Pharmacology Quiz 2

24. A nurse is preparing to administer haloperidol 5 mg IM to a client. The amount available is haloperidol 20 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest hundredth. Use a leading zero if it applies. Do not use a trailing zero.)

0.25 mL

A nurse is caring for a client who has schizophrenia and is experiencing hallucinations. The provider prescribes chlorpromazine 50 mg IM every 4 hr as needed. Available is chlorpromazine injection 25 mg/mL. How many mL should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

2 mL

27. A nurse is preparing to administer fluoxetine 30 mg PO daily to a client. The amount available is fluoxetine 10 mg/tablet. How many tablets should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

3 tablet(s)

11. A nurse is teaching a client who has a new prescription for alprazolam to treat insomnia. Which of the following instructions should the nurse included? A. "Take this medication every night before sleep." Rationale: The client should take this medication intermittently (3 or 4 nights per week) to prevent physical dependence. B. "Take this mediation with a high fat meal. "Rationale: Fatty foods reduce the absorption of this medication. C. "Avoid activities that require alertness such as driving." Rationale: The client should avoid activities that require alertness. Diazepam is a benzodiazepine that causes sedation and dizziness. D. "Monitor for urinary retention. "Rationale: Morphine can cause urinary retention.

C. "Avoid activities that require alertness such as driving." Rationale: The client should avoid activities that require alertness. Diazepam is a benzodiazepine that causes sedation and dizziness.

12. A nurse is reviewing discharge instructions with a client who has bipolar disorder and is taking lithium. Which of the following manifestations should the nurse include as an indication of mild toxicity? A. Constipation Rationale: The nurse should instruct the client that diarrhea is a manifestation of mild toxicity, not constipation. B. Urinary retention Rationale: The nurse should instruct the client that polyuria is a manifestation of mild toxicity, not urinary retention. C. Muscle weakness Rationale: The nurse should instruct the client that muscle weakness is a manifestation of mild toxicity. D. Hyperactivity Rationale: The nurse should instruct the client that lassitude is a manifestation of mild toxicity, not hyperactivity.

C. Muscle weakness Rationale: The nurse should instruct the client that muscle weakness is a manifestation of mild toxicity.

9. A nurse is teaching a client who has a new prescription for fluoxetine to treat depression. Which of the following statements by the client indicates an understanding of the teaching? A. "I should expect to feel better after 24 hours of starting this medication."Rationale: The therapeutic effects of this medication can take 1 to 4 weeks to occur. B. "I should not take this medicine with grapefruit juice. "Rationale: Grapefruit juice can interfere with the metabolism of lovastatin, but it does not affect fluoxetine. C. "I'll take this medicine with food. "Rationale: The client can take fluoxetine with or without food. D. "I'll take this medicine first thing in the morning. "Rationale: The client should take fluoxetine in the morning to reduce the risk for insomnia.

D. "I'll take this medicine first thing in the morning. "Rationale: The client should take fluoxetine in the morning to reduce the risk for insomnia.

28. A nurse is preparing to administer buspirone 7.5 mg PO every 12 hr to a client. The amount available is buspirone 15 mg/tablet. How many tablets should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

0.5 tablet(s)

13. A nurse is teaching a client who has multiple sclerosis about a new prescription for baclofen. Which of the following instructions should the nurse include in the teaching? A. "Do not take antihistamines with this medication." Rationale: The nurse should instruct the client not to take antihistamines while taking baclofen. Antihistamines will intensity the depressant effects of baclofen. B. "Take the medication on an empty stomach." Rationale: The medication causes nausea and gastrointestinal distress, so the client should take it with milk or meals. C. "Stop taking the medication immediately for a headache." Rationale: Abrupt withdrawal of baclofen, a centrally acting muscle relaxant, might cause seizures, fever, and hypotension. A better alternative is to treat the headache, which can have many other causes, and see if it resolves as medication therapy with baclofen continues. D. "Expect to develop diarrhea initially. "Rationale: Baclofen is more likely to cause constipation than diarrhea.

