Pharmacology Test One Questions and Answers WITH Rationales

-A nurse is caring for a client who has cancer and a new prescription for ondansetron to treat chemotherapy-induced nausea. For which of the following adverse effects should the nurse monitor?

Headache RATIONALE: Headache is a common adverse effect of ondansetron. Analgesic relief is often required.

-A nurse is preparing a presentation about echinacea to a group of clients. Which of the following information should the nurse include in the teaching?

"Echinacea increases the ability to walk further distances for clients who have PAD." RATIONALE: Ginkgo biloba can increase the client's ability to walk further distances by decreasing pain in the lower extremities.

-nontherapeutic

B (Hormones)

-A nurse is educating a group of clients about the contraindications of warfarin therapy. Which of the following statements should the nurse include in the teaching?

"Clients who are pregnant should not take warfarin." RATIONALE: Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta and places the fetus at risk for bleeding.

-A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide?

"Crushing the medication might cause you to have a stomachache or indigestion." RATIONALE: The pill is enteric-coated to prevent breakdown in the stomach and decrease the possibility of GI distress. Crushing the pill destroys that protection.

-A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching?

"I have started taking ginger root to treat my joint stiffness." RATIONALE: Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. This statement indicates the client needs further teaching.

-A nurse is providing teaching to a client who has a new prescription for transdermal nitroglycerin paste. Which of the following statements by the client indicates the need for further teaching?

"I should leave the patch in place until it is time for the next dose." RATIONALE: Clients should have a period of 10 to 12 hr without the patch on to reduce the risk for nitrate tolerance.

-A nurse is providing teaching to a client who has a new prescription for lisinopril. Which of following statements by the nurse indicates an understanding of the teaching?

"I should report a cough to my provider." RATIONALE: The client should report a cough to the provider. The provider should discontinue the medication for a persistent, irritating cough.

-A nurse is teaching about medications to a group of clients. Which of the following statements by a client indicates a need for further teaching?

"I will take aspirin to reduce pain from my peptic ulcer." RATIONALE: Aspirin is contraindicated in clients who have bleeding disorders and peptic ulcer disease.

-A nurse is teaching a client who has angina pectoris about starting therapy with SL nitroglycerin tablets. The nurse should include which of the following instructions regarding how to take the medication?

"Take one tablet at the first indication of chest pain." RATIONALE: The client should take nitroglycerin as soon as he feels pain, pressure, or tightness in his chest and not wait until his chest pain is severe.

-A nurse is teaching a client who has a new prescription for docusate. Which of the following information should the nurse include in the teaching?

"Take the medication with a full glass of water." RATIONALE: The nurse should instruct the client to take this medication with a full glass of water, unless contraindicated, to reduce the risk for constipation.

-A nurse is caring for a client who has a new prescription for ferrous sulfate tablets twice daily for iron-deficiency anemia. The client asks the nurse why the provider instructed that she take the ferrous sulfate between meals. Which of the following responses should the nurse make?

"Taking the medication between meals will help you absorb the medication more efficiently." RATIONALE: Ferrous sulfate provides the iron needed by the body to produce red blood cells. Taking iron supplements between meals helps to increase the bioavailability of the iron.

-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?

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.

-A nurse is teaching a client who has diabetes mellitus and a new prescription for glimepiride. The nurse should teach the client to avoid which of the following drinks while taking this medication?

Alcohol. RATIONALE: The nurse should teach the client to avoid alcohol while taking this medication to prevent a disulfiram reaction, such as nausea, headache, and hypoglycemia.

-A nurse is teaching a client who has a new prescription for transdermal nitroglycerin to treat angina pectoris. Which of the following instructions should the nurse include in the teaching?

Apply the transdermal patch in the morning. RATIONALE: The client should apply the patch every morning and leave it in place for a 12 to 14 hr, then remove it in the evening.

-A nurse caring for a client who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions?

