Pharmacology ATI Practice Test A & B
A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus about adverse effects of metformin. The nurse should instruct the client to monitor for which of the following findings as manifestations of lactic acidosis? Select all that apply. 1. Muscle pain 2. Hyperventilation 3. Weight gain 4. Constipation 5. Dizziness
1, 2, 5 -Muscle pain (Symptom of lactic acidosis, which is a severe effect of metformin). -Hyperventilation (Symptom of lactic acidosis, which is a severe effect of metformin). -Dizziness (Symptom of lactic acidosis, which is a severe effect of metformin). **Metformin can cause: Weight loss and diarrhea.
A nurse is reinforcing teaching about comfort measures with the parent of a 10-year-old child who has a viral infection. The nurse should plan to tell the parent that aspirin is contraindicated because of the risk for which of the following conditions? 1. Juvenile idiopathic arthritis 2. Reye syndrome 3. Glomerulonephritis 4. Iron-deficiency anemia
Reye syndrome.
A nurse is reinforcing teaching with a newly licensed nurse about using metoprolol to treat hypertension. Which of the following conditions should the nurse include as a contraindication for this medication? 1. Peripheral vascular disease 2. Diabetes mellitus 3. Bradycardia 4. Chronic kidney disease
Bradycardia. --Metoprolol is a beta blocker that slows the conduction through the AV node, therefore it is contraindicated in patients with bradycardia or HR consistently less than 60 bpm. **Diabetes mellitus: Can mask the manifestations of hypoglycemia in patients taking metoprolol. **Metoprolol can cause urinary frequency.
A nurse is reinforcing dietary teaching with a client who has a new prescription for phenelzine. Which of the following foods should the nurse include in the teaching as an appropriate food choice? 1. Yogurt 2. Avocado 3. Smoked salmon 4. Pepperoni
Yogurt. --Clients taking phenelzine should avoid consuming tyramine, which can cause high blood pressure. Yogurt contains little or no tyramine. **Foods high in tyramine: Avocado, Smoked salmon, Pepperoni
A nurse is caring for a client who has a new prescription for sumatriptan. The nurse notes that the client takes fluoxetine. The nurse should notify the provider that the combination of these medications will place the client at risk for which of the following adverse effects? 1. Tremors 2. Renal calculi 3. Dysphagia 4. Hearing loss
Tremors. --Sumatriptan and fluoxetine used concurrently can lead to excessive stimulation of serotonin receptors, resulting in serotonin syndrome, which presents as: Tremors, confusion, and hallucinations.
A nurse is reinforcing teaching with a client who has a new prescription for a fluticasone inhaler. Which of the following client statements indicates an understanding of the teaching? 1. "I will administer two puffs of the medication consecutively." 2. "I will use this inhaler if I feel an asthma attack coming on." 3. "I will avoid intake of dairy products in my diet." 4. "I will rinse my mouth after I use this inhaler."
"I will rinse my mouth after I use this inhaler." --A patient should rinse their mouth after inhaling a glucocorticoid to reduce the risk for the development of oral thrush. **The patient should wait 1 - 2 minutes between inhalations to increase absorption. **The medication should be used as a prophylactic measure to prevent an asthma attack. **The nurse should instruct the patient to increase intake of dairy products to reduce the risk for bone loss.
A nurse is caring for a client who has a prescription for an IM injection of penicillin G benzathine. The client asks why the injection must be given IM instead of through the IV line. Which of the following responses should the nurse make? 1. "The medication is more rapidly absorbed when given IM." 2. "Your medication can't be given IV because it is not water-soluble." 3. "You will experience less discomfort with an IM injection." 4. "An IM injection allows more precise control of the medication level in your blood."
"Your medication can't be given IV because it is not water-soluble."
A nurse is caring for a client who has genital herpes. Which of the following medications should the nurse expect to administer? 1. Levofloxacin 2. Acyclovir 3. Ceftriaxone 4. Metronidazole
Acyclovir. --This is an antiviral medication to treat genital herpes by reducing manifestations and the rate of viral shedding. **Levofloxacin: Treats cystitis. **Ceftriaxone: Treats Lyme disease **Metronidazole: Treats clostridium difficile infection.
A nurse is contributing to the plan of care for a client who has schizophrenia and a new prescription for clozapine. The nurse should include in the plan to monitor the client for which of the following adverse effects of this medication? 1. Hypoglycemia 2. Iron-deficiency anemia 3. Serotonin syndrome 4. Agranulocytosis
Agranulocytosis. --Nurse should monitor the patient's WBC count and notify if the values fall below the expected range of: 5,000 - 10,000/mm3. **The nurse should also monitor for: HYPERGLYCEMIA, HYPERLIPIDEMIA, and TARDIVE DYSKINESIA.
A nurse is collecting data from a client who has bacterial pneumonia and is taking ceftriaxone. Which of the following findings indicates a therapeutic effect of the medication? 1. WBC count 10,500/mm3 2. Clear, bilateral breath sounds 3. Heart rate 110/min 4. Tolerates small meal servings
Clear, bilateral breath sounds. --Wheezing and crackles are findings of bacterial pneumonia, this gets relieved after therapeutic use of the medication. **WBC count 10,500/mm3: Is above the expected reference range, indicating a continuation of the infection. **Heart rate 110/min: Tachycardia is a manifestation of pneumonia. **Tolerates small meal servings: Pneumonia decreases a client's energy and can interfere with maintaining adequate nutrition, such as taking small meal servings.
A nurse is caring for a client who has multiple sclerosis and a new prescription for baclofen. Which of the following findings indicates to the nurse that the medication is having a therapeutic effect? 1. Decreased muscle spasticity 2. Increased urinary output 3. Increased mental alertness 4. Decreased heart rate
Decreased muscle spasticity. --Baclofen is an antispasmodic that decreases muscle spasticity. **Urinary frequency: Adverse effect of baclofen. **Baclofen causes CNS adverse effects such as: Drowsiness, fatigue, and confusion.
A nurse is reinforcing teaching with a client who is using phenylephrine nasal spray three times daily and reports rebound congestion. Which of the following instructions should the nurse include to reduce the effects of rebound congestion? 1. "Decrease the frequency to twice daily." 2. "Continue use for one more week." 3. "Discontinue use in the left nostril, then in the right nostril." 4. "Add oxymetazoline nasal spray to relieve symptoms."
"Discontinue use in the left nostril, then in the right nostril." --This can help overcome rebound congestion. **Decreasing or continuing the use: Will not eliminate rebound congestion. **Oxymetazoline: Can cause rebound congestion as well.
A nurse is reinforcing teaching with the parent of a preschooler who has otitis media. The child has had a low-grade fever and irritability for 2 days. Which of the following instructions should the nurse include in the teaching? 1. "Administer amoxicillin twice a day for 3 days." 2. "Apply cold packs every 4 hours for relief of pain." 3. "Give acetaminophen as needed for discomfort and fever." 4. "Return to the office in 72 hours for a follow-up appointment."
"Give acetaminophen as needed for discomfort and fever." **The parent should administer the full course of antibiotics, which is approximately 5 - 7 days for mid to moderate infection and 10 days for severe infections. **The child should lay on the affected side (to promote drainage of exudate) and apply heat to their ear to reduce discomfort. **The patient should return for a follow-up appointment after the antibiotic therapy has been completed.