A. "Do not take antihistamines with this medication." Rationale: The nurse should instruct the client not to take antihistamines while taking baclofen. Antihistamines will intensity the depressant effects of baclofen.

10. A nurse is instructing the parents of a client who has a new prescription for methylphenidate. Which of the following instructions should the nurse include? A. Avoid activities that require alertness such as driving. Rationale: The client should avoid driving and other activities that require alertness until the effects of this medication are known. B. Increase caffeine intake. Rationale: The client should decrease caffeine intake to reduce the risk for excessive stimulation and irritability. C. Take this medication before bedtime. Rationale: The client should take this medication 6 hr before sleep to reduce the risk for insomnia. D. Reduce calorie intake. Rationale: This medication can cause anorexia and weight loss.

A. Avoid activities that require alertness such as driving. Rationale: The client should avoid driving and other activities that require alertness until the effects of this medication are known. B. Increase caffeine intake.

A nurse is teaching a client who has a new prescription for diazepam. Which of the following information should the nurse include in the teaching? A. Diazepam can cause drowsiness. Rationale: Diazepam has sedative properties, so the client should not engage in potentially hazardous activities after receiving diazepam. B. This medication must be swallowed whole. Rationale: Diazepam can be crushed and taken with food if the client is unable to swallow the medication whole. C. It is important to avoid foods that contain tyramine. Rationale: Clients who take monoamine oxidase inhibitors must avoid foods that contain tyramine. D. Grapefruit juice inactivates this medication. Rationale: Although grapefruit juice can affect the metabolism of many medications, generally raising their blood levels, diazepam is not among them.

A. Diazepam can cause drowsiness. Rationale: Diazepam has sedative properties, so the client should not engage in potentially hazardous activities after receiving diazepam.

29. A charge nurse is teaching a group of nurses about the antagonist action of medications. The nurse should include in the teaching that which of the following antagonist medications is used for benzodiazepines? A. Flumazenil Rationale: The nurse should teach that flumazenil is an antagonist that reverses the effects of benzodiazepines by recognition site on the GABA/benzodiazepine receptor complex. B. Diphenhydramine Rationale: The nurse should teach that diphenhydramine hydrochloride is a H1-receptor antagonist, which blocks histamine that decreases allergic responses. C. Protamine Rationale: The nurse should teach that protamine is a heparin antagonist that binds with heparin and makes it ineffective. D. Naloxone Rationale: The nurse should teach that naloxone is an opiate antagonist that competes with opioids at opiate receptor sites making the opioid ineffective.

A. Flumazenil Rationale: The nurse should teach that flumazenil is an antagonist that reverses the effects of benzodiazepines by recognition site on the GABA/benzodiazepine receptor complex.

14. A nurse is caring for a client who has just begun therapy with alprazolam to treat anxiety. The nurse should monitor the client for which of the following adverse effects of this medication? A. Insomnia Rationale: The nurse should monitor the client for paradoxical effects such as insomnia and excitation. If these occur, the medication should be withdrawn. B. BradycardiaRationale: Alprazolam is more likely to cause tachycardia than bradycardia. C. Hearing lossRationale: Alprazolam can cause the adverse effect of tinnitus but does not cause hearing loss. D. HypertensionRationale: The nurse should monitor the client for the adverse effects of hypotension and orthostatic hypotension rather than hypertension.

A. Insomnia Rationale: The nurse should monitor the client for paradoxical effects such as insomnia and excitation. If these occur, the medication should be withdrawn.

