ATI NURS 126 Pharmacology Practice B
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 to taking sildenafil? A) Isosorbide B) Phenytoin C) Metronidazole
A) 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 caring for a client who is on warfarin therapy for atrial fibrillation. The client's INR is 5.2. Which of the following medications should the nurse prepare to administer? A) Epinephrine B) Atropine C) Protamine D) Vitamin K
Vitamin K
A nurse is caring for a client who has a deep vein thrombosis and is prescribed heparin by continuous IV infusion at 1,200 units/hr. Available is heparin 25,000 units in 500 mL D5W. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest tenth/whole number. Use a leading zero if it applies. Do not use a trailing zero.)
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A nurse is providing teaching to a client who has oral candidiasis and a new prescription for nystatin suspension. Which of the following statements by the client indicates an understanding of the teaching? A) "I will store the medication at room temperature." B) "I will take the medicine every morning on an empty stomach." C) "I will spit the medication out after swishing it around my mouth." D) "I will only need to take this medication for a few days."
A) "I will store the medication at room temperature." Nystatin oral suspension should be stored at room temperature
A nurse is caring for a client who has deep vein thrombosis 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? A) "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level" B) "I will call the provider to get a prescription for discontinuing the IV heparin today" C) "Both heparin and warfarin work together to dissolve the clots"
A) "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.
A nurse is teaching a client about taking diphenhydramine. The nurse should explain to the client that which of the following is an adverse effect of this medication? A) Sedation B) Constipation C) Hypertension D) Bradycardia
A) Sedation Dephenhydramine can cause sedation. It is used to treat rhinitis, allergies, and insomnia
A nurse is caring for a client who his to receive a unit of paced RBCs. The nurse should prime the blood administration tubing using which of the following IV solutions? A) Lactated Ringer's solution B) 0.9% sodium chloride C) Dextrose 5% in water D) Dextrose 5% in 0.45% sodium chloride
B) 0.9% sodium chloride The nurse should prime the tubing with 0.9% sodium chloride, as this is the only IV solution that does not hemolyze RBCs
A nurse is preparing to administer phenytoin IV to a client who has a seizure disorder. Which of the following actions should the nurse plan to take? A) Administer the medication at 100 mg/min B) Administer a saline solution after injection C) Hold the injection if seizure activity is present D) Dilute the medication with dextrose 5% in water
B) Administer a saline solution after injection The nurse should flush the injection site with a saline solution after the injection of phenytoin to reduce and prevent venous irritation
A nurse is reviewing a client's admission record. The nurse notes that there are prescriptions for several medications. Which of the following factors should the nurse recognize is a primary consideration when determining the schedule of administration? A) Institutional policies regarding routine medication administration times B) Specific characteristics of the medications C) Schedule of administration that the client follows at home D) Time at which the medication can be available from the pharmacy
B) Specific characteristics of the medications Evidence-based practice indicates that the specific characteristics of the medications be the primary consideration of scheduling administration times
A nurse is assessing a client who has acute cocaine toxicity. Which of the following findings should the nurse expect? (Select all that apply) A) Report of tinnitus B) Fever C) Bradycardia D) Tremor E) Agitation
B, D, E Fever: Hyperpyrexia is a manifestation of acute cocaine toxicity Tremor: Tremor and dizziness are manifestations of acute cocaine toxicity Agitation: Agitation and hallucination are manifestations of acute cocaine toxicity
A nurse is educating a group of clients about the contraindications of warfarin therapy. Which of the following statements should the nurse include in the teaching? A) "Clients who have glaucoma should not take warfarin." B) "Clients who have rheumatoid arthritis should not take warfarin." C) "Clients who are pregnant should not take warfarin." D) "Clients who have hyperthyroidism should not take warfarin."
