Pharmacology Practice Test 2019

A client is to receive enoxaparin 30 mg subcutaneously. Available is enoxaparin 40 mg/mL. How many mL should the nurse administer?

0.8 mL

A nurse is reviewing the medical record of a client who has hypertension and a new prescription for metoprolol. Which of the following findings should the nurse further investigate?

A history of left-sided heart failure The nurse should further investigate the client's history of heart failure. Although metoprolol can be used to treat heart failure, it can also cause heart failure, so this medication should be used with great caution with a client who has a history of heart failure. The nurse should teach the client to watch for signs of increasing left-sided heart failure, such as shortness of breath and weight gain indicating fluid retention, and report these findings to the provider.

The nurse is providing dietary teaching for a client who takes furosemide. The nurse should recommend which of the following foods as the best source of potassium?

Bananas The nurse should determine that bananas are the best food source to recommend because 1 cup of bananas contains 806 mg of potassium. In addition to the potassium supplements the provider might prescribe, the client should increase his daily intake of foods that have high potassium content, such as bananas, orange juice, and spinach.

A nurse is teaching a client who is to begin long-term therapy with prednisone to treat RA. The nurse should instruct the client to take which of the following supplements while taking this medication?

Calcium and vitamin D Long-term use of glucocorticoids, such as prednisone, places the client at risk for osteoporosis. The nurse should instruct the client to take calcium and vitamin D supplements to reduce this risk.

A nurse in a provider's office is reviewing the lab results of a client who take furosemide for hypertension. The nurse notes that the client's potassium level is 3.3 mEq/L. The nurse should monitor the client for which of the following complications?

Cardiac dysrhythmias This client's potassium level is below the expected reference range. Hypokalemia can cause a number of cardiac effects including flattened T waves, prominent U waves, and S-T depression.

A nurse is assessing a client with a prescription for methotrexate PO. Which of the following actions should the nurse take when the client reports bleeding gums?

Check the value of the client's current platelet count. The nurse should recognize that the bleeding is likely due to the adverse effect of the chemotherapy and needs to be evaluated further. Bleeding gums is a sign of thrombocytopenia (decreased platelet count) secondary to bone marrow suppression, which can be life-threatening in a client who is receiving chemotherapy.

A nurse is caring for a client who has poison ivy and is prescribed diphenhydramine. Which of the following instructions should the nurse give regarding the adverse effect of dry mouth?

Chew on sugarless gum or suck on hard, sour candies. Clients who report dry mouth can get the most effective relief by sucking on hard candies (especially the sour varieties that stimulate salivation), chewing gum, or rinsing the mouth frequently. It is the local effect of these actions that provides comfort to the client.

The nurse is caring for a client who is has heart failure and a new prescription for furosemide. For which of the following adverse effects should the nurse monitor?

Hypokalemia Hypokalemia is an adverse effect of furosemide.

A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect?

I feel nauseated and have no appetite. Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity.

A nurse is teaching a client who has a new prescription for esomeprazole to manage his GERD. Which of the following statements by the client indicates an understanding of the teaching?

I have an increased risk of getting pneumonia while taking this medication. The client taking esomeprazole is at a greater risk for developing pneumonia due to an elevation of gastric pH, especially during the first few days of treatment. The nurse should instruct the client about manifestations of a respiratory infection and to report these findings to the provider if they occur.

The nurse is planning an educational program on sildenafil to a group of older male clients. Which of the following information should the nurse include in the program?

Ingestion of the medication with nitrates causes hypotension. The nurse should include in the teaching to take nitrates with sildenafil may cause severe hypotension due to the vasodilation effect of each medication and is not recommended.

A nurse is preparing to administer lispro insulin to a client. Which of the following actions should the nurse take?

Inject the insulin 15 min before a meal. The nurse should administer lispro insulin 15 min before a meal, because lispro insulin is rapid-acting insulin that has an onset within 15 to 30 min. The client may develop hypoglycemia quickly if they do not eat.

A nurse is assessing a client who is taking levothyroxine. The nurse should recognize that which of the following findings is a manifestation of overdose?

Insomnia Levothyroxine overdose will result in manifestations of hyperthyroidism, which include insomnia, tachycardia, and hyperthermia.

A nurse is teaching a client who has chronic kidney disease and a new prescription for epoetin alfa. The nurse should instruct the client to increase dietary intake of which of the following substances?

Iron Epoetin alfa is a synthetic form of erythropoietin, a substance produced by the kidneys that stimulates the bone marrow to produce red blood cells. Increased iron is needed for the production of hemoglobin and red blood cells by the bone marrow.

