ATI Quizbank Pharm II exam 3

A nurse is preparing to administer heparin 12,000 units subcutaneously to a client every 8 hr. Heparin 20,000 units/1 mL is available. How many mL should the nurse administer per dose? (Fill in the blank with the numeric value only, round the answer to the nearest tenth, and use a leading zero if applicable. Do not use a trailing zero.)

0.6

A nurse is preparing to administer 1 mg of enalapril via IV bolus to a client who is experiencing hypertension. The amount available is enalapril 1.25 mg/mL. How many mL should the nurse plan to administer per dose? (Fill in the blank with the numeric value only, round the answer to the nearest tenth, and use a leading zero if applicable. Do not use a trailing zero.)

0.8

A nurse is preparing to administer digoxin 0.2 mg via IV bolus to a client. The amount available is digoxin 0.25 mg/1 mL. How many mL should the nurse administer? (Fill in the blank with the numeric value only, round the answer to the nearest tenth, and use a leading zero if applicable. Do not use a trailing zero.)

0.8

A nurse is preparing to administer heparin 8,000 units subcutaneously every 8 hr. Heparin 10,000 units/1 mL is available. How many mL should the nurse administer per dose? (Fill in the blank with the numeric value only, round the answer to the nearest tenth, and use a leading zero if applicable. Do not use a trailing zero.)

0.8

A nurse is preparing to administer heparin 500 units/hr to a client who has a deep-vein thrombosis. Heparin is available at 25,000 units in 500 mL of 5% dextrose in water. The nurse should set the IV pump to deliver how many mL/hr? (Fill in the blank with the numeric value only, round to the nearest whole number, use a leading zero if applicable. Do not use a trailing zero.)

10

A nurse is preparing to administer heparin 900 units/hr via IV infusion. The amount available is heparin 25,000 units in 500 mL 5% dextrose in water. The nurse should set the IV pump to deliver how many mL/hr? (Fill in the blank with the numeric value only, round the answer to the nearest whole number, and use a leading zero if applicable. Do not use a trailing zero.)

18

A nurse is preparing to administer verapamil 5.5 mg via IV bolus to a client who has hypertension. The amount available is verapamil 2.5 mg/1 mL. How many mL should the nurse administer? (Fill in the blank with the numeric value only, round to the nearest tenth, and use a leading zero if applicable. Do not use a trailing zero.)

2.2

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 radial pulse daily." E. "Change positions slowly." Clients who stop taking metoprolol abruptly increase their risk of angina, hypertension, and myocardial infarction. They should reduce the dosage gradually over 1 to 2 weeks. Clients should count the radial pulse daily and report a heart rate slower than 60/min. Metoprolol can cause orthostatic hypotension; to prevent injury, the client should move slowly from lying down or sitting to standing.

A nurse is caring for a client who takes warfarin to treat chronic atrial fibrillation and has early manifestations of Alzheimer's disease. The client's partner asks the nurse if the client would benefit from taking ginkgo biloba. Which of the following responses should the nurse make?

A. "Ginkgo biloba will likely interfere with the effectiveness of his other medications." B. "You should ask his provider if ginkgo biloba is safe." C. "Ginkgo biloba is most effective in the later stages of Alzheimer's disease." D. "People who have Alzheimer's disease should adhere to the medication regimen their provider prescribes." Ginkgo biloba may delay the mental deterioration of Alzheimer's disease if taken in the early stages. Research has not demonstrated this, however. More importantly, ginkgo biloba increase the client's risk of bleeding when taken with warfarin.

A nurse is assessing a client who has been taking simvastatin to treat hyperlipidemia. Which of the following statements by the client indicates an adverse effect of the medication that should be reported to the provider immediately?

A. "I have had occasional constipation." B. "I have had some gas." C. "My head has been hurting for some days." D. "My legs feel weak and achy." When using the urgent vs nonurgent approach to client care, the nurse should determine that the priority finding is muscle pain and weakness. A serious adverse effect of this medication is muscle injury, which can progress to severe myositis. The client should report any unusual onset of muscle pain or tenderness to the provider immediately.

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." 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 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." 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 providing teaching to a client with hypertension and type 1 diabetes mellitus who has a new prescription for metoprolol. Which of the following statements by the client indicates an understanding of the teaching?

A. "I might have difficulty recognizing when my blood sugar is low." B. "I will have a lower risk of developing an infection while I take this medication." C. "I should be concerned about losing excess weight while I take this medication." D. "I could have more problems with high blood sugar while taking this medication." Metoprolol, a beta-adrenergic blocker, is used to treat hypertension. Because it decreases the heart rate, this common manifestation of hypoglycemia can be masked, and hypoglycemia might become more difficult to recognize. The client should be taught to recognize hypoglycemia by other manifestations such as hunger, nausea, and sweating.

A nurse is teaching a client who has a new ezetimibe prescription for hyperlipidemia. Which of the following client statements should indicate to the nurse that the teaching was effective?