A nurse is caring for a 4-year-old child who is resistant to taking medication. Which of the following strategies should the nurse use to elicit the child's cooperation? A. Offer the child a choice of taking the medication with juice or water. Rationale: While taking the medicine is not a choice, the child can decide what kind of fluid to take with the medication. This gives the preschool-aged child a sense of control over a stressful situation and increases the child's ability to cope. B. Tell the child it is candy. Rationale: It is unsafe to tell a child that medicine is candy. Telling this to a child can lead to an increased risk of accidental poisoning. C. Hide the medication in a large dish of ice cream. Rationale: When mixing a medication with food, the nurse should mix it in a small amount to increase the chance the child will take it. D. Tell the child he will have to have a shot instead. Rationale: It is unacceptable to threaten any client. This is considered assault.

A. Offer the child a choice of taking the medication with juice or water. Rationale: While taking the medicine is not a choice, the child can decide what kind of fluid to take with the medication. This gives the preschool-aged child a sense of control over a stressful situation and increases the child's ability to cope.

A nurse is caring for a 2-year-old child who has seizures and is receiving phenytoin in suspension form. Which of the following actions should the nurse take before administering each dose? A. Shake the container vigorously. Rationale: A suspension form of medication refers to one in which the particles of medication are mixed with, but not dissolved in, a fluid. It is important for the nurse to shake the container that contains the suspension because the child can be under-medicated if the medication is not evenly distributed. B. Be sure the child has not eaten within the hour. Rationale: Phenytoin is a gastric irritant. It should be given with or immediately after a meal to decrease gastric upset. C. Perform mouth care. Rationale: Mouth care is not necessary prior to every dose. D. Check the child's blood pressure. Rationale: When giving the oral form of phenytoin, this action is not necessary.

A. Shake the container vigorously. Rationale: A suspension form of medication refers to one in which the particles of medication are mixed with, but not dissolved in, a fluid. It is important for the nurse to shake the container that contains the suspension because the child can be under-medicated if the medication is not evenly distributed.

A nurse is caring for a client who has bipolar disorder and has been taking lithium for 1 year. Before administering the medication, the nurse should check to see that which of the following tests have been completed? A. Thyroid hormone assay Rationale: Thyroid testing is important because long-term use of lithium may lead to thyroid dysfunction. B. Liver function tests Rationale: LFTs must be monitored before and during valproic acid therapy, not lithium therapy. C. Erythrocyte sedimentation rate Rationale: This is not a necessary test related to lithium therapy. D. Brain natriuretic peptide Rationale: Brain natriuretic peptide (BNP) is not a necessary test related to lithium therapy. The BNP is used to monitor heart failure.

A. Thyroid hormone assay Rationale: Thyroid testing is important because long-term use of lithium may lead to thyroid dysfunction.

A nurse is providing teaching for a client who has schizophrenia and a new prescription for fluphenazine. Which of the following information should the nurse provide? A. "This medication might turn urine your orange. "Rationale: The nurse should inform the client that fluphenazine might turn the urine pink to reddish brown. B. "Sleepiness should subside within a week." Rationale: The nurse should inform the client that fluphenazine, like other first-generation antipsychotics, may cause sedation with early treatment, but should subside within a week or so. C. "Stop the medication if hypotension occurs." Rationale: The nurse should inform the client that fluphenazine may cause orthostatic hypotension and to rise slowly from a seated position. Fluphenazine should not be stopped abruptly, but should be withdrawn slowly on the advice of the provider. D. "A low-grade fever is expected with first doses." Rationale: The nurse should inform the client that fluphenazine might cause leukopenia or agranulocytosis. The client should notify the provider immediately of adverse effects such as sore throat, fever, malaise.

B. "Sleepiness should subside within a week." Rationale: The nurse should inform the client that fluphenazine, like other first-generation antipsychotics, may cause sedation with early treatment, but should subside within a week or so.

