Pharm Final (Chalker) Endo, GI, Motley
Which time for medication scheduling would a nurse teach to a client prescribed the oral pancreatic enzymes pancrelipase?
*With meals
The nurse is preparing to administer a client's prescribed NPH and regular insulins. Which action should the nurse take first when mixing the insulins in one syringe?
Inject air into the NPH
The nurse is preparing to administer a client's prescribed insulins and needs to mix NPH and lispro. Which of the following actions should the nurse take first?
Inject air into the long-acting insulin
Which birth control agent requires administration once every 3 months?
Intramuscular progestin
Which topic will the nurse include in the discharge teaching of a client who has had a total gastrectomy?
Injections of vitamin B 12 for life
Which finding in a client with hypothyroidism and hypertension who reports taking an extra dose of levothyroxine indicates the need to obtain a thyroid function panel? Select all that apply. One, some, or all responses may be correct.
*Tremors *Diaphoresis *Nervousness *Temperature 101°F *Heart rate 116 beats/min
Which clinical manifestation exhibited by a client taking levothyroxine for hypothyroidism for 3 months would cause a nurse to suspect that a decrease in dosage is needed?
*Tremors *Heat intolerance
When would the nurse plan to administer pancrelipase to a child with cystic fibrosis?
*With meals and snacks
A client is prescribed alendronate. Which instruction should the nurse emphasize when teaching about this medication?
"Be sure to take this medication on an empty stomach."
A nurse has administered oral radioactive iodine to a client with thyroid cancer. What instructions will the nurse provide to the client upon discharge?
"Do not share utensils with your family members."
The nurse is counseling a client with gastroesophageal reflux disease (GERD) who has been taking prescribed famotidine for two days. Which statement would require immediate follow up by a healthcare provider?
"I take digoxin for my heart failure."
A client has been prescribed alendronate for osteoporosis. Which statements indicate that the client understands how to safely take this medication?
"I will notify my doctor if I experience worsening heartburn." "I will swallow the pill with a full glass of water." "I will stand or sit quietly for 30 minutes after taking the pill."
A client with cirrhosis of the liver asks the nurse about the purpose of taking lactulose. How should the nurse respond?
"It helps to reduce ammonia levels in your blood."
Which instruction will the nurse provide to a client with type 2 diabetes who develops gout when teaching about the administration of allopurinol?
"Monitor blood glucose levels more frequently."
Which response would a nurse give to a client taking an oral hypoglycemic tablet daily who asks if an extra tablet should be taken before exercise?
"No, but you should observe for signs of hypoglycemia while exercising."
A client asks the nurse if glipizide (Glucotrol) is an oral insulin. Which response should the nurse provide?
"No, it is not an oral insulin and can be used only when some beta cell function is present."
The nurse is providing medication teaching for a client prescribed famotidine for the treatment of gastroesophageal reflux disease (GERD). Which statement by the client indicates an understanding of the teaching?
"This medication will both prevent and treat heartburn."
The nurse teaches a client about side effects that necessitate discontinuation of oral contraceptives. Which statement made by the client indicates that the teaching was effective?
'I'll stop taking the pills if I have chest pain.'
A 20-year-old woman visiting the clinic says that she wishes to begin using depot medroxyprogesterone acetate as a form of birth control. Which important information would the nurse include when teaching the client about this medication?
'Increase your calcium intake and exercise because loss of bone mineral density may occur.'
The nurse is caring for a 6-year-old child who has undergone craniotomy. The parents ask what effect mannitol has. Which response by the nurse is most appropriate?
'It relieves cerebral pressure.'
A client asks the nurse what she should do if she forgets to take her contraceptive pill 1 day. Which response by the nurse is appropriate?
'On the next day take 1 pill in the morning and 1 pill before bedtime.'
A health care provider prescribes oral antacids and intravenous ranitidine for a client with burns and crushing injuries caused by an accident. The client asks how these medications work. Which explanation would the nurse provide?
