Pharm Pre-asessment

Methotrexate blood levels are monitored to determine therapeutic dosing. The nurse knows that high-dose levels of methotrexate therapy can lead to __________ damage. Select one: a. connective tissue b. neurologic c. liver d. retinal

Acetaminophen, methotrexate, tetracyclines, and tamoxifen increase levels of mipomersen and can increase risk for liver damage. The correct answer is: liver

A client has been prescribed lisinopril. Which of the following medication interactions should the nurse instruct this client about? Select one: a. Escitalopram b. Ciprofloxacin c. Potassium supplements d. Magnesium supplements

C. Correct. Potassium supplements and potassium-sparing diuretics increase the risk of hyperkalemia in clients taking ACE inhibitors such as lisinopril.

Disulfiram is taken by a client daily for abstinence maintenance. What is an adverse effect of this therapy? Select one: a. Diarrhea b. Wernicke's aphasia c. Hepatoxicity d. Suicidal ideations

Hepatoxicity is an adverse effect of disulfiram. Wernicke's aphasia, suicidal ideations and diarrhea are not associated with this therapy. The correct answer is: Hepatoxicity

A client taking lithium should be cautioned about drug interactions with which below medication? Select one: a. Fluoxetine b. Nifedipine c. St. John's Wart d. Warfarin

Lithium and fluoxetine drug-drug interaction can lead to serotonin syndrome which may include symptoms such as confusion, hallucination, seizure and increase in heart rate and blood pressure. In severe cases, death can be the outcome. The other medications do not have documented instances of drug/drug interactions with lithium. The correct answer is: Fluoxetine

A nurse is reviewing the medication class, benzodiazepines. The nurse would use caution when administering benzodiazepines to which of the below clients? Select one: a. A client with insomnia. b. A client with renal failure. c. A client with hypertension. d. A client with glaucoma.

The correct answer is: A client with glaucoma.

A nurse is caring for a client prescribed montelukast. Which of the following should the nurse include in teaching related to this medication? Select one: a. Advise client to take the medication once daily at bedtime. b. Avoid dairy products while taking this medication. c. This medication is for acute management of asthma. d. If the client forgets to take the medication for a few days he can double up on doses to catch up.

The correct answer is: Advise client to take the medication once daily at bedtime.

A nurse is providing care to a client with staphylococcus epidermidis, who is prescribed vancomycin. Identify the adverse effect associate with this antibiotic therapy? Select one: a. Infusion reaction b. Hepatotoxicity c. Constipation d. Immunosuppression

The correct answer is: Infusion reaction

Which of the following are contraindications to aspirin therapy? Select all that apply. Select one or more: a. Thrombocytopenia b. Deep vein thrombus c. Coronary artery disease d. Third trimester pregnancy e. Adolescents with chickenpox

The correct answer is: Third trimester pregnancy, Thrombocytopenia, Adolescents with chickenpox

A client has been prescribed vasopressin for the treatment of diabetes insipidus. What is the expected pharmacological action of this medication? Select one: a. To slow the absorption of glucose in the intestine. b. To increase blood pressure. c. To stimulate the pancreas to secrete insulin. d. To increase reabsorption of water in the renal tubules.

The correct answer is: To increase reabsorption of water in the renal tubules.

The nurse knows that a client with renal insufficiency should be reevaluated for best diabetic management, when it is noted the client is on metformin. What is the reason metformin is contraindicated for clients who have renal insufficiency? Select one: a. The medication increases glucose productions. b. The medication decrease renal perfusion. c. The medication increases potassium excretion. d. The medication increases the risk of lactic acidosis.

The medication increases lactic acidosis. The medication does not decrease renal perfusion, increase potassium excretion or increase glucose production. The correct answer is: The medication increases the risk of lactic acidosis.

A nurse is preparing to administer an intramuscular injection to an adult client. At what angle should the nurse administer the medication using the ventrogluteal site? Select one: a. A 90 degree angle b. a 75 degree angle c. a 60 degree angle d. a 45 degree angle

a. A 90 degree angle CorrectIM injections should be administered at a 90 degree angle.

A client with osteoporosis is prescribed alendronate. What client education should the nurse provide to ensure optimal absorption of the medication? Select one: a. Advise the client to take the medication on an empty stomach with at least 8 oz of water. b. Advise the client to take the medication with no more than 4 oz of water. c. Advise the client to take the medication with a glass of milk. d. Advise the client to take the medication with grapefruit juice.

a. Advise the client to take the medication on an empty stomach with at least 8 oz of water. CorrectCorrect - This is a correct statement. Alendronate absorption decreases when taken with calcium supplements, antacids, citric juices and caffeine.

A nurse is to instill ear drops to a 2 year-old child. To straighten the ear canal, the nurse should pull the auricle of the ear: Select one: a. Down and backward b. Upward and outward c. Upward and backward d. Down and outward

a. Down and backward CorrectCorrect. In infants and young children, the nurse should gently pull the auricle of the ear down and back.

A client has been prescribed metoclopramide. Which of the following should the nurse include in client education regarding this medication? Select one: a. Notify your provider if you experience restlessness or spasms of the face or neck. b. This medication can cause insomnia. c. Decrease your fluid intake while taking this medication. d. This medication can cause urinary frequency.

a. Notify your provider if you experience restlessness or spasms of the face or neck. CorrectAn adverse effect of Reglan is extrapyramidal symptoms. The client should stop the medication and notify the provider if these occur.

