Pharm Test 3 NCLEX Questions

Answer: C (: Omeprazole should never be crushed because it is intended to be long acting. All other statements are true. For answer D, each tablet contains sodium, so taking one 40 mg tablet instead of taking two 20 mg tablets reduces sodium intake)

Question 1: A nurse is providing education on the use of omeprazole (Prilosec) to a patient with heart failure. Which of the following statements from the patient indicates a need for further education? A "I understand that long-term treatment with this drug is linked with fractures." B "I'll take this medication at least 1 hour before eating." C "I'll need to crush this medication to help it absorb better in my stomach." D"I'll make sure my pharmacist provides me 40 mg tablets instead of 20 mg tablets because I am on a 2-gram diet."

2 ( The presence of dizziness could indicate orthostatic hypotension which may place the patient at risk for falls)

The healthcare provider prescribes fluoxetine to a 72 year old patient with depression. Which transient adverse effect requires immediate attention by the nurse? 1. Nausea 2. Dizziness 3. Sedation 4. Dry mouth

(A, B, C, D) (cough, hoarseness, dry mouth, and a risk of developing oral candidiasis are all known side effects of corticosteroids. Corticosteroids are not known to cause fatigue.)

1. A patiënt with emphysema is prescribed a corticosteroid. Which of the following side effects should the nurse instruct the patient about in the discharge instructions? SELECT ALL THAT APPLY A. Cough B. Oral candidiasis C. Hoarseness D. Dry mouth E. Fatigue

b. (The patient should take this medication with food to prevent gastric upset)

1. A physician tells a patient to take aspirin for back pain. It is most important to instruct the patient to a. Take the medication on an empty stomach to enhance absorption. b. Take the medication after a meal to prevent gastric upset c. Crush the enteric-coated tablet for increased effectiveness d. Take the medication 2 hours after a meal to enhance absorption

B (8 oz of water. Psyllium (Metamucil) is a bulk-forming laxative and it is important to take the drug with at least 8 oz of water or another liquid to ovoid obstruction in the GI system. Psyllium has similar effects as dietary fiber so need enough water to get through the GI tracts.)

1. To avoid fecal impaction, psyllium (Metamucil) should be administered with at least how many ounces of fluid? 6 oz 8 oz 4 oz 10 oz

C (The oral form is only approved for management of exercise-induced asthma.)

1. When administering Montelukast, the nurse understands that the oral form is only used to A. treat anaphylaxis B. manage acute asthma attacks C. treat exercise induced asthma D. treat infections

A (Restlessness is a common side effect of bronchodilators because of central nervous system stimulation.)

(2) A nurse is preparing to administer a bronchodilator to a client who has asthma. Which of the following is a common side effect of these drugs for which the nurse should monitor? A. Restless B. Nystagmus C. Ataxia D. Gingival hyperplasia

B (Naloxone displaces opiate medications from receptor sites, reversing the respiratory depression, sedation, hypertension, and analgesia opiates cause.)

(1) A nurse is caring for a client who has been in the PACU for more than 1 hour and is difficult to arouse. The nurse should anticipate which of the following medication prescriptions? A. Pentazocine (Talwin) B. Naloxone (narcan) C. Naltrexone (Trexan) D. Butorphanol (Stadol)

1 (Health care providers and patient must be cautioned to avoid crushing or chewing the tablets or opening capsules because immediate release of the drug constitutes an overdose. None of the other answers apply.)

1 A patient has difficulty swallowing and requests to have his medications crushed. You, the nurse, notes that he has been prescribed an OxyContin, an extended release opioid. You will contact the health care provider because: 1 Chewing or crushing the medication may precipitate an overdose. 2 The medication can be very irritating to mucous membranes. 3 The medication can permanently stain teeth. 4 The medication cannot be absorbed.

c (Respiratory rate is too low)

1. Which of the following situations will cause the nurse to fill an incident report. (a)administering morphine sulfate to a postoperative patient who rates pain of 7 on a pain scale of 0-10 (b)administering acetylcysteine to a patient admitted with acetaminophen overdose (c)administering morphine sulfate to a patient whose respiratory rate is 8 breaths per minute (d)monitoring oxygen saturation on patient on patient controlled analgesics (PCA) pump

C (Descriptive scales are a more objective means of measuring pain intensity. A. Asking the client what precipitates the pain does not assess intensity, but rather is an assessment of the pain pattern. B. Asking the client about the location of pain does not assess the intensity of the client's pain. D. To determine the quality of the client's pain, the nurse may ask open-ended questions to find out about the sensation experienced.)

1.) When assessing the intensity of the pain, the nurse should: A) Ask about what precipitates the pain B) Question the client about the location of the pain C) Offer the client a pain scale to objectify the information D) Use open-ended questions to find out about the sensation

D (Clozapine is associated with agranulocytosis. Therefore, the nurse must instruct the client about the need for weekly blood tests to monitor for this adverse effect.)

1.) When preparing the teaching plan for a client who is to start clozapine, which information is correct to include? a.) description of akathisia and drug-induced parkinsonism b.) measures to relieve episodes of diarrhea c.) the importance of reporting insomnia d.) an emphasis on the need for weekly blood tests

B ( When giving liquid Atropine a calibrated dropper is required to ensure accurate dosage.)

2) A young child is taking Atropine (lomotil) for diarrhea. What nursing consideration should the nurse take when administering this medication in liquid form? A) Give with a straw B) Use calibrated dropper C) Give in the morning D) Give with food

B (When a client is prescribed an inhaled beta 2-agonist (such as albuterol) and an inhaled glucocorticoid (such as betomethasone) the client should take the beta 2-agonist first, it promotes bronchodilation and enhances absorption of the glucocorticoid.)

2. A nurse is providing instructions to a client who has a new prescription for albuterol and beclomethasone inhalers for the control of asthma. which of the following instructions should the nurse include in the teaching? a.) Take the albuterol at the same time each day. b.) Administer the albuterol inhaler prior to using the beclomethasone inhaler. c.) Use beclomethasone if experiencing an acute episode. d.) Avoid shaking the beclomethasone before use.

