Pharmacology study guide WITH RATIONALE

A nurse is caring for a client who takes warfarin to treat chronic atrial fibrillation and has early manifestations of Alzheimer's disease. The client's partner asks the nurse if the client would benefit from taking ginkgo biloba. Which of the following responses should the nurse provide?

"Ginkgo biloba will probably interfere with the effectiveness of his other medications." Some experts believe that ginkgo biloba can delay the mental deterioration of Alzheimer's disease if taken in the early stages. Research, however, has not demonstrated this; more importantly, ginkgo biloba increases the client's risk for bleeding when taken with warfarin.

A nurse is collecting data from a client who has been taken esomeprazole. Which of the following reports by the client indicates a therapeutic response to the medication?

"I am experiencing much less reflux since taking this medication." The nurse should identify a report of less gastric reflux as a therapeutic effect of esomeprazole. Esomeprazole is a proton pump inhibitor (PPI) that is used for the treatment of GERD, duodenal and gastric ulcers, and erosive esophagitis. PPIs decrease the production of acid secretion and are the drug of choice for treating GERD.

A nurse is reinforcing discharge teaching about lithium toxicity with a client who has a new prescription for this medication. Which of the following statements by the client indicates an understanding of the teaching?

"I can develop lithium toxicity if I experience vomiting or diarrhea." Vomiting or diarrhea can cause electrolyte imbalances. If serum sodium decreases, lithium is retained by the kidneys, increasing the risk of lithium toxicity.

A nurse in a provider's office is collecting data from a client who has been taking feverfew. Which of the following statements by the client indicates a therapeutic effect from the supplement?

"I have fewer migraine headaches since I started taking feverfew." Feverfew is an herb that is used for the prophylaxis of migraine headaches. It can reduce the frequency of migraines and decrease the severity of accompanying manifestations such as nausea and photophobia.

A nurse is teaching a client who has a new diagnosis of angina and has a prescription for isosorbide mononitrate 10 mg PO twice daily. Which of the following client statements indicates an understanding of the teaching?

"I should change positions slowly when getting out of bed." The nurse should identify that isosorbide mononitrate is an antianginal medication that produces vasodilation. Therefore, this medication can cause orthostatic hypotension. Clients should change positions slowly upon rising to minimize the effects of orthostatic hypotension.

A nurse is reinforcing teaching with a client who has a new prescription for a fentanyl transdermal patch. Which of the following statements by the client indicates an understanding of the teaching?

"I will have to stop drinking grapefruit juice while using the patch." The client should avoid drinking grapefruit juice while using the fentanyl transdermal patch. Grapefruit juice can increase the absorption of the medication, raising the fentanyl level in the client's blood and placing the client at risk for CNS and respiratory depression.

A nurse is teaching a client who has osteoporosis and a new prescription for alendronate. Which of the following client statements indicates that the teaching was effective?

"I will sit upright for 30 minutes after taking the medication." The nurse should instruct the client to sit upright or stand for at least 30 minutes after taking the medication to prevent esophagitis.

A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus about a prescription for insulin lispro. Which of the following statements should the nurse include in the teaching?

"Insulin lispro has an onset of about 15 minutes." Insulin lispro is a rapid-acting insulin and has an onset of 15 to 30 minutes.

A nurse is reinforcing teaching with a client about taking tetracycline PO. Which of the following statements should the nurse include in the teaching?

"Limit your consumption of dairy products while taking this medicine." The nurse should tell the client to avoid or limit the consumption of dairy products while taking tetracycline. An interval of at least 2 hours should separate tetracycline ingestion and the ingestion of products that can chelate this medication such as milk or calcium.

A nurse is caring for a client who is receiving chlorpromazine to treat schizophrenia. Which of the following statements by the client should prompt the nurse notify the provider immediately?

"My tongue keeps moving like a worm." Involuntary tongue movement indicates that this client is at greatest risk for tardive dyskinesia, which is a rare neurological syndrome that has no cure. Therefore, this is the priority statement.

A nurse is reinforcing teaching with a client who has a seizure disorder and a new prescription for carbamazepine. Which of the following statements should the nurse include in the teaching?

"This medication will decrease the effectiveness of oral contraceptives." The nurse should reinforce with the client that traditional antiepileptic drugs (AEDs) such as carbamazepine decrease the effectiveness of oral contraceptives.

A nurse is reinforcing teaching with a client who is starting patient-controlled analgesia (PCA) following a procedure. Which of the following client statements indicates an understanding of the teaching?

"This method works by keeping my opioid levels steady." The nurse should tell the client that a PCA pump is effective for pain control because it delivers a small amount of medication continuously rather than administering a large amount of medication infrequently.

A nurse is caring for a client with premenstrual disorder (PMD) who has a prescription for fluoxetine. The client asks the nurse, "When should I notice the benefits of this medication?" Which of the following responses should the nurse make?

"You should expect decreased manifestations within a few days." The nurse should inform the client that fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used to treat PMD. Unlike using fluoxetine to treat depression, using fluoxetine to treat PMD will improve manifestations more quickly.

A nurse is caring for an 18-month-old toddler who has Kawasaki disease (KD). The child is receiving intravenous immune globulin (IVIG). The guardian asks the nurse to administer the child's scheduled measles, mumps, and rubella (MMR) vaccine before discharge. Which of the following statements should the nurse provide?

"Your child will not be able to receive the MMR vaccine for at least 3 months after discharge." The nurse should explain to the guardian that IVIG given for the treatment of KD contains antibodies that can interfere with the action of live-virus vaccines such as MMR. The MMR immunization should be postponed for 3 to 6 months.

