ATI Pharmacology 2019 A

Nurse is teaching pt about warfarin. Pt asks if they can take aspirin while taking warfarin. Which of following responses should nurse make?

"Aspirin will increase the risk of bleeding." Aspirin inhibits platelet aggregation and can potentiate the action of the anticoagulant warfarin. Therefore, the client should avoid taking aspirin because it increases the risk for bleeding.

Nurse at urgent care clinic is collecting Hx from female pt who has UTI. Nurse anticipates prescription of ciprofloxacin. Nurse should identify that which of following pt statements indicates contraindication for administering this med?

"I have tendonitis, so I haven't been able to exercise." The nurse should identify tendonitis as a contraindication for taking ciprofloxacin due to the risk of tendon rupture.

Nurse is teaching pt about use of risedronate for treatment of osteoporosis. Nurse should identify which of following statements as an indicaiont about pt understands teaching?

"I should sit up for 30 minutes after taking the risedronate." Sitting upright for at least 30 min after taking risedronate will reduce the adverse gastrointestinal effects of esophagitis and dyspepsia. Risedronate is contraindicated for a client who cannot sit or stand upright for this length of time.

Nurse is providing discharge instructions to pt who has HF and new prescription for captopril. Which of following pt statements indicates understanding of teaching?

"I should tell my provider if I develop a sore throat." The client should report a sore throat to the provider because this can indicate neutropenia, a serious adverse effect of captopril. Neutropenia can be reversed if it is identified early and the medication is promptly discontinued.

Nurse is instructing pt on application of nitroglycerin transdermal patches. Which of following statements by pt indicates understanding of teaching?

"I will take the patch off right after my evening meal." Clients should remove the patch each evening for a medication free time of 12 to 14 hr before applying a new patch to avoid developing a tolerance to the medication's effects.

Nurse is teaching pt about cyclobenzaprine. Which of following pt statements should indicate to nurse that teaching is effective?

"I will taper off the medication before discontinuing it." The client should taper off cyclobenzaprine before discontinuing it to prevent abstinence syndrome or rebound insomnia.

Nurse is providing teaching to pt who has gastric ulcer and new prescription for ranitidine. Which of following instructions should nurse include?

"Report yellowing of the skin." Ranitidine can be hepatotoxic and cause jaundice. The nurse should instruct the client to monitor for and report yellowing of the skin or eyes to the provider.

Nurse is providing teaching to pt who is to start Tx for asthma w/ beclomethasone and albuterol inhalers. Which of following instructions should nurse include in teaching?

"Rinse your mouth after inhaling the beclomethasone." The client should rinse their mouth after using beclomethasone, a glucocorticoid inhaler, to prevent oropharyngeal candidiasis and hoarseness.

Nurse is providing teaching to pt who has prescription for ergotamine sublingual to Tx migraine headaches. Which of following information should nurse include in instructions?

"Take one tablet at onset of migraine." The client should take one tablet immediately after the onset of aura or headache. Ergotamine, an alpha-adrenergic blocking medication, is not used prophylactically because this can result in ergotamine dependence. The client can take up to a maximum of three tablets in a 24-hr period. Excessive dosing can lead to ergotism, which can cause peripheral gangrene due to vasoconstriction and ischemia. The client can take one sublingual tablet every 30 min for a maximum of three tablets in a 24-hr period to manage a migraine.

Nurse is caring for pt receiving NS 1L over 4 hr instead of over 8 hr as prescribed. Which of following information should nurse enter as complete documentation of incident?

0.9% sodium chloride 1 L IV infused over 4 hr. Vital signs stable, provider notified. The nurse should document the type and amount of fluid, how long it took to infuse, provider notification, and the client's physical status.

Nurse is preparing to administer scheduled antibiotic at 0800 to pt and discovers antibiotics is not present in pt's med drawer. Nurse identify that administration of med can occur at which of following time periods w/o requiring an incident report?

0830 The nurse should identify that an antibiotic can be administered 30 min before or after the scheduled time to maintain therapeutic blood levels without requiring an incident report.

