Respiratory & cardiac pharmacology ATI

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." ✔ Correct answer DD. "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 nurse is caring for a client who has a vitamin K deficiency. Which of the following manifestations should the nurse expect? A. Irregular bone formation B. Abnormal movements C. Blurred vision D. Excessive bruising

D. Excessive bruising The nurse should identify that excessive bruising can indicate bleeding under the skin. Vitamin K is needed by clotting factors to coagulate the blood. Therefore, a client who has a deficiency in vitamin K is at risk for excessive bruising and bleeding.

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.

A nurse is caring for a client who is developing acute pulmonary edema and has a new prescription for furosemide 40 mg IV bolus. The nurse should plan to administer the medication using which of the following methods? A. Undiluted administered over 2 min B. Diluted administered over 20 min C. Undiluted administered as rapidly as possible D. Diluted administered over 5 min

A. Undiluted administered over 2 min The nurse should plan to administer low-dose furosemide therapy (e.g. 40 mg undiluted via IV bolus) at a rate of 20 mg/min or a dose of 40 mg over 2 min.

A nurse is caring for a client who is receiving continuous cardiac monitoring. Which of the following medications should the nurse anticipate administering to treat atrial fibrillation? A. Atropine B. Diltiazem C. Epinephrine D. Phenytoin

B. Diltiazem Diltiazem, a calcium channel blocker, is used to slow the ventricular rate in atrial fibrillation or flutter. Diltiazem is also prescribed to treat hypertension, angina, and other supraventricular tachyarrhythmias.

A nurse is providing teaching to a client who has a new prescription for sertraline. The client asks the nurse if he should continue to take St. John's wort for depression. Which of the following instructions should the nurse give the client? A. Take the medication and herbal supplement together. B. Stop taking the herbal supplement while taking the medication. C. Take the herbal supplement and the medication at least 2 hr apart. D. Take an antacid with both the herbal supplement and the medication.

B. Stop taking the herbal supplement while taking the medication. Taking the antidepressant sertraline and the herbal supplement St. John's wort increases the client's risk of serotonin syndrome.

A nurse is providing teaching to a client who has hypertension and a new prescription for oral clonidine. Which of the following instructions should the nurse include in the teaching? A. Discontinue the medication if a rash develops. B. Expect increased salivation during the first few weeks of therapy. C. Minimize fiber intake to prevent diarrhea. D. Avoid driving until the client's reaction to the medication is known.

D. Avoid driving until the client's reaction to the medication is known. Clonidine can cause drowsiness, weakness, sedation, and other CNS effects. Until the client's response to the medication is known, the nurse should instruct the client to avoid driving or handling other potentially hazardous equipment. Over time, these effects are likely to decrease.

A nurse is reviewing a new prescription for fexofenadine for a 7-year-old client who has seasonal allergies. Which of the following findings should the nurse clarify with the provider? A.The prescription says to avoid taking the medication with orange juice. B.The prescription says to take standard tablets. C.The prescription says to take 30 mg twice daily D.The prescription says to administer the medicine orally.

B.The prescription says to take standard tablets.

A nurse is administering oral hydroxyzine to a client. Which of the following adverse effects should the nurse instruct the client to expect? A. Diarrhea B. Anxiety C. Nausea and vomiting D. Dry mouth

D. Dry mouth Hydroxyzine has anticholinergic properties. Dry mouth is a common adverse effect of this medication. The nurse should instruct the client to take sips of water or suck hard candies to minimize this effect.

A nurse is providing teaching to a parent of a child who has asthma and a new prescription for a cromolyn sodium metered-dose inhaler. Which of the following statements by the parent indicates the need for further teaching? A. "I will give my child a dose as soon as wheezing starts." B. "My child should rinse out his mouth after using the inhaler." C. "My child should exhale completely before placing the inhaler in his mouth." D. "If my child has difficulty breathing in the dose, a spacer can be used."

A. "I will give my child a dose as soon as wheezing starts." Cromolyn is a mast cell inhibitor that has a slow onset and is given for prophylactic treatment of asthma. It is not a rescue medication.

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 antiplatelet aggregates, such as NSAIDs and clopidogrel.

