Pharmacology Assessment 4

A nurse is caring for a client who has poison ivy and dermatitis and is started on diphenhydramine (Benadryl). Which of the following nursing recommendations is appropriate for decreasing the dry mouth associated with the use of diphenhydramine?

"Chew on sugarless gum or suck on hard, sour candies."

A nurse is caring for a child in status asthmaticus. Which of the following is the priority action for the nurse to take?

Administer a short-acting ß2 -agonist.

A nurse is preparing a medication and is converting 0.8 grams to milligrams. The nurse should do which of the following?

Move the decimal point 3 places to the right.

A nurse is caring for a client who has been prescribed timolol (Timoptic). Which of the following is the appropriate procedure for administration of this medication?

Drop prescribed amount of medication into the conjunctival sac.

When talking with a patient about taking cimetidine (Tagamet), the nurse should include which of the following instructions?

Do not take this medication if you start taking blood-thinning medications.

A nurse is preparing to administer prednisone (Deltasone) to a client for treatment of rheumatoid arthritis. Which of the following indicates effective therapy?

Improved range of motion

A client who is postoperative reports incisional pain. The surgeon has prescribed subcutaneous morphine. Before administering this medication, the nurse should complete which priority assessment?

Respiratory rate The priority action the nurse should take when using the airway, breathing, and circulation (ABC) approach to client care is to evaluate the client's respirations. The respiratory rate is especially important because opioid analgesics like morphine can cause respiratory depression.

A nurse is caring for a client who has just begun therapy with alprazolam (Xanax) to treat anxiety. The nurse should observe the client for which of the following adverse effects of this medication?

Sedation

Which of the following should be recognized by the nurse as part of the medication reconciliation process?

The documented list includes all medications taken by the client.

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

History of gastric ulcers.

A client has developed agranulocytosis as a result of taking propylthiouracil (PTU) to treat hyperthyroidism. When preparing to counsel the client, the nurse should base her instructions on the fact that the client is at serious risk for which of the following?

Infection

A nurse is caring for a client who is taking levothyroxine (Synthroid). Which of the following manifestations should suggest to the nurse that the client may have taken an overdose of levothyroxine?

Insomnia

A nurse is reviewing medications for a client who has a diagnosis of a small bowel obstruction. The nurse should withhold senna (Senoket) prescribed orally based on understanding of which of the following?

Laxatives are contraindicated in clients who have a small bowel obstruction.

A nurse is caring for a client who has received chemotherapy. The client experiences severe nausea and vomiting. The nurse should monitor the client for which of the following clinical manifestations?

Metabolic alkalosis

A nurse is talking with a client who is about to start taking allopurinol (Zyloprim) to treat gout. Which of the following statements indicates that the client understands how to take this medication?

"I need to drink at least 3 quarts of water a day."

A nurse is caring for a client who reports daily use of acetaminophen (Tylenol) to manage mild knee pain. Which of the following statements by the client should be of most concern to the nurse?

"I take three or four Vicodin ES tablets a day for severe knee and joint pain."

A nurse is reinforcing teaching with a client who is receiving continuous subcutaneous insulin via an external insulin pump. Which of the following client statements indicates a need for further teaching?

"I will adjust my dosages of Lantus insulin according to my blood glucose results."

A nurse is caring for a client who has several environmental allergies and was admitted in status asthmaticus. The provider prescribes cromolyn sodium (Intal) via metered dose inhaler (MDI) to be added to the client's home management along with an albuterol (Proventil) MDI. When performing discharge teaching, the nurse should identify the need for additional teaching when the client states,

"I will be sure to take the Intal four times a day before using the Proventil." The client should always use the bronchodilator MDI prior to any other MDI. This helps to ensure that the maximum dose of medication will get to the client's lungs. Albuterol is a beta-agonist bronchodilator, but cromolyn sodium is a mast cell inhibitor that prevents the release of histamine; therefore, the albuterol should be used prior to the cromolyn sodium.

A client diagnosed with oral candidiasis has received instructions from the nurse about the use of nystatin (Mycostatin) suspension. Which of the following statements made by the client should indicate to the nurse that the teaching has been effective?

"I will hold the medication in my mouth for as long as possible."