A nurse in a provider's clinic is caring for a client who reports erectile dysfunction and requests a prescription for sildenafil. Which of the following medications currently prescribed for the client is a contraindication?

Isosorbide Clients who are on nitrates including isosorbide and nitroglycerin preparations cannot take sildenafil, because of the serious medication interaction. There is the possibility of sudden death due to hypotension.

A nurse is teaching a client who is taking metronidazole. Which of the following sense alterations should the nurse include as an adverse effect of metronidazole?

Metallic taste Metronidazole is an antiprotozoal medication that treats giardiasis and trichomoniasis. It most common adverse effects are headaches, nausea, dry mouth, and an unpleasant metallic taste in their mouth.

A nurse manager is providing an educations program on antibiotic sensitivity to bacterial infections. The nurse should include in the teaching that vancomycin is indicated for which of the following infections?

Methicillin-resistant Staphylococcus aureus The nurse should teach that vancomycin is sensitive to the infection methicillin-resistant Staphylococcus aureus and Clostridium difficile infections, and should be the antibiotic of choice to treat this organism.

A nurse is caring for a client who receives furosemide to treat heart failure. Which of the following lab values should the nurse monitor for this client?

Potassium Furosemide is a loop diuretic that promotes the excretion of potassium. The nurse should monitor the client's potassium level to watch for hypokalemia.

A nurse in a coronary care unit is admitting a client who has had CPR following a cardiac arrest. The client is receiving lidocaine IV at 2 mg/min. When the client asks the nurse why he is receiving that medication, the nurse should explain that it has which of the following actions?

Prevents dysrhythmias Lidocaine is an antidysrhythmic medication that delays the conduction in the heart and reduces the automaticity of heart tissue.

A nurse is admitting a client who is having an exacerbation of his asthma. When reviewing the provider's orders, the nurse recognizes that clarification is needed for which of the following medications?

Propranolol Medications that block beta-2 receptors, such as propranolol, are contraindicated in clients with asthma.

A nurse is caring for a client who is prescribed warfarin. Which of the following lab values should the nurse monitor for therapeutic effect?

Prothrombin time (PT) This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation.

A nurse is teaching a client who is starting to take alendronate effervescent tablets. Which of the following information should the nurse include?

Sit upright or stand for at least 30 mins after taking this medication. The nurse should instruct the client to sit or stand for 30 minutes after administration of this medication to reduce prolonged contact of the medication with the esophageal mucosa that can cause esophagitis.

A nurse is caring for a client who has streptococcal pneumonia and a prescription for penicillin G by intermittent IV bolus. The client reports he feels dizzy and short of breath. Which of the following actions should the nurse take first?

Stop the infusion When using the airway, breathing, circulation approach to client care, the nurse should place the priority on stopping the infusion. The client is exhibiting signs of penicillin anaphylaxis and the first action that should be taken is to withdraw the medication.

A nurse is caring for a client who has a prescription for digoxin 0.25 mg PO daily. The amount available is digoxin 0.125 mg tab. The client's current vital signs are: blood pressure 144/96, heart rate 54/min, respirations 18/min and temperature 98.6. Which of the following actions should the nurse take?

Withhold the digoxin dose for decreased pulse rate. The nurse should withhold the prescribed dose of digoxin as the heart rate is less than 60/min, and notify the provider.

The nurse is providing discharge teaching to a female client who has neuropathy and a new prescription for gabapentin. Which of the following statements should the nurse include in the teaching?

You may experience drowsiness while taking this medication. The nurse should instruct the client that drowsiness can occur while taking this medication and to exercise caution while performing activities that require alertness.

A nurse is teaching a client who has a new prescription for clopidogrel. Which of the following instructions should the nurse include?

You might have to stop taking this medication 5 days before any planned surgeries. Clopidogrel inhibits platelet aggregation and can cause bleeding. The client should report taking this medication to providers to determine whether to discontinue the medication prior to elective procedures to reduce the risk for bleeding.

A nurse is teaching a client who has a new prescription for codeine. Which of the following instructions should the nurse include in teaching?

You should change positions slowly. The client should change positions slowly to avoid the risk of falls. Codeine is an opioid analgesic that causes CNS depression and orthostatic hypotension.

A nurse in the emergency department is caring for a client who has acute toxicity from acetaminophen overdose. The nurse should prepare to administer which of the following medications?

Acetylcysteine Acetylcysteine is the antidote for acetaminophen. It converts the toxic metabolite to a nontoxic form.

