Adaptive Quizzes
A nurse is providing teaching to a client who has a new prescription for a fentanyl transdermal patch. Which of the following statements by the client indicates an understanding of the teaching?
"I will have to stop drinking GFJ while using the patch" Rationale: GFJ while taking Fentanyl can raise the amount of fentanyl in the client's blood, putting them more at risk for respiratory depression
A nurse is providing teaching to a client who is scheduled to start taking hydrochlorothiazide for HTN. The nurse instructs the client to eat foods that are rich in potassium. Which of the following statements by the client indicates an understanding of the teaching?
"This medication can cause a loss of potassium"
A nurse is preparing to administer iron dextran IV to a client. Which of the following actions should the nurse plan to take?
-Answer: administer a small test dose before giving the full dose -Rationale: a severe adverse effect of iron dextran is anaphylaxis d/t hypersensitivity;
What are the common ADRs of taking corticosteroids?
-Bone loss -Weight gain -Fluid retention -HypERglycemia -Hypokalemia -Infection -PUD *(Can cause peptic ulceration)* -Adrenal gland suppression -Skin fragility -GI upset
What are the other ADRs while taking Ciprofloxacin/levofloxacin?
-Diarrhea -Superinfection (e.g., C. diff) -Photosensitivity
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?
-Do not stop taking this medication abruptly (rebound HTN) -Change positions slowly (ortho hypo) -Count your radial pulse daily
What are the ADRs of taking Metformin?
-Lactic acidosis -Diarrhea (GI upset) -Metallic taste -Vitamin B12 deficiency
What do you need to monitor in a patient taking Epoetin Alfa?
-Monitor BP -Monitor Hgb and Hct levels
What do you need to monitor in a patient taking gentamicin?
-Monitor for hearing loss (tinnitus) -Monitor kidney function (Cr, BUN, urinalysis) -Monitor peak/trough levels
What teaching should be done and what needs to be monitored for patients taking TB meds?
-NO ALCOHOL -Monitor for S/S of liver damage -Family members need to be tested
Rifampin is used for Tuberculosis. What are the ADRs of this med besides hepatotoxicity?
-Orange secretions -GI upset -Decreases effectiveness of oral contraceptives
A nurse is providing teaching for a client who has received a liver transplant and has a prescription to transition from cyclosporine (immunosuppressant) to tacrolimus. Which instructions should be given?
-Stop taking cyclosporine for 24 hours and THEN begin taking the tacrolimus -Rationale: These medications should not be used together due to increased risk of developing nephrotoxicity
Iron dextran is an iron supplement for treatment of iron deficiency anemia. What are the ADRs of this medication?
-Teeth staining -Dark green/black stools (HARMLESS) -Can cause staining at IV site, hypotension and flushing
What is allopurinol used to treat and what needs to be monitored?
-Treatment of hyperuricemia with CHRONIC gout -Monitor liver and renal function; can cause hepatotoxicity & nephrotoxicity
In general, what should needle lengths be for IM injections in a client who has normal weight?
1 to 1.5 inches
A nurse is caring for a client who has hyperlipidemia and is receiving simvastatin 40mg PO daily. Which of the following items should the nurse remove from the clients breakfast tray before it is delivered to the room?
AVOID GRAPEFRUIT JUICE Rationale: GFJ while taking Simvastatin will raise blood levels of Simvastatin by inactivating a liver enzyme responsible for metabolism!
When a patient with TB is taking TB meds, when is the patient no longer infectious?
After 3 negative sputum cultures
What may the client experience if naloxone is used to reverse respiratory depression from fentanyl, morphine, dilaudid, or oxycodone?
An increase in pain! Can result in HTN, tachycardia and agitation
What is the main use of epinephrine?
Anaphylaxis
What is Epoetin alfa used to treat?
Anemia related to chronic kidney disease (also used in HIV and chemotherapy)
Besides hepatotoxicity, what other ADR can the TB med Pyrazinamide cause?