A. "I should let my doctor know if I have yellowing of my eyes." B. "This medication will stop my liver from making cholesterol." C. "I should expect to experience some bruising when I begin this medication." D. "I will take this medication at the same time as my gemfibrozil." The nurse should include in the teaching that jaundice can be an adverse effect of ezetimibe as a result of hepatitis. The client should notify the provider if this occurs.

A nurse is providing teaching to a client who has heart failure and is taking spironolactone. Which of the following statements by the client indicates an understanding of the teaching?

A. "I will increase my intake of citrus fruits, bananas, and potatoes." B. "I will use salt substitutes on my food." C. "I will drink as much water as I can while taking this medication." D. "I will watch for increased breast tissue growth while taking this medication." Spironolactone, which is derived from steroids, can cause adverse endocrine effects such as gynecomastia, impotence in men, and irregular menses and hirsutism in women. The nurse should instruct the client that these changes can occur.

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." 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 preparing to administer warfarin to a client who has a new onset of atrial fibrillation. The client asks the nurse, "What should this medication do?" Which of the following responses should the nurse make?

A. "It helps your heart return to a normal rhythm." B. "It dissolves blood clots." C. "It can reduce your risk of having a stroke." D. "It helps to prevent bleeding in atrial fibrillation." The nurse should identify that atrial fibrillation increases the client's risk of having a stroke due to clot formation in the atrium. Warfarin can prevent clot formation when used long-term, which will reduce the client's risk of having a stroke.

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

A nurse is providing teaching to a client who is scheduled to start taking hydrochlorothiazide for hypertension. 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?

A. "This medication will not work unless I have enough potassium." B. "Potassium will increase the therapeutic effect of my blood pressure medication." C. "Potassium will lower my blood pressure." D. "This medication can cause a loss of potassium." Hydrochlorothiazide can result in hypokalemia caused by excessive potassium excretion from the kidneys. The client should supplement his diet with potassium-rich foods to avoid the occurrence of hypokalemia. Foods that are high in potassium include bananas, raisins, baked potatoes, pumpkins, and milk.

A nurse is providing discharge teaching to a client who has angina pectoris and a new prescription for verapamil. The client tells the nurse, "My brother takes verapamil for high blood pressure. Do you think the provider made a mistake?" Which of the following responses should the nurse make?

A. "Verapamil is used to treat both high blood pressure and angina." B. "You should talk to your provider to make sure the prescription is correct for you." C. "Are you concerned that you might have high blood pressure?" D. "Your provider has prescribed verapamil so that you will not develop high blood pressure." Verapamil is a calcium channel blocker that is used for both hypertension and anginal pain because of its ability to dilate arteries and decrease afterload.

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." 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 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 The heparin should be administered into the client's abdomen.

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 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 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 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 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. 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 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 The nurse should monitor this client who is taking amlodipine for dizziness, palpitations, and peripheral edema as adverse effects of the medication. The nurse should advise the client to avoid activities that require alertness until the effect of the medication is known and to notify the provider if any of these adverse effects occur.

A nurse is caring for a client who has congestive heart failure and is taking digoxin. The client reports nausea and refuses to eat breakfast. Which of the following actions should the nurse take first?

A. Encourage the client to eat the toast on the breakfast tray B. Administer an antiemetic C. Inform the client's provider D. Check the client's apical pulse Nausea, anorexia, fatigue, visual effects, and cardiac dysrhythmias (often caused by a slow pulse rate) are possible findings in digoxin toxicity. Caring for this client requires the 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 the provider about a change in the client's status, the nurse must first collect adequate data from the client. Assessing will provide the nurse with the knowledge to make an appropriate decision.

A nurse is caring for a client who has hyperlipidemia and is receiving simvastatin 40 mg PO daily. Which of the following items should the nurse remove from the client's breakfast tray before it is delivered to the room?

A. Grapefruit juice B. Hardboiled eggs C. Coffee D. Oatmeal Grapefruit juice is contraindicated for a client who is taking simvastatin because it raises blood levels of the medication significantly by inactivating a liver enzyme that is responsible for metabolism.

A nurse is caring for a client who is taking warfarin. Which of the following laboratory values should the nurse recognize as an effective response to the medication?

A. Hct 45% B. Hgb 15 g/dL C. aPTT 35 seconds D. INR 3.0 Warfarin is an anticoagulant that prevents thrombus formation in susceptible clients. The INR measures its effectiveness. For most clients taking warfarin, an INR of 3.0 indicates effective therapy.

A nurse is caring for a client who has heart failure and is prescribed dobutamine hydrochloride by continuous IV infusion. The nurse should identify that which of the following is the therapeutic effect of this medication?

A. Improves oxygen saturation rate B. Decreases elevated blood pressure C. Reduces heart rate D. Improves cardiac output The nurse should identify that dobutamine is a vasopressor that improves cardiac output and hemodynamic status in clients.

