pharm exam 2 nclex questions

A physician has prescribed a central nervous system stimulant for a 7-year-old child, who is already of short statue. Which of the following interventions will promote growth? A. administer growth hormone B. encourage daily exercise C. maintain a 220-calorie diet D. drug holidays when on school breaks

D

Which statement indicates the client understands discharge instructions regarding cholestyramine (Questran)? a. "I will take Questran 1 hour before my other medications." b. "I will increase fiber in my diet." c. "I will weigh myself weekly." d. "I will have my blood pressure checked weekly."

b. "I will increase fiber in my diet."

A nurse is caring for a client with elevated triglyceride levels who is unresponsive to HMG-CoA reductase inhibitors. What medication will the nurse administer? a. cholestyramine (Questran) b. colestipol (Colestid) c. gemfibrozil (Lopid) d. simvastatin (Zocor)

c. gemfibrozil (Lopid)

The nurse receives a lab report indicating that the phenytoin (Dilantin) level for the patient she saw in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? A) Continue as planned since the level is within normal limits. B) Tell the patient to hold today's dose and return to the clinic. C) Consult the prescriber to recommend an increased dose. D) Have the patient call 911 and meet the patient in the emergency department.

A) Continue as planned since the level is within normal limits

The nurse is assessing a newly admitted patient who has a history of seizures. During the assessment, the patient has a generalized seizure that does not stop for several minutes. The nurse expects that which drug will be ordered for this condition? a) valproic acid (Depakote) b) neurontin (Gabapentin) c) carbamazepine (Tegretol) d) diazepam (Valium)

) diazepam (Valium)

The nurse is educating a patient who has been prescribed methylphenidate for narcolepsy about the drug's adverse effects. What potential adverse effects would the nurse include in the patient teaching?

-weight loss -headache -insomnia

A client who has overdosed on amphetamine sulfate and dextroamphetamine (Adderall XR) is admitted to the emergency department. The nurse would anticipate which medications to be administered to assist in counteracting the effects of the overdosage? 1. Chlorpromazine (Thorazine) 2. Phenytoin (Dilantin) 3. Propofol (Diprivan) 4. Dexamethasone (Decadron)

1

A nurse is reading the laboratory results for a client being treated with carbamazepine (Tegretol) for prophylaxis of complex-partial seizures. The nurse interprets that which of the following values is consistent with an adverse reaction to this medication? 1. White blood cell count 3200/mm3 2. Blood urea nitrogen 19 mg/dL 3. Sodium 136 mEq/L 4. Platelet count 350,000/mm3

1. White blood cell count 3200/mm3

The nurse who is monitoring a client is taking phenytoin (Dilantin) has noted symptoms of nystagmus, confusion, and ataxia. Considering these findings, the nurse would suspect that the dose of the drug should be: 1. Reduced 2. Increased 3. Maintained 4. Discontinued

1. Reduced

he nurse is reviewing the laboratory test results for a 68-year-old patient whose warfarin (Coumadin) therapy was terminated during the preoperative period. The nurse concludes that the patient is in the most stable condition for surgery after noting which INR (international normalized ratio) result? 1.0 1.8 2.7 3.4

1.0 The therapeutic range for INR is 2.0 to 3.0 for many clinical diagnoses. The larger the INR number, the greater the amount of anticoagulation. For this reason, the safest value before surgery is 1.0, meaning that the anticoagulation has been reversed.

Which therapeutic outcome would the nurse consider more significant in evaluating a client who started atomoxetine (Strattera) 6 months ago? 1. Decrease in attention 2. Decrease in hyperactivity 3. Development of mydriasis 4. Elevated liver enzymes

2

The client is to begin taking atorvastatin (Lipitor) and the nurse is providing education about the drug. Which symptom related to this drug should be reported to the health care provider? 1. Constipation 2. Increasing muscle or joint pain 3. Hemorrhoids 4. Flushing or "hot flash"

2 Rationale: "Statins" (HMG-CoA reductase inhibitors) such as atorvastatin (Lipitor) may cause rhabdomyolysis, a rare but serious adverse effect.

The nurse is caring for a patient with a recent history of deep vein thrombosis (DVT). The patient now needs to undergo surgery for appendicitis. The nurse is reviewing the laboratory results for this patient before administering an ordered dose of vitamin K. The nurse determines that the medication is both safe to give and is most needed when the international normalized ratio (INR) is which result? 1.0 1.2 1.6 2.2

2.2 Vitamin K is the antidote to warfarin (Coumadin), which the patient has most likely been taking before admission for treatment of DVT. Warfarin is an anticoagulant that impairs the ability of the blood to clot. Therefore it is necessary to give vitamin K before surgery to reduce the risk of hemorrhage. The largest value of the INR indicates the greatest impairment of clotting ability, making 2.2 the correct selection.

141.) The nurse has reinforced instructions to a client who has been prescribed cholestyramine (Questran). Which statement by the client indicates a need for further instructions? 1. "I will continue taking vitamin supplements." 2. "This medication will help lower my cholesterol." 3. "This medication should only be taken with water." 4. "A high-fiber diet is important while taking this medication."