C) "Clients who are pregnant should not take warfarin." Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta and places the fetus at risk for bleeding
A nurse is providing discharge teaching to a client who has a new prescription for verapamil for angina. Which of the following instructions should the nurse include? A) "Limit your fluid intake to mail times" B) "Do not take this medication on an empty stomach" C) "Increase your daily intake of dietary fiber"
C) "Increase your daily intake of dietary fiber" The nurse should instruct the client to increase his daily intake of dietary fiber to reduce the risk of constipation associated with verapamil
A nurse is caring for a client who has atrial fibrillation and receives digoxin daily. Before administering this medication, which of the following actions should the nurse take? A) Offer the client a light snack B) Measure the client's blood pressure C) Measure the client's apical pulse D) Weigh the client
C) Measure the client's apical pulse Digoxin decreases the heart rate, so the nurse should count the apical pulse for at least 1 minute before administering. The nurse should hold the medication and notify the provider if the client's heart rate is below 60 bpm or if a change in heart rhythm is detected
A nurse is providing discharge teaching to a client who has a new prescription for lithium. Which of the following information should the nurse include in the teaching? A) Follow a low-sodium diet B) Limit daily fluid intake C) Obtain a daily weight D) Avoid foods that have a high tyramine content
C) Obtain a daily weight Clients who are taking lithium should monitor their daily weight due to the risk of fluid imbalance
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? A) Obtain intravenous fluids for administration B) Record the observed data in the medical record C) Deliver a dose of aminophylline by inhalation D) Administer epinephrine subcutaneously
D) 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 preparing to transfuse one unit of packed RBC to a client who experienced a mild allergic reaction during a previous transfusion. The nurse should administer diphenhydramine prior to the transfusion for which of the following allergic responses? A) Urticaria B) Fever C) Fluid overload
A) Urticaria For clients who have previously had allergic reactions to blood transfusions, administering an antihistamine such as diphenhydramine prior to the transfusion might prevent further reactions. Allergic reactions typically include urticaria (hives)
A nurse is providing teaching for a client who has schizophrenia and a new prescription for fluphenazine. Which of the following information should the nurse provide? A) "This medication might turn your urine orange." B) "Sleepiness should subside within a week." C) "Stop the medication if hypotension occurs." D) "A low-grade fever is expected with first doses."
B) "Sleepiness should subside within a week." The nurse should inform the client that fluphenazine, like other first-generation antipsychotics, may cause sedation with early treatment, but should subside within a week or so
A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for therapeutic effect of warfarin? A) Hemoglobin (Hgb) B) Prothrombin time (PT) C) Bleeding time D) Activated partial thromboplastin time (aPTT)
B) 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 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? A) Take the medication on an empty stomach to decrease gastrointestinal irritation B) Take the medication with orange juice to enhance absorption C) Take the medication with milk D) Rinse the mouth before taking the iron
B) 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 is caring for a client who receives furosemide to treat heart failure. Which of the following laboratory values should the nurse monitor for this client due to this medication? A) Potassium B) Albumin C) Cortisol
A) 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 is caring for a 2-year-old child who has seizures and is receiving phenytoin in suspension form. Which of the following actions should the nurse take before administering each dose? A) Shake the container vigorously B) Be sure the child has not eaten within the hour C) Perform mouth care
A) Shake the container vigorously A suspension form of medication refers to one in which the particles of medication are mixed with, but not dissolved in, a fluid. It is important for the nurse to shake the container that contains the suspension because the child can be under-medicated if the medication is not evenly distributed
