CMS Practice A Pharm
A nurse is reinforcing teaching w/ a female client who has a new presciption for isotretinoin. Which of the following information should the nurse include in the teaching? (Select all that apply.) -"You will need to have your liver enzymes monitored after 1 month." -"You can have nosebleeds while taking this medication." -"You should report any thoughts of harming yourself." -"You will need to have two negative pregnancy tests prior to starting this medication." -"You will need to take a vitamin A supplement twice daily."
Answer: -"You will need to have your liver enzymes monitored after 1 month." -"You can have nosebleeds while taking this medication." -"You should report any thoughts of harming yourself." -"You will need to have two negative pregnancy tests prior to starting this medication."
A nurse is collecting data from a client who is receiving digoxin for treatment of heart failure. The nurse should identify which of the following findings as adverse effects of this medication? (Select all that apply.) -Blurred vision -Nausea -Hyperactivity -Increased appetite -Dysrhythmia
Answer: -Blurred vision -Nasuea -Dysrhythmia
A nurse is reinforcing teaching w/ a client who is using phenylephrine nasal spray three times daily and reports rebounce congestion. Which of the following instructions should the nurse include to reduce the effects of rebound congestion? -"Decrease the frequency to twice daily." -"Continue use for one more week." -"Discontinue use in the left nostril, then in the right nostril." -"Add oxymetazoline nasal spray to relieve symptoms."
Answer: "Discontinue use in the left nostril, then in the right nostril." Discontinuing the medication one nostril at a time can overcome rebound congestion.
A nurse is reinforcing teaching w/ the parent of a preschooler who has otitis media. The child has had a low-grade fever and irritability for 2 days. Which of the following instruction should the nurse include in the teaching? -"Administer amoxicillin twice a day for 3 days." -"Apply cold packs every 4 hours for relief of pain." -"Give acetaminophen as needed for discomfort and fever." -"Return to the office in 72 hours for a follow-up appointment."
Answer: "Give acetaminophen as needed for discomfort and fever." The nurse should instruct the parent to administer analgesics, such as acetaminophen or ibuprofen, to decrease discomfort and fever related to otitis media.
a nurse is reinforcing teaching w/ a client who has a new prescription for regular insulin. Which of the following statements by the client indicates an understanding of the teaching? -"I should eat right before I give myself an insulin injection." -"I should shake the vial gently prior to drawing up the insulin." -"I should ensure that the insulin is clear prior to drawing it up." -"I should inject the insulin deep into a muscle."
Answer: "I should ensure that the insulin is clear prior to drawing it up." Regular insulin is clear in appearance. Clients should discard the vial and use the new vial if the insulin appears cloudy.
A nurse is reinforcing teaching w/ a client who has HIV and a new prescription for zidovudine. Which of the following client statements should indicate to the nurse an understanding of the teaching? -"I can have unprotected sex after 6 months of taking this medication." -"I can expect to have constipation while taking this medication." -"I will be sure to have my blood tested for anemia." -"My fingers might feel numb after I start therapy."
Answer: "I will be sure to have my blood tested for anemia." Zidovudine can cause severe anemia and neutropenia. The client should have blood tests performed before treatment begins and have continued monitoring during the course of treatment.
A nurse is reinforcing teaching w/ a client who has a new prescription for ethinyl estradiol/norethindrone, an oral contraceptive. Which of the following client statements should indicate to the nurse an understanding of the teaching? -"I should expect my mentrual flow to increase." -"I should monitor my blood pressure for hypotension while on this medication." -"I will take the medication at the same time each day." -"This type of medication is the most effective because it only contains estrogen."
Answer: "I will take this medication at the same time each day." The client should take this medication at the same time each day to maintain a consistent level to reduce fertility and the chance of pregnancy.
A nurse is reinforcing teaching w/ a client who has a prescription alendronate. Which of the following client responses indicates to the nurse an understanding of the teaching? -"I will take the medication with my breakfast." -"I will take the medication with 1 tablespoon of an antacid." -"I will lie down for 30 minutes after taking this medication." -"I will take this medication with 8 ounces of water."