3. "This medication should only be taken with water." Rationale: Cholestyramine (Questran) is a bile acid sequestrant used to lower the cholesterol level, and client compliance is a problem because of its taste and palatability. The use of flavored products or fruit juices can improve the taste. Some side effects of bile acid sequestrants include constipation and decreased vitamin absorption. *Note the closed-ended word "only" in option 3*

A high school student taking atomoxetine (Strattera) for ADHD disorder visits the school nurse's office and confides "I am so depressed. The world would be better off without me." Which actions would the nurse take for this client. 1. Tell the client to stop taking atomoxetine immediately and not to take it until checking with the provider. 2. Assure the client that these are normal symptoms because the drug may 3 or 4 weeks to work. 3. Alert the family or caregiver that immediate attention and treatment are needed for these symptoms. 4. Have the client increase intake of caffeine by consuming cola products, coffee, or tea to counteract the depressive effect.

3. Alert the family or caregiver that immediate attention and treatment are needed for these symptoms.

Carbamazepine (Tegretol) has been prescribed for a 24-year-old for the control of partial seizures. The nurse will teach the client to immediately report: 1. Blurred vision 2. Leg cramps 3. Blister-like rash 4. Lethargy

3. Blister-like-rash

A client who is receiving carbamazepine (Tegretol) daily has a white blood cell (WBC) count of 2800 cells/mm3, blood urea nitrogen (BUN) of 17 mg/dL, sodium of 141 mEq/L, and uric acid of 5 mg/dL. The nurse makes which interpretation, based on these laboratory values? 1. The uric acid level is elevated, indicating the risk for renal calculi. 2. The sodium level is low, indicating an electrolyte imbalance. 3. The BUN is elevated, indicating nephrotoxicity. 4. The WBC count is low, indicating a blood dyscrasia.

4. The WBC count is low, indicating a blood dyscrasia.

1.) A home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which of the following statements, if made by the client, indicates the need for further education? 1. "Constipation and bloating might be a problem." 2. "I'll continue to watch my diet and reduce my fats." 3. "Walking a mile each day will help the whole process." 4. "I'll continue my nicotinic acid from the health food store."

4. "I'll continue my nicotinic acid from the health food store." Rationale: Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin is to be avoided. Constipation and bloating are the two most common side effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

An elementary school nurse is providing education to the faculty on the use of central nervous system stimulants used to treat attention deficit/hyperactivity disorder. Of the following, which is most important for the nurses to convey to the faculty? 1. Have the child bring the drug dose in a lunch bag and come to the office to take it to avoid being teased. 2. Request that the parents leave extra copy of the prescription at the school in case the dose runs out. 3. Suggest that the parents have two prescriptions filled, one for home and one to keep at school. 4. Keep the drugs in a locked drawer, clearly labeled with the client's name and only the number of doses allowed by school policy.

4. Keep the drugs in a locked drawer, clearly labeled with the client's name and only the number of doses allowed by school policy.

An 80-year old client is prescribed carbamazepine (Tegretol) for a newly diagnosed seizure disorder. The nurse will implement safety measures because this client is at an increased risk for which adverse effects with the administration of this drug? 1. Dementia and confusion. 2. Insomnia and forgetfulness related to sleep deprivation. 3. Stroke and decreased motor function. 4. Sedation and falls.

4. Sedation and falls.

Which client should the nurse assess first? A. The client taking carbamazepine (Tegretol) who is not oriented to place or time. B. The client taking carbamazepine (Tegretol) who has bruises on his arms. C. The client taking valproic acid (Depakene) with an increased appetite. D. The client taking valproic acid (Depakene) who has lost 2 pounds since starting therapy.

A The client who is not oriented and taking carbamazepine could be experiencing adverse effects of therapy. This is the client the nurse should assess first. The other clients are not experiencing adverse effects.

The patient has been placed on the oral form of valproic acid for seizure management. Which is an appropriate meal choice for this patient? A. Chicken, broccoli, iced tea B. Hamburger, French fries, seltzer C. Steak, macaroni and cheese D. Chicken sandwich, apple, milk

A The patient who is being treated with the oral form of valproic acid should avoid both milk products and carbonated beverages. These should be avoided because they may lead to the drug dissolving early and irritating the mucosa.

The nurse is monitoring a patient with a phenytoin level of 8 mcg/ml. What is an appropriate nursing action? A. Call the healthcare provider for an increase in dosage. B. Hold the medication and call the healthcare provider. C. Document the value and continue to monitor the patient. D. Draw another lab value within the hour.

A Therapeutic levels for phenytoin therapy are 10 to 20 mcg/ml. A patient with a level of 8 is likely to continue to have seizures. The healthcare provider needs to be called for an increase in dosage. Since the phenytoin level is not therapeutic, holding the medication or giving it and continuing to monitor or check labs are inappropriate actions.

The nurse is administering IV diazepam (Valium). When will the nurse expect the onset of the drug to occur? A. Immediately B. Within 5 minutes C. Within 15 minutes D. Within 1 hour

A When diazepam is given intravenously, the nurse should expect the onset of the drug to occur immediately.

Which patient would the nurse need to assess first if the patient is receiving mannitol (Osmitrol)? A 67-year-old patient with type 1 diabetes mellitus A 21-year-old patient with a head injury A 47-year-old patient with anuria A 55-year-old patient receiving cisplatin to treat ovarian cancer

A 47-year-old patient with anuria Correct Mannitol (Osmitrol) is not metabolized but excreted unchanged by the kidneys. Potential water intoxication could occur if mannitol is given to a patient with anuria. Mannitol is safe to use with diabetic patients and those with head injuries, and it may function as a nephroprotectant when cisplatin is being used.

