ATI Pharmacology Practice Set #6
A nurse is preparing to use the z-track technique to administer a medication to a client. Which of the following is an appropriate action during this procedure? A. Pull the skin 1.3 cm (1/2 inch) to the side. B. Insert the needle slowly and gently C. Use a 45 degree angle of insertion. D. Aspirate for 5 to 10 seconds.
D. Aspirate for 5 to 10 seconds. Rationale: A. The nurse should pull the skin 2.5 cm (1 in) to 3.5 cm (1.4 in) down or to the side to make it easier to insert the needle. B. The nurse should insert the needle quickly and smoothly to minimize the client's discomfort. C. The nurse should insert the needle at a 90° angle. D. Aspirating for 5 to 10 seconds allows blood in a small blood vessel to appear, an indication that the nurse should withdraw the needle and prepare a fresh injection.
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. A. Carbonated beverage B. Milk C. Orange juice D. Grapefruit juice
D. Grapefruit juice Rationale: A. While there are some medications that can interact with carbonated beverages, many recommend the client take the dose with a carbonated beverage. Therefore, the nurse should not include an across-the-board warning about carbonated beverages. Rather, the nurse should instruct the clients to check the recommendation for each medication that they take. B. While there are some medications that can interact with milk, many recommend the client take the dose with milk. Therefore, the nurse should not include an across-the-board warning about milk. Rather, the nurse should instruct the clients to check the recommendation for each medication that they take. C. While there are some medications that can interact with orange juice, many recommend the client take the dose with juice. Therefore, the nurse should not include an across-the-board warning about orange juice. Rather, the nurse should instruct the clients to check the recommendation for each medication that they take. D. 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 2-year-old child who has seizures and is receiving phenytoin in suspension form. Which of the following actions should the nurse take before administering each dose? A. Shake the container vigorously. B. Be sure the child has not eaten within the hour. C. Perform mouth care. D. Check the child's blood pressure.
A. Shake the container vigorously. Rationale: A. A suspension form of medication refers to one in which the particles of medication are mixed with, but not dissolved in, a fluid. It is important for the nurse to shake the container that contains the suspension because the child can be under-medicated if the medication is not evenly distributed. B. Phenytoin is a gastric irritant. It should be given with or immediately after a meal to decrease gastric upset. C. Mouth care is not necessary prior to every dose. D. When giving the oral form of phenytoin, this action is not necessary.
A nurse is teaching a client who has multiple sclerosis about a new prescription for baclofen. Which of the following instructions should the nurse include in the teaching? A. "Do not take antihistamines with this medication." B. "Take the medication on an empty stomach." C. "Stop the medication immediately for a headache." D. "Expect to develop diarrhea initially."
A. "Do not take antihistamines with this medication." Rationale: A. The nurse should instruct the client not to take antihistamines while taking baclofen. Antihistamines will intensity the depressant effects of baclofen. B. The medication causes nausea and gastrointestinal distress, so the client should take it with milk or meals. C. Abrupt withdrawal of baclofen, a centrally acting muscle relaxant, might cause seizures, fever, and hypotension. A better alternative is to treat the headache, which can have many other causes, and see if it resolves as medication therapy with baclofen continues. D. Baclofen is more likely to cause constipation than diarrhea.
A nurse is planning to apply a transdermal analgesic cream prior to inserting an IV for a preschool