Pharmacology "Hard" PART 2

A nurse is assessing a client who has a new prescription for chlorpromazine to treat schizophrenia. The client has a mask-like facial expression and is experiencing involuntary movements and tremors. Which of the following medications should the nurse anticipate administering? A. Amantadine B. Bupropion C. Phenelzine D. Hydroxyzine

A. Amantadine This client is experiencing Parkinsonism, which is an adverse effect of the antipsychotic medication chlorpromazine. Amantadine is an antiparkinsonian medication used to treat the extrapyramidal manifestations that can occur with chlorpromazine therapy. - B, C, & D: Bupropion is an atypical antidepressant. Phenelzine is an MAOI antidepressant. Hydroxyzine is an antihistamine used to treat mild to moderate anxiety. These are not used to treat Parkinsonism adverse effects caused by chlorpromazine.

A nurse is planning discharge teaching for a client who has major depressive disorder and a new prescription for phenelzine. Which of the following foods should the nurse include in the plan as safe for the client to consume while taking phenelzine? A. Broiled beef steak B. Macaroni and cheese C. Pepperoni pizza D. Smoked salmon

A. Broiled beef steak Phenelzine, an MAOI, is an antidepressant. This medication interacts with a variety of foods to produce a hypertensive crisis. Beef steak and other meats that are fresh do not interact with phenelzine and are safe to consume. - B: Most cheeses, except for cottage cheese and cream cheese, interact with MAOIs like phenelzine and can cause hypertensive crisis. - C: Pepperoni, salami, and other dried or cured meats interact with MAOIs and can cause hypertensive crisis. - D: Fish that has been cured or dried interacts with MAOIs and can cause hypertensive crisis.

A nurse is caring for a client who has multiple sclerosis and is receiving interferon beta-1a. The nurse should identify that which of the following client statements indicates a potential adverse effect of the medication? A. My body aches all over B. I have abdominal cramping C. My hair seems to be thinning D. It hurts when I urinate

A. My body aches all over The adverse effects of interferon beta-1a include flu-like symptoms such as general body and muscle aches. - B, C, & D: These are not common adverse effects of this medication.

A nurse is caring for a client who has cystic fibrosis (CF) and has a prescription for high-dose ibuprofen daily. The nurse should identify that which of the following is an expected outcome for the client receiving this medication? A. Thinned pulmonary secretions that are retained in the airways B. Slowed progression of pulmonary damage C. Potentiated action of bronchodilator therapy D. Decreased risk of fevers associated with CF

B. Slowed progression of pulmonary damage The nurse should identify that clients who have CF are prescribed high-dose ibuprofen, which is an NSAID, to slow the progression of pulmonary damage by suppressing the inflammatory response that causes pulmonary damage. - CF is a genetic disorder that primarily affects the lungs, pancreas, and sweat glands. - A & C: High-dose ibuprofen does not have an impact on the thinning of pulmonary secretions and does not potentiate the action of bronchodilators. - D: Ibuprofen can be used to treat a client who has a fever. However, high-dose ibuprofen is not used to treat fevers for clients who have CF.

A nurse is caring for a client with COPD who has been taking tiotropium. Which of the following client statements should indicate to the nurse that the client is experiencing an adverse effect of this medication? A. My body aches all over B. I am urinating more during the day C. My mouth feels dry all the time D. I have trouble sleeping at night

C. My mouth feels dry all the time The nurse should identify that dry mouth is a common adverse effect of this medication's anticholingeric effects. Tiotropium is a long-acting anticholinergic inhaled medication used for maintenance therapy for clients with COPD. - A & D: Tiotropium does not cause generalized body aches or insomnia. - B: Tiotropium is an inhaled anticholinergic and can cause urinary retention.

A nurse is caring for a female client who has osteoporosis and is taking raloxifene. Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect of this medication? A. Severe leg cramps B. Urinary frequency C. Jaw pain D. Sudden onset of dyspnea

D. Sudden onset of dyspnea The nurse should identify that raloxifene is a selective estrogen receptor modulator (SERM), which can have estrogenic effects in some of the tissues and anti-estrogenic effect in other tissues. - Clients who are taking raloxifene have an increased risk of thromboembolic events such as DVT, pulmonary embolism, or stroke. Therefore, the nurse should notify the provider if the client is experiencing sudden onset of dyspnea while taking raloxifene. - A, B, & C: Severe leg cramps, urinary frequency, and jaw pain are not adverse effects of this medication.

A nurse is caring for a client who has asthma and a prescription for zileuton. Which of the following laboratory values should the nurse monitor while the client is taking this medication? A. Alanine aminotransferase (ALT) B. WBC count C. Potassium D. Chloride

A. Alanine aminotransferase (ALT) The nurse should identify that ALT is a liver function test. Zileuton is a leukotriene modifier that can affect the liver, causing increased ALT levels. - The nurse should monitor this laboratory value closely while the client is taking the medication. - B: A WBC count that is outside of the expected reference range can indicate a blood disorder or infection. However, this laboratory value is not associated with a potential adverse reaction to this medication. - C: Potassium levels that are outside of the expected reference range can be associated with acute or chronic conditions of the heart, kidneys, nerve, or muscle cells. However, potassium levels that are outside of the expected reference range are not associated with a potential adverse reaction to this medication. - D: Chloride levels that are outside of the expected reference range can occur as a result of an acid-base or electrolyte imbalance. However, chloride levels that are outside of the expected reference range are not associated with a potential adverse reaction to this medication.

A nurse is preparing to administer the varicella vaccine to a 12-month-old infant. The nurse asks the infant's guardian if the infant has any allergies. Which of the following allergies is a contraindication to the infant receiving the vaccine? A. Gelatin B. Milk C. Eggs D. Peanuts

A. Gelatin An allergy to gelatin is a contraindication to receiving the varicella vaccine; therefore, the nurse should contact the infant's provider. - B: An infant who has a milk allergy can receive the varicella vaccine. - C: An egg allergy is a contraindication to receiving the influenza vaccine, and the client's parent should consult the provider. An infant who has an egg allergy can receive the varicella vaccine. - D: An infant who has a peanut allergy can receive the varicella vaccine.

A nurse is teaching a client who has systemic lupus erythematosus about a new prescription for oral glucocorticoid therapy. Which of the following client statements indicates an understanding of the teaching? A. I should take a calcium supplement while on this medication B. Regular liver function studies will have to be done while I am taking this medication C. I can take NSAIDs to treat mild pain while using this medication D. I will be sure to eat 6 small meals a day to prevent hypoglycemia from this medication

A. I should take a calcium supplement while on this medication An adverse effect of systemic glucocorticoid therapy is osteoporosis. Increasing calcium-rich foods in the diet and adding calcium and vitamin D supplements should be encouraged to prevent osteoporosis and decrease the risk of fractures. - B: Glucocorticoids do not affect liver function. Other medications like HMG-CoA reductase inhibitors or statins require periodic liver function tests. - C: NSAIDs should be avoided while undergoing systemic glucocorticoid therapy due to the increased risk of gastric ulceration. Combining these medications increases the risk of GI bleeding. The client should be instructed to check for GI bleeding and report black, tarry stools to the provider. - D: The nurse should instruct the client that hyperglycemia is a side effect of oral glucocorticoid therapy, not hypoglycemia.

A nurse is providing teaching to a client with chronic bronchitis about administering acetylcysteine using a hand-held nebulizer (HHN). Which of the following client statements indicates an understanding of the teaching? A. I should discard an open vial of the medication after 24 hr B. I should limit my fluid intake while taking this medication C. I should try to cough productive just before I begin the treatment D. If the medication becomes discolored, I should throw it out and get a new supply

C. I should try to cough productive just before I begin the treatment A productive cough prior to beginning the treatment will clear sputum from lung surfaces, allowing better absorption of the medication. - A: The nurse should teach the client that an open vial of the medication can be stored in the refrigerator for up to 96 hours. The client should discard any unused medication after that time. - B: The client should drink plenty of fluids, at least 2 to 3 L each day, to help thin the secretions. - D: After opening, the medication mixture might develop a light purple color, which is expected and does not alter the potency of the medication. Therefore, the client does not need to discard medication that changes color in this way.