The nurse is conducting discharge teaching related to a new prescription for phenytoin (Dilantin). Which statements are appropriate to include in the teaching for this patient and his family? Select all that apply. A) "Be sure to call the clinic if you or your family notice increased anxiety or agitation." B) "You may have some mild sedation. Do not drive until you know how this drug will affect you." C) "This drug may cause easy bruising. If you notice this, call the clinic immediately." D) "It is very important to have good oral hygiene and visit your dentist regularly." E) "You may continue to have wine with your evening meals but only in moderation."

A, B, D Patients receiving an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin even at therapeutic levels. Carbamazepine(Tegretol), not phenytoin, increases the risk for hematologic effects, such as easy bruising. Phenytoin causes gingival hyperplasia in about 20% of patients who take it. Dental hygiene is important. Patients receiving phenytoin should avoid alcohol and other central nervous system depressants because they have an additive depressant effect.

A child diagnosed with attention deficit hyperactivity disorder (ADHD) shows hyperactivity, aggression, and impaired play. The health care provider prescribed amphetamine salts (Adderall). The nurse should monitor for which desired behavior? a. Increased expressiveness in communication with others b. Abilities to identify anxiety and implement self-control strategies c. Improved abilities to participate in cooperative play with other children d. Tolerates social interactions for short periods without disruption or frustration

ANS: C The goal is improvement in the child's hyperactivity, aggression, and play. The remaining options are more relevant for a child with intellectual development disorder or an anxiety disorder.

The patient has an international normalized ratio (INR) value of 1.5. In response to this, the nurse could anticipate the health care provider placing which order? Administer an additional dose of warfarin (Coumadin). Hold the next dose of warfarin (Coumadin). Increase the heparin drip rate. Administer protamine sulfate.

Administer an additional dose of warfarin (Coumadin). Correct A therapeutic INR is 2 to 3. The patient needs more warfarin to reach a therapeutic level.

Shortly after admission to an acute care facility, a male client with a seizure disorder develops status epilepticus. The physician orders diazepam (Valium) 10 mg I.V. stat. How soon can the nurse administer a second dose of diazepam, if needed and prescribed? a. In 30 to 45 seconds b. In 10 to 15 minutes c. In 30 to 45 minutes d. In 1 to 2 hours

Answer: B When used to treat status epilepticus, diazepam may be given every 10 to 15 minutes, as needed, to a maximum dose of 30 mg. The nurse can repeat the regimen in 2 to 4 hours, if necessary, but the total dose shouldn't exceed 100 mg in 24 hours. The nurse must not administer I.V. diazepam faster than 5 mg/minute. Therefore, the dose can't be repeated in 30 to 45 seconds because the first dose wouldn't have been administered completely by that time. Waiting longer than 15 minutes to repeat the dose would increase the client's risk of complications associated with status epilepticus.

A male client has a history of painful, continuous muscle spasms. He has taken several skeletal muscle relaxants without experiencing relief. His physician prescribes diazepam (Valium), 2 mg P.O. twice daily. In addition to being used to relieve painful muscle spasms, diazepam also is recommended for: a. Long-term treatment of epilepsy. b. Postoperative pain management of laminectomy clients. c. Postoperative pain management of diskectomy clients d. Treatment of spasticity associated with spinal cord lesions.

Answer: D Rationale: In addition to relieving painful muscle spasms, diazepam also is recommended for treatment of spasticity associated with spinal cord lesions. Diazepam's use is limited by its central nervous system effects and the tolerance that develops with prolonged use. The parenteral form of diazepam can treat status epilepticus, but the drug's sedating properties make it an unsuitable choice for long-term management of epilepsy. Diazepam isn't an analgesic agent.

What information should the nurse provide to a patient who will self-administer an antiepileptic agent for the first time at home? A. Wait to see how you react to the medication before driving. B. Lie in bed for at least an hour after taking any antiepileptic agent. C. Take the antiepileptic agent with milk or juice to prevent stomach upset. D. Do not take the medication if you have a fever.

Antiepileptic medications suppress the central nervous system. The patient should know how they respond to the medication before attempting tasks such as driving. The patient does not have to lie in bed for an hour after taking an antiepileptic. Several medications cannot be taken with milk or fruit juice, and the nurse should not instruct the patient to administer medication in this manner. A fever is not a contraindication to taking an antiepileptic agent.

A patient taking Dilantin (phenytoin) for a seizure disorder is experiencing breakthrough seizures. A blood sample is taken to determine the serum drug level. Which of the following would indicate a sub-therapeutic level? A. 15 mcg/mL. B. 4 mcg/mL. C. 10 mcg/dL. D. 5 mcg/dL.

B. 4 mcg/mL. The therapeutic serum level for Dilantin is 10 - 20 mcg/mL. A level of 4 mcg/mL is sub-therapeutic and may be caused by patient non-compliance or increased metabolism of the drug. A leve of 15 mcg/mL is therapeutic. Choices C and D are expressed in mcg/dL, which is the incorrect unit of measurement.

A patient taking methylphenidate HCl (Ritalin) is nauseous and vomiting. What is the nurse's best action? Monitor the patient's vital signs. Ask the patient if he or she has been taking the medication regularly. Assess the patient's temperature. Administer an antiemetic medication.

