ATI Pharm Pre-Assignment 1

A nurse have provided education to a client regarding prescribed levothyroxene sodium. What of the following client statements demonstrates understanding of medication administration?

"I should take the medication in the morning to prevent insomnia." Synthroid should be taken once in the morning to prevent insomnia.

A nurse is administering 15,000 units of subcutaneous heparin. The amount available is heparin injection 30,000 units/mL. How many milliliters should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero).

0.5 mL Rationale: 30,000 units x 15,000 units __________ __________ 1 mL X mL = 0.5 mL

A nurse is preparing to administer an intramuscular injection to an adult client. At what angle should the nurse administer the medication using the ventrogluteal site?

A 90 degree angle IM injections should be administered at a 90 degree angle

A nurse is reviewing the medication class, benzodiazepines. The nurse would use caution when administering benzodiazepines to which of the below clients?

A client with glaucoma. benzodiazepines can increase intraocular pressure due to the pupil-dilating effects of the medication.

A nurse is caring for a client prescribed montelukast. Which of the following should the nurse include in teaching related to this medication?

Advise client to take the medication once daily at bedtime. Clients should take montelukast once daily at bedtime.

A client with osteoporosis is prescribed alendronate. What client education should the nurse provide to ensure optimal absorption of the medication?

Advise the client to take the medication on an empty stomach with at least 8 oz of water. Alendronate absorption decreases when taken with calcium supplements, antacids, citric juices and caffeine.

Before administering blood products, which action should be taken?

Assess the client's temperature. Assess the client's vital signs, obtain consent for the procedure and ensure compatibility. Prime the IV tubing with 0.9% sodium chloride. The nurse would not document client response or administer epinephrine prior to starting the transfusion.

A client is prescribed propranolol. Which of the following client history findings would require the nurse to clarify this medication prescription?

Asthma Clients with asthma should avoid Beta2 Blockade agents such as propranolol. Bronchoconstriction can occur. Clients with asthma should be administered a beta1selective agent.

A nurse is caring for a client newly prescribed doxazosin mesylate. Which of the following instructions should the nurse include in client education regarding taking the first dose of this medication?

Change positions slowly and lie down if dizziness occurs. First-dose orthostatic hypotension can occur with Cardura. The nurse should instruct clients to change positions slowly and to lie down if feeling dizzy, lightheaded or faint.

A nurse is preparing to administer enoxaparin to a client. Which of the following actions should the nurse take when administering this medication?

Do not expel the air bubble from the prefilled syringe The nurse should not expel the air bubble from the prefilled syringe. The air bubble should follow the medication to ensure the client receives the full dose of medication in the syringe.

A nurse is to instill ear drops to a 2 year-old child. To straighten the ear canal, the nurse should pull the auricle of the ear:

Down and backward In infants and young children, the nurse should gently pull the auricle of the ear down and back.

A nurse is caring for a client receiving patient-controlled analgesia (PCA). Which of the following interventions should the nurse take while caring for this client?

Encourage the client to use the PCA before dressing changes. The nurse should encourage the client to use the PCA prophylactically prior to activities that are likely to augment pain levels.

A client taking lithium should be cautioned about drug interactions with which below medication?

Fluoxetine Both lithium and fluoxetine drug-drug interaction can lead to serotonin syndrome which may include symptoms such as confusion, hallucination, seizure and increase in heart rate and blood pressure.

Disulfiram is taken by a client daily for abstinence maintenance. What is an adverse effect of this therapy?

Hepatoxicity Hepatoxicity is an adverse effect of disulfiram

A nurse is providing care to a client with staphylococcus epidermidis, who is prescribed vancomycin. Identify the adverse effect associate with this antibiotic therapy?

Infusion reaction Red Man Syndrome or an infusion reaction that results in rashes, flushing, tachycardia and hypotension can occur as an adverse reaction. For this reason, vancomycin should be administered over a 60 minute period.

Match the hematopoietic medication to the correct expected pharmacological action.