26. A nurse is teaching a female client who has a new prescription for transdermal sumatriptan to treat migraine headaches. Which of the following instructions should the nurse include? A. "Take this medication daily to prevent headaches. "Rationale: The client should take this medication as needed to abort an ongoing migraine headache. B. "Activate the patch 30 minutes after application. "Rationale: The client should activate the patch within 15 min of application by pushing an activation button. C. "Use contraception while taking this medication." Rationale: Sumatriptan can cause teratogenesis and should not be used during pregnancy. D. "You can bathe with the patch in place." Rationale: The client should keep the transdermal sumatriptan dry to prevent malfunction of the device. The client should not bathe, shower, or swim with the patch.

C. "Use contraception while taking this medication." Rationale: Sumatriptan can cause teratogenesis and should not be used during pregnancy.

A nurse is providing dietary teaching for a client who has a new prescription for a monoamine oxidase inhibitor (MAOI). When the client develops a sample lunch menu, which of the following items requires intervention by the nurse? A. Glass of whole milk Rationale: Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Milk is safe for a client taking an MAOI. B. Celery sticks Rationale: Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Celery is safe for a client taking an MAOI. C. Bologna sandwich Rationale: Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Bologna has a high tyramine content and should be avoided. D. Sliced apples Rationale: Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Apples are safe for a client taking an MAOI.

C. Bologna sandwich Rationale: Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Bologna has a high tyramine content and should be avoided.

20. A nurse is caring for a client who has a prescription for olanzapine. The nurse should monitor the client for which of the following manifestations as an expected response to this medication? A. A decrease in resting blood pressure Rationale: Hypotension is an adverse effect of olanzapine. B. Control of seizure activity Rationale: Seizures are an adverse effect of olanzapine. C. Decreased auditory hallucinations Rationale: Olanzapine is prescribed for the treatment of the manifestations of schizophrenia, one of which is auditory hallucinations. D. Increased energy level and involvement in activities Rationale: Fatigue is an adverse effect of olanzapine.

C. Decreased auditory hallucinations Rationale: Olanzapine is prescribed for the treatment of the manifestations of schizophrenia, one of which is auditory hallucinations.

23. A nurse is providing teaching to a client who has a new diagnosis of Parkinson's disease. On which of the following medications should the nurse prepare to instruct the client? A. Piperacillin/tazobactam Rationale: Piperacillin/tazobactam is a broad spectrum anti-infective used in the treatment of moderate to severe infections. It is not used in the treatment of Parkinson's disease. B. Levothyroxine Rationale: Levothyroxine is a thyroid hormone used in the treatment of hypothyroidism. It is not used in the treatment of Parkinson's disease C. Levodopa/carbidopa Rationale: Levodopa/carbidopa is the cornerstone of Parkinson's treatment. The nurse should prepare to instruct the client on the use of this medication. D. Carbamazepine Rationale: Carbamazepine is an anticonvulsant used in the treatment of seizures, trigeminal neuralgia, bipolar disorder, and diabetic neuropathy. It is not used in the treatment of Parkinson's disease.

C. Levodopa/carbidopa Rationale: Levodopa/carbidopa is the cornerstone of Parkinson's treatment. The nurse should prepare to instruct the client on the use of this medication.

25. A nurse is teaching a client who has a new prescription for phenytoin. The nurse should instruct the client to monitor for and report which of the following adverse effects of this medication? A. Metallic taste Rationale: Adverse effects of clarithromycin include an altered taste. Phenytoin can cause gingival hyperplasia. B. Diarrhea Rationale: Adverse effects of phenytoin include constipation. C. Skin rash Rationale: Phenytoin is an antiepileptic medication used to treat partial seizures and generalized tonic-clonic seizures. Phenytoin can cause a rash that can progress to Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). If a rash develops, the client should notify the provider immediately and stop the use of phenytoin. D. Anxiety Rationale: Adverse effects of phenytoin include suicidal tendencies and aggression.

C. Skin rash Rationale: Phenytoin is an antiepileptic medication used to treat partial seizures and generalized tonic-clonic seizures. Phenytoin can cause a rash that can progress to Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). If a rash develops, the client should notify the provider immediately and stop the use of phenytoin.