Answer: "I will take this medication with 8 ounces of water." The client should take alendronate on an empty stomach with 240 mL (8 oz) of water to ensure it does not lodge in the esophagus, which can result in esophageal ulcerations.
A nurse is collecting data from a client who has Parkinson's disease and is taking leodopa/carbidopa. The nurse should identify which of the following findings as an adverse effect of this medication? -Dark urine -Hypertension -Increased salvation -Bradycardia
Answer: Dark urine The nurse should idenfity that levodopa/carbidopa can cause a darkening of the client's urine, sweat, and saliva.
A nurse is reinforcing teaching w/ a client who has a new prescription for propranolol. Which of the following information should the nurse include in the teaching? -"If you miss a dose, double the next scheduled dose." -"Discontinue this medication if lightheadedness occurs." -"If your pulse rate is less than 50 bpm, notify your provider." -"This medication can cause heat intolerance."
Answer: "If your pulse rate is less than 50 bpm, notify your provider." The nurse should instruct the client to check their pulse before taking the medication and to withhold the medication if their pulse is less than 50/min. The client should also notify their provider. Bradycardia is a common adverse effect of beta blockers.
A nurse is planning to reinforce teaching about newborn immunizations w/ a client who is 24 hr postpartum. Which of the following information should the nurse plan to include? -"Your baby will receive the first hepatitis B vaccine before discharge." -"Your baby will receive the rotavirus vaccine if your blood titer is low." -"Your baby will receive their first influenza vaccine at the 4-week checkup." -"Your baby will receive the varicella vaccine if you have a history of chickenpox."`
Answer: "Your baby will receive the first hepatitis B vaccine before discharge." The newborn should receive the first hepatitis B vaccine at birth, with the new dose at age 1 - 2 months.
A nurse is caring for a client who has a prescription for an IM injection of penicillin G benzathine. The client asks why the injection must be given IM instead of through the IV line. Which of the following responses should the nurse make? -"The medication is more rapidly absorbed when given IM." -"Your medication can't be given IV because it is not water-soluble." -"You will experience less discomfort with an IM injection." -"An IM injection allows more precise control of the medication level in your blood."
Answer: "Your medication can't be given IV because it is not water-soluble." The nurse should inform the client this type of penicillin has poor water solubility and is never administered intravenously.
A nurse is caring for a client who is receiving 0.9% sodium chloride 1,000 mL to infuse over 8 hr. The drop factor on the manual IV tubing is 15 gtt/mL. The nurse should ensure that the manual IV infusion is set to delivere how many gtt/min? (Round to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
Answer: 31 gtt/min
At 0800 a nurse assists w/ initiating a 1,000 mL IV infusion for a client, which is running at 125 mL/hr. How much fluid is left in the IV bag at 1300? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
Answer: 375 mL
A nurse is preparing to administer a PRN medication to a group of client. Which of the following clients should the nurse administer medication to first? -A client who has GERD and requests an antacid -A client who reports constipation for 3 days and requests a stool softener -A client who has mild generalized anxiety disorder and request and antianxiety medication -A client who is attending postoperative physical therapy and requests pain medication.
Answer: A cliuent who is attending postoperative phyiscal therapy and request pain medication. When using the urgen vs. nonurgen approach to client care, the nurse should determine that the client who is postoperative and going to phyiscal therapy should receive medication first. Administering medication to the client can reduce the client's pain during and after therapy.
A nurse is reinforcing teaching w/ a client who has a new prescription for colchicine to manage gouty arthritis. Which of the following manifestations should the nurse include as an adversce effect of this medication? -Abdominal pain -Wheezing -Excessive urination -Tinnitus
Answer: Abdominal pain Abdominal pain indicates cellular damange to the GI tract. The nurse should notify the provider, and the client should discontinue the medication immediately.
A nurse is reinforcing teaching w/ a client who has seizures and a new prescription for valproic acid. The nurse should instruct the client to report which of the following adverse effects of valporic acid to the provider immediately? -Abdominal pain -Hair loss -Weight gain -Ataxia
Answer: Abdominal pain The greatest risk to the client is heptotoxicity and pancreatitis, which can cause abdominal pain. Therefore, the client should notify the provider immediately if experiencing a decrease in appetite, nausea, abdominal pain, or yellowing of the skin.