A nurse is providing teaching to a client who has a new prescription for doxycycline. The nurse should instruct the client to monitor for which of the following adverse effects? A. Photosensitivity B. Constipation C. Ototoxicity D. Blurred vision

A. Photosensitivity An adverse effect of doxycycline, a tetracycline antibiotic is photosensitivity. - This makes skin react abnormally to light, especially ultraviolet radiation or sunlight. - Prevention involves avoiding direct exposure to sunlight and ultraviolet light, wearing protective clothing outdoors, and using sunscreen. - B: Doxycycline is more likely to cause diarrhea than constipation. - C: Ototoxicity is an adverse effect of aminoglycosides. Doxycycline is a tetracycline antibiotic. - D: Doxycycline is more likely to interfere with color vision than visual acuity.

A nurse is teaching a newly licensed nurse about contraindications to ceftriaxone. A severe allergy to which of the following medications is a contraindication to ceftriaxone? A. Gentamicin B. Clindamycin C. Piperacillin D. Sulfamethoxazole-trimethoprim

C. Piperacillin Clients who have a severe allergy to piperacillin, which is a penicillin, can have a cross-sensitivity reaction to ceftriaxone, a third-generation cephalosporin. - Ceftriaxone is contraindicated for a client who has an allergy to cephalosporins or a severe allergy to penicillin. - A, B, & D: Ceftriaxone is not contraindicated for a client who has a severe allergy to gentamicin, clindamycin, or sulfamethoxazole-trimethoprim.

A nurse is assessing a client with rheumatoid arthritis who has been taking high doses of prescribed hydroxychloroquine. Which of the following client statements should indicate to the nurse that the client is experiencing an adverse effect of hydroxychloroquine? A. I have developed sores in my mouth B. I often feel like the room is spinning C. I noticed that the whites of my eyes look yellow D. I have had a change in my vision recently

D. I have had a change in my vision recently The nurse should identify that hydroxychloroquine is an antimalarial medication used to treat rheumatoid arthritis. Clients who take hydroxychloroquine in high doses are at risk for developing retinopathy, which can be irreversible and cause blindness. - A: Methotrexate is a disease-modifying anti rheumatic drug (DMARD) that causes immunosuppression, which decreases manifestations of rheumatoid arthritis. Methotrexate can cause gastrointestinal tract ulceration. - B: Minocycline is a tetracycline antibiotic that can improve the manifestations of rheumatoid arthritis when an infectious etiology is suspected. Clients who are experiencing an adverse effect of minocycline might report dizziness. - C: Leflunomide is an immunosuppressant medication used to slow the progression of rheumatoid arthritis. It is hepatotoxic. Clients should be assessed for manifestations of liver failure, including abdominal pain, dark urine, and jaundice.

A nurse is reviewing the medical record of a client who has been taking a vitamin D supplement. Which of the following findings from the client's record should the nurse identify as a risk factor for developing vitamin D deficiency? A. Middle-age B. Obesity C. Dark-colored eyes D. Light-pigmented skin

B. Obesity The nurse should identify that a client who is obese is at risk for vitamin D deficiency. A screening can be prescribed to determine if a deficiency is present. - A, C, & D: Risk factors for vitamin D deficiency include pregnancy, obesity, and dark-pigmented skin. Older adult clients can be at an increased risk for vitamin D deficiency, not middle-aged clients. Dark-colored eyes are not a risk factor for vitamin D deficiency.

A nurse is caring for a client who has atrial fibrillation and is scheduled for cardioversion. The nurse should anticipate a prescription from the provider for which of the following medications for this procedure? A. Amlodipine B. Diltiazem C. Nifedipine D. Lidocaine

B. Diltiazem The nurse should anticipate a prescription for diltiazem, which blocks calcium channels in the heart and blood vessels, thereby lowering blood pressure. - Also, it is an anti arrhythmic medication that is used during cardioversion to treat atrial fibrillation. - A: Amlodipine is a calcium channel blocker. However, it minimally blocks calcium channels in the heart and is not used to treat arrhythmias. Amlodipine is used to treat hypertension or angina pectoris. - C: Nifedipine is a CCB that minimally blocks calcium channels in the heart and is not used to treat arrhythmias. It is indicated for hypertension or angina pectoris. - D: Lidocaine is an antidysrhythmic medication used to treat ventricular dysrhythmias.

A nurse is providing teaching to a client with tuberculosis who has prescriptions for rifampin and ethambutol. Which of the following findings is an adverse effect of these medications that the client should report to the provider? A. Red-orange discoloration of the urine B. Unexpected weight gain C. Ringing in the ears D. Decreased visual acuity

D. Decreased visual acuity The nurse should identify optic neuritis as an adverse effect of ethambutol. - The nurse should instruct the client to monitor for changes in visual acuity or color identification as indications of optic neuritis to report to the provider. This adverse effect necessitates termination of ethambutol therapy because irreversible blindness can result. - A: The nurse should instruct the client that rifampin commonly causes a red-orange discoloration of body fluids. This adverse effect is considered harmless and does not require reporting to the provider. - B: Anorexia resulting in possible weight loss is an adverse effect of both rifampin and ethambutol. - C: Although low-frequency hearing loss is a potential adverse effect of rifampin, tinnitus is not an adverse effect associated with either of the medications prescribed to this client.

A nurse is teaching a group of nurses about the manifestations of progestin deficiency for clients who take a combination oral contraceptive (OC). Which of the following findings should the nurse include in the teaching as an indication of progestin deficiency? A. Amenorrhea B. Weight gain C. Depression D. Acne

A. Amenorrhea A client who takes a combination OC and has a progestin deficiency can have amenorrhea. Increasing the OC dose of progestin can result in a more regular menstrual cycle. - B: A client who takes a combination OC can experience weight gain due to excess progestin levels that can cause an increased appetite. - C: The client who takes a combination OC can experience depression due to excess progestin levels. - D: A client who takes a combination OC can experience acne due to excess progestin levels that can cause strong androgenic effects.

A nurse is teaching a client who has chemotherapy-induced anemia and a prescription for epoetin alfa. The nurse should instruct the client to report which of the following findings as an adverse effect of epoetin alpha? A. Hypertension B. Leukocytosis C. Bone pain D. Neutropenia

A. Hypertension The nurse should instruct the client to report hypertension, which is an adverse effect of epoetin alfa. Other adverse effects can include headaches, seizures, heart failure, and thromboembolic events related to increased hemoglobin levels. - B & C: Epoetin alfa is a growth factor that is used to stimulate the production of RBCs in the bone marrow. It can cause polycythemia vera, not leukocytosis or bone pain. - D: Clients who are receiving chemotherapy have decreased neutrophil counts as a result of the treatment. Therefore, epoetin alfa is used to stimulate the production of RBCs in the client's bone marrow.

A nurse is caring for a client who has a prescription for subdermal etonogestrel. The nurse should alert the provider about which of the following findings in the client's medical history? A. Takes St. John's wort B. Breastfeeds a 6-month-old infant C. Has a parent with hypertension D. Has a positive human papillomavirus (HPV) test result

A. Takes St. John's wort St. John's wort can reduce the effects of subdermal etonogestrel because it stimulates hepatic drug-metabolizing enzymes. Therefore, the nurse should alert the provider about the client's use of St. John's wort, and it should be discontinued. - B: Subdermal etonogestrel is safe to use during breastfeeding after postpartum day 21 because minimal etonogestrel is excreted in breastmilk. - C: A family history of hypertension is not a contraindication for using subdermal etonogestrel and does not impact the medication's effectiveness. Subdermal etonogestrel can raise the client's blood pressure, but the risk with a low-estrogen preparation is minimal. - D: A positive HPV test result does not impact the effectiveness of the subdermal etonogestrel. A client who is sexually active should also use other contraceptive methods to prevent sexually transmitted infections.

A nurse in a postpartum unit is caring for a client who plans to breastfeed her newborn exclusively. The client has a prescription for depot medroxyprogesterone acetate (DMPA). At which of the following times should the nurse schedule the client to receive the first dose of the medication? A. After 3 months postpartum B. At 6 weeks postpartum C. Within the first 5 days postpartum D. During the first week of the firs postpartum menstrual cycle

B. At 6 weeks postpartum The nurse should tell the client that the first dose should be administered at 6 weeks postpartum if the client is exclusively breastfeeding and after ensuring the client is not pregnant. - A: The second dose is administered 3 months after the first dose. - C: The first dose should be administered within the first 5 days postpartum only if the client is not breastfeeding and after ensuring the client is not pregnant. - D: The first dose should be administered during the first 5 days of a normal menstrual period for a client who is not postpartum and after ensuring the client is not pregnant.