Ask the patient if he or she has been taking the medication regularly. these symptoms are signs of withdrawal. The nurse should find out if the patient has been taking the medication regularly.

The nurse is caring for a child taking methylphenidate for ADHD. Assessment reveals a heart rate of 110, and the child is complaining of chest pain. What is the nurse's best action? Administer an antianxiety agent. Assess for over-the-counter medication use. Stay with the child and use relaxation techniques. Hold the next dose of the medication.

Assess for over-the-counter medication use. This medication interacts with over-the-counter cold medication. The nurse should assess for the use of over-the-counter medication use.

While obtaining a patient history, the nurse notes that the patient has been prescribed ethosuximide (Zarontin). What is the nurse's primary assessment? Assess patient for absence seizures. Assess patient for panic attacks. Assess patient for migraines. Assess patient for tonic-clonic seizures.

Assess patient for absence seizures Ethosuximide (Zarontin) is the first-line drug of choice to treat absence seizures. It does not treat panic attacks, migraines, or tonic-clonic seizures

The mother of a child with attention deficit hyperactivity disorder (ADHD) who has been prescribed methylphenidate (Ritalin) expresses concern regarding the use of a controlled substance to treat her child and asks if there are any other options. The nurse's response is based on the knowledge that an option for treatment for ADHD might include which non-controlled central nervous system (CNS) stimulant?

Atomoxetine (Strattera) Atomoxetine (Strattera) is not a controlled substance as it lacks addictive properties, unlike amphetamines and phenidates.

The nurse is preparing to give ethosuximide (Zarontin). The nurse understands that this drug is only indicated for which seizure type? A) Tonic-clonic B) Absence C) Simple partial D) Complex partial

B) Absence Absence seizures are the only indication for ethosuximide. The drug effectively eliminates absence seizures in approximately 60% of patients and effectively controls 80% to 90% of cases.

A 20-year-old client presents to the clinic with complaints of breast tenderness, nausea, vomiting, and absence of menses for 2 months. She has a history of a seizure disorder well controlled with carbamazepine (Tegretol). She tells the nurse that she has been taking her oral contraceptives as directed, but she wonders if she might be pregnant. The nurse's best response to her concern should be which of the following? A. "You can't be pregnant if you have been taking your oral contraceptives correctly." B. "Carbamazepine can decrease the effectiveness of oral contraceptive drugs, so we need to do a pregnancy test." C. "There is no need to worry. Oral contraceptives are very effective." D. "Taking antiseizure drugs with oral contraceptives significantly decreases your risk of getting pregnant."

B. "Carbamazepine can decrease the effectiveness of oral contraceptive drugs, so we need to do a pregnancy test.

The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam [Valium]. Which agent is most likely to be administered to reverse the effects of diazepam? A. Naloxone [Narcan] B. Flumazenil [Romazicon] C. Acetylcysteine [Mucomyst] D. Vitamin K

B. Flumazenil [Romazicon] Flumazenil [Romazicon], a benzodiazepine receptor antagonist, is the treatment of choice for overdose of the benzodiazepine diazepam [Valium]. Naloxone [Narcan] is used to reverse opioid overdose. Acetylcysteine [Mucomyst] is used to reverse acetaminophen [Tylenol] overdose. Vitamin K is used to reverse warfarin toxicity.

Which statement by the nurse explains to the patient the action of cholestyramine to decrease blood lipid levels?

Binds to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces.

A patient with increased ICP has mannitol (Osmitrol) prescribed. Which option is the best indication that the drug is achieving the desired therapeutic effects? A. Urine output increases from 30 mL to 50 mL/hour. B. Blood pressure remains less than 150/90 mm Hg. C. The LOC improves. D. No crackles are auscultated in the lung fields.

C LOC is the most sensitive indicator of ICP. Mannitol is an osmotic diuretic that works to decrease the ICP by plasma expansion and an osmotic effect. Although the other options may indicate a therapeutic effect of a diuretic, they are not the main reason this drug is given.

1. Which of the following statements made by a client taking phenytoin indicates understanding of the nurse's teaching? A. "I will increase the dose if my seizures don't stop." B. "I don't need to contact my health care provider before taking an over-the-counter cold remedy." C. "I will take good care of my teeth and see my dentist regularly." D. "I cannot take this drug with food."

C. "I will take good care of my teeth and see my dentist regularly."

The nurse instructs a 50-year-old woman about cholestyramine to reduce pruritis caused by gallbladder disease. Which statement by the patient to the nurse indicates she understands the instructions? A. "This medication will help me digest fats and fat-soluble vitamins." B. "I will apply the medicated lotion sparingly to the areas where I itch." C. "The medication is a powder and needs to be mixed with milk or juice." D. "I should take this medication on an empty stomach at the same time each day."

C. "The medication is a powder and needs to be mixed with milk or juice." For treatment of pruritus, cholestyramine may provide relief. This is a resin that binds bile salts in the intestine, increasing their excretion in the feces. Cholestyramine is in powder form and should be mixed with milk or juice before oral administration.

Which information should be given to the client taking phenytoin (Dilantin)? A. Taking the medication with meals will increase its effectiveness. B. The medication can cause sleep disturbances C. More frequent dental appointments will be needed for special gum care. D. The medication decreases the effects of oral contra- ceptives.

C. More frequent dental appointments will be needed for special gum care. Gingival hyperplasia is a side effect of phenytoin. The client will need more frequent dental visits. Answers A, B, and D do not apply to the medication; therefore, they are incorrect.