A nurse is preparing to administer an IM injection for a client. Which of the following factors should the nurse identify as a potential contraindication to administering the medication via the IM route? A. The medication is a depot preparation. B. The client is taking an anticoagulant. C. The medication is a particulate suspension. D. The client has been vomiting.

B. The client is taking an anticoagulant. Because of the risk of bleeding from the injection site, anticoagulant therapy (e.g. warfarin) is a contraindication to receiving medications via the IM route.

A nurse is caring for a client who has COPD and has been taking fluticasone via inhaler for many years. Which of the following findings should the nurse identify as an adverse effect of long-term use of this medication? A. Glomerular filtration rate (GFR) <60 B. Alanine aminotransferase (ALT) 82 units/L C. Anorexia and weakness D. Varicose veins in the lower extremities

C. Anorexia and weakness The nurse should identify adrenal insufficiency as an adverse effect of the long-term use of an inhaled corticosteroid such as fluticasone. Manifestations can include anorexia, weakness, nausea, hypotension, and hypoglycemia

A nurse is providing discharge teaching for a client who has a new prescription for metoprolol.Which of the following instructions should the nurse include? (Select all that apply). A."Do not stop taking this medication abruptly." B."Take the medication right before bedtime. C."Avoid exposure to sunlight". D."Count your rapid pulse daily". E."Change positions slowly."

A."Do not stop taking this medication abruptly." D."Count your rapid pulse daily". E."Change positions slowly."

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 nurse is proving teaching to a client about a new prescription for captopril to treat hypertension. Which of the following client statements indicates an understanding of the teaching? A. "I might have a sore throat that will go away after a few days" B. "I will take this medication with food to avoid getting an upset stomach" C. "I might feel dizzy at times while taking the his medication" D. "I will take ibuprofen if I get a fever while taking this medication"

C. "I might feel dizzy at times while taking the his medication" Hypotension and dizziness are potential adverse effects of this medication. The nurse should monitor the clients blood pressure and instruct the client to change positions slowly.

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.

A nurse is reviewing the medication history of a client who has mild intermittent asthma. The nurse should anticipate a prescription for which of the following inhalers for the client? A. Ipratropium B. Albuterol sulfate C. Tiotropium D. Budesonide

B. Albuterol sulfate The nurse should anticipate a client who has mild intermittent asthma to be prescribed albuterol sulfate. Albuterol sulfate is a short-acting beta2-agonist that activates beta2-receptors in the smooth muscle of the lung, allowing the client's airway and lungs to dilate, thereby relieving bronchospasm and allowing the client to breathe.

A nurse is caring for a client who has heart failure and is taking oral furosemide 40 mg daily. For which of the following adverse effects should the client be taught to monitor and notify the provider if it occurs? A. Nasal congestion B. Tremors C. Tinnitus D. Frontal headache

C. Tinnitus Loop diuretics such as furosemide can cause ototoxicity. The client should be taught to notify the provider if tinnitus, a full feeling in the ears, or hearing loss occurs.

A nurse is assessing a client who is experiencing chest pain. Which of the following medications should the nurse expect to administer to suppress the aggregation of platelets? A. Nitroglycerin ✔ Correct answer BB. Aspirin C. Morphine D. Metoprolol

B. Aspirin Aspirin suppresses platelet aggregation, producing an immediate antithrombotic effect. The client should chew the first dose of aspirin to allow rapid absorption.

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 nurse is reviewing the laboratory values of a client who is receiving a continuous IV heparin infusion and has an aPTT of 90 sec. Which of the following actions should the nurse prepare to take? A. Administer vitamin K B. Reduce the infusion rate C. Give the client a low-dose aspirin D. Request an INR

B. Reduce the infusion rate An aPTT of 90 seconds is outside the expected reference range of 60 to 80 seconds, which can cause anticoagulation. The nurse should contact the provider, reduce the infusion rate, and assess the client for bleeding.

A nurse is caring for a client who is taking fludrocortisone. Which of the following findings indicates to the nurse that the client is experiencing an adverse effect of the medication? A. Hypotension B. Weight loss C. Hypokalemia D. Anorexia

C. Hypokalemia The nurse should identify that hypokalemia is an adverse effect of fludrocortisone due to excessive sodium and water retention, resulting in the loss of excessive amounts of potassium.

