Pharmacological and parenteral therapies quiz

A client has been prescribed spironolactone for treatment of heart failure. Which statement made by the client would indicate a need for further teaching? a. "I will limit the use of salt in my diet and use a salt substitute instead." b. "I will weigh myself daily and report any changes in weight." c. "I will need to have routine labs drawn while taking this medication." d. "I should take my medication at the same time each day in the morning."

a. "I will limit the use of salt in my diet and use a salt substitute instead." Correct: Spironolactone is a potassium sparing diuretic and caution should be taken when using this medication with anything that may increase potassium levels. Most salt substitutes contain potassium and should be avoided. Clients should also never take an oral potassium substitute, and be cautioned about large dietary changes that increase potassium. ACE inhibitors should also be used with cautions when on a potassium sparing diuretic.

A client experiencing pain has been prescribed meperidine 30mg IM every three hours, as needed for pain. The vial available is merperidine 75mg/1 mL. How much merperidine should the nurse administer?

a. 0.4 ml 0.4 mL of merperidine will be administered by the nurse.30 mg / x = 75 mg / 1 mL30 = 75x30/75 = 0.4 ml

A client diagnosed with bipolar disorder and prescribed lithium carbonate is being discharged from the hospital. Which of the following medication prescriptions should the nurse should question? a. Furosemide 20 mg by mouth twice per day b. Ranitidine 150 mg by mouth daily c. Valproic acid 250 mg by mouth three times per day d. Captopril 25 mg by mouth twice per day

a. Furosemide 20 mg by mouth twice per day The furosemide prescription should be questioned. Lithium ingestion predisposes the client to sodium loss which increase the risk of rapidly elevating level of lithium. Diuretics would exacerbate sodium loss and predispose the client to lithium toxicity.

A client is prescribed digoxin 1mg by mouth QID. The client states that the objects in his room have a yellowish tinge and he is nauseated. Select the most appropriate nursing action at this time. a. Hold the drug and call the health care provider. b. Administer the medication and observe the client for further nausea. c. Hold the medication and count the apical pulse before the next dose is to be given. d. Count the apical pulse; if it is regular and above 60, administer the drug as ordered.

a. Hold the drug and call the health care provider. This client is showing signs of digitalis toxicity. The most appropriate action is to hold the drug and call the health care provider. Severe arrhythmia may develop if action is not taken.

A client experiences postural hypotension during initial drug therapy with diltiazem. Which of the following would be most important for the nurse to recommend to this client? a. Rise slowly from a sitting or lying position. b. Drink additional oral fluids each day. c. Lie down for 30 minutes after taking the medication. d. Eat small, frequent meals during the day.

a. Rise slowly from a sitting or lying position. Rise slowly from a sitting or lying position. This will allow them to adjust to the upright position; slowly rising allows the heart to adjust the cardiac output to pump harder to maintain adequate BP to offset any orthostatic hypotension from occurring.

A nurse is caring for a client with a history of rheumatoid arthritis who is receiving methotrexate. Which of the following should be included in client education? a. The complete blood count (CBC) will be monitored. b. Methotrexate will decrease the risk of developing cancer. c. Daily monitoring of blood glucose is recommended d. Methotrexate can be administered during pregnancy

a. The complete blood count (CBC) will be monitored. Bone marrow suppression is a common side effect when using methotrexate for long term therapy in the treatment of rheumatoid arthritis. The client will have their complete blood count monitored periodically for evidence of anemia, neutropenia or thrombocytopenia.

A nurse is to administer nitroglycerin to a client for the treatment of angina. Which of the following should the nurse first advise the client? a. To sit or lie down. b. To rise slowly c. A headache may occur. d. Dizziness may occur.

a. To sit or lie down. Inform client to sit or lie down. This intervention is priority due to the orthostatic hypotension effects that can occur with nitroglycerin administration; including dizziness, light-headedness, and reduced cardiac output. This can cause a drop in blood pressure. Lying with feet elevated promotes venous return and thereby restores blood pressure. This is a safety concern and action needs to be taken before medication administration

The nurse is providing client education regarding the combined use of herbal supplements with prescribed medications. Which of the following statements indicates the client correctly understands the interaction of ginkgo biloba and warfarin? a. "I should take the warfarin in the morning and the ginkgo at bedtime so that they do not interact." b. "Ginkgo increases the effects of warfarin so I will stop taking the ginkgo." c. "The ginkgo and warfarin work together to help my memory." d. "Ginkgo and warfarin should be taken at the same time during the day.

b. "Ginkgo increases the effects of warfarin so I will stop taking the ginkgo." When ginkgo biloba is taken with antiplatelet or anticoagulant medications, the effect of the antiplatelet/anticoagulant drug may be increased, resulting in uncontrolled bleeding.

