Pharm ATi Review
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." Explanation: Aspirin inhibits plate aggregation
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
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?
400 mL/60 min= 6.666= 6.67 (*15 gtt/mL)= 100.05= 100 gtt/min
Nurse is preparing to administer ciprofloxacin 15 mg/kg PO q12h to child weighs 44 lb. How many mg should nurse administer per dose?
44 lb/2.2 kg= 20 kg (*15)= 300 mg/dose
A nurse is teaching a group of unit nurses about medication reconciliation. Which of the following information should the nurse include in the teaching?
A transition in care requires the nurse to conduct medication reconciliation. Explanation: 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 Can prevent injury when given orally or by IV infusion within 8-10 hrs
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.
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 An anticholinergic agent
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 Explanation: Mannitol is an osmotic diuretic that can cause HF and pulmonary edema. Lung crackles signify complication and infusion should be stopped.
Nurse is caring for pt who is receiving heparin therapy via continuous IV to treat pulmonary embolism. Which of following findings should nurse identify as adverse effect of med and report to Dr?
Blood in the urine Explanation: Could be manifestation of heparin toxicity. Other manifestations include bruising, hematomas, hypotension and tachycardia.
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
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. Explanation: Nurse should first asses the pt bc pt is at risk for hypoglycemia. Nurse should monitor blood glucose and provide pt with a snack to reduce risk of 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 Explanation: It is a common adverse effect of morphine. Docusate Sodium is a stool softener that promotes easier evac of stool by increasing water and fat in the intestines.
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.
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. Explanation: Life-threathening bradycardia is a possible adverse effect. If pulse rate is less than 60 bpm withold med and notify 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 Explnation: Ca 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.
Nurse is administering donepezil to a pt who has Alzheimer's disease. Which of following findings should nurse report to provider immediately?
Dyspnea Explanation: Think ABC's !! airway/ breathing
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 Epi 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 Antidote for benzodiazepines
Nurse is providing teaching to pt who has peptic ulcer disease and is to start a new prescription for sucralfate. Which of following actions of sucralfate should nurse include in teaching?
Forms a protective barrier over ulcers Explanation: Sucralfate, a mucosal protectant, forms a gel-like substance that coats the ulcer, creating a barrier to hydrochloric 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 Explanation: Digoxin slows conduction rate through SA and AV nodes therefore decreasing heaart rate. Nurse should withold meds bc 55 bpm is an early sign 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 Estrogen receptot blocking action of tamoxifen results iin hot flashes
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 Thyroid hormone antagonist that decreases the circulating T4 hormone, reducing the manifestations of hyperthyroidism.
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 Explanation: Bupropion is an atypical antidepressent and has stimulant properties which can result in agitation, tremors, mania, and insomnia.
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 Using a spacer and rinsing your mouth will minimize amount of medication in oropharynx
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 Explanation: Platelet count is below the expected range of 150,000 to 400,000. Platelet count less than 100,000 while on heparin can indicate heparin-induced thrombocytopenia, a potentially fatal condition that requires stopping the infusion. "aPTT two times the control" -INCORRECT bc this is therapeutic for a pt on heparin.
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
Nurse is planning care for pt who is prescribed metoclopramide following bowel surgery. For which of following adverse effects should nurse monitor?
Sedation Explanation: CNS ffects include 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 Explanation: Decreased libido, impotence, delayed orgasm, anorgasmia are common effects of fluoxetine and occurs in about 70% of pt taking this SSRI.
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." Explanation: Due to 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." Will reduce adverse GI effects. Contraindicated in pts who can not sit or stand up right for this amount 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." Explanation: Can indicate neutropenia which can be reversed if identified early and medication is 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." Explanation: Pt should remove patch each evening for a medication free time of 12-14 hours before applying a new patch to avoid tolerance "I should discard the used patch by flushing it down the toilet"-INCORRECT
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." Explanation: To prevent abstinence syndrome or rebound insomnia
Nurse is providing teaching to pt who has gastric ulcer and new prescription for ranitidine/ famotidine. Which of following instructions should nurse include?
"Report yellowing of the skin." Can be hepatotoxic and cause jaundice. Monitor and report yellow skin or eyes.
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." Pt should rinse mouth after using gluccocorticoid 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."
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. Explanation: Nurse should only chart factual information in clients medical record wihtout indicating the error that occured
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 Explnation: Window of time is 30 minutes to maintain therapeutic levels.
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: Gluccocorticoids increase glucose levels 2. Avoid contact with people who have known infections: Gluccocorticoids depress the immune system 3. Grapefruit juice can increase the effects of the medication: Increase levels of methylprednisolone in the body.
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 caring for pt who is receiving filgrastim Which of following findings should nurse document to indicate effectiveness of therapy?
Increased neutrophil count Filgrastim stimulates bone marrow to produce neutrophils.
Nurse is caring for pt who is receiving oprelvekin. Which of following findings should nurse document to indicate effectiveness of therapy?
Increased platelet count
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 Explanation: Miosis is pupillary constriction, and a common adver fx of neoostigmine due to excessive muscarinic stimulation
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. Explanation: Bc it could lead to fecal impaction. Oral meds should be held for 6 hours before and after admin of sodium polystyrene and it is stable for 24 hours when refrigerated.
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 Explanation: This medication should be spelled out per The Joint Commision
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 Administer opioid agonist BUT not too quickly.
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. Explanation: Assess for adverse fx of atenolol, such as hypotension
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 Explanation: Isotretinoin has teratogenic effects.
Nurse is reviewing an ECG of pt who is receiving IV furosemide for heart failure. Nurse should identify which of following findings as indication of hypokalemia?
Presence of U-waves
Nurse is caring for pt who is experiencing acute alcohol w/drawl. For which of following pt outcomes should nurse administer chlordiazepoxide?
Prevent delirium tremens
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. & client should move medication stick around in the mouth
A nurse is assessing a client who has schizophrenia and is taking haloperidol. The nurse should report which finding to the provider as a manifestation of neuroleptic malignant syndrome.
Temp 103.5 Explanation: 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.
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 Explanation: The client's description of 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. Explanation: When levels indicate the gas exchannge is adequate "The client is passing flatus"- INCORRECT bc this applies to pt who were under general anesthesia
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 Explanation: Pt should report adverse effects of paresthesia, a tingling sensation, in the extremeties.
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 Explanation: Aminoglycosides are ototoxic which can manifest as tinnitus or deafness . Nurse should monitor pt for high-pitched ringing in the ears and h.aches and should notify 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. Explanation: Greatest risk to the fetus experiencing late decelerations is injury from uteroplacental insufficiency. Therefore priority action is to place the pt in lateral position.
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 significantly increase lithium levels