Pharm B
A nurse is reinforcing teaching with a client who has a new prescription for a fluticasone inhaler. Which of the following client statements indicates an understanding of the teaching
"I will rinse my mouth after I use this inhaler" -The client should rinse his mouth after using inhaled glucocorticoids to avoid the development of oral thrush. Therefore, the nurse should identify this statement as indicating an understanding of the teaching.
A nurse in a community health clinic is preparing to administer the varicella vaccine to a young adult female client who has not previously had chickenpox or its vaccine. The nurse should withhold the vaccine and collect additional data when the client makes which one of the following statements?
"I am allergic to neomycin" -A hypersensitivity to neomycin is a contraindication for receiving the varicella vaccine.
A nurse is reinforcing teaching with a client who has a new prescription for vitamin B12 intranasal to treat malabsorption syndrome. Which of the following instructions should the nurse include in the teaching?
"Massage your nose gently after medication administration." -The nurse should instruct the client to massage her nose gently to increase absorption of the medication.
A nurse is reinforcing discharge teaching with a client who has a prescription for a metered-dose inhaler (MDI). Which of the following information should the nurse include in the teaching?
"Take a slow deep breath lasting 3 to 5 seconds after releasing the medication." -The client should take a slow, deep breath lasting 3 to 5 seconds to allow the medication to be distributed deeply into her lungs.
A nurse on a medical-surgical unit is preparing to administer medication to a client. Which of the following question should the nurse ask the client to verify the client's identity?
"What is your name and date of birth?" -Acceptable client identifiers include the client's name, telephone number, facility identification number, date of birth, and other client-specific identifiers. The nurse must use at least two identifiers to verify the client's identity and should compare the information to what is on the client's wristband or in the medical record.
A nurse is reinforcing teaching with a client who is to start therapy with a nitroglycerin transdermal patch. Which of the following statements by the client indicates and understanding of the teaching?
"While using the patch, I will be careful when rising from a chair." -Nitroglycerin can cause orthostatic hypotension, which can result in dizziness. The client should change positions slowly to avoid injury.
A nurse is reinforcing teaching about nicotine polacrilex gum with a client who smokes 3 packs of cigarettes per day. Which of the following statements should the nurse include in the teaching?
"You should chew the gum for a full 30 minutes before discarding." -The nurse should instruct the client to chew the gum slowly for a full 30 min before discarding. The full dose of nicotine from the gum occurs within 15 to 30 min.
A nurse is collecting data from a client who is taking exenatide to treat diabetes mellitus. For which of the following findings should the nurse withhold the exenatide dose and notify the provider immediately?
Abdominal Pain -The greatest risk to this client is the development of pancreatitis as an adverse effect of exenatide; therefore, the nurse should withhold the medication and immediately notify the provider of the client's abdominal pain. Manifestations of pancreatitis include severe, persistent abdominal pain with possible emesis.
A nurse is caring for a client with genital herpes. Which of the following medications should the nurse expect to administer?
Acyclovir -The client should receive acyclovir, an antiviral medication, to treat genital herpes by reducing symptoms and the rate of viral shedding.
A nurse is caring for a client who is having and cute asthma attack. Which of the following medications should the nurse administer first?
Albuterol -According to evidence-based practice, the nurse should administer a short-acting beta2 agonist with a rapid onset when a client is experiencing an acute asthma attack. Therefore, the nurse should administer the albuterol prior to the other medications for prompt relief of airway constriction.
A nurse is collecting data prior to administering digoxin to a client. For which of the following findings should the nurse withhold this medication and notify the provider?
Apical pulse 52/min -The nurse should check the client's apical pulse prior to administering digoxin because it decreases the heart rate and improves contractility. If the client's heart rate is below 60/min, the nurse should withhold the dose and notify the provider.
A nurse is monitoring a client who is 2 hr postoperative and has a prescription for opioid analgesics. Which of the following actions provides the nurse with the priority data to determine the client's need for analgesia?
