of the newborn, the nurse understands the medication was effective when she observes which of the following?

The newborn has normal respiratory patterns This stimulates surfactant production, which improves oxygenation and lung compliance in neonates

A client is just diagnosed with tuberculosis and is prescribed a for medication regimen of isoniazid , pyrainamide, rifampin, and ethambutol

This regimen will eliminate various combinations of resistant strains of TB The risk of undesired effects increases with multi medication therapy

A client newly diagnosed with hypothyroidism is prescribed levothyroxine 0.25 mg PO daily after six weeks of treatment the nurse determines that the medication was effective if the

Thyroid stimulating hormone level is 2 microunits/milliliter Measuring TSH is the most sensitive method for determining thyroid activity a TSH level 2 micro units per milliliter indicates appropriate thyroid activity

A nurse is caring for a client who is taking acetazolamide for chronic open angle glaucoma for which of the following adverse affects should the nurse instruct the client to monitor and report

Tingling of fingers Hyperglycemia rather than hypoglycemia is an adverse effect of Acetazolaminde

A nurse on the acute care unit is caring for a client who is receiving gentamicin IV. The nurse should report which of the following findings to the provider as an adverse effect of the medication?

Tinnitus Aminoglycosides, such as gentamicin, are ototoxic, which can manifest as tinnitus and deafness

Nurse is caring for a client who is 24 hour post operative following abdominal surgery and has been taking morphine sulfate PRN for incisional pain the nurse should assess the client for which of the following adverse affects

Urinary retention morphine increases bladder sphincter and detrussor muscle tone as well as dulling the clients ability to perceive bladder fullness resulting in urinary retention

A nurse is preparing to administer a new prescription of amoxicillin/clavulanic to a client. The client tells the nurse that he is allergic to penicillin. Which of the following actions should the nurse take first?

Withhold the medication This is the priority action to prevent injury to client "urgent vs nonurgent"

A nurses providing teaching to a client who is to start therapy with digoxin which of the following should the nurse instruct the client to monitor and report

Yellow tinged vision The nurse should instruct the client to monitor for and report yellow tinged vision which is a sign of digoxin toxicity and should be reported to the provider

Client understanding of "ciprofloxacin":

"I will report any signs of tendon pain or swelling." This drug is associated with risk of tendon rupture (increased in older adults)

A nurse is caring for a client who is to receive 0.9% sodium chloride at a rate of 1L q 8hr. The drip factor shown on the package of IV tubing is 15gtt/mL the nurse should regulate the IV to deliver how many gtt/min (nearest whole)

31 gtt/min Rationale:

The nurse is preparing to administer amoxicillin 250 mg PO to a school aged child, available is amoxicillin oral suspension 200 mg over 5 mL how many milliliters should the nurse administer. round to the nearest 10th

6.3 250 mg times 5 mL divided by 200 mg

Medication reconciliation:

A transition in care requires the nurse to conduct medication reconciliation

A nurse is caring for a client who has acute acetaminophen toxicity. The nurse should anticipate administering which of the following medications?

Acetylcysteine This is an antidote for acetaminophen

A nurse is precepting a newly licensed nurse who is caring for four clients. The nurse should complete an incident report for which of the following actions by the newly licensed nurse?

Administers isosorbide mononitrate to a client who has BP 82/60 mm Hg Nurse should withhold medication and notify provider. Isosorbide mononitrate is used for clients with angina. Taking this leads to vasodilation which can lead to hypotension.

A nurses caring for a client who is receiving haloperidol for which of the following adverse affects of the nurse be observing

Akathisia Akathisia is an extra extrapyramidal symptom that can be caused by haloperidol

And nurses providing teaching for a client who is to begin pharmacological therapy for a new diagnosis of asthma which of the following medications should the nurse instruct the client to use during an acute asthma attack

Albuterol albuterol is a short acting beta 2 adrenergic agonist which causes bronchodilation relieves bronchospasm during acute asthma attacks the nurse should instruct the client to keep medication nearby for emergency use

A nurse in the clinic is talking to a client on the phone who tells the nurse he has not taken any of his morning medications and reports tinnitus the nurse instructs the client to come to the clinic and withhold which of the following medications

Aspirin tinnitus is not a side effect of clopidogrel

A nurse in the emergency department is caring for a client who has myasthenia gravis an dis in a cholinergic crisis. Which of the following medications should the nurse plan to administer?

Atropine Administer atropine, an anticholinergic agent, to reverse cholinergic toxicity

A nurse is playing to provide medication education for client to begin a course of therapy with metronidazole which of the following should the nurse instruct the client to avoid during the course of therapy

Beer the combination of metronidazole and alcohol can cause a disulfiram like reaction that can include severe vomiting hypotension and weakness

A nurse is planning care for a client who is receiving mannitol via continuous IV infusion. The nurse should monitor the client for which of the following adverse effects?