C,D,F (Methylphenidate is a stimulant. Insomnia and nervousness are the two most common side effects. Other side effects include GI discomfort, nausea, loss of appetite, arrhythmias, diaphoresis, palpitations, and dizziness)

A 14-year old is prescribed methylphenidate for the treatment of ADHD. The nurse instructs the patient on the potential side effects, including which of the following? (select all that apply) A. Urinary retention B. Constipation C. Loss of appetite D. Insomnia E. Sedation F. Nervousness

C( Albuterol is contraindicated with the presence of an abnormal heart beat because it increases the heart rate.)

A 24 year old man with asthma has just been prescribed an albuterol inhaler as needed. The nurse reviewing the chart is concerned about this prescription noting the patient has a diagnosis of what condition? a. Cushing's b. Hypotension c. cardiac dysrhythmia d. sleep apnea

C (Rationale: Similar to an antibiotic, it is a common mistake for people to think that once the symptoms go away the medication does not need to be taken anymore. However, for a full therapeutic effect, medications should be taken for the entire duration that they are prescribed.)

A 25-year-old female was recently diagnosed with Bipolar disorder. Which of the following statements would indicate to the nurse that the patient needs more education? a. "The doctor is going to prescribe me a low dose of Lithium first, and may increase the dose if he feels it's needed" b. "I will need to have my lithium levels checked periodically to make sure my levels don't get too high." c. "I only have to take Lithium for a few weeks until my symptoms subside" d. "Lithium is going to help treat my manic episodes."

D

A nurse has just started working for a home-health agency. The nurse is preparing the schedule of patients to be seen. One of the patients is scheduled to receive a scheduled IM injection of risperidone. The nurse knows that risperidone is used in the treatment of which of the following? A. Attention deficit hyperactivity disorder (ADHD) B. Depression C. Generalized anxiety disorder D. Schizophrenia

1, 2, 5

A nurse is planning to administer ondansetron IV for an older adult client who has a history of diabetes mellitus and cardiac myopathy and is receiving chemotherapy for cancer. For which of the following adverse effects of ondansetron should the nurse monitor? (Select all that apply) 1 Headache 2 Diarrhea 3 Shortened PR interval 4 Hyperglycemia 5 Prolonged QT interval

B (Constipation Opioid analgesics commonly cause constipation, especially in the elderly. Bed rest and NPO are also contributing factors for constipation. Nausea is a side effect, but this can be medicated. The nurse would be most concerned about addressing the side effects of constipation, then nausea. Opioids can cause nausea and dizziness, but hypertension is not a side effect.)

An alert and oriented elderly patient is prescribed oral morphine sulphate for acute pain management. The patient is on bed rest and is NPO except for meds. The nurse is MOST concerned about which side effect of oral morphine sulfate? A) Dizziness B) Constipation C) Nausea D) Hypertension

C ( infection. Haloperidol is not approved for use in clients with dementia due to increased risk of death related to cardiovascular complications and infection)

An elderly woman with dementia has received haloperidol. What adverse effect is the woman at increased risk for developing? A) Anorexia B) Increased Temp C) Infection D) Tardive Dyskinesia

D (Methylphenidate (Ritalin) may cause slow growth. The nurse will need to keep track of the client's height and weight to make sure that there is normal growth and development.)

Methylphenidate (Ritalin) is prescribed to an 8 year old boy for the treatment of attention deficit hyperactivity disorder (ADHD). The nurse will most likely monitor which of the following during medication therapy? A) Intake and output B) Deep tendon reflex C) Temperature D) Height and weight

d (After administering naloxone, the nurse should monitor the client's respiratory statues carefully because the drug is short acting and respiratory depression may reoccur after its effects wear off. Cerebral edema, kidney failure, and seizure activity are not directly related to opioid overdose or naloxone therapy.)

NCLEX Questions Exam #3 After administering naloxone (Narcan), an opioid antagonist, the nurse should monitor the client carefully for which of the following? A Cerebral edema B Kidney failure C Seizure activity D Respiratory depression

B (The chance of excessive cns and cardiac simulations goes up with asthma medications if the patient drinks caffeine.)

Nurse if providing teaching about the asthma medication that has been prescribed. What statement by the patient indicates the need for more teaching? A "I'll take montelukast (singulair) pill before I work out so I can worry less about an asthma attack while working out B "Since I'm quitting smoking, I'm glad I'll have my coffee to look forward to every morning" C "I'll keep my albuterol with me at all time, and only use it if I have an asthma attack" D "I'm glad I changed from a beta-blocker to an arb!"

2. (Instruct the client to stop taking the SSRI Serotonin syndrome is a serious complication of SSRIs that produces mental changes (confusion, anxiety, and restlessness), hypertension, tremors, sweating, hyperpyrexia (elevated temperature), and ataxia. Conservation treatment includes stopping the SSRI and supportive treatment. If untreated, ESE can lead to death)

The client with a major depressive disorder taking the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac) calls the psychiatric clinic and reports feeling confused and restless and having an elevated temperature. Which action should the psychiatric nurse take? 1. Determine if the client has flulike symptoms 2. Instruct the client to stop taking the SSRI 3. Recommend the client take the medication at night. 4. Explain that these are expected side effects

1 (lithium has a therapeutic lag time of 1-2weeks. Haloperidol is prescribed temporarily to produce a neuroleptic effect and discontinued when the lithium starts to take effect. )

The client with acute mania is prescribed 500mg lithium PO three times a day. The healthcare provider also prescribes 5mg of haloperidol PO for bedtime. Which action should the nurse take? 1. Administer the medications as prescribed 2. Question the Healthcare provider about the prescription 3. Administer the haloperidol but not the lithium 4. Consult with the nursing supervisor before administering the medications

b (Administer the albuterol first, wait 5 minutes, and administer ipratropium bromide, followed by beclomethasone several minutes later.)