Ask the client to rate her pain level -According to evidence-based practice, the nurse should first ask the client to rate her pain level to provide a verbal report of pain, which is the priority indicator of the need for pain medication.
A nurse in reinforcing teaching with a client who experiences migraine headaches and has a new prescription for sumatriptan. The nurse should instruct the client to report which of the following manifestations to the provider as an adverse effect of this medication?
Chest tightness -The nurse should instruct the client to report chest pain or tightness to the provider because this can be a manifestation of a vasospastic response.
A nurse is collecting data from a client who has bacterial pneumonia and is taking Ceftriaxone. Which of the following findings indicates a therapeutic effect of the medication?
Clear, bilateral breath sounds -The nurse should identify that wheezing and crackles are findings of bacterial pneumonia. A decrease in these manifestations indicates a therapeutic effect of the medication.
A nurse is performing the third check before administering hydromorphone to a client. After opening the unit-dose packet, the client tells the nurse he does not want to take the medication now. Which of the following actions should the nurse make?
Dispose of the medication with a second nurse as a witness. -The nurse is legally required to have a witness when disposing of a controlled substance.
The nurse erroneously administered zolpidem to the wrong client. Which of the following actions should the nurse take when documenting the medication error?
Document the notification of the client's provider. -In the medical record of the client who received the zolpidem, the nurse should document the objective facts of the error, including follow-up actions and notification of the provider.
A nurse is collecting data from a client who has multiple sclerosis and a new prescription for baclofen. Which of the following findings should the nurse identify as an adverse effect of this medication?
Drowsiness -The nurse should identify drowsiness as an adverse effect of baclofen. Other adverse effects include dizziness, weakness, and fatigue.
A nurse is preparing to administer cefazolin 1g in 100ml 0.9% sodium chloride to infuse over 30 minutes. The drop factor of the manual IV tubing is 15gtt/ml. The nurse should set the manual IV infusion to deliver how many gtt/min?
Follow these steps to calculate the infusion rate: Step 1: What is the unit of measurement the nurse should calculate? gtt/min Step 2: What is the volume the nurse should infuse? 100 mL Step 3: What is the total infusion time? 30 min Step 4: Should the nurse convert the units of measurement? No Step 5: Set up an equation and solve for X. Volume (mL)/Time (min) x drop factor (gtt/mL) = X gtt/min 100 mL/30 min x 15 gtt/1 mL = X gtt/min X = 50 Step 6: Round if necessary. Step 7: Reassess to determine if the amount to administer makes sense. If the provider prescribed cefazolin 1 g in 0.9% sodium chloride 100 mL to infuse over 30 min and the drop factor of the manual IV tubing is 15 gtt/mL, it makes sense to administer 50 gtt/min. The nurse should adjust the manual IV infusion to deliver cefazolin 1 g in 0.9% sodium chloride 100 mL at 50 gtt/min.
The nurse is reviewing the medical administration record of a client who has a history of Stevens-Johnson syndrome when taking sulfamethoxazoletrimethoprim. Which of the following medications should the nurse identify as contraindicated for this client?
Furosemide -A client who has a history of Stevens-Johnson syndrome when taking sulfonamides is at risk for an allergic reaction to furosemide because the two medications are chemically related. The client should also avoid thiazide diuretics and sulfonylurea-type oral hypoglycemic agents.
The nurse is reviewing the medication administration record for a client who has a new prescription for tobramycin to treat a pulmonary infection. Which of the following medications should the nurse identify as increasing the risk for ototoxicity while taking tobramycin?
Furosemide -Tobramycin is an aminoglycoside antibiotic that can cause ototoxicity. Furosemide is a diuretic that also can cause ototoxicity. The client's risk for hearing loss is increased if receiving both of these medications at the same time.