A nurse is providing teaching to a client who has a new prescription for hydrochlorothiazide 50 mg PO daily to treat hypertension. Which of the following instructions should the nurse include in the teaching? A. "Take hydrochlorothiazide as needed for edema." B. "Check your weight once each week." C. "Take hydrochlorothiazide on an empty stomach." D. "Take hydrochlorothiazide in the morning."

D. "Take hydrochlorothiazide in the morning." The client should take hydrochlorothiazide in the morning to allow for diuresis during the day and to prevent nocturia.

A nurse is preparing to administer a sublingual nitroglycerin tablet to a client who is reporting chest pain. For which of the following adverse effects should the nurse monitor after giving this medication? A. Hypotension B. Myalgia C. Diarrhea D. Ototoxicity

A. Hypotension Nitroglycerin is a coronary vasodilator and antianginal agent. A major adverse effect of this medication is hypotension; therefore, blood pressure and pulse must be monitored before and after administration.

A nurse is teaching a client with chronic asthma who has a new prescription for cromolyn. Which of the following instructions should the nurse include in the teaching? A. "Use the inhaler just before exercise." B. "The medication's therapeutic effects can take up to several weeks to develop." C. "You will shake the medication container for 3 seconds." D. "You will need to exhale slowly after you inhale."

B. "The medication's therapeutic effects can take up to several weeks to develop." The nurse should include in the teaching that the therapeutic effects of cromolyn can take up to several weeks to develop.

A nurse is caring for a client who reports crushing chest pain. The nurse reviews the client's ECG results and notes ST changes. Which of the following medications should the nurse administer? A. Simvastatin B. Furosemide C. Nitroglycerin D. Sildenafil

C. Nitroglycerin The nurse should identify the need to administer nitroglycerin, which is used to treat angina. Nitroglycerin acts directly on vascular smooth muscle to promote vasodilation

A nurse is caring for a client who has severe asthma and allergic rhinitis. The client is taking theophylline. Which of the following medications should the nurse identify as being incompatible with theophylline? A. Cromolyn B. Albuterol C. Zafirlukast D. Methylprednisolone

C. Zafirlukast

A nurse is providing discharge teaching to a client who has a bacterial infection about adverse effects of imipenem to report to the provider. Which of the following pieces of information should the nurse include? A. "Seizures can occur with this medication." B. "You should observe for manifestations of bleeding." C. "Check your hands and feet for sensory dysfunction." D. "This medication can increase the risk of ototoxicity."

A. "Seizures can occur with this medication." The nurse should tell the client that seizures can occur when receiving imipenem. The client should notify the provider immediately if these occur.

A nurse is administering subcutaneous heparin to a client who is at risk for deep vein thrombosis. Which of the following actions should the nurse take? A. Administer the medication into the client's abdomen B. Inject the medication into a muscle C. Massage the site after administering the medication D. Use a 22-gauge needle to administer the medication

A. Administer the medication into the client's abdomen The heparin should be administered into the client's abdomen.

A nurse is preparing to administer an epinephrine IV bolus to a client. Which of the following should the nurse verify before initiating the IV medication? A. Concentration of the formulation B. Reversibility of the medication C. Potential barriers to absorption D. Gastric emptying time

A. Concentration of the formulation The nurse should verify the concentration of the formulation of the medication prior to administration. Epinephrine can be injected through several routes, and a solution prepared for use by a certain route can differ in concentration from others. Solutions intended for subcutaneous administration are generally concentrated, whereas solutions intended for intravenous use are dilute. If a solution prepared for subcutaneous administration is administered intravenously, the result could be fatal because intravenous administration of concentrated epinephrine can overstimulate the heart and blood vessels, causing severe hypertension, cerebral hemorrhage, stroke, and death.

A nurse is providing teaching about benzodiazepines to a client who is discontinuing long-term alprazolam use. Which of the following pieces of information should the nurse include in the teaching? A. "You might experience somnolence." B. "Plan to taper the dose slowly over several months." C. "Call the provider if you have muscle weakness." D. "Confusion is common during this process."

B. "Plan to taper the dose slowly over several months." The nurse should instruct the client to plan to taper the alprazolam dose slowly over several weeks or months to ease the physiological and psychological manifestations of withdrawal.