Asthma. RATIONALE: Propranolol, a beta-blocker, is contraindicated in clients who have asthma because it can cause bronchospasms. Propranolol blocks the sympathetic stimulation, which prevents smooth muscle relaxation.

-A nurse is teaching a client who has hypertension and a new prescription for atenolol. Which of the following findings should the nurse include as adverse effects of this medication?

Bradycardia. RATIONALE: Atenolol is a beta-blocker, which slows the heart rate. The nurse should instruct the client to monitor his pulse rate and report bradycardia.

-complementary and alternative therapies

C (Herbs)

-A nurse is reviewing the medical record of a client who has been on levothyroxine for several months. Which of the following findings indicates a therapeutic response to the medication?

Decrease in level of thyroid stimulating hormone (TSH). RATIONALE: In hypothyroidism, the nonfunctioning thyroid gland is unable to respond to the TSH, and no endogenous thyroid hormones are released. This results in an elevation of the TSH level as the anterior pituitary continues to release the TSH to stimulate the thyroid gland. Administration of exogenous thyroid hormones, such as levothyroxine, turns off this feedback loop, which results in a decreased level of TSH.

-A nurse is assessing a client who is receiving IV vancomycin. The nurse notes a flushing of the neck and tachycardia. Which of the following actions should the nurse take?

Decrease the infusion rate on the IV. RATIONALE: This client is experiencing Red man syndrome, which includes a flushing of the neck, face, upper body, arms and back along with tachycardia, hypotension and urticaria. This can lead to an anaphylactic reaction if the IV infusion rate is not slowed down to run greater than 1 hour.

-A nurse is caring for a client who is taking lisinopril. Which of the following outcomes indicates a therapeutic effect of the medication?

Decreased blood pressure RATIONALE: Lisinopril, an ACE inhibitor, may be used alone or in combination with other antihypertensives in the management of hypertension and congestive heart failure. A therapeutic effect of the medication is a decrease in blood pressure.

-The _______________ route means the nurse will administer the drug to the patient by mouth, under the tongue, or into the rectum.

Enteral

-A nurse is assessing a client prior to administering atenolol. Which of the following findings should prompt the nurse to withhold the medication?

Heart rate 46/min. RATIONALE: The nurse should check the client's heart rate prior to administering a beta-blocker. If the client's heart rate is less than 50/min, the nurse should hold the medication and contact the provider. Atenolol is a beta-blocker and is used in the treatment of hypertension and angina, and following a myocardial infarction. This medication works by slowing the heart rate, decreasing the speed of electrical impulses through the atrioventricular node, and decreasing the force of contraction.

-A nurse is caring for a client who has heart failure and is receiving IV furosemide. The nurse should monitor the client for which of the following electrolyte imbalances?

Hyperuricemia. RATIONALE: The nurse should monitor the client who is receiving IV furosemide for hyperuricemia. The nurse should instruct the client to notify the provider for any tenderness or swelling of the joints.

-A nurse is preparing to administer verapamil by IV bolus to a client who is having cardiac dysrhythmias. For which of the following adverse effects should the nurse monitor when giving this medication?

Hypotension RATIONALE: Verapamil, a calcium channel blocker, can be used to control supraventricular tachyarrhythmias. It also decreases blood pressure and acts as a coronary vasodilator and antianginal agent. A major adverse effect of verapamil is hypotension; therefore, blood pressure and pulse must be monitored before and during parenteral administration.

-A nurse is assessing a client who reports acute pain. The nurse should anticipate which of the following findings?

Increased heart rate. RATIONALE: Acute pain stimulates the sympathetic nervous system and can cause an increase in heart rate.

-A nurse is preparing to administer heparin to a client. Which of the following actions should the nurse plan to take?

Inject the medication into the abdomen above the level of the iliac crest. RATIONALE: The nurse should inject the medication into the abdomen above the level of the iliac crest, at least 2 inches from the umbilicus.

-A nurse is teaching a client who has a new prescription for aspirin to prevent cardiovascular disease. Which of the following instructions should the nurse include in the teaching?