A nurse is preparing to administer levothyroxine 12.5 mcg PO daily to a client who has hypothyroidism. Levothyroxine 25 mcg/1 tablet is available. How many tablets should the nurse administer per dose? (Fill in the blank with the numeric value only. Round the answer to the nearest tenth. Use a leading zero if applicable but do not use a trailing zero.) Fill in the blank

0.5 Follow these steps for the ratio and proportion method of calculation: Step 1: What is the unit of measurement the nurse should calculate? tablet Step 2: What is the dose the nurse should administer? 12.5 mcg Step 3: What is the dose available? 25 mcg Step 4: Should the nurse convert the units of measurement? No Step 5: What is the quantity of the dose available? 1 tablet Step 6: Set up an equation and solve for X. Have/Quantity = Desired/X 25 mcg/1 tablet = 12.5 mcg/X tablet X = 0.5 tablet Step 7: Round if necessary. Step 8: Reassess to determine whether the amount to give makes sense. If there are 25 mcg/1 tablet and the amount prescribed is 12.5 mcg, the nurse should administer levothyroxine 0.5 tablet PO. Follow these steps for the "desired over have" method of calculation: Step 1: What is the unit of measurement the nurse should calculate? tablet Step 2: What is the dose the nurse should administer? 12.5 mcg Step 3: What is the dose available? 25 mcg Step 4: Should the nurse convert the units of measurement? No Step 5: What is the quantity of the dose available? 1 tablet Step 6: Set up an equation and solve for X. Desired x Quantity/Have = X 12.5 mcg x 1 tablet/25 mcg = X tablet 0.5 tablet = X Step 7: Round if necessary. Step 8: Reassess to determine whether the amount to give makes sense. If there are 25 mcg/1 tablet and the amount prescribed is 12.5 mcg, the nurse should administer levothyroxine 0.5 tablet PO. Follow these steps for the dimensional analysis method of calculation: Step 1: What is the unit of measurement the nurse should calculate? tablet Step 2: What is the quantity of the dose available? 1 tablet Step 3: What is the dose available? 25 mcg Step 4: What is the dose the nurse should administer? 12.5 mcg Step 5: Should the nurse convert the units of measurement? No Step 6: Set up an equation and solve for X. X = Quantity/Have x Conversion (Have)/Conversion (Desired) x Desired X tablet = 1 tablet/25 mcg x 12.5 mcg X = 0.5 tablet Step 7: Round if necessary. Step 8: Reassess to determine whether the amount to give makes sense. If there are 25 mcg/1 tablet and the amount prescribed is 12.5 mcg, the nurse should administer levothyroxine 0.5 tablet PO.

A nurse is caring for a client who has been receiving gastrostomy tube feedings and insulin. The client is scheduled to receive a tube feeding at 0700. At which of the following times should the nurse plan to administer insulin lispro subcutaneously?

0645 Lispro is a rapid-acting insulin with an onset of 15 minutes. The nurse should administer the insulin dose 15 minutes prior to the feeding.

A nurse is preparing to administer meperidine 100 mg IM to a client who has a BMI of 23. Which of the following needle lengths should the nurse use to administer the medication?

1 ½ inch In general, needle lengths for IM injections are 1 to ½ inches, unless the client is obese. A BMI of 23 is considered to be an optimal weight.

A nurse is preparing to administer metoclopramide 10 mg IM to a client who is postoperative and nauseated. The amount available is metoclopramide 5 mg/1 mL. How many mL should the nurse administer? (Fill in the blank with the numeric value only. Round to the nearest whole number. Use a leading zero if applicable but do not use a trailing zero.) Fill in the blank

2 Follow these steps for the ratio and proportion method of calculation: Step 1: What is the unit of measurement the nurse should calculate? mL Step 2: What is the dose the nurse should administer? 10 mg Step 3: What is the dose available? 5 mg Step 4: Should the nurse convert the units of measurement? No Step 5: What is the quantity of the dose available? 1 mL Step 6: Set up an equation and solve for X. Have/Quantity = Desired/X 5 mg/1 mL = 10 mg/X mL X = 2 mL Step 7: Round if necessary. Step 8: Reassess to determine whether the amount to give makes sense. If there are 5 mg/1 mL and the amount prescribed is 10 mg, the nurse should administer metoclopramide 2 mL IM. Follow these steps for the "desired over have" method of calculation: Step 1: What is the unit of measurement the nurse should calculate? mL Step 2: What is the dose the nurse should administer? 10 mg Step 3: What is the dose available? 5 mg Step 4: Should the nurse convert the units of measurement? No Step 5: What is the quantity of the dose available? 1 mL Step 6: Set up an equation and solve for X. Desired x Quantity/Have = X 10 mg x 1 mL/5 mg = X mL 2 mL = X Step 7: Round if necessary. Step 8: Reassess to determine whether the amount to give makes sense. If there are 5 mg/1 mL and the amount prescribed is 10 mg, it makes sense to administer 2 mL. The nurse should administer metoclopramide 2 mL IM. Follow these steps for the dimensional analysis method of calculation: Step 1: What is the unit of measurement the nurse should calculate? mL Step 2: What is the quantity of the dose available? 1 mL Step 3: What is the dose available? 5 mg Step 4: What is the dose the nurse should administer? 10 mg Step 5: Should the nurse convert the units of measurement? No Step 6: Set up an equation and solve for X. X = Quantity/Have x Conversion (Have)/Conversion (Desired) x Desired X mL = 1 mL/5 mg x 10 mL X = 2 mL Step 7: Round if necessary. Step 8: Reassess to determine whether the amount to give makes sense. If there are 5 mg/1 mL and the amount prescribed is 10 mg, the nurse should administer metoclopramide 2 mL IM.

A nurse is planning care for a client who is postoperative and scheduled to ambulate. At which of the following times should the nurse plan to administer PO morphine to the client for peak analgesic effect during the ambulation?

60-90 mins prior to admin It takes 60 to 90 minutes for the peak effect of PO morphine to occur. Medicating the client 60 to 90 minutes prior to ambulation will provide the greatest analgesic effect.

A nurse is caring for a client who has peptic ulcer disease and reports a headache. Which of the following medications should the nurse plan to administer?

Acetaminophen Acetaminophen is an analgesic used for mild to moderate pain. It can be administered to a client who has peptic ulcer disease because it does not affect blood coagulation and does not increase the risk of gastrointestinal bleeding.

A nurse is preparing to administer nitroglycerin topical ointment to a client who has angina. Which of the following actions should the nurse take?

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

A nurse is reinforcing teaching about preventing systemic toxicity with a client who is using topical lidocaine. Which of the following pieces of information should the nurse include about the application of topical lidocaine?

Apply topical lidocaine to affected areas that are intact The nurse should tell the client to apply topical lidocaine to skin that is intact rather than blistered, broken, or irritated to prevent a large amount of medication from being absorbed and to decrease the risk of systemic toxicity.