A nurse is caring for a female client who has been taking clomiphene to treat infertility. Which of the following findings should indicate to the nurse that the medication has been effective? A. Decreased serum luteinizing hormone (LH) levels B. Follicular enlargement and conversion to corpus lute after ovulation C. Increased human chorionic gonadotropin (hCG) levels D. Blocked endogenous release of LH and prevention of premature ovulation

B. Follicular enlargement and conversion to corpus lute after ovulation The nurse should identify that clomiphene is a medication that promotes follicular maturation and is used in the treatment of infertility. - Successful treatment reveals progressive follicular enlargement, followed by conversion of the follicle to a corpus luteum after ovulation occurs. - A: Clomiphene increases serum LH and follicular-stimulating hormone (FSH) levels, which cause follicular maturation. - C: Clomiphene promotes follicular maturation. Medications that stimulate ovulation will increase hCG levels. - D: Medications that prevent premature ovulation block the endogenous release of LH. Clomiphene promotes follicular maturation rather than preventing premature ovulation.

A nurse is teaching about levodopa with a family member of a client who has Parkinson's disease. Which of the following pieces of information should the nurse include? A. A full therapeutic response may take several months to happen B. The medication should be taken with high-protein foods C. A full therapeutic response might cause vivid dreams D. The medication is given at the onset of mild symptoms

A. A full therapeutic response may take several months to happen The nurse should inform the family member that although levodopa is the most effective medication for Parkinson's disease, a full therapeutic response might not occur for several months. - B: Amino acids compete with levodopa for intestinal absorption. Therefore, high-protein foods decrease the therapeutic effects of levodopa. - C: Vivid dreams may occur with levodopa as an adverse effect, not as a therapeutic response. - D: Mild symptoms of Parkinson's are usually treated with selegiline, an MAO-B inhibitor. Levodopa is generally prescribed for the management of more severe symptoms.

A nurse is caring for a client who has bronchitis and a prescription for a mucolytic agent. Which of the following findings should the nurse identify as an adverse effect of this type of medication? A. Fluid overload B. Bronchospasm C. Electrolyte imbalance D. Tachycardia

B. Bronchospasm The nurse should identify that bronchospasm is an adverse reaction to a mucolytic agent. Mucolytic agents such as a hypertonic saline solution or acetylcysteine can irritate the airways, resulting in bronchospasm while producing a cough and thinning mucus secretions. - A: A mucolytic agent such as a hypertonic saline solution or acetylcysteine can be used for thinning secretions as well as producing a cough in a client who has an upper respiratory infection. Fluid overload is not an adverse effect of this type of medication. - C: Electrolyte imbalance is not an adverse effect of this type of medication. - D: Some nebulizer medications cause tachycardia, such as beta2-agonist bronchodilators. A mucolytic agent does not cause tachycardia.

A nurse is teaching a client about taking tetracycline PO. Which of the following statements should the nurse include in the teaching? A. Take this medication on a full stomach B. Limit your consumption of dairy products while taking this medicine C. Take the medication with your regular iron supplement D. Take antacids if you have an upset stomach from using tetracycline

B. Limit your consumption of dairy products while taking this medicine The nurse should tell the client to avoid or limit the consumption of dairy products while taking tetracycline. - An interval of at least 2 hours should separate tetracycline ingestion and the ingestion of products that can chelate this medication such as milk or calcium. - A: The nurse should tell the client to take oral tetracycline on an empty stomach 1 hour before meals or 2 hours after. - C: Iron supplements contain chelating agents that interfere with the absorption of tetracycline. The client should take tetracycline at least 1 hour before or two hours after ingestion chelating agents such as iron supplements. - D: The nurse should not recommend taking antacids because most antacids contain metal ions that form non absorbable chelates. This interferes with the absorption of the medication.

A nurse is caring for a client who is receiving bleomycin IV to treat lymphoma. Which of the following assessments is the nurse's priority? A. Pulmonary function B. CBC C. Urinary output D. Peripheral edema

A. Pulmonary function Bleomycin can cause severe lung injury, including pneumonitis and pulmonary fibrosis, which affects a significant percentage of clients receiving this medication. Therefore, pulmonary function is the priority assessment. - B: The client is at risk for CBC changes because bleomycin can cause thrombocytopenia; however, another assessment is the priority. - C: The client is at risk for decreased kidney function; however, another assessment is the priority. - D: The client is at risk for peripheral edema and weight gain due to possible effects on kidney function; however, another assessment is the priority.

A nurse is providing teaching to a newly licensed nurse about administering morphine via IV bolus to a client. Which of the following pieces of information should the nurse include in the teaching? A. Respiratory depression can occur 7 min after the morphine is administered B. The morphine will peak in 10 min C. Withhold the morphine if the client has a respiratory rate of <16/min D. Administer the morphine over 2 min

A. Respiratory depression can occur 7 min after the morphine is administered Respiratory depression can occur within 7 minutes of the administration of IV bolus morphine. The nurse should monitor the client's respirations and have naloxone available to reverse the effects of the morphine. - B: IV morphine peaks in 20 minutes. - C: The nurse should withhold the morphine if the client has a respiratory rate of <12/min. - D: The nurse should administer morphine via IV bolus slowly over 4 to 5 minutes to prevent hypotension and respiratory depression.

A nurse is caring for a client who is taking a prescription for glucocorticoid adrenal replacement medication for the long-term treatment of Addison's disease. Which of the following findings indicates that the client is experiencing an adverse effect of the medication? A. Weight loss B. Hypotension C. Lethargy D. Osteoporosis

D. Osteoporosis Long-term use of steroid medications such as glucocorticoid medication can inhibit bone growth and result in the adverse effect of osteoporosis with long-term treatment. - A: The nurse should identify that long-term treatment with a glucocorticoid can result in weight gain due to sodium and water retention. - B: The nurse should identify that long-term treatment with a glucocorticoid can result in hypertension due to sodium and water retention. - C: The nurse should identify that long-term treatment with a glucocorticoid can result in restlessness, agitation, anxiety, and irritability rather than lethargy.

A nurse is checking a client who is receiving an IV infusion of telavancin for Streptococcus pyogenes. Which of the following actions should the nurse include? A. Check to see if the client's urine is blue in color B. Check the client for pruritus C. Check for hypertension D. Check for numbness in the limbs

B. Check the client for pruritus The nurse should monitor a client who receives telavancin for pruritus, which can occur if the client develops generalized exfoliative dermatitis from infusing the medication too rapidly. - Manifestations of this condition can include flushing, rash, pruritus, urticaria, tachycardia, and hypotension. - A: The nurse should check the client's urine for a foaminess after administering telavancin. Foamy urine is a typical adverse effect of telavancin. The medication does not change the urine to a blue color. - C: The nurse should monitor a client who receives telavancin for hypotension, which can occur if the client develops "red-man syndrome" from infusing the medication too rapidly. This condition includes hypotension, flushing, rash, pruritus, urticaria, and tachycardia. - D: The nurse does not need to check for numbness. Neuropathy is not associated with telavancin.

A nurse is teaching a client who has severe gout and a new prescription for pegloticase. The client has been taking allopurinol for 1 month. Which of the following instructions should the nurse include about pegloticase? A. You will take this medication along with allopurinol B. You will take this medication by mouth C. There are very few adverse effects of this medication D. If you experience a flare-up, you can take an NSAID while receiving this medication

D. If you experience a flare-up, you can take an NSAID while receiving this medication The nurse should instruct this client who has chronic gout that, during the first few months of treatment, an increase in gout manifestations is expected. To reduce the intensity of these manifestations, clients are instructed to take an NSAID such as Naproxen. - A: Allopurinol is the first medication of choice when a client is initially diagnosed with chronic gout. Pegloticase can be prescribed if treatment with allopurinol has been unsuccessful. - B: Pegloticase is administered intravenously. It is a recombinant form of uric oxidase that inhibits the reabsorption of uric acid in clients who have chronic gout. - C: Pegloticase has several severe adverse effects such as anaphylaxis. Manifestations include difficulty breathing, periorbital edema, wheezing, and a rash. Therefore, precautions should be taken such as pre-medicating the client with an antihistamine and reducing the rate of the infusion if necessary.