A nurse is preparing to administer diphenhydramine 50 mg PO at 2200 to a client who has difficult swallowing pills and capsules. Available is diphenhydramine syrup 12.5 mg/5 mL PO. Which of the following nursing actions requires the completion of an incident report? -Giving the medication at 2140 -Administering the medication w/ grapefruit juice -Giving the medication when the client's apical pulse is 58/min -Administering 25 mL of the syrup
Answer: Administering 25 mL of the syrup This dose is higher than the client should receive. The correct dosage is 20 mL. Administering an incorrect amount of medication to a client requires completion of an incident report.
A nurse in contributing to the plan of care for a client who has schizophrenia and a new prescription for clozapine. The nurse should include in the plan to monitor the client for which of the following adverse effects of this medication? -Hypoglycemia -Iron-deficiency anemia -Serotonin syndrome -Agranulocytosis
Answer: Agranulocytosis The nurse should monitor the client's WBC count and notify the provider for a value below the expected reference range of 5,000-10,000/mm3.
A nurse is reinforcing teaching w/ a newly licensed nurse about using metoprolol to treat HTN. Which of the following conditions should the nurse include as a contraindication for this medication? -Peripheral vascular disease -Diabetes mellitus -Bradycardia -Chronic kidney disease
Answer: Bradycardia Metoprolol is a beta blocker the slows the conduction through the AV node. Therefore, it is contraindicated for client who have bradycardia, or a heart rate that is consistenly less than 60/min.
A client come to an urgent care clinic and announces with great enthusiam, "I am an expert at all things medical as they apply to me, and I requre zolpidem." The client's pupils are dilated, along with an elevated HR and BP. The nurse should suspect intoxication w/ which of the following substances? -Alcohol -Cocaine -Barbiturates -Heroin
Answer: Cocaine The client who has cocaine toxicity typically has tachycardia, elevated BP, dilated pupils, and displays delusions. This client's behavior and physiological data indicated cocaine intoxication.
A nurse is caring for a client who has hyperthyroidism and have been taking methimazole. Which of the following findings should indicate to the nurse that the medication has had a therapeutic effect? -Decreased blood glucose level -Increased Hgb -Increased platelets -Decreased T4
Answer: Decreased T4 The nurse should identify that methimazole inhibits the synthesis of thyroid hormone, reducing levels to provide a euthyroid state. Therefore, a decreased level of T4 is an indication of a therapeutic effect.
A nurse is caring for a client who has multiple sclerosis and a new prescription for baclofen. Which of the following findings indicates to the nurse that the medication is having a therapeutic effect? -Decreased muscle spasticity -Increased urinary output -Increased mental alertness -Decreased heart rate
Answer: Decreased muscle spasticity The nurse should identify that baclofen is an antispasmodic that decreases muscle spasticity in a client who has multiple sclerosis.
A nurse is caring for a client who has TB and will being taking isoniazid. Which of the following actions should the nurse take? -Determine the client's daily alcohol intake. -Tell the client to expect red-orange colored urine. -Reinforce teaching about a low-calorie diet. -Instruct the client to have a yearly TB skin test.
Answer: Determine the client's daily alcohol intake. The nurse should instruct the client to reduce or avoid all use of alcohol because isoniazid can cause liver damage; therefore, it is important for the nurse to determine the client's daily alcohol intake.
A nurse is reinforcing teaching w/ a client who has a new prescription for theophylline. The nurse should instruct te client that which of the following is an expected outcome of this medication? -Dilates bronchioles -Reduces inflammation -Loosens secretions -Blocks leukotrienes
Answer: Dilates bronchioles Theophylline is a bronchodilator, which affects smooth muscle relaxation and leads to opened airways.
