PHARMA FINAL BLUEPRINT

A nurse is caring for a client who takes warfarin to treat chronic atrial fibrillation and has early manifestations of Alzheimer's disease. The client's partner asks the nurse if the client would benefit from taking ginkgo biloba. Which of the following responses should the nurse make? A. "Ginkgo biloba will likely interfere with the effectiveness of his other medications." B. "You should ask his provider if ginkgo biloba is safe." C. "Ginkgo biloba is most effective in the later stages of Alzheimer's disease." D. "People who have Alzheimer's disease should adhere to the medication regimen their provider prescribes."

A. "Ginkgo biloba will likely interfere with the effectiveness of his other medications.

A nurse in a provider's office is assessing a client who has been taking feverfew. Which of the following statements by the client indicates a therapeutic effect of the supplement? A. "I am having fewer migraine headaches since I started taking feverfew." B. "My memory seems to be getting better since I started taking feverfew." C. "I have fewer infections when I take feverfew." D. "I have not had another urinary tract infection since starting feverfew."

A. "I am having fewer migraine headaches since I started taking feverfew."

A nurse is caring for a client who takes Ginkgo biloba daily at home. Which of the following effects should the nurse expect from the use of this herbal supplement? A. Decreased platelet aggregation B. Prevention of migraine headaches C. Increased risk of deep-vein thrombosis D. Lowered cholesterol and triglyceride levels

A. Decreased platelet aggregation

A nurse is caring for a client who has a prescription for subdermal etonogestrel. The nurse should alert the provider about which of the following findings in the client's medical history? A. Takes St. John's wort B. Breastfeeds a 6-month-old infant C. Has a parent with hypertension D. Has a positive human papillomavirus (HPV) test result

A. Takes St. John's wort

A nurse is assessing a client who reports using several herbal and vitamin supplements daily, including saw palmetto. The nurse should recognize that saw palmetto is a supplement used by clients to elicit which of the following therapeutic effects? A. Urinary health promotion B. Immune system stimulation C. Decreased leg pain from arterial disease D. Prevention of nausea caused by motion sickness

A. Urinary health promotion

A nurse is performing a preoperative assessment of a client who is about to undergo an aneurysm clipping. The nurse should identify a risk for increased bleeding when the client reports taking which of the following dietary supplements? A. Soy B. Garlic C. Black cohosh D. Green tea

B. Garlic

A nurse is providing teaching to a client who has a new prescription for sertraline. The client asks the nurse if he should continue to take St. John's wort for depression. Which of the following instructions should the nurse give the client? A. Take the medication and herbal supplement together. B. Stop taking the herbal supplement while taking the medication. C. Take the herbal supplement and the medication at least 2 hr apart. D. Take an antacid with both the herbal supplement and the medication.

B. Stop taking the herbal supplement while taking the medication.

A nurse is caring for a client who reports using several herbal medicines. Which of the following actions should the nurse take? A. Discourage the use of unregulated medications and supplements B. Verify the herbal supplements do not interact with medications the provider has prescribed C. Tell the client to limit the number of herbal supplements to no more than 2 D. Describe the dangers of taking plant-derived medications and supplements

B. Verify the herbal supplements do not interact with medications the provider has prescribed

A nurse is providing teaching to a client about a new prescription for captopril to treat hypertension. Which of the following client statements indicates an understanding of the teaching? A. "I might have a sore throat that will go away after a few days." B. "I will take this medication with food to avoid getting an upset stomach." C. "I might feel dizzy at times while taking this medication." D. "I will take ibuprofen if I get a fever while taking this medication."