Arthralgia (joint pain)
A nurse is planning to administer diphenhydramine 50mg via IV bolus to a client having an allergic reaction. The client has an IV infusion containing a medication that is incompatible with diphenhydramine in solution. Which of the following actions should the nurse take?
Aspirate to check for IV patency before administering diphenhydramine Rationale: Some medications can cause severe tissue damage when inadvertently administered into tissue rather than into a vein
A nurse is preparing to administer medications to a client who is NPO and is receiving enteral feedings through an NG tube. Which of the following prescriptions should the nurse clarify with the provider?
Aspirin EC 325mg per NG tube should be questioned, as Aspirin EC (enteric coated) should not be crushed
A nurse in a postpartum unit is caring for a client who plans to breast feed her newborn exclusively. The client has a prescription for depot medroxyprogesterone acetate (DMPA). At which of the following times should the nurse schedule the client to receive the first dose of the medication?
At 6 weeks postpartum Rationale: this is to ensure the patient is not pregnant
What are the ADRs a/w injectable Depo-Provera?
BONE LOSS; advise to take Calcium & Vitamin D
What class does phenazopyridine belong to/treat?
Bladder analgesic/anesthetic to relieve burning and pain in the bladder mucosa caused by bladder spasm & inflammation
A nurse is planning discharge teaching for a client who has major depressive disorder and a new prescription for phenelzine. Which of the following foods should the nurse INCLUDE in the plan as safe for the client to consume while taking phenelzine?
Broiled beef steak
What can happen if propranolol is used in a patient with asthma?
Bronchospasm! Non-selective BB
A nurse is planning to administer diltiazem via IV bolus to a client who has atrial fibrillation. When assessing the client, the nurse should recognize that which of the following findings is a contraindication to administering diltiazem?
C/I- Hypotension Rationale: Diltiazem can be used to treat essential HTN
What should be used for infusion of Vinecristine?
Central line IV
Why should *Simvastatin* be administered with an EVENING meal?
Cholesterol is synthesized at night
A nurse is administering ciprofloxacin and phenazopyridine to a client who has a severe UTI. The client asks why both medications are needed. What response should the nurse make?
Ciprofloxacin hydrochloride treats the infection; phenazopyridine treats pain
A nurse is caring for a client who has suspected adrenal insufficiency. Which of the following medications should the nurse anticipate the provider using to determine the presence of adrenal insufficiency?
Consyntropin Rationale: Injection of Consyntropin is used to see if the cortisol levels rise above 20mcg/dL; if the cortisol level does not rise, the patient is said to have adrenal insufficiency
Besides inducing labor by ripening the cervix, what is the other therapeutic use of misoprostol?
Cytoprotectant E analog for prevention of gastric ulcers
A nurse is caring for a client who has been taking metformin for 6 months. Which of the following findings should the nurse identify as an expected therapeutic effect of the medication?
Decreased blood glucose level
What is the injectable form of medoxyprogesterone?
Depo-Provera
What are the ADRs of diltiazem?
Diltiazem= CCB ADRs: peripheral edema, hypOtension, bradycardia, HA, constipation
What are the first generation antihistamines and what are their ADRs?
Diphenhydramine & hydroxyzine ADRs: Sedation, anticholinergic effects
What should you NOT do to the vials of Epoetin Alfa?
Do not agitate vials
Why is HYPERTENSION a SE of taking Epoetin alfa?
Due to an increase in hematocrit
What do you need to monitor when you are giving a patent epinephrine?
EKG and vital signs
What do medroxyprogesterone's increase the risk of?
Embolic events; can also cause menstrual changes, edema and increased risk of breast cancer; these are progesterones
What should iron dextran be taken with?
Empty stomach, 1hr before or 2 hours after meals
What is a common SE of alendronate?
Esophagitis (maintain upright position after taking this medication)
What is the PO version of iron dextran?