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

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

A nurse is talking with a client about how to use montelukast (Singulair) to treat asthma. Which of the following client statements should indicate that the client understood the nurse's instructions?

"I'll take this medication once a day in the evening."

A nurse is caring for a client who is taking naproxen (Naprosyn) following an exacerbation of rheumatoid arthritis. Which of the following comments by the client requires further discussion by the nurse?

"I've been buying Tagamet to help with the indigestion I've had."

A nurse is caring for a client who has a prescription for diphenhydramine (Benadryl) to relieve pruritus. The client asks the nurse how he can minimize the daytime sedation he is experiencing. Which of the following is an appropriate response by the nurse?

"Take most of the daily dose at bedtime."

A nurse is caring for a preoperative client who is prescribed hydroxyzine (Vistaril). The nurse should know that which of the following are beneficial actions of hydroxyzine for the preoperative client? (Select all that apply.)

- Controlling emesis - Diminishing anxiety - Reducing the amount of narcotics needed for pain relief - Drying secretions

A nurse is reinforcing the controlled substance guidelines with a newly licensed nurse. Which of the following should the nurse include in the teaching? (Select all that apply.)

- Count each dose of narcotics in inventory. - Match number of available doses to record. - Sign acceptance of narcotic count if correct.

A nurse is monitoring a client's IV site. Which of the following findings are associated with phlebitis and should be reported to the RN? (Select all that apply.)

- Erythema - Throbbing - Warmth at insertion site - Streak formation

A nurse is caring for an older adult client who is hospitalized. Which of the following medications is likely to put the client at risk for orthostatic hypotension? (Select all that apply.)

- Furosemide (Lasix) - Telmisartan (Micardis) - Phenelzine sulfate (Nardil)

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

- Jaw pain - Blurred vision - Dysphagia

Which of the following are appropriate references for the nurse to use to ensure safe medication administration? (Select all that apply.)

- Published journals - Pharmacists - Physicians' Desk Reference

A nurse is caring for a client who asks how albuterol (Proventil) helps his breathing. Which of the following should the nurse include in the response? (Select all that apply.)

- The medication will prevent wheezing. - The medication will open the airways. - The medication will decrease coughing episodes.

A nurse is talking with a client who has peptic ulcer disease and is starting therapy with sucralfate (Carafate). The nurse should instruct the client to take the medication

1 hr before meals. Sucralfate is a mucosal protectant. The client should take it on an empty stomach, 1 hr before meals, for maximum effectiveness.

A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client. What is the sequence of events the nurse should follow? (Move the steps of mixing insulin on the left into the box on the right, placing them in the selected order of performance. All steps must be used.)

1- Inspect vials for contaminants. 2- Roll NPH vial between palms of hands. 3- Inject air into NPH insulin vial. 4- Inject air into regular insulin vial. 5- Withdraw short-acting insulin into syringe. 6- Add intermediate insulin to syringe.

A nurse receives a new prescription from the provider which reads "give 14 units of regular insulin and 28 units of long-acting insulin to be given subcutaneously at the breakfast hour". What is the total number of units of insulin that the nurse will prepare in the insulin syringe?

42 units

A nurse receives a new prescription from the provider which reads "give 14 units of regular insulin and 28 units of long-acting insulin to be given subcutaneously at the breakfast hour." What is the total number of units of insulin that the nurse will prepare in the insulin syringe?

42 units

A nurse is caring for a client after a craniotomy for pituitary tumor who has developed diabetes insipidus. The client is receiving vasopressin (Pitressin). The desired response to the medication is evident when the nurse observes which of the following findings?

A decrease in urine output.

A nurse is giving discharge instructions to a client who has asthma and is about to start taking zileuton (Zyflo). The nurse should tell the client to report which of the following adverse effects to the provider?

Abdominal pain Zileuton can cause liver damage and hepatitis. The client should report any signs of hepatic toxicity, such as abdominal pain or jaundice.

A nurse is preparing to administer phenytoin (Dilantin) 50 mg IV to an older client who has a seizure disorder. Which of the following action should the nurse include?

Administer over two minute.

A nurse is providing teaching to a client who has diabetes mellitus and has a new prescription for chlorpropamide (Diabinese). The nurse should teach the client to avoid consumption of which of the following while taking this medication?

