VATI Pharmacology Pre-Assessment

A nurse is caring for a client who has a prescription for digoxin 0.25 mg PO daily. Available is digoxin 0.125 mg/tab. How many tablets should the nurse administer?

2 tablets

A nurse is assessing a client after administering a dose of losartan. The client has a hoarse voice, and swollen lips and tongue. In which order should the nurse take the following actions?

- Assess the client's airway - Call the emergency response team - Apply high-flow oxygen - Initiate IV access - Administer IV epinephrine - Administer IV antihistamines

A nurse is preparing to titrate morphine 6 mg via IV bolus to a client. The amount available is morphine 8 mg/mL. How many mL should the nurse administer per dose?

0.75 mL

A nurse is preparing to administer dextrose 5% in water (D5W) 150 mL IV to infuse over 3 hr. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min?

8 gtt/min

A nurse is providing instructions to a client who has a new prescription for sublingual nitroglycerin to treat angina pectoris. Which of the following instructions should the nurse include? A. "Place the tablet under your tongue, and then take a small sip of water." B. "The medication can take up to 15 minutes to take effect." C. "Avoid taking the medication prior to exercising." D. "Stop taking the medication and notify your provider if you develop a headache."

A. "Place the tablet under your tongue, and then take a small sip of water." A client who takes a sublingual medication should place it under his tongue. A sip of water can help the medication dissolve. The nurse should tell the client that the medication takes effect rapidly in 1-3 min. The nurse should tell the client that the medication can be used to terminate an ongoing anginal attack as well as to prevent anginal pain prior to exertion. Therefore the client might need the medication prior to exercising. Headache is a common adverse effect of this medication that often dissipates with prolonged use. The client should continue to take the medication and take aspirin or acetaminophen for headache.

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? A. Feverfew B. Black cohosh C. Echinacea D. Flaxseed

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

A nurse on a medical unit is planning care for an older adult client who takes several medications. Which of the following prescribed medications places the client at risk for orthostatic hypotension? (Select all that apply.) A. Furosemide B. Telmisartan C. Duloxetine D. Clopidogrel E. Atorvastatin

A. Furosemide B. Telmisartan C. Duloxetine Furosemide is correct. This medication is used to reduce edema and hypertension, and an adverse effect is orthostatic hypotension. Telmisartan is correct. This medication is used to control hypertension, and an adverse effect is orthostatic hypotension. Duloxetine is correct. This medication is used to treat depression and anxiety disorder, and an adverse effect is orthostatic hypotension.

A nurse is preparing to administer potassium chloride (KCL) to a client who is receiving diuretic therapy. The nurse reviews the client's serum potassium level results and discovers the client's potassium level is 3.2 mEq/L. Which of the following actions should the nurse take? A. Give the ordered KCL as prescribed. B. Omit the KCL dose and document that it was not given. C. Hold the prescribed dose and notify the provider of the serum potassium level. D. Call the lab to verify the client's results.

A. Give the ordered KCL as prescribed. The client's serum potassium level is below the recommended reference range. The nurse should administer the KCL as prescribed.

A nurse is assessing a client prior to administering atenolol. Which of the following findings should prompt the nurse to withhold the medication? A. Heart rate 46/min B. Oxygen saturation 95% C. Respiratory rate 18/min D. Blood pressure 160/94 mm Hg

A. Heart rate 46/min 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 preparing to administer an osmotic diuretic IV to a client with increased intracranial pressure. Which of the following should the nurse identify as the purpose of the medication? A. Reduce edema of the brain. B. Provide fluid hydration. C. Increase cell size in the brain. D. Expand extracellular fluid volume.

A. Reduce edema of the brain. An osmotic diuretic is used to decrease intracranial pressure by moving fluid out of the ventricles into the bloodstream.

A nurse is providing teaching to a client who has gout and a new prescription for allopurinol. Which of the following statements by the client indicates an understanding of the teaching? A. "If I get a rash from this medication, I will take my usual antihistamine." B. "I need to increase my fluid intake while taking this medication." C. "I should take this medicine on an empty stomach." D. "If I get a fever while taking this medication, I will take some aspirin."

B. "I need to increase my fluid intake while taking this medication." Clients who have gout should increase their fluid intake to 2 to 3L per day to prevent toxicity of allopurinol and decrease uric acid levels.

A nurse is caring for four clients. After administering morning medications, she realizes that the nifedipine prescribed for one client was inadvertently administered to another client. Which of the following actions should the nurse take first? A. Notify the client's provider. B. Check the client's vital signs. C. Fill out an occurrence form. D. Administer the medication to the correct client.