A nurse is assessing an older client who is receiving digoxin. The nurse should recognize that which of the following findings is a manifestation of digoxin toxicity?

Anorexia Anorexia, vomiting, confusion, headache, and vision changes are manifestations of digoxin toxicity.

A nurse is caring for a client who is experiencing status asthmaticus. Which of the following interventions is the priority for the nurse to take?

Administer a short acting B2- agonist (SABA) When using the urgent versus non-urgent approach to client care, the nurse should determine that the priority action is to administer a nebulized high-dose SABA to relieve bronchoconstriction and improve ventilation.

The nurse administers 1 sublingual nitroglycerin tablet. After 5 min, the client states that his chest pain is not a severity of 2. Which of the following actions should the nurse take?

Administer another nitroglycerin tablet. Administration guidelines for sublingual nitroglycerin indicate that it is appropriate to administer another tablet 5 min after the first one if the client is still reporting pain.

A nurse is caring for a client who received an injection of penicillin G procaine. The client begins to experience dyspnea and tongue swelling. Which of the following actions should the nurse perform first?

Administer epinephrine subcutaneously. The priority action the nurse should take when using the airway, breathing, circulation approach to client care is to administer epinephrine. The effect of the epinephrine is to act on adrenergic receptors, causing bronchodilation of the lungs and an elevation of blood pressure. By stimulating both alpha and beta adrenergic receptors to cause these effects, it accomplishes more of the goals of treatment of anaphylaxis than any other single therapy.

A nurse is admitting a client who is at 37 weeks of gestation and has severe gestation hypertension. Which of the following actions should the nurse expect to implement?

Administer magnesium sulfate IV Provide a dark, quiet environment Ensure that calcium gluconate is readily available Magnesium sulfate IV is given as a tocolytic medication for preterm labor to relax smooth muscle of the uterus and as a treatment for preeclampsia. The underlying pathophysiology of preeclampsia is vasospasm. The nurse should closely monitor the client for signs of magnesium toxicity, such as loss of patellar reflexes, respiratory depression, cardiac arrhythmias, cardiac arrest, urinary retention, and serum magnesium levels higher than 8 mEq/L. A dark, quiet environment helps to decrease CNS stimulation, which minimizes the risk of seizures. Calcium gluconate is the antidote for magnesium sulfate and should be readily available when administering magnesium sulfate. The nurse should be prepared to administer the medication in response to manifestations of magnesium toxicity, such as depressed respirations, oliguria, sudden drop in BP, loss of deep-tendon reflexes, and fetal distress.

A nurse is caring for a child who has a prescription for montelukast granules. Which of the following instructions should the nurse provide the parents on administration?

Administer the medication 2 hr before exercise. Montelukast should be given daily during the evening, except when being used for exercise-induced bronchospasm. It should then be given 2 hr before exercise, and not given again for 24 hr.

A nurse in an urgent care center is caring for a client who is having an acute asthma exacerbation. Which of the following actions is the nurse's highest priority?

Administering a nebulized beta-adrenergic The greatest risk to the client's safety is airway obstruction. Beta-adrenergic medications act as bronchodilators. They provide prompt relief of airflow obstruction by relaxing bronchiolar smooth muscle and are the initial priority intervention when a client has an acute asthma exacerbation.

A nurse is teaching a client who has been taking prednisone to treat asthma and a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects?

Adrenocortical insufficiency Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids can suppress production of glucocorticoids, and an abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency.

A nurse assessing a client for hypoxemia during an asthma attack. Which of the following manifestations should the nurse expect?

Agitation The nurse should expect agitation due to neurological changes from poor oxygen exchange.

A nurse is caring for a child who is allergic to penicillin. The nurse should verify which of the following prescriptions with the provider?

Amoxicillin-clavulanate Penicillin is the most common medication allergy. Clients who are allergic to one penicillin medication should be considered allergic to all penicillins, which would include amoxicillin-clavulanate. Reactions may mild or life-threatening.

A nurse is teaching a client who has hypertension and a new prescription for atenolol. Which of the following findings should the nurse include as adverse effects of this medication?

Bradycardia Atenolol is a beta-blocker, which slows the heart rate. The nurse should instruct the client to monitor his pulse rate and report bradycardia.

A nurse is providing teaching to a client who has stable angina and a new prescription for transdermal nitroglycerin. Which of the following instructions should the nurse include?

Apply the patch to a hairless area and rotate. Hair can interfere with the adhesion of the patch. Rotating sites helps prevent skin irritation. Apply a new patch each morning. Therapeutic preventive effects of transdermal nitroglycerin patches begin 30 to 60 min after application and last up to 14 hr. Remove the patch for 10 to 12 hr daily. Removing the patches for 10 to 12 hr each day helps prevent tolerance to the medication.