A nurse is assessing an older adult client who is receiving IV therapy. The nurse should recognize that which of the following findings indicates fluid volume excess? (Select all that apply) A) Bounding pulse B) Pitting edema C) Swelling at the IV site D) Urine-specific gravity greater than 1.030 E) Crackles upon auscultation
A, B, E Bounding pulse: Fluid volume excess is due to excessive fluid intake or inadequate fluid excretion. Manifestations include increased blood pressure, pulse, and respirations. With fluid volume excess, the pulse is full and bounding Pitting edema: Excess extracellular fluid can lead to pitting edema in dependent areas of the body Crackles upon auscultation: Pulmonary edema can occur with fluid volume excess
A nurse in a provider's clinic is assessing a client who has cancer and a prescription for methotrexate PO. Which of the following actions should the nurse take when the client reports bleeding gums? A) Explain to the client that this is an expected adverse effect B) Check the value of the client's current platelet count C) Instruct the client to use an electric toothbrush D) Have the client make an appointment to see the dentist
B) 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 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 monitoring a client who is receiving a unit of packed RBCs following surgery. Which of the following assessments is an indication that the client might be experiencing circulatory overload? A) Flushing B) Dyspnea C) Bradycardia D) Vomiting
B) Dyspnea Circulatory overload causes dyspnea, cough, rales, tachycardia, and jugular vein distention
A 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? A) Bananas B) Cooked carrots C) Cheddar Cheese D) 2% milk
Bananas
A nurse is providing teaching for a client who is on diuretic therapy and has a new prescription for potassium chloride (KCl) 20 mEq extended release PO daily. Which of the following instructions should the nurse provide about the new prescription? A) Take the extended release tablets on an empty stomach B) Add an antacid if the medication causes indigestion C) Take the extended release tablets whole D) Expect urinary output to decrease while on this medication
C) Take the extended release tablets whole The nurse should teach the client that extended release tablets should be taken whole and should not be broke, crushed, or chewed
A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa. Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication? A) The leukocyte count B) The platelet count C) The hematocrit (Hct) D) The erythrocyte sedimentation rate (ESR)
C) 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 is preparing to administer Ringer's lactate by continuous IV infusion at 120 ml/hr. The drop factor of the manual IV tubing is 60 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. use a leading zero if it applies. Do not use a trailing zero)
120 gtt/min
A nurse is caring for a client who has a new prescription for propranolol. The nurse should monitor the client for which of the following adverse reactions to this medication? A) Ototoxicity B) Tachycardia C) Postural hypotension
C) Postural hypotension Propranolol can cause postural hypotension. The client should change positions slowly and the nurse should monitor the client's blood pressure from a lying to a sitting to standing position
A nurse is caring for a client who has a fractured ulna and a new prescription for cyclobenzaprine. Before administering, which of the following explanations should the nurse provide to explain the purpose of the medication? A) The medication will kill microorganisms that can cause infection at the fracture site B) Cyclobenzaprine will reduce itching that might occur as the fracture begins to heal C) The medication will relieve muscle spasms that might occur with a fracture D) Cyclobenzaprine will relieve any nausea associated with a fracture
C) The medication will relieve muscle spasms that might occur with a fracture The nurse should explain that the provider prescribed cyclobenzaprine to relieve muscle spasms that can accompany the acute pain of fractures
A nurse is providing teaching to a client who has angina pectoris and a new prescription for nitroglycerin. Which of the following statements by the client indicates an understanding of the teaching? A) "I'll dial 911 if I still have pain after taking 3 nitroglycerin tablets 5 minutes apart." B) "I'll dial 911 if I still have pain after taking 4 nitroglycerin tablets over a 20-minute period." C) " I'll dial 911 when I have pain and then take the nitroglycerin tablets." D) "I'll dial 911 if 1 nitroglycerin tablet does not relieve my pain, and then take up to two more tablets 5 minutes apart while waiting."