A nurse is reviewing the medical record for a client who has migraines and a prescription for sumatriptan. Which of the following factors in the client's medical history should the nurse identify as a contraindication to receiving sumatriptan? A. Renal impairment B. Ischemic heart disease C. Severe osteoporosis D. Cirrhosis

B. Ischemic heart disease The nurse should identify that ischemic heart disease is a contraindication to receiving sumatriptan. - Sumatriptan is a serotonin receptor agonist that can cause vasoconstriction and coronary vasospasm. - This medication is also contraindicated in clients who had a myocardial infarction or clients who have coronary artery disease, uncontrolled hypertension, or other types of heart disease. - A: Sumatriptan is excreted by the kidneys. However, renal impairment is not a contraindication to receiving sumatriptan. - C: Sumatriptan does not adversely affect the bones or bone density. Therefore, it is not contraindicated for clients who have severe osteoporosis. - D: Sumatriptan is not contraindicated for clients who have cirrhosis. Although the medication is metabolized by the liver, the metabolism is mainly carried out by monoamine oxidase and excreted through the urine.

A nurse is caring for a client who is experiencing an acute gout attack. The nurse should anticipate a prescription from the provider for which of the following medications? A. Colchicine B. Allopurinol C. Probenecid D. Pegloticase

A. Colchicine The nurse should anticipate a prescription for colchicine because it is the medication of choice for an acute gout attack. - The client can experience relief from the attack within hours of receiving this medication. - Colchicine can also be prescribed for long-term use to prevent future attacks from occurring. - B: Allopurinol is the mediation of choice for clients who have chronic tophaceous gout. Allopurinol acts by lowering the uric acid levels in the blood and reducing the development of new tophus formation, which are nodular masses resulting from increased uric acid levels producing uric crystals. However, it is not used to treat an acute gout attack. - C: Probenecid is not indicated for a client who is experiencing an acute gout attack. This medication acts by lowering the plasma urate levels and increasing the excretion of uric acid in the urine. This can exacerbate an acute gout attack and is indicated once the acute gout attack is controlled. - D: Pegloticase is an intravenous medication used to treat chronic gout that has not responded to the normal treatment. It is not indicated to treat an acute gout attack.

A nurse is teaching a client who has a prescription for a combination oral contraceptive (OC) that uses a 28-day cycle. Which of the following instructions should the nurse include in the teaching? A. If you miss a pill, take the missed pill with your next dose B. If you miss 2 pills during the second and third week, discard the inactive placebo pills and begin a new pack C. If you miss 3 pills during the second week, take a pill as soon as possible and continue with your scheduled doses D. You can miss up to 7 pills with little risk in getting pregnant as long as you have taken the pills regularly for the previous 3 weeks

D. You can miss up to 7 pills with little risk in getting pregnant as long as you have taken the pills regularly for the previous 3 weeks The nurse should instruct this client that up to 7 days can be missed with little or no increase in the chance of getting pregnant, provided that the client took the pills continuously for the previous 3 weeks. - A: The nurse should include in the teaching that taking additional pills with the next dose after missing individual or multiple doses is not recommended or considered safe. - B: With OC products that use a 28-day cycle, the client should take 1 pill as soon as possible if 1 or 2 pills are missed during the second or third week. The client should then continue with the active pills in the pack, skipping the placebo pills. - C: With OC products that use a 28-day cycle, if 3 or more pills are missed during the second or third week, the client should take a pill as soon as possible. The client should then continue with the active pills in the pack and skip the placebo pills before starting a new pack. An additional form of contraception should be also used.

A nurse is caring for a client who takes Ginkgo biloba daily at home. Which of the following effects should the nurse expect from the use of this herbal supplement? A. Decreased platelet aggregation B. Prevention of migraine headaches C. Increased risk of deep-vein thrombosis D. Lowered cholesterol and triglyceride levels

A. Decreased platelet aggregation Ginkgo biloba can decrease platelet aggregation by inhibiting the ability of platelets to clump together. The nurse and the client should discuss the potential increase in bleeding tendencies when taking Ginkgo biloba and other anti platelet aggregates, such as NSAIDs and clopidogrel. - B: Feverfew, not Ginkgo biloba, is used to prevent the onset of migraine headaches. However, feverfew does not help a migraine headache once the headache has developed. Feverfew can also decrease platelet aggregation. - C: Ginkgo biloba can increase the client's risk of bleeding, rather than clotting. Ginkgo biloba decreases platelet aggregation, which decreases the risk of deep-vein thrombosis. - D: Garlic, not Ginkgo biloba, can lower cholesterol and triglyceride levels. Garlic can also decrease platelet aggregation.

A nurse is caring for a client who is receiving sumatriptan for cluster headaches. Which of the following findings should the nurse expect as an adverse effect? A. Hypotension B. Tinnitus C. Urinary retentionterm-12 D. Chest pressure

D. Chest pressure A client who takes sumatriptan can develop sensations of chest pressure and heavy arms. The nurse should monitor the client; if the chest pressure continues, the nurse should notify the provider. - About 50% of clients who take sumatriptan experience chest pressure and heaviness of the arms that are transient and resolve. - A: The nurse should expect the client to have transient hypertension when taking sumatriptan, not hypotension. - B: The nurse should expect the client to have alterations in vision when taking sumatriptan, not tinnitus. - C: The nurse should NOT expect the client to have any urinary problems when taking sumatriptan.

A nurse is caring for a client who is experiencing an acute gout attack. The nurse should anticipate a prescription from the provider for which of the following medications? A. Naproxen B. Pegloticase C. Probenecid D. Allopurinol

A. Naproxen The nurse should anticipate that the provider will prescribed an NSAID such as naproxen. This type of medication is recommended as the first choice of treatment for relieving the manifestations of an acute gout attack. - B: Pegloticase is indicated for IV therapy for clients who have chronic gout and have not responded to oral irate-lowering therapy. Pegloticase is not indicated for an acute gout attack. - C: Probenecid is not indicated for a client who is experiencing an acute gout attack. This medication acts by lowering the client's plasma urate levels and increasing the excretion of uric acid in the urine. This can exacerbate an acute gout attack and is indicated once the acute gout attack has already been controlled. - D: Allopurinol is the medication of choice for clients who have chronic tophaceous gout. Allopurinol acts by lowering uric acid levels in the blood and reducing the development of new trophus formation, which are nodular assess created as a result of increased uric acid levels producing uric crystals. However, this medication is not used for the treatment of an acute gout attack.

A nurse is assessing a client who was recently admitted and has a history of alcohol use disorder. The client displays ataxia, an altered level of consciousness, and nystagmus. Which of the following medications should the nurse anticipate administering to the client? A. Parenteral thiamine B. Niacin extended-release capsules C. Parenteral pyridoxine D. Riboflavin tablets

A. Parenteral thiamine The nurse should identify that a client who has a history of alcohol use disorder and displays ataxia, an altered level of consciousness, and nystagmus is exhibiting manifestations of Wernicke-Korsakoff syndrome due to thiamine deficiency. Therefore, the nurse should anticipate administering parenteral thiamine. - B: Niacin is used to reduce cholesterol levels or correct a deficiency. Therefore, it is not used to treat manifestations of thiamine deficiency. - C: Parenteral pyridoxine is used to treat a vitamin B6 deficiency. Manifestations of a vitamin B6 deficiency include peripheral neuritis and neuropathy, which is a numbness and tingling of the extremities. The client is not exhibiting these manifestations. - D: Riboflavin tablets are used to treat a deficiency of vitamin B2 in its early manifestations, which can cause a sore throat and cracks in the skin at the corners of the mouth. Later manifestations include painful cracks in the lips, inflammation of the tongue, and itchy dermatitis of the scrotum or vulva. The client is not exhibiting these manifestations.

A nurse is caring for a client who has asthma and requires long-term treatment. The nurse should identify that which of the following medications used for long-term treatment places the client at an increased risk of asthma-related death? A. Salmeterol B. Fluticasone C. Budesonide D. Theophylline

A. Salmeterol The nurse should identify that salmeterol is a long-acting beta2-agonist. When this medication is used alone for the long-term treatment of asthma, this class of medication increases the client's risk of asthma-related death. - To decrease this risk, the client should be prescribed both a long-acting beta2-agonist along with an inhaled corticosteroid. - B: Fluticasone is an inhaled corticosteroid used to decrease airway inflammation as a part of the long-term treatment of asthma. The use of this medication for a long period of time does not increase the risk of asthma-related death for the client. - C: Budesonide is an inhaled corticosteroid used to decrease airway inflammation as a part of the long-term treatment of asthma. The use of this medication for a long period of time does not increase the risk of asthma-related death for the client. - D: Theophylline is a bronchodilator that is used to alleviate bronchospasm by relaxing smooth muscle in the bronchi during an asthma attack. The use of this medication for a long period of time does not increase the risk of asthma-related death for the client.