A nurse is caring for a client who is taking an agonist medication. The nurse should expect which of the following actions from this type of medication? A. Acts with a partial agonist molecule to block receptors fully B. Temporarily occupies receptors instead of other competitive molecules C. Blocks receptors and prevents them from activating with a regulatory molecule D. Binds to receptors and mimics regulatory molecules

D. Binds to receptors and mimics regulatory molecules Full agonist medications act by binding to receptors and mimicking the actions of the body's regulatory molecules. Agonists activate receptors to produce the expected effects. Hormones are an example of agonists.

A nurse is teaching to 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.

A nurse is providing teaching about sodium phosphate to a client who has a new prescription for sodium phosphate. The client is scheduled for a colonoscopy and is currently taking furosemide for hypertension. Which of the following client statements should indicate to the nurse that the teaching has been effective? A. "I can take my water pill as prescribed." B. "I can experience an imbalance in my electrolytes from this medication." C. "I should drink 8 ounces of bowel cleanser every 10 minutes until I drink a total of 4 liters." D. "I can experience rebound constipation after using this medication."

B. "I can experience an imbalance in my electrolytes from this medication." Sodium phosphate can cause excess fluid loss as a result of cleansing the bowel of stool. Therefore, the client is at risk for electrolyte imbalance and should be monitored closely.

A nurse is caring for a client who is in preterm labor and has a new prescription for nifedipine. The client states she is concerned because her father takes nifedipine for his angina pectoris. The nurse should explain that nifedipine works for clients who are pregnant through which of the following mechanisms? A. It decreases the incidence of bacterial vaginosis, thus preventing uterine contractions. B. It inhibits uterine contractions by blocking the entry of calcium into uterine cells. C. It decreases activity within the CNS, which regulates all smooth muscle. D. It stimulates beta-2 receptors in the uterus, which decreases the frequency of contractions.

B. It inhibits uterine contractions by blocking the entry of calcium into uterine cells. Nifedipine, a calcium channel blocker, causes uterine relaxation by blocking the flow of calcium to the myometrial cells of the uterus.

A nurse is providing teaching to a client about a new prescription for captopril to treat hypertension. Which of the following client statements indicates an understanding of the teaching? A. "I might have a sore throat that will go away after a few days." B. "I will take this medication with food to avoid getting an upset stomach." C. "I might feel dizzy at times while taking this medication." D. "I will take ibuprofen if I get a fever while taking this medication."

C. "I might feel dizzy at times while taking this medication." Hypotension and dizziness are potential adverse effects of this medication. The nurse should monitor the client's blood pressure and instruct the client to change positions slowly.

A nurse is teaching a client about the adverse effects of omeprazole. Which of the following client statements indicates an understanding of the teaching? A. "If I experience severe diarrhea, I will call my doctor." B. "Pneumonia is associated with long-term use of this medication." C. "I will need to take this medication with food." D. "I should take vitamin B12 while using this medication."

A. "If I experience severe diarrhea, I will call my doctor." Clients who experience diarrhea while taking omeprazole or other proton pump inhibitors (PPIs) should report this finding to the provider immediately. Omeprazole and other PPIs are associated with a dose-related increase in the risk of infection with Clostridium difficile, which is a bacterium that can cause severe diarrhea.

A nurse is providing teaching to a female client who has a new prescription for pravastatin to treat hyperlipidemia. Which of the following pieces of information should the nurse include in the teaching? A. Pravastatin can be taken with grapefruit juice. B. Pravastatin can be continued during pregnancy. C. Pravastatin should be taken with the morning meal. D. Laboratory testing to monitor the client's WBC count is required.

A. Pravastatin can be taken with grapefruit juice. Pravastatin, unlike other statins, such as lovastatin, simvastatin, and atorvastatin, is not affected by CYP3A4 inhibitors. It is safe for the client to consume grapefruit juice if desired.

A nurse is caring for a school-aged child who has cystic fibrosis (CF) and has been using a corticosteroid inhaler for long-term treatment. Which of the following findings should the nurse identify as an adverse effect of long-term use of this medication? A. Small stature for age B. Decreased weight C. Poor dentition D. Atrophied muscles

A. Small stature for age The nurse should identify that an adverse effect of the long-term use of inhaled glucocorticoids can be a slowing in the rate of growth in children.