A nurse is assessing a client after administering IV vancomycin. Which of the following findings is the nurse's priority to report?

Audible inspiratory stridor When using the airway, breathing, circulation approach to client care the nurse determines the priority finding is inspiratory strider. The client is at risk for bronchospasms, hypotension and circulatory collapse due to anaphylaxis. The nurse should contact the rapid response team, discontinue the vancomycin, and administer epinephrine.

A nurse is caring for a client who has active pulmonary TB and is to be started on IV rifampin. The nurse should instruct the client that this medication can cause which of the following adverse effects?

Body secretions turning a red-orange color Rifampin is used in combination with other medicines to treat TB. Rifampin will cause the urine, stool, saliva, sputum, sweat, and tears to turn reddish-orange to reddish-brown.

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

Bologna sandwich Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Bologna has a high tyramine content and should be avoided.

A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide?

Crushing the medication 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 is reviewing the medical record of a client who has been on levothyroxine for several months. Which of the following findings indicates a therapeutic response to the medication?

Decrease in level of TSH. In hypothyroidism, the nonfunctioning thyroid gland is unable to respond to the TSH, and no endogenous thyroid hormones are released. This results in an elevation of the TSH level as the anterior pituitary continues to release the TSH to stimulate the thyroid gland. Administration of exogenous thyroid hormones, such as levothyroxine, turns off this feedback loop, which results in a decreased level of TSH.

A nurse is assessing a client who is receiving IV vancomycin. The nurse notes a flushing of the neck and tachycardia. Which of the following actions should the nurse take?

Decrease the infusion rate on the IV. This client is experiencing Red man syndrome, which includes a flushing of the neck, face, upper body, arms and back along with tachycardia, hypotension and urticaria. This can lead to an anaphylactic reaction if the IV infusion rate is not slowed down to run greater than 1 hour.

A nurse is caring for a client who is taking lisinopril. Which of the following outcomes indicates a therapeutic effect fo the medication?

Decreased blood pressure Lisinopril, an ACE inhibitor, may be used alone or in combination with other antihypertensives in the management of hypertension and congestive heart failure. A therapeutic effect of the medication is a decrease in blood pressure.

A nurse is teaching a client on prednisone. The nurse should inform the client that which of the following is a therapeutic effect?

Decreases inflammation Prednisone is used to treat rheumatoid arthritis because it produces anti-inflammatory and immunosuppressive effects, which reduces inflammation, decreases pain, and increases mobility.

A nurse is teaching a client who has a new prescription for prednisone to treat RA. The nurse should inform the client that which of the following is a therapeutic effect of this medication?

Decreases inflammation Prednisone is used to treat rheumatoid arthritis because it produces anti-inflammatory and immunosuppressive effects, which reduces inflammation, decreases pain, and increases mobility.

A nurse is providing discharge instructions to a client who has asthma and a new prescription for montelukast. The nurse should instruct the client to report which of the following adverse effects?

Depression Montelukast can cause neuropsychiatric effects such as depression, behavior changes, hallucinations, and suicide ideation. The nurse should instruct the client to report such adverse effects. A change in medication might be prescribed.

A nurse is teaching a client who has a new prescription for diazepam. Which of the following information should the nurse include in the teaching?

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

A nurse is teaching a client following a cystoscopy about his new prescription for tamsulosin. Which of the following adverse effects should the nurse include in the teaching?

Dizziness Lightheadedness or dizziness is likely with the first several doses. Clients should be taught to rise slowly and carefully from lying or sitting positions until the sensation disappears.

A nurse is providing teaching to a client who has RA and a new prescription for methotrexate. Which of the following instructions should the nurse include?

Do not drink alcoholic beverages while taking this medication. Report unexplained bruising to the provider. Avoid people who have infections. Alcohol ingestion can increase the risk of liver damage. Methotrexate can cause thrombocytopenia. Clients should report bruising or petechiae as they may indicate a low platelet count. Methotrexate causes bone marrow suppression and increases the risk for infection.

A nurse is providing teaching to a client who has hypertension and a new prescription for captopril. Which of the following instructions should the nurse provide?

Do not use salt substitues while taking this medication. Captopril, an ACE inhibitor, can cause hyperkalemia due to potassium retention by the kidney. The client should avoid salt substitutes, as most of them are high in potassium.

A nurse providing teaching to a client on methotrexate. Which of the following information should the nurse provide?