Monitor for tinnitus. RATIONALE: Tinnitus is a manifestation of salicylism, or aspirin toxicity. Other manifestations include sweating, headache, and dizziness.

-A nurse is caring for a client who has a bacterial infection and is receiving gentamicin. Which of the following actions should the nurse take to minimize the risk of an adverse effect of the medication?

Monitor the serum medication levels. RATIONALE: A disadvantage of gentamicin, an aminoglycoside, is the association with nephrotoxicity and ototoxicity, both of which are a result of elevated trough levels. Monitoring the serum medication levels is an important action to minimize the risk of an adverse effect of gentamicin.

-_______________ deals with how medications affect body responses.

Pharmacodynamics

-A nurse is taking a health history of a client who reports occasionally taking several over-the-counter medications, including an H2 receptor antagonist (H2RA). Which of the following outcomes indicates the H2RA is therapeutic?

Relief of heartburn RATIONALE: Histamine2 receptor antagonists are used to treat duodenal ulcers and prevent their return. In over-the-counter strengths, these medications, such as cimetidine and ranitidine, are used to relieve or prevent heartburn, acid indigestion, and sour stomach.

-A nurse is caring for a client who has osteoporosis and takes a daily calcium supplement. Which of the following adverse effects of calcium should the nurse suspect when the client reports having flank pain?

Renal stones. RATIONALE: Calcium supplements can cause renal stones. Clients should increase their water intake while taking calcium supplements to hydrate the kidneys and should report any blood in the urine or flank pain.

-The nurse is preparing a medication for a client and observes the date of expiration on the vial occurred 2 months ago. Which of the following actions should the nurse take?

Return the medication to the pharmacy. RATIONALE: The nurse should return the medication to pharmacy. Laws require that all medication include an expiration date.

-A nurse is administering a cleansing enema to a client who reports mild cramping. The client asks the nurse to stop the enema and allow him to go to the bathroom. Which of the following actions should the nurse take?

Slow the flow of enema solution briefly. RATIONALE: Slowing the enema solution flow temporarily prevents cramping.

-A nurse is caring for a client who has streptococcal pneumonia and a prescription for penicillin G by intermittent IV bolus. 10 minutes into the infusion of the third dose, the client reports that the IV site itches and that he feels dizzy and short of breath. Which of the following actions should the nurse take first?

Stop the infusion. RATIONALE: When using the airway, breathing, circulation approach to client care, the nurse should place the priority on stopping the infusion. The client is exhibiting signs of penicillin anaphylaxis and the first action that should be taken is to withdraw the medication.

-A nurse is reviewing the health history for a client who has angina pectoris and a prescription for propranolol hydrochloride PO 40 mg twice daily. Which of the following findings in the history should the nurse report to the provider?

The client has a history of bronchial asthma. RATIONALE: Beta-adrenergic blockers can cause bronchospasm in clients who have bronchial asthma; therefore, this is a contraindication to its use and should be reported to the provider.

-A nurse is teaching a client who has asthma about how to use an albuterol inhaler. Which of the following actions by the client indicates an understanding of the teaching?

The client holds his breath for 10 seconds after inhaling the medication. RATIONALE: The medication should be retained in the lungs for a minimum of 10 seconds so the maximum amount of the dosage can be delivered properly to the airways. To use the inhaler, the client exhales normally just prior to releasing the medication, inhales deeply as the medication is released, then holds the medication in the lungs for approximately 10 seconds prior to exhaling.

-A home health nurse is assessing an older adult client who reports falling a couple of times over the past week. Which of the following findings should the nurse suspect is contributing to the client's falls?

The client takes alprazolam. RATIONALE: Alprazolam is a CNS depressant that can cause dizziness and orthostatic hypotension, which can cause the client to lose his balance and fall.

-A drug's _______________ offers the nurse practical information on the safety of a drug.

Therapeutic Index

-A nurse is providing discharge teaching for a client who has a new prescription for warfarin. Which of the following instructions should the nurse include in the teaching?