A nurse in a community health clinic is preparing to administer the varicella vaccine to a young adult female client who has not previously had chickenpox or its vaccine. The nurse should withhold the vaccine and collect additional data when the client makes which of the following statements? 1. "I am allergic to neomycin." 2. "I am taking antibiotics for my acne." 3. "My irritable bowel syndrome has been acting up the last few days." 4. "I have been taking an oral contraceptive for the last 6 months."
"I am allergic to neomycin." --Hypersensitivity to neomycin is contraindicated for receiving the varicella vaccine. **Pregnancy is a contraindication for receiving the varicella vaccine.
A nurse is reinforcing teaching with a client who has a new prescription for regular insulin. Which of the following statements by the client indicates an understanding of the teaching? 1. "I should eat right before I give myself an insulin injection." 2. "I should shake the vial gently prior to drawing up the insulin." 3. "I should ensure that the insulin is clear prior to drawing it up." 4. "I should inject the insulin deep into a muscle."
"I should ensure that the insulin is clear prior to drawing it up." --The insulin is clear in appearance, discard insulin if the insulin appears cloudy. **Onset of regular insulin (short-acting insulin): 30 - 60 minutes. The insulin should be administered at least 15 - 30 minutes before eating. **Gently roll a vial of insulin to ensure uniform solution. **Insulin should be administered SubQ.
A nurse is reinforcing teaching with a client who has a prescription for scopolamine transdermal patches to prevent motion sickness. Which of the following statements by the client indicates an understanding of the teaching? 1. "I might have a runny nose during therapy." 2. "I should replace the patch every day." 3. "I might experience diarrhea while taking this medication." 4. "I should place the patch behind my ear."
"I should place the patch behind my ear." --This is a patch that goes on a hairless area of skin. **Adverse effects of scopolamine (anticholinergic medication) transdermal patches: Blurred vision, drowsiness, constipation, and dry mouth. **Remove old patch and replace it with a new one every 3 days.
A nurse is reinforcing teaching with a client who has HIV and a new prescription for zidovudine. Which of the following client statements should indicate to the nurse an understanding of the teaching? 1. "I can have unprotected sex after 6 months of taking this medication." 2. "I can expect to have constipation while taking this medication." 3. "I will be sure to have my blood tested for anemia." 4. "My fingers might feel numb after I start therapy."
"I will be sure to have my blood tested for anemia." --Zidovudine can cause severe anemia and neutropenia. **Protection during sexual activity should be continued, even if the plasma HIV RNA is undetectable after taking medication. **Zidovudine can cause GI disturbances such as diarrhea, abdominal pain, nausea, and vomiting. **The patient's nail beds might have changes to pigmentation while taking this medication.
A nurse is reinforcing teaching with a client who has a new prescription for timolol eye drops to treat glaucoma. Which of the following client statements indicates an understanding of the teaching? 1. "I will rub my eyes for 10 seconds after putting in the medication." 2. "I will look up when putting the medication into my eyes." 3. "I will clean my eyes from the outer edge toward the nose before putting in the medication." 4. "I will close my eyes tightly after putting in the medication."
"I will look up when putting the medication into my eyes." --To protect the cornea and minimize blinking. **The patient should apply pressure to the lacrimal sac for 60 seconds after instilling the medication into their eyes to reduce the risk of systemic absorption of the medication, which can cause hypotension. **The patient should clean their eyes from the inner canthus to the outer canthus to reduce the risk for introducing micro-organisms into the lacrimal duct. **The patient should gently close their eyes after instilling the medication, closing eyes can result in loss of medication.
A nurse is reinforcing teaching with a client who has a new prescription for ethinyl estradiol/norethindrone, an oral contraceptive. Which of the following client statements should indicate to the nurse an understanding of the teaching? 1. "I should expect my menstrual flow to increase." 2. "I should monitor my blood pressure for hypotension while on this medication." 3. "I will take the medication at the same time each day." 4. "This type of medication is the most effective because it only contains estrogen."
"I will take the medication at the same time each day." --This helps maintain a consistent level to reduce fertility and the chance of pregnancy. **Menstrual flow volume will decrease, as well as the number of days of menses. **BP should be monitored for hypertension due to the medication causing increased secretion of aldosterone and angiotensin. **Each tablet in this combination oral contraceptive contains both estrogen and progestin.
A nurse is reinforcing teaching with a client who has a prescription for alendronate. Which of the following client responses indicates to the nurse an understanding of the teaching? 1. "I will take the medication with my breakfast." 2. "I will take the medication with 1 tablespoon of an antacid." 3. "I will lie down for 30 minutes after taking the medication." 4. "I will take the medication with 8 ounces of water."
"I will take the medication with 8 ounces of water." --Alendronate is to be taken on an empty stomach with 240 mL (8 oz) of water to ensure it doesn't lodge in the esophagus, resulting in esophageal ulcerations. **The medication should be taken upon arising and at least 30 minutes before eating or drinking liquids other than water. **Alendronate should not be taken with antacids because they can decrease the absorption of alendronate. **The patient should sit upright for 30 minutes after taking the medication due to the risk of erosion of the esophagus.
A nurse is reinforcing teaching with a client who has a new prescription for propranolol. Which of the following information should the nurse include in the teaching? 1. "If you miss a dose, double the next scheduled dose." 2. "Discontinue this medication if lightheadedness occurs." 3. "If your pulse rate is less than 50 beats per minute, notify your provider." 4. "This medication can cause heat intolerance."
"If your pulse rate is less than 50 beats per minute, notify your provider." --Withhold medication if patient's pulse is less than 50/min. --Bradycardia is a common adverse effect of beta blockers. **Take a missed dose ASAP and prior to 4 hours before the next scheduled dose. **Lightheadedness & Dizziness are adverse effects of medication and the patient should not operate heavy machinery (driving), DO NOT DISCONTINUE due to RISK OF LIFE-THREATENING DYSRHYTHMIAS. **Beta blockers (propranolol) can cause COLD INTOLERANCE.
A nurse is reinforcing teaching with a client who has a new prescription for vitamin B12 intranasal to treat malabsorption syndrome. Which of the following instructions should the nurse include in the teaching? 1. "Take this medication once per day." 2. "Drink a hot liquid after administering the medication." 3. "Massage your nose gently after medication administration." 4. "Store this medication in the refrigerator."
"Massage your nose gently after medication administration." --To increase absorption of the medication. **The nurse should instruct the client to administer vitamin B12 intranasally once per week. Oral vitamin B12 formulations require daily dosing. **The nurse should instruct the client to avoid hot liquids within 1 hr before and after taking intranasal vitamin B12. Hot liquids or spicy foods can cause rhinitis, which limits the effectiveness of the medication. **The nurse should instruct the client to store vitamin B12 at room temperature.
A nurse is reinforcing discharge teaching with a client who has a prescription for a metered-dose inhaler (MDI). Which of the following information should the nurse include in the teaching? 1. "Wait for 15 seconds between each puff of the same medication." 2. "Hold your breath for 5 seconds after inhaling the medication." 3. "Take a slow, deep breath lasting 3 to 5 seconds after releasing the medication." 4. "Roll the canister between your hands for 10 to 15 seconds to mix the medication."