A nurse is assessing a client who began taking clozapine 3 weeks ago. Which of the following findings should the nurse report to the provider immediately? A. Tachypnea and tachycardia B. Abdominal pain and constipation C. Enuresis and polyuria D. Dry mouth and blurred vision

A. Tachypnea and tachycardia The greatest risk to the client is the development of myocarditis, a potentially fatal adverse effect of clozapine. Myocarditis is an inflammation of the heart muscle that typically occurs within 30 days of starting the medication. Manifestations of myocarditis include chest pain, palpitations, tachycardia, cardiac arrhythmias, dyspnea, tachypnea, a fever, peripheral edema, and unexplained fatigue. Clozapine should be discontinued if a client develops myocarditis, and its use should be avoided in the future.

A nurse is assessing a client who reports using several herbal and vitamin supplements daily, including saw palmetto. The nurse should recognize that saw palmetto is a supplement used by clients to elicit which of the following therapeutic effects? A. Urinary health promotion B. Immune system stimulation C. Decreased leg pain from arterial disease D. Prevention of nausea caused by motion sickness

A. Urinary health promotion

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 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 productively 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 productively 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 nurse is caring for a client and realizes after administering the 0900 medications that she administered digoxin 0.25 mg PO to the client instead of the prescribed digoxin 0.125 mg PO. Which of the following actions should the nurse take first? A. Notify the provider B. Contact the nursing supervisor C. Assess the client's apical pulse D. Complete an incident report

C. Assess the client's apical pulse Caring for this client requires application of the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider about a change in the client's status, she must first collect adequate data from the client. An assessment will provide the nurse with the knowledge needed to make an appropriate decision.

A nurse is reviewing the medical record of a client who is receiving hydrochlorothiazide (HCTZ). The nurse should expect to find an improvement in which of the following conditions as a result of this medication? A. Gouty arthritis B. Dehydration C. Diabetes insipidus D. Hypokalemia

C. Diabetes insipidus A thiazide diuretic such as HCTZ is administered to treat diabetes insipidus. Diabetes insipidus is a condition in which there is an overproduction of urine. Thiazides reduce urine production by 30% to 50%.

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 nurse is caring for a client who is experiencing an acute asthma exacerbation. Which of the following medications should the nurse identify as being contraindicated for this client? A. Dextromethorphan B. Montelukast C. Ciprofloxacin D. Propranolol

D. Propranolol The nurse should identify that a client who is experiencing an acute asthma exacerbation requires the use of a beta2-agonist to alleviate bronchospasm and relax the client's airway. Therefore, propranolol is contraindicated for this client. Propranolol is a beta-blocker that is used to treat cardiac conditions, including hypertension. Blocking the beta receptors prevents the action of beta2-agonists such as albuterol.

A nurse is reviewing the laboratory results of a client who is taking a medication and notes that the client's blood tests show an elevated level of the enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT). The nurse should recognize that these findings are potential indications of which of the following conditions? A. Renal dysfunction B. Myelotoxicity C. Hepatic toxicity D. Cardiac dysrhythmia

C. Hepatic toxicity The nurse should identify that elevated levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are indications the client might be at risk for hepatic toxicity. AST and ALT are enzymes that test liver function. Therefore, this should indicate to the nurse that the medication the client is taking is damaging to the liver. The client should undergo liver function tests, and the nurse should notify the provider of this finding.

A nurse is preparing to administer iron dextran IV to a client. Which of the following actions should the nurse plan to take? A. Administer a small test dose before giving the full dose. B. Infuse the medication over 30 seconds. C. Monitor the client closely for hypertension after the infusion. D. Administer cyanocobalamin as an antidote if iron dextran toxicity occurs.

A. Administer a small test dose before giving the full dose. A serious adverse effect of iron dextran is anaphylaxis caused by hypersensitivity to the medication. A small test dose should be administered over 5 minutes before giving the full dose. The client should be monitored carefully for an allergic reaction during and for a period of time following the test dose.

A nurse is caring for a client who had a myocardial infarction 2 hours ago and is receiving alteplase. Which of the following findings should the nurse identify as an adverse effect of receiving this medication? A. Bleeding B. Increased clot formation C. Shortness of breath D. Blockage of the central venous catheter

A. Bleeding The nurse should identify that an adverse effect of alteplase is bleeding. Severe bleeding can occur as a result of the alteplase-plasminogen complex, which catalyzes the conversion of other plasminogen molecules that digest fibrin clots. This action of the medication can contribute to hemorrhage.