A nurse is preparing to administer levothyroxine to a client who has hypothyroidism. The nurse should identify which of the following laboratory results as supporting the administration of this medication? A. Thyroid-stimulating hormone (TSH) 8 microunits/mL B. Free triiodothyronine (T3) 300 ng/dL C. Free thyroxine (T4) 7 mcg/dL D. Thyroxine-binding globulin 2.3 mg/dL

A. Thyroid-stimulating hormone (TSH) 8 microunits/mL The expected reference range for TSH is 0.3 to 5 microunits/mL. When a client has primary hypothyroidism, the TSH level becomes elevated in an attempt to normalize the thyroid gland's function. - When the client has had a therapeutic response to treatment, the TSH level returns to the expected reference range. - B: T3 is a hormone the thyroid gland produces. Free T3 is a blood test that helps evaluate thyroid function, primarily to diagnose hyperthyroidism. The expected reference range for free T3 for adults up to the age of 50 is 70 to 205 ng/dL. Over the age of 50, it is 40 to 180 ng/dL. With primary hypothyroidism, the level of T3 decreases. - C: T4 is a hormone the thyroid gland produces. Free T4 is a blood test that helps evaluate thyroid function. The expected reference range for T4 is 4 to 12 mcg/dL for adult male clients up to the age of 60. For adult female clients up to the age of 60, it is 5 to 12 mcg/dL. Over the age of 60, it is 5 to 11 mcg/dL. With primary hypothyroidism, the level of T4 decreases. - D: Thyroxine-binding globulin is a thyroid hormone protein carrier that helps evaluate clients who have total T3 and T4 levels outside their respective reference ranges. The expected reference range for thyroxine-binding globulin is 1.7 to 3.6 mg/dL.

A nurse is assisting with a client's laceration repair in which the provider will use both lidocaine and epinephrine. The nurse should inform the client that the epinephrine will perform which of the following actions? A. Act as a catalyst for the anesthetic properties of lidocaine B. Delay systemic absorption of the anesthetic properties of lidocaine C. Open the blood vessels for rapid anesthesia from the lidocaine D. Prevent medication toxicity during the procedure

B. Delay systemic absorption of the anesthetic properties of lidocaine The nurse should inform the client that medications such as lidocaine are often administered in combination with a vasoconstrictor such as epinephrine. Epinephrine decreases local blood flow and delays systemic absorption of the anesthetic property of lidocaine. - A: A catalyst increases the chemical reaction of a substance. Epinephrine acts on blood vessels by constricting them and decreasing blood flow, not by acting as a catalyst. - C: Epinephrine is a vasoconstrictor, which decreases the diameter of the blood vessels. It does not promote rapid anesthesia. - D: Epinephrine can result in decreased risk of toxicity from the lidocaine. However, the absorption of the epinephrine can cause a systemic toxicity. The client should be observed for manifestations such as palpitations, tachycardia, and nervousness.

A nurse is teaching a client who has a new prescription for alosetron. Which of the following client statements indicates an understanding of the teaching? A. Nausea is a common adverse effect of this medication B. I should contact my provider immediately if I experience constipation C. If I do not respond to treatment at the lowest dosage, my provider may continue to increase the dosage at weekly intervals D. Abdominal pain with diarrhea can indicate a serious complication

B. I should contact my provider immediately if I experience constipation The nurse should identify that constipation is an adverse effect of this medication and requires the provider to be notified. - The provider may adjust the dose or withhold the medication and then instruct the client to resume taking is once the constipation has resolved. - A: Nausea is not an adverse effect of this medication. - C: The initial dosage of alosetron is 0.5mg PO twice daily. If the client sees no improvement after a month, the dosage may be increased to 1mg PO twice daily. If there is no improvement following this increase in dosage, it is assumed that this treatment will be ineffective, and the medication will be discontinued. - D: Abdominal pain and diarrhea are primary manifestations of irritable bowel syndrome-diarrhea (IBS-D). A decrease in these manifestations is considered a therapeutic response to alosetron.

A nurse working in a mental health facility is admitting a client with opioid use disorder who is experiencing withdrawal. The nurse should anticipate a prescription for which of the following medications from the provider? A. Methylnaltrexone B. Methadone C. Naloxone D. Hydromorphone

B. Methadone The nurse should anticipate a prescription from the provider for methadone for a client who is experiencing opioid withdrawal. - Methadone is an opioid medication that is used for pain management and treatment of withdrawal manifestations in clients who have opioid use disorder. - A: Methylnaltrexone is an opioid antagonist that is used to treat opioid-induced constipation for clients who have not responded to other laxatives. - C: Naloxone is an opioid antagonist that is used to treat opioid overdose. Naloxone is used cautiously in clients who have opioid use disorder because it can cause acute opioid withdrawal. - D: Hydromorphone is a strong opioid that is used to treat moderate to severe pain.

A nurse is providing teaching to a client who has type 2 diabetes mellitus and a new prescription for metformin. Which of the following adverse effects of metformin should the nurse instruct the client to watch for and report to the provider? A. Weight gain B. Myalgia C. Hypoglycemia D. Severe constipation

B. Myalgia Myalgia, malaise, somnolence, and hyperventilation are manifestations of lactic acidosis, which rarely occur while taking metformin due to the blockage of lactic acid oxidation. - The nurse should instruct the client to report these findings promptly to the provider. - A: Weight loss, rather than weight gain, is a common finding when beginning metformin. Sulfonylurea medications for type 2 diabetes such as glipizide and tolbutamide are likely to cause weight gain. - C: Although metformin lowers blood sugar, taking it in prescribed doses as the sole medication for diabetes does not cause hypoglycemia. Other medications for type 2 diabetes such as sulfonylureas and glitazones can cause severe hypoglycemia and, when used in combination with metformin, might cause this adverse effect. - D: Metformin can cause nausea, vomiting, and diarrhea. Constipation is not an adverse effect of metformin.

A nurse is teaching a client who has persistent cancer pain about the adverse effects of opioids. Which of the following statements should the nurse include in the teaching? A. Opioids do not relieve pain without causing severe adverse effects B. Physical dependence is not the same as addiction C. Tolerance typically means that the medication will no longer be effective D. The most common adverse effect is respiratory depression with prolonged use

B. Physical dependence is not the same as addiction The nurse should explain that physical dependence can occur in all clients who take opioids, and the client may develop abstinence syndrome if the opioid is abruptly withdrawn. - Physical dependence is not the same as addiction, but it can result in addiction. - Addiction results when the opioid is continued despite physical or psychological harm. - A: The nurse should assure the client that when opioids are correctly prescribed and used, they are both safe and effective. - C: The dosage of the medication can increase when tolerance develops. A dosage increase will restore the effectiveness of the medication. - D: The most dangerous adverse effect of opioids is respiratory depression, which is uncommon with prolonged use.

A nurse is providing teaching to a client who has received a liver transplant and has a prescription to transition from cyclosporine to tacrolimus. Which of the following instructions should the nurse include in the teaching? A. Take both medications together for 72 hours and then stop taking the cyclosporine B. Stop taking the cyclosporine for 24 hr and then begin taking the tacrolimus C. Alternate taking the medications for 48 hr and then take only the tacrolimus D. If adverse reactions to the tacrolimus occur, stop taking it and restart the cyclosporine

B. Stop taking the cyclosporine for 24 hr and then begin taking the tacrolimus The nurse should should instruct the client that these medications should not be taken concurrently due to the increased risk of developing nephrotoxicity. The client should stop cyclosporine for 24 hours prior to beginning the tacrolimus prescription. - A: These medications should not be taken concurrently due to the increased risk of nephrotoxicity. - C: The nurse should instruct the client to not alternate between these medications because taking both medications can increase the risk of nephrotoxicity. - D: The nurse should instruct the client to report any adverse reactions to the provider. The client should continue taking tacrolimus unless instructed otherwise by the provider.

A nurse is reviewing the laboratory report for a client who is taking tobramycin and notes that the peak blood level is 9.3 mcg/mL. Which of the following actions should the nurse take? A. Administer half of the prescribed dosage at the client's next scheduled dose B. Tell the client that the medication seems to be appropriate C. Advise the client to drink more water throughout the day D. Ask if the client has been experiencing any peripheral neuropathy

B. Tell the client that the medication seems to be appropriate A therapeutic peak level of 9.3 mcg/mL is within the expected range of 5 to 10 mcg/mL. - The nurse should recognize that this laboratory result indicates the client is receiving a sufficient dose of the medication to promote therapeutic effects and a reduction in the manifestations of infection. - A: The nurse should not alter the medication prescriptions without approval from the provider. Therefore, the nurse should not administer only half of the dose because this is not within the nurse's scope of practice. - C: The therapeutic peak level of 9.3 mcg/mL does not reflect dehydration or inadequate water intake. Therefore, the nurse does not need to make this recommendation. - D: There is no reason for the nurse to suspect the client would be experiencing peripheral neuropathy. The therapeutic peak level of 9.3 mcg/mL does not indicate an alteration of the peripheral nervous system.