Use an electric razor while on this medication. RATIONALE: Warfarin, an anticoagulant, increases the client's risk for bleeding. The nurse should teach the client safety measures, such as using an electric razor, to decrease the risk for injury and bleeding.

-A nurse is reviewing the medication record for a client who has chronic kidney disease. Which of the following medications should the nurse identify as having the potential to cause nephrotoxicity?

Vancomycin. RATIONALE: The nurse should identify that vancomycin, an antibiotic, to be associated with nephrotoxic adverse effects.

-A nurse is caring for a client who is on warfarin therapy for atrial fibrillation. The client's INR is 5.2. Which of the following medications should the nurse prepare to administer?

Vitamin K. RATIONALE: Vitamin K reverses the effects of warfarin.

-The three types of drug names are _______________, _______________, and _______________ names.

Chemical, Generic, Trade

-A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give?

"Heparin does not dissolve clots. It stops new clots from forming." RATIONALE: This statement accurately answers the client's question.

-A nurse is preparing to administer a medication to a client who states, "That looks different from the pill I usually take." Which of the following responses should the nurse make?

"Describe what the pill looks like." RATIONALE: The nurse must collect more data prior to administering the medication. There is a chance that this is not the correct dose or medication. The nurse should clarify the prescription with the provider in order to ensure safe and effective administration of therapy.

-A nurse is providing discharge teaching to a client who has asthma and new prescriptions for cromolyn and albuterol, both by nebulizer. Which of the following statements by the client indicates an understanding of the teaching?

"I will be sure to take the albuterol before taking the cromolyn." RATIONALE: The client should always use the bronchodilator (albuterol) prior to using the leukotriene modifier (cromolyn). Using the bronchodilator first allows the airways to be opened, ensuring that the maximum dose of medication will get to the client's lungs.

-A nurse is performing discharge teaching for a client who has seizures and a new prescription for phenytoin. Which of the following statements by the client indicates a need for further teaching?

"I'll be glad when I can stop taking this medicine." RATIONALE: Phenytoin is an anticonvulsant used to treat various types of seizures. Clients on anticonvulsant medications commonly require them for lifetime administration, and phenytoin should not be stopped without the advice of the client's provider.

-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?

"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 caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make?

"Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." RATIONALE: Heparin and warfarin are both anticoagulants that decrease the clotting ability of the blood and help prevent thrombosis formation in the blood vessels. However, these medications work in different ways to achieve therapeutic coagulation and must be given together until therapeutic levels of anticoagulation can be achieved by warfarin alone, which is usually within 1 to 5 days. When the client's PT and INR are within therapeutic range, the heparin can be discontinued.

-A nurse is teaching a client who has a new prescription for simvastatin. Which of the following instructions should the nurse include?

"You should avoid grapefruit juice." RATIONALE: Grapefruit inhibits the drug-metabolizing enzyme CYP3A4 which slows the metabolism of simvastatin. This can cause an increase in serum simvastatin. Potential adverse effects include elevated liver enzymes, and rhabdomyolysis.

-A nurse is assessing an older adult client who is receiving digoxin. The nurse should recognize that which of the following findings is a manifestation of digoxin toxicity?

Anorexia. RATIONALE: Anorexia, vomiting, confusion, headache, and vision changes are manifestations of digoxin toxicity.

-A nurse is providing dietary teaching for a client who takes furosemide. The nurse should recommend which of the following foods as the best source of potassium?

Bananas. RATIONALE: The nurse should determine that bananas are the best food source to recommend because 1 cup of bananas contains 806 mg of potassium. In addition to the potassium supplements the provider might prescribe, the client should increase his daily intake of foods that have high potassium content, such as bananas, orange juice, and spinach.

-In the early days of pharmacology, _______________ had to isolate _______________ from _______________ to create drugs used to treat patients.

Chemists, Specific substances, complex mixtures

-biologics

D (Sunscreen)

-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?