The nurse should instruct the client taking atomoxetine (Strattera) to avoid foods containing which substance?

Caffine

he nurse is caring for a patient who has been receiving warfarin (Coumadin) and digoxin (Lanoxin) as treatment for atrial fibrillation. Because the warfarin has been discontinued before surgery, the nurse should diligently assess the patient for which complication early in the postoperative period until the medication is resumed? Decreased cardiac output Increased blood pressure Cerebral or pulmonary emboli Excessive bleeding from incision or IV sites

Cerebral or pulmonary emboli Warfarin is an anticoagulant that is used to prevent thrombi from forming on the walls of the atria during atrial fibrillation. Once the medication is terminated, thrombi could again form. If one or more thrombi detach from the atrial wall, they could travel as cerebral emboli from the left atrium or pulmonary emboli from the right atrium.

A 34-year-old woman who developed Stevens-Johnson syndrome while undergoing treatment with carbamazepine (Tegretol) is being transferred in stable condition from the intensive care unit to the medical unit. There are 4 beds available. The nurse knows the best choice of roommates for this client is which of the following? (a) A 40-year-old man with methicillin-resistant Staphylococcus aureus (MRSA). (b) A 28-year-old woman diagnosed with diarrhea. (c) A 72-year-old man with fever of unknown origin. (d) A 68-year-old woman with atrial fibrillation .

Correct answer: (d) A 68-year-old woman with atrial fibrillation. Rationale: A client with Stevens-Johnson syndrome is likely to have severe skin integrity issues, including blistering and skin shedding, which can place the client at high risk for infection. Atrial fibrillation is not an infectious process. All other patients may be an infection risk for an individual with altered skin integrity.

A clinician prescribes dextroamphetamine for a patient. Which of the following is an adverse effect of this medication? A. increased appetite B. respiratory depression C. sedation D. cardiac dysrhythmias

D

A patient taking valproic acid (Depakene) has elevated liver function tests. What will the nurse expect the provider to order? A. Daily liver function tests B. Immediate discontinuation of the medication C. Every other day administration of the medication D. Tapering the medication as another medication is started.

D Hepatotoxicity is an adverse effect associated with the use of valproic acid. When the medication is changed, the first medication is withdrawn as the second one is increased. The medication should not be stopped abruptly as this can precipitate seizures. The medication should not be continued.

The nurse is assessing a patient receiving valproic acid (Depakene) for potential adverse effects associated with this drug. Which item represents the most common problem with this drug? A) Increased risk for infection B) Reddened, swollen gums C) Nausea, vomiting, and indigestion D) Central nervous system depression

D) Central nervous system depression Valproic acid is generally well tolerated. It does not cause hematologic effects resulting in increased risk for infection nor does it cause gingival hyperplasia. It causes minimal sedation. Gastrointestinal effects, which include nausea, vomiting, and indigestion, are the most common problems but tend to subside with use and can be lessened by giving with food.

Which assessment indicates to the nurse a therapeutic effect of mannitol (Osmitrol) has been achieved? Decreased intracranial pressure Decreased potassium Increased urine osmolality Decreased serum osmolality

Decreased intracranial pressure Correct Mannitol (Osmitrol) is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This will decrease intracranial pressure, increase excretion of medications, decrease urine osmolality, and increase serum osmolality.

The nurse will assess a patient receiving gemfibrozil (Lopid) and warfarin (Coumadin) for which adverse effect?

Increased risk of bleeding

Disseminated intravascular coagulopathy (DIC) and severe diffuse edema develop in a 24-year-old female patient after a serious motor vehicle accident (MVA). Which of these diuretics can the nurse administer to avoid aggravating the coagulopathy? (Choose all that apply.)

Mannitol (Osmitrol) Among the listed medications, mannitol is the only diuretic that can be administered to this patient to avoid aggravation of a coagulopathy. Furosemide is contraindicated because it can cause thrombocytopenia and bone marrow suppression. Triamterene and spironolactone are contraindicated because they are potassium-sparing diuretics, and the patient is likely to be hyperkalemic as a result of hemolysis and injuries sustained in the crash. In addition, triamterene is a fairly weak diuretic that can cause megaloblastic anemia. Acetazolamide can cause hematuria and melena, which might confound evaluation of the patient's hematologic therapy; the medical team would not be able to determine whether the hematuria and melena were the result of the diuretic or the coagulopathy. Finally, hydrochlorothiazide is contraindicated because it can cause bone marrow suppression, which could lead to thrombocytopenia.

Which diuretic is the drug of choice for the prevention of tissue damage after a closed head injury?

Mannitol (Osmitrol) Mannitol is the drug of choice to prevent increased intracranial pressure after a closed head injury; although it works along the entire length of the nephron, it reduces intracranial pressure and cerebral edema by reducing cellular edema. Metolazone and furosemide are loop diuretics and hydrochlorothiazide is a thiazide diuretic; they are of little benefit in reducing cerebral edema.

The parent of a child with attention-deficit/hyperactivity disorder (ADHD) asks the nurse how a drug like methylphenidate (Ritalin), a CNS stimulant, can help the child. What is the nurse's best response?

Methylphenidate has a paradoxical effect in children Methylphenidate (Ritalin), a CNS stimulant, has a paradoxical effect in children, producing calmness in children with hyperactive behavior. The exact mechanism of action is not clearly understood.