A nurse is collecting data from a client who has angina and has a new prescription for sublingual nitroglycerin. Which of the following manifestations should the nurse expect as an adverse effect of this medication?
Headache -The nurse should expect the client to have headaches as a common adverse effect of taking sublingual nitroglycerin because it causes vasodilation.
A nurse is assisting with the admission of a client who reports muscle aches and pains associated with construction work. The provider suggests taking acetaminophen. The nurse should notify the provider about which of the following information obtained from the client?
History of hepatitis b -Acetaminophen can cause hepatotoxicity. Clients who have a history of liver damage are at risk for further liver damage and can require a lower dose.
The nurse is assisting with the care of a client who is in preterm labor and is receiving magnesium sulfate by continuous IV infusion. Which of the following findings indicates magnesium toxicity?
Hyporeflexia -Magnesium sulfate depresses neuromuscular activity, causing muscle weakness and paralysis. Therefore, the nurse should identify hyporeflexia as an indication of magnesium toxicity and report it to the charge nurse.
A nurse is evaluating a client who is receiving amphotericin B via intermittent IV bolus. Which of the following findings indicates and adverse reaction to this medication?
Hypotension -The nurse should identify that amphotericin B is considered a high-alert drug due to potentially serious adverse effects, such as hypotension. Therefore, the nurse should report this or other adverse effects of amphotericin, such as nephrotoxicity, hypokalemia, and cardiac dysrhythmias.
A nurse is caring for a client who has a 10-year history of alcohol use disorder and is experiencing acute alcohol withdrawal. The nurse should identify which of the following interventions as the priority?
Implement seizure precautions -The greatest risk to the client is injury from seizures and falls. Grand mal seizures can occur during severe alcohol withdrawal. Therefore, the nurse's priority is to implement seizure precautions to prevent injury if the client experiences a seizure.
A nurse is caring for a client who has schizophrenia and is to start therapy with Resperidone. For which of the following manifestations should the nurse monitor to determine whether the treatment is effective?
Improved social interactions -Clients who have schizophrenia typically have difficulty interacting with others and maintaining relationships. Manifestations can include dull affect and speech deficiency. Risperidone is an atypical antipsychotic that can minimize these manifestations, improving social interactions with others.
A nurse is reinforcing teaching with a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following information should the nurse include in the teaching?
Increase fluid intake -Clients who are taking methotrexate should increase fluid intake to reduce the risk for renal damage and to increase drug excretion.
A nurse is caring for a patient who has kidney failure and has been taking Epoetin alfa. Which of the following is a therapeutic effect for this medication?
Increased Hgb -Epoetin alfa is used to elevate erythrocyte count for clients who have kidney failure. An increased Hgb is the desired therapeutic effect of this medication.
A nurse in a provider's office is reviewing the immunization records of a 12-month old-infant who is immunocompromised. Which of the following vaccines should the nurse identify as contraindicated for this client?
Measles, mumps, rubella (MMR) -Although most infants should receive the MMR vaccine between the ages of 12 months and 15 months, the nurse should identify that the MMR vaccine is composed of live viruses and is contraindicated for an infant who is immunocompromised.
A nurse is reinforcing discharge teaching with a client who has type 2 diabetes mellitus and a new prescription for metformin. The nurse should instruct the client to monitor for which of the following manifestations as adverse effects of this medication? (select all that apply)
Muscle pain is (correct.) - Clients taking metformin should monitor for muscle pain or hyperventilation as indications of lactic acidosis. Fatigue is (correct.) -Metformin can decrease vitamin B12 absorption, causing pernicious anemia. Therefore, clients taking metformin should monitor for manifestations of anemia, including fatigue and pallor. Absence of adequate vitamin B12 can also cause neurological damage. Weight gain is (incorrect.) -Unlike sulfonylurea medications, metformin does not cause weight gain, and can cause weight loss in some clients. Constipation is (incorrect.) -Metformin can cause GI manifestations such as diarrhea, nausea, and vomiting. Metallic taste is (correct.) -Metformin can cause GI manifestations such as a bitter or metallic taste.