Ferrous sulfate
A nurse is providing teaching to a client who has gout and a new prescription for allopurinol. The nurse should instruct the client to discontinue taking the medication for which of the following adverse effects?
Fever Rationale: Indication of a hypersensitivity rxn
What should be AVOIDED with CCBs (Diltiazem, Verapamil, Nifedipine)?
Grapefruit juice!
What is the risk if a patient taking phenelzine and has a tyramine rich food?
HTN crisis (MAOI)
What are the ADRs of taking epinephrine?
HTN, dysrhythmias, angina, nervousness, tremor (all from CNS stimulation due to stimulating alpha 1 receptors and vasoconstriction)
When epinephrine is given for shock, what needs to be corrected FIRST before using vasopressors?
HYPOVOLEMIA
What can all antituberculars (TB meds- rifampin, isoniazid, pyrazinamide, ethambutol) cause?
Hepatotoxicity
What are the ADRs of Simvastatin?
Hepatotoxicity and muscle pain that can lead to rhabdomyolysis!
What electrolyte imbalances does HCTZ cause?
HypOkalemia and HypOnatremia
What can metoprolol mask the SE of?
Hypoglycemia
A nurse is teaching a client who had kidney transplant surgery about immunosuppressive medications. Which of the following adverse effects of these medications can the nurse include in the teaching?
Increased susceptibility to infection
If a patient is taking corticosteroids and are going through a period of stress, what may be done?
Increased/additional doses may be required
What is a SE of taking cyclosporine?
Infections
What is the purpose of oral contraceptives?
Inhibition of ovulation
A nurse is preparing to administer meperidine to a client who is postoperative and reports a pain level of 8 on a scale of 0-10. Which of the following routes of administration will deliver the medication with the shortest amount of time?
Intravenous
What do you need to monitor in a patient taking Simvastatin?
Liver function and CK levels (ADR is muscle pain and rhabdomyolysis)
What lab levels need to be monitored in a client taking Ciprofloxacin/levofloxacin?
Liver values- AST, ALT, LDH, bilirubin; can cause increase in these values
A nurse is assessing a client who has multi-drug resistant tuberculosis and takes ethambutol. The nurse should identify which of the following findings as an adverse effect of this medication?
Loss of red/green color discrimination Rationale: can cause optic neuritis
What foods should be AVOIDED while taking phenelzine?
MAOI! Tyramine rich foods: aged cheese, red wine, bananas, avocados, salami/pepperoni, chocolate, soy sauce, protein supplements
What is recommended after taking alendronate for osteoporosis?
Maintain an upright position for 30 minutes after taking to decrease the risk of esophagitis
What are the cardioSELECTIVE beta blockers?
Metoprolol, Bisoprolol, & Atenolol (MBA)
A nurse is caring for a client who takes a combination oral contraceptive (OC). Which of the following findings should indicate to the nurse that the client is experiencing a deficiency of estrogen in the OC?
Mid-cycle breakthrough bleeding/spotting Rationale: a deficiency in estrogen can cause breakthrough bleeding due to more progesterone
What labs should be monitored in a patient taking alendronate for osteoporosis postmenopausally?
Monitor Calcium and vitamin D and encourage taking these supplements; encourage weight bearing exercises and monitor bone density
What do you need to monitor in a client taking corticosteroids?
Monitor for S/S of infection and PUD (coffee ground emesis and tarry black stools)
What medications should NEVER be used in patients with asthma?
NON-selective beta blockers; Propranolol, labetalol, carvedilol
What drug needs to be AVOIDED when taking corticosteroids?
NSAIDs
What is the antidote for overdose of fentanyl, morphine, dilaudid, and oxycodone (Opioid agonists)?
Naloxone
Besides Hepatotoxicity, what other ADR can the TB med isoniazid cause?
Neuropathy
What are the side effects of taking phenazopyridine for UTIs?