The nurse is caring for a patient who describes symptoms indicative of narcolepsy. The nurse recognizes that the physician is most likely to order which medication for the patient? Phentermine-topiramate (Qsymia) Diethylpropion HCl (Tenuate) Modafinil (Provigil) Benzphetamine HCl (Didrex)

Modafinil (Provigil) Modafinil (Provigil) is indicated for treatment of narcolepsy.

A 10-year-old child has been evaluated for a learning disability and has been diagnosed with absence seizures. Ethosuximide (Zarontin) has been ordered and the nurse is teaching the client and family about the drug. Because of the client's age, it is important to include instructions to: a. Curtail afterschool sports activities, because the drug's metabolism may be increased with physical activity. b. Increase intake of calcium-rich foods and vitamin D to prevent bone loss. c. Monitor height and weight weekly to be sure GI side effects are not hindering nutrition and normal growth. d. Increase fluid intake to avoid dehydration caused by the drug.

Monitor height and weight weekly to be sure GI side effects are not hindering nutrition and normal growth. Rationale: GI effects such as nausea, anorexia, and abdominal pain are common with ethosuximide. Because the client is still growing, improper nutrition may affect normal growth. Monitoring height and weight weekly will assist in tracking normal growth. Options 1, 2, and 4 are incorrect. Physical activity will not affect the drug's metabolism, and activity is normal and needed for healthy growth and development. Ethosuximide is not known to cause bone loss or dehydration.

A patient with cardiovascular disease is taking rosuvastatin [Crestor]. The nurse is monitoring for potential adverse effects. Which finding indicates a potential adverse effect of this drug?

Muscle pain and tenderness

The nurse is caring for a preoperative patient who has an order for vitamin K by subcutaneous injection. The nurse should verify that which laboratory study is abnormal before administering the dose? Hematocrit (Hct) Hemoglobin (Hgb) Prothrombin time (PT) Partial thromboplastin time (PTT)

Prothrombin time (PT) Vitamin K counteracts hypoprothrombinemia and/or reverses the effects of warfarin (Coumadin) and thus decreases the risk of bleeding. High values for either the prothrombin time (PT) or the international normalized ratio (INR) demonstrates the need for this medication.

The client, age 8, is prescribed valproic acid (Depokene) for treatment of a seizure disorder. The nurse should monitor the client closely for: Vitamin B deficiency. Restlessness and agitation. Hyperthermia. Respiratory distress

Restlessness and agitation. Objective: For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of drug action, primary actions, and important adverse effects. Rationale: Valproic acid can produce an idiosyncratic response in children, including restlessness and psychomotor agitation. Hyperthermia, vitamin B deficiency, and respiratory distress are not side effects of valproic acid. Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Nursing Process: Assessment

A 36-year-old woman has been taking atorvastatin 20 mg PO daily for 6 months to treat mild dyslipidemia. At a clinic appointment, she tells the nurse she is 6 weeks pregnant. The nurse counsels the patient that it is likely that her midwife will counsel her A. to increase the dose of prenatal vitamins B. to reduce the dosage of her lovastatin to 20 mg PO daily C. to increase the dosage to 40 mg PO twice daily D. about discontinuing the drug during pregnancy

d

A teenaged boy will be receiving atomoxetine (Strattera) as part of treatment for attention deficit hyperactivity disorder (ADHD). Which statement about this drug therapy is accurate? The patient should be monitored for possible suicidal thoughts and behavior. Strattera is used to treat narcolepsy as well as ADHD. Psychotherapy is rarely helpful in cases of ADHD. Strattera is highly addictive.

The patient should be monitored for possible suicidal thoughts and behavior. Prescribers are advised to work with parents to monitor closely for suicidal thoughts and behavior. In addition, psychosocial problems within the patient's family should be addressed if needed. Strattera is not addictive, and it is not used to treat narcolepsy.

Drug therapy with atorvastatin (Lipitor) is initiated for a client with hyperlipidemia. The nurse develops a teaching plan and includes what information? a) Continues to make lifestyle changes toward lowering cholesterol levels. b) Stop taking the drug when dietary changes are accomplished. c) Eliminate all cholesterol from the diet. d) Always take the drug just before bedtime.

a Rationale: Drug therapy should be used in conjunction with lifestyle changes. Lipitor is the only statin that can be administered at any time of day. Cholesterol intake should be reduced, but not totally eliminated.

A 10-year-old child diagnosed with attention deficit hyperactivity disorder has been taking amphetamine sulfate (Adderall) for the past 2 years. Which of the following are normal adverse effects of the drug? (Choose all that apply) A. weight loss B. anorexia C. dry mouth D. bradycardia

a,b,c

A client is prescribed enoxaparin (Lovenox). The nurse knows that low-molecular-weight heparin (LMWH) has what kind of half-life? a. A longer half-life than heparin b. A shorter half-life than heparin c. The same half-life as heparin d. A four-times shorter half-life than heparin

a. A longer half-life than heparin

A client's serum digoxin level is drawn, and it is 0.4 ng/mL. What is the nurse's priority action? a. Administer ordered dose of digoxin. b. Hold future digoxin doses. c. Administer potassium. d. Call the health care provider.

a. Administer ordered dose of digoxin

When a newly admitted client is placed on heparin, the nurse acknowledges that heparin is effective for preventing new clot formation in clients who have which disorder(s)? (Select all that apply.) a. Coronary thrombosis b. Acute myocardial infarction c. Deep vein thrombosis (DVT) d. Cerebrovascular accident (CVA) (stroke) e. Venous disorders

a. Coronary thrombosis b. Acute myocardial infarction c. Deep vein thrombosis (DVT) d. Cerebrovascular accident (CVA) (stroke) e. Venous disorders

A client is taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg. When the nurse enters the room, the client states, "There are yellow halos around the lights." Which action will the nurse take? a. Evaluate digoxin levels. b. Withhold the furosemide c. Administer potassium. d. Document the findings and reassess in 1 hour.

a. Evaluate digoxin levels.