A nurse is reinforcing teaching w/ a client following placement of a cast for a fractured ankle. The client is to take oxycodone for pain management. The nurse should instruct the client that which of the following over-the-counter medications is contraindicated while taking oxycodone? -Docusate sodium -Famotidine -Diphenhydramine -Ibuprofen
Answer: Diphenhydramine Both diphenhydramine, an antihistamine, and oxycodone, an opioid analgesic, can cause CNS depression. Therefore, when a client uses the two medications together, the client is at an increased risk for sedation, respiratory depression, and injury.
A nurse is reinforcing treaching w/ a client who has a new presciption for etanercept to treat rheumatoid arthritis. Which of the following instructions about self-administering this medication should the nurse include? -Discard any solutions that are cloud. -Attach a 21-gauge needle to the syringe for injection. -Self-administer the medication on alernate days. -Shake the reconstituted soluation well before self-administration
Answer: Discard any solutions that are cloudy. The client should discard any vials ore pre-filled syringes that contain solutions that are discolored, cloudy, or have any sediment in them.
A nurse is reviewing mediation prescriptions for a group of clients. The nurse should recognize that which of the following presciptions can result in a medication administration error? -Pennicillin G benzathine 1.2 million units IM daily -Furozemide 10.0 mg PO daily -Albuterol 2.5 mg 2 inhalations every 6 hr as needed for shortness of breath -Insulin glargine 15 units subcutaneous daily at bedtime
Answer: Furosemide 10.0 mg PO daily The nurse should avoid using a trailing zero following a whole number. This prescription can result in a medication error because the nurse can mistake the dosage as 10 mg instead of 10 mg because of the decimal point is not always recognized.
A nurse is collecting data from the parent of a toddler who is about to receive the varicella immunization. The nurse should idenitfy that an anaphylactic reaction to which of the following substances is a contraindication for receiving this immunization? -Gelatin -Pennicillin -Sulfa -Eggs
Answer: Gelatin The nurse should identify that a hypersensitivity reaction to either gelatin or neomycin is a contraindication for receiving the varicella vaccine because it contains both of these substances.
A nurse is monitoring a client who has type 2 DM and is receiving repaglinide. Which of the following laboratory tests should the nurse plan to review to obtain information about the long-term effect of this medication? -Fasting blood glucose level -1-hr oral glucose tolerance test -Urinary ketones -Glycosylated HbA1c
Answer: Glycosylated HbA1c The client's HbA1c value measures the average blood glucose leels over the past 2-3 months. Therefore, the nurse should reivew this laboratory test to obtain information about the long-term therapeutic effect of repaglinide.
A nurse is caring for a client who has chronic kidney disease and has been receiving epoetin for 2 weeks. Which of the following findings should indicate to the nurse that the client's medication if having the desired therapeutic effect? -Albumin is within the expected reference range -Urine output increases to 60 mL/hr -Hemoglobin rises 0.5 g/dL -Blood urea nitrogen level is within the expected reference range
Answer: Hemoglobin rises 0.5 g/dL Initial therapeutic effects, such as hemoglobin rising 0.5 g/dL, can occure within the first 2 weeks of therapy. The client's hemoglobin should reach target levels of 10 - 11 g/dL in 2-3 months.
A nurse is collecting data from a client who is asking about taking celecoxib for treatment of joint pain. The nurse should identify that which of the following findings is a contraindication to receiving celecoxib? -Hyperglycemia -Allergy to penicillin -History of myocardial infarction -Peptic ulcer disease
Answer: History of myocardial infarction Celecoxib increased the risk of myocardial infarction caused by increased vasoconstriction and unimpeded platelet aggregation. It is contraindicated for a client who has a history of myocardial infarction or heart disease.
A nurse is caring for a client who has a new prescription for eplerenone to treat HTN. The nurse should monitor for which of the following adverse effects of this medication? -Hematuria -Hypernatremia -Hyperkalemia -Constipation
Answer: Hyperkalemia The nurse should identify that eplerenone can place te client at risk for increased potassium levels because eplerenone can cause potassium retention.