The health care provider orders ipratropium bromide (Atrovent), albuterol (Proventil), and beclomethasone (Vanceril) inhalers for a client. What is the nurse's best action? a. Question the order; three inhalers should not be given at one time. b. Administer the albuterol first, wait 5 minutes, and administer ipratropium bromide, followed by beclomethasone several minutes later. c. Administer each inhaler at 30-minute intervals. d. Administer beclomethasone first, wait 2 minutes, and administer ipratropium bromide, followed by the albuterol several minutes later.

C (pH testing is used to evaluate the quantity, frequency and duration of acid-reflux episodes. The minimal acceptable pH with antacid therapy is 3.5.)

The nurse is caring for a patient who is taking Mylanta to treat GERD and requires pH testing. The minimal acceptable gastric pH level is A. 1.5 B. 4.0 C. 3.5 D. 3.0

B (The patient is showing symptoms of anaphylactic shock. Albuterol is not used to treat anaphylactic shock. Norepinephrine and aminophylline are often used in anaphylactic shock after epinephrine since epinephrine is short acting. Epinephrine is the first response drug for anaphylactic shock.)

The nurse is caring for a patient who reports that their throat feels like it's swelling shut. The patient has stridor lung sounds on auscultation. What medication should the nurse prepare to administer? A.) Albuterol B.) Epinephrine C.) Norepinephrine D.) Aminophylline

A and C. (Multiple antibiotics are not prescribed for the purpose of preventing other types of bacterial growth. The patient should continue to take both medications for the entire course of treatment regardless of feeling improvement.)

The nurse is educating a patient on the treatment regimen for Helicobacter pylori. Which statements would be appropriate when describing the rationale behind combination therapy? (Select all that apply) A. "You will take an acid reducer to aid healing and promote the effectiveness of the antibiotic treatment prescribed." B. "At least two antibiotics are prescribed primarily to eliminate other common bacteria that are commonly seen in conjunction with H. Pylori infections." C. "Taking multiple antibiotics help to ensure that the bacteria do not acquire resistance to the selected antibiotics." D. "One of the antibiotics can be discontinued after the second day of treatment if you are free of pain."

4 (monitor EKG, this is the most important to monitor because it will show if the patient has a fluid and electrolyte imbalance (especially potassium). When patients are taking Zofran, they are at an increased risk of fluid and electrolyte imbalances. The two biggest that they are depleted in are potassium and magnesium. The other vitals to monitor will not give the best diagnostic information to determine if the patient has a fluid and electrolyte imbalance. The answer output is supposed to be a bit trickier because it could indicate a fluid and electrolyte imbalance if we were measuring input and output but the ECG will give the most accurate information. )

The nurse is giving a patient Ondansetron (Zofran) for severe vomiting and nausea. What is most important to monitor when a patient is receiving Zofran? 1. Blood pressure 2. Output 3. Temperature 4. EKG

2 (The most common side effects related to this medication include CNS and GI system dysfunction. Fluoxetine affects the GI system by causing nausea and vomiting, cramping, and diarrhea. CV symptoms, dry mouth, and excessive sweating are not side effects associated with this medication.)

The nurse is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine (Prozac). What information would be important for the nurse to obtain during this client visit regarding the side/adverse effects of the medication? 1. Cardiovascular symptoms 2. GI symptoms 3. Problems with mouth dryness 4. Problems with excessive sweating

D (Saline cathartics are for short term used and should not be administered over a long period of time. It will not stop diarrhea. Semifluid stool is an expected outcome so there is no need to immediately call the provider. Typical uses are for cleansing the bowel prior to a colonoscopy or in fecal impactions.)

The nurse is preparing to administer a saline cathartic to a patient. The patient requests more information. What information from the nurse is correct? A.) "This is going to be administered every day for the next several weeks." B.) "This should help stop your diarrhea." C.) "You need to let your provider know immediately if you experience loose stool." D.) "This procedure will help clean the bowel before your scheduled colonoscopy."

B (Rationale: the nurse should hold the 1700 hours dose of lithium because a level of 1.8 mEq can cause adverse reactions. the nurse should report this lithium level to the health care provider and monitor the patient for signs of lithium toxicity.)

The nurse is reviewing the laboratory report with the client's lithium level prior to administrating the 1700 hours dose. The lithium level is 1.8mEq/L. The nurse should: A. administer the 1700 hours dose of lithium B. hold the 1700 hours dose of lithium C. give the client 240 mL of water with the lithium D. give the lithium after the client's supper

B (Rationale: the nurse should hold the 1700 hours dose of lithium because a level of 1.8 mEq can cause adverse reactions. the nurse should report this lithium level to the health care provider and monitor the patient for signs of lithium toxicity.)

The nurse is reviewing the laboratory report with the client's lithium level prior to administrating the 1700 hours dose. The lithium level is 1.8mEq/L. The nurse should: A. administer the 1700 hours dose of lithium B. hold the 1700 hours dose of lithium C. give the client 240 mL of water with the lithium D. give the lithium after the client's supper

a, d (The client should shake the inhaler and hold it upright when administering the drug. The head should be tilted back slightly. The client should wait about 1-2 minutes between puffs. The mouth should be rinsed following the use of a corticosteroid MDI to decrease the likelihood of developing an oral infection. The client does not need to lie supine; instead, the client will likely be able to breathe more freely if sitting upright.)

The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a corticosteroid. Which of the following indicates that the client is using the MDI correctly? Select all that apply. A The inhaler is held upright B The head is tilted down while inhaling the medicine C The client waits 5 minutes between puffs D The client rinses the mouth with water following administration E The client lies supine for 15 minutes following administration

C (Rationale: The nurse should monitor the clients respirations closely for 4 to 6 hours because naloxone has a shorter duration of action than opioids. The client may need repeated doses of naloxone to prevent or treat a recurrence of the respiratory depression. Naloxone is usually effective in a few minutes; however, its effects last only 1 to 2 hours and ongoing monitoring of the clients respiration's is necessary. )

The physician ordered I.V. naloxone (Narcan) to reverse the respiratory depression from morphine administration. After administration of the naloxone the nurse should: A) Check Respirations in 5 minutes because naloxone is immediately effective in relieving respiratory depression. B) Check respirations in 30 minutes because the effects of morphine will have worn off by then. C) Monitor respirations frequently for 4 to 6 hours because the client may need repeated doses of naloxone D) Monitor respirations each time the client receives morphine sulfate 10 mg I.M.