The nurse would question an order for cholestyramine (Questran) if the client has which condition? a. Impaction b. Glaucoma c. Hepatic disease d. Renal disease

a. Impaction

The client asks the nurse why the health care provider prescribed acetazolamide (Diamox), a diuretic, to treat gout. What is the nurse's best response? a. It causes an alkaline urine, which facilitates the elimination of uric acid. b. It increases alkalinity of urine, thus decreasing the formation of uric acid. c. It causes an acid urine, which facilitates the elimination of uric acid. d. It decreases alkalinity of urine, thus decreasing the formation of uric acid.

a. It causes an alkaline urine, which facilitates the elimination of uric acid.

Which assessment finding will alert the nurse to suspect early digoxin toxicity? a. Loss of appetite with slight bradycardia b. Blood pressure 90/60 mm Hg c. Heart rate 110 beats per minute d. Confusion and diarrhea

a. Loss of appetite with slight bradycardia

The nurse has just administered the initial dose of enalapril (Vasotec) to a newly admitted patient. Which nursing intervention takes priority over the next several hours? A. Monitoring the blood pressure B. Measuring the heart rate C. Auscultating the lungs D. Drawing blood for potassium levels

a. monitor BP

A client who received heparin begins to bleed, and the physician calls for the antidote. The nurse knows that which is the antidote for heparin? a. protamine sulfate b. vitamin K c. aminocaproic acid d. vitamin C

a. protamine sulfate

A client has been admitted through the emergency department and requires emergency surgery. The client has been receiving heparin. What nursing intervention is essential? a. Teach the client about the phenytoin. b. Administer protamine sulfate. c. Assess the INR before surgery. d. Administer vitamin K.

b

Which of the following data obtained by the nurse during the history and physical of a client receiving atorvastatin (Lipitor) requires immediate attention? a) History of diabetes mellitus b) Possibility of pregnancy c) History of glaucoma d) Coronary artery disease

b Lipitor is a pregnancy Category X drug and should not be used by clients who are planning to become pregnant, are pregnant, or are breastfeeding. The drug should be stopped if the client becomes pregnant while taking it.

A client is started on warfarin (Coumadin) therapy while still receiving intravenous heparin. The client questions the nurse about the risk for bleeding. How should the nurse respond? a. "Your concern is valid. I will call the doctor to discontinue the heparin." b. "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." c. "Because of your valve replacement, it is especially important for you to be anticoagulated. The heparin and warfarin together are more effective than one alone." d. "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications."

b. "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic."

A client is prescribed gemfibrozil (Lopid) for treatment of hyperlipidemia type IV. What is important for the nurse to teach the client? a. "Take aspirin before the medication if you experience facial flushing." b. "You may experience headaches with this medication." c. "You will need to have weekly blood drawn to assess for hyperkalemia." d. "Cholesterol levels will need to be assessed daily for one week."

b. "You may experience headaches with this medication."

A client is receiving an intravenous heparin drip. Which laboratory value will require immediate action by the nurse? a. Platelet count of 150,000 b. Activated partial thromboplastin time (aPTT) of 120 seconds c. INR of 1.0 d. Blood urea nitrogen (BUN) level of 12 mg/dL

b. Activated partial thromboplastin time (aPTT) of 120 seconds

The nurse is monitoring a client taking digoxin (Lanoxin) for treatment of heart failure. Which assessment finding indicates a therapeutic effect of the drug? a. Heart rate 110 beats per minute b. Heart rate 58 beats per minute c. Urinary output 40 mL/hr d. Blood pressure 90/50 mm Hg

b. HR of 58

The nurse reviews a client's laboratory values and finds a digoxin level of 10 ng/mL and a serum potassium level of 5.9 mEq/L. What is the nurse's primary intervention? a. To administer atropine b. To administer digoxin immune FAB c. To administer epinephrine d. To administer Kayexalate

b. To administer digoxin immune FAB (antidote)

Your patient is taking valproic acid (Depakote). Which of the following is a false statement? a. Valproic acid requires hepatic monitoring b. Valproic acid has the lowest seizure relapse rate when discontinued c. Valproic acid is also used in migraine therapy d. Valproic acid is also used in bipolar disorder therapy

b. Valproic acid has the lowest seizure relapse rate when discontinued

The nurse is caring for a patient who has diabetes and hypertension. Which agent is most likely to be prescribed to treat this patient's hypertension? A. Hydrochlorothiazide (HCTZ) B. Enalapril (Vasotec) C. Propranolol (Inderal) D. Methyldopa (Aldomet)

b. enalapril

A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. What type of electrolyte imbalance does the nurse expect to occur? a. Hypocalcemia b. Hypokalemia c. Hyperkalemia d. Hypermagnesemia

b. hypokalemia

The client is taking rosuvastatin (Crestor). What severe skeletal muscle adverse reaction should the nurse observe for? a. Myasthenia gravis b. Rhabdomyolysis c. Dyskinesia d. Agranulocytosis

b. rhabdomyolysis

A patient with increased ICP is being monitored in the intensive care unit (ICU) with a fiberoptic catheter. Which order is a priority for you? A. Perform hourly neurologic checks. B. Take a complete set of vital signs. C. Administer the prescribed mannitol (Osmitrol). D. Give an H2-receptor blocker.