Bibasilar cracles Mannitol, an osmotic diuretic, can precipitate heart failure and pulmonary edema. Therefore, the nurse should recognize crackles as an indicator of a potential complication and stop the infusion

A nurse is caring for a client who is receiving heparin therapy via continuous IV infusion to treat a pulmonary embolism. Which of the following findings should the nurse identify as an adverse effect of the medication and report to the provider.

Blood in the urine This can be a manifestation of heparin overdose, as well as bruising, hematomas, hypotension, and tachycardia

The nurse is caring for a client who is receiving long term treatment for systemic lupus erythematosus with prednisone the nurse should inform the client to expect to undergo which of the following diagnostic test to monitor for long-term complications

Bone density scans adverse effects of glucocorticoids include osteoporosis which is monitored with regular schedule bone density scans

A nurses caring for a client taking Atorvastatin which of the following should the nurse monitor for the client

CK Mild injury causing muscle weakness or aches develops in some clients taking statins and this occasionally progresses to myositis creatinine kinase (CK) levels rise in response to enzyme is released with muscle injury

A nurse is planning teaching for a child who has been prescribed fluticasone propionate for chronic asthma the nurse plans to teach the child to use a spacer to minimize the risk for which of the following

Candidiasis of the mouth Side effects of inhaled corticosteroids include dysphonia and oral candidiasis using a spacer and rinsing the mouth after inhalation will minimize the amount of medication remaining in the oropharynx preventing the development of the side effects

A nurse is assessing a client who is taking oral contraceptives which of the following medications will interfere with the effectiveness of oral contraceptives

Carbamazepine There are no medication interactions between oral contraceptives and lorazepam

A nurses caring for a client who has a new diagnosis of type 1 diabetes mellitus. The nurse administers regular insulin six units subcutaneously at 0700 at 1000 the client reports feeling nauseous and lightheaded which of the following actions should the nurse take first

Check the clients blood glucose level the first action that a nurse should take using the nursing process is to assess the client therefore the nurse should check the clients blood glucose level

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

Cromolyn Cromolyn stabilizes mast cells, inhibiting release of histamine and inflammatory mediators. Use this 10-15 min. before exercise

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

Decrease in flexor and extensor spasticity baclofen decreases the frequency and severity of muscle spasm's allowing for improved muscle function

A nurse is monitoring clients receiving an IV infusion of magnesium sulfate for preterm labor which of the following findings indicate to the nurse that the client is experiencing magnesium toxicity

Decreased level of consciousness magnesium toxicity results in central nervous system depression

A nurse is teaching a client who is to start taking hydrocodone with acetaminophen tablets for pain. Which of the following information should the nurse include in the teaching?

Decreased respirations might occur Respiratory depression is an adverse effect of this medication. Consult provider before taking these medications

A nurse is teaching a client who is taking allopurinol for the treatment of gout. Which of the following information should the nurse include in the teaching?

Drink 2 L water daily Prevent renal stone formation and kidney injury bc allopurinol is eliminated through kidneys

A nurse is providing teaching to a client who is to begin taking oxybutynin for urinary incontinence which of the following symptoms should the nurse tell the client to expect. ( all that apply)

Dry mouth blurred vision photophobia Oxybutynin is an anti-cholinergic agents that can cause dry mouth Oxybutynin is an anticholinergic agents that can cause blurred vision Oxybutynin is an anti-cholinergic agent that can cause photophobia

Nurses in a providers office is assessing a client who has been taking aspirin daily for the past year which of the following findings should the nurse notify the provider immediately

Hyperventilation aspirin may cause gastrointestinal distress including heartburn but that is not the most urgent finding

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

I should let my dentist know I'm taking this medication The client should NOT take phenytoin with milk or other calcium-containing foods because phenytoin can decrease the absorption of calcium and vitamin D

A nurses providing teaching to a client who has depression and is prescribed fluoxetine which of the following statements indicates to the nurse and the client understands the teaching

I should take acetaminophen instead of ibuprofen for my headaches while taking this medication You do not need a tyramine restriction for this kind of medication

A nurse is collecting a medication history from a client who has a new prescription for lithium. The nurse should identify that the client should discontinue which of the following over-the-counter medications?

Ibuprofen This NSAID interacts with lithium and increases lithium levels

A nurse is assisting a client who is taking salmenterol. which of the following reports from the client indicates effectiveness of this medication

Improved breathing Improved mood just not indicate effectiveness of salmenterol

Bupropion as an aid to quit smoking: What is an adverse effect?

Insomnia Bupropion is an atypical antidepressant, has stimulant properties, which can result in agitation, tremors, mania, and insomnia

A nurse is reviewing the health history of a client who has diabetes mellitus and will begin taking insulin. Which of the following findings should the nurse identify as a factor that might cause the client to have difficulty safely self-administering insulin?