A nurse is reinforcing teaching with a client who has ulcerative colitis and a new prescription for sulfasalazine. The nurse should instruct the client to monitor for which of the following adverse effects of this medication?

Arthralagia Sulfasalazine can cause nausea, vomiting, and arthralgia.

A nurse is reinforcing discharge teaching with a client who has major depressive disorder and a new prescription for phenelzine. Which of the following foods should the nurse include in the plan as safe for the client to consume while taking phenelzine?

Broiled beef steak Phenelzine is an MAOI antidepressant. This medication interacts with a variety of foods to produce a hypertensive crisis. Beef steak and other meats that are fresh do not interact with phenelzine and are safe to consume.

A nurse is reviewing the medical history of a client who has a respiratory infection. The nurse notes the client has a severe penicillin allergy. Which of the following class of antibiotics is also contraindicated for this client?

Cephalosporins Cephalosporins such as cefazolin, cefaclor, and cefepime should not be prescribed to clients who have a severe allergy to penicillins as fatal anaphylaxis can occur. Cephalosporins can be prescribed to clients who have a mild penicillin allergy.

A nurse is collecting data from a client who has taken methimazole for a thyroid disorder over the past month. Which of the following findings demonstrates an expected response to methimazole?

Decreased body temperature Methimazole inhibits thyroid production for clients with hyperthyroidism. Increased body temperature with warm, moist skin is a manifestation of hyperthyroidism; therefore, a decreased body temperature is an expected response to the medication. Other findings demonstrating the effectiveness of the medication include a decreased pulse rate and a decreased metabolic rate, which allows the client to maintain a healthy body weight.

A nurse is caring for a client who takes ginkgo biloba daily at home. Which of the following effects should the nurse expect from the use of this herbal supplement?

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

A nurse is preparing to administer raloxifene to a client. Which of the following conditions is a contraindication for the administration of this medication?

Deep-vein thrombosis The nurse should identify that raloxifene, like estrogen, increases the risk of deep-vein thrombosis, pulmonary embolism, and stroke. Raloxifene is contraindicated for clients who have a history of venous thrombotic events.

A nurse is caring for a client who is 12 hours postoperative following a total hip arthroplasty. Which of following medications should the nurse anticipate administering to this client to prevent deep vein thrombosis (DVT)?

Enoxaparin The nurse should anticipate the administration of enoxaparin for a client who is 12 hours postoperative following surgery. Enoxaparin is low-molecular-weight (LMW) heparin that is used to prevent a DVT by inhibiting the effects of antithrombin and thrombin.

A nurse is caring for a client who has chronic renal failure and has developed anemia. Which of the following medications should the nurse expect the provider to prescribe?

Erythropoietin Erythropoietin is a hormone produced by the kidneys that stimulates the production of red blood cells. When levels are low, the kidneys increase the level of erythropoietin production. This homeostatic mechanism fails in a client who has chronic renal failure, and exogenous erythropoietin is prescribed. Administering erythropoietin to a client who has chronic renal failure can reduce the need for blood transfusions.

A nurse is reviewing the medical record of a client with rheumatoid arthritis who has a prescription for infliximab. Which of the following findings should the nurse identify as a contraindication to the client receiving this medication?

Hepatitis B virus The nurse should identify that infliximab is a tumor necrosis factor (TNF) antibody medication that is used to reduce the disease manifestations and to delay disease progression. Infliximab has immunosuppressant properties that can increase the risk of infection. Clients who have an active or chronic infection such as hepatitis B virus should not take infliximab.

A nurse is reviewing the medical record of a client who has postmenopausal osteoporosis and a prescription for raloxifene. Which of the following findings in the client's medical record should the nurse identify as a contraindication to receiving this medication?

History of deep-vein thrombosis (DVT) The nurse should identify that a history of DVT is a contraindication for receiving raloxifene because this medication can cause DVT in clients who have a prior history. Therefore, the nurse should notify the provider of this finding and request an alternative medication prescription for the client.

A nurse is reviewing the medical record of a client who is asking about taking a combination oral contraceptive. Which of the following findings should the nurse identify as a contraindication to taking this form of contraceptive?

History of thrombophlebitis The nurse should identify that a history of thrombophlebitis is an absolute contraindication to taking combination oral contraceptives (OCs). OCs promote thrombosis by raising levels of clotting factors.

A nurse is reviewing the medical record of a client who is experiencing an acute migraine attack and has a new prescription for sumatriptan. Which of the following findings indicates a contraindication to the administration of this medication?

History of uncontrolled hypertension Sumatriptan can cause coronary vasospasm; therefore, it is contraindicated for a client who has a history of a myocardial infarction, heart disease, or uncontrolled hypertension.

A nurse is caring for a client who has heart failure and is prescribed dobutamine hydrochloride by continuous IV infusion. The nurse should identify that which of the following is the therapeutic effect of this medication?

Improves cardiac output The nurse should identify that dobutamine is a vasopressor that improves cardiac output and hemodynamic status in clients.

A nurse is collecting data from an infant during a routine checkup. The parent asks the nurse about the infant's immunization schedule. Which of the following responses should the nurse make?

It is recommended that your infant have 6 immunizations at 2 mths of age An infant who is 2 months of age should receive 6 immunizations, followed by 5 immunizations at 4 months of age. The monovalent hepatitis B vaccine is administered within 12 hours of the infant's birth.

A nurse working in a mental health facility is admitting a client with opioid use disorder who is experiencing withdrawal. The nurse should anticipate a prescription for which of the following medications from the provider?

Methadone The nurse should anticipate a prescription from the provider for methadone for a client who is experiencing opioid withdrawal. Methadone is an opioid medication that is used for pain management and treatment of withdrawal manifestations in clients who have opioid use disorder.

A nurse in a provider's office is reinforcing teaching for a client who has type 2 diabetes mellitus and a new prescription for dulaglutide. Which of the following instructions should the nurse include?

Nausea is an adverse effect that decrease over time. Dulaglutide is a glucagon-like peptide 1 receptor agonist that is used for the treatment of type 2 diabetes mellitus. The most common adverse effect is nausea that usually decreases over time. Pancreatitis is another adverse effect. The client should be instructed to notify the provider if abdominal pain and nausea with vomiting occur.creases over time.