A client has an order for an IV of 1000 ml of lactated ringers with 20 mEq of potassium/L to infuse at 40 ml/hr. The drip factor is 15 drops/ml. The nurse calculates the flow rate to be: ______ gtt/min.

b. 10 drops/min ml/hr X drops/ml 40 ml/hr X 15 drops/ml time in mins 60 mins

A client with a recent myocardial infarction is prescribed digoxin. Which of the following findings indicate to the nurse that a therapeutic response to this medication has been attained? a. An increase in apical pulse rate. b. A decrease in pulmonary crackles. c. A decrease in urinary output. d. A rise in central venous pressure.

b. A decrease in pulmonary crackles. Heart failure exists to some degree in all clients with myocardial infarction. Crackles would be present due to left-sided failure and passive reflux of blood leading to pulmonary hypertension. Digoxin increases the force of the systolic contraction which allows complete ventricular emptying and improved cardiac output. Pulmonary edema is thus reduced.

A clinic nurse is preparing to administer a Penicillin IM injection to a client who has never taken the medication before. Which of the following interventions should be included in the plan of care? a. Instruct the client to expect a slight rash to develop at the injection site. b. Instruct the client to sit in the clinic for 30 minutes after the injection c. Inject the client with a small test dose of Penicillin subcutaneously. d. Ask the client if they are allergic to shell fish before administering.

b. Instruct the client to sit in the clinic for 30 minutes after the injection. To ensure prompt treatment if anaphylaxis should develop, clients should remain in the prescriber's office for at least 30 minutes after drug injection. After 30 minutes, the risk of anaphylactic reaction is reduced.

A nurse is providing discharge instructions for a client who is taking atenolol. Which instructions should the nurse give to the client to prevent postural hypotension? a. Take the medication with plenty of fluids b. Move slowly when changing from lying to standing c. Take the medication immediately after awakening d. Lie down if dizziness or lightheadedness occurs

b. Move slowly when changing from lying to standing Taking Tenormin at bedtime will help with symptoms of postural hypotension, which is a common side effect of beta blockers.

A nurse is caring for a client taking captopril who has started experiencing a frequent dry cough. What action should the nurse take? a. Encourage the client to use over the counter cough syrup for the cough. b. Notify the provider of the client's symptom. c. Encourage the client to continue taking the medication as prescribed. d. Instruct the client to decrease the dosage of the medication.

b. Notify the provider of the client's symptom. An adverse effect of ACE inhibitors is a cough related to inhibition of kinase II which results in an increase in bradykinin. The provider should be notified if a dry cough occurs so that the medication can be discontinued.

A client is prescribed lisinopril. Which of the following is most important for the nurse to assess before administering this medication to the client? a. Body temperature. b. Serum electrolytes. c. Peripheral edema. d. Breath sounds.

b. Serum electrolytes. A side effect of lisinopril is hyperkalemia. Hyperkalemia can lead to life threatening dysrhythmias. The nurse should monitor the client's serum K+ level closely and notify the provider of a critical level before administering an ACE inhibitor.

A client with Type 1 diabetes has the following values from the morning laboratory testing: fasting plasma glucose = 115 mg/dL and HgA1C = 7.5%. How would a nurse interpret these values with regard to the client's glucose control? a. Short term values normal, long term values normal b. Short term values normal, long-term values elevated c. Short term values elevated, long term values elevated d. Short term values elevated, long-term values normal

b. Short term values normal, long-term values elevated Fasting plasma glucose is normal. Normal fasting plasma glucose range for the diabetic client is 90-130 mg/dl. HgA1C level is elevated. HgA1C normal level range is less than 7% with the optimal range being 4-6% in the diabetic. HgA1C level indicates the client's glucose range over the last 120 day period and is considered to be the best indicator of long term glycemic control.

A nurse is caring for a client prescribed omeprazole. What information should the nurse provide to the client regarding administration of this medication? a. Take the medication after a meal twice daily. b. Take the medication in the morning before breakfast. c. Take the medication at bedtime. d. You may crush the medication for easier swallowing.

b. Take the medication in the morning before breakfast. Clients should take omeprazole once a day prior to eating in the morning.