c he priority is to treat the known existing problem, and mannitol is the only thing that can do that. Because the patient is having the current pressure measured with objective numbers, treating the known problem is a priority over additional assessments. H2-blockers are given when corticosteroids are administered to help prevent gastrointestinal bleeding, but they are not a priority compared with the treatment of ICP.

patient is taking enalapril (Vasotec) an ACE inhibitor. The nurse understands that patients taking this type of drug for heart failure need to be monitored carefully for: a. hypernatremia. b. hypertension. c. hyperkalemia. d. hypokalemia.

c hyperkalemia

A nurse is caring for a client receiving acetazolamide (Diamox). Which assessment finding will require immediate nursing intervention? a. A decrease in bicarbonate level b. An increase in urinary output c. A decrease in arterial pH d. An increase in PaO2

c. A decrease in arterial pH

The nurse reviews the history for a client taking atorvastatin (Lipitor). What will the nurse act on immediately? a. Client takes medications with grape juice. b. Client takes herbal therapy including kava kava. c. Client is on oral contraceptives. d. Client was started on penicillin for a respiratory infection.

c. Client is on oral contraceptives.

A nurse is caring for a client taking cholestyramine (Questran). The client is complaining of constipation. What will the nurse do? a. Call the health care provider to change the medication. b. Tell the client to skip a dose of the medication. c. Have the client increase fluids and fiber in his diet. d. Administer an enema to the client.

c. Have the client increase fluids and fiber in his diet.

A client is to begin treatment for short-term management of heart failure with milrinone lactate (Primacor). What is the priority nursing action? a. Administer digoxin via IV infusion with the Primacor. b. Administer Lasix (furosemide) via IV infusion after the Primacor. c. Monitor blood pressure continuously. d. Maintain an infusion of lactated Ringers with Primacor infusion.

c. Monitor blood pressure continuously. [Milrinone lactate (Primacor) is a phosphodiesterase inhibitor administered intravenously for short-term treatment in patients with heart failure not responding adequately to digoxin, diuretics, or other vasodilators. Blood pressure and heart rate should be closely monitored. Digoxin is not administered with the milrinone but is usually tried before treatment with milrinone. Furosemide is not necessarily administered after the milrinone, although it could be. It is not, however, administered routinely via IV infusion. Lactated Ringer's does not have to be administered with milrinone]

Which nursing diagnosis would be possible for a client receiving intravenous heparin therapy? a. Potential for fluid volume excess b. Potential for pain c. Risk for injury d. Potential for body image disturbance

c. Risk for injury

The client with chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication: a) during dialysis b) just before dialysis c) the day after dialysis d) on return from dialysis

d) on return from dialysis Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and also from having the medication removed from the bloodstream by dialysis. No rationale exists for waiting an entire day to resume the medication. This would lead to ineffective control of the blood pressure.

7. A client is taking valproic acid (Depakote). The nurse should monitor the client for a which therapeutic serum range? a. 10 to 20 mcg/mL b. 15 to 40 mcg/mL c. 20 to 80 ng/mL d. 40 to 100 mcg/mL

d. 40 to 100 mcg/mL

The parent of a client taking atomoxetine (Strattera) asks how the medication works to control attention deficit hyperactivity disorder (ADHD). The nurse's correct explanation is based on which fact?

he medication inhibits norepinephrine (NE) transport and reuptake

Which solution has an osmotic pressure similar to plasma; expands extracellular fluid without changing osmolarity? A isotonic crystalloid solutions B hypotonic crystalloid solution C hypertonic crystalloid solution D. hypertonic colloid solutions

isotonic crystalloid solutions

A man has not been able to decrease his low-density lipoprotein (LDL) cholesterol levels with lifestyle management, and his nurse practitioner has prescribed atorvastain, a hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor. The nurse explains to him that atorvastatin is best administered A. without regard for time of day B. at noon, taken with grapefruit juice C. with a snack in the early afternoon D. every other day with a dose of red yeast rice

take in evening with food or before going to bed- cholesterol biosynthesis but out of these options take A

The nurse is admitting a 68-year-old preoperative patient with a suspected abdominal aortic aneurysm (AAA). The medication history reveals that the patient has been taking warfarin (Coumadin) on a daily basis. Based on this history and the patient's admission diagnosis, the nurse should prepare to administer which medication? Vitamin K Cobalamin Heparin sodium Protamine sulfate

vitamin K Coumadin is a Vitamin K antagonist anticoagulant that could cause excessive bleeding during surgery if clotting times are not corrected before surgery. For this reason, vitamin K is given as the antidote for warfarin (Coumadin).

patient who has been taking warfarin (Coumadin) is admitted with coffee-ground emesis. What can the nurse anticipate being prescribed for this patient? Vitamin E Vitamin K Protamine sulfate Calcium gluconate

vitamin k