A nurse is collecting data from a client who is taking tobramycin. Which of the following findings should the nurse report to the provider immediately>
Oliguria -Oliguria indicates the client is at greatest risk for nephrotoxicity. Therefore, the nurse should report this finding to the provider immediately.
A nurse in reinforcing teaching with a client who is newly diagnosed with hypertension and is taking metoprolol. The nurse should instruct the client to report which of the manifestations to the provider as an adverse effect of this medication?
Peripheral Edema -The nurse should instruct the client to monitor for and report the development of peripheral edema because this can be an indication of heart failure, which is an adverse effect of metoprolol.
A nurse is caring for a client who is taking disulfiram and consumed alcohol 12 hr ago. Which of the following adverse reactions is the priority finding to report to the provider?
Respiratory depression -When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is respiratory depression, which can indicate the client is experiencing acetaldehyde syndrome, a life-threatening event.
A nurse is monitoring a client who has just returned to the unit following surgery. The client received an initial dose of morphine 5 mg IV bolus for pain relief. Which of the following adverse effects should the nurse report immediately to the provider?
Respiratory rate 11/min -When using the airway, breathing, circulation approach to client care, the priority finding is a respiratory rate of 11/min, which indicates respiratory depression.
A nurse is collecting data from a client who is taking lithium to treat bipolar disorder. Which of the following findings should the nurse report to the provider?
Slurred speech -The nurse should recognize that slurred speech is an indication of toxicity and should be reported to the provider.
A nurse is collecting data from a client who recently began taking Niacin to treat hyperlipidemia . The client reports experiencing facial flushing after taking the medication. The nurse should expect the provider to make which of the following recommendations?
Take aspirin 30 minutes before taking the medication -The nurse should expect a recommendation of aspirin 30 min prior to each dose to minimize facial flushing. The nurse should inform the client that this manifestation is often transient and diminishes over time.
A nurse is preparing to administer phenobarbital 3 mg/kg PO twice a day to a school-age child who weighs 44 lb. Available is phenobarbital elixir 20 mg/5 ml. How many ml should the nurse plan to administer per dose?
Step 1: What is the unit of measurement the nurse should calculate? kg Step 2: Set up an equation and solve for X. 2.2 lb/1 kg = Client's weight in lb/X kg 2.2 lb/1 kg = 44 lb/X kg X = 20 Step 3: Round if necessary. Step 4: Reassess to determine whether the conversion to kg makes sense. If 2.2 lb = 1 kg, it makes sense that 44 lb = 20 kg. Step 5: What is the unit of measurement the nurse should calculate? mg Step 6: Set up an equation and solve for X. mg x kg/dose = X 3 mg x 20 kg = 60 mg/dose Step 7: Round if necessary. Step 8: Reassess to determine whether the amount makes sense. If the provider prescribed 3 mg/kg and the child weighs 20 kg, it makes sense to administer 60 mg. Step 9: What is the unit of measurement the nurse should calculate? mL Step 10: What is the dose the nurse should administer? Dose to administer = Desired 60 mg Step 11: What is the dose available? Dose available = Have 20 mg Step 12: Should the nurse convert the units of measurement? No Step 13: What is the quantity of the dose available? 