"Take a slow, deep breath lasting 3 to 5 seconds after releasing the medication." --The client should take a slow, deep breath lasting 3 to 5 seconds to allow the medication to be distributed deeply into the lung **The client should wait 20 to 60 seconds between puffs of the same medication. If two different medications are administered, the client should wait 2 to 5 min between administrations. **The client should hold their breath for at least 10 seconds after inhaling the medication to allow the medication to be distributed deeply into the lungs. **The client should shake the canister vigorously for 3 to 5 seconds to ensure that fine particles are aerosolized.
A client who has terminal cancer reports pain as 5 on a scale of 0 to 10. The client has a prescription for morphine 15 mg orally every 4 hours. The client's adult children express concern that the client is receiving too much of the medication. Which of the following responses should the nurse make? 1. "Clients who receive this medication orally have a lower risk for addiction." 2. "Additional doses will not be needed because this medication is given on a fixed schedule." 3. "The dose should remain constant to prevent breakthrough pain." 4. "We can switch from oral administration to rectal administration."
"The dose should remain constant to prevent breakthrough pain." --This offers the best pain control for clients who have severe and persistent pain. **The risk for addiction does not change with the route of administration. **Additional doses may be needed if breakthrough pain occurs. **Rectal administration is used for clients who cannot take the medication orally.
A nurse on a medical-surgical unit is preparing to administer medications to a client. Which of the following questions should the nurse ask the client to verify the client's identity? 1. "What is your phone number?" 2. "What is your room number?" 3. "What is your provider's name?" 4. "What is your diagnosis?"
"What is your phone number?" --Acceptable patient identifiers: Client's name, telephone number, facility identification number, DOB, other client-specific identifiers. --At least two identifiers are used to verify the patient's identity and that needs to be compared to the patient's wristband or the medical record.
A nurse is reinforcing teaching with a client who is to start therapy with a nitroglycerin transdermal patch. Which of the following statements by the client indicates and understanding of the teaching? 1. "While using the patch, I will be careful when rising from a chair." 2. "I should leave the patch in place for 24 hours." 3. "I should apply the patch to the same location with each application." 4. "I will apply a new patch if I have chest pain."
"While using the patch, I will be careful when rising from a chair." --This medication can cause orthostatic hypotension, which can result in dizziness. **The patch should be applied each morning, but removed 12 - 14 hours and allow 10 - 12 hours without any medication, to reduce the risk for the development of tolerance to the medication. **The site should be rotated to avoid skin irritation. **Rapid onset, short acting nitroglycerin is used to treat acute angina.
A nurse is planning to reinforce teaching about newborn immunizations with a client who is 24 hr postpartum. Which of the following information should the nurse plan to include? 1. "Your baby will receive the first hepatitis B vaccine before discharge." 2. "Your baby will receive the rotavirus vaccine if your blood titer is low." 3. "Your baby will receive their first influenza vaccine at the 4-week checkup." 4. "Your baby will receive the varicella vaccine if you have a history of chickenpox."
"Your baby will receive the first hepatitis B vaccine before discharge." --The next dose will be done at age 1 - 2 months. **Rotavirus vaccine: Administered in 2 - 3 doses starting at age 2 months. **Annual influenza vaccine: is done starting at age 6 months. **Varicella vaccine: First of two doses is given between 12 - 15 months.
A nurse is reinforcing teaching with a female client who has a new prescription for isotretinoin. Which of the following information should the nurse include in the teaching? Select all that apply. 1. "You will need to have your liver enzymes monitored after 1 month." 2. "You can have nosebleeds while taking this medication." 3. "You should report any thoughts of harming yourself." 4. "You will need to have two negative pregnancy tests prior to starting the medication." 5. "You will need to take a vitamin A supplement twice daily."
1, 2, 3, 4 -"You will need to have your liver enzymes monitored after 1 month." (Isotretinoin is metabolized in the liver). -"You can have nosebleeds while taking this medication." (Due to the drying effects of isotretinoin). -"You should report any thoughts of harming yourself." (Isotretinoin can cause depression, which can lead to suicide). -"You will need to have two negative pregnancy tests prior to starting the medication." (Due to potential for severe birth defects). **Vitamin A enhances the risk of isotretinoin toxicity.
A nurse is caring for a client who is receiving methylprednisolone. Which of the following laboratory values should the nurse plan to monitor? Select all that apply. 1. White blood cell count 2. Serum potassium 3. Creatine phosphokinase 4. Blood glucose 5. Amylase
1, 2, 4 -White blood cell count (Methylprednisolone increases the risk for infection causing leukocytosis). -Serum potassium (Methylprednisolone can cause hypokalemia, as well as fluid and sodium retention). -Blood glucose (Methylprednisolone can cause increased blood glucose levels).
A nurse is collecting data from a client who is receiving digoxin for treatment of heart failure. The nurse should identify which of the following findings as adverse effects of this medication? Select all that apply. 1. Blurred vision 2. Nausea 3. Hyperactivity 4. Increased appetite 5. Dysrhythmia
1, 2, 5 -Blurred vision (also, halos, and a yellow or green tinge to vision). -Nausea (& vomiting). -Dysrhythmia --Additional adverse effects: Fatigue & weakness, and anorexia.
A nurse is preparing to administer phenobarbital 3 mg/kg PO twice a day to a school-age child who weighs 44 lb. Available is phenobarbital elixir 20 mg/5 mL. How many mL should the nurse plan to administer per dose? Round the answer to the nearest whole number.
15 mL.
A nurse is caring for a client who is receiving 0.9% sodium chloride 1,000 mL to infuse over 8 hr. The drop factor on the manual IV tubing is 15 gtt/mL. The nurse should ensure that the manual IV infusion is set to deliver how many gtt/min? Round the answer to the nearest whole number.
31 gtt/min. 1000 mL 1 hour 15 gtt 15,000 --------- X --------- X ---------- = --------- = 31.25 gtt/min 8 hours 60 mins 1 mL 480
At 0800 a nurse assists with initiating a 1,000 mL IV infusion for a client, which is running at 125 mL/hr. How much fluid is left in the IV back at 1300? Round the answer to the nearest whole number.
375 mL. --0800 - 1300 = 5 hours --1,000 mL / 125 mL/hr = 8 hours to finish infusion. --8 hours - 5 hours = 3 hours remaining. --3 hours remaining * 125 mL/hr = 375 mL remaining.
A nurse is preparing to administer cefazolin 1 g in 100 mL 0.9% sodium chloride to infuse over 30 min. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? Round the answer to the nearest whole number.
50 gtt/min. 100 mL 15gtt = 1500 ------- X ------ ------ = 50 gtt/min 30 min 1 mL 30
A nurse is preparing to administer a PRN medication to a group of clients. Which of the following clients should the nurse administer medication to first? 1. A client who has GERD and requests an antacid 2. A client who reports constipation for 3 days and requests a stool softener 3. A client who has mild generalized anxiety disorder and requests an antianxiety medication 4. A client who is attending postoperative physical therapy and requests pain medication
A client who is attending postoperative physical therapy and requests pain medication. --This can reduce the clients pain during and after therapy.
A nurse is collecting data from a client who is taking exenatide to treat diabetes mellitus. For which of the following findings should the nurse withhold the exenatide dose and notify the provider immediately? 1. Loss of appetite 2. Abdominal pain 3. Muscle weakness 4. Heartburn
Abdominal pain. --The greatest adverse effect of exenatide is pancreatitis, the medication will need to be withheld and reported to the PCP. --Manifestations of Pancreatitis include: Severe, persistent abdominal pain w/ possible emesis. **Muscle weakness or asthenia indicates the patient is at risk for fatigue and impaired self-care. **Heartburn indicates that the client is at risk for gastroesophageal reflux.