C. "I might feel dizzy at times while taking this medication."

A nurse in a provider's office is assessing a client who reports taking a dietary supplement to reduce hot flashes related to menopause. Which of the following supplements should the nurse expect the client to report taking? A. Flaxseed B. Ginkgo biloba C. Black cohosh D. St. John's wort

C. Black cohosh

A nurse is preparing a discharge teaching plan for a 6-year-old client with asthma who has several prescription medications using metered-dose inhalers (MDIs). Which of the following interventions should the nurse include in the plan? A. Add a spacer to each MDI B. Instruct the child to inhale more rapidly than usual when using an MDI C. Ask the provider to change the child's medications from inhaled to oral formulations D. Administer oxygen by facemask along with the MDI

Correct Answer: A. Add a spacer to each MDI MDIs are difficult to use correctly; even when properly used, only a portion of the medication is delivered to the lungs. A spacer applied to an MDI can make up for a lack of hand-lung coordination by increasing the amount of medication delivered to the lungs.

A nurse is preparing to administer iron dextran IV to a client. Which of the following actions should the nurse plan to take? A. Administer a small test dose before giving the full dose. B. Infuse the medication over 30 seconds. C. Monitor the client closely for hypertension after the infusion. D. Administer cyanocobalamin as an antidote if iron dextran toxicity occurs.

Correct Answer: A. Administer a small test dose before giving the full dose. A serious adverse effect of iron dextran is anaphylaxis caused by hypersensitivity to the medication. A small test dose should be administered over 5 minutes before giving the full dose. The client should be monitored carefully for an allergic reaction during and for a period of time following the test dose.

A nurse is preparing to administer iron dextran IV to a client. Which of the following actions should the nurse plan to take? A. Administer a small test dose before giving the full dose. B. Infuse the medication over 30 seconds. C. Monitor the client closely for hypertension after the infusion. D. Administer cyanocobalamin as an antidote if iron dextran toxicity occurs.

Correct Answer: A. Administer a small test dose before giving the full dose. A serious adverse effect of iron dextran is anaphylaxis caused by hypersensitivity to the medication. A small test dose should be administered over 5 minutes before giving the full dose. The client should be monitored carefully for an allergic reaction during and for a period of time following the test dose.

A nurse is caring for a client who has asthma and a prescription for zileuton. Which of the following laboratory values should the nurse monitor while the client is taking this medication? A. Alanine aminotransferase (ALT) B. WBC count C. Potassium D. Chloride

Correct Answer: A. Alanine aminotransferase (ALT) The nurse should identify that ALT is a liver function test. Zileuton is a leukotriene modifier that can affect the liver, causing increased ALT levels. The nurse should monitor this laboratory value closely while the client is taking the medication.

A nurse is caring for a client who has asthma and a prescription for zileuton. Which of the following laboratory values should the nurse monitor while the client is taking this medication? A.Alanine aminotransferase (ALT) B.WBC count C.Potassium D.Chloride

Correct Answer: A. Alanine aminotransferase (ALT) The nurse should identify that ALT is a liver function test. Zileuton is a leukotriene modifier that can affect the liver, causing increased ALT levels. The nurse should monitor this laboratory value closely while the client is taking the medication.

A nurse is caring for a client who takes Ginkgo biloba daily at home. Which of the following effects should the nurse expect from the use of this herbal supplement? A. Decreased platelet aggregation B. Prevention of migraine headaches C. Increased risk of deep-vein thrombosis D. Lowered cholesterol and triglyceride levels Check Answer

Correct Answer: A. Decreased platelet aggregation Ginkgo biloba can decrease platelet aggregation by inhibiting the ability of platelets to clump together. The nurse and the client should discuss the potential increase in bleeding tendencies when taking Ginkgo biloba and other antiplatelet aggregates, such as NSAIDs and clopidogrel.

A nurse is caring for a client who has asthma and advanced rheumatoid arthritis and deformity of the hands. The nurse should anticipate that the client will receive which of the following medication-delivery devices for the treatment of asthma? A. Dry-powder inhaler (DPI) B. Metered-dose inhaler (MDI) with spacer C. Respimat D. Nebulizer

Correct Answer: A. Dry-powder inhaler (DPI) The nurse should identify that DPIs do not require hand-breath coordination and are easier to use for clients who have deformities of the hands. DPIs are used to deliver medications in a dry, micronized powder directly to the lungs.