2. (periodic laboratory monitoring of renal and thyroid function Two major long-term risks of lithium therapy are hypothyroidism and impairment of the kidney's ability to concentrate urine; therefore, a person receiving lithium therapy must have periodic follow-ups to assess thyroid and renal function. Weight gain and fine tremors are common side effects associated with this medication, but the patient should continue taking the medication. Sodium intake for clients who take lithium is not restricted.)

The plan of care for a patient who takes lithium (Lithobid) should include: 1. dietary teaching to restrict daily sodium intake 2. periodic laboratory monitoring of renal and thyroid function 3. the requirement for laboratory tests to monitor serum potassium level 4. the importance of discontinuing the medication if fine hand tremor occurs

d (Decreased ammonia levels Rationale: Hepatic encephalopathy is a complication of liver failure and is associated with elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract and also has a laxative effect that helps remove it from the body as stool. This lowers ammonia levels in the body and can reduce symptoms of hepatic encephalopathy)

The provider orders lactulose for a patient with hepatic encephalopathy. Which of the following assessment findings indicates to the nurse that this medication has been effective? a Relief of abdominal pain b Relief of constipation c Decreased liver enzymes d Decreased ammonia levels

1, 3, 4 (AST, Bilirubin, and PT are all tests that measure liver function. ESR is a test to measure inflammation. A1C is a test to measure long-term glucose levels.)

What are some labs the nurse should watch for when giving acetaminophen to an alcoholic with severe liver damage? Select all that apply. 1 AST 2 ESR 3 Bilirubin 4 PT 5 A1C

C (Atrovent is a maintenance therapy for bronchoconstriction and should not be used for relief of acute bronchospasms. All other answers are appropriate.)

What statement by the patient indicates to the nurse that additional teaching is needed for a new prescription of ipratropium bromide (Atrovent)? A"I will rinse my mouth after using my inhaler." B"I know that a possible side effect is gastrointestinal upset." C"I will use my Atrovent inhaler for immediate relief during an asthma attack." D "I may use a spacer with my inhaler to help ensure appropriate medication delivery."

d (only Methylphenidate is an Amphetamine, and can function as an appetite suppressant because of the way it stimulates the central nervous system.)

Which of the following drugs should be avoided for a patient who was struggling with Anorexia? a) Lithium carbonate b) Albuterol c) Oxycodone d) Methylphenidate

B. (Loss of salt leads to an increased risk of adverse effects while taking lithium carbonate so a low sodium diet would not be advised. Maintaining adequate hydration, avoiding excessive sweating to avoid salt loss, and use of birth control while are all appropriate while taking lithium carbonate.)

You are caring for a client with bipolar disorder you know they need further education in regards to use of lithium carbonate when... A.They state they will be sure to drink 8 to 12 glasses of water per day. B. Will cut back their sodium intake. C. Will avoid using the sauna when they swim at the gym. D. Will use birth control

C, D (C. bisacodyl a stimulant cathartic and/or D.magnesium citrate a saline cathartic are the preferred types of laxatives for use in preparing for exams, endoscopy, and medical procedures as they are fast acting. Psyllium and lactulose are slower acting and not used typically for procedure prep. )

You are instructing a client on preparation for a colonoscopy which laxative would you expect to be prescribed for them. select all that apply. A. psyllium B. lactulose C. bisacodyl D. magnesium citrate

A (is correct: The client who is taking lithium needs an adequate intake of sodium and fluid to prevent the development of lithium toxicity.)

which of the following findings is a factor in the development of lithium toxicity? A. Hyponatremia B. Hypercalcemia C. Hypocalcaemia D. Hypernatremia

Answer: B (Fluoxetine should not have been prescribed for this patient because he has a history of attempted suicides. Although drinking alcohol can enhance sedation, it is still okay to drink alcohol as long as it is in moderation. Explaining that the medication takes 2 weeks to take effect is a true statement, but his is not the best choice.)

Question 2: You are working with a 23-year-old patient who has a history of suicide attempts and depression. He was prescribed Fluoxetine (Prozac) a week ago and is back at the clinic. During the assessment he explains that his depression has not changed, and that he has started drinking lately (in moderation) to help cope. How should the nurse respond? A Explain to the patient that he cannot drink alcohol with Fluoxetine (even in moderation) because it can cause serious side effects. B Call the provider and recommend discontinuing this medication. C Explain to the patient that the medication takes up to 2 weeks to take effect. D Explain the risks of drinking alcohol with this medication and that the medication takes 2 weeks to take effect.

B (Rationale: Corticosteroids have expected effects on certain electrolytes and blood sugars. It is common for blood sugars to be slightly elevated and hypocalcemia and hyponatremia to occur. A common effect is hypokalemia; therefore having an elevated potassium, especially at that level should signal to the nurse that something is wrong right away. Due to the fluctuating serum levels when on corticosteroids, blood sugars and electrolytes should always be checked regularly during the use of this medication.)

. A non-diabetic patient has just started taking Prednisone. Which lab value would the nurse be concerned about most? a. Fasting blood sugar of 130 b. Serum potassium of 5.5 mEq/L c. Serum calcium of 8.2 mg/dL d. Serum sodium of 132 mEq/L

A (because if this person doesn't get adequate treatment they will get under treated and possibly start using drug seeking behaviors and may also go into withdrawals)

1) how should a nurse manage pain in a client with a history of drug abuse? A)Provide adequate pain relief B)Provide half the pain medication ordered C)Give extra pain medication because this patient will have a increased tolerance D)Don't provide medication because they will become addicted

C (Loperamide (Imodium) is an antidiarrheal.)