A nurse is reinforcing teaching with a client who has seizures and a new prescription for valproic acid. The nurse should instruct the client to report which of the following adverse effects of valproic acid to the provider immediately? 1. Abdominal pain 2. Hair loss 3. Weight gain 4. Ataxia
Abdominal pain. --This could be caused by hepatotoxicity and pancreatitis. --Additional symptoms to be aware of are: A decrease in appetite, nausea, abdominal pain, or yellowing of the skin. **The client is still at risk for all of the other symptoms but they aren't the priority.
A nurse is reinforcing teaching with a client who has a new prescription for colchicine to manage gouty arthritis. Which of the following manifestations should the nurse include as an adverse effect of this medication? 1. Abdominal pain 2. Wheezing 3. Excessive urination 4. Tinnitus
Abdominal pain. --This indicates cellular damage to the GI tract.
A nurse is preparing to administer diphenhydramine 50 mg PO at 2200 to a client who has difficulty swallowing pills and capsules. Available is diphenhydramine syrup 12.5 mg/5 mL PO. Which of the following nursing actions requires the completion of an incident report? 1. Giving the medication at 2140 2. Administering the medication with grapefruit juice 3. Giving the medication when the client's apical pulse is 58/min 4. Administering 25 mL of the syrup
Administering 25 mL of the syrup. --The dose is higher than the client should receive. The correct dosage is 20 mL. **Administration can occur 1 to 2 hours before or after the scheduled time for the medication. **Grapefruit juice doesn't affect diphenhydramine. **Diphenhydramine can be administered if the client's HR is below 60/min due to this medication causing palpitations.
A nurse is caring for a client who is having an acute asthma attack. Which of the following medications should the nurse administer first? 1. Beclomethasone 2. Albuterol 3. Cromolyn 4. Prednisone
Albuterol. --This is a short-acting beta2 agonist with a rapid onset when a client is experiencing an acute asthma attack. --This medication will help prompt relief of airway constriction. **Beclomethasone: Is used as a maintenance therapy for chronic asthma. **Cromolyn: Used as maintenance therapy for chronic asthma attacks. **Prednisone: A glucocorticoid that helps relieve airway inflammation. The patient should take this medication for 10 days following an acute attack to decrease inflammation.
A nurse is collecting data prior to administering digoxin to a client. For which of the following findings should the nurse withhold this medication and notify the provider? 1. Digoxin level 0.9 ng/mL 2. Blood pressure 142/80 mm Hg 3. Potassium 4.4 mEq/L 4. Apical pulse 52/min
Apical pulse 52/min. --The nurse should check the client's apical pulse prior to administering digoxin because it can cause bradycardia. If the client's heart rate is below 60/min, the nurse should withhold the dose and notify the provider. **The client's digoxin level is within the expected reference range. **The nurse should identify this blood pressure reading as hypertension, which does not require withholding the digoxin. **Hypokalemia places clients at risk for cardiac dysrhythmias when taking digoxin. Client's potassium level is within the expected reference range.
A nurse is monitoring a client who is 2 hr postoperative and has a prescription for opioid analgesics. Which of the following actions provides the nurse with the priority data to determine the client's need for analgesia? 1. Observe the client for signs of restlessness. 2. Monitor the client for facial grimacing. 3. Watch the client for indications of decreased mobility. 4. Ask the client to rate their pain level.
Ask the client to rate their pain level. --This is a priority indicator of the need for pain medication. **Indications of pain: Restlessness, grimacing, and decreased mobility.
A nurse is reviewing a client's medical history before administering hydromorphone for postoperative pain. The nurse should notify the provider of which of the following findings before administering this medication? 1. Benign prostatic hyperplasia 2. History of hypertension 3. Rheumatoid arthritis 4. Allergy to aspirin
Benign prostatic hyperplasia. --A patient with benign prostatic hyperplasia is at increased risk for developing acute urinary retention while taking opioids. **History of hypertension: A patient may experience a lowering of BP when taking an opioid due to vasodilation effects. **History of severe pulmonary disease: Can be a contraindication. **History of an allergy to bisulfates: A component in some medications is a contraindication for hydromorphone.
A nurse is reviewing the medical record of a client who has a new prescription for dimenhydrinate to treat motion sickness. Which of the following conditions in the client's medical record should the nurse report to the provider? 1. Major depressive disorder 2. Diabetes mellitus 3. Benign prostatic hyperplasia 4. Ménière's disease
Benign prostatic hyperplasia. --Clients who have benign prostatic hyperplasia might have urinary hesitancy and retention and, therefore, should not take dimenhydrinate due to the anticholinergic adverse effects of the medication.
A nurse is reinforcing teaching with a client who experiences migraine headaches and has a new prescription for sumatriptan. The nurse should instruct the client to report which of the following manifestations to the provider as an adverse effect of this medication? 1. Insomnia 2. Photophobia 3. Chest tightness 4. Respiratory depression
Chest tightness. --This can be a manifestation of a vasospastic response. **Adverse effects of sumatriptan: Drowsiness, visual changes, and bronchospasm.
A client comes to an urgent care clinic and announces with great enthusiasm, "I am an expert at all things medical as they apply to me, and I require zolpidem." The client's pupils are dilated, along with an elevated heart rate and blood pressure level. The nurse should suspect intoxication with which of the following substances? 1. Alcohol 2. Cocaine 3. Barbiturates 4. Heroin
Cocaine. --Cocaine toxicity presents as: tachycardia, elevated BP, dilated pupils, and displays delusions. **Alcohol toxicity: Presents with slurred speech, drowsiness, impaired judgement, irritability, and decreased BP. **Barbiturates toxicity: Presents with respiratory depression, constricted pupils, drowsiness, impaired judgement, irritability, and decreased BP. **Heroin toxicity: Presents with slurred speech, drowsiness, constricted pupils, and decreased BP.
A nurse is collecting data from a client who has Parkinson's disease and is taking levodopa/carbidopa. The nurse should identify which of the following findings as an adverse effect of this medication? 1. Dark urine 2. Hypertension 3. Increased salivation 4. Bradycardia
Dark urine. --Levodopa/carbidopa can cause darkening of the client's urine, sweat, and saliva. **Other adverse effects of levodopa/carbidopa: Orthostatic hypotension, dry mouth, and tachycardia.
A nurse is caring for a client who has hyperthyroidism and has been taking methimazole. Which of the following findings should indicate to the nurse that the medication has had a therapeutic effect? 1. Decreased blood glucose level 2. Increased Hgb 3. Increased platelets 4. Decreased T4
Decreased T4. --Methimazole inhibits the synthesis of thyroid hormone, reducing levels to provide a euthyroid state. **Methimazole can cause agranulocytosis (lowered WBC count) as an adverse effect.
A nurse is caring for a client who has tuberculosis and will begin taking isoniazid. Which of the following actions should the nurse take? 1. Determine the client's daily alcohol intake. 2. Tell the client to expect red-orange colored urine. 3. Reinforce teaching about a low-calorie diet. 4. Instruct the client to have a yearly tuberculin skin test.
Determine the client's daily alcohol intake. --Consuming alcohol can cause liver damage.