'They limit acidity in the gastrointestinal tract
A client prescribed omeprazole for gastroesophageal reflux disease reports a new occurrence of significant diarrhea. Which response by the nurse is most appropriate?
'We are going to collect a stool sample for testing.'
A client comes in for a pregnancy test. She tells the nurse that pregnancy may have occurred because she missed her contraceptive pills for 1 week when she had the flu. Which response by the nurse is appropriate?
'You may be correct. The effect of contraceptive pills depends on them being taken on a regular schedule.'
Which statement made by a client prescribed metformin extended release to control type 2 diabetes mellitus indicates the need for further education?
*"I will stop taking metformin for 24 hours before and after having a test involving dye."
Which explanation will the nurse give as to why potassium iodide solution should be taken before a subtotal thyroidectomy?
*"It will reduce the risk of hemorrhage during surgery."
A client with type 2 diabetes takes one glyburide tablet daily. The client asks whether an extra tablet should be taken before exercise. Which response will the nurse provide?
*'Do not take an extra pill because you may become hypoglycemic when exercising.'
A client is admitted to the hospital for a subtotal thyroidectomy. When discussing postoperative medication therapy with the client, which advice will the nurse include in the teaching?
*'If you develop palpitations, nervousness, or tremors, the dose of thyroid hormone may need to be decreased.'
A child is prescribed insulin glargine before breakfast. Which instruction is most appropriate for the nurse to give the parents regarding a bedtime snack?
*'Offer a snack to prevent hypoglycemia during the night.'
When a female client becomes hypothyroid, levothyroxine is prescribed. The client asks whether she can become pregnant while taking levothyroxine. How will the nurse respond?
*'This medicine will not interfere with your ability to become pregnant.'
Daily regular insulin has been prescribed for a client with type 1 diabetes. The nurse administers the insulin at 8 AM. When will the nurse monitor the client for a potential hypoglycemic reaction?
*Before lunch
Which medication will the nurse expect the health care provider to prescribe to a client who had a thyroidectomy and is pale with spasms of the hand when taking the blood pressure?
*Calcium
Which mineral deficiency would a nurse suspect in a client who reports tingling in the fingers and around the mouth and exhibits carpopedal spasm and tremors after a surgical thyroidectomy ?
*Calcium
The health care provider prescribes an oral hypoglycemic medication for the client with type 2 diabetes. Which statement will the nurse need to consider when developing the teaching plan?
*Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control.
A client who is taking an oral hypoglycemic daily for type 2 diabetes develops an infection with anorexia. Which advice will the nurse provide to the client? Select all that apply. One, some, or all responses may be correct.
*Continue to take the oral medication. *Drink fluids throughout the day. *Monitor capillary glucose levels.
A client with hyperthyroidism is to receive potassium iodide solution before a subtotal thyroidectomy is performed. Which purpose would the nurse include when explaining why this medication is prescribed?
*Decreases the size and vascularity of the thyroid gland
The nurse prepares to administer extended-release metformin to an older adult who has asked that it be crushed because it is difficult to swallow. Which rationale will prompt the nurse to ask the provider for a different form of metformin?
*Extended-release formulations are designed to be released slowly and crushing the tablet will prevent this from occurring.
A 12-year-old child with cystic fibrosis is prescribed four pancrelipase capsules five times a day. The nurse explains to the child they would take the medication with meals and snacks to accomplish which goal?
*Facilitate nutrient utilization
Which purpose is served by an evening snack of milk, crackers, and cheese for a client who is receiving NPH insulin?
*Food to counteract late insulin activity
A client who receives NPH insulin every morning reports feeling nervous at 4:30 PM. The nurse observes that the client's skin is moist and cool. Which condition is the client likely experiencing?
*Hypoglycemia
A client with diabetes presents to the emergency department with a 3-hour history of profound weakness and nervousness. According to the spouse, the client became confused shortly after self-administering the morning dose of 10 units of regular insulin and 25 units of NPH insulin. The client had a light breakfast and no additional intake since that time. Which condition would the nurse identify as the likely cause of the client's signs and symptoms?