22. A nurse is preparing to administer phenytoin 50 mg by intermittent IV bolus to a client who has a seizure disorder. Which of the following actions should the nurse take? A. Slow the injection if the medication crystallizes. Rationale: The nurse should discontinue the medications if it crystalizes. Mixing phenytoin with other solutions can cause a precipitate to form. It should not be added to an existing IV infusion and the tubing should be flushed before and after administration. B. Dilute the medication before injecting. Rationale: The nurse should not dilute the IV injection before administration, as phenytoin is given undiluted. C. Follow the IV injection with sterile water. Rationale: The nurse should follow the IV injection with sterile 0.9% sodium chloride, not water, to prevent a precipitate developing. D. Administer the medication over 1 min. Rationale: The nurse should administer phenytoin slowly, no faster than 50 mg/min.

D. Administer the medication over 1 min.Rationale: The nurse should administer phenytoin slowly, no faster than 50 mg/min.

A hospice nurse is caring for a client who has terminal cancer and takes PO morphine for pain relief. The client reports that he had to increase the dose of morphine this week to obtain pain relief. Which of the following scenarios should the nurse document as the explanation for this situation? A. The client not been taking the medication properly. Rationale: The nurse should not document the client has not been taking the medication properly without further investigation. The client is able to tell the nurse that he had to increase the dose, which does not indicate taking the medication improperly. B. The client is experiencing episodes of confusion. Rationale: The nurse should not document the client is experiencing confusion. The client is clearly able to tell the nurse that that he had to increase the dose to achieve pain relief. This does not indicate the client is confused. C. The client has become addicted to the medication. Rationale: Addiction is the compulsive need for and use of a habit-forming substance, such as a narcotic. However, this client is not describing addiction, and addiction is not a concern when treating a terminal client who has cancer pain. D. The client developed a tolerance to the medication. Rationale: The nurse should document that the client has developed a tolerance to the medication. Morphine is a narcotic analgesic used for the treatment of severe pain. Tolerance is an adverse effect of narcotic analgesics in which a larger dose is needed to produce the same response.

D. The client developed a tolerance to the medication. Rationale: The nurse should document that the client has developed a tolerance to the medication. Morphine is a narcotic analgesic used for the treatment of severe pain. Tolerance is an adverse effect of narcotic analgesics in which a larger dose is needed to produce the same response.

A nurse is teaching a client who has a new prescription for lithium to treat bipolar disorder. The nurse should instruct the client to ensure an adequate intake of which of the following dietary elements? A. Sodium Rationale: Lithium is a salt. If sodium level falls, the client will retain lithium and have an increased risk for lithium toxicity. B. Potassium Rationale: Potassium intake is an issue for clients who take diuretics, but it does not affect lithium levels. C. Vitamin K Rationale: Clients who take warfarin, not lithium, must keep their intake of vitamin K consistent. D. Vitamin C Rationale: Vitamin C promotes the absorption of iron, but it does not affect lithium levels.

A. Sodium Rationale: Lithium is a salt. If sodium level falls, the client will retain lithium and have an increased risk for lithium toxicity.

A nurse is assessing a client who has schizophrenia and has been on long-term treatment with chlorpromazine. He notes the client is experiencing some involuntary movements of the tongue and face. The nurse should suspect the client has developed which of the following adverse effects? A. Tardive dyskinesia Rationale: These findings indicate tardive dyskinesia, which can develop in clients during long-term therapy with chlorpromazine. For many clients, the manifestations are irreversible. B. Parkinsonism Rationale: Parkinsonism can occur in clients taking chlorpromazine; however, it is characterized by drooling, shuffling gait and bradykinesia. C. Dystonia Rationale: Dystonia is an acute adverse effect involving severe spasm of the muscles of the tongue, face, neck or back that generally develops within the first few days of therapy. D. Akathisia Rationale: Akathisia can occur in clients taking chlorpromazine; however, it is characterized by pacing and squirming, which is brought on by an uncontrollable need to stay in motion.