Alcohol

A nurse is developing home instructions for a client who is prescribed phenytoin (Dilantin) via the tube. Which of the following should the nurse include in the instructions?

Alcohol increases the chance of phenytoin toxicity.

A home health nurse is reviewing the medication list of an older adult client who reports falling a couple of times over the past week. Which of the following medications should the nurse suspect is contributing to the client's falls?

Alprazolam (Xanax)

A nurse is preparing to use the Z-track technique to administer a medication to a client. Which of the following is an appropriate action during this procedure?

Aspirate for 5 to 10 seconds.

Following surgery, a client has a prescription for nalbuphine (Nubain) for moderate to severe pain. The nurse caring for the client should check for possible adverse reactions by assessing for which of the following findings?

Blurred vision

A nurse is providing dietary teaching for a client who has a new prescription for a monoamine oxidase inhibitor (MAOI). When the client develops a sample lunch menu, which of the following items requires intervention?

Bologna sandwich

A nurse is caring for a client with cirrhosis who has a new prescription for cephulac (Lactulose). Following administration, the nurse will monitor the client for which adverse effect of this medication?

Diarrhea The nurse will monitor for diarrhea. Lactulose is a synthetic disaccharide that the small intestine cannot utilize. It causes diarrhea by lowering the pH so that the bacterial flora are changed in the bowel.

A nurse is speaking with a client who is about to receive a one-time dose of diazepam (Valium). Which of the following information should the nurse be sure to give to the client?

Diazepam can cause drowsiness. Valium has sedative properties, so the client should not engage in potentially hazardous activities after receiving diazepam.

A nurse is caring for a client. The client states, "I don't want to take my medication.Which of the following actions should the nurse take?

Document that the client refuses the medication. The client has the right to refuse the medication. It is appropriate for the nurse to document the client's wishes.

A nurse is caring for a client who is at 6 weeks of gestation and has pneumonia. While the nurse is obtaining the client's history, she tells the nurse that she takes the herb feverfew for migraine headaches. Which of the following actions should the nurse take?

Explain that she should not take this herb while she is pregnant.

A nurse is to administer subcutaneous short-acting insulin combined with long acting insulin to the client before he eats breakfast at 8:00 AM. Which of the following should the nurse do?

Give the insulin at 7:30 AM after checking the blood glucose level results.

A nurse is teaching medication safety to a group of healthy older adults at a community center. The nurse explains that due to the high frequency of food-drug interactions, the clients should avoid taking their medications with which of the following?

Grapefruit juice

A client is taking ibuprofen (Advil, Motrin) to treat hip pain. The nurse should teach the client that, to minimize gastric mucosal irritation, she should take this medication at which of the following times?

Immediately after a meal

A nurse is caring for a client who requests pain medication. The nurse should understand that acute pain can cause which of the following?

Increased heart rate

A nurse is preparing to administer aminophylline intravenous (IV) drip infusion. Which of the following is a safe nursing action?

Infuse with an IV controller.

A nurse is caring for a client who has a diagnosis of diabetes mellitus and hypertension and recently began taking propranolol (Inderal). When the client reports dizziness upon standing, the nurse should perform which of the following actions?

Monitor blood pressure lying, sitting, and standing.

A nurse is preparing to administer an intramuscular (IM) dose of meperidine (Demerol) to a client, which of the following is the priority for the nurse to take?

Respiratory rate

A nurse is caring for client who has a prescription for phenytoin (Dilantin). For which of the following findings should the nurse instruct the client to notify the provider?

Skin rash

A nurse is providing teaching to a client who has hypothyroidism and has a new prescription for levothyroxine (Synthroid). The nurse should instruct the client to avoid which of the following herbal supplements?

Soy isoflavones

A nurse is talking with a client about taking an expectorant to treat a cough. The nurse should explain that this type of medication treats coughs because of which of the following actions?

Stimulates secretions

A nurse is administering medication to a client. Which of the following medications is most effective when administered with little or no water?

Sucralfate (Carafate)

A nurse is giving discharge instructions to a client who has asthma and is about to start taking theophylline (Theo-24). The nurse should tell the client that this medication might cause which of the following adverse effects?