*Hypoglycemia
A client with type 1 diabetes receives 30 units of neutral protamine Hagedorn (NPH) insulin at 7:00 AM. At 3:30 PM, the client becomes diaphoretic, weak, and pale. With which condition would the nurse determine that these physiological responses are associated?
*Hypoglycemic reaction
Which insulin will the nurse prepare for the emergency treatment of ketoacidosis?
*Insulin aspart
At the client's request, the nurse performs a fingerstick to test the client's blood glucose and the results are 322 mg/dL (17.9 mmol/L). Following the insulin sliding scale orders, the nurse administers 3 units of insulin lispro at 11:00 AM. When does the nurse anticipate the insulin lispro will begin to act?
11:15 am
The nurse is caring for a client who has a prescription for an insulin sliding scale to manage the client's hyperglycemia. At 11 am, the client's blood glucose level was 285 mg/dL (15.8 mmol/L). According to the following sliding scale parameters, how many units of insulin should the nurse administer? For glucose less than 140, give 0 units of insulin aspart. • For glucose between 140 to 180, give 2 units of insulin aspart. • For glucose between 181 to 220, give 4 units of insulin aspart. • For glucose between 221 to 260, give 6 units of insulin aspart. • For glucose between 261 to 300, give 8 units of insulin aspart. •For glucose greater than 300, notify the health care provider
8 units
The nurse is preparing to administer a prescribed dose of lactulose to a client who has cirrhosis. Which lab value will the nurse monitor to evaluate the therapeutic effect of the medication?
Ammonia
Which concern would prompt the nurse to contact the health care provider when a client with gastric ulcers receives a prescription for ranitidine 150 mg twice a day?
An administration route is not specified
Which administration instruction would the nurse give a client prescribed ranitidine 150 mg daily to treat peptic ulcer disease (PUD)?
At bedtime
Which B vitamin deficiency will result in Wernicke encephalopathy?
B 1 (thiamine)
A client is scheduled for discharge after surgery. The medical record indicates that the client has not had a bowel movement since before surgery, which was 4 days ago. Which prescribed medication will the nurse administer to ensure a bowel movement before discharge?
Bisacodyl suppository
Which antidiarrheal agent should be used with caution in clients taking high dosages of aspirin for arthritis?
Bismuth subsalicylate (Pepto Bismol).
Which vitamin would the nurse anticipate may become deficient in a client prescribed cholestyramine for the treatment of type II hyperlipoproteinemia?
Calciferol (vitamin D)
The nurse is preparing to administer prescribed IV pantoprazole to the hospitalized client. The medication has been stocked in tablet form. Which action by the nurse is appropriate?
Call the pharmacy to stock the correct form of the medication
Which finding would lead the nurse to recheck the blood glucose level of a diabetic client before administering a mealtime insulin dose?
Confusion Drowsiness Diaphoresis Nervousness Heart rate 110 beats/min
A nurse is preparing to administer intravenous mannitol to a client with increased intracranial pressure. Which action will the nurse perform prior to administering the medication?
Connect an in-line filter to the infusion tubing
A client is prepared for a supratentorial craniotomy with burr holes, and an intravenous infusion of mannitol is instituted. The nurse concludes that this medication is primarily given for which purpose?
Decrease fluid in the brain
The nurse administers lactulose to a client with cirrhosis of the liver. Which laboratory test change leads the nurse to determine that the lactulose is effective?
Decreased ammonia
Which therapeutic effect would the nurse expect to identify when mannitol is administered to a client?
Decreased intracranial pressure
Why would lactulose be prescribed for a client with a history of cirrhosis of the liver?
Elevated ammonia levels are lowered.
A health care provider prescribes bed rest, loperamide, and esomeprazole for a client who just had major surgery. After several days of this regimen, the client complains of diarrhea. Which treatment strategy would the nurse conclude is the cause of the diarrhea?