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

-A nurse is providing teaching to a client who has hypertension and a new prescription for captopril. Which of the following instructions should the nurse provide?

Do not use salt substitutes while taking this medication. RATIONALE: Captopril, an ACE inhibitor, can cause hyperkalemia due to potassium retention by the kidney. The client should avoid salt substitutes, as most of them are high in potassium.

-A nurse is preparing to administer medications to a client who states, "I don't want to take those drugs." Which of the following actions should the nurse take?

Document that the client refuses the medications. RATIONALE: The client has the right to refuse the medication. It is appropriate for the nurse to document the client's refusal of the medications. The nurse should then inform the provider of the client's refusal.

-A nurse is caring for a client who has an infection and a prescription for gentamicin intermittent IV bolus every 8 hr. A peak and trough is required with the next dose. Which of the following actions should the nurse take to obtain an accurate gentamicin serum level?

Draw a trough level immediately prior to administering the medication and a peak level 30 min after the dose. RATIONALE: Timing of the peak and trough is based on the pharmacokinetics of absorption and the half-life of the medication. The trough level is the lowest serum level after pharmacokinetic effects have taken place. For divided doses, correct timing for the trough is just before administering the next dose. The peak is the highest serum level of the medication; if this level is too low, then the medication will not be effective. Correct timing for the peak is between 30 and 60 min after the dose has finished infusing.

-A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following actions is appropriate?

Evaluating the client for nausea, vomiting, and anorexia. RATIONALE: Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity.

-A nurse is caring for a client who is taking digoxin for heart failure and develops indications of severe digoxin toxicity. Which of the following medications should the nurse prepare to administer?

Fab antibody fragments. RATIONALE: Fab antibody fragments, also called digoxin immune Fab, bind to digoxin and block its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity.

-The traditional _______________ _______________ of drug administration form the operational basis for the safe delivery of medications.

Five rights

-A nurse is assessing a client who is taking levothyroxine. The nurse should recognize that which of the following findings is a manifestation of levothyroxine overdose?

Insomnia RATIONALE: Levothyroxine overdose will result in manifestations of hyperthyroidism, which include insomnia, tachycardia, and hyperthermia.

-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?

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 teaching a client who takes acetaminophen daily to manage mild knee pain. The nurse should instruct the client to monitor for which of the following adverse reactions to this medication?

Jaundice. RATIONALE: Acetaminophen can cause hepatotoxicity. The client should monitor and report jaundice, abdominal pain, clay colored stools, and fever.

-A nurse is assessing a client who has heart failure and is prescribed furosemide. Which of the following findings is an adverse effect of this medication?

Leg cramps. RATIONALE: Leg cramps is a manifestation of hypokalemia, an adverse effect of furosemide. The nurse should assess the client for hypokalemia and monitor the client's potassium level.

-A nurse is providing teaching to a client who has a new diagnosis of hypothyroidism. On which of the following medications should the nurse prepare to instruct the client?

Levothyroxine. RATIONALE: Levothyroxine is a synthetic thyroid hormone that is chemically identical to thyroxoine (T4). It is used in the treatment of hypothyroidism. The nurse should prepare to instruct the client on the use of this medication.

-A charge nurse is teaching a group of nurses about agonists and antagonists. The nurse should include in the teaching that which of the following agonist medications binds to receptors and causes activation that affects the cardiovascular system?

Morphine. RATIONALE: The nurse should include that morphine is an agonist that activates the receptors that affect the CNS and relieve the client's pain.

-A nurse is assessing a client who has hypercholesterolemia and is receiving simvastatin. Which of the following findings should the nurse recognize as a potential adverse effect?

Muscle weakness. RATIONALE: Myopathy is an adverse effect of this medication. Signs of myopathy include muscle aches, tenderness, and muscle weakness.

-A nurse is preparing to administer oral medication to a 3-month-old infant. Which of the following actions should the nurse plan to take?