A nurse is planning care for a client with thrombophlebitis who has a prescription to receive heparin via continuous IV infusion. Which of the following actions should the nurse include in the plan of care?

A. Infuse the heparin using an electronic IV pump B. Administer vitamin K if the client has indications of hemorrhage C. Adjust the dosage of heparin based on the client's PT levels D. Inform the client that the heparin will dissolve the thrombus The nurse should administer heparin using an electronic IV pump, rather than by gravity, to prevent an accidental increase or change in the rate of infusion.

A nurse is caring for a client who has a prescription for clopidogrel. The nurse should monitor the client for which of the following adverse effects?

A. Insomnia B. Hypotension C. Bleeding D. Constipation Clopidogrel is an antithrombotic medication that inhibits platelet aggregation. It is used to prevent stenosis of coronary stents, myocardial infarctions, and strokes. The nurse should monitor for coffee-ground emesis, black tarry stools, ecchymosis, or any indication of bleeding.

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 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 laboratory reports of a client who has been taking warfarin for atrial fibrillation. Which of the following results should the nurse report to the provider immediately?

A. PT 18 seconds B. Platelet count 160,000/mm^3 C. Hct 43% D. INR 5.5 When using the urgent vs nonurgent approach to client care, the nurse should determine that the priority laboratory result is an INR of 5.5. A client who is taking warfarin for the treatment of atrial fibrillation is expected to have an INR in the range of 2 to 3. A level of 5.5 is considered a critical value and places the client at risk of bleeding; therefore, the nurse should report this result to the provider immediately.

A nurse is providing teaching to a newly licensed nurse about caring for a client who has a prescription for gemfibrozil. The nurse should instruct the newly licensed nurse to monitor which of the following laboratory tests?

A. Platelet count B. Electrolyte levels C. Thyroid function D. Liver function Gemfibrozil reduces triglycerides by decreasing the liver's uptake of fatty acids. It can cause liver toxicity; therefore, the nurse should monitor the client's liver function.

A nurse is caring for a client at 39 weeks of 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 client's risk of complications due to the use of this medication?

A. Positive bacterial vaginosis culture B. History of failure to progress C. Previous cesarean delivery D. Positive serum Rh sensitization The nurse should identify that misoprostol is a prostaglandin that promotes cervical ripening. An adverse effect of misoprostol is uterine tachysystole (excessively frequent uterine contractions). Therefore, this medication should be used with extreme caution and is contraindicated in clients who have experienced a previous cesarean delivery.

A nurse is monitoring a client who has asthma, takes albuterol, and recently started taking propranolol to treat a cardiovascular disorder. The client reports that the albuterol has been less effective. Which of the following factors should the nurse identify as a possible explanation for this change?

A. Potentiative interaction B. Detrimental inhibitory interaction C. Increased adverse reaction D. Toxicity-reducing inhibitory interaction A detrimental inhibitory interaction can occur with the concurrent use of propranolol and albuterol. When a client takes propranolol and albuterol together, propranolol can interfere with albuterol's therapeutic effects.

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. 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 client who takes warfarin 2.5 mg PO daily and has an INR of 6.2. The nurse should anticipate a prescription from the provider for which of the following medications?

A. Protamine sulfate B. Fondaparinux C. Vitamin K D. Bivalirudin The nurse should anticipate the provider to prescribe vitamin K for a client who has an INR of 6.2. Vitamin K antagonizes warfarin's actions, which can reverse warfarin-induced inhibition of clotting factor synthesis.

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 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 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 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 assessing a client who has heart failure and is receiving digoxin. Which of the following findings should indicate to the nurse the client is experiencing digoxin toxicity?

A. Suppression of dysrhythmias B. Increased atrioventricular (AV) conduction C. Visual disturbances D. Weight gain The nurse should recognize that nausea, vomiting, abdominal discomfort, fatigue, and visual disturbances are common manifestations that can indicate that the client is experiencing digoxin toxicity.

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 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 a prescription for chlorothiazide to treat hypertension. The nurse should plan to monitor the client for which of the following adverse effects?

A. Thrombophlebitis B. Hyperactive reflexes C. Muscle weakness D. Hypoglycemia Chlorothiazide is a thiazide diuretic used to treat hypertension and congestive heart failure. It promotes the excretion of water, sodium, and potassium and can cause hypokalemia. Manifestations of hypokalemia include muscle weakness, muscle cramps, and dysrhythmias.

A nurse is providing teaching to a client who has a new prescription for lisinopril. Which of the following should the nurse include in the teaching as an adverse effect of lisinopril?

A. Tongue swelling B. Low potassium level C. Runny nose D. Bruising Angioedema is a fatal response that occurs in about 1% of clients who use ACE inhibitors such as lisinopril. Manifestations of angioedema include swelling of the tongue, lips, or pharynx.