Esomeprazole
A nurse is reviewing prescribed medications for a client diagnosed with diabetic ketoacidosis. Which medication will the nurse clarify with the healthcare provider?
Glipizide
The nurse is assessing a client who began taking omeprazole a month ago. Which finding by the nurse, indicates that the drug has had the desired effect?
Heartburn discomfort is lessened
A 6-year-old child is receiving an intravenous solution of 10% glucose and mannitol to reduce cerebral edema. Which complication would the nurse monitor the child for?
Hypovolemic shock
Which mechanism is specifically responsible for the action of the medication ranitidine?
Inhibiting the histamine at H 2 receptors
Famotidine is prescribed for a client with peptic ulcer disease. Which mechanism of action is a characteristic of this medication?
Inhibits gastric acid secretion
A client has been diagnosed with hypothyroidism. Which medication should the nurse administer to treat the client's bradycardia?
Levothyroxine
The nurse is caring for a client with diabetes mellitus. The client reports feeling hungry and thirsty. The client's most recent blood glucose level was 175 mg/dL. Which type of insulin should the nurse anticipate being prescribed for this client?
Lispro
Which medication for treatment of gastroesophageal reflux disease would be contraindicated in the pregnant client?
Misoprostol
The nurse is providing preoperative teaching for a client preparing for a thyroidectomy about the medication saturated solution of potassium iodide drops. Which information is important for the nurse to include?
Mix the medication with juice or milk.
The nurse is caring for a client with osteoporosis who has been prescribed alendronate. When providing care, which intervention would be a priority?
Notify the health care provider if the client reports jaw pain
A child is prescribed intravenous mannitol. The nurse understands mannitol belongs to which classification of diuretics?
Osmotic
A nurse is reviewing laboratory data for a client taking pramlintide for diabetes management. Which clinical finding indicates medication effectiveness?
Postprandial glucose of 160 mg/dL
Which condition contraindicates the use of ginseng herbal therapy?
Pregnancy
Which information would the nurse include when teaching a client about the administration of ranitidine?
Ranitidine reduces gastric acidity in the stomach
A client who takes daily megadoses of vitamins is hospitalized with joint pain, loss of hair, yellow pigmentation of the skin, and an enlarged liver due to vitamin toxicity. Which type of toxicity would the nurse suspect?
Retinol (vitamin A)
Which finding in a menopausal client's health history would prevent the health care provider from prescribing hormone replacement therapy?
Smoking Cirrhosis Cholecystitis Breast cancer Deep vein thrombosis
A health care provider prescribes bisacodyl for a client with constipation. The nurse explains to the client that this medication acts by which mechanism?
Stimulating peristalsis
In evaluating the effects of lactulose (Cephulac), which outcome would indicate that the drug is performing as intended?
Two or three soft stools per day.
Which assessment would the nurse perform specific to the safe administration of intravenous mannitol?
Urine output hourly
A female client with rheumatoid arthritis takes ibuprofen (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which information is most important for the nurse to include in client teaching?
Use contraception during intercourse.
Which supplement would the nurse instruct a client taking oral contraceptives to increase?
Vitamin C
A thin 24-year-old woman who runs 10 miles each week asks the nurse for advice about preventing osteoporosis. Which vitamin would the nurse recommend?
Vitamin D
Which prescription would the nurse anticipate for the client who takes a medication that interferes with fat absorption?
Water-miscible forms of vitamins A and E
The nurse is preparing to teach a client with type 2 diabetes mellitus about their newly prescribed exenatide pen. Which instructions should the nurse include? Select all that apply.
You may experience some weight loss. Take any oral medications 1 hour before the exenatide. Inject yourself in the abdominal or thigh area
A client is scheduled to have a thyroidectomy. Which medication is indicated for decreasing the size and vascularity of the thyroid gland before surgery?
*Potassium iodide
A client takes an oral hypoglycemic agent daily. For which condition is an oral hypoglycemic agent indicated?