A nurse is evaluating a client's understanding of lithium. Which statement by the client indicates a need for further education? . "I should have my blood level drawn as directed." b. "I will drink 8-12 glasses of water a day." c. "I should take the medication on an empty stomach." d. "I will contact my provider if I develop diarrhea."

c. "I should take the medication on an empty stomach." Lithium should be taken with meals or milk to decrease gastric upset.

A client is prescribed digoxin. Which of the following statements by the client indicates to the nurse the need for further teaching? a. "I should eat bananas and drink orange juice when I am on this medication." b. "I will check my pulse every day before taking my medication." c. "If I see halos around lights there is no need to notify my provider." d. "I will take my medication at the same time each day."

c. "If I see halos around lights there is no need to notify my provider." CNS effects such as blurred vision, diplopia and white halos around objects are a sign of drug toxicity and client should notify provider immediately.

A client is prescribed phenytoin 5 mg/kg/day in 3 divided doses. The client weighs 36 lb. The drug is available at 50mg/mL. What is the total daily dosage in milliliters for this client?

c. 1.6 mL 36 /2.2=16.4kg5 X 16.4 = 82 mg/day82/50=1.64 mL/day

A nurse notes the following prescription for a client with thrombophlebitis: Heparin sodium 25,000 units in 500 mL of D5W to infuse at 1,200 units/hour. What is the flow rate in mL per hour? a. 50 ml/hr b. 25 ml/hr c. 24 ml/hr d. 10 ml/hr

c. 24 ml/hr Have 25000 units in 500 mL D5W25000 divide by 500cc = 50 units/mLNeed to infuse at 1200 units/hr1200 divide by 50 = 24 ml/hr

A nurse is teaching a client with gout who is starting allopurinol. Which of the following should the nurse include in the client teaching? a. Take allopurinol on an empty stomach. b. Sudden onset of muscle pain can result with initiation of this therapy. c. Drink 2-3 liters of fluid per day. d. Do not take allopurinol within 2-3 weeks of an acute gout attack.

c. Drink 2-3 liters of fluid per day. Correct: The client should be encouraged to drink 2-3 liters of fluid per day to prevent kidney injury, an adverse effect of this medication therapy.

A client is admitted to the hospital with a diagnosis of diabetic ketoacidosis (DKA). An intravenous infusion of regular insulin has been started. Which of the following nursing interventions is most appropriate for this client? Select one: a. Add the prescribed dose of NPH insulin to the IV infusion b. Monitor blood glucose levels every 4 hours c. Ensure glucagon is readily available d. Obtain an arterial blood gas every 2 hours

c. Ensure glucagon is readily available Glucagon and D50 are used for rapid treatment of hypoglycemia which can occur when insulin is administered intravenously

A client is a Jehovah's Witness and is scheduled for an elective hysterectomy secondary to prolonged and heavy menses. Which medication would the nurse anticipate being ordered prior to surgery for this client? a. Methylergonovine b. Retrovir c. Epoetin Alfa d. Interferon

c. Epoetin Alfa Correct: Epoetin Alfa is a growth factor used to treat anemia related to renal disease, chemotherapy, HIV / AIDS treatment and for clients who are anemic undergoing elective surgery. Jehovah's Witness' clients generally do not accept blood transfusions, and this client has had prolonged and heavy menstrual bleeding and is likely anemic. In this case, Epoetin Alfa dosing 2-4 weeks prior to surgery (generally once per week for four weeks prior to surgery) would be indicated to raise the hemoglobin to a therapeutic level.

A nurse is monitoring client compliance with the diabetes mellitus treatment regimen. Which of the following values best indicates compliance with the regimen? a. Blood glucose level of 125 mg/dL b. Fasting blood glucose level of 127 mg/dL c. Hemoglobin A1c of 5% d. Pre-meal glucose of 140 mg/dL

c. Hemoglobin A1c of 5% Glycosylated hemoglobin (HbA1c) is the best indicator of average blood glucose levels for the past 120 days. This test assists in evaluating treatment effectiveness and compliance. The target value is 4-6%. The value given is within the normal range.

A client admitted with an acute exacerbation of asthma has been prescribed methylprednisolone sodium succinate IV. Which of the following findings should the nurse report to the provider immediately? a. Blood glucose 120 mg/dL b. Mild wheezing c. Oral temperature of 100.5 F d. Increased hunger

c. Oral temperature of 100.5 F◦ Correct. Infection is a potential adverse of glucocorticoids. The nurse should monitor this client for signs of infection such as fever and sore throat and report immediately if they occur.