1. A client has a PRN order for loperamide (Imodium). The nurse should plan to administer this medication if the client has: A. Constipation B. Abdominal pain C. Episode of diarrhea D. Hematest-positive nasogastric tube drainage

D (Constipation is an adverse effect of opioids. Increasing fiber consumption can help prevent it)

1. A client is discharged with a prescription for an oral opioid analgesic with codeine. The nurse instructs the client to increase dietary intake of fiber. Which of the following is the rational for this instruction? A. Binds with the medication to relieve pain B. prevents nausea caused by opioids C. Aids in the absorption of opioids D. Helps prevent constipation

D (corticosteroid have a side effect of causing hyperglycemia)

1. A client is ordered to receive a high dose of a corticosteroid IV. Which action should the nurse anticipate to include in the client's plan of care? A. Observe the client for hypotension. B. Increase the client's oral fluid intake. C. Restrict the client's potassium intake. D. Monitor the client for hyperglycemia.

A (Benzodiazepines can be given for withdrawal of alcohol)

1. A nurse is completing the admission history for a client who reports drinking one pint of whiskey every week for 8 years. The last drink was 10 hours ago. Which of the following medications should the nurse plan to administer? A. Diazepam (Valium) B. Disulfiram (Antabuse) C. Fluoxetine (Prosac) D. Acetaminophen (Tylenol)

D (Due to the risk for fatal agranulocytosis, weekly monitoring of the client's WBC count is recommended. It is not appropriate to increase carbohydrate intake due to increased risk of developing DM. Clozapine has a low risk for hand tremors and it does not cause temporary numbing of the mouth.)

1. A nurse is providing discharge teaching to a client who has a new prescription for Clozapine. Which of the following statements should the nurse include in the teaching? a. "You should have a high-carbohydrate snack between meals and at bedtime." b. "You are likely to develop hand tremors if you take this medication for a long period of time." c. "You may experience temporary numbness of your mouth after each dose." d. "You should have your white blood cell count monitored every week."

D (The nurse should instruct the grandparents that aspirin increases children's risk of developing Reye's syndrome (swelling in the liver and brain), and they should not give the drug to children.)

1. A nurse is teaching a child care class to prospective grandparents. Which of the following medications is contraindicated in children? A. ibuprofen B. acetaminophen C. amoxicillin D. aspirin

C (Naloxone (Narcan) is an opioid antagonist (blocks receptors. It counteracts the overdose. However, in conditions of extreme pain, Narcan should be given in small increments to avoid a complete loss of pain control. )

2. For an overdose of morphine sulfate, which drug should the nurse have on hand as an antidote? A. phenytoin (Dilantin) B. tramadol (Ultram) C. naloxone (Narcan) D. atropine sulfate (Atropine)

B (A patient with attention deficit hyperactivity disorder does not follow rules in a game and has conflicts with peers. Methylphenidate (Ritalin) is a physicostimulant drug used in attention deficit hyperactivity disorder. Botulinum toxin type A (Botox) is given in Tourette's syndrome to calm the muscles. Naltrexone (Revia) is an opioid antagonist which is usually given in Tourette's syndrome to block the euphoric responses. Diphenhydramine (Benadryl) is an antihistaminic drug prescribed for allergies.)

1. A nurse observed that during play therapy, a patient is unable to follow the rules of the game and has conflict with peers. Which of these drugs would you anticipate would be administered to the patient? 1. Botulinum Toxin type A (Botox) 2. Methylphenidate (Ritalin) 3. Naltrexone (Revia) 4. Diphenhydramine (Benadryl)

b (rationale: the first action the nurse should take using the nursing process is to assess the client. identifying the clients level of orientation is priority action)

1. A nurse working in an emergency department is caring for a client who has benzodiazpine toxicity due to an overdose. Which of the following actions is the nurse's priority? a.) administer flumazenil b.) identify the clients level of orientation c.) infuse iv fluids d.) prepare the client for gastric lavage

b

2. The nurse is working with a patient admitted with diazepam (valium) overdose. What medication will the nurse anticipate the care provider to order to refer the effect of diazepam? (a)naloxone (narcan) (b)flumazenil (c)acetylcysteine (d)hydrocodone

A (Clients taking antidepressant medication should avoid herbal preparations containing hypericum (St. John's wort) unless directed by the physician.)

2) the physician has ordered Paxil (paroxetine) for a client with generalized anxiety disorder. the nurse should instruct the client to avoid herbal preparations that contain: A. Hypericum (St. John's Wort) B. Angelica C. Chamomile D. Echinacea

A,C,D (with this drug there is a increase in suicidal ideations in children adolescents and young adults. serotonin syndrome is a side effect of this drug characterized by hypertensive crisis.)

2) when a nurse is administering fluoxetine (Prozac) for the treatment of depression what should the nurse assess for? (select all that apply) A)increased suicidal ideations in young adults? B)respiratory depression C)serotonin syndrome D)Hypertensive crisis E)Monitor ECG

C (clozapine has been known to cause agranulocytosis)

2. A client with chronic schizophrenia is receiving clozapine. Which of the following should a nurse be most concerned with monitoring? A. Sodium B. Potassium C. White blood cell count D. Hemoglobin and hematocrit

(A Acetylcysteine is the correct antidote for Acetaminophen overdose. Narcan is for opioid overdose, Flumazenil is for Diazepam overdose and Dantrium is for Malignant Hyperthermia.)