A nurse is collecting data from a client who has a new diagnosis of fibromyalgia. Which of the following medications should the nurse expect the provider to prescribe?

Pregabalin Pregabalin is 1 of 3 anticonvulsant medications specifically approved for the treatment of fibromyalgia. Pregabalin treats fibromyalgia pain by inhibiting neurotransmitter release. The medication has several adverse effects such as dizziness, sleepiness, blurred vision, weight gain, altered thinking, headache, peripheral edema, and dry mouth. Other medications approved for the treatment of fibromyalgia include the antidepressants duloxetine and milnacipran.

A nurse is reviewing the medical record of a client. The medication administration record shows the client is taking clopidogrel. Which of the following events should the nurse expect to be reported in the client's medical history?

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

A nurse is reinforcing teaching with a client who has tuberculosis and a prescription for rifampin. The nurse should identify which of the following findings as a harmless and expected adverse effect of rifampin?

Red-orange discoloration of urine The nurse should instruct the client that rifampin commonly causes a red-orange discoloration of body fluids. This adverse effect is considered harmless and does not need to be reported to the provider.

A nurse is preparing to administer an initial dose of etanercept for a client who has rheumatoid arthritis. For which of the following manifestations should the nurse monitor as a potential adverse effect of the medication?

Rhinitis The nurse should monitor the client for rhinitis as an adverse effect of etanercept. Other manifestations the nurse should monitor for include an upper respiratory infection, pharyngitis, and a cough.

A nurse in a provider's office is reinforcing teaching with a client who has osteoporosis and a new prescription for alendronate sodium. Which of the following pieces of information should the nurse provide?

Take alendronate sodium with a full glass of water on an empty stomach Alendronate sodium should be taken with at least 230 mL (8 oz) of water 30 minutes before ingesting foods. Maintaining an upright position is recommended after taking alendronate sodium to decrease the risk for esophagitis.

A nurse in a community health clinic is collecting data from a new client who has prescriptions for isoniazid and rifampin. Which of the following disorders should the nurse expect the client to have?

Tuberculosis The nurse should recognize that isoniazid and rifampin are first-line antitubercular medications used to treat active tuberculosis in combination therapy.

A nurse is reinforcing teaching with a client who has a prescription for a transdermal estradiol patch. In which of the following locations should the nurse instruct the client to apply the patch?

abdomen The nurse should instruct the client to apply the transdermal estradiol patch to the skin of the trunk (e.g. the abdominal area) but not the breasts. This allows the estrogen from the patch to be absorbed through the skin directly into the client's blood.

A nurse in a provider's office is collecting data from a client who has been taking amoxicillin for 10 days and reports diarrhea and cramping. The nurse should recognize that these manifestations occur secondary to which of the following adverse effects?

alterations in GI flora The typical gastrointestinal flora are often destroyed by broad-spectrum antibiotics such as amoxicillin, causing poor digestion and possible superinfection with other bacteria.

A nurse is assisting with the care of a client who has been in the PACU for more than 1 hour. He has a respiratory rate of 9/min and is difficult to arouse. The nurse should expect a prescription for which of the following medications?

naloxone The nurse should expect a prescription for naloxone. This medication displaces opiate medications from receptor sites, reversing the respiratory depression, sedation, and analgesia that opiates cause.

A nurse is reinforcing teaching about benzodiazepines with a client who is discontinuing long-term use of alprazolam. Which of the following pieces of information should the nurse include in the teaching?

plan to taper the dose slowly over several months The nurse should instruct the client to plan to taper the alprazolam, a benzodiazepine and CNS depressant, dose slowly over several weeks or months to ease the physiological and psychological manifestations of withdrawal.

A nurse is teaching a client who has type 1 diabetes mellitus about a new subcutaneous insulin infusion pump. Which of the following pieces of information should the nurse reinforce in the teaching?

plan to use a type of short duration insulin in the insulin pump The client should plan to use short-duration insulin such as regular, lispro, aspart, or glulisine insulin in the infusion pump to deliver a baseline infusion of insulin. The client should also administer bolus doses of insulin before each meal.

A nurse is reinforcing teaching about self-administration of NPH insulin with a client who has type 2 diabetes mellitus. Which of the following instructions should the nurse include?

rotate injection sites within the same area To prevent lipodystrophy, the client should rotate injection sites, making them about 2.5 cm (1 in) apart, within the same anatomical area.

A nurse is caring for an adolescent who has cystic fibrosis (CF) and has a prescription for high-dose ibuprofen daily. The nurse should identify that which of the following is an expected outcome for the client receiving this medication?

slowed progression of pulmonary damage The nurse should identify that clients who have CF are prescribed high-dose Ibuprofen, which is an NSAID, to slow the progression of pulmonary damage by suppressing the inflammatory response that causes pulmonary damage. CF is a genetic disorder that primarily affects the lungs, pancreas, and sweat glands.

A nurse is reinforcing discharge teaching with a client who has a new prescription for cyclosporine following a kidney transplant. Which of the following client statements indicates an understanding of the teaching?

"I should schedule an appointment with my dentist every 3 months." The nurse should reinforce with the client that gingival hyperplasia is a potential adverse effect of cyclosporine. The client should maintain proper oral hygiene and schedule a dental examination for teeth cleaning and plaque control every 3 months to help decrease gingival inflammation and hyperplasia.

A nurse is teaching a client who has a new prescription for amitriptyline to treat depression. Which of the following client statements indicates an understanding of the teaching?

"I should take this medication before bedtime." The nurse should instruct the client that an adverse effect of amitriptyline is sedation. The nurse should instruct the client to take the medication at bedtime to minimize sedation during waking hours while promoting sleep.

A nurse in a provider's office is reinforcing teaching with a female client who has a new diagnosis of seizures and a prescription for valproic acid. Which of the following pieces of information should the nurse provide?

"This medication can cause changes in your mood and behavior." All anti-seizure medications can cause an increased risk of suicidal thoughts and behavior. The nurse should inform the client of this adverse effect and instruct her to notify the provider if depression, anxiety, panic, or thoughts of dying occur.

A nurse is reinforcing teaching with a client who has been taking an NSAID to treat rheumatoid arthritis. During the client's first month checkup, the provider prescribed methotrexate to be added to the medication regimen. Which of the following statements should the nurse include in the teaching about the purpose of this change in the client's medication?