A nurse is caring for a client taking captopril. Which finding would require immediate attention for this client? a. Sodium 133 b. Pulse 56 c. Potassium 5.8 d. Blood pressure 96/48

c. Potassium 5.8 A potassium of 5.8 is elevated- normal is 3.5-5. One effect of Capoten is elevation of potassium levels because this drug inhibits the formation of angiotensin II and blocks the release of aldosterone. The blocking of the aldosterone results in sodium excretion and potassium retention. Hyperkalemia can result in cardiac arrhythmias and if untreated lead to cardiac arrest.

A nurse is reviewing the morning laboratory results while preparing to administer a client their dose of digoxin. Which result would the nurse need to report to the primary care provider? a. Sodium level of 133 mEq/l b. Digoxin level of 0.5 ng/ml c. Potassium level of 3.4 mEq/l d. Calcium level of 11mg/dl

c. Potassium level of 3.4 mEq/l Serum potassium is important to monitor for the client on digoxin. Hypokalemia can lead to digoxin toxicity while hyperkalemia can lead to a low therapeutic level. The normal range for potassium is 3.5-5.0 mEq/l.

During administration of vancomycin IV, the nurse notices the client's neck and face becoming flushed. Which of the following actions should the nurse take first? a. Notify the health care provider. b. Check the client's temperature. c. Stop the infusion. d. Obtain an order for an antihistamine.

c. Stop the infusion. Flushing of the face and neck are symptoms of red man or red neck syndrome occurring with too rapid infusion of Vancomycin. Vancomycin can cause two types of hypersensitivity reactions, the red man syndrome and anaphylaxis. Red man syndrome has often been associated with rapid infusion of the first dose of the drug and was initially attributed to impurities found in vancomycin preparations. First action should be to stop the infusion. Contacting the health care provider is necessary after the infusion is stopped. The client should be monitored for serious reactions such as hypotension, dyspnea, anaphylaxis, renal failure or hearing loss. Other minor reactions are chills, dizziness, fever, pruritis, and tinnitus.

A client diagnosed with depression has been prescribed fluoxetine. Which of the following information should the nurse emphasize? a. Avoid foods high in tyramine b. Maintain an adequate fluid and sodium balance c. Take the medication in the morning d. Take the medication at bedtime

c. Take the medication in the morning Take the medication in the morning, as insomnia is a side effect of SSRIs.

A nurse is to administer morphine sulfate 10 mg intramuscular (IM) to an adult client for post-operative pain. Which injection site is the most appropriate? a. Deltoid b. Epidural c. Ventrogluteal d. Dorsogluteal

c. Ventrogluteal This site is a deep site, situated away from the major nerves and blood vessels. This site is preferred for medications (such as antibiotics) that are larger in volume, more viscous, and irritating for adults, children, and infants. This site is safe for all clients with large muscle development.

A nurse has just taught a client about the side effects of levodopa. Which client statement would indicate to the nurse that further instructions is needed? a. "I will get out of bed slowly." b. "I will not eat bananas." c. "I will administer the medication with food." d. "I still can drive."

d. "I still can drive." Correct: This medication may cause sudden onset of sleep, drowsiness and dizziness. Instruct client to avoid driving and other activities that required alertness.

A client in the behavioral health unit began taking fluoxetine 20 mg per day three days ago for depression. Which of the following should the nurse immediately report to the health care provider? a. Headache and nausea b. Sexual dysfunction c. Weight gain d. Agitation and fever

d. Agitation and fever Agitation and fever are symptoms of serotonin syndrome, a potentially life-threatening condition that can develop in client's taking SSRIs such as fluoxetine. These symptoms develop within 2-72 hours after starting treatment and may also include mental confusion, anxiety, hallucinations, tremors, and hyperreflexia.

A client ingested a full bottle of imipramine hydrochloride. Which of the following toxic effects is most important for the nurse monitor? a. Photophobia b. Hypertension c. Blurred vision d. Arrhythmias

d. Arrhythmias With a Tricyclic antidepressant (TCA) overdose, there is a high risk for serious cardiac problems, including arrhythmias, tachycardia and myocardial infarction.

A client has been prescribed bupropion to assist with smoking cessation therapy. Which of the following findings would a nurse report to the health care provider immediately? a. Nausea and Vomiting b. Photosensitivity c. Dry mouth d. Seizures

d. Seizures Correct: This is an adverse effect of the mediation and should be addressed immediately.