*Reduced insulin production
) An adolescent with diabetes had a 6:30 AM fasting blood glucose level of 180 mg/dL (10.0 mmol/L). Which nursing action is a priority?
*Tell the adolescent that the prescribed dose of rapid-acting insulin should be administered.
An adolescent with diabetes had a 6:30 AM fasting blood glucose level of 180 mg/dL (10.0 mmol/L). Which nursing action is a priority?
*Tell the adolescent that the prescribed dose of rapid-acting insulin should be administered.
An infant with congenital hypothyroidism receives levothyroxine for 3 months. Which finding would indicate to the nurse that the medication is effective?
*The infant is alert and interactive.
A client with thyroid cancer is scheduled for a thyroidectomy. Which information will the nurse teach the client?
*Thyroxine replacement therapy will be required indefinitely.
Several hours after administering insulin, the nurse assesses the client's response to the insulin. Which client responses are indicative of a hypoglycemic reaction? Select all that apply. One, some, or all responses may be correct.
*Tremors *Confusion *Diaphoresis
A client calls the clinic and states to the triage nurse: "I had an upset stomach and took Pepto-Bismol and now my tongue looks black. What's happening to me?" What would be the nurse's best response?
"This is a common and temporary side effect of this medication."
A child with type 1 diabetes is receiving 15 units of regular insulin and 20 units of NPH insulin at 7:00 AM each day. Which time would the nurse anticipate a hypoglycemic reaction from the NPH insulin to occur?
*In the afternoon
A client with diabetes mellitus is scheduled to receive an intravenous (IV) administration of 25 units of insulin in 250 mL normal saline. Which type of insulin would the nurse recognize as compatible with IV solutions?
*Insulin lispro
The nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? Select all that apply. One, some, or all responses may be correct.
*Irritability *Heart palpitations
The nurse administers a tube of glucose gel to a client who is hypoglycemic. Which explanation would the nurse share regarding the reversal of hypoglycemia?
*It provides a glucose source that is rapidly absorbed.
The health care provider prescribes metformin as monotherapy for the client with type 2 diabetes. The nurse will teach the client to monitor for which adverse effect?
*Lactic acidosis
In addition to clients who are receiving insulin for type 1 diabetes, the nurse will assess for signs and symptoms of hypoglycemia in clients who have which diagnosis?
*Liver failure
Which independent nursing action would be included in the plan of care for a client after an episode of ketoacidosis?
*Monitoring for signs of hypoglycemia resulting from treatment
The nurse is planning an evening snack for a child receiving NPH insulin. The nurse offers a snack for which reason?
*Nourishment helps counteract late insulin activity.
Which purpose of insulin would a nurse identify when caring for a client prescribed insulin added to a solution of 10% dextrose in water after an intravenous solution containing potassium inadvertently was infused too rapidly?
*Potassium follows glucose into the cells of the body, thereby raising the intracellular potassium level.
The nurse administers cimetidine to a 75-year-old client diagnosed with a gastric ulcer. The nurse should monitor the client for which adverse reaction?
Mental status change
A health care provider prescribes mannitol for a client with a head injury. Which mechanism of action is responsible for therapeutic effects of this medication?
Drawing fluid from brain cells into the bloodstream
A client who has returned from surgery reports feeling nauseated and later has an emesis. The nurse administers promethazine per standing orders. In addition to relief from nausea, what other effects of this medication does the nurse expect?
Dry mouth Sedation Pinpoint pupils Heart palpitations
Which statements would the nurse include when teaching a client who is considering medroxyprogesterone injection as a form of hormonal birth control?
It can cause nausea and vomiting. Side effects include drowsiness or insomnia and depression. The most severe undesirable effects are liver dysfunction and thromboembolic disorders.
The nurse is providing instructions to a client with a new prescription for levothyroxine 50 mcg daily to treat hypothyroidism. Which of the following is important for the nurse to include in the discharge instructions?
It should be taken in the morning.