A nurse is assisting w/ the care of a client who has methicillin-resistant Stphylococcus aureus (MRSA) infection and is receiving vancomycin via IV infusion. Which of the following changes in the client's condition should the nurse identify as the priority finding to report to the provider? -Nausea -Back pain -Hypotension -Chills
Answer: Hypotension When using the urgent vs. nonurgent approach to client care, the nurse determines that the priority finding to report to the provider is hypotension. If the client's vancomycin infusion is too rapid, it can cause red man syndrome, which is a group of adverse effects that includes tachycardia, hypotension, flushing, and urticaria.
A nurse is caring for a client who is taking phenylephrine. The nurse should plan to monitor the client for which of the following manifestations as an adverse effect of this medication? -Increased drowsiness -Increased heart rate -Decreased BP -Decreased WBC count
Answer: Increased heart rate Due to cardiac effects, phenylephrine can cause tachycardia and other cardiac dysrythmias.
A nurse is collecting data from a client who is taking ferrous sulfate orally. Which of the following findings reported by the client should indicate to the nurse that the medication is having therapeutic effect? -Passing of a soft, formed stool daily -Decreased number of viral illnesses -Improved ability to fall asleep -Increased tolerance to exercise
Answer: Increased tolerance to exercise. The client who takes ferrous sulfate, which is used to treat iron-deficiency anemia, can have fatigue and shortness of breath due to a low hemoglobin level. An increased tolerance to exercise is an indication the ferrous sulfate is having a therapeutic effect. Increased tolerance to exercise occurs when the hemoglobin level increases, allowing more oxygen to be carried to the vital organs and tissues.
A nurse is caring for a client who has a history of psychosis and is taking chlorpromazine. Which of the following actions should the nurse take to counteract the adverse effects of this medication? -Suggest that the client apply antiperspirant deodorant more frequently. -Inform the client to apply sunblock before going outside. -Give the client a list of OTC antidiarrheal medications. -Recommend that the client take the medication on an empty stomach.
Answer: Inform the client to apply sunblock before going outside. The nurse should inform the client to apply sunblock, which will counteract the adverse effects of photosensitivity. Chlorpromazine increases skin's sensitivity to ultraviolet light causing temporary pigmentation changes and increases the risk of sunburn.
A nurse is reinforcing teaching w/ a client who has bipolar disorder and a new prescription for lithium. Which of the following instructions should the nurse include in the teaching? -Take the medication on an empty stomach. -Monitor for signs of hyperthyroidism. -Watch for signs of urinary retention. -Maintain a consistent sodium intake.
Answer: Maintain a consistent sodium intake. The client should maintain a consistent sodium intake qwhile taking lithium. Decreased serum sodium levels cause lithium excretion to decline, which can lead to toxicity.
A nurse is reinforcing teaching w/ a client aout the adverse effects of simvastatin. For which of the following adverse effects should the nurse instruct the client to notfy the provider? -Muscle pain -Find hand tremors -Urinary retention -Double vision
Answer: Muscle pain The nurse should instruct the client to notify the provider if muscle pain or tenderness develops because this can indicate the client is developing rhabdomyolysis.
A nurse is collecting data from a client who is postoperative and taking morphine for pain. Which of the following findings is the priority for the nurse to report to the provider? -Constipation -O2 saturation 87% -Vomiting -Urinary output is 25 mL over 1 hr
Answer: O2 saturation 87% When using the airway, breathing, and circulation approach to the client care, the nurse determines that the priority finding it an O2 saturation of 87%, which if an manifestation of respiratory depression and should be reported to the provider.
A nurse is reviewing the history of a client who is to start taking cefotetan to treat bacterial infection. Which of the following information from the client's medical record should the nurse report to the provider before the client begins receiving this medication? -Hearing impairment -Milk-protein allergy -Tendon pain -Penicillin allergy
Answer: Penicillin allergy Cefotetan is a cephalosporin, and antibiotic structurally similar to penicillins. A client who has a severe allergy to penicillin can develop cross-reactivity and have an allergic reaction to cephalosporins. Therefore, the nurse should report this information to the provider before the client starts taking the medication.
A nurse is reinforcing teaching w/ a client who is to start therapy using nitroglycerin transdermal patch. Which of the following instructions should the nurse include? -Cover the patch with a dry dressing. -Apply another patch is experiencing chest pain. -Leave each patch in place for 24 hours. -Place the patch on a difference site for each application.