A nurse is collecting data from a client who is taking oral amoxicillin to treat a respiratory infection. The nurse should monitor the client for which of the following manifestations as an adverse effect of the medication? 1. Hearing loss 2. Diarrhea 3. Bruising 4. Tendonitis
Diarrhea. --This is an adverse effect of antibiotics. **Hearing loss: Should be monitored in patient's taking aminoglycosides, such as amikacin. **Bruising and bleeding: Should be monitored in patient's taking cephalosporins, such as ceftriaxone. **Tendonitis and tendon rupture: Should be monitored for patient taking fluoroquinolones, such as ciprofloxacin.
A nurse is reinforcing teaching with a client who has a new prescription for theophylline. The nurse should instruct the client that which of the following is an expected outcome of this medication? 1. Dilates bronchioles 2. Reduces inflammation 3. Loosens secretions 4. Blocks leukotrienes
Dilates bronchioles. --Theophylline is a bronchodilator, which affects smooth muscle relaxation and leads to opened airways. **Glucocorticoids: Anti-inflammatory agents that reduces inflammation. **Expectorants: Help the flow of secretions and loosens secretions. **Leukotriene modifiers: Block the results of leukotrienes, reducing smooth muscle constriction and inflammatory responses.
A nurse is reinforcing teaching with a client following placement of a cast for a fractured ankle. The client is to take oxycodone for pain management. The nurse should instruct the client that which of the following over-the-counter medications is contraindicated while taking oxycodone? 1. Docusate sodium 2. Famotidine 3. Diphenhydramine 4. Ibuprofen
Diphenhydramine. --Diphenhydramine (antihistamine) and oxycodone (opioid analgesic) can cause CNS depression. --Both these medications together can cause an increased risk for sedation, respiratory depression, and injury. **Docusate sodium: Due to oxycodone possibly causing constipation, the stool softener can help alleviate this symptom. **Famotidine: No know interactions. **Ibuprofen: Beneficial for musculoskeletal injury along with opioid analgesic.
A nurse is reinforcing teaching with a client who has a new prescription for etanercept to treat rheumatoid arthritis. Which of the following instructions about self-administering this medication should the nurse include? 1. Discard any solutions that are cloudy. 2. Attach a 21-gauge needle to the syringe for injection. 3. Self-administer the medication on alternate days. 4. Shake the reconstituted solution well before self-administration.
Discard any solutions that are cloudy. --Also solutions that are discolored or have any sediment in them. **The client should attach a 27-gauge needle to the syringe for injecting the medication SubQ. **The client should self-administer the medication once per week. **The client should swirl the solution gently before self-administration.
A nurse is performing the third check before administering hydromorphone to a client. After opening the unit-dose packet, the client tells the nurse they do not want to take the medication now. Which of the following actions should the nurse take? 1. Complete an occurrence report of the incident. 2. Encourage the client to take the medication. 3. Leave the medication at the client's bedside in case they change their mind. 4. Dispose of the medication with a second nurse as a witness.
Dispose of the medication with a second nurse as a witness. --The nurse is legally required to have a witness when disposing of a controlled substance **The nurse should record the disposal of the medication. **The nurse should respect the client's wishes to refuse the medication. **The nurse should NOT leave the medication at the client's bedside because hydromorphone is a controlled substance that should NOT be left unattended.
A nurse erroneously administered zolpidem to the wrong client. Which of the following actions should the nurse take? 1. Document the completion of an incident report in the medical record of the client who received the zolpidem. 2. Administer a dose of naloxone to reverse the effects of the medication. 3. Keep a copy of the incident report on the unit. 4. Document the notification of the client's provider.
Document the notification of the client's provider. --In the medical record of the client who received the zolpidem, the nurse should document the objective facts of the error, including follow-up actions and notification of the provider. **Practice errors can lead to litigation. A notation on the medical record about completion of an incident report can lead to a prosecuting attorney gaining access to it because it is a part of the client's medical record. **The nurse should notify the provider and plan to do additional monitoring. Naloxone is used to reverse the effects of opioids. **Incident reports are confidential. The nurse should follow the facility's protocol for handling these reports, which usually includes submitting the report to the risk management department and not keeping a copy where others might access it.
A nurse is collecting data from a client who has multiple sclerosis and a new prescription for baclofen. Which of the following findings should the nurse identify as an adverse effect of this medication? 1. Diarrhea 2. Weight loss 3. Drowsiness 4. Hypertension
Drowsiness. --The nurse should identify drowsiness as an adverse effect of baclofen. Other adverse effects include dizziness, weakness, and fatigue. **Other adverse effects of baclofen: Constipation, Weight gain, Hypotension.
A nurse is reinforcing teaching with a client who is receiving enalapril 20 mg PO daily. The nurse should instruct the client to monitor for which of the following adverse effects of this medication? 1. Hypokalemia 2. Blurred vision 3. Tremors 4. Dry cough
Dry cough. --The nurse should identify that a persistent dry or nonproductive cough is an adverse effect of enalapril. The underlying cause of the dry cough is the accumulation of bradykinin from the medication. **Additional adverse effects of enalapril: Hyperkalemia, abnormal taste, dizziness.
A nurse is caring for a client who has a new prescription for risperidone to manage schizophrenia. Which of the following laboratory tests should the nurse plan to obtain prior to administering the first dose? 1. Fasting blood glucose level 2. Albumin level 3. CD4 T-cell count 4. Blood creatinine level
Fasting blood glucose level. --The development of hyperglycemia can be an adverse effect of risperidone. --Additional adverse effects of risperidone: Polyuria. **Albumin level: Is obtained to measure protein levels. **CD4 T-Cell count: Is obtained for a patient who has AIDS and is at risk for developing an opportunistic infection. **Blood creatinine level: Is obtained to diagnose impaired kidney function.
A nurse is reviewing medication prescriptions for a group of clients. The nurse should recognize that which of the following prescriptions can result in a medication administration error? 1. Penicillin G benzathine 1.2 million units IM daily 2. Furosemide 10.0 mg PO daily 3. Albuterol 2.5 mg 2 inhalations every 6 hr as needed for shortness of breath 4. Insulin glargine 15 units subcutaneous daily at bedtime
Furosemide 10.0 mg PO daily. --The nurse should avoid using a trailing zero following a whole number. --> This can result in a dosage of 100 mg instead of 10 mg. **All other prescriptions are written correctly.
A nurse is reviewing the medication administration record of a client who has a history of Stevens-Johnson syndrome when taking sulfamethoxazole-trimethoprim. Which of the following medications should the nurse identify as contraindicated for this client? 1. Prednisone 2. Furosemide 3. Lansoprazole 4. Digoxin
Furosemide. --A client who has a history of Stevens-Johnson syndrome when taking sulfonamides is at risk for an allergic reaction to furosemide because the two medications are chemically related. The client should also avoid thiazide diuretics and sulfonylurea-type oral hypoglycemic agents.