D) "I'll dial 911 if 1 nitroglycerin tablet does not relieve my pain, and then take up to two more tablets 5 minutes apart while waiting." If 1 nitroglycerin tablet does not relieve the client's pain, he should access emergency services then take 2 more tablets at 5-minute intervals if he still has pain
A charge nurse is supervising a newly licensed nurse care for a client who is receiving a transfusion of packed RBC. The nurse suspects a possible hemolytic reaction. After stopping the blood transfusion, which of the following actions by the new nurse requires intervention by the charge nurse? A) The nurse initiates an infusion of 0.9% sodium chloride B) The nurse collects a urine specimen C) The nurse sends a blood specimen to the laboratory D) The nurse starts the transfusion of another unit of blood product
D) The nurse starts the transfusion of another unit of blood product When suspecting a hemolytic reaction, the nurse should immediately stop the transfusion of all blood products. The transfusion of additional products can increase the client's risk for further complication
A nurse is caring for a client who has acute respiratory distress syndrome (ARDS), and requires mechanical ventilation. The client receives a prescription for pancuronium. The nurse recognizes that this medication is for which of the following purposes? A) Decrease chest wall compliance B) Suppress respiratory effort C) Induce sedation D) Decrease respiratory secretions
Suppress respiratory effort Neuromuscular blocking agents, such as pancuronium, induce paralysis and suppress the client's respiratory efforts to the point of apnea, allowing the mechanical ventilator to take over the work of breathing for the client. This therapy is especially helpful for a client who has ARDS and poor lung compliance
A nurse is caring for a child who is experiencing status asthmaticus. Which of the following interventions is the priority for the nurse to take? A) Administer a short-acting B2-agonist (SABA) B) Obtain a peak flow reading C) Administer an inhaled glucocorticoid D) Determine the cause of the acute exacerbation
A) 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
A nurse on a telemetry unit is caring for a client who has unstable angina and is reporting chest pain with a severity of 6 on a 0 to 10 scale. The nurse administers 1 sublingual nitroglycerin tablet. After 5 minutes, the client states that his chest pain is now a severity of 2. Which of the following actions should the nurse take? A) Administer another nitroglycerin tablet B) Initiate a peripheral IV C) Call the Rapid Response Team
A) Administer another nitroglycerin tablet Administration guidelines for sublingual nitroglycerin indicate that it is appropriate to administer another tablet 5 minutes after the first one if the client is still reporting pain
A nurse is caring for a client who has prostate cancer. The nurse should expect the provider to prescribe which of the following medications for this client? A) Leuprolide B) Cyclophosphamide C) Finasteride D) Tamoxifen
A) Leuprolide Leuprolide treats cancer of the prostate hormonally. It antagonizes the androgens that androgen-dependent neoplasms require
A nurse is preparing to administer a transfusion of RBCs to a client who has heart failure. For which of the following manifestations should the nurse monitor to prevent fluid volume overload? (Select all that apply) A) Dyspnea B) Gastrointestinal bloating C) Jugular vein distention D) Confusion E) Hypotension
A, C, D Dyspnea is a clinical manifestation of fluid volume overload Jugular vein distention is a clinical manifestation of fluid volume overload Confusion is a clinical manifestation of fluid volume overload
A nurse is caring for a client who is at least 6 weeks of gestation and has pneumonia. While the nurse is obtaining the client's history, the client tells the nurse that she takes the herb feverfew for migraine headaches. Which of the following actions should the nurse take? A) Tell the client that she should take an over-the-counter analgesic instead B) Explain to the client that she should not take this herb while she is pregnant C) Ask the client why she would take an herb during pregnancy
B) Explain to the client that she should not take this herb while she is pregnant The nurse should explain that feverfew interferes with the platelet action and can therefore cause bleeding. It is unsafe for the client to take during pregnancy
A nurse is preparing to administer verapamil by IV bolus to a client who is having cardiac dysrhythmias. For which of the following adverse effects should the nurse monitor when giving this medication? A) Hyperthermia B) Hypotension C) Ototoxicity D) Muscle pain
B) Hypotension Verapamil, a calcium channel blocker, can be used to control supraventricular tachyarrhythmias. It also decreases blood pressure and acts as a coronary vasodilator and antianginal agent. A major adverse effect of verapamil is hypotension; therefore, blood pressure and pulse must be monitored before and during parenteral administration
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? A) The client has a history of hypothyroidism B) The client has a history of bronchial asthma C) The client has a history of hypertension
B) The client has a history of bronchial asthma Beta-adrenergic blockers can cause bronshospasm in clients who have bronchial asthma: therefore, this is a contraindication to its use and should be reported to the provider
A nurse is providing teaching to a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following instructions should the nurse include? (Select all that apply) A) Expect to feel the medication's effects immediately B) Do not drink alcoholic beverages while taking this medication C) Report unexplained bruising to the provider D) Avoid people who have infections E) Take NSAIDs to help minimize the adverse effects of the medication
B, C, D 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 teaching a client who has angina pectoris about starting therapy with SL nitroglycerin tablets. The nurse should include which of the following instructions regarding how to take the medication? A) "Take this medication after each meal and at bedtime." B) "Take one tablet every 15 minutes during an acute attack." C) "Take one tablet at the first indication of chest pain." D) "Take this medication with 8 ounces of water."