Drink 2 to 3 L of water per day while on this medication. Methotrexate can cause renal toxicity. Adequate hydration promotes its excretion and helps prevent this adverse effect.

A nurse is providing discharge teaching for a client who has pulmonary edema and is about to start taking furosemide. Which of the following instructions should the nurse include?

Eat foods that contain plenty of potassium. Furosemide, a high-ceiling (loop) diuretic, can cause potassium loss. The client should add potassium-rich foods to his diet, such as nuts, dried fruits, bananas, and citrus fruits.

A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following actions is appropriate?

Evaluating the client for nausea, vomiting, and anorexia. Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity.

A nurse is providing teaching to a client who has hypertension and a new prescription for verapamil. Which of the following beverages should the nurse tell the client to avoid while taking this medication?

Grapefruit juice Grapefruit juice increases blood levels of verapamil, a calcium channel blocker, by inhibiting its metabolism. The excess amount of medication can intensify the medication's hypotensive effects, putting the client at risk for syncope and dizziness.

A nurse is teaching a client who take warfarin daily. Which of the following statements by the client indicates need for further teaching?

I have started taking ginger root to treat my joint stiffness. Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. This statement indicates the client needs further teaching.

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

I may not feel like eating as much. Anorexia and a decreased appetite are adverse effects of paroxetine.

A nurse is reviewing discharge instructions with a client who has RA and a new prescription for prednisone. Which of the following statements by the client indicates an understanding of the teaching?

I should eat more bananas while taking this medication. The nurse should instruct the client to eat more potassium-rich foods such as bananas and citrus fruits while taking this medication. Prednisone can cause a loss of potassium, and the nurse should instruct the about the manifestations of hypokalemia such as muscle weakness and cramping and to notify the provider should these occur.

A nurse is providing teaching to a client who has a new prescription for transdermal nitroglycerin paste. Which of the following statements by the client indicates the need for further teaching?

I should leave the patch in place until it is time for the next dose. Clients should have a period of 10 to 12 hr without the patch on to reduce the risk for nitrate tolerance.

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

I should report a cough to my provider. The client should report a cough to the provider. The provider should discontinue the medication for a persistent, irritating cough.

A nurse is providing teaching to a client who has asthma and new prescriptions for cromolyn and albuterol, both by nebulizer. Which of the following statements by the client indicates understanding of the teaching?

I will be sure to take albuterol before taking the cromolyn. The client should always use the bronchodilator (albuterol) prior to using the leukotriene modifier (cromolyn). Using the bronchodilator first allows the airways to be opened, ensuring that the maximum dose of medication will get to the client's lungs.

A nurse is teaching a client who has diabetes and a new prescription for prednisone. Which of the following statements by the client indicates the need for further teaching?

I will gradually stop the prednisone when ,my rash goes away. The client should discontinue glucocorticoids gradually to reduce the risk for adrenal insufficiency. Manifestations of adrenal insufficiency include nausea, vomiting, confusion, and hypotension.

A nurse is providing teaching to a client who has osteoporosis and a new prescription for alendronate. Which of the following adverse effects should the nurse instruct the client to report to the provider?

Jaw pain Blurred Vision Dysphagia Alendronate can cause osteonecrosis of the jaw, so the client should report this adverse effect to the provider, ocular inflammation, so the client should report vision problems to the provider, and cause esophagitis, so the client should report any difficulty or pain with swallowing.

A nurse is assessing a client who has heart failure and is prescribed furosemide. Which of the following findings is an adverse effect fo this medication?

Leg cramps Leg cramps is a manifestation of hypokalemia, an adverse effect of furosemide. The nurse should assess the client for hypokalemia and monitor the client's potassium level.

A nurse is caring for a client who has TB and new prescriptions for rifampin and pyrazinamide. Which of the following lab tests should the nurse instruct the client will be required while on this medication regimen?

Liver function tests Pyrazinamide and rifampin can both cause hepatotoxicity, thus the provider will monitor liver function regularly.

A nurse is teaching a client who has a new prescription for hydrochlorothiazide. Which of the following instructions should the nurse include?

Monitor for leg cramps Hydrochlorothiazide can cause hypokalemia. The client should monitor for manifestations of hypokalemia, such as fatigue, tachycardia, leg cramps, and muscle weakness.

A nurse is assessing a client who is receiving simvastatin. Which of the following findings should the nurse recognize as a potential adverse effect?

Muscle weakness Myopathy is an adverse effect of this medication. Signs of myopathy include muscle aches, tenderness, and muscle weakness.