5 mL Step 14: Set up an equation and solve for X. Have/Quantity = Desired/X 20 mg/5 mL = 60 mg/X mL X = 15 mL Step 15: Round if necessary. Step 16: Reassess to determine whether the amount to give makes sense. If there are 20 mg/5 mL and the provider prescribed 60 mg, it makes sense to administer 15 mL. The nurse should administer phenobarbital 15 mL PO per dose. Follow these steps for the Desired Over Have method of calculation: Step 1: What is the unit of measurement the nurse should calculate? kg Step 2: Set up an equation and solve for X. 2.2 lb/1 kg = Client's weight in lb/X kg 2.2 lb/1 kg = 44 lb/X kg X = 20 Step 3: Round if necessary. Step 4: Reassess to determine whether the conversion to kg makes sense. If 2.2 lb = 1 kg, it makes sense that 44 lb = 20 kg. Step 5: What is the unit of measurement the nurse should calculate? mg Step 6: Set up an equation and solve for X. mg x kg/dose = X 3 mg x 20 kg = 60 mg/dose Step 7: Round if necessary. Step 8: Reassess to determine whether the amount makes sense. If the provider prescribed 3 mg/kg and the child weighs 20 kg, it makes sense to administer 60 mg. Step 9: What is the unit of measurement the nurse should calculate? mL Step 10: What is the dose the nurse should administer? Dose to administer = Desired 60 mg Step 11: What is the dose available? Dose available = Have 20 mg Step 12: Should the nurse convert the units of measurement? No Step 13: What is the quantity of the dose available? 5 mL Step 14: Set up an equation and solve for X. Desired x Quantity/Have = X 60 mg x 5 mL/20 mg = X mL 15 mL = X Step 15: Round if necessary. Step 16: Reassess to determine whether the amount to administer makes sense. If there are 20 mg/5 mL and the provider prescribed 60 mg, it makes sense to administer 15 mL. The nurse should administer phenobarbital 15 mL PO per dose. Follow these steps for the Dimensional Analysis method of calculation: Step 1: What is the unit of measurement the nurse should calculate? kg Step 2: Set up an equation and solve for X. 2.2 lb/1 kg = Client's weight in lb/X kg 2.2 lb/1 kg = 44 lb/X kg X = 20 Step 3: Round if necessary. Step 4: Reassess to determine whether the conversion to kg makes sense. If 2.2 lb = 1 kg, it makes sense that 44 lb = 20 kg. Step 5: What is the unit of measurement the nurse should calculate? mg Step 6: Set up an equation and solve for X. mg x kg/dose = X 3 mg x 20 kg = 60 mg/dose Step 7: Round if necessary. Step 8: Reassess to determine whether the amount makes sense. If the provider prescribed 3 mg/kg and the child weighs 20 kg, it makes sense to administer 60 mg. Step 9: What is the unit of measurement the nurse should calculate? mL Step 10: What is the quantity of the dose available? 5 mL Step 11: What is the dose available? Dose available = Have 20 mg Step 12: What is the dose the nurse should administer? Dose to administer = Desired 60 mg Step 13: Should the nurse convert the units of measurement? No Step 14: Set up an equation and solve for X. X = Quantity/Have x Conversion (Have)/Conversion (Desired) x Desired/ X mL = 5 mL/20 mg x 60 mg/ X = 15 Step 15: Round if necessary. Step 16: Reassess to determine whether the amount to administer makes sense. If there are 20 mg/5 mL and the provider prescribed 60 mg, it makes sense to administer 15 mL. The nurse should administer phenobarbital 15 mL PO per dose.
A nurse is reinforcing teaching about immunizations with a client who is pregnant. Which of the following vaccines should the nurse include in the teaching as safe to administer during pregnancy?
Tetanus and diphtheria (Td) -The nurse should include that either the Td vaccine or the tetanus, diphtheria, and pertussis (Tdap) vaccine is safe for administration during pregnancy. Tdap is the preferred vaccine.
A nurse is collecting data from a client who has been taking levodopa/carbidopa. Which of the following findings should indicate to the nurse that the medication is effective
The client is able to wash his face -Levodopa works by activating dopamine receptors, restoring nerve transmission for clients who have Parkinson's disease. Carbidopa enhances these effects by inhibiting the breakdown of levodopa in the intestine and periphery. These therapeutic effects assist the client with moving freely and resuming ADLs.
A nurse is reinforcing teaching with a client who has type 1 diabetes mellitus and is learning to self-administer NPH insulin. Which of the client actions indicates an understanding of the teaching?