Position the syringe to the side of the infant's tongue. RATIONALE: The syringe should be placed along the side of the infant's tongue, and the liquid should be administered slowly in small amounts, allowing the child time to swallow.

-A nurse is providing teaching to a client who has a new prescription for levothyroxine for hypothyroidism. The nurse should instruct the client to avoid which of the following herbal supplements?

Soy. RATIONALE: The nurse should instruct the client to avoid soy because soy can reduce the effectiveness of the levothyroxine.

-A nurse is teaching a group of young women about the use of oral contraceptives. The nurse should teach that taking which of the following herbal preparations reduces the effectiveness of this birth control method?

St. John's wort. RATIONALE: St. John's wort decreases the effectiveness of oral contraceptives and can be responsible for breakthrough bleeding and unintended pregnancies.

-A nurse is completing a medical interview with a client who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the client can potentiate the effects of warfarin?

The client uses garlic to lower cholesterol levels. RATIONALE: The nurse should recognize that garlic can potentiate the action of the warfarin.

-A nurse is teaching a client about the adverse effects of cisplatin. Which of the following adverse effects should the nurse include in the teaching?

Tinnitus. RATIONALE: Tinnitus and hearing loss are adverse effects of cisplatin.

-A nurse is providing teaching for a client who is newly diagnosed with type 2 diabetes mellitus and has a prescription for glipizide. Which of the following statements by the nurse best describes the action of glipizide?

"Glipizide stimulates your pancreas to release insulin." RATIONALE: Glipizide is an oral antidiabetic medication in the pharmacological classification of sulfonylurea agents. These medications help to lower blood glucose levels in clients who have type 2 diabetes mellitus using several methods, including reducing glucose output by the liver, increasing peripheral sensitivity to insulin, and stimulating the release of insulin from the functioning beta cells of the pancreas.

-A nurse is providing teaching to a client who has angina pectoris and a new prescription for nitroglycerin sublingual tablets. Which of the following statements by the client indicates an understanding of the teaching?

"I'll dial 911 if 1 nitroglycerin tablet does not relieve my pain, and then take up to 2 more tablets 5 minutes apart while waiting." RATIONALE: If 1 nitroglycerin tablet does not relieve the client's pain, he should access emergency services and then take 2 more tablets at 5-min intervals if he still has pain.

-A nurse is providing discharge teaching to a client who has a new prescription for verapamil for angina. Which of the following instructions should the nurse include?

"Increase your daily intake of dietary fiber." RATIONALE: The nurse should instruct the client to increase his daily intake of dietary fiber to reduce the risk of constipation associated with verapamil.

-A nurse is caring for a client who has a prescription for 3,000 mL of dextrose 5% in 0.45% sodium chloride to infuse IV over 24 hr. The nurse initiates an IV infusion of 1,000 mL of this fluid at 0800. At what time should the nurse prepare to initiate the second 1,000 mL bag?

1600. RATIONALE: 3000 mL is going to be infused over 24 hr. Each 1000 mL will hang for 8 hr. The first 1000 mL bag was initiated at 0800, so the second 1000 mL bag will be initiated in 8 hr, or at 1600.

-A nurse is teaching a client who reports taking gingko biloba to improve his memory. Which of the following adverse effects should the nurse include?

Bleeding gums. RATIONALE: Gingko biloba is an herbal medication used by clients to improve age-related memory loss as well as to decrease leg pain in clients with peripheral arterial disease (PAD). Although gingko biloba is generally well-tolerated, it may suppress coagulation. There have been reports of spontaneous bleeding in clients taking this herbal medication. Clients should be instructed to discontinue use and report increased bleeding, such as nosebleeds, bleeding gums, any cuts that do not stop bleeding, to their provider.

-A nurse is caring for a client who has a prescription for potassium chloride (KCL) 20 mEq PO daily. The nurse reviews the client's most recent laboratory results and finds the client's potassium level is 5.2 mEq/L. Which of the following actions should the nurse take?