A nurse is preparing to administer morphine IV to a client. Which of the following medications should the nurse plan to have available?

Naloxone Naloxone is given to reverse the effects of morphine. Then nurse should monitor the client for respiratory depression, bradycardia, and hypotension.

A nurse is teaching a client who has angina about nitroglycerin sublingual tablets. Which of the following statements should the nurse include in the teaching?

Nitroglycerin dilates cardiac blood vessels to deliver more oxygen to the heart. Nitroglycerin is a nitrate medication that increases collateral blood flow, redistributes blood flow toward the subendocardium, and dilates the coronary arteries.

A nurse is caring for a client who has a serum lithium level of 2.0 mEq/L. Which of the following is the priority action for nurse to take?

Notify the primary provider the result indicates toxicity. The therapeutic reference range for lithium is 0.8-1.4 mEq/L. The nurse should recognize the client could require hospitalization and report the finding to the provider. The nurse should check the client for findings associated with advanced to severe lithium toxicity like vision changes, neurological impairment, and hypotension.

A nurse is teaching a client who has bipolar disorder about lithium. Which of the following statements should the nurse include in the teaching?

Notify your provider if you experience vomiting or diarrhea. Vomiting and diarrhea are both manifestations of lithium toxicity and should be reported to the provider. Vomiting and diarrhea can also cause dehydration, which can result in lithium toxicity.

A nurse is administering morphine 2 mg IV every 2 to 4 hr to a client who has an abdominal incision. The nurse should monitor the client for which of the following adverse effects?

Orthostatic hypotension The nurse should monitor the client for orthostatic hypotension and encourage the client to rise or change position slowly to decrease the risk for falls.

A nurse is reviewing laboratory results of a client who has atrial fibrillation and is taking warfarin. For which of the following results should the nurse notify the provider?

PT 45 seconds The expected reference range for PT is 11 to 12.5 seconds. During therapy, the nurse should expect to see the values increase 1.5 to 2.5 times the baseline. Therefore, the nurse should withhold the warfarin and notify the provider.

A nurse is caring for an adolescent client who has a long history of diabetes mellitus and is being admitted to the emergency department confused, flushed, and with an acetone odor of breath. Diabetic ketoacidocis is suspected. The nurse should anticipate using which of the following types of insulin to treat this client?

Regular insulin Regular insulin is classified as a short-acting insulin. It can be given intravenously with an onset of action of less than 30 min. This is the insulin that is most appropriate in emergency situations of severe hyperglycemia or diabetic ketoacidosis.

A nurse is monitoring a client who received epinephrine for angioedema after a first dose of losartan. Which of the following data indicates a therapeutic response to the epinephrine?

Respirations are unlabored. Losartan is an angiotensin receptor blocker (ARB). Both ARBs and angiotensin converting enzyme (ACE) inhibitors have the adverse effect of angioedema. The primary symptom of angioedema is swelling of the tongue, glottis, and pharynx. This results in limitation or blockage of the airway. Angioedema causes the capillaries to become more permeable, resulting in fluid shifting into the subcutaneous tissues. Although the mouth and throat are most often affected, any area may be involved in the process. Untreated, angioedema can result in death. Improvement of respiratory effort following the administration of epinephrine is the most important therapeutic indicator.

A nurse is assessing a client prior to administration of morphine. The nurse should recognize that which of the following assessments is the priority?

Respiratory rate When using the airway, breathing, circulation approach to client care, the nurse should determine the priority assessment is respiratory rate. Morphine can cause respiratory depression. The nurse should withhold the medication and notify the prescriber if the client has a respiratory rate less than 12/min.

A nurse is assessing a client 15 min after administering morphine sulfate 2 mg via IV push. The nurse should identify which of the following findings as an adverse effect?

Respiratory rate 8/min A respiratory rate of 8/min represents an adverse effect of the morphine and the nurse should notify the provider. Expected respiratory rate is 12/min or greater.

A nurse is providing teaching to a client who has asthma and a new prescription for inhaled beclomethasone. Which of the following instructions should the nurse provide?

Rinse the mouth after administration. Use of glucocorticoids by metered dose inhaler can allow a fungal overgrowth in the mouth. Rinsing the mouth after administration can lessen the likelihood of this complication.

A nurse is providing teaching to a client with a new prescription for phenelzine. The nurse should instruct the client to avoid which of the following foods when taking this medication?

Salami Aged foods, such as hard cheeses and meats, salami, and air-dried sausage should be avoided when taking an oral MAOI such as phenelzine.