C) "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 has a fungal infection and has a new prescription for amphotericin B. Which of the following laboratory values should the nurse report to the provider before initiating the medication? A) Sodium 140 mEq/L B) Potassium 4.5 mEq/L C) BUN 55 mg/dL Glucose 120 mg/dL
C) BUN 55 mg/dL This BUN level is above the expected reference range (10-20 mg/dL). Amphotericin B is nephrotoxic and is contraindicated if BUN is >40 mg/dL. The nurse should report this laboratory value to the provider before initiating the medication
A nurse is preparing to administer heparin subcutaneously to a client who has a deep vein thrombosis. Which of the following techniques should the nurse use? A) Cleanse the skin with an alcohol swab, insert the needle, aspirate, and inject the heparin B)Cleanse the skin with an alcohol swab, insert the needle, aspirate, inject the heparin, and massage the site C) Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, and observe for bleeding D) Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, aspirate, and observe for bleeding
C) Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, and observe for bleeding The is the correct technique for the nurse to use to inject heparin
A nurse is caring for a client who has an infection and a prescription for gentamicin intermittent IV bolus every 8 hr. A peak and trough is required with the next dose. Which of the following actions should the nurse take to obtain an accurate gentamicin serum level? A) Draw a trough level at 0900 and a peak level at 2100 B) Draw a peak level 90 minutes prior to administering the medication and a trough level 90 minutes after the dose C) Draw a trough level immediately prior to administering the medication and a peak level 30 minutes after the dose D) Draw a peak level at 0900 and a trough level at 2100
C) Draw a trough level immediately prior to administering the medication and a peak level 30 minutes after the dose Timing of the peak and trough is based on the pharmacokinetics of absorption and the half-life of the medication. The trough level is the lowest serum level after pharmacokinetic effects have taken place. For divided doses, correct timing for the trough is just before administering the next dose. The peak is the highest serum level of the medication; if this level is too low, then the medication will not be effective. Correct timing for the peak is between 30 and 60 minutes after the dose has finished infusing
A nurse is caring for a client who has active pulmonary tuberculosis (TB) and is to be started on intravenous rifampin therapy. The nurse should instruct the client that this medication can cause which of the following adverse effects? A) Constipation B) Black colored stools C) Staining of teeth D) Body secretions turning a red-orange color
D) 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 preparing to administer digoxin to a client who has heart failure. Which of the following actions is appropriate? A) Withholding the medication if the heart rate is above 100/min B) Instructing the client to eat foods that are low in potassium C) Measuring apical pulse rate after 30 seconds before administration D) Evaluating the client for nausea, vomiting, and anorexia
D) 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 caring for a client whose serum potassium level is 5.3 mEq/L. Which of the following schedule medications should the nurse plan to administer? A) Lisinopril B) Digoxin C) Furosemide D) Potassium iodide
Furosemide Furosemide results in loss of potassium from the nephron as part of its diuretic effect