A nurse is administering an enteric-coated tablet to a client and explaining the pharmaceutical preparation. Which of the following statements should the nurse make? A. This coated tablet dissolves better in your stomach and intestines B. You are less likely to have an upset stomach with this pill because of the coating on the tablet C. The coating on the tablet improves the absorption of the medication D. The coating on the tablet allows a gradual release of the medication

B. You are less likely to have an upset stomach with this pill because of the coating on the tablet Enteric-coated preparations have an outside coating substance that dissolves in the intestines instead of in the stomach. This protects the medication from acids and enzymes in the stomach and protects the stomach from ingredients in the medication that can cause gastric upset. - A: The nurse should recognize that enteric-coated preparations sometimes fail to dissolve. When this occurs, the client does not get the therapeutic effects of the medication. - C: Absorption varies with enteric-coated preparations due to variations in gastric emptying time. - D: Sustained-release formulations have small spheres of medication with coatings that dissolve at variable rates. Therefore, they release steady amounts of the medication continuously throughout the day.

A nurse is teaching about taking donepezil with a client who was recently diagnosed with early Alzheimer's disease. Which of the following instructions should the nurse include in the teaching? A. You should chew the medication thoroughly prior to swallowing B. You should take this medication late in the evening C. You should take this medication with food D. If you miss taking a dose for a day, take 2 doses the following day

B. You should take this medication late in the evening The nurse should instruct the client to take donepezil late in the evening, just before going to bed. - A: The nurse should instruct the client to swallow donepezil tablets whole and not to crush, split, or chew the tablet because this can increase absorption. - C: Donepezil can be taken with or without food. Gastrointestinal effects such as nausea, vomiting, dyspepsia, and diarrhea might occur with or without food. - D: The nurse should instruct the client that if a dose is missed, the dose should be skipped, and the medication schedule should be resumed the following day.

A nurse is providing teaching to a client who has gout and a new prescription for allopurinol. The nurse should instruct the client to discontinue taking the medication for which of the following adverse effects? A. Nausea B. Metallic taste C. Fever D. Drowsiness

C. Fever A fever can indicate a potentially fatal hypersensitivity reaction. The client should discontinue allopurinol and notify the provider if a fever or rash develops. - A: Mild gastrointestinal adverse effects (e.g. nausea, vomiting, abdominal pain, and diarrhea) can occur with allopurinol. The client should take the medication with food to reduce these effects. - B: Metallic taste is a mild adverse effect of allopurinol. The nurse should inform the client that this can occur and not to discontinue the medication. - D: Drowsiness is mild adverse effect of allopurinol. The nurse should inform the client that this can occur and not to discontinue the medication.

A nurse is caring for a client who was recently diagnosed with Addison's disease and has been placed on long-term mineralocorticoid therapy with fludrocortisone. Which of the following pieces of information should the nurse provide when explaining the purpose of this therapy? A. Mineralocorticoids help the body metabolize carbohydrates, fats, and proteins B. Mineralocorticoids support secondary sexual development C. Mineralocorticoids maintain electrolyte and fluid balance D. Mineralocorticoids reduce the risk of cardiac dysrhythmias

C. Mineralocorticoids maintain electrolyte and fluid balance Mineralocorticoids (specifically aldosterone) are necessary for the regulation of fluid and electrolyte balance (particularly for sodium, potassium, and water). - Addison's disease results in a deficiency of cortisol and aldosterone production and requires supplementation with glucocorticoids and mineralocorticoids. - Fludrocortisone is the only mineralocorticoid available. - A: Glucocorticoids enhance carbohydrate, fat, and protein metabolism. - B: Adrenal androgens have minimal effects on the development of secondary sex characteristics and libido maintenance. - D: Mineralocorticoids, specifically high levels of aldosterone, increase the risk of cardiac dysrhythmias due to the promotion of myocardial fibrosis.

A nurse is teaching the parent of a child who has severe reactive airway disease about glucocorticoid therapy. The parent asks why her child has to inhale the medication instead of taking it orally. Which of the following pieces of information should the nurse provide to the parent? A. Inhaled glucocorticoids are less likely to cause thrush B. Oral glucocorticoids are hazardous during times of stress C. Oral glucocorticoids are more likely to slow linear growth in children D. Inhaled glucocorticoids are more effective for acute bronchospasm

C. Oral glucocorticoids are more likely to slow linear growth in children The chronic use of oral glucocorticoids in high doses by children can result in decreased linear growth. - Inhaled glucocorticoids deliver the anti-inflammatory agent directly to the local target area (the client's airways), resulting in a decreased risk for adrenal suppression. - A: The development of oral candidiasis is among the most common adverse effects of inhaled glucocorticoids. To prevent this, the client should rinse her mouth after inhaling a glucocorticoid. - B: During times of stress (e.g. infection, surgery, trauma), the client will need additional oral glucocorticoids due to adrenal suppression. - D: Inhaled glucocorticoids are not rescue medications. For acute bronchospasm, the client should inhale a bronchodilator.

A nurse is caring for a client at 39 weeks of gestation who has gestational hypertension. The client has a new prescription for misoprostol for cervical ripening and induction of labor. Which of the following findings in the client's medical history should the nurse identify as increasing the client's risk of complications due to the use of this medication? A. Positive bacterial vaginosis culture B. History of failure to progress C. Previous cesarean delivery D. Positive serum Rh sensitization

C. Previous cesarean delivery The nurse should identify that misoprostol is a prostaglandin that promotes cervical ripening. - An adverse effect of misoprostol is uterine tachysystole (excessively frequent uterine contractions). - This medication should be used with extreme caution and is contraindicated in client who have experienced a previous cesarean delivery. - A: While bacterial vaginosis increases the client's risk of preterm labor, this finding alone does not increase the risk of premature delivery when using misoprostol. - B: A history of failure to progress (the inability to dilate fully prior to birth) does not increase the client's risk of premature delivery when using misoprostol. - D: Rh sensitization can occur if the mother is Rh-negative and is pregnant with a baby who is Rh-positive because the mother's immune system creates antibodies to destroy the Rh factor. While this is a serious complication during pregnancy, it does not increase premature delivery risk with the use of misoprostol.

A nurse is preparing a discharge teaching plan for a client who is scheduled to begin long-term oral prednisone for asthma. Which of the following instructions should the nurse include in the plan? A. Stop taking the medication if a rash occurs B. Take the medication on an empty stomach to enhance absorption C. Schedule the medication on alternate days to decrease adverse effects D. Treat shortness of breath with an extra dose of the medication

C. Schedule the medication on alternate days to decrease adverse effects Some of the adverse effects caused by long-term glucocorticoid therapy (e.g. suppression of the adrenal gland) can be avoided by using alternate-day therapy. - A: A rash is not an expected adverse effect of oral glucocorticoids like prednisone. A client should not stop taking prednisone or other glucocorticoids abruptly if taking the medications for more than 10 days. The dosage should be decreased gradually to prevent withdrawal syndrome during long-term therapy. - B: Glucocorticoids can cause significant GI distress and lead to ulcer formation. The client should not take steroids on an empty stomach. - D: Oral glucocorticoids are not used as rescue medications. The client might need a short-acting bronchodilator if acute distress occurs.

A nurse is teaching a client with a new diagnosis of peptic ulcer disease (PUD) who has a prescription for bismuth subsalicylate. The client asks the nurse, "How will the medication help my ulcer?" Which of the following statements should the nurse make? A. This medication will decrease prostaglandins B. The amount of bicarbonate in your body will be increased C. This medication can decrease bacteria in the gastrointestinal tract D. This medication acts by increasing blood flow to the stomach

C. This medication can decrease bacteria in the gastrointestinal tract The nurse should include in the teaching that bismuth subsalicylate can assist by eliminating the bacteria Helicobacter pylori, which can cause PUD. - A: A decrease in prostaglandins can contribute to the progression of PUD. Some medications used to treat PUD increase prostaglandins, which stimulate the secretion of defensive factors such as mucus. Bismuth subsalicylate does not decrease in prostaglandins. - B: A decrease in bicarbonate can contribute to the progression of PUD. Some medications increase bicarbonate, which neutralizes hydrogen ions that might penetrate the mucus layer in the GI tract. Bismuth subsalicylate does not increase the bicarbonate in the client's body. - D: Bismuth subsalicylate does not increase blood flow to the stomach. Some medications used for the treatment of PUD can increase blood flow to the GI tract. With sufficient blood flow, the mucosal integrity of the GI tract is maintained. Decreased blood flow to the GI tract can result in ischemia, leading to vulnerability to acid and pepsin.