2. A nurse is admitting a toddler to the hospital after an Acetaminophen overdose. Which of the following medications should the nurse anticipate administering to this client? a. Acetylcysteine b. Narcan c. Flumazenil d. Dantrium (Dantrolene Sodium)

A. (Anticonvulsants decrease the effectiveness of oral contraceptives )

2. A nurse is caring for a client who is receiving an anticonvulsant for a seizure disorder. Which of the following information should the nurse include in the teaching plan for the client? A. This medication decreases the effectiveness of oral contraceptives B. Once the client is seizure- free for one month, the medication may be discontinued C. Medication may be discontinued if GI upset occurs D. Medication may initially increase the frequency of seizures

D (Pain management of a burn patient should be through the use of IV opioids, typically morphine. )

2. A nurse is caring for a critical burn patient. The patient is suffering from intense pain and requires medication. The nurse should expect the physician to prescribe which of the following? A. Fentanyl patch B. Hydromorphone, intranasal C. Oxycodone via nasogastric tube D. Morphine sulfate, IV

C (Lithium should be taken with meals, Tylenol is generally safe for use with lithium, and the effects of lithium begin in 5-7 days, and full therapeutic affects may take 2-3 weeks to develop. C is correct because the nurse should encourage the client to maintain adequate dietary intake of sodium because decreased levels can result in lithium toxicity.)

2. A nurse is reinforcing teaching with a client prescribed lithium (Eskalith). Which of the following statements indicates a need for further teaching? A. "I should take my medication with meals" B. "I can take Tylenol for headaches" C. "I need to limit my salt intake with this medication" D. "I should feel better in about 2-3 weeks"

d (Aspirin increases children's risk of developing Reye's syndrome, and should not be given to children.)

2. A nurse is teaching a child care class to prospective grandparents. Which of the following medications is contraindicated in children? a. ibuprofen b. acetaminophen c. amoxicillin d. aspirin

D (Epi is a bronchodilator and is a first line drug administered in anaphylaxis)

2. A toddler develops stridor and swelling of the eyelids 10 minutes after receiving an IM antibiotic. Which of the following actions should the nurse take first? A. Monitor urinary output B. Assess for signs of fluid overload C. Give diphenhydramine (Benadryl) D. Administer epinephrine

B (Acetaminophen is extensively metabolized by pathways in the liver. Toxic doses of acetaminophen deplete hepatic glutathione, resulting in accumulation of the intermediate agent, quinine, which leads to hepatic necrosis. Prolonged use of acetaminophen may result in an increased risk of renal dysfunction, but a single overdose does not precipitate life-threatening problems in the respiratory system, renal system, or adrenal glands.)

2. Walter, teenage patient is admitted to the hospital because of acetaminophen (Tylenol) overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which of the following organs? a. Lungs b. Liver c. Kidney d. Adrenal Glands

A (It is recommended that systemic corticosteroid medications be administered on alternate days. The dose administered is two times the normal daily dose)

2. When administering long-term systemic corticosteroid medications, which of the following dosing schedules is recommended? a. alternate-day therapy b. once daily at noon c. weekly therapy d. nightly therapy .

A, C, E (Imodium does not penetrate the CNS well so it does not cause the CNS effects associated with opioid use and lacks potential for abuse. Although adverse effects are few and mild. However, treatment of overdose of Imodium can be naloxone, gastric lavage, and administration of activated charcoal. Imodium and Lomotil may cause dizziness or drowsiness. Imodium is an unscheduled and nonprescription drug.)

2. Why is Loperamide (Imodium) safer than Lomotil? (Select all apply) A Imodium does not penetrate the CNS well. B Imodium needs to be prescribed. C There are treatments if a patient is overdose Imodium. D Imodium does not cause dizziness or drowsiness. E Imodium has few and mild adverse effects comparing to Lomotil.

C (Corticosteroids have an ant-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections.)

2.) A client with acute asthma is prescribed short-term corticosteroid therapy. Which is the expected outcome for the use of steroids in clients with asthma? a.) promote bronchodilation b.) act as an expectorant c.) have an anti-inflammatory effect d.) prevent development of respiratory infections

C (An expected assessment finding of a client experiencing acute pain would be diaphoresis due to sympathetic nerve stimulation. A. An expected assessment finding of a client experiencing acute pain would be an increased heart rate, not bradycardia. B. An expected assessment finding of a client experiencing acute pain would be an increased respiratory rate, not bradypnea. D. The client experiencing acute pain will have increased muscle tension.)

2.) Upon entering the room, the nurse discovers that the client is experiencing acute pain. An expected assessment finding for this client is: A) Bradycardia B) Bradypnea C) Diaphoresis D) Decreased muscle tension

3

A 74 y.o. female pt w/ GERD takes over-the-counter meds. For which med, if taken long-term, should the nurse teach about increased risk of fractures? 1. Sucralfate (Carafate) 2. Cimetidine (Tagamet) 3. Omeprazole (Prilosec) 4. Metoclopramide (Reglan)

1, 2 (both benzodiazepines are used during alcohol withdrawal to decrease anxiety and reduce the risk for seizures. )

A charge nurse is planning a staff education session to discuss medications used to treat alcohol withdrawal. Which of the following medications should the charge nurse include in the discussion? (Select all that apply) 1. Lorazepam 2. Diazepam 3. Disulfiram 4. Naltrexone 5. Acamprosate

2, 4, 5 (Cimetidine (Tagamet) should be taken with meals or at bedtime. If taking an antacid, take at least one hour before or after taking cimetidine (Tagamet).)

A client is prescribed Cimetidine (Tagamet). When teaching the client about taking this medication, the nurse will tell the patient, (select all that apply): 1 "You should take this medication in the morning before breakfast." 2 "You can take this medication with lunch." 3 "You can take this medication with an antacid." 4 "You can take this medication with dinner." 5 "You can take this medication at bedtime."

A (Singulair is a maintenance medication and is not intended for treatment of acute asthma attacks)

A client with COPD is taking a leukotriene antagonist, montelukast (Singulair). The nurse is aware that this medication is given for which purpose? a. Maintenance treatment of asthma b. Treatment of an acute asthma attack c. Reversing bronchospasm associated with COPD d. Treatment of inflammation in chronic bronchitis

b ( though Metamucil is considered the "best" laxative to use on a regular basis, the body can become dependent on it to the point that it becomes constipated without it.)

A healthy 26 year old male without any constipation, GI, or motility problems buys Metamucil (Psyllium) and starts using it "to stay regular." Why would the RN recommend that he NOT use this product on a daily basis? a) Psyllium can lead to hepatic failure if used for too long, especially at such a young age. b) The client may have trouble stooling regularly once he stops using Psyllium. c) Bulking laxatives require fluid restriction. d) Psyllium can reduce cholesterol to dangerously low levels.