Nurse is providing teaching to pt who has MS and new prescription for methylprednisolone. Which of following instructions should nurse include? (select all that apply)

1. Blood glucose levels will be monitored during therapy: The nurse should monitor the client for hyperglycemia while providing methylprednisolone to the client. Glucocorticoids, such as methylprednisolone, increase serum glucose levels and can require management with insulin or antihyperglycemics. 2. Avoid contact with people who have known infections: The nurse should instruct the client to avoid exposure to infectious agents, such as contact with those who have active infections or illnesses. Glucocorticoids, such as methylprednisolone, depress the immune system, placing the client at an increased risk for developing an infection. 3. Grapefruit juice can increase the effects of the medication: The nurse should instruct the client that grapefruit and grapefruit juice can increase the level of methylprednisolone in the body. The nurse should instruct the client to avoid exposure to infectious agents, such as contact with those who have active infections or illnesses. Glucocorticoids, such as methylprednisolone, depress the immune system, placing the client at an increased risk for developing an infection. The nurse should instruct the client to take the medication with food or milk to decrease gastrointestinal upset. The nurse should instruct the client to take the medication with food or milk to decrease gastrointestinal upset.

Nurse is providing teaching to pt who is taking oxybutynin for urinary incontinence. Which of following adverse effects should nurse include in teaching? (select all that apply)

1. Dry mouth is correct. Oxybutynin is an anticholinergic agent that can cause dry mouth. 2. Blurred vision is correct. Oxybutynin is an anticholinergic agent that can cause blurred vision due to an increase in intraocular pressure. 3. Dry eyes is correct. Oxybutynin is an anticholinergic agent that can cause dry eyes and mydriasis, or pupil dilation.

Nurse is developing teaching plan for pt who has new prescription for simvastatin. Which of following instructions should nurse include in teaching plan? (select all that apply)

1. Report muscle pain to the provider: Myopathy is an adverse effect of simvastatin that can lead to rhabdomyolysis. The nurse should instruct the client to report this to the provider. 2. Avoid taking the medication with grapefruit juice: When taken with grapefruit juice, simvastatin increases the risk of muscle injury from elevations in creatine kinase. 3. Expect therapy with this medication to be lifelong: If medication therapy is discontinued, cholesterol levels will return to their pretreatment range within several weeks to months.

Nurse is preparing to administer D5W 400 ml IV over 1 hr. Drop factor is 15 gtt/ml. Nurse should set IV infusion to deliver how many gtt/min?

100 gtt/min

Nurse is caring for parent of newborn. Parent asks nurse when their newborn should receive 1st DTaP. Nurse instruct parent that their newborn should receive immunization at which following ages?

2 months The CDC recommends that newborns receive the first dose of the five-dose series of the DTaP immunization at 2 months of age.

Nurse is preparing to administer ciprofloxacin 15 mg/kg PO q12h to child weighs 44 lb. How many mg should nurse administer per dose?

300 mg

Nurse is teaching group of unit nurses about medication reconciliation. Which of following information should nurse include in teaching?

A transition in care requires the nurse to conduct medication reconciliation. The nurse should conduct medication reconciliation anytime the client is undergoing a change in care such as admission, transfer from one unit to another, or discharge. A complete listing of all prescribed and over-the-counter medications should be reviewed.

Nurse is caring for pt who has acute acetaminophen toxicity. Nurse should anticipate administering which of following meds?

Acetylcysteine Acetylcysteine is a specific antidote for acetaminophen toxicity. It can prevent severe injury when given orally or by IV infusion within 8 to 10 hr.

Nurse is preparing to administer heparin subq to pt. Which of following actions should nurse plan to take?

Administer the medication outside the 5-cm (2-in) radius of the umbilicus. The nurse should administer the heparin by subcutaneous injection to the abdomen in an area that is above the iliac crest and at least 5 cm (2 in) away from the umbilicus.

Nurse in ER is caring for pt who has myasthenia gravis and is in cholinergic crisis. Which of following meds should nurse plan to give?

Atropine A cholinergic crisis is caused by an excess amount of cholinesterase inhibitor, such as neostigmine. The nurse should plan to administer atropine, an anticholinergic agent, to reverse cholinergic toxicity.

Nurse is planning care for pt who is receiving mannitol via continuous IV infusion. Nurse should monitor pt for which of following adverse effects?

Bibasilar crackles Mannitol, an osmotic diuretic, can precipitate heart failure and pulmonary edema. Therefore, the nurse should recognize lung crackles as an indicator of a potential complication and stop the infusion.

Nurse is caring for pt who is receiving heparin therapy via continuous IV to Tx PE. Which of following findings should nurse identify as adverse effect of med and report to Dr?

Blood in the urine The nurse should report blood in the urine to the provider because this can be a manifestation of heparin toxicity. Other manifestations can include bruising, hematomas, hypotension, and tachycardia.