A charge nurse is teaching a newly licensed nurse about a client who has severe allergy-related asthma and a new prescription for omalizumab. Which of the following pieces of information should the charge nurse include to describe the medication's mechanism of action? A. It reduces the number of immunoglobulin E (IgE) molecules on mast cells. B. It stabilizes the cellular membrane of mast cells. C. It decreases the synthesis and release of inflammatory mediators. D. It relaxes the smooth muscles by blocking adenosine receptors

A. It reduces the number of immunoglobulin E (IgE) molecules on mast cells. The charge nurse should include in the teaching that the mechanism of action of omalizumab reduces the number of IgE molecules on mast cells. This limits the ability of allergens to trigger immune mediators that cause bronchospasm

A nurse is reviewing the medical record of a client. The medication administration record shows the client is taking clopidogrel. Which of the following events should the nurse expect in the client's medical history? A. Recent myocardial infarction B. History of hemorrhagic stroke C. Current outbreak of psoriasis D. History of hypertension

A. Recent myocardial infarction The nurse should expect the client's medical record to indicate a history of an atherosclerotic event such as myocardial infarction, ischemic stroke, or peripheral vascular disease. Clopidogrel is an antiplatelet medication that inhibits the aggregation of platelets to prevent such thrombotic events.

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.

A nurse is assessing a client who has cystic fibrosis. Which of the following pieces of information indicates a therapeutic response to pancreatic enzyme replacement? A. The client is having 1-2 bowel movements per day. B. The client's glucose level is elevated. C. The client has experienced weight loss. D. The client has abdominal distention.

A. The client is having 1-2 bowel movements per day. One to two bowel movements per day indicates adequate absorption of food and a therapeutic response to pancreatic enzyme replacement for clients who have cystic fibrosis. Frequent stooling, defined as more than one to two bowel movements per day, indicates inadequate replacement

A nurse is caring for a client who is receiving lidocaine for localized pain. The nurse should recognize that which of the following actions will help prevent systemic toxicity of this medication? A. Applying a heating pad following administration to increase blood flow to the area B. Applying the medication to intact skin C. Applying a large amount of the medication at once to avoid frequent reapplication D. Applying the medication to large areas for maximum spread

B. Applying the medication to intact skin Lidocaine applied to broken or irritated skin can increase the risk of systemic absorption.

A nurse is providing discharge teaching to a client who has venous thrombosis and a prescription for warfarin. Which of the following instructions should the nurse include in the teaching? A. Take ibuprofen as needed for headaches or other minor pains B. Carry a medical alert ID card C. Report to the laboratory weekly to have blood drawn for aPTT D. Increase intake of dark green vegetables

B. Carry a medical alert ID card A client who is taking warfarin is at increased risk for bleeding. In the case of an emergency, any medical personnel must be aware of the client's medication history.

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 antiarrhythmic medication that is used during cardioversion to treat atrial fibrillation.

A nurse is assessing a client who is experiencing chest pain. Which of the following medications should the nurse expect to administer to suppress the aggregation of platelets? A. Nitroglycerin B. Aspirin C. Morphine D. Metoprolol

B. Aspirin Aspirin suppresses platelet aggregation; producing an immediate anti thrombotic effect. The client should chew the first dose of aspirin to allow rapid absorption.

A nurse is caring for a client who has been in the PACU for more than 1 hr, has a respiratory rate of 9/min, and is difficult to arouse. The nurse should expect a prescription for which of the following medications? A. Pentazocine B, Naloxone C. Naltrexone D. Butorphanol

B. Naloxone The nurse should expect a prescription for naloxone. This medication displaces opiate medications from receptor sites, reversing the respiratory depression, sedation, and analgesia that opiates cause.

A nurse is administering adenosine via IV bolus for a client who has developed paroxysmal atrial tachycardia. For which of the following findings should the nurse assess the client during the administration of adenosine? A. Seizures B. Cinchonism C. Dyspnea D. Transient pallor of the face

C. Dyspnea Dyspnea can occur during the administration of adenosine due to bronchoconstriction. Since adenosine has a short half-life of about 10 seconds, this effect should be short-lived.