"This medication was added to delay the disease progression." The nurse should inform the client that the provider prescribed methotrexate to be added to the medication regimen along with an NSAID to delay the progression of the disease and to delay joint damage or deformity that can result from the disease.

A nurse is preparing to administer cefaclor 750 mg PO in 3 divided doses. Cefaclor 500 mg/tablet is available. How many tablets should the nurse administer with each dose? (Fill in the blank with the numeric value only. Round the answer to the nearest tenth. Use a leading zero if applicable but do not use a trailing zero.)

0.5 Follow these steps for the ratio and proportion method of calculation: Step 1: What is the unit of measurement the nurse should calculate? tablet Step 2: What is the dose the nurse should administer? 750 mg/3 doses daily = 250 mg Step 3: What is the dose available? 500 mg Step 4: Should the nurse convert the units of measurement? No Step 5: What is the quantity of the dose available? 1 tablet Step 6: Set up an equation and solve for X. Have/Quantity = Desired/X 500 mg/1 tablet = 250 mg/X tablet X = 0.5 Step 7: Round if necessary. Step 8: Reassess to determine whether the amount to administer makes sense. If there are 500 mg/tablet and the amount prescribed is 250 mg, the nurse should administer cefaclor 0.5 tablet PO 3 times daily. Follow these steps for the "desired over have" method of calculation: Step 1: What is the unit of measurement the nurse should calculate? tablet Step 2: What is the dose the nurse should administer? 750 mg/3 doses daily = 250 mg Step 3: What is the dose available? Dose available = Have 500 mg Step 4: Should the nurse convert the units of measurement? No Step 5: What is the quantity of the dose available? 1 tablet Step 6: Set up an equation and solve for X. Desired x Quantity/Have = X 250 mg x 1 tablet/500 mg = X tablet 0.5 = X Step 7: Round if necessary. Step 8: Reassess to determine whether the amount to administer makes sense. If there are 500 mg/tablet and the amount prescribed is 250 mg, the nurse should administer cefaclor 0.5 tablet PO 3 times daily. Follow these steps for the dimensional analysis method of calculation: Step 1: What is the unit of measurement the nurse should calculate? tablet Step 2: What is the quantity of the dose available? 1 tablet Step 3: What is the dose available? Dose available = Have 500 mg Step 4: What is the dose the nurse should administer? 750 mg/3 doses daily = 250 mg Step 5: Should the nurse convert the units of measurement? No Step 6: Set up an equation and solve for X. X = Quantity/Have x Conversion (Have)/Conversion (Desired) x Desired X tablet = 1 tablet/500 mg x 250 mg X = 0.5 Step 7: Round if necessary. Step 8: Reassess to determine whether the amount to administer makes sense. If there are 500 mg/tablet and the amount prescribed is 250 mg, the nurse should administer cefaclor 0.5 tablet PO 3 times daily.

A nurse is preparing to administer heparin 8,000 units subcutaneously every 8 hours. Heparin 10,000 units/1 mL is available. How many mL should the nurse administer per dose? (Fill in the blank with the numeric value only. Round the answer to the nearest tenth. Use a leading zero if applicable but do not use a trailing zero.) Fill in the blank

0.8 To solve using the ratio and proportion method: STEP 1: What is the unit of measurement the nurse should calculate? mL STEP 2: What is the dose the nurse should administer? 8,000 units STEP 3: What is the dose available? 10,000 units STEP 4: Should the nurse convert the units of measurement? No STEP 5: What is the quantity of the dose available? 1 mL STEP 6: Set up an equation and solve for X. Have/Quantity = Desired/X 10,000 units/1 mL = 8,000 mg/X mL X = 0.8 mL STEP 7: Round if necessary. STEP 8: Reassess to determine whether the amount to give makes sense. If there are 10,000 units/1 mL and the amount prescribed is 8,000 units, the nurse should administer 0.8 mL heparin subcutaneously every 8 hours. To solve using the "desired over have" method: STEP 1: What is the unit of measurement the nurse should calculate? mL STEP 2: What is the dose the nurse should administer? 8,000 units STEP 3: What is the dose available? 10,000 units STEP 4: Should the nurse convert the units of measurement? No STEP 5: What is the quantity of the dose available? 1 mL STEP 6: Set up an equation and solve for X. Desired x Quantity/Have = X 8,000 units x 1 mL/10,000 units = X mL 0.8 mL = X STEP 7: Round if necessary. STEP 8: Reassess to determine whether the amount to give makes sense. If there are 10,000 units/1 mL and the amount prescribed is 8,000 units, the nurse should administer 0.8 mL heparin subcutaneously every 8 hours. To solve using dimensional analysis: STEP 1: What is the unit of measurement the nurse should calculate? mL STEP 2: What is the quantity of the dose available? 1 mL STEP 3: What is the dose available? 10,000 units STEP 4: What is the dose the nurse should administer? 8,000 units/hr STEP 5: Should the nurse convert the units of measurement? No STEP 6: Set up an equation and solve for X. X = Quantity/Have x Conversion (Have)/Conversion (Desired) x Desired X mL = 1 mL/10,000 units x 8,000 units/ X = 0.8 STEP 7: Round if necessary. STEP 8: Reassess to determine whether the amount to give makes sense. If there are 10,000 units/1 mL and the amount prescribed is 8,000 units, the nurse should administer 0.8 mL heparin subcutaneously every 8 hours. Peer Comparison Correct 76% Incorrect 24% Response Time: 0:00 Difficulty level: Moderate

A nurse is preparing to administer meperidine 50 mg IM for pain. Meperidine is available for injection at 25 mg/0.5 mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if applicable but do not use a trailing zero.) Fill in the blank