Leukopoietic growth factor that stimulates the bone marrow to increase production of neutrophils. - filgrastim Thrombopoietic growth factor that increase the production of platelets. - oprelvekin Erythropoietic growth factor that acts on the bone marrow to increase production of red blood cells. - epoetin alfa Granulocyte macrophage colony stimulator that acts on the bone marrow to increase production of white blood cells (neutrophils, monocytes, macrophages, eosinophils). - sargramostim

A nurse is caring for a client prescribed the HMG CoA reductase inhibitor, atorvastatin. Which of the following should be monitored while this medication is prescribed?

Liver function tests Statins (HMG CoA reductase inhibitors) like atorvastatin (Lipitor) can cause hepatotoxicity. Prior to initiating therapy the client's baseline liver function should be determined then liver function tests should be checked after 12 weeks of therapy and then every 6 months. The nurse should advise the client to observe for symptoms of liver dysfunction (anorexia, vomiting, nausea, jaundice) and to notify the provider if these occur.

A nurse is caring for a client prescribed hydromorphone for severe pain. The client's respiratory rate has decreased from 16 breaths per minute to 6. Which if the following medications should the nurse prepare to administer?

Naloxone This client is experiencing respiratory depression likely related to over administration of hydromorphone (Dilaudid). Naloxone (Narcan) and nalmefene (Revex) are opioid antagonists used to reverse an overdose of opioids.

A client has been prescribed metoclopramide. Which of the following should the nurse include in client education regarding this medication?

Notify your provider if you experience restlessness or spasms of the face or neck. An adverse effect of Reglan is extrapyramidal symptoms. The client should stop the medication and notify the provider if these occur.

A 55-year-old client has levothyroxine ordered. Which of the below past medical history concerns may contraindicate with her medication management of hypothyroidism?

Osteoporosis Caution should be used to prevent overtreatment with levothyroxine and monitor drug levels. Chronic overtreatment can cause atrial fibrillation and an increased risk of fractures from bone loss, especially in older adults.

A client with peptic ulcer disease takes cimetidine. Which of the below outcomes can occur if H2-receptor antagonists, such as cimetidine are taken long term?

Pneumonia H2-receptor antagonists decrease gastric acidity, which promotes bacterial colonization of the stomach and the respiratory tract, which can lead to the outcome of pneumonia.

A client has been prescribed lisinopril. Which of the following medication interactions should the nurse instruct this client about?

Potassium supplements Potassium supplements and potassium-sparing diuretics increase the risk of hyperkalemia in clients taking ACE inhibitors such as lisinopril. Clients should only take potassium supplements if prescribed by the provider. Clients should also avoid salt substitutes that contain potassium.

A 52-year-old client with a history of angina has been prescribed transdermal nitroglycerin. Which of the following adverse effects is not seen with this therapy?

Productive cough Nitroglycerin therapy does not directly have an on effect lung function. Physiologically, vasodilation should effect capillary perfusion and decrease lung secretions.

A nurse has just administered a wrong medication to a client. Which of the following actions should the nurse take next?

Report error to the provider. The nurse should acknowledge the error and report it to the provider for further orders. The nurse should also monitor the client for adverse effects.

Which of the following agents is used for motion sickness?

Scopolamine Scopolamine is an anticholingeric that interferes with the transmission of nerve impulses traveling from the vestibular apparatus of the inner ear to the vomiting center of the brain.

A nurse is caring for a client receiving a dopamine infusion via a peripheral IV. Which of the following actions should the nurse take if the IV site appears infiltrated?

Stop the infusion. If infiltration is suspected, the infusion should be stopped. Necrosis can occur from extravasation of high doses of dopamine. Extravasation can be treated with local injection of an alpha-adrenergic blocking agent, such as phentolamine.

A 45-year-old client is taking methylprednisolone. What pharmacological action should the nurse expect with this therapy?

Suppression of airway mucus production. Corticosteroids, such as methylprednisolone (Solu-Medrol) will suppress airway mucus production.

A client diagnosed with Parkinson's disease is prescribed levodopa. The nurse should instruct the client not to take over the counter pyridoxine supplements while taking this medication.

TRUE. Pyridoxine (vitamin B6) decreases the effects of levodopa. Clients should not take over the counter supplements without consulting their provider.

A nurse is caring for a client prescribed ferrous sulfate for the treatment of anemia. Which of the following instructions should be included in client teaching about this medication?