A nurse is teaching a client about diphenhydramine. The nurse should explain to the client that which of the following is an adverse effect of this medication?

Sedation Diphenhydramine can cause sedation. It is used to treat rhinitis, allergies, and insomnia.

A nurse is teaching a client who has a new diagnosis of Type 1 diabetes about self-administration of insulin. Which of the following instructions should the nurse include?

Store the current bottle of insulin at room temperature. The nurse should instruct the client to keep the bottle of insulin she is currently using at room temperature to minimize painful injections. The client should refrigerate unused bottles of insulin to protect the quality of the medication.

A nurse is assessing a client who is taking lisinopril to treat hypertension. Which of the following findings is a priority to report?

Swelling of the tongue When using the urgent vs non-urgent approach to client care, the nurse determines that the priority finding is swelling of the tongue, which is a manifestation of angioedema. The nurse should withhold the medication and notify the provider immediately if the client reports swelling of the tongue or throat. Other manifestations include giant wheals and edema of the tongue, glottis, and pharynx. Severe reactions are treated with subcutaneous epinephrine. If angioedema develops, ACE inhibitors are discontinued.

A nurse is teaching the family of a client who has Alzheimer's disease about donepezil. Which of the following information should the nurse include in the teaching?

Syncope episodes may occur when taking this medication. The nurse should inform the family to monitor for syncope, which places the client at risk for falling.

A nurse is teaching a client who is about to start therapy with SL nitroglycerin tablets. The nurse should include which of the following instructions regarding how to take the medication?

Take one tablet at the first indication of chest pain. The client should take nitroglycerin as soon as he feels pain, pressure, or tightness in his chest and not wait until his chest pain is severe.

A nurse is caring for a client who is to start therapy with ibuprofen for hip pain. Which of the following information should the nurse provide?

Take the medication with food. To minimize gastric irritation, the nurse should instruct the client to take ibuprofen with food, water, or milk.

A nurse is providing teaching for a client who has anemia and a new prescription for ferrous sulfate liquid. Which of the following instructions should the nurse provide?

Take the medication with orange juice to enhance absorption. Ascorbic acid (vitamin C), which is found in orange juice, will enhance the absorption of iron and increase its bioavailability. This will also help to decrease the gastrointestinal side effects of iron.

A nurse receives a call from a client who is prescribed oral contraceptives but forgot to take one dose. The client reports she is in the first week of a 28-day cycle pack. Which of the following instructions should the nurse provide?

Take the missed dose now, then continue the medication as ordered. The nurse should tell the client to take the missed dose immediately, then continue with the pack as ordered. The nurse should also tell the client to use an additional form of contraception for 7 days.

A nurse is providing teaching to a client who is taking warfarin about monitoring its therapeutic effect. Which of the following explanations should the nurse provide about the INR test?

The INR is a standardized test that eliminates the variations between laboratories reports in prothrombin times.

A nurse is observing a LPN preparing to administer a 2 mL penicillin G injection to a client. Which of the following actions by the LPN require intervention by the nurse?

The LPN plans to inject the needle 5.08 cm (2 in) below the acromion process. This is the correct insertion site for an IM injection into the deltoid muscle; however, 2 mL of penicillin G should be injected deep into a large muscle. The deltoid is a small muscle and would not be an appropriate site of administration. Instead, this medication should be administered in the ventrogluteal muscle.

A hospice nurse is caring for a client who has terminal cancer and take PO morphine for pain relief. The client reports that he had to increase the dose of morphine this week to obtain pain relief. Which of the following scenarios should the nurse document as the explanation for this situation?

The client developed a tolerance to the medication. The nurse should document that the client has developed a tolerance to the medication. Morphine is a narcotic analgesic used for the treatment of severe pain. Tolerance is an adverse effect of narcotic analgesics in which a larger dose is needed to produce the same response.

A nurse is reviewing the health history for a client who has angina pectoris and a prescription for propranolol hydrochloride PO 40 mg twice daily. Which of the following findings in the history should the nurse report to the provider?

The client has a history of bronchial asthma. Beta-adrenergic blockers can cause bronchospasm in clients who have bronchial asthma; therefore, this is a contraindication to its use and should be reported to the provider.

A nurse is teaching a client who has asthma about how to use an albuterol inhaler. Which of the following actions by the client indicates an understanding of the teaching?

The client holds his breath for 10 seconds after inhaling the medication. The medication should be retained in the lungs for a minimum of 10 seconds so the maximum amount of the dosage can be delivered properly to the airways. To use the inhaler, the client exhales normally just prior to releasing the medication, inhales deeply as the medication is released, then holds the medication in the lungs for approximately 10 seconds prior to exhaling.