Macular degeneration With macular degeneration, you lose central vision, making it difficult for self-administration

A nurse is assessing a client who has myasthenia gravis and is taking neostigmine which of the following findings should alert the nurse that the client is experiencing an adverse reaction

Nausea Neostigmine is more likely to cause bradycardia than tachycardia

A client is receiving a second dose of IV cefazolin postoperatively. The nurse notes uriticaria, dysrhythmia anxiety and hypotension. Which of the following should the nurse anticipate administering?

Parenteral epinephrine The client findings indicate an allergic reaction to cefazolin therefore the nurse should anticipate administering parenteral epinephrine to induce vasoconstriction and bronchodilation

A nurse is caring for a client who has acute angle closure glaucoma and has been receiving a continuous IV infusion of mannitol 25% for one hour which of the following adverse affects should the nurse report to the provider immediately

Peripheral edema the greatest risk to the client receiving mannitol IV is development of heart failure therefore the nurse should report peripheral edema to the provider immediately

A nurse is assessing a client whose taking Indomethacin which of the following should the nurse monitor to evaluate the medications effectiveness

Reduced pain indomethacin is a nonsteroidal anti-inflammatory medication which reduces pain and inflammation

A nurse Is providing teaching to a client who is diagnosed with migraine headaches the client is prescribed something ergotamine sublingual which of the following should the nurse include in her instructions

Take one tablet at onset of migraine one tablet should be taken immediately after the unsent of aura or headache

Nurse is caring for a client who is starting a new prescription for warfarin which of the following medication should the nurse plan to administer if the clients experiences bleeding

Vitamin K acetylcysteine is the antidote for acetaminophen toxicity

A nurse is providing teaching about clindamycin to a client which of the following is an adverse effects of this medication that the nurse should instruct the client to report to the provider

Watery diarrhea An adverse effect of clincamycin because it can cause clostridium defficile associated diarrhea which manifests as watery diarrhea without treatment this adverse affects can be fatal

A nurse is teaching a client who has tuberculosis about the adverse effects of isoniazid. The nurse should instruct the client to report to the provider which of the following findings as an adverse effect of the medication?

Yellowish skin tones This is a hepatotoxic medication that can cause hepatitis. Monitor for malaise, nausea, and yellowish skin tones and report to provider

The nurses providing teaching to a client who takes Valporic acid for which of the following should the nurse instruct the client to monitor and report to the provider

jaundice Valporic acid is unlikely to cause blurred vision

A nurse is providing care for a client who is postoperative following an open cholecystectomy with the placement of a closed suction drain and is receiving morphine via patient-controlled analgesia for pain. Which of the following assessments is the nurse's priority?

Respiratory rate AIRWAY, breathing, circulation

A nurse is planning care for a client who is prescribed metoclopramide following bowel surgery for which of the following address affection of the nurse monitor

Sedation metoclopramide has multiple effects on the central nervous system including sedation fatigue restlessness headache sleeping is dystonia

Adverse effect for fluoxetine (for depression):

Sexual dysfunction This is an SSRI depressant

A nurse is monitoring a client who is receiving amphotericin B intermittent IV bolus for histoplasmosis for which of the following adverse affects of the nurse notify the provider

Fever fever and chills are signs of an infusion reaction that requires immediate intervention

Nurses planning to teach a client about taking methotrexate for which of the following should the nurse instruct the client to monitor and report to the provider

Fever methotrexate an immunosuppressant can cause bone marrow suppression the nurse should advise the client to muncher any poor indications of infection such as fever or sore throat

A nurse is caring for a client to the emergency department following a diazepam overdose the nurse should administer which of the following medications

Flumazenil Is the reversal agent for benzodiazepine toxicity

Nurses providing teaching to a client with peptic ulcer disease and is to start a new prescription for sucralfate theaters explain to the client with medication

Forms a protective barrier over ulcers Sucralfate a mucosal protectant forms a gel like substance coating the ulcer creating a barrier to hydrochloric acid

At 0900 a nurse is preparing the clients medications based on the chart findings which of the following medications should the nurse administer first

Sodium polystyrene sulfate You do not need to give pain medication first if the patient's pain is only moderate

A nurse is assessing a client who is receiving epoetin alpha to treat anemia for which of the following findings should the nurse monitor related to this medication

Increased blood pressure

A nurse is caring for a client who is to start therapy with benztropine for which of the following findings should the nurse monitor

Tachycardia benztropine is an anti-cholinergic agent

A Client is taking trimethoprim/ sulfamethoxazole which of the following findings should the nurse reports the provider

Vesicular, crusty rash This is a sign of Steven Johnson syndrome and adverse affect the nurse should report to the provider