A nurse is preparing to administer digoxin to a client. Which of the following findings should the nurse identify as a contraindication to the client receiving this medication? A. Blood pressure 180/70 mmHg B. Oxygen saturation rate 94% C. Heart rate 51/min D. Respiratory rate 21/min

C. Heart rate 51/min The nurse should identify that if the client's heart rate is less than 60/min, the medication should be withheld, and the provider should be notified.

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 nurse is providing discharge teaching to a client who has heart failure and a prescription for digoxin 0.125 mg PO daily and furosemide 20 mg PO daily. Which of the following statements by the client indicates an understanding of the teaching? A. "I know that blurred vision is expected to happen while I'm taking digoxin." B. "I will measure my urine output each day and document it in my diary." C. "I will skip a dose of my digoxin if my resting heart rate is below 72 beats per minute." D. "I will eat fruits and vegetables that have a high potassium content every day."

D. "I will eat fruits and vegetables that have a high potassium content every day." Hypokalemia is an adverse effect of diuretic therapy. Because the client is taking digoxin, it is important to maintain a potassium level between 3.5 to 5.0 mg/dL to avoid digoxin toxicity.

A nurse is caring for a client with benign prostatic hyperplasia who has a new prescription for doxazosin. Which of the following manifestations should the nurse monitor for as an adverse effect of doxazosin? A. Seizures B. Tachycardia C. Bronchodilation D. Hypotension

D. Hypotension Nonselective alpha1-adrenergic antagonists like doxazosin block sympathetic receptors in the blood vessels as well as receptors in the bladder. These agents promote vasodilation, which can cause decreased blood pressure.

A nurse is teaching a female client about vitamin A supplementation. Which of the following client statements indicates an understanding of the teaching? A. "Vitamin A supplements are usually prescribed during pregnancy." B. "Vitamin A can be taken in high doses because it is water-soluble." C. "Vitamin A is encouraged for women who have osteoporosis." D. "A deficiency of vitamin A can cause night blindness."

"A deficiency of vitamin A can cause night blindness." The nurse should identify that vitamin A is required for dark light adaptation. When a client has a deficiency of vitamin A, night blindness is often the first sign. As the deficiency continues, other eye conditions can arise such as a dry and thickened conjunctiva and degeneration of the cornea.

A nurse is teaching a client who has a new prescription for warfarin. Which of the following statements should the nurse identify as an indication that the client understands the instructions? A. "I'll use a safety razor to shave each day." B. "I'll be sure to eat lots of spinach." C. "I'll avoid contact sports like football." D. "I'll take ibuprofen if I get a headache."

"I'll avoid contact sports like football." The most common adverse effect of taking anticoagulants is bleeding. Therefore, the client should avoid any activities that have a high risk of causing injury, such as contact sports.

A nurse is providing teaching to a client with a new diagnosis of heart failure who has a prescription for furosemide. Which of the following statements should the nurse include in the teaching? A. "You can take ibuprofen for headaches while taking this medication." B. "You may experience increased swelling in your lower extremities while taking this medication." C. "You should eat foods that are high in potassium while taking this medication." D. "You should take this medication at bedtime."

"You should eat foods that are high in potassium while taking this medication." The nurse should instruct this client who has a prescription for furosemide to consume foods that are high in potassium. Furosemide is a high-ceiling loop diuretic that depletes potassium, sodium, chloride, magnesium, and water.

A nurse in a provider's office is assessing a client who has been taking feverfew. Which of the following statements by the client indicates a therapeutic effect of the supplement? A. "I am having fewer migraine headaches since I started taking feverfew." B. "My memory seems to be getting better since I started taking feverfew." C. "I have fewer infections when I take feverfew." D. "I have not had another urinary tract infection since starting feverfew."

A. "I am having fewer migraine headaches since I started taking feverfew." Feverfew is an herb that is used for the prophylaxis of migraine headaches. It can reduce the frequency of migraines and decrease the severity of accompanying manifestations such as nausea and photophobia.

A nurse in an outpatient facility is assessing a client who is prescribed furosemide 40 mg daily. The client reports taking extra doses to promote weight loss. Which of the following findings should indicate to the nurse that the client is dehydrated? A. Urine specific gravity 1.035 B. Distended neck veins C. BUN 18 mg/dL D. Bounding radial pulses

A. Urine specific gravity 1.035 Oliguria, an increased urine concentration, and an increased urine specific gravity greater than 1.030 are expected findings in clients who are dehydrated.