Answer: Place the patch on a different site for each application. The client should place the patch on a different site for each application to prevent skin irritation.
A nurse is instilling timolol eyedrops for a client who has glaucoma. Which of the following actions should the nurse take after instilling the eyedrops? -Press the nasolacrimal duct. -Apply pressure to the upper eyelid. -Ask the client to blink their eyes several times. -Tell the client to keep their eyes ovpen for atleast 15 seconds.
Answer: Press the naolacrimal duct The nurse should press the client's duct after instilling the eye drops to prevent the medication from absorbing into the systemic circulation.
A nurse is collecting data from a female client who has been taking propylthiouracil (PTU) for 2 months to treat Graves' disease. Which of the following findings should the nurse recognize as an indication that the medication is effective? -Weight loss -Pulse 82/min -Respiratory rate 22/min -Decreased menstrual flow
Answer: Pulse 82/min Tachycardia is a manifestation of hyperthyroidism. The nurse should identify that a pulse of 82/min is within the expected reference range of 60-100/min, indicating that the medication is effective.
A nurse is reinforcing teaching w/ a client who has HTN and a new prescription for spironolactone. Which of the following instructions should the nurse include in the teaching? -Increase foods high in Zinc. -Restrict foods high in potassium. -Restrict foods high in vitamin K. -Increase foods high in magnesium.
Answer: Restrict foods high in potassium. The nurse should instruct the client that spironolactone is a potassium-sparing diuretic, which can cause hyperkalemia. Therefore, the client should restrict foods that are high in potassium and salt substitutes that contain potassium.
A nurse is reinforcing teaching about comfort measures w/ the parent of a 10-year-old child who has a viral infection. The nurse should plan to tell the parent that aspirin is contraindicated because of the risk for which of the following conditions? -Juvenile idiopathic arthritis -Reye syndrome -Glomerulonephritis -Iron-deficiency anemia
Answer: Reye Syndrome Apirin is contraindicated for children and adolescents who have a viral illness because it increases the risk for the development of Reye syndrome.
A nurse is monitoring a client who is receiving a transfusion of packed RBCs. The client's temperature increases to 39.1 C (102.4 F). Which of the following actions should the nurse take first? -Obtain a urine speciment -Administer diphenhydramine -Stop the transfusion -Notify the charge nurse
Answer: Stop the transfusion The greatest risk to this client is injury from a transfusion reaction that can cause acute intravascular hemolysis or anaphylaxis. Therefore, the first action the nurse should take is to stop the transfusion.
A nurse is reinforcing teaching w/ a client who has a new prescription for omeprazole oral capsules. Which of the following instructuons should the nurse include? -Take the medication at bedtime. -Swallow the medication whole. -Take the medication with food. -Avoid antacids when taking this medication.
Answer: Swallow the medication whole. The nurse should instruct the client to swallow the capsules or tablets whole and not chew or crush them. Omeprazole, a proton pump inhibitor, blocks the secretion of gastric acid. It is available in delayed-release capsules and OTC in delayed-release tablets, as well as suspensions and powders.
A nurse is caring for a client who has a new prescription for sumatriptan. The nurse notes that the client take fluoxetine. The nurse should notify the provider that the combination of these medications will place the client at risk for which of the following adverse effects? -Tremors -Renal calculi -Dysphagia -Hearing loss
Answer: Tremors Concurrent use of sumatriptan and fluoxetine can lease to excessive stimulation of the serotonin receptors, placing the client at risk for serotonin syndrome. The client can experience tremors, confusion, and hallucinations.
A nurse is planning to administer metoprolol to a client who has heart failure and a heart rate of 48/min. Which of the following actions should the nurse take? -Encourage the client to ambulate. -Request a different beta blocker medication to administer. -Administer one-half of the client's prescribed dose. -Withhold the client's medication.
Answer: Withhold the client's medication. The nurse should identify tat metoprolol, a beta blocker medication, results in a decrease in heart rate and should withhold the medication for a heart rate less than 50/min. The nurse should also notify the client's provider of the client's heart rate.