Call the prescribing physician and inform her of the client's serum potassium level results. RATIONALE: As a potassium level of 5.2 mEq/L is above the expected reference range, the nurse should hold the medication and notify the provider of the client's serum potassium level.

-A nurse is preparing to administer a soap suds enema to a client who has constipation. As the nurse explains the procedure, the client states, "The doctor didn't tell me I was supposed to receive an enema." Which of the following nursing actions is appropriate at this time?

Check the client's medical record for the provider's prescription. RATIONALE: The nurse should use the client's medical record to verify the provider prescribed an enema for the client.

-A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first?

Check the client's vital signs. RATIONALE: It is possible that the client's nausea is secondary to digoxin toxicity. By obtaining vital signs, the nurse can assess for bradycardia, which is a symptom of digoxin toxicity. The nurse should withhold the medication and call the provider if the client's heart rate is less than 60 bpm.

-active agent

D (Sunscreen)

-A nurse is reviewing the laboratory results of a client who has liver failure with ascites and is receiving spironolactone. Which of the following findings should the nurse expect?

Decreased sodium level. RATIONALE: The nurse should expect a decreased sodium level. Spironolactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in an increased excretion of sodium.

-A nurse is completing a medication history for a client who reports using over-the-counter calcium carbonate antacid. Which of the following recommendations should the nurse make about taking this medication?

Drink a glass of water after taking the medication. RATIONALE: Calcium carbonate is a dietary supplement used when the amount of calcium taken in the diet is not enough. Calcium carbonate may also be used as an antacid to relieve heartburn, acid indigestion, and stomach upset. The client should drink a full glass of water after taking an antacid to enhance its effectiveness.

-A nurse in a public clinic is planning a health fair for older adult clients in the community. In teaching medication safety, which of the following foods should the nurse advise the clients to avoid when taking their prescriptions?

Grapefruit juice. Rationale: There is a high rate of food-drug interactions between grapefruit juice and many medications frequently taken by older adults, especially lipid-lowering agents. It is thought that one or more of the chemicals (most likely flavonoids) in grapefruit juice alter the activity of specific enzymes (such as CYP3A4 and CYP1A2) in the intestinal tract. These enzymes decrease the rate at which medications enter the systemic circulation. This could allow a larger amount of these drugs to reach the bloodstream, resulting in increased drug levels and possibly toxicity.

-A nurse is caring for a client who has atrial fibrillation and receives digoxin daily. Before administering this medication, which of the following actions should the nurse take?

Measure the client's apical pulse. RATIONALE: Digoxin decreases the heart rate, so the nurse should count the apical pulse for at least 1 min before administering. The nurse should hold the medication and notify the provider if the client's heart rate is below 60/min or if a change in heart rhythm is detected.

-A nurse is caring for a client who has a new prescription for propranolol. The nurse should monitor the client for which of the following adverse reactions to this medication?

Postural hypotension. RATIONALE: Propranolol can cause postural hypotension. The client should change positions slowly and the nurse should monitor the client's blood pressure from a lying to sitting to standing position.

-A nurse is caring for a client who has heart failure and a new prescription for furosemide. Which of the following laboratory values should the nurse review before administering furosemide?

Potassium. RATIONALE: Furosemide is a loop diuretic and therefore promotes excretion of potassium. The nurse should monitor the client's serum potassium level before administering it to prevent hypokalemia.

-A nurse is caring for a client who receives furosemide to treat heart failure. Which of the following laboratory values should the nurse monitor for this client due to this medication?

Potassium. RATIONALE: Furosemide is a loop diuretic that promotes the excretion of potassium. The nurse should monitor the client's potassium level to watch for hypokalemia.

-A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects?

Protamine sulfate. RATIONALE: Protamine sulfate reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties.

-A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin?

Prothrombin time (PT) RATIONALE: This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation

-A nurse is reviewing a client's admission record. The nurse notes that there are prescriptions for several medications. Which of the following factors should the nurse recognize is of primary consideration when determining the schedule of administration?