A 52-year-old client with a history of angina has been prescribed transdermal nitroglycerin. Which of the following adverse effects is not seen with this therapy? Select one: a. Productive cough b. Orthostatic hypotension c. Tolerance d. Headache

a. Productive cough CorrectCorrect - Nitroglycerin therapy does not directly have an effect lung function. Physiologically, vasodilation should effect capillary perfusion and decrease lung secretions.

A nurse is caring for a client prescribed ferrous sulfate for the treatment of anemia. Which of the following instructions should be included in client teaching about this medication? Select one: a. Take the medication on an empty stomach to maximize absorption. b. Notify your provider if your stool becomes dark green. c. Decrease dietary fiber intake while taking this medication. d. Take prescribed antacids at the same time as this medication.

a. Take the medication on an empty stomach to maximize absorption. Correct The nurse should instruct the clients to take iron on an empty stomach, such as 1 hr before meals to maximize absorption. Stomach acid increases absorption. If GI adverse effects occur, the client can take with food to increase adherence to therapy even though absorption is also decreased.

A nurse is caring for a client prescribed the HMG CoA reductase inhibitor, atorvastatin. Which of the following should be monitored while this medication is prescribed? Select one: a. Renal function tests b. Liver function tests c. Hearing screenings d. Visual acuity screenings

b. Liver function tests CorrectCorrect. Statins (HMG CoA reductase inhibitors) like atorvastatin (Lipitor) can cause hepatotoxicity. Prior to initiating therapy the client's baseline liver function should be determined then liver function tests should be checked after 12 weeks of therapy and then every 6 months. The nurse should advise the client to observe for symptoms of liver dysfunction (anorexia, vomiting, nausea, jaundice) and to notify the provider if these occur.

A 55-year-old client has levothyroxine ordered. Which of the below past medical history concerns may contraindicate with her medication management of hypothyroidism? Select one: a. Peripheral Vascular Disease b. Osteoporosis c. Scleroderma d. Asthma

b. Osteoporosis CorrectCorrect: There is an increased risk for fractures, especially in older adults.

A 45-year-old client is taking methylprednisolone. What pharmacological action should the nurse expect with this therapy? Select one: a. Fortification of bones. b. Suppression of airway mucus production. c. Suppression of candidiasis. d. Suppression of beta2 receptors.

b. Suppression of airway mucus production. CorrectCorrect - Corticosteroids, such as methylprednisolone (Solu-Medrol) will suppress airway mucus production.

A nurse is preparing to administer enoxaparin to a client. Which of the following actions should the nurse take when administering this medication? Select one: a. Carefully rub the injection site after administration b. Administer the medication via shallow subcutaneous injection in the deltoid muscle c. Do not expel the air bubble from the prefilled syringe d. Aspirate prior to administration

c. Do not expel the air bubble from the prefilled syringe Correct The nurse should not expel the air bubble from the prefilled syringe. The air bubble should follow the medication to ensure the client receives the full dose of medication in the syringe

A nurse is preparing to administer a measles, mumps, and rubella vaccine (MMR) to an adult client. Which of the following is a contraindication to this vaccine? Select one: a. Client history of genital herpes b. The possibility of overseas travel in the next month c. The possibility of pregnancy within 4 weeks d. Client allergy to strawberries

c. The possibility of pregnancy within 4 weeks CorrectPregnancy or the possibility of pregnancy with 4 weeks is a contraindication to the MMR vaccine.

A nurse is caring for a client prescribed digoxin. Which the following should alert the nurse to possible digitalis toxicity? Select one: a. tachycardia and increased urination b. polyphagia and polydipsia c. anorexia and weakness d. hyperactivity and hunger

c. anorexia and weakness CorrectCorrect. Anorexia, fatigue and weakness are signs of potential digitalis toxicity. GI effects of digitalis toxicity include anorexia, nausea, vomiting and abdominal pain. CNS effects include fatigue, weakness, vision changes (diplopia, blurred vision, yellow-green or white halos around objects). Bradycardia is also commonly noted in digitalis toxicity.

A nurse is caring for a client newly prescribed doxazosin mesylate. Which of the following instructions should the nurse include in client education regarding taking the first dose of this medication? Select one: a. Do not eat green leafy vegetables. b. There is no need to avoid normal activities. c. Avoid dairy products while taking this medication. d. Change positions slowly and lie down if dizziness occurs.

d. Change positions slowly and lie down if dizziness occurs. CorrectFirst-dose orthostatic hypotension can occur with Cardura. The nurse should instruct clients to change positions slowly and to lie down if feeling dizzy, lightheaded or faint.

A client has been prescribed isosorbide mononitrate. Which of the following should the nurse include in this client's education related to this medication? Select one: a. Take the medication in the evening after dinner. b. Take an additional tablet if you experience chest pain. c. You can crush this medication if needed. d. This medication is prescribed for long-term prophylaxis against anginal attacks.

d. This medication is prescribed for long-term prophylaxis against anginal attacks. CorrectIsosorbide mononitrate (Imdur) is used for long-term prophylaxis against anginal attacks.