D (Pain is what the patient says it is. The nurse should notify the surgeon of the inability to control the patient's pain. People who are narcotic tolerant often require additional opioids to manage the pain associated with surgery. Distraction should not be used to avoid administration of medication in patients in pain.)

A man has an order for morphine sulfate 2 mg intravenously every 2 hours following a cholecystectomy. the patient has a history of IV drug abuse. He reports that his pain is 7 out of 10 (with 10 being the worst) and requests the morphine every hour. what is the nurse's appropriate response? a. to instruct him about possible adverse effects b. to tell him that you can administer the drug only every 2 hours c. to use distraction techniques to help him forget his pain d. to notify the surgeon of his request

B

A manic patient has been taking lithium for 9 months. When the patient's serum laboratory results are complete, the nurse should compare the patient's lithium levels to what therapeutic range? A. 0.2-0.8 mEq/L B. 0.6-1.2 mEq/L C. 1.2-2 mEq/L D. 2.4-3.2 mEq/L

A. Acetylcysteine (Acetylcysteine is the antidote for acetaminophen. Narcan is the antidote for opioids. Flumazenil is the antidote for diazepam. Naltrexone is used to treat symptoms of alcohol and opiate withdrawal.)

A nurse is admitting a toddler to the hospital after an acetaminophen overdose. Which of the following medications should the nurse anticipate administering to this client? A Acetylcysteine B Narcan C Flumazenil D Naltrexone

C (Tardive dyskinesia is an extrapyramidal effect of haldol. Early signs include writhing movements.)

A nurse is assessing a client in the clinic who is displaying involuntary movements of the extremities that are writhing in nature. The client reports taking haldol (Haloperidol) 0.5 mg daily. The nursing assessment for this client is likely to indicate which of the following? A Akathisia B Dystonia C Tardive dyskinesia D Restless leg syndrome

2. (This is the most correct answer out of the choices because lactulose is a laxative that will help reduce constipation. However, what's unique about this specific laxative is that it also can decrease ammonia levels. This is super important for a patient with cirrhosis who is showing signs of decreased cognition because they could be experiencing hepatic encepalopathy which happens from increased ammonia levels. Incorrect answers: Mylanta is used for GERD, and the other laxatives do not have the capability of decreasing ammonia and therefore it's in the patients best interest to use a medication that can treat both symptoms. )

A nurse is caring for a an older adult who has been admitted for cirrhosis, with signs of decreased cognition and now has developed constipation due to immobility. Which GI medication would be most effective in treating this patient with these conditions? 1. Pysyllium (Metamucil) 2. Lactulose 3. Saline cahartics (Miralax) 4. Mylanta

D (drowsiness and confusion are common side effects of morphine; 89% oxygen saturation does not warrant the need for Narcan, other interventions can be used to increase O2 sat; respiration rate of less than 10 is a sign of respiratory distress and Narcan should be used to reverse the morphine.

A nurse is caring for a patient who is receiving IV morphine for pain. The nurse knows to administer Narcan when she assesses: a. the patient is sleeping b. the patient's O2 sat is 89% c. the patient is disoriented d. the patient's respiration rate is 9

A (Omneprozale is a proton pump inhibitor that decreases gastric acid secretion. When combined with warfarin, omniprazole can prolong elimination and increase INR. Omneprazole has not been shown to cause encehpalopathy when mixed with warfarin. Although omneprazole inhibits absorption of many drugs, it actually increases the effects of warfarin.)

A nurse is obtaining a medication history from a patient with GERD. The patient claims to take omneprozale and warfarin at bedtime. The nurse should be concerned because A) Omneprazole magnifies the effects of warfain B) Omneprazole may inhibit warfarin absorption C) Omneprazole should be taken before meals D) Omneprazole can cause encephalopathy when mixed with other medications

A ( The patient reports taking less than the recommended total daily dose for Acetaminophen (< 4000 mg), but it is necessary to find out if they may be taking other OTC medications that may contain further Acetaminophen. Further information is needed before action can be taken.)

A nurse is performing medication reconciliation with a patient. The client complains of a severe headache and states that they have been taking 600-800 mg of Acetaminophen every 6 hours for the past 3 days. What is the first thing the nurse should do? A. Ask the patient what other OTC medications they have been taking. B. Stop and assess the patient for adverse symptoms from taking more than the recommended daily limit for this medication. C. Consult with the provider about ordering a prescription medication to help control the patients pain D. Educate the patient about the complications associated with taking too much Acetaminophen.

A (The nurse should monitor for urinary retention because morphine can suppress awareness that the bladder is full.)

A nurse is preparing to administer an opioid agonist to a client who has acute pain. Which of the following complication should the nurse monitor? a) urinary retention b) tachypnea c) HTN d) Irritating cough

A (Restlessness is a common side effect of bronchodilators because of central nervous system stimulation.)

A nurse is preparing to to administer a bronchodilator to a client who has asthma. Which of the following is a common side effect of these drugs for which the nurse should monitor? A Restlessness B Ataxia C Nystagmus

A & B (Lorazepam and Diazepam are benzodiazepines used during alcohol withdrawal to decrease anxiety and reduce risk of seizures)

A nurse is providing care to a client experiencing alcohol withdrawal, which of the following meds should the nurse plan on administering? Select all that apply a) lorazepam b) diazepam c) disulfiram d) naloxolne e) propranolol

A (The client needs specific information about the effects of the drug, specifically its effect on the blood. The statement about weekly blood tests to determine safe dosage and monitoring for effects on the blood gives the client specific information to ensure follow up with the required protocol for Clorazil therapy. Lack of accurate knowledge can lead to noncompliance with necessary follow-up procedures and noncompliance with medication. It is also true that the medication is given out only in a one week supply and the provider will want to know how well the patient is progressing, but the correct response is one that will help the client understand and thereby follow through with appointments.)