Orange/red discoloration of urine that can possibly stain clothing and soft contact lenses
Besides HTN crisis being a severe ADR of taking phenelzine, what else can a patient experience?
Orthostatic hypotension and agitation/anxiety
What are the 2 major ADRs of gentamicin?
Ototoxicity & nephrotoxicity
A nurse is assessing a child who has acute lymphocytic leukemia and is receiving Vinecristine sulfate. Which of the following findings is the nurse's priority?
Paresthesia Rationale: Using Maslow's hierarchy of needs- this would pose the greatest risk to the client when compared to other answer choices- alopecia, stomatitis, constipation
What are the ADRs of taking Vinecristine?
Peripheral neuropathy
Besides previous cesarean delivery, what is another C/I for taking misoprostol?
Pregnancy (if not using for the off label use of induction of labor)
A nurse is caring for a client at 39 weeks gestation who has gestational hypertension. The client has a new prescription for misoprostol for cervical ripening and induction of labor. Which of the following findings in the client's medical history should the nurse identify as increasing the clients risk of complications due to the use of this medication?
Previous cesarean delivery
A nurse is providing teaching to a client who has chronic kidney failure with an AV fistula for hemodialysis and a new prescription for epoetin alfa. Which of the following therapeutic effects of epoetin alfa should the nurse include in the teaching?
Promotes RBC production
A nurse is assessing a client who is receiving IV gentamicin TID. Which of the following findings indicates that the client is experiencing an adverse effect of this medication?
Proteinurea Rationale: Proteinuria is a manifestation of nephrotoxicity!
What does taking Epoetin alfa put a patient at risk for?
Since there is an increase in RBC production, patient is at an increased risk for DVT, stroke, MI and seizures
What is a severe reaction to allopurinol?
Stevens-Johnson Syndrome; Monitor for rash
A nurse is teaching a client who has type 2 DM about storing unopened vials of insulin. Which of the following pieces of information should the nurse include in the teaching?
Store the vials in the refrigerator
A nurse is providing teaching to a client who has RA and a prescription for long-term prednisone therapy. The nurse should instruct the client to monitor for which of the following adverse effects?
Stress fractures Rationale: Steroid- can cause bone demineralization and lead to osteoporosis
What is a major ADR of taking Ciprofloxacin/levofloxacin?
TENDON rupture
What are the RAPID acting insulins?
THINK LA people drive fast- Lispro (Humalog) and Aspart (Novolog)
A nurse is administering subcutaneous epinephrine for a client who is experiencing anaphylaxis. The nurse should monitor for which of the following adverse effects?
Tachycardia
A nurse in a provider's office is providing teaching for a client with osteoporosis who has a new prescription for alendronate sodium. Which of the following pieces of information should the nurse include?
Take alendronate with a full glass of water on an empty stomach
Since Allopurinol is used to treat CHRONIC gout, how long does this treatment take to work?
Takes 2-6 weeks for improvement of symptoms
What is a nursing consideration for older clients in regards to pharmacokinetic considerations?
The excretion of medications is reduced
Why should you recommend patients to take HCTZ (diuretic) in the morning?
To prevent disruption of sleep
How long can UNOPENED vials of insulin be stores in the refrigerator?
Until the printed expiration date
The nurse should recognize that saw palmetto is a supplement used to elicit which therapeutic effect?
Urinary health promotion Rationale: Saw Palmetto is mainly used for manifestations r/t BPH, but has not been scientifically proven
What is Vincristine used for?
Variety of tumors/cancers
Most antineoplastic agents can cause bone marrow suppression, EXCEPT which agent?
Vinecristine
What can increase the absorption of iron dextran?
Vitamin C
What teaching needs to be done for patients taking Ciprofloxacin/levofloxacin?
Wear sunscreen (photosensitivity)
When giving IM iron dextran, what method of administration should be used?
Z-track method
When giving iron dextran via IV, a small test dose should be administered over how many minutes?
over 5 minutes