A charge nurse is teaching a newly licensed nurse about a client who has severe allergy-related asthma and a new prescription for omalizumab. Which of the following pieces of information should the charge nurse include to describe the medication's mechanism of action? A. It reduces the number of immunoglobulin E (IgE) molecules on mast cells. B. It stabilizes the cellular membrane of mast cells. C. It decreases the synthesis and release of inflammatory mediators. D. It relaxes the smooth muscles by blocking adenosine receptors.

Correct Answer: A. It reduces the number of immunoglobulin E (IgE) molecules on mast cells. The charge nurse should include in the teaching that the mechanism of action of omalizumab reduces the number of IgE molecules on mast cells. This limits the ability of allergens to trigger immune mediators that cause bronchospasm

A nurse is reviewing the medical record of a client. The medication administration record shows the client is taking clopidogrel. Which of the following events should the nurse expect in the client's medical history? A. Recent myocardial infarction B. History of hemorrhagic stroke C. Current outbreak of psoriasis D. History of hypertension

Correct Answer: A. Recent myocardial infarction The nurse should expect the client's medical record to indicate a history of an atherosclerotic event such as myocardial infarction, ischemic stroke, or peripheral vascular disease. Clopidogrel is an antiplatelet medication that inhibits the aggregation of platelets to prevent such thrombotic events.

A nurse in a community health clinic is assessing a new client who has prescriptions for isoniazid and rifampin. Which of the following disorders should the nurse expect the client to have? A. Tuberculosis B. Hypertension C. Diabetes D. Cirrhosis

Correct Answer: A. Tuberculosis Isoniazid and rifampin are first-line antitubercular medications used to treat active tuberculosis. The medications are used in combination therapy.

A nurse is caring for a client who is developing acute pulmonary edema and has a new prescription for furosemide 40 mg IV bolus. The nurse should plan to administer the medication using which of the following methods? A. Undiluted administered over 2 min B. Diluted administered over 20 min C. Undiluted administered as rapidly as possible D. Diluted administered over 5 min

Correct Answer: A. Undiluted administered over 2 min The nurse should plan to administer low-dose furosemide therapy (e.g. 40 mg undiluted via IV bolus) at a rate of 20 mg/min or a dose of 40 mg over 2 min.

A nurse is caring for a client who is at 16 weeks gestation and has severe iron-deficiency anemia. The provider prescribes an injection of iron dextran IM. Which of the following methods should the nurse use to administer the medication? A. Use a 20-gauge needle and administer the medication using the Z-track method B. Use a 22-gauge needle and administer the medication deep into the thigh C. Use a 25-gauge needle and administer the medication into the deltoid muscle D. Use an 18-gauge needle and administer the medication into the rectus femoris muscle

Correct Answer: A. Use a 20-gauge needle and administer the medication using the Z-track method The nurse should administer iron using the Z-track method to prevent staining of tissue. A 20-gauge needle is the correct size.

A nurse is providing teaching to a female client who has a new prescription for pravastatin to treat hyperlipidemia. Which of the following pieces of information should the nurse include in the teaching? A. Pravastatin can be taken with grapefruit juice. B. Pravastatin can be continued during pregnancy. C. Pravastatin should be taken with the morning meal. D. Laboratory testing to monitor the client's WBC count is required.

Correct Answer: A. Pravastatin can be taken with grapefruit juice.

A nurse is providing teaching about sodium phosphate to a client who has a new prescription for sodium phosphate. The client is scheduled for a colonoscopy and is currently taking furosemide for hypertension. Which of the following client statements should indicate to the nurse that the teaching has been effective? A. "I can take my water pill as prescribed." B. "I can experience an imbalance in my electrolytes from this medication." C. "I should drink 8 ounces of bowel cleanser every 10 minutes until I drink a total of 4 liters." D. "I can experience rebound constipation after using this medication."