Specific characteristics of the medications. RATIONALE: Evidence-based practice indicates that the specific characteristics of the medications be the primary consideration of scheduling administration times. The characteristics of each medication, including the indication, onset, durations of action, and potential adverse effects and interactions, primarily determine the schedule of administration. Although an institutional policy may require that all once daily medications be administered at 0800, the nurse should be aware that some classifications of medications should only be given at bedtime, or should only be given with food. Likewise, the client's preferences, as well as the availability of each medication from the pharmacy, play important but smaller roles in determining the schedule of administration.

-A nurse is assessing a client who is taking lisinopril to treat hypertension. Which of the following findings is a priority to report?

Swelling of the tongue RATIONALE: When using the urgent vs non-urgent approach to client care, the nurse determines that the priority finding is swelling of the tongue, which is a manifestation of angioedema. The nurse should withhold the medication and notify the provider immediately if the client reports swelling of the tongue or throat. Other manifestations include giant wheals and edema of the tongue, glottis, and pharynx. Severe reactions are treated with subcutaneous epinephrine. If angioedema develops, ACE inhibitors are discontinued.

-A nurse is providing teaching to a client who has hypertension and a new prescription for hydrochlorothiazide. Which of the following instructions should the nurse provide?

Take the medication early in the day. RATIONALE: The nurse should instruct the client to take hydrochlorothiazide early in the day to avoid nocturia.

-A nurse is teaching a client who has a new prescription for ibuprofen to treat hip pain. Which of the following instructions should the nurse include in the teaching?

Take the medication with food. RATIONALE: To minimize gastric irritation, the client should take ibuprofen with food or immediately after a meal.

-A nurse is providing teaching for a client who has anemia and a new prescription for ferrous sulfate liquid. Which of the following instructions should the nurse provide?

Take the medication with orange juice to enhance absorption. RATIONALE: Ascorbic acid (vitamin C), which is found in orange juice, will enhance the absorption of iron and increase its bioavailability. This will also help to decrease the gastrointestinal side effects of iron.

-A nurse is providing discharge teaching for a client who has pulmonary edema and is about to start taking furosemide. Which of the following instructions should the nurse include?

Eat foods that contain plenty of potassium. RATIONALE: Furosemide, a high-ceiling (loop) diuretic, can cause potassium loss. The client should add potassium-rich foods to his diet, such as nuts, dried fruits, bananas, and citrus fruits.

-A nurse is teaching a class about medication reconciliation. Which of the following information should the nurse include in the teaching?

Provide a list of the client's current medications during admission to a health care facility. RATIONALE: The nurse should create a list of current medications including the name, indication, route, dosage, and dosing interval upon admission to a health care facility. The list consists of all medications, including vitamins, herbal products, and prescription and nonprescription medications.

-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?

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 caring for a client who is taking naproxen following an exacerbation of rheumatoid arthritis. Which of the following statements by the client requires further discussion by the nurse?

"I've been taking an antacid to help with indigestion." RATIONALE: NSAIDs, like naproxen, can cause serious adverse gastrointestinal reactions such as ulceration, bleeding, and perforation. Warning manifestations such as nausea or vomiting, gastrointestinal burning, and blood in the stool reported by the client require further investigation by the nurse. The client might be taking an antacid because he is experiencing one or more of these manifestations.

-A nurse is providing teaching to a client who is taking warfarin about monitoring its therapeutic effects. Which of the following explanations should the nurse provide about the international normalized ratio (INR) test?

"The INR is a standardized test that eliminates the variations between laboratories reports in prothrombin times." RATIONALE: The INR is a standardized test, which means that the result will be the same, no matter which laboratory performs it.

-A nurse is obtaining a medical history from a client who is to start warfarin therapy and currently uses herbal supplements at home. The nurse should inform the client that which of the following herbal supplements can interact adversely with warfarin?

Feverfew. RATIONALE: The nurse should instruct the client to avoid taking feverfew while taking warfarin because it will increase the anticoagulant effect.

-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?

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.