A nurse is teaching a patient with severe schizophrenia about Clozaril (clozapine). The patient questions why he needs to return in 1 weeks time for blood work. Which of the following is the most appropriate nursing response? A) "Weekly blood test are necessary to determine safe dosage and to monitor the effect of the medication on the blood." B) "Your physician will want to know how well you are progressing with the medication therapy." C) "Everyone taking Clozapine has to go through the same procedure because it is required by the drug company." D) "Weekly blood tests are done so that you can receive another week's supply of the medication."

B. (Leave the patch on for 9 hours. Rationale: Transdermal methylphenidate patches should be left on for 9 hours/day then removed. They are administered only once daily and should be applied to the child's hip. Opened tray of patches should be used within 2 months.)

A nurse is teaching the parents of a school-age child about transdermal methylphenidate. Which of the following instructions should the nurse include? Apply one patch twice per day. Leave the patch on for 9 hours. Apply the patch to the child's waist. Use opened tray within 6 months.

C (Saline cathartics are commonly given before colonoscopy)

A patient asks about how to prepare for a colonoscopy. The nurse can expect the physician to prescribe which of the following medications? A. Omeprazole B. Mylanta C. Milk of Magnesia D. psyllium

1 (These foods include aged cheeses, cured meats, and foods with soy sauce. Alcoholic beverages and other antidepressants should be avoided)

A patient has been started on an MAOI and the nurse is preparing discharge instructions for the patient. What should the nurse include in the teaching? 1. Avoid food and drinks containing tyramine, tryptamine, or tryptophan. 2. Check blood pressure daily because of the risk of hypotension. 3. Continue taking fluoxetine with the MAOI 4. Occasional consumption of red wine is permitted .

4 ( Usually you need to avoid certain meds for 14 days before taking a MAO Inhibitor. While most SSRIs only need 14 days, fluoxetine needs 5 weeks to be cleared before you can take a MAO inhibitor. for number 2, if the patient ate certain cheeses that contained tyramine, that would cause concern, but since he does not, it's not a concern.)

A patient has received a prescription for a MAO Inhibitor. The nurse is reviewing the patient's medical history. Which finding made the nurse question the provider on the oder. 1) Patient stopped taking albuterol 3 weeks ago 2) Patient is lactose intolerant, and he specifically avoids cheese 3) Patient stopped taking lithium 3 weeks ago 4) Patient stopped taking fluoxetine 3 weeks ago.

4. ("Are you having any thoughts of harming yourself?" The patient is starting to experience increased energy, but suicidal thoughts may still remain. The patient may now have the energy for self-harm. It is important to assess for other side effects, such as appetite changes and depression, but suicide is the highest priority.)

A patient hospitalized for major depression has been taking sertraline (Zoloft) for the past week and has verbalized increased energy and improved sleep. What is the highest priority question the nurse should ask? 1. "Have you experienced any side effects from this drug?" 2. "How has your appetite changed since starting this drug?" 3. "Do you think your depression is less severe?" 4. "Are you having any thoughts of harming yourself?"

a, d, e (Dizziness, tachycardia, and tremors are side effects the nurse should be watching for on this patient.)

A patient in severe respiratory distress is prescribed continuous albuterol nebulizers. Which of the following side effects should the nurse expect? Select all that apply. a) Dizziness b) Urticaria c) Hyperkalemia d) Tachycardia e) Tremors

a & b (Bisacodyl is a stimulant laxative that acts on the myenteric plexus to increase colonic movement. It is also a contact laxative, increasing fluid and electrolyte secretion.)

A patient is prescribed bisacodyl and asks the nurse how the medication works. The nurse responds by stating which of the following? (Select all that apply) a. Increases colonic movement b. Increases fluid and electrolyte secretion to facilitate evacuation c. Is bulk forming d. Reduces stool surface tension

A( - montelukast (Singulair) should be taken in the evening or at bedtime, and is taken by mouth because it only comes as an oral tablet; Singulair can be used with bronchodilators and corticosteroids; serious toxicity and adverse effects are very rare with Singulair.)

A patient was recently prescribed montelukast (Singulair) for treatment of asthma. The nurse knows her teaching was effective when the patient states: a. "I take my Singular by mouth one time every night before bed" b. "I should never use my Singulair together with my bronchodilator" c. "There are extreme, life-threatening adverse effects I should be cautious of" d. "I should take my Singulair when I am having difficulty breathing"

A, C, D, E ( Common side effects of beclomethasone and other inhaled corticosteroids include dry mouth, cough, hoarseness, sore throat, nausea, and upset stomach. Local immunosuppression can cause oral candidiasis)

A patient with emphysema is prescribed beclomethasone. Which of the following side effects should the nurse instruct the patient about in the discharge instructions? (select all that apply) A. Cough B. Fatigue C. Dry mouth D. Oral candidiasis E. Hoarseness

C ( the client should wait 5-10 mins after using albuterol to allow for it to open the constricted airways so the corticosteroid inhaler can be effective.)

A woman begins using an albuterol inhaler and a beclomethasone inhaler for her asthma. Which statement by the client indicates further teaching is necessary? A) I use the albuterol inhaler first. After 5-10 minutes I use my beclomethasone inhaler. B) I should rinse my mouth with warm tap water after using my inhalers. C) I use my albuterol inhaler first then immediately use my beclomethasone inhaler. D) I can only use my albuterol inhaler when I am having an acute asthma attack.

b. ("He should take the medication 10-15 minutes before eating. One of the adverse effects of Ritalin is appetite suppression, to minimize appetite-suppressive effects patients should take the drug 30-45 minutes before meals. All other statements are true. )

Your pediatric patient with ADHD has just been prescribed Ritalin. While educating the patient and their parent on this medication, which statement indicates a need for further teaching? a "I should fill my son's prescription as soon as possible to prevent misplacing the script." b "He should take the medication 10-15 minutes before eating. c "He should take the first dose upon waking." d "A drug holiday could be an option during the summer months."