Correct Answer: B. "I can experience an imbalance in my electrolytes from this medication." Sodium phosphate can cause excess fluid loss as a result of cleansing the bowel of stool. Therefore, the client is at risk for electrolyte imbalance and should be monitored closely.

A nurse is teaching a client about taking tetracycline PO. Which of the following statements should the nurse include in the teaching? A. "Take this medication on a full stomach." B. "Limit your consumption of dairy products while taking this medicine." C. "Take the medication with your regular iron supplement." D. "Take antacids if you have an upset stomach from using tetracycline."

Correct Answer: B. "Limit your consumption of dairy products while taking this medicine." The nurse should tell the client to avoid or limit the consumption of dairy products while taking tetracycline. An interval of at least 2 hours should separate tetracycline ingestion and the ingestion of products that can chelate this medication such as milk or calcium.A. The nurse should tell the client to take oral tetracyclines on an empty stomach 1 hour before meals or 2 hours after meals.

A nurse is teaching a client who has asthma and a prescription for a fluticasone dry powder inhaler (DPI). Which of the following instructions should the nurse include in the teaching? A. "This medication should be taken at the start of your symptoms." B. "Rinse your mouth after administering this medication." C. "Shake the canister prior to administering this medication." D. "This medication relaxes your airways to decrease your symptoms."

Correct Answer: B. "Rinse your mouth after administering this medication." The nurse should include in the teaching that this medication is an oral corticosteroid. Oral corticosteroids increase the risk of the development of oral candidiasis, also known as thrush. In order to prevent this effect, the nurse should advise the client to rinse the mouth after the administration of this medication.

A nurse is preparing to administer nitroglycerin topical ointment to a client who has angina. Which of the following actions should the nurse take? A. Cover the applied ointment with cotton gauze B. Apply the ointment using a dose-measuring applicator C. Apply the ointment using the index finger D. Massage the ointment into the client's skin Check Answer

Correct Answer: B. Apply the ointment using a dose-measuring applicator The nurse should apply the ointment using a dose-measuring applicator. This allows the nurse to measure the correct dose the client is to receive.

A nurse is caring for a client who is taking acarbose to treat type 2 diabetes mellitus. For which of the following adverse effects of this medication should the nurse monitor the client? Insomnia B. Diarrhea C. Joint pain D. Polycythemia

Correct Answer: B. Diarrhea The most common adverse effects of acarbose, an alpha-glucosidase inhibitor, are gastrointestinal. They include diarrhea, abdominal distention and cramping, and flatulence.

A nurse is caring for a client who is taking streptomycin. Which of the following medications increases the client's risk of developing ototoxicity when taken with streptomycin? A. Cefoxitin B. Furosemide C. Naproxen D. Amphotericin B

Correct Answer: B. Furosemide Furosemide, a high-ceiling (loop) diuretic, increases the risk of developing ototoxicity when taken with streptomycin, an aminoglycoside.

A nurse is caring for a client who has a prescription for clopidogrel. The nurse should monitor the client for which of the following adverse effects? A. Insomnia B. Hypotension C. Bleeding D. Constipation

Correct Answer: C. Bleeding Clopidogrel is an antithrombotic medication that inhibits platelet aggregation. It is used to prevent stenosis of coronary stents, myocardial infarctions, and strokes. The nurse should monitor for coffee-ground emesis, black tarry stools, ecchymosis, or any indication of bleeding.