1 Follow these steps for the Ratio and Proportion method of calculation: STEP 1: What is the unit of measurement the nurse should calculate? mL STEP 2: What is the dose the nurse should administer? 50 mg STEP 3: What is the dose available? 25 mg STEP 4: Should the nurse convert the units of measurement? No STEP 5: What is the quantity of the dose available? 0.5 mL STEP 6: Set up an equation and solve for X.Have/Quantity = Desired/X25 mg/0.5 mL = 50 mg/X mLX = 1 mL STEP 7: Round if necessary. STEP 8: Determine whether the amount to administer makes sense. If there are 25 mg/0.5 mL and the amount prescribed is 50 mg, the nurse should administer 1 mL meperidine IM. Follow these steps for the "desired over have" method of calculation: STEP 1: What is the unit of measurement the nurse should calculate? mL STEP 2: What is the dose the nurse should administer? 50 mg STEP 3: What is the dose available? 25 mg STEP 4: Should the nurse convert the units of measurement? No STEP 5: What is the quantity of the dose available? 0.5 mL STEP 6: Set up an equation and solve for X.Desired x Quantity/Have = X50 mg x 0.5 mL/25 mg = X mL1 mL = X STEP 7: Round if necessary. STEP 8: Determine whether the amount to administer makes sense. If there are 25 mg/0.5 mL and the amount prescribed is 50 mg, the nurse should administer 1 mL meperidine IM. Follow these steps for the dimensional analysis method of calculation: STEP 1: What is the unit of measurement the nurse should calculate? mL STEP 2: What is the quantity of the dose available? 0.5 mL STEP 3: What is the dose available? 25 mg STEP 4: What is the dose the nurse should administer? 2.5 mg STEP 5: Should the nurse convert the units of measurement? No STEP 6: Set up an equation and solve for X.X = Quantity/Have x Conversion (Have)/Conversion (Desired) x DesiredX mL = 0.5 mL/25 mg x 50 mgX = 1 mL STEP 7: Round if necessary. STEP 8: Determine whether the amount to administer makes sense. If there are 25 mg/0.5 mL and the amount prescribed is 50 mg, the nurse should administer 1 mL meperidine IM.

A nurse is reinforcing teaching with the guardian of an infant about the diphtheria, tetanus, and pertussis (DTaP) vaccine. Which of the following pieces of information should the nurse include in the teaching?

1st immunization for DTaP in the series is given at 2 months The nurse should tell the guardian that the first immunization of DTaP is given at 2 months, with the rest of the vaccinations occurring at 4 months, 6 months, 15 to 18 months, and 4 to 6 years of age.

A nurse is assisting with the administration of cefepime 1 g in 5% dextrose in water (D5W) 50 mL over 30 minutes to a client who has pneumonia. 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? (Fill in the blank with the numeric value only. Round to the nearest whole number. Use a leading zero if applicable but do not use a trailing zero.)

25

A nurse is preparing to administer lactated Ringer's (LR) 700 mL IV infused over 24 hours to a pediatric client. The drop factor of the manual IV tubing is 60 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Fill in the blank with the numeric value only. Round the answer to the nearest whole number. Use a leading zero if applicable but do not use a trailing zero.) Fill in the blank

29 Follow these steps to calculate the infusion rate: Step 1: What is the unit of measurement the nurse should calculate? gtt/min Step 2: What is the quantity of the drop factor that is available? 60 gtt/mL Step 3: What is the total infusion time? 24 hr Step 4: What is the volume the nurse should infuse? 700 mL Step 5: Should the nurse convert the units of measurement? Yes (min does not equal hr) 1 hr/60 min Step 6: Set up an equation and solve for X. Quantity/1 mL x Conversion (hr)/Conversion (min) x Volume (mL)/Time (min) = X gtt/min 60 gtt/1 mL x 1 hr/60 min x 700 mL/24 hr = X gtt/min 60 gtt/1 mL x 700 mL/1,440 min = X gtt/min X = 29.2 Step 7: Round if necessary. 29.2 = 29 gtt/min Step 8: Reassess to determine if the amount to administer makes sense. If the prescription is for 700 mL infused over 24 hours and the drop factor is 60 gtt/mL, the nurse should set the manual IV infusion to deliver lactated Ringer's by continuous IV at 29 gtt/min.

A nurse is caring for a client who has asthma and a prescription for zileuton. Which of the following laboratory values should the nurse monitor while the client is taking this medication?

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

A nurse in a provider's office is reinforcing medication teaching with a client who has developed asthma. Which of the following medications should the nurse identify as being prescribed for the short-term relief of asthma symptoms?

Albuterol Albuterol is a beta-adrenergic agonist that is used as a short-acting medication for the control of asthma. It is administered by inhalation either through an inhaler or a nebulizer. Short acting beta-adrenergic agonists (SABAs) work by inducing bronchodilation to relieve bronchospasms. They also can suppress histamine relief and increase ciliary motility in the lungs. SABAs are the most effective medications for bronchospasm and exercise induced bronchospasm.

A nurse is assisting in teaching a group of nurses about the manifestations of progestin deficiency for clients who take a combination oral contraceptive (OC). Which of the following findings should the nurse include in the teaching as an indication of progestin deficiency?

Amenorrhea A client who takes a combination OC and has a progestin deficiency can have amenorrhea. Increasing the OC dose of progestin can result in a more regular menstrual cycle.

A nurse working in the emergency department is admitting a client who has a gastric ulcer and gastrointestinal (GI) bleeding. Which of the following factors in the client's medical history should the nurse report to the provider?

Arthritis treated with ibuprofen every 8 hours as needed The nurse should identify that ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs can cause gastrointestinal bleeding and are contraindicated for clients who have ulcer disease. NSAIDs inhibit prostaglandin secretion, which decreases blood flow in the GI tract and decreases bicarbonate and mucus secretion. This environment promotes the secretion of gastric acid and needs to be reported to the provider.

A nurse in a provider's office is collecting data from a client who reports taking a dietary supplement to reduce hot flashes related to menopause. Which of the following supplements is this client probably taking?

Black cohosh Black cohosh is an herb that is used for the treatment of menopausal symptoms such as hot flashes, vaginal dryness, irritability, and sleep disturbance.

A nurse is reinforcing teaching with an assistive personnel (AP) about dietary restrictions for a client who is taking phenelzine to treat depression. The AP's selection of which of the following foods for the client's lunch indicates an understanding of the instructions?

Chicken salad Phenelzine is an MAOI. Clients taking MAOIs must avoid foods that contain tyramine due to a dangerous food-drug interaction. Foods high in tyramine include those that are processed and aged such as lunchmeats and cheeses. This menu selection does not contain foods high in tyramine; therefore, it is the best choice.

A nurse is caring for a client who has multiple medication allergies. During which of the following steps of the nursing process should the nurse identify the client's allergies?