Tachycardia

A nurse is preparing an injection using a single dose glass ampule. Which of the following techniques should the nurse use when opening the glass ampule?

Tap the top of the ampule, place a gauze pad or unwrapped alcohol swab around the ampule neck, and break off the top with a forward motion away from the hands.

A nurse is administering ipratropium bromide (Atrovent) via nebulizer to a client who has emphysema. Which of the following client findings should cause the nurse to consult the provider before administering the next dose?

Visual changes

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

Warfarin sodium (Coumadin) and multivitamins

A nurse is discontinuing a course of prednisone (Deltasone) for a client with an exacerbation of asthma. The nurse should taper the dose so that the client does not experience

adrenocortical insufficiency.

A nurse is attempting to administer a dose of lactulose (Cephulac) to a client who has cirrhosis when the client states, "I don't need this medication. I am not constipated." The nurse should explain that lactulose is also used to decrease serum

ammonia.

A nurse is caring for a child who has asthma and is prescribed chewable montelukast (Singulair). The nurse should instruct the child's parent to administer the medication

daily at bedtime.

A hospice nurse makes weekly visits to a client who has terminal cancer. For several weeks, the client has been taking morphine sulfate for pain relief. At today's visit, the client reports to the nurse that the usual dose of morphine does not seem to be working. The nurse should understand that the most likely explanation is that the client has

developed a tolerance to the medication.

A nurse is instructing a hospitalized client who has asthma about how to use an albuterol (Proventil) inhaler. The nurse should recognize that the client understands how to use the inhaler when the client demonstrates by

holding a breath for 10 seconds after inhaling the medication.

A nurse is instructing a pediatric client and his and family about how methylphenidate (Ritalin) will help manage attention-deficit hyperactivity disorder (ADHD). The nurse should explain that this medication therapy will help

increase focus.

A nurse is caring for a client who takes prednisone (Deltasone) and has developed an infection. The nurse should expect that the provider will

increase the dosage of prednisone.

A nurse is caring for a client who has difficulty swallowing medications and is prescribed aspirin (Ecotrin) PO once daily. The client asks if the medication can be crushed to make it easier to swallow. The nurse's response should be, "Crushing the pill

might cause you to have a stomachache or indigestion." The pill is enteric-coated to prevent breakdown in the stomach and decrease the possibility of GI distress. Crushing the pill destroys that protection.

A nurse who is teaching a client who is about to start taking docusate (Colace) should make sure that the client understands that this medication should result in

regular bowel movements.

A nurse is interviewing a client during a yearly health assessment. The client reports occasionally taking several over-the-counter (OTC) medications, including H2-blockers, as needed. When evaluating the effectiveness of H2-blocker therapy, the nurse should assess for

relief of heartburn. Histamine H2-receptor antagonists, also known as H2-blockers, are used to treat duodenal ulcers and prevent their return. In OTC strengths, these medicines are used to relieve or prevent heartburn, acid indigestion, and sour stomach.

A provider prescribes cyclobenzaprine (Flexeril) for a client who has a fractured ulna. When the client asks the nurse what this medication is supposed to do for him, the nurse should explain that cyclobenzaprine will

relieve muscle spasms.

A nurse is teaching a client who has asthma the appropriate use of inhaled beclomethasone (Beclovent). To avoid complications related to the use of beclomethasone, the nurse should encourage the client to

rinse the mouth after administration.

A nurse is talking with a client about taking diphenhydramine (Benadryl). The nurse should explain that the most common side effect of this medication is

sedation.

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

water.

A nurse who has just admitted a client to an inpatient medical unit notices that the client brought a container of ginkgo biloba with him. When the nurse asks him about it, he says he takes it every day to "help his brain." Which of the following is an appropriate nursing response?

"For now, let's just make sure your doctor is okay with you taking it while you're in the hospital."

A nurse is caring for a client who reports taking bisacodyl (Ducolax) to promote a daily bowel movement. Which of the following should be the nurse's priority response?

"How long have you been taking the Ducolax?"

A nurse is teaching a client with multiple sclerosis who has a new prescription for dantrolene (Dantrium). Which of the following client statements indicates that the client understands the teaching?

"I need to apply a sunscreen when I go outside."