A nurse is caring for a client who has diabetes insipidus. Which of the following laboratory values should the nurse identify as reflecting a contraindication to receiving vasopressin to treat this disorder? A. Sodium 152 mEq/L B. Potassium 6.0 mEq/L C. Creatinine clearance 50 mL/min D. Aspartate aminotransferase (AST) 52 units/L

Correct Answer: C. Creatinine clearance 50 mL/min Creatinine clearance should be above 87 mL/min for female clients and above 107 mL/min for male clients. A creatinine clearance of 50 mL/min indicates renal impairment and is a contraindication to receiving vasopressin. Renal impairment increases the likelihood of the life-threatening adverse effect of water intoxication.5

A nurse is reviewing the medical record of a client who is receiving hydrochlorothiazide (HCTZ). The nurse should expect to find an improvement in which of the following conditions as a result of this medication? A. Gouty arthritis B. Dehydration C. Diabetes insipidus D. Hypokalemia

Correct Answer: C. Diabetes insipidus A thiazide diuretic such as HCTZ is administered to treat diabetes insipidus. Diabetes insipidus is a condition in which there is an overproduction of urine. Thiazides reduce urine production by 30% to 50%.

A nurse is preparing a discharge teaching plan for a client who is scheduled to begin long-term oral prednisone for asthma. Which of the following instructions should the nurse include in the plan? A. Stop taking the medication if a rash occurs. B. Take the medication on an empty stomach to enhance absorption. C. Schedule the medication on alternate days to decrease adverse effects. D. Treat shortness of breath with an extra dose of the medication.

Correct Answer: C. Schedule the medication on alternate days to decrease adverse effects. Some of the adverse effects caused by long-term glucocorticoid therapy (e.g. suppression of the adrenal gland) can be avoided by using alternate-day therapy.

A nurse is caring for a client who has heart failure and is taking oral furosemide 40 mg daily. For which of the following adverse effects should the client be taught to monitor and notify the provider if it occurs? A. Nasal congestion B. Tremors C. Tinnitus D. Frontal headache

Correct Answer: C. Tinnitus Loop diuretics such as furosemide can cause ototoxicity. The client should be taught to notify the provider if tinnitus, a full feeling in the ears, or hearing loss occurs.

A nurse is providing teaching for a client who has a new prescription for nitroglycerin administered through a transdermal patch. Which of the following client statements indicates an understanding of the teaching? A. "I need to wear the patch continuously for it to be effective." B. "I will stop using the patch immediately if it gives me a headache." C. "I should change the patch whenever I have chest pain." D. "I need to rotate the location of my patch every few days."

Correct Answer: D. "I need to rotate the location of my patch every few days." The nitroglycerin patch should be rotated to different hairless areas of the client's body every few days to avoid local skin irritation.

A nurse is providing teaching to a client who has heart failure and is taking spironolactone. Which of the following statements by the client indicates an understanding of the teaching? A. "I will increase my intake of citrus fruits, bananas, and potatoes." B. "I will use salt substitutes on my food." C. "I will drink as much water as I can while taking this medication." D. "I will watch for increased breast tissue growth while taking this medication."

Correct Answer: D. "I will watch for increased breast tissue growth while taking this medication." Spironolactone, which is derived from steroids, can cause adverse endocrine effects such as gynecomastia, impotence in men, and irregular menses and hirsutism in women. The nurse should instruct the client that these changes can occur.

A nurse is providing teaching to a client who has hypertension and a new prescription for oral clonidine. Which of the following instructions should the nurse include in the teaching? A. Discontinue the medication if a rash develops. B. Expect increased salivation during the first few weeks of therapy. C. Minimize fiber intake to prevent diarrhea. D. Avoid driving until the client's reaction to the medication is known.

Correct Answer: D. Avoid driving until the client's reaction to the medication is known. Clonidine can cause drowsiness, weakness, sedation, and other CNS effects. Until the client's response to the medication is known, the nurse should instruct the client to avoid driving or handling other potentially hazardous equipment. Over time, these effects are likely to decrease.

A nurse is caring for a client who is pregnant and inquiring about alternative, non-pharmacological therapies for nausea and vomiting of pregnancy (NVP). Which of the following options should the nurse recommend? A. "Be sure to eat at least 3 large meals each day." B. "If you're experiencing nausea when you wake up, wait to eat until lunchtime." C. "You may need to take additional supplements to alleviate nausea." D. "Ginger is effective in the treatment of nausea and vomiting."

D. "Ginger is effective in the treatment of nausea and vomiting."