Nurse is providing teaching to pt who is taking bupropion as an aid to quit smoking. Which of following findings should nurse identify as adverse effect of med?

Insomnia Bupropion, an atypical antidepressant, has stimulant properties, which can result in agitation, tremors, mania, and insomnia.

Nurse is reviewing med list of pt who wants to begin taking oral contraceptives. Nurse should identify that which of following pt meds will interfere w/ effectiveness of oral contraceptives?

Carbamazepine Carbamazepine causes an accelerated inactivation of oral contraceptives because of its action on hepatic medication-metabolizing enzymes. sumatriptan, which is a medication to treat migraines.

Nurse administers metformin to pt instead of prescribed dose of metoclopramide. Which of following actions should nurse take 1st?

Check the client's blood glucose. The first action the nurse should take using the nursing process is to assess the client. The client is at risk for hypoglycemia. The nurse should monitor the client's blood glucose and provide the client with a snack to reduce the risk for hypoglycemia.

Nurse is caring for pt who has cancer and is taking oral morphine and docusate sodium. Nurse instruct pt that taking docusate sodium QD can minimize which of following adverse effects of morphine?

Constipation Constipation is a common adverse effect of morphine that can be minimized by taking docusate sodium, a stool softener that promotes easier evacuation of stool by increasing water and fat in the intestine.

Nurse is teaching pt who is to start taking hydrocodone w/ acetaminophen tablets for pain. Which of following information should nurse include in teaching?

Decreased respirations might occur. The nurse should instruct the client that hydrocodone with acetaminophen might cause respiratory depression, which is an adverse effect of the medication. The client should avoid taking over-the-counter medications or newly prescribed medications without consulting their provider to avoid increased respiratory depression.

Nurse is planning care for pt who has HTN and is to start taking metoprolol. Which of following interventions should nurse include in plan of care?

Determine apical pulse prior to administering. Life-threatening bradycardia is an adverse effect that might affect this client. Therefore, the nurse should assess the client's apical pulse prior to administering the medication. If the client's pulse rate is less than 60/min, the nurse should withhold the medication and notify the provider.

Nurse is reviewing MAR of pt who has hypocalcemia and new prescription for IV Ca gluconate. Nurse should identify that which of following meds can interact w/ calcium gluconate?

Digoxin The nurse should identify that calcium gluconate can cause hypercalcemia, which increases the risk of digoxin toxicity.

Nurse is preparing to administer meds to pt who tells nurse, "I don't wan to take my fluid pill until I get home today." Which of following actions should nurse take?

Document the refusal and inform the client's provider. The nurse has the responsibility to verify that the client understands the risks of refusing the medication so that an informed decision can be made. The nurse should then document the refusal in the client's medical record and notify the health care provider.

Nurse is administering donepezil to a pt who has Alzheimer's disease. Which of following findings should nurse report to provider immediately?

Dyspnea When using the airway, breathing, circulation approach to client care, the nurse should report the adverse effect of dyspnea, caused by bronchoconstriction, to the provider first. Bronchoconstriction, dyspepsia, diarrhea, and dizziness are caused by the increase in acetylcholine levels, which is a primary effect of donepezil.

Nurse is assessing pt after giving 2nd dose of cefazolin IV. Nurse notes client has anxiety, hypotension, and dyspnea. Which of following meds should nurse administer 1st?

Epinephrine According to evidence-based practice, the nurse should administer epinephrine first to induce vasoconstriction and bronchodilation during anaphylaxis.

Nurse in ER is caring for pt who has family reports pt has taken large amounts of diazepam. Which of following meds should nurse anticipate giving?

Flumazenil The nurse should anticipate administering flumazenil, an antidote used to reverse benzodiazepines such as diazepam.

Nurse is providing teaching to pt who has PUD and is to start new prescription for sucralfate. Which of following actions of sucralfate should nurse include in teaching?

Forms a protective barrier over ulcers Secretions by the parietal and chief cells, hydrochloric acid and pepsin, can further irritate the ulcerated areas. Sucralfate, a mucosal protectant, forms a gel-like substance that coats the ulcer, creating a barrier to hydrochloric acid and pepsin.

Nurse is assessing pt's VS prior to giving PO digoxin. Pt's BP 144/86, HR 55/min, RR 20/min. Nurse should w/hold med and contact Dr for which of following findings?