The client wipes the cap with alcohol prior to filling the syringe. -The client should wipe the cap with alcohol prior to filling the syringe to prevent contamination.
A nurse is reinforcing dietary teaching with a client who has a new prescription for phenelzine. Which of the following foods should the nurse include in the teaching as an appropriate food choice?
Yogurt -Clients taking phenelzine should avoid consuming tyramine, which can cause high blood pressure. Yogurt contains little or no tyramine. Therefore, it is an appropriate food choice to include in the teaching.
A nurse is collecting data from a client who has hyperthyroidism and a new prescription for propylthiouracil. The nurse should monitor the client for which of the following manifestations as an adverse effect of this medication?
sore throat -The nurse should monitor for sore throat and fever because these are early indications of agranulocytosis, which is an adverse effect of propylthiouracil.
A nurse is reviewing a client's medical history before administering hydromorphone for post operative pain. The nurse should notify the provider of which of the following findings before administering this medication?
Benign prostatic hyperplasia -A client who has benign prostatic hyperplasia is at increased risk for developing acute urinary retention while taking opioids. Therefore, the nurse should notify the provider about this finding before administering hydromorphone.
A nurse is reviewing the medical record of a client who has a new prescription for dimenhydrinate to treat motion sickness. Which of the following disorders in the client's medical record should the nurse report to the provider?
Benign prostatic hyperplasia -Clients who have benign prostatic hyperplasia might have urinary hesitancy and retention and, therefore, should not take dimenhydrinate due to the anticholinergic adverse effects of the medication.
A nurse is collecting data from a client who has been taking digoxin for 1 month. The nurse should identify which of the following findings as a manifestation of digoxin toxicty?
Vomiting -The nurse should identify vomiting as an early manifestation of digoxin toxicity.
A nurse is reinforcing teaching with a client who has a new prescription for timolol eye drops to treat glaucoma. Which of the following client statements indicates an understanding of the teaching?
"I will look up when putting the medication into my eyes." -The nurse should instruct the client to look up during administration of eye drops to help protect the cornea and minimize blinking.
An older adult client who has terminal cancer reports a pain level of 5 using a 0 to 10 pain scale. The client has prescription morphine for 15 mg orally every 4 hours. The client's children express concern that the client is receiving too much of the medication. Which of the following responses should the nurse make?
"The dose should remain constant to prevent breakthrough pain" -Fixed or scheduled dosing around the clock offers the best pain control for clients who have severe and persistent pain.
A nurse is collecting data from a client who is taking oral amoxicillin to treat respiratory infection. The nurse should monitor the client for which of the following manifestations as an adverse effect of the medication?
Diarrhea -The nurse should monitor the client for diarrhea. A Clostridium difficile infection is an adverse effect of antibiotics, including amoxicillin.
A nurse is reinforcing teaching with a client who is receiving enalapril 20 mg PO daily. The nurse should instruct the client to monitor for which of the following adverse effects of this medication?
Dry cough -The nurse should identify that a persistent dry or nonproductive cough is an adverse effect of enalapril. The underlying cause of the dry cough is the accumulation of bradykinin from the medication. The client should notify the provider of this adverse effect.
A nurse is caring for a client who is receiving methylprednisolone. Which of the following laboratory values should the nurse plan to monitor? ( Select all that apply)
White blood cell count is (correct.) -Methylprednisolone can increase the client's risk for infection and cause leukocytosis. Serum potassium is (correct.) -Methylprednisolone can cause hypokalemia, as well as fluid and sodium retention. Creatine phosphokinase is (incorrect.) -Methylprednisolone does not damage the muscles and, therefore, does not cause release of creatine phosphokinase. Blood glucose is (correct.) -Methylprednisolone can cause increased blood glucose levels. Amylase is (incorrect.) -Methylprednisolone does not affect pancreatic function.