A client is prescribed linsinopril. Which of the following findings indicates to the nurse that the client is experiencing an adverse effect of this medication? a. Creatine kinase (CK) 120 units/L b. White blood cell count 10,000mm3 c. Fasting blood glucose 40 mg/dl d. Serum potassium 5.8 mEq/L

d. Serum potassium 5.8 mEq/L Serum potassium 5.8 mEq/L is the correct answer. ACE inhibitors may cause hyperkalemia. Suppression of angiotensin II leads to a decrease in aldosterone levels. Since aldosterone is responsible for increasing the excretion of potassium, ACE inhibitors can lead to elevated serum potassium. The nurse should monitor potassium levels to maintain normal range of 3.5 - 5.0 mEq/L.

A nurse is administering mannitol to the client with increased intracranial pressure. What supplies are necessary when administering this medication? a. Alcohol wipe, syringe, 18 gauge needle b. Pressure cuff, 1000mL bag of normal saline c. Pill cup, glass of water, straw d. Syringe, filter needle, IV filter tubing

d. Syringe, filter needle, IV filter tubing Correct: Mannitol is an osmotic diuretic, indicated for treatment of increased intracranial pressure, increased intraocular pressure and in certain cases of acute kidney injury. Mannitol is an injectable medication, given slow IV push or via continuous IV infusion. Mannitol may crystalize (form white or icy looking precipitate) in the vial if exposed to extreme temperatures, and this precipitate could be dangerous to the client. For this reason, all mannitol must be drawn up with a filter needle, and then the nurse should remove the filter needle and use the injection port to administer the medication.

A nurse is caring for a client receiving total parenteral nutrition (TPN). Which of the following outcomes best demonstrates that TPN therapy is effective? a. The client gains one kilogram per day. b. The client's urinary output increases by 800 mL per day. c. The client reports less frequent bowel movements. d. The client maintains an albumin level of 5.0 g/100mL.

d. The client maintains an albumin level of 5.0 g/100mL. When clients are on TPN therapy, laboratory values such as electrolytes, CBC, BUN, and plasma glucose should be monitored closely. All laboratory values should be within normal range. Normal range for albumin is 4.5-5.0 g/100ml.

A client with a digoxin level of 2.4 ng/ml has a heart rate of 39. The health care provider prescribes atropine sulfate. Which of the following best describes the intended action of atropine for this client? a. To reduce peristalsis and urinary bladder tone. b. To stimulate the SA node and sympathetic fibers to increase the rate. c. To dry oral and tracheobronchial secretions. d. To accelerate the heart rate by interfering with vagal impulses.

d. To accelerate the heart rate by interfering with vagal impulses. Atropine accelerates the heart rate by interfering with vagal impulses. It is given IVP at doses of 0.5mg to 1.0mg per dose; every 3 to 5 minutes; up to 2.0mg. Doses less than 0.5mg may cause a paradoxical slowing of the heart rate. When Atropine is given to a client with history of an MI it should be used with great caution; increasing the heart rate also increases myocardial oxygen consumption!

A client diagnosed with preterm labor has been prescribed nifedipine. The client asks the nurse why this particular medication has been prescribed. Which of the following statements by the nurse is correct? a. To decrease the intensity of your pain b. To promote development of your baby's lungs c. To lower your blood pressure d. To relax your muscles of your uterus

d. To relax your muscles of your uterus The use of nifedipine for the treatment of preterm labor is an unlabeled use of the drug. Nifedipine, a calcium channel blocker, is more commonly used to treat high blood pressure and heart disease. Smooth muscle tissue, like the uterus, needs calcium to contract. Nifedipine blocks the passage of calcium into certain tissues, relaxing the uterine muscles and smooth muscles of blood vessels throughout the body.

A nurse is caring for a client who is prescribed gentamicin sulfate. Which of the following side effects would indicate an adverse reaction to this medication? a. Muscular cramping in the lower extremities. b. Fine tremors in the fingers and hands. c. Pruritis in the forearms and upper arms. d. Urinary output of 185 mL in an 8 hour shift.

d. Urinary output of 185 mL in an 8 hour shift. Urinary Output of 185 mL in an 8 hour period could indicate nephrotoxicity which is an adverse side effect of an aminoglycosides. Normal urinary output should be at least 30 mL per hour to adequately remove waste products from the body.