Data collection The data collection step of the nursing process involves collecting pertinent information, which includes the identification of the client's allergies.

A nurse is assisting with the admission of a client who has atrial fibrillation with a heart rate of 155/min. The nurse should anticipate a prescription from the provider for which of the following medications?

Diltiazem The nurse should anticipate the provider to prescribe diltiazem for a client who is experiencing atrial fibrillation. Diltiazem is an antiarrhythmic agent that reduces the ventricular rate in atrial fibrillation.

A nurse in a provider's office is reinforcing teaching with a client who has psoriatic arthritis and a new prescription for adalimumab. Which of the following instructions should the nurse provide about treatment with adalimumab?

Do not receive live vaccines while on this medication. The nurse should instruct the client that vaccinations with live viruses should not be received while on adalimumab. The medication can cause neutropenia, which will suppress the immune system. The client should be instructed to protect against and monitor for infections while on the medication.

A nurse is preparing to administer the varicella vaccine to a 12-month-old infant. The nurse asks the infant's guardian if the infant has any allergies. Which of the following allergies is a contraindication to the infant receiving the vaccine?

Gelatin An allergy to gelatin is a contraindication to receiving the varicella vaccine; therefore, the nurse should contact the infant's provider.

A nurse is collecting data from a client who has type 2 diabetes mellitus and is taking metformin. Which of the following findings should indicate to the nurse that the medication is having a therapeutic effect?

Glycosylated hemoglobin (HbA1C) of 6.8% The nurse should identify that an HbA1c level of 6.8% is within the expected reference range of less than 7%, indicating the medication is having a therapeutic effect.

A nurse is preparing to administer an initial dose of zileuton to a client for asthma prophylaxis. For which of the following manifestations should the nurse monitor as a potential adverse reaction?

Hallucinations Leukotriene modifiers such as zileuton can cause adverse neuropsychiatric effects like hallucinations, unusual dreams, agitation, anxiety, and suicidal thinking. The nurse should report this adverse effect so the provider can consider switching the client to a different medication.

A nurse is collecting data from a client who is taking vasopressin for diabetes insipidus. Which of the following findings should the nurse identify as a manifestation of water intoxication associated with this medication?

Headache The nurse should identify that a headache is a manifestation of water intoxication, an adverse effect of vasopressin. The nurse should report this manifestation to the client's provider.

A nurse is reviewing the medical history of a client who has spasticity due to multiple sclerosis and a new prescription for tizanidine. Which of the following comorbidities should the nurse identify as increasing the client's risk for adverse effects while taking this medication?

Hepatitis Tizanidine can cause liver damage. This medication should be used with extreme caution by a client who has a preexisting impairment of hepatic function.

A nurse is collecting data on a client who has developed hypertension that is unresponsive to lifestyle changes. The client has no other comorbidities. Which of the following medications should the nurse expect the provider to prescribe first?

Hydrochlorothiazide Hydrochlorothiazide is a thiazide diuretic that is used alone or with other antihypertensive agents. It is a first-line choice for treating hypertension. Hydrochlorothiazide is the most frequently prescribed medication for hypertension.

A nurse is caring for a client who has osteoporosis and has been taking a vitamin D supplement. The nurse notes that the client reports also taking a multivitamin daily. Which of the following findings should indicate to the nurse that the client might be experiencing vitamin D toxicity?

Hypercalcemia The nurse should identify that vitamin D increases plasma calcium levels by increasing reabsorption from bone, decreasing excretion by the kidneys and increasing absorption from the intestines. Clients who take a vitamin D supplement along with a multivitamin daily might be taking too much calcium.

A nurse is reinforcing teaching with a client who has chemotherapy-induced anemia and a prescription for epoetin alfa. The nurse should instruct the client to report which of the following findings as an adverse effect of epoetin alpha?

Hypertension The nurse should instruct the client to report hypertension, which is an adverse effect of epoetin alfa. Other adverse effects can include headaches, seizures, heart failure, and thromboembolic events related to increased hemoglobin levels.

A nurse is monitoring a client with pneumonia who has received penicillin G intramuscularly (IM). Which of the following findings should the nurse plan to evaluate first?

Laryngeal edema When using the urgent vs nonurgent approach to client care, the nurse should determine that the priority finding is laryngeal edema, which can indicate the client is experiencing an allergic reaction to penicillin G. The nurse should also consider that the client is experiencing an anaphylactic reaction, which can be life-threatening. Anaphylaxis is an immediate hypersensitivity reaction that requires the primary treatment of epinephrine in addition to respiratory support.

A nurse is reviewing the medical record of a client who has a prescription for a combination oral contraceptive. The nurse should identify that which of the following findings is a contraindication to receiving this medication?

Liver disease The nurse should identify that liver disease or abnormal liver function is a contraindication to receiving a combination oral contraceptive. Therefore, the nurse should notify the client's provider. Other contraindications include thrombophlebitis or breast cancer.

A nurse is reinforcing teaching with a newly licensed nurse about caring for a client who has a prescription for gemfibrozil. The nurse should instruct the newly licensed nurse to monitor which of the following laboratory tests?

Liver function Gemfibrozil reduces triglycerides by decreasing the liver's uptake of fatty acids. It can cause liver toxicity; therefore, the nurse should monitor the client's liver function.

A nurse is caring for a client who is receiving a continuous IV infusion of erythromycin lactobionate to treat a Bordetella pertussis infection. Which of the following actions should the nurse perform to minimize the risk of thrombophlebitis?

Make sure the medication infuses slowly The nurse should make sure erythromycin infuses slowly to minimize the risk of thrombophlebitis, which is an inflammatory process resulting from the formation of a blood clot in a vein. These blood clots usually form in the legs.

A nurse is caring for a client who has dry mouth resulting from radiation therapy and a new prescription for oral pilocarpine. The nurse should identify a potential incompatibility with which of the following medications?

Metoprolol The nurse should identify that taking a beta blocker such as metoprolol with oral pilocarpine can increase the risk of cardiovascular adverse reactions like conduction disturbances.

A nurse is caring for a client who has developed a mild Clostridium difficile infection following antibiotic therapy. After discontinuing the current antibiotic, the nurse should expect the provider to prescribe which of the following medications?