B. Check the client's vital signs. The first action the nurse should take using the nursing process is to assess the client. The nurse should know that the action of nifedipine is to lower blood pressure. Immediately upon realizing the error, the nurse should check the client's vital signs (especially the client's blood pressure) to ensure that the client is not hypotensive as a result. Only after ensuring that the client is safe and has stable vital signs should the nurse take other actions.

A nurse is providing teaching to a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following information should the nurse provide? A. Expect to have a fever for the first days of therapy. B. Drink 2 to 3 L of water per day while on the medication. C. Administer the medication with an NSAID to enhance effectiveness. D. Take the medication in the morning to prevent insomnia.

B. Drink 2 to 3 L of water per day while on the medication. B. Drink 2 to 3 L of water per day while on the medication.

A nurse is preparing to administer amipicillin and gentamicin sulfate via IV infusion. Which of the following resources should the nurse consult first regarding medication compatibility? A. Nurse manager B. Hospital pharmacist C. Health care proivder D. Medication sales representative

B. Hospital pharmacist The greatest risk to the client is injury form medication error; therefore, the nurse should consult the hospital pharmacist first. The pharmacist will have information about medications, including adverse effects, recommended dosages, and drug incompatibilities.

A nurse is caring for a client who has thromboplebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects? A. Vitamin K B. Protamine sulfate C. Acetylcysteine D. Deferasirox

B. Protamine sulfate Protamine sulfate reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties. Vitamin K reverses the effects of warfarin, not heparin, by promoting the synthesis of coagulation factors VI, IX, X, and prothrombin. Acetylcysteine, a mucolytic, reduces the risk of hepatotoxicity after acetaminophen overdose. It does not reverse the effects of heparin toxicity. A chelating agent such as deferasirox binds to iron to reduce iron toxicity from supplemental iron therapy. It does not reverse the effects of heparin toxicity.

A nurse is caring for a client who is receiving total parenteral nutrition (TPN). The pharmacy is delayed in supplying the client's next container of TPN. Which of the following fluids should the nurse infuse until the next container arrives? A. Dextrose 5% in water B. 0.9% sodium chloride C. Dextrose 10% in water D. Lactated Ringer's solution

C. Dextrose 10% in water TPN contains high concentrations of dextrose and proteins. To avoid hypoglycemia, the nurse should infuse dextrose 10% or 20% in water until the next container of TPN solution arrives.

A nurse is teaching a client who has a new prescription for esomeprazole to manage his GERD. Which of the following statements by the client indicates an understanding of the teaching? A. "I won't pass gas as often now that I am taking this medication." B. "I will take this medication each morning with my breakfast." C. "I have an increased risk of getting pneumonia while taking this medication." D. "I will need to take a daily stool softener while taking this medication."

C. "I have an increased risk of getting pneumonia while taking this medication." The client taking esomeprazole is at a greater risk for developing pneumonia due to an elevation of gastric pH, especially during the first few days of treatment. The nurse should instruct the client about manifestations of a respiratory infection and to report these findings to the provider if they occur.

A nurse is evaluating teaching on a client who has a new prescription for montelukast to treat asthma. Which of the following statements by the client indicates an understanding of the teaching? A. "I'll rinse my mouth after taking this medication." B. "I'll take this medication when I get an asthma attack." C. "I'll take this medication once a day in the evening." D. "I'll use a spacer device when I inhale this medication."

C. "I'll take this medication once a day in the evening." Montelukast, a leukotriene modifier, is used to prevent asthma exacerbations. The client should take it on a daily basis once a day in the evening.

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? A. Give the ordered KCL as prescribed. B. Omit the KCL dose and document it was not given. C. Call the prescribing physician and inform her of the client's serum potassium level results. D. Call the lab to verify the client's results.

C. Call the prescribing physician and inform her of the client's serum potassium level results. 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 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? A. Offer the client a light snack B. Measure the client's blood pressure C. Measure the client's apical pulse D. Weigh the client

C. Measure the client's apical pulse 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 providing discharge teaching to a client who has a new prescription for lithium. Which of the following information should the nurse include in the teaching? A. Follow a low-sodium diet. B. Limit daily fluid intake. C. Obtain a daily weight. D. Avoid foods that have a high tyramine content.

C. Obtain a daily weight Clients who are taking lithium should monitor their daily weight due to the risk of fluid imbalance. Clients who are taking lithium should avoid a low-sodium diet due to the risk of hyponatremia. Clients who are taking lithium should drink plenty of fluids. Clients who are taking a monoamine oxidase inhibitor (MAOI), rather than lithium, should avoid foods that have a high tyramine content.

A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize which of the following medications can cause glucose intolerance? A. Ranitidine B. Guaifenesin C. Prednisone D. Atorvastatin

C. Prednisone Corticosteroids such as prednisone can cause glucose intolerance and hyperglycemia. The client might require increased dosage of a hypoglycemic medication. Ranitidine can alter serum creatinine levels, but it does not affect blood glucose levels. Guaifenesin can cause drowsiness and dizziness, but does not alter blood glucose. Atorvastatin can interfere with thyroid function tests.