A. Tardive dyskinesia Rationale: These findings indicate tardive dyskinesia, which can develop in clients during long-term therapy with chlorpromazine. For many clients, the manifestations are irreversible.

8. A nurse is preparing to administer phenytoin IV to a client who has a seizure disorder. Which of the following actions should the nurse plan to take? A. Administer the medication at 100 mg/min. Rationale: The nurse should administer phenytoin IV slowly, not faster than 50 mg/min, to reduce the risk of hypotension. B. Administer a saline solution after injection. Rationale: The nurse should flush the injection site with a saline solution after the injection of phenytoin to reduce and prevent venous irritation. C. Hold the injection if seizure activity is present. Rationale: The nurse should administer phenytoin to prevent and to abort seizure activity. D. Dilute the medication with dextrose 5% in water. Rationale: The nurse should dilute phenytoin in 0.9% sodium chloride solution to prevent precipitation of the medication.

B. Administer a saline solution after injection. Rationale: The nurse should flush the injection site with a saline solution after the injection of phenytoin to reduce and prevent venous irritation.

21. A nurse is providing teaching to a client who has seizures and a new prescription for phenytoin. Which of the following information should the nurse provide? A. Phenytoin turns urine blue. Rationale: The nurse should include in the home instructions that phenytoin turns the urine pink, red, or red-brown, not blue. B. Alcohol increases the chance of phenytoin toxicity. Rationale: The nurse should include in the home instructions that alcohol alters the blood level of phenytoin. C. Avoid flossing the teeth to prevent gum irritation. Rationale: The nurse should instruct the client to floss the teeth to prevent gingival hyperplasia, which is associated with the use of phenytoin. D. Take an antacid with the medication if indigestion occurs. Rationale: The nurse should instruct the client to avoid taking an antacid within 2 hr of administering phenytoin.

B. Alcohol increases the chance of phenytoin toxicity. Rationale: The nurse should include in the home instructions that alcohol alters the blood level of phenytoin.

A nurse is teaching a client who has bipolar disorder and a prescription for lithium to recognize the manifestations of toxicity. Which of the following statements by the client indicates an understanding of the teaching? A. "I will report any loss of appetite. "Rationale: Anorexia is a common side effect, especially in the period after lithium has first been prescribed and the body is adjusting to the medication. It is not a sign of toxicity. B. "Increased flatulence is an indication of toxicity." Rationale: Increased flatulence is a common adverse effect, especially in the period after lithium is first prescribed and the body is adjusting to the medication. It is not a sign of toxicity. C. "Vomiting is an indication of toxicity." Rationale: Since vomiting and diarrhea are early signs of lithium toxicity, the client should omit the next dose of lithium and call the provider. D. "I will call my provider if I experience any headaches." Rationale: Headaches are a common adverse effect, especially in the period after lithium has first been prescribed and the body is adjusting to the medication. It is not a sign of toxicity.

C. "Vomiting is an indication of toxicity." Rationale: Since vomiting and diarrhea are early signs of lithium toxicity, the client should omit the next dose of lithium and call the provider.

A nurse is providing discharge teaching to a client who has a new prescription for lithium. Which of the following information should the nurse include in the teaching? A. Follow a low-sodium diet. Rationale: Clients who are taking lithium should avoid a low-sodium diet due to the risk of hyponatremia. B. Limit daily fluid intake. Rationale: Clients who are taking lithium should drink plenty of fluids. C. Obtain a daily weight. Rationale: Clients who are taking lithium should monitor their daily weight due to the risk of fluid imbalance. D. Avoid foods that have a high tyramine content. Rationale: Clients who are taking a monoamine oxidase inhibitor (MAOI), rather than lithium, should avoid foods that have a high tyramine content.

C. Obtain a daily weight. Rationale: Clients who are taking lithium should monitor their daily weight due to the risk of fluid imbalance.