Heart rate Digoxin slows the conduction rate through the SA and AV nodes, thereby decreasing the heart rate. The nurse should withhold the medication and notify the provider for a heart rate of 55/min because this is an early indication of digoxin toxicity.

Nurse is teaching pt who is taking tamoxifen for Tx of breast cancer. Which of following adverse effects should nurse include in teaching?

Hot flashes The estrogen receptor blocking action of tamoxifen commonly results in the adverse effect of hot flashes.

Nurse is collecting med Hx from pt who has new prescription for lithium. Nurse should identify that pt should discontinue which of following OTC meds?

Ibuprofen Most NSAIDs can significantly increase lithium levels. Therefore, the client should not take ibuprofen and lithium concurrently. Although most NSAIDs interact with lithium to increase lithium levels, aspirin does not interact with lithium.

Nurse is assessing pt who is taking propylthiouracil for Tx of Grave's disease. Which of following findings should nurse identify as indication that med has been effective?

Increase in ability to focus A client who has Graves' disease can experience psychological manifestations such as difficulty focusing, restlessness, and manic-type behaviors. Propylthiouracil is a thyroid hormone antagonist that decreases the circulating T4 hormone, reducing the manifestations of hyperthyroidism. An increased ability to focus indicates that the medication has been effective.

Nurse is caring for pt who is receiving oprelvekin. Which of following findings should nurse document to indicate effectiveness of therapy?

Increased platelet count Oprelvekin stimulates the bone marrow to produce platelets. For clients receiving chemotherapy, thrombocytopenia is minimized; therefore, clients will require fewer platelet transfusions.

Nurse is assessing pt who has myasthenia gravis and is taking neostigmine. Which of following findings indicate to nurse that pt is experiencing adverse effect?

Miosis Miosis, which is pupillary constriction, is a common adverse effect of neostigmine due to the excessive muscarinic stimulation that causes difficulty with visual accommodation.

Nurse is preparing to administer PO sodium polystyrene sulfonate to pt who has hyperkalemia. Which of following actions should nurse plan to take?

Monitor the client for constipation. The nurse should monitor the client for the adverse effect of constipation and report it to the provider because this can lead to fecal impaction.

Nurse receives verbal order from provider to administer morphine 5 mg q4h subq for severe pain prn. Nurse should identify which of following entries as correct format for MAR?

Morphine 5 mg subcut every 4 hr PRN severe pain The nurse should identify this entry as the correct format for the MAR. The medication name is spelled out and there are not any abbreviations from The Joint Commission's "Do Not Use" list included in the transcription.

Nurse in ER is caring for pt who has heroin toxicity. Pt is unresponsive w/ pinpoint pupils and RR 6/min. Which of following meds should nurse plan to administer?

Naloxone The nurse should administer naloxone, an opioid antagonist, to a client who has heroin toxicity to reverse the respiratory depressive effects of the heroin. However, the nurse should not administer naloxone too quickly because naloxone can cause hypertension, tachycardia, nausea, vomiting, and might cause the client to enter a state of opioid withdrawal.

Nurse is preparing to administer med to pt who has gout. Nurse discovers that an error was made during previous shift and pt received atenolol instead of allupurinol. Which of following actions should nurse take 1st?

Obtain the client's blood pressure. When using the nursing process, the first action the nurse should take to prevent injury to the client is to assess the client for adverse effects of atenolol, such as hypotension.

Nurse is planning to teach about use of spacer to child who has new prescription for fluticasone inhaler to Tx chronic asthma. Nurse should include that spacer decreases risk for which of following adverse effects of med?

Oral candidiasis Dysphonia and oral candidiasis are adverse effects of inhaled corticosteroids. Using a spacer and rinsing the mouth after inhalation will minimize the amount of medication remaining in the oropharynx, preventing the development of these adverse effects.

Nurse is reviewing lab results for pt who is receiving heparin via coninuous IV infusion for DVT. Nurse should discontinue med infusion for which of following client findings?

Platelets 96,000/mm3 A platelet count of 96,000/mm3 is below the expected range of 150,000 to 400,000/mm3. A platelet count less than 100,000/mm3 while receiving heparin can indicate heparin-induced thrombocytopenia, a potentially fatal condition that requires stopping the infusion.

Nurse is reviewing lab results of pt who is taking digoxin for HF. Which of following results should nurse report to provider?