Take the medication on an empty stomach to maximize absorption. The nurse should instruct the clients to take iron on an empty stomach, such as 1 hr before meals to maximize absorption. Stomach acid increases absorption. If GI adverse effects occur, the client can take with food to increase adherence to therapy even though absorption is also decreased.

Match the following classifications of diuretics to their mechanism of action.

The correct answer is: action of aldosterone (sodium and water retention) which result in potassium retention and the secretion of sodium and water. Osmotic diuretics - Reduce intracranial pressure and intraocular pressure by raising serum osmolality and drawing fluid back into the vascular and extravascular space. Thiazide diuretics - Work in the early distal convoluted tubule to block the reabsorption of sodium and chloride and prevent the reabsorption of water that this site. Loop diuretics - Work on the ascending limb of the loop of Henle to block reabsorption of sodium and chloride and to prevent reabsorption of water.

Match the following medications with the correct classification.

The correct answer is: prednisone - Glucocorticoid, amiodarone - Antidysrhythmic agent, atenolol - Beta Adrenergic Blocker, ondansetron - Antiemetic, Serotonin antagonist, terazosin - Alpha-Adrenergic blocker, clonidine - Centrally acting alpha-2 agonist, ciprofloxacin - Fluroquinolone, captopril - Angiotensin converting enzyme (ACE) inhibitor, glipizide - Oral hypoglycemic, Sulfonylurea

The nurse knows that a client with renal insufficiency should be reevaluated for best diabetic management, when it is noted the client is on metformin. What is the reason metformin is contraindicated for clients who have renal insufficiency?

The medication increases the risk of lactic acidosis.

A nurse is preparing to administer a measles, mumps, and rubella vaccine (MMR) to an adult client. Which of the following is a contraindication to this vaccine?

The possibility of pregnancy within 4 weeks Pregnancy or the possibility of pregnancy with 4 weeks is a contraindication to the MMR vaccine.

Which of the following are contraindications to aspirin therapy? Select all that apply.

Third trimester pregnancy Aspirin is pregnancy risk category D in the third trimester. Adolescents with chickenpox Correct Aspirin should not be given to children or adolescents with fever or recent chickenpox due to the risk of Reye syndrome. Thrombocytopenia Aspirin is contraindicated in clients with bleeding disorders and thrombocytopenia.

A client has been prescribed isosorbide mononitrate. Which of the following should the nurse include in this client's education related to this medication?

This medication is prescribed for long-term prophylaxis against anginal attacks. Isosorbide mononitrate (Imdur) is used for long-term prophylaxis against anginal attacks.

A client has been prescribed vasopressin for the treatment of diabetes insipidus. What is the expected pharmacological action of this medication?

To increase reabsorption of water in the renal tubules. The expected pharmacological action is to promote reabsorption of water within the kidney.

A client prescribed the tricyclic antidepressant, amitriptyline has been on the medication for three weeks. The client vocalizes increased mood, but complains of anticholinergic effects. What is an example of an anticholingeric adverse effect?

Urinary retention C Anticholinergic effects include dry mouth, blurred vision, photophobia, urinary retention, constipation and tachycardia. Orthostatic hypotension, sedation and anxiety are not associated with anticholingeric effects.

Match the medication to the lab value that should be monitored during therapy with that medication. Match the antidote to the correct medication.

Warfarin - prothrombin time (PT) and International Normalized Ratio (INR) Protamine sulfate - Heparin Vitamin K - Warfarin (Coumadin) Heparin - activated partial thromboplastin time (aPTT)

A nurse is caring for a client prescribed digoxin. Which the following should alert the nurse to possible digitalis toxicity?

anorexia and weakness Anorexia, fatigue and weakness are signs of potential digitalis toxicity. GI effects of digitalis toxicity include anorexia, nausea, vomiting and abdominal pain. CNS effects include fatigue, weakness, vision changes (diplopia, blurred vision, yellow-green or white halos around objects). Bradycardia is also commonly noted in digitalis toxicity.

Methotrexate blood levels are monitored to determine therapeutic dosing. The nurse knows that high-dose levels of methotrexate therapy can lead to __________ damage.

liver Acetaminophen, methotrexate, tetracyclines, and tamoxifen increase levels of mipomersen and can increase risk for liver damage.