Metronidazole Metronidazole is a nitroimidazole antibiotic that is active against anaerobic bacteria such as C. difficile infection. It is the drug of choice for mild to moderate cases of C. difficile. Metronidazole is also effective against protozoal infections.

A nurse is caring for a client who has a new prescription for ergotamine. The nurse should recognize that ergotamine is administered to treat which of the following conditions?

Migraine headaches Ergotamine prevents or stops migraine headaches by blocking alpha-adrenergic receptors in the cranial peripheral vascular smooth muscle, which causes vasoconstriction of dilated cerebral blood vessels.

A nurse is assisting with the admission of a client who has unstable angina. Which of the following medications should the nurse anticipate administering to the client?

Nitroglycerin The nurse should anticipate administering nitroglycerin to a client who has unstable angina. This medication acts by relaxing or preventing spasms in the coronary arteries along with dilating the arteries, which increases oxygenation and blood flow.

A nurse is preparing to apply a fentanyl transdermal patch to a client who has chronic pain. Which of the following actions should the nurse take?

Press the patch firmly for 30 seconds to ensure contact with the skin To apply a fentanyl transdermal patch, the nurse should press firmly on the patch (especially around the edges) for 30 seconds to ensure that contact with the skin is complete.

A nurse in an acute care facility is preparing a reconciled list of medications for a client who is being discharged home. Which of the following actions should the nurse take?

Provide the client and the next care provider with a list of medications the client will take after discharge The nurse should provide a reconciled medication list that includes any medications the provider prescribes at the time of discharge for the client to take after discharge. The list should also include any other medications the client will be taking, including over-the-counter medications and supplements. If the client was taking other prescription medications before admission to the acute-care facility and did not receive them during treatment in the facility, the provider should confirm whether the client should resume taking them after discharge.

A nurse is preparing to administer an otic medication to an adult client. Which of the following actions should the nurse take?

Pull the pinna of the client's ear upward and outward The nurse should pull the pinna of the client's ear upward and outward so the nurse can instill the medication into the clients ear canal

A nurse is reinforcing teaching with a client who has a new prescription for sertraline. The client asks the nurse if he should continue to take St. John's wort for depression. Which of the following instructions should the nurse give the client?

Stop taking the herbal supplement while taking the medication Taking the antidepressant sertraline and the herbal supplement St. John's wort together puts the client at risk for serotonin syndrome.

A nurse is reinforcing teaching with a client who has rheumatoid arthritis and a prescription for long-term prednisone therapy. The nurse should instruct the client to monitor for which of the following adverse effects?

Stress fractures Prednisone can cause demineralization of the bones and can lead to osteoporosis and stress fractures.

A nurse in a provider's office is collecting data from a client who has been experiencing migraine headaches. Which of the following medications should the nurse expect the provider to prescribe for abortive therapy of migraine headaches?

Sumatriptan Sumatriptan is prescribed to abort an ongoing migraine headache. The medication is available as oral tablets, nasal inhalation, subcutaneous injection, and transdermal patch. Sumatriptan can also relieve the associated symptoms related to migraine headaches such as nausea and photophobia.

A nurse is collecting data from a client who is receiving clozapine to treat schizophrenia. The nurse should identify that an increase in which of the following parameters is an early indication of agranulocytosis?

Temperature Antipsychotic medications such as clozapine can cause agranulocytosis, which is the depletion of WBCs. This increases the client's risk of infection. A fever is an early indication that the client should have a WBC count check to detect agranulocytosis.

A nurse suspects that a client is having an allergic reaction to a medication. Which of the following factors should the nurse identify as increasing the likelihood of an allergic reaction to the medication?

The client has had previous exposure to the medication. Once the immune system has developed sensitization to a medication, a subsequent exposure to that same medication can result in an allergic response. The more exposure the client has to the medication, the more intense the reaction will likely be.

A nurse is preparing to administer an IM injection for a client. Which of the following factors should the nurse identify as a potential contraindication to administering the medication via the IM route?

The client is taking an anticoagulant. Because of the risk of bleeding from the injection site, anticoagulant therapy (e.g. warfarin) is a contraindication to receiving medications via the IM route.

A nurse is reviewing the medication history of a client who has asthma. Which of the following medication combinations should the nurse identify as incompatible?

Theophylline and zileuton The nurse should identify that zileuton, a leukotriene modifier, impairs the metabolism of certain medications. Concurrent use of zileuton with theophylline can cause toxicity due to elevated theophylline, which is a systemic methylxanthine used to relax the smooth muscles of the airway. Therefore, these medications are incompatible when used together.

A nurse is assisting with the administration of an IV injection to a client. For which of the following reasons should the nurse inject the medication slowly?

To reduce toxicity risk Prior to injecting an IV medication, the nurse should plan to infuse the medication slowly over 1 minute to reduce the risk for toxicity to the central nervous system (CNS). Manifestations of CNS toxicity can become evident as soon as 15 seconds after initiating the injection. If the injection is done slowly, only a small amount of the total dose will have been administered when manifestations of toxicity appear. If the nurse is able to discontinue the administration immediately, adverse effects can be much less severe than if the entire dose had been given quickly.

A nurse is caring for a client who takes gentamicin IM and has a prescription to obtain a blood sample to measure a trough level. At which of the following times should the nurse should draw the blood sample?

Within 15 minutes prior to the next medication dose The nurse should obtain the blood sample for a trough medication level immediately before or within 15 minutes of giving a dose of the medication, regardless of the route of administration.

A nurse is caring for a client who was recently diagnosed with rheumatoid arthritis. The nurse should expect the provider to prescribe methotrexate at which of the following times?

Within 3 months of the initial diagnosis The nurse should identify that current guidelines recommend starting a disease-modifying antirheumatic drug (DMARD) such as methotrexate within 3 months of a diagnosis of rheumatoid arthritis to prevent or delay joint degeneration.

A nurse is reinforcing teaching with a client who has a prescription for a combination oral contraceptive (OC) that uses a 28-day cycle. Which of the following instructions should the nurse include in the teaching?

You can miss up to 7 pills with little risk in getting pregnant as long as you have taken the pills regularly for the previous 3 weeks The nurse should instruct this client that up to 7 days can be missed with little or no increase in the chance of getting pregnant, provided that the client took the pills continuously for the previous 3 weeks.