A nurse is reviewing the medication administration record for a client who has a new prescription for tobramycin to treat a pulmonary infection. Which of the following medications should the nurse identify as increasing the risk for ototoxicity while taking tobramycin? 1. Furosemide 2. Propranolol 3. Gabapentin 4. Guaifenesin
Furosemide. --Tobramycin is an aminoglycoside antibiotic that can cause ototoxicity. Furosemide is a diuretic that also can cause ototoxicity. The client's risk for hearing loss is increased if receiving both of these medications at the same time. **Propranolol: Beta blocker **Gabapentin: Anticonvulsant **Guaifenesin: Expectorant
A nurse is collecting data from the parent of a toddler who is about to receive the varicella immunization. The nurse should identify that an anaphylactic reaction to which of the following substances is a contraindication for receiving this immunization? 1. Gelatin 2. Penicillin 3. Sulfa 4. Eggs
Gelatin. --Or even neomycin is a contraindication for receiving the varicella vaccine because it contains both substances. **The Measles, mumps, and rubella (MMR) vaccine requires caution for patient's who have a hypersensitivity reaction to EGGS, GELATIN, or NEOMYCIN.
A nurse is monitoring a client who has type 2 diabetes mellitus and is receiving repaglinide. Which of the following laboratory tests should the nurse plan to review to obtain information about the long-term therapeutic effect of this medication? 1. Fasting blood glucose level 2. 1-hr oral glucose tolerance test 3. Urinary ketones 4. Glycosylated HbA1c
Glycosylated HbA1c. --This measures the average of blood glucose levels over the past 2 - 3 months. **Fasting blood glucose level: Indicates the client's current status, not the long-term effect of repaglinide. **1-hour oral glucose tolerance test: Evaluates the patient's response to a carb challenge, this is used to determine gestational diabetes. **Urinary ketones: Indicates diabetic ketoacidosis.
A nurse is collecting data from a client who has angina and a new prescription for sublingual nitroglycerin. Which of the following manifestations should the nurse expect as an adverse effect of this medication? 1. Shortness of breath 2. Bradycardia 3. Headache 4. Double vision
Headache. --This is a common adverse effect of this medication due to it causing vasodilation. **Nitroglycerin reduces oxygen demand and can improve breathing. **Tachycardia can occur due to sympathetic stimulation of the heart is an adverse effect of this medication. ' **Blurred vision is an adverse effect of this medication as well.
A nurse is caring for a client who has chronic kidney disease and has been receiving epoetin for 2 weeks. Which of the following findings should indicate to the nurse that the client's medication is having the desired therapeutic effect? 1. Albumin is within the expected reference range 2. Urine output increases to 60 mL/hr 3. Hemoglobin rises 0.5 g/dL 4. Blood urea nitrogen level is within the expected reference range
Hemoglobin rises 0.5 g/dL. --Initial therapeutic effects, such as hemoglobin rising 0.5 g/dL can occur in the first 2 weeks of therapy. --The patient's hemoglobin should reach target levels of 10 - 11 g/dL in 2-3 months. **Epoetin doesn't affect the following: Albumin levels, Urine output, and BUN levels.
A nurse is collecting data from a client who is asking about taking celecoxib for treatment of joint pain. The nurse should identify that which of the following findings is a contraindication to receive celecoxib? 1. Hyperglycemia 2. Allergy to penicillin 3. History of myocardial infarction 4. Peptic ulcer disease
History of myocardial infarction. --Celecoxib increases the risk of MI caused by increased vasoconstriction and unimpeded platelet aggregation. **Celecoxib can cause hypersensitivity reactions in clients who are allergic to sulfonamides or salicylates. **Celecoxib needs to be used cautiously with patients who have peptic ulcer disease.
A nurse is caring for a client who has a new prescription for eplerenone to treat hypertension. The nurse should monitor for which of the following adverse effects of this medication? 1. Hematuria 2. Hypernatremia 3. Hyperkalemia 4. Constipation
Hyperkalemia. --This medication can place the patient at risk for increased potassium levels because eplerenone can cause potassium retention. **Eplerenone can cause vaginal bleeding. **Eplerenone can cause decreased sodium levels. **Eplerenone can cause diarrhea.
A nurse is monitoring a client who has been receiving long-term hydrochlorothiazide therapy for recurring episodes of heart failure. Which of the following findings should the nurse identify as an adverse effect of this medication? 1. Hypokalemia 2. Hypermagnesemia 3. Hypernatremia 4. Hypocalcemia
Hypokalemia. --Hydrochlorothiazide is a thiazide diuretic that can cause hypokalemia due to excessive potassium excretion in the urine. **Other adverse effects of hydrochlorothiazide: Hypomagnesemia, Hyponatremia, and Hypercalcemia.
A nurse is assisting with collecting data for a client who is in preterm labor and is receiving magnesium sulfate via continuous IV infusion. Which of the following findings should the nurse identify as an indication of magnesium toxicity? 1. Urinary output 60 mL/hr 2. Hyporeflexia 3. Respirations 16/min 4. Tachycardia
Hyporeflexia. --Magnesium sulfate depresses neuromuscular activity, causing muscle weakness and paralysis. **Urine output less than 25 - 30 mL/hr can indicate magnesium toxicity. **Respirations less than 12/min can indicate magnesium toxicity. **Bradycardia is an adverse effect of magnesium toxicity.
A nurse is evaluating a client who is receiving amphotericin B via intermittent IV bolus. Which of the following findings indicates an adverse reaction to this medication? 1. Serum potassium 5.6 mEq/L 2. Hematocrit 55% 3. Polyuria 4. Hypotension
Hypotension. --Amphotericin B is a high-alert medication that has the following additional adverse effects: nephrotoxicity, hypokalemia, and cardiac dysrhythmias. **The medication can cause Hypokalemia. **The medication can cause bone marrow suppression, resulting in anemia, so hematocrit levels would be analyzed. **The medication can cause nephrotoxicity, resulting in decreased urinary output.
A nurse is assisting with the care of a client who has a methicillin-resistant Staphylococcus aureus (MRSA) infection and is receiving vancomycin via IV infusion. Which of the following changes in the client's condition should the nurse identify as the priority finding to report to the provider? 1. Nausea 2. Back pain 3. Hypotension 4. Chills
Hypotension. --If the vancomycin infusion is too rapid, it can cause red man syndrome, which is a group of adverse effects that includes: Tachycardia, hypotension, flushing, and urticaria.
A nurse is caring for a client who has a 10-year history of alcohol use disorder and is experiencing acute alcohol withdrawal. The nurse should identify which of the following interventions as the priority? 1. Suggest the client attend a support group. 2. Administer naltrexone. 3. Implement seizure precautions. 4. Assist the client to identify triggers of alcohol use.
Implement seizure precautions. --Grand mal seizures can occur during severe alcohol withdrawal. **A support group is recommended to support assistance with maintaining abstinence after detoxification. **Naltrexone is to be administered to maintain abstinence after detoxification. **Identifying triggers of alcohol use to assist with maintaining abstinence after detoxification.
A nurse is caring for a client who has schizophrenia and is to start therapy with risperidone. For which of the following manifestations should the nurse monitor to determine whether the treatment is effective? 1. Improved social interactions 2. Decreased obsessive-compulsive thoughts 3. Decreased hand tremors 4. Improved urinary control
Improved social interactions. --Risperidone is an atypical antipsychotic used to minimize manifestations of schizophrenia such as: Interacting with others, maintaining relationships, dull affect, and speech deficiency. **Patients with OCD might take an SSRI (fluoxetine). **Patients with bipolar disorder might take a beta-adrenergic blocking agent (propranolol) to decrease hand tremors. **Patients who have an overactive bladder might take oxybutynin to reduce urinary urgency and frequency, nocturia.