A nurse is teaching a client who has a new prescription for phenytoin. The nurse should instruct the client to monitor for and report which of the following adverse effects of this medication? A. Metallic taste B. Diarrhea C. Skin rash D. Anxiety

C. Skin rash Phenytoin is an antiepileptic medication used to treat partial seizures and generalized tonic-clonic seizures. Phenytoin can cause a rash that can progress to Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). If a rash develops, the client should notify the provider immediately and stop the use of phenytoin. Adverse effects of clarithromycin include an altered taste. Phenytoin can cause gingival hyperplasia. Adverse effects of phenytoin include constipation. Adverse effects of phenytoin include suicidal tendencies and aggression.

A nurse is providing teaching to a client who has a new prescription for lisinopril. Which of the following statements by the nurse indicates an understanding of the teaching? A. "I should increase my intake of potassium-rich foods." B. "I should expect to have facial swelling when taking this medication." C. "I should take this medication with food." D. "I should report a cough to my provider."

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

A nurse in an emergency department is caring for a client who has diabetic ketoacidosis (DKA) and a blood glucose level of 925 mg/dL. The nurse should anticipate which of the following prescriptions from the provider? A. Glucocorticoid medications B. Dextrose 5% in 0.45% sodium chloride C. Oral hypoglycemic medications D. 0.9% sodium chloride IV bolus

D. 0.9% sodium chloride IV bolus The nurse should expect a prescription for an IV bolus of 0.9% sodium chloride to be administered at 15 to 20 mL/kg/hr for the first hour to restore volume and maintain perfusion to the vital organs.

A nurse is caring for a client who has HIV-1 infection and is prescribed zidovudine as part of antiretroviral therapy. The nurse should monitor the client for which of the following adverse effects of this medication? A. Cardiac dysrhythmia B. Metabolic alkalosis C. Renal failure D. Aplastic anemia

D. Aplastic anemia Severe myelosuppression that results in anemia (decreased red blood cells), agranulocytosis (decreased white blood cells), and thrombocytopenia (decreased platelets) is a life-threatening adverse reaction to zidovudine therapy. Consequently, zidovudine must be used cautiously in clients already experiencing myelosuppression, and the client must be monitored with a CBC performed every few weeks for early detection of marrow failure, which may lead to aplastic anemia. Zidovudine has no documented adverse effects on the heart. Lactic acidosis, not metabolic alkalosis, is an adverse effect of zidovudine. Zidovudine is not known as a nephrotoxic agent.

A nurse is assessing a client after administering IV vancomycin. Which of the following findings is the nurse's priority to report to the provider? A. Localized redness at the catheter insertion site. B. Client report of a headache C. Client report of tinnitus D. Audible inspiratory stridor

D. Audible inspiratory stridor When using the airway, breathing, circulation approach to client care the nurse determines the priority finding is inspiratory strider. The client is at risk for bronchospasms, hypotension and circulatory collapse due to anaphylaxis. The nurse should contact the rapid response team, discontinue the vancomycin, and administer epinephrine.

A nurse is caring for a newborn who has respiratory depression. Which of the following medications should the nurse anticipate administering? A. Flumazenil B. Physostigmine C. Terbutaline D. Naloxone

D. Naloxone Naloxone is an opioid antagonist and is administered to reverse opioid toxicity or reverse neonatal respiratory depression. Dosage for a newborn is 0.01 mg/kg, and is repeated every 2 to 3 min until adequate respiratory function returns. Flumazenil is a benzodiazepine antagonist and is given to reverse benzodiazepine toxicity. Physostigmine is a cholinesterase inhibitor used to reverse the effects of nondepolarizing neuromuscular blockers. Terbutaline is a bronchodilator and is used to relax uterine smooth muscle to stop premature labor.

A nurse is preparing to administer an intramuscular (IM) injection of meperidine to a client. Which of the following is the priority assessment the nurse should complete? A. Apical pulse rate B. Blood pressure C. Level of consciousness D. Respiratory rate

D. Respiratory rate Airway, breathing, and circulation are the priority focus of the nurse at this time. Meperidine can cause respiratory depression and the client's respiratory rate should be monitored prior to administering this medication.

A nurse is teaching a client about taking an expectorant to treat a cough. The nurse should explain that this type of medication has which of the following actions? A. Reduces inflammation B. Suppresses the urge to cough C. Dries mucous membranes D. Stimulates secretions

D. Stimulates secretions Expectorants act by increasing secretions to improve a cough's productivity. Glucocorticoids reduce inflammation. Antitussives suppress the cough stimulus. Anticholinergic medications dry mucous membranes and reduce secretions.