A client who is a smoker expresses a desire to postpone her first pregnancy for at least 5 years and declines to use a barrier method. Which method would the nurse anticipate providing education for?
Medroxyprogesterone
Which body function maintained by thiamine (vitamin B 1) and niacin (vitamin B 3) will the nurse monitor when prescribed for a client with alcoholism?
Neuronal activity
A primary health care provider prescribes venlafaxine for a client with a diagnosis of major depressive disorder who has been taking herbal medications. Which herbal supplement is contraindicated when taking venlafaxine?
St. John's wort
A 43-year-old female client is prescribed thyroid replacement hormone following a thyroidectomy. Which adverse effects should the nurse instruct the client to report immediately to the healthcare provider?
Tachycardia and chest pain.
A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has completed discharge teaching regarding medication administration. Which morning schedule would indicate to the nurse that the client teaching has been effective?
Take medication, go for a 30 minute morning walk, then eat breakfast.
Which action by a client taking alendronate requires correction? Select all that apply.
Taking medication twice a week Taking medication before rising Taking medication with breakfast Taking medication before bedtime Taking medication with apple juice
A nurse is educating a client with diabetes type 2 about newly prescribed glipizide. Which statement by the nurse best describes the action of glipizide?
This medication will stimulate your pancreas to release insulin."
A client is to receive metoclopramide intravenously 30 minutes before initiating chemotherapy for cancer of the colon. The nurse explains that metoclopramide is given for which purpose?
To stimulate peristalsis of the upper gastrointestinal (GI) tract
A nurse is administering insulin glargine to a client with diabetes type I. The client asks the nurse why insulin is the only option for therapy. Which statement by the nurse is appropriate?
Your body does not produce an adequate amount of insulin
Which complication of diabetes would the nurse suspect when a health care provider prescribes one tube of glucose gel for a client with type 1 diabetes?
insulin-induced hypoglycemia
The nurse is providing teaching to the client taking metoclopramide. Serious side effects that should be reported to the provider are included in the teaching plan. Which of the following side effects is the priority?
Involuntary muscle movements
A nurse administers cimetidine to a 79-year-old male with a gastric ulcer. Which parameter may be affected by this drug and should be closely monitored by the nurse?
Mental status
A client has type 2 diabetes controlled with oral antidiabetic medications. When admitted for elective surgery, the health care provider prescribes regular insulin. Which information would the nurse include when teaching the client about the addition of insulin?
*'With insulin, dosage can be adjusted to your changing needs during recovery from surgery.'
Which period of time would a nurse recognize as the greatest risk of hypoglycemia when caring for a client who receives regular insulin daily at 8:00 AM?
*10:00 AM to 1:00 PM
The nurse teaches an adolescent with type 1 diabetes about peak action of NPH insulin and the risk for hypoglycemia. The nurse determines teaching has been effective when the adolescent identifies insulin peak action within which time frame?
*4 to 12 hours
Which rationale will the nurse provide to a client with Crohn's disease who asks why the prescribed vitamins have to be given intravenously (IV) rather than by mouth? Select all that apply. One, some, or all responses may be correct.
"They provide more rapid action results." "Oral vitamins are less effective." "Intestinal absorption may be inadequate."
A health care provider prescribes famotidine for a client with dyspepsia. Which statement is important to include in a teaching session about famotidine?
Decreases secretions in the stomach
Which condition is contraindicated for St. John's wort herbal therapy?
Dementia
A client reports to the nurse, 'I've been using St. John's wort to try and feel more like myself again. I'm not sure whether it's going to work.' Which symptom would the nurse further assess?
Depression
Propylthiouracil and potassium iodide are prescribed for the client with hyperthyroidism. Which statement would the nurse include in the client's plan of care?
*Assess the client for signs of infection and bleeding every shift.
The nurse teaches an adolescent about administration of intermediate-acting insulin and regular insulin. Which response indicates the adolescent understands when to administer the second dose of NPH insulin?
*At dinnertime