Potassium level 2.8 mEq/L A potassium level of 2.8 mEq/L is below the expected reference range of 3.5 to 5 mEq/L. The nurse should notify the provider if a client has hypokalemia prior to administration of digoxin due to the increased risk of developing digoxin toxicity and cardiac dysrhythmias. A digoxin level of 1.1 ng/mL is within the expected reference range of 0.8 to 2 ng/mL. The nurse should report a digoxin level that is outside the expected reference range to the provider for a dosage adjustment.

Nurse is caring for 20 y/o female pt who has prescription for isotretinoin for severe nodulocystic acne vulgaris. Before pt can obtain refill, nurse should advise pt that which of following tests required?

Pregnancy test The nurse should instruct the client that isotretinoin has teratogenic effects; therefore, pregnancy must be ruled out before the client can obtain a refill. The client must provide two negative pregnancy tests for the initial prescription and one negative test before monthly refills.

Nurse is receiving ECG of pt who is receiving IV furosemide for HF. Nurse should identify which of following findings as indication of hypokalemia?

Presence of U-waves The nurse should identify the presence of U-waves as a manifestation of hypokalemia, an adverse effect of furosemide.

Nurse is caring for pt who is experiencing acute EtOH w/drawl. For which of following pt outcomes should nurse administer chlordiazepoxide?

Prevent delirium tremens The client should take chlordiazepoxide to prevent delirium tremens during acute alcohol withdrawal.

Nurse is planning care for pt who is prescribed metoclopramide following bowel surgery. For which of following adverse effects should nurse monitor?

Sedation Metoclopramide has multiple CNS adverse effects, including dizziness, fatigue, and sedation.

Nurse at clinic is providing follow-up care to pt who is taking fluoxetine for depression. Which of following findings should nurse identify as adverse effect of med?

Sexual dysfunction Sexual dysfunction, including a decreased libido, impotence, and delayed orgasm, or anorgasmia, is a common adverse effect of fluoxetine and occurs in about 70% of clients who take this SSRI antidepressant.

Nurse is providing discharge teaching about handling med to pt who is to continue taking oral transmucosal fentanyl raspberry-flavored lozenges on a stick. Which of following information should nurse include in teaching?

Store unused medication sticks in a storage container. The nurse should instruct the client to store unused, used, or partially used medication sticks in the safe storage container that comes in the kit when the medication is initially prescribed. The nurse should instruct the client to periodically move the medication stick to a different location in the mouth for best absorption.The nurse should instruct the client to expect the medication's analgesia effects to begin within 10 to 15 min.

Nurse is assessing pt who has schizophrenia and is taking haloperidol. Nurse should report which of following findings to Dr as manifestions of neuroleptic malignant syndrome (NMS)?

Temperature of 39.7° C (103.5° F) The nurse should report fever to the provider as an indication of NMS, an acute life-threatening emergency. Other manifestations can include respiratory distress, diaphoresis, and either hyper- or hypotension. The nurse should report severe muscle rigidity as a manifestation of NMS. The nurse should report incontinence as a manifestation of NMS.

Nurse is assessing pt 1 hr after administering morphine for pain Nurse should identify which of following findings as best indication that morphine has been effective?

The client rates pain as 3 on a scale from 0 to 10. The client's description of the pain is the most accurate assessment of pain.

Nurse is assessing pt who is postoperative following outpatient endoscopy procedure using midazolam. Nurse should monitor for which of following findings indicate that pt is ready for discharge?

The client's capnography has returned to baseline. The nurse should identify that the client is ready for discharge when the capnography level indicates that gas exchange is adequate.

Nurse is caring for pt who is taking acetazolamide for chronic open-angle glaucoma. For which of following adverse effects should nurse instruct pt to monitor and report?

Tingling of fingers The nurse should instruct the client to report the adverse effect of paresthesia, a tingling sensation in the extremities, when taking acetazolamide.

Nurse on acute care unit is caring for pt who is receiving gentamicin IV. Nurse report which of following findings to Dr as adverse effect of med?

Tinnitus Aminoglycosides, such as gentamicin, are ototoxic, which can manifest as tinnitus and deafness. The nurse should monitor the client for high-pitched ringing in the ears and headaches and should notify the provider if these occur.

Nurse is caring for pt who is in labor. Pt is receiving oxytocin by continuous IV infusion w/ maintenance IV solution. External FHR monitor indicates late decelerations. Which of following actions should nurse take 1st?

Turn the client to a side-lying position. The greatest risk to the fetus experiencing late decelerations is injury from uteroplacental insufficiency. Therefore, the priority action the nurse should take is to place the client in a lateral position.