A nurse is reinforcing teaching with a client who has recently began taking furosemide. Which of the following instructions should the nurse include in the teaching? 1. Increase dietary potassium while taking the medication. 2. Lie down for 30 min after taking the medication. 3. Take the medication 30 min before going to bed. 4. Avoid taking the medication with dairy products.
Increase dietary potassium while taking the medication. --Furosemide causes potassium to be excreted in the urine, increasing dietary potassium will help prevent hypokalemia. **To remove orthostatic hypotension the patient should change positions slowly. **The patient shouldn't take the medication any later than 1700 to avoid disruption of sleep.
A nurse is reinforcing teaching with a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following information should the nurse include in the teaching? 1. Avoid grapefruit juice. 2. Increase salt intake. 3. Avoid aged cheese. 4. Increase fluid intake.
Increase fluid intake. --This is to reduce the risk for renal damage and to increase medication excretion.
A nurse is caring for a client who has kidney failure and has been taking epoetin. Which of the following is a therapeutic effect of this medication? 1. Decreased BUN 2. Increased Hgb 3. Decreased leukocyte production 4. Increased platelet production
Increased Hgb. --Epoetin is used to elevate the erythrocyte count for clients who have kidney failure. An increased Hgb is the desired therapeutic effect of this medication.
A nurse is caring for a client who is taking phenylephrine. The nurse should plan to monitor the client for which of the following manifestations as an adverse effect of this medication? 1. Increased drowsiness 2. Increased heart rate 3. Decreased blood pressure 4. Decreased WBC count
Increased heart rate. --Phenylephrine can cause tachycardia and other cardiac dysrhythmias. **Insomnia: A common adverse effect of phenylephrine due to CNS stimulation. **Increase in BP: A common adverse effect of phenylephrine due to CNS stimulation.
A nurse is collecting data from a client who is taking ferrous sulfate orally. Which of the following findings reported by the client should indicate to the nurse that the medication is having a therapeutic effect? 1. Passing of a soft, formed stool daily 2. Decreased number of viral illnesses 3. Improved ability to fall asleep 4. Increased tolerance to exercise
Increased tolerance to exercise. --Ferrous sulfate is used to treat iron-deficiency anemia, which can cause fatigue and SOB due to a low hemoglobin level. --Increased tolerance to exercise occurs when the hemoglobin level increases, allowing more oxygen to be carried to the vital organs and tissues. **Ferrous sulfate can also cause: Constipation.
A nurse is caring for a client who has a history of psychosis and is taking chlorpromazine. Which of the following actions should the nurse take to counteract the adverse effects of this medication? 1. Suggest that the client apply antiperspirant deodorant more frequently. 2. Inform the client to apply sunblock before going outside. 3. Give the client a list of over-the-counter antidiarrheal medications. 4. Recommend that the client take the medication on an empty stomach.
Inform the client to apply sunblock before going outside. --This counteracts the adverse effects of photosensitivity. --Chlorpromazine increases the skin's sensitivity to ultraviolet light causing temporary pigmentation changes and increasing the risk of sunburn. **Adverse effects of Chlorpromazine include: reduced perspiration, constipation. **Chlorpromazine should be taken with food or fluid to reduce the risk of GI distress. **Tricyclic antidepressants: Causes excessive sweating.
A nurse is reinforcing teaching with a client who has bipolar disorder and a new prescription for lithium. Which of the following instructions should the nurse include in the teaching? 1. Take the medication on an empty stomach. 2. Monitor for signs of hyperthyroidism. 3. Watch for signs of urinary retention. 4. Maintain a consistent sodium intake.
Maintain a consistent sodium intake. --Decreased serum sodium levels cause lithium excretion to decline, leading to toxicity. **Lithium should be taken with meals or milk to reduce GI upset. **Hypothyroidism can occur with lithium. **Polyuria can occur when taking lithium.
A nurse in a provider's office is reviewing the immunization records of a 12-month-old infant who is immunocompromised. Which of the following vaccines should the nurse identify as contraindicated for this client? 1. Hepatitis A (Hep A) 2. Measles, mumps, and rubella (MMR) 3. Pneumococcal conjugate (PCV13) 4. Haemophilus B conjugate (Hib)
Measles, mumps, and rubella (MMR). --Although most infants should receive the MMR vaccine between the ages of 12 months and 15 months, the nurse should identify that the MMR vaccine is composed of live viruses and is contraindicated for an infant who is immunocompromised. **Hepatitis A (Hep A) vaccine: Doesn't contain a live virus, is given between the ages of 12 - 23 months. **Pneumococcal conjugate (PCV13): Doesn't contain a live virus, is given between the ages of 2 - 15 months. **Haemophilus B conjugate (Hib): Doesn't contain a live virus, is given between the ages of 2 - 15 months.
A nurse is reinforcing teaching with a client about the adverse effects of simvastatin. For which of the following adverse effects should the nurse instruct the client to notify the provider? 1. Muscle pain 2. Fine hand tremors 3. Urinary retention 4. Double vision
Muscle pain. --This can be an indication of developing rhabdomyolysis.
A nurse is collecting data from a client who is taking tobramycin. Which of the following findings should the nurse report to the provider immediately? 1. Report of nausea 2. Fever 3. Oliguria 4. Report of headache
Oliguria. --This indicates the client is at greatest risk for nephrotoxicity. **Nausea is an adverse effect of tobramycin. **Fever is a possible indication of superinfection and will need to determine whether further diagnostic testing needs to be done. **Headache is a possible manifestation of an electrolyte imbalance and a prescription will need to be obtained for analgesia.
A nurse is collecting data from a client who is postoperative and taking morphine for pain. Which of the following findings is the priority for the nurse to report to the provider? 1. Constipation 2. Oxygen saturation 87% 3. Vomiting 4. Urinary output 25 mL over 1 hr
Oxygen saturation 87%. --ABCs recommend the priority is the patient's oxygen saturation levels, which is a manifestation of respiratory depression. **The nurse should monitor and treat the following: Constipation, vomiting, and urinary retention, but they are not the priority.
A nurse is reviewing the history of a client who is to start taking cefotetan to treat a bacterial infection. Which of the following information from the client's medical record should the nurse report to the provider before the client begins receiving this medication? 1. Hearing impairment 2. Milk-protein allergy 3. Tendon pain 4. Penicillin allergy
Penicillin allergy. --Cefotetan is a cephalosporin (which is similar to penicillin's) and having a severe allergy to penicillin can develop cross-reactivity resulting in an allergic reaction. **Hearing loss: A contraindication to antibiotics like aminoglycosides, due to their ototoxic effects. **Milk-protein allergy: May cause a reaction to cefditoren, which is a cephalosporin. **Tendon pain: may cause the adverse effect of tendon rupture when taking fluoroquinolone antibiotics.
A nurse is reinforcing teaching with a client who is newly diagnosed with hypertension and is taking metoprolol. The nurse should instruct the client to report which of the following manifestations to the provider as an adverse effect of this medication? 1. Tachycardia 2. Tinnitus 3. Peripheral edema 4. Urinary retention
Peripheral edema. --This is an indication of heart failure, which is an adverse effect of metoprolol. **The patient should monitor for bradycardia **The patient should monitor for blurred vision. **The patient should monitor for urinary frequency.