A nurse is providing teaching to a client who has a prescription for famotidine to treat a gastric ulcer. Which of the following statements should the nurse include in the teaching? A. This medication is more effective when taken on an empty stomach B. You should take this medication with an antacid for pain control C. This medication is less effective for people who smoke D. You should expect to experience dizziness when taking this medication

C. This medication is less effective for people who smoke The nurse should instruct the client that smoking interferes with the effectiveness of famotidine. - If a client taking famotidine smokes, the nurse should encourage the client to quit smoking or, if unable to quit, to avoid smoking after the last dose of the day. - A: The nurse should instruct the client that food does not affect the absorption of famotidine. Therefore, the client is able to take the medication without regard to food intake. - B: The nurse should instruct the client to take antacids at least 30 to 60 minutes after taking famotidine. - D: The nurse should instruct the client that dizziness is an adverse effect of famotidine and to contact her provider if she experiences this manifestation.

A nurse is teaching a client who has been taking an NSAID to treat rheumatoid arthritis. During the client's first month checkup, the provider prescribed methotrexate to be added to the medication regimen. Which of the following statements should the nurse include in the teaching about the purpose of this change in the client's medication? A. Your current medication was not strong enough to manage this condition B. Once your blood levels of methotrexate are within the therapeutic range, the NSAID will be discontinued C. This medication was added to delay the disease progression D. Treating this disease with 2 medications will help protect you from becoming treatment-resistant

C. This medication was added to delay the disease progression The nurse should inform the client that the provider prescribed methotrexate to be added to the medication regimen along with an NSAID to delay the progression of the disease and to delay joint damage or deformity that can result from the disease. - A: When a medication is no longer effective, the dosage is increased, or the medication is discontinued. - B: Methotrexate does not have to reach a therapeutic range in the client's blood to be effective. However, it is the fastest acting medication in its class and has a therapeutic effect at 3 to 6 weeks. - D: Rheumatoid arthritis is not a disease in which treatment resistance is a concern.

A nurse is providing teaching to a client who has tuberculosis (TB) and a prescription for isoniazid. Which of the following instructions should the nurse include? A. You'll need to take this medication for the rest of your life to prevent recurrence B. Your provider will monitor your thyroid function while you are taking this medication C. You should take this medication on an empty stomach D. You should take this medication with an antacid

C. You should take this medication on an empty stomach The nurse should instruct the client to take isoniazid on an empty stomach to improve absorption of the medication. - To ensure the stomach is empty, the client should take the medication either 1 hour before or 2 hours after a meal. - A: Therapy usually lasts 6 months to 2 years, depending on the type of TB. The nurse should emphasize the need for adherence to the course of treatment for medication effectiveness. - B: The provider will monitor the client's liver function while taking isoniazid due to the risk of hepatotoxicity. - D: The nurse should instruct the client to avoid antacids while taking this medication because antacids decrease the absorption of isoniazid.

A nurse is planning to administer diphenhydramine 50mg via IV bolus to a client who is having an allergic reaction. The client has an IV infusion containing a medication that is incompatible with diphenhydramine in solution. Which of the following actions should the nurse take? A. Choose an IV port for IV bolus injection of diphenhydramine as near as possible to the client's hanging IV bag B. Flush the IV tubing with 2 mL of 0.9 % sodium chloride before and after administering diphenhydramine C. Allow the IV infusion to keep running while administering the diphenhydramine via IV bolus D. Aspirate to check for IV patency before administering diphenhydramine

D. Aspirate to check for IV patency before administering diphenhydramine It is important to confirm IV patency prior to administering an IV bolus. Some medications cause severe tissue damage when inadvertently administered into tissue rather than into a vein. - A: The nurse should choose the injection port that is nearest to the client to administer an IV bolus injection. - B: When IV medications are incompatible in solution, the nurse should flush the IV tubing with 10 mL of 0.9NS before and after administering the diphenhydramine. - C: When medications are incompatible, the infusing IV fluids should be stopped by clamping the IV just above the chosen injection port.

A nurse is providing teaching for a client who has a new prescription for nitroglycerin administered through a transdermal patch. Which of the following client statements indicates an understanding of the teaching? A. I need to wear the patch continuously for it to be effective B. I will stop using the patch immediately if it gives me a headache C. I should change the patch whenever I have chest pain D. I need to rotate the location of my patch every few days

D. I need to rotate the location of my patch every few days The nitroglycerin patch should be rotated to different hairless areas of the client's body every few days to avoid local skin irritation. - A: Nitroglycerin parches should be worn for 12 to 14 hours each day and removed at night so that tolerance to the medication does not develop. A new patch should be placed on the body each morning. - B: A headache is a common adverse effect of nitroglycerin that usually subsides in time. The patch should not be discontinued abruptly because this can lead to cardiac vasospasms. Placing the patch on a lower part of the body right decrease the intensity of the headache. - C: Transdermal nitroglycerin patches have a delayed onset of action. Therefore, they are not applied to treat an ongoing episode of chest pain.

A nurse is providing teaching to a client who has heart failure and is taking spironolactone. Which of the following statements by the client indicates an understanding of the teaching? A. I will increase my intake of citrus fruits, bananas, and potatoes B. I will use salt substitutes on my food C. I will drink as much water as I can while taking this medication D. I will watch for increased breast tissue growth while taking this medication

D. I will watch for increased breast tissue growth while taking this medication Spironolactone, which is derived from steroids, can cause adverse endocrine effects such as gynecomastia, impotence in men, and irregular menses and hirsutism in women. The nurse should instruct the client that these changes can occur. - A: Spironolactone is a potassium-sparing diuretic. Clients taking potassium-sparing diuretics should limit their intake of foods high in potassium due to the risk of hyperkalemia. - B: Clients who are taking potassium-sparing diuretics should not use salt substitutes because they contain potassium and place the client at risk for hyperkalemia. - C: Drinking large amounts of water can cause dilution hyponatremia, which is dangerous when taking spironolactone since electrolyte imbalances, including hyponatremia, are common.

A nurse is administering a prescription for nifedipine to a client who is pregnant. Which of the following pieces of information related to nifedipine should the nurse monitor and document? A. Hypoglycemia B. Uterine ripening C. Increased blood pressure D. Number of uterine contractions

D. Number of uterine contractions A client who is going into preterm labor can have a prescription for nifedipine, which is a calcium channel blocker that inhibits the entry of calcium into myometrial cells, which can delay labor. - A: Nifedipine is a CCB and is not used to lower blood glucose levels in a client who is pregnant. However, an adverse effect of nifedipine is hyperglycemia. - B: Nifedipine is a CCB used to stop preterm labor for at least 48 hours. It does not increase uterine ripening. - C: Nifedipine is a CCB that is used to lower blood pressure if the client is experiencing hypertension. Nifedipine can cause hypotension in a client who is hypovolemic.

A nurse suspects that a client is having an allergic reaction to a medication. Which of the following factors should the nurse identify as increasing the likelihood of an allergic reaction to the medication? A. This is the client's initial dose of the current prescription B. The client received a large dosage C. The route of administration was oral D. The client has had previous exposure to the medication

D. The client has had previous exposure to the medication Once the immune system has developed sensitization to a medication, a subsequent exposure to that same medication can result in an allergic response. The more exposure the client has to the medication, the more intense the reaction will likely be. - A: Since an allergic reaction is an immune response, an initial dosage rarely causes an allergic reaction. - B: The intensity of allergic reaction does not depend on the dosage. As a result, a dose that provokes a strong reaction in a client might trigger a very mild reaction in another client. A client's sensitivity to a medication can also vary with time. A dose that results in a mild reaction soon after starting treatment can provoke an intense reaction with a later dose. - C: While the effects of medication can vary with the route of administration, the oral route is preferable for medication administration. A client can have an allergic reaction following any route of administration.