A nurse is providing discharge teaching to a client who has bipolar disorder and will be discharged with a prescription for lithium. The nurse should teach the client that which of the following factors puts her at risk for toxicity?

The client runs 4 miles outdoors every afternoon. Strenuous exercise in outdoor heat, which can lead to dehydration, puts the client at risk for lithium toxicity. Mild to moderate exercise will not lead to lithium toxicity, but if the client engages in strenuous exercise during hot weather, she should take care to replace any water and sodium that have been lost through profuse sweating. This also applies to other factors that can cause the client to become dehydrated, such as having diarrhea or taking diuretics.

A nurse is completing a medical interview with a client who has elevated cholesterol levels and take warfarin. The nurse should recognize that which of the following actions by the client can potentiate the effects of warfarin?

The client uses garlic to lower cholesterol levels. The nurse should recognize that garlic can potentiate the action of the warfarin.

A nurse is caring for a client who is receiving therapy with epoetin alfa. Which of the following lab results should the nurse review for an indication of a therapeutic effect?

The hematocrit (Hct) Epoetin alfa is an antianemic medication that is indicated in the treatment of clients who have anemia due to reduced production of endogenous erythropoietin, which may occur in clients who have end-stage renal disease or myelosuppression from chemotherapy. The therapeutic effect of epoetin alfa is enhanced red blood cell production, which is reflected in an increased RBC, Hgb, and Hct.

A nurse reviews the lab report for a client who is receiving lithium three times daily PO. The client's current blood lithium is 1.8 mEq/L. The nurse identifies that this lab value indicates which of the following?

The lithium level is at the toxic level. A blood lithium level greater than 1.5 mEq/L indicates toxicity. The nurse should monitor the client for GI manifestations, coarse hand tremor, confusion, drowsiness, and should withhold the lithium and notify the provider. A therapeutic initial blood level of lithium is 0.8 to 1.4 mEq/L. Blood levels for lithium maintenance should be between 0.4 and 1.3 mEq/L.

A nurse is caring for a client who asks how albuterol helps with breathing.

The medication will prevent wheezing, open the airways, and decrease coughing episodes. Albuterol promotes bronchodilation. The primary purpose is to provide rapid relief of bronchoconstriction, thus opening the airway and improving oxygenation. Coughing is often an early indicator of bronchospasm. Albuterol provides a rapid response to relax smooth muscle and reduce bronchoconstriction, which will decrease coughing.

A nurse is caring for a client who has bipolar disorder and has been taking lithium for 1 year. Before administering the medication, the nurse should check to see which of the following tests have been completed?

Thyroid hormone assay Thyroid testing is important because long-term use of lithium may lead to thyroid dysfunction.

A nurse is providing discharge teaching to a client who has pulmonary TB and a new prescription for rifampin. Which of the following information should the nurse provide?

Urine and other secretions might turn orange. Rifampin might turn the urine and other secretions reddish-orange. This includes sputum, tears, and sweat.

A nurse is providing discharge teaching for a client who has a new prescription for warfarin. Which of the following instructions should the nurse include in the teaching?

Use an electric razor while on this medication. Warfarin, an anticoagulant, increases the client's risk for bleeding. The nurse should teach the client safety measures, such as using an electric razor, to decrease the risk for injury and bleeding.

A nurse is caring for a client who is on warfarin. The client's INR is 5.2. Which of the following medications should the nurse prepare to administer?

Vitamin K Vitamin K reverses the effects of warfarin.

A nurse is monitoring a client who took an overdose of acetaminophen. Which of the following findings is a manifestation of acetaminophen poisoning?

Vomiting The nurse should expect a client who has acetaminophen poisoning to have early manifestations of nausea, vomiting, abdominal distress, diarrhea, and sweating.

A nurse is teaching a client with a prescription of lithium to recognize for toxicity. Which of the following statements by the client indicates understanding?

Vomiting is an indication of toxicity. Since vomiting and diarrhea are early signs of lithium toxicity, the client should omit the next dose of lithium and call the provider.

A nurse is caring for a client who has DVT and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make?

Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level. Heparin and warfarin are both anticoagulants that decrease the clotting ability of the blood and help prevent thrombosis formation in the blood vessels. However, these medications work in different ways to achieve therapeutic coagulation and must be given together until therapeutic levels of anticoagulation can be achieved by warfarin alone, which is usually within 1 to 5 days. When the client's PT and INR are within therapeutic range, the heparin can be discontinued.