A nurse is reinforcing teaching with a client who is to start therapy using a nitroglycerin transdermal patch. Which of the following instructions should the nurse include? 1. Cover the patch with a dry dressing. 2. Apply another patch if experiencing chest pain. 3. Leave each patch in place for 24 hr. 4. Place the patch on a different site for each application.
Place the patch on a different site for each application. --This is to prevent skin irritation. **Nitroglycerin ointment should be covered with a plastic dressing, a prepared patch doesn't need to be covered. **Transdermal patch is used to treat acute chest pain. **The patient should remove the patch after 12-14 hours with a 10-12 hour break before applying a new patch to prevent tolerance.
A nurse is instilling timolol eyedrops for a client who has glaucoma. Which of the following actions should the nurse take after instilling the eyedrops? 1. Press the nasolacrimal duct. 2. Apply pressure to the upper eyelid. 3. Ask the client to blink their eyes several times. 4. Tell the client to keep their eyes open for at least 15 seconds.
Press the nasolacrimal duct. --This prevents the medication from absorbing into systemic circulation.
A nurse is collecting data from a female client who has been taking propylthiouracil (PTU) for 2 months to treat Graves' disease. Which of the following findings should the nurse recognize as an indication that the medication is effective? 1. Weight loss 2. Pulse 82/min 3. Respiratory rate 22/min 4. Decreased menstrual flow
Pulse 82/min. --Tachycardia is a manifestation of hyperthyroidism (Graves' disease). **Weight loss: Manifestation of hyperthyroidism, making medication not effective. **Respiratory rate 22/min: Tachypnea is a manifestation of hyperthyroidism, indicating the medication is not effective. **Decreased menstrual flow: Amenorrhea is a manifestation of hyperthyroidism, indication the medication is not effective.
A nurse is caring for a client who is taking disulfiram and consumed alcohol 12 hr ago. Which of the following adverse reactions is the priority finding to report to the provider? 1. Hyperemesis 2. Severe headache 3. Palpitations 4. Respiratory depression
Respiratory depression. --This is an indication of acetaldehyde syndrome, a life-threatening event. **Expected reactions of disulfiram: Hyperemesis, severe headache, and palpitations.
A nurse is collecting data from a client who received morphine IV for pain relief. Which of the following findings is the nurse's priority to report to the provider? 1. Emesis 2. Sedation 3. Respiratory rate 11/min 4. Blood pressure 90/54 mm Hg
Respiratory rate 11/min. --This indicates respiratory depression. **Emesis: Antiemetic is used treat this and is an adverse effect of opioids. **Sedation: Fall precautions would be implemented, this is an adverse effect of opioids. **BP 90/54 mm Hg: Is below the reference range, a fluid bolus is requested.
A nurse is reinforcing teaching with a client who has hypertension and a new prescription for spironolactone. Which of the following instructions should the nurse include in the teaching? 1. Increase foods high in zinc. 2. Restrict foods high in potassium. 3. Restrict foods high in vitamin K. 4. Increase foods high in magnesium.
Restrict foods high in potassium. --Spironolactone is a potassium-sparing diuretic, which can cause hyperkalemia. **Spironolactone can increase magnesium levels.
A nurse is collecting data from a client who is taking lithium to treat bipolar disorder. Which of the following findings should the nurse report to the provider? 1. Bloating 2. WBC count 8,500/mm3 3. Slurred speech 4. Sodium 140 mEq/L
Slurred speech. --This is a manifestation of lithium toxicity.
A nurse is collecting data from a client who has hyperthyroidism and a new prescription for propylthiouracil. The nurse should monitor the client for which of the following manifestations as an adverse effect of this medication? 1. Sore throat 2. Metallic taste 3. Mania 4. Urinary retention
Sore throat. --The nurse should monitor for sore throat and fever because these are early indications of agranulocytosis. **Other adverse effects of propylthiouracil: Loss of taste, drowsiness, and glomerulonephritis
A nurse is monitoring a client who is receiving a transfusion of packed RBCs. The client's temperature increases to 39.1* C (102.4* F). Which of the following actions should the nurse take first? 1. Obtain a urine specimen. 2. Administer diphenhydramine. 3. Stop the transfusion. 4. Notify the charge nurse.
Stop the transfusion. --The greatest risk to the patient is injury from a transfusion reaction that can cause acute intravascular hemolysis or anaphylaxis. **Urine specimen: Collected to determine the extent of the reaction. **Diphenhydramine administration: An antihistamine that is used as an emergency medication. **Notify the Charge nurse: Due to a possible transfusion reaction being an emergent situation.
A nurse is reinforcing teaching with a client who has a new prescription for omeprazole oral capsules. Which of the following instructions should the nurse include? 1. Take the medication at bedtime. 2. Swallow the medication whole. 3. Take the medication with food. 4. Avoid antacids when taking this medication.
Swallow the medication whole. --Omeprazole is a proton pump inhibitor, it blocks the secretion of gastric acid. **Omeprazole is taken in the AM prior to the first meal of the day, to increase the absorption of the medication. **Take the medication without food to avoid reducing the absorption of omeprazole.
A nurse is collecting data from a client who has been taking levodopa/carbidopa. Which of the following findings should indicate to the nurse that the medication is effective? 1. The client is able to wash their face. 2. The client experiences fewer seizures. 3. The client reports decreased heartburn. 4. The client is able to sleep through the night.
The client is able to wash their face. --Levodopa works by activating dopamine receptors, restoring nerve transmission for clients who have Parkinson's disease. --Carbidopa enhances these effects by inhibiting the breakdown of levodopa in the intestine and periphery. These help with the patient moving freely and resuming ADLs. **Abnormal involuntary movements are an adverse effects of levodopa and can be reduced by amantadine administration. **Nausea and vomiting are adverse effects of levodopa. **Vivid dreams and hallucinations are adverse effects of levodopa.
A nurse is reinforcing teaching with a client who has type 1 diabetes mellitus and is learning to self-administer NPH insulin. Which of the following client actions indicates an understanding of the teaching? 1. The client shakes the insulin vial prior to drawing up the dose. 2. The client uses the tip of the plunger to measure the correct dose. 3. The client injects air into the vial after inverting it. 4. The client wipes the cap with alcohol prior to filling the syringe.
The client wipes the cap with alcohol prior to filling the syringe. --This reduces the risk for contamination. **The vial should be gently rolled between the palms to disperse the particles in the solution. **The patient should use the widest portion of the plunger and line it up with the prescribed number on the syringe. **Inject air into the vial prior to inverting it, this reduces the risk of creating air bubbles.
A nurse is collecting data from a client who has been taking digoxin for 1 month. The nurse should identify which of the following findings as a manifestation of digoxin toxicity. 1. Pulse rate 100/min 2. Blood pressure 140/90 mm Hg 3. Wheezing 4. Vomiting
Vomiting. --This is an early manifestation of digoxin toxicity. **Other manifestations of digoxin toxicity: Hypotension.
A nurse is planning to administer metoprolol to a client who has heart failure and a heart rate of 48/min. Which of the following actions should the nurse take? 1. Encourage the client to ambulate. 2. Request a different beta blocker medication to administer. 3. Administer one-half of the client's prescribed dose. 4. Withhold the client's medication.
Withhold the client's medication. --Metoprolol (beta blocker) results in a decrease in HR and should withhold the medication for a heart rate less than 50/min. **Ambulating can increase the client's risk of falling due to the patient being hypotensive. **Beta blocker medications can cause a decrease in HR.