A nurse is preparing to administer amlodipine to a client who has hypertension. The nurse should plan to monitor the client for which of the following adverse effects of the medication? (Select all that apply). A. Dizziness B.Pale appearance C. Palpitations D.Abdominal pain E.Peripheral edema

A. Dizziness C. Palpitations E.Peripheral edema

A nurse is caring for a client who has acute glomerulonephritis and a prescription for furosemide. The nurse should monitor the client for which of the following therapeutic effects of this medication? A. Hypotension B. Diuresis C. Increased blood glucose level D. Weight gain

B. Diuresis The nurse should identify that furosemide is a high-ceiling loop diuretic indicated for the treatment of clients who have severe renal impairment such as acute glomerulonephritis. Furosemide blocks the reabsorption of sodium and chloride, thereby preventing the reabsorption of water. Diuresis is a therapeutic response to the administration of furosemide.

A nurse is teaching a client who is using topical lidocaine about preventing systemic toxicity. Which of the following pieces of information should the nurse include about the application of topical lidocaine? A. Apply dressing after covering the affected areas with topical lidocaine B. Apply topical lidocaine to affected areas that are intact C. Apply topical lidocaine in a thick layer to affected areas D. Apply topical lidocaine frequently to large affected areas

B. Apply topical lidocaine to affected areas that are intact

A nurse is assisting with a client's laceration repair in which the provider with use both lidocaine and epinephrine. The nurse should inform the client that the epinephrine will perform which of the following action? A. Acts 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

A nurse is admitting a client who has atrial fibrillation with a heart rate of 155/min. The nurse should anticipate a prescription from the provider for which of the following medications? A. Atropine B. Diltiazem C. Epinephrine D. Vasopressin

B. Diltiazem

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, leukotriene modifier, impairs the metabolism of certain medications.

A nurse is providing discharge teaching about lithium toxicity to a client who has a new prescription for lithium. Which of the following statements by the client indicates an understanding of the teaching? A. "I should take naproxen if I have a headache because aspirin can cause lithium toxicity." B. "I can develop lithium toxicity if I eat foods with lots of sodium." C. "I can develop lithium toxicity if I experience vomiting or diarrhea." D. "I might need to take a daily diuretic along with my lithium to prevent lithium toxicity."

C. "I can develop lithium toxicity if I experience vomiting or diarrhea." Vomiting or diarrhea can cause electrolyte imbalances. If serum sodium decreases, lithium is retained by the kidneys, and the risk of lithium toxicity increases.

A nurse is caring for a client who has severe asthma and allergic rhinitis. The client is taking theophylline. Which of the following medications should the nurse identify as being incompatible with theophylline? A. Cromolyn B. Albuterol C. Zafirlukast D. Methylprednisolone

C. Zafirlukast The nurse should identify that zafirlukast is a leukotriene receptor antagonist prescribed for asthma maintenance. Concurrent use of zafirlukast along with theophylline suppresses the metabolism of theophylline, which can lead to toxicity. Therefore, another medication should be used.

A nurse is caring for a client who has a new prescription for enalapril. The nurse should monitor the client for which of the following adverse effects? A. Ecchymosis B. Jaundice C. Hypotension D. Hypokalemia

C. Hypotension Enalapril, an ACE inhibitor, can cause hypotension and postural hypotension, especially during the first 3 hours following initial dosage.

A nurse is assessing a client who has heart failure and is receiving digoxin. Which of the following findings should indicate to the nurse the client is expediting digoxin toxicity? A. Suppression of dysrhythmias B. Increased atrioventricular conduction C. Visual disturbances D. Weight gain

C. Visual disturbances The nurse should recognize the nausea, vomiting, abdominal discomfort, fatigue, and visual disturbances are coming manifestations that can indicate that the client is experiencing digoxin toxicity

A nurse is administering subcutaneous epinephrine for a client who is experiencing anaphylaxis. The nurse should monitor the client for which of the following adverse effects? A. Hypotension B. Hyperthermia C. Hypoglycemia D. Tachycardia

D. Tachycardia Adverse effects of epinephrine, an adrenergic agonist, can include tachycardia and dysrhythmias due to cardiac stimulation.