A nurse is preparing to administer timolol eye drops to a client who has primary open-angle glaucoma (POAG). Prior to administering the medication, the nurse should recognize that which of the following conditions in the client's medical history is a contraindication to receiving this medication? A. Hypertension B. Peripheral vision loss C. Asthma D. Increased intraocular pressure

C. Asthma The nurse should identify that asthma is a contraindication to receiving timolol. - Timolol is a beta-blocker that can cause blocking of the beta2-receptors, causing bronchospasm. - A client who has a history of asthma is a candidate for an alternate medication to treat this condition such as betaxolol. - A: The nurse should identify that hypertension is not a contraindication to receiving timolol. Timolol can also be prescribed to treat hypertension. An adverse effect of this medication can be hypotension. - B: The nurse should identify that peripheral vision loss is a manifestation of POAG, which is progressive optic nerve damage with impairment of the client's peripheral vision. Timolol is a medication that treats this condition. - D: The nurse should identify that intraocular pressure is a manifestation of POAG. Timolol decreases intraocular pressure by reducing the amount of aqueous humor being formed in the anterior chamber of the eye.

A nurse is teaching a client who has primary adrenal insufficiency (Addison's disease) and a prescription for hydrocortisone. Which of the following statements should the nurse include in the teaching about this medication? A. You may need to take a lower dosage when you are ill or experiencing stress B. Take this medication before going to bed because it will make you tired C. Carry a supply of pills and a single-use injectable preparation with you at all times D. You will need to stop this medication before routine procedures such as a colonoscopy

C. Carry a supply of pills and a single-use injectable preparation with you at all times The nurse should tell the client to carry an emergency supply of the medication to take during times of unexpected stress. - The client should carry an adequate supply at all times, which should include an injectable preparation plus a supply equal to the regular oral dosage. The single-use injectable preparation should be administered IM if the client has an emergency and needs an extra dose of the glucocorticoid. - A: The nurse should tell the client to increase the hydrocortisone dosage according to the prescribed guideline for administering supplemental doses of the medication during times of stress. An example of this is the "3 by 3 rule," which requires the client to take 3 times the usual dosage for 3 days. - B: The nurse should tell the client that levels of cortisol secretion naturally peak in the morning, unless the client has an alternate sleep schedule. Therefore, the client should take the medication upon awakening. An alternative is to divide the daily dose, giving 2/3 in the morning and 1/3 in the afternoon around 1600 if a client does experience fatigue in the afternoon or evening. - D: The nurse should tell the client to take a regular dose of the prescribed glucocorticoid on the day of any minor medical procedure. The client should also inform the provider if he is taking hydrocortisone since, in an emergency medical situation resealing in increased stress, additional oral doses or parental therapy might be needed.

A nurse is monitoring a client who received diphenoxylate-atropine. Which of the following statements by the client should indicate to the nurse that the medication has been effective? A. I feel a little drowsy with this medication B. I am not drinking much more water C. I have not had a bowel movement today D. I no longer feel chest tightness

C. I have not had a bowel movement today The nurse should identify that diphenoxylate-atropine is an opioid used to treat diarrhea. The therapeutic response of this medication is a decrease in the frequency of watery stools due to reduced motility of the intestinal lining. - A: Drowsiness is an adverse effect of diphenoxylate-atropine. The nurse should monitor the client closely and verify the dosage if this occurs. Excessive doses can elicit morphine-like subjective effects. If drowsiness continues, the nurse should notify the provider. - B: Dry mouth is an adverse effect of diphenoxylate-atropine. The nurse should offer the client fluids to relive dryness of the mouth. - D: Bronchodilation is not an expected response of diphenoxylate-atropine; however, the atropine component can cause bronchial plugging and stimulate asthma-like manifestations.

A nurse is providing teaching to a client who has postmenopausal osteoporosis and a new prescription for intranasal calcitonin-salmon. Which of the following statements by the client indicates an understanding of the teaching? A. I will administer a spray into each nostril daily B. I should expect nasal bleeding for the first week C. I will need to depress the side arms to activate the pump D. I should expect to take this medication for a short-term course of treatment

C. I will need to depress the side arms to activate the pump The nurse should instruct the client to activate the pump for the initial use by holding the bottle upright and depressing both white side arms toward the bottle 6 times. - A: The nurse should instruct the client to administer calcitonin-salmon to a single nostril daily, alternating nostrils. - B: The nurse should instruct the client that nasal bleeding or ulcerations are indications to discontinue the medication and to notify the provider if nasal bleeding occurs. - D: Calcitonin-salmon is a long-term treatment therapy for postmenopausal osteoporosis. The medication has no documented long-term adverse effects.

A nurse is caring for a client who is at 6 weeks of gestation and has just received a diagnosis of hyperthyroidism. The nurse should anticipate a prescription from the provider for which of the following medications? A. Propylthiouracil B. Liothyronine C. Methimazole D. Iodine-131

A. Propylthiouracil This medication is used to treat hyperthyroidism during the first trimester of pregnancy because it does not cross the placental barrier well, posing little risk to the fetus. - However, methimazole is the preferred medication in the second and third trimesters of pregnancy. - B: This is a synthetic thyroid hormone preparation that treats hypothyroidism, not hyperthyroidism. - C: This medication poses several risks to the fetus during the first trimester, including neonatal and congenital hypothyroidism as well as goiter. - D: This medication is radioactive and is pregnancy risk category X. Pregnancy is a contraindication for receiving this medication.

A nurse on the medical unit is preparing to administer alendronate 40 mg PO for an older adult client who has Paget's disease of the bone. Which of the following actions should be the nurse's priority? A. Administer the medication to the client before breakfast in the morning B. Ambulate the client to a chair prior to administering the medication C. Give the medication to the client with water rather than milk D. Teach the client how to take the medication at home

B. Ambulate the client to a chair prior to administering the medication The nurse should ambulate the client to a chair and ensure that the client is sitting upright before administering the alendronate to prevent esophagitis from occurring. - The client must also be able to sit or stand upright for 30 minutes after taking the medication. - A: The nurse should administer the medication before breakfast in the morning since food can reduce the absorption of alendronate; however, there is another action the nurse should take first. - C: The nurse should administer the medication with water rather than milk since milk and other calcium-containing substances can decrease the client's absorption of alendronate; however, there is another action the nurse should take first. - D: The nurse should teach the client how to take the medication at home after discharge; however, there is another action the nurse should take first.

A nurse is reviewing the medication history of a client who has asthma. Which of the following medication combinations should the nurse identify as incompatible? A. Albuterol and montelukast B. Theophylline and zileuton C. Aminophylline and fluticasone D. Salmeterol and levalbuterol

B. Theophylline and zileuton The nurse should identify that zileuton, a leukotriene modifier, impairs the metabolism of certain medications. Concurrent use of zileuton with theophylline can cause toxicity due to elevated theophylline, which is a systemic methylxanthine used to relax the smooth muscles of the airway. Therefore, these medications are incompatible when used together. - A: Allbuterol is a short-acting beta2-agonist bronchodilator, and montelukast is a leukotriene modifier. These medications are often prescribed together to treat the immediate manifestations of asthma as well as to help prevent asthma attacks. - C: Aminophylline is a systemic methylxanthine that helps decrease smooth muscle contraction, dilating the bronchioles. Fluticasone is an inhaled corticosteroid that decreases airway inflammation. These medications can be administered concurrently without causing additional harm to the client. - D: Salmeterol is a long-acting beta2-agonist bronchodilator, and levalbuterol is a short-acting beta2-agonist bronchodilator. These medications are often prescribed together for both short- and long-term control of asthma manifestations.

A nurse is caring for a client who has diabetes insipidus. Which of the following laboratory values should the nurse identify as reflecting a contraindication to receiving vasopressin to treat this disorder? A. Sodium 152 mEq/L B. Potassium 6.0 mEq/L C. Creatinine clearance 50 mL/min D. Aspartate aminotransferase (AST) 52 units/L

C. Creatinine clearance 50 mL/min Creatinine clearance should be above 87 mL/min for female clients and above 107 mL/min for male clients. - A creatinine clearance of 50 mL/min indicates renal impairment and is a contraindication to receiving vasopressin. Renal impairment increases the likelihood of the life-threatening adverse effect of water intoxication. - A: This sodium level is above the expected reference range of 135-145 mEq/L. This level indicates hypernatremia, which is an expected finding for a client who has diabetes insipidus and is not a contraindication to receiving this medication. - B: This potassium level is above the expected reference range of 3.5-5.0 mEq/L. This level indicates mild hyperkalemia. Although this is a finding that requires attention, it is not a contraindication to receiving this medication. - D: The expected reference range for AST is 0 to 35 units/L. This enzyme is measured as a part of liver function tests. Although this level is elevated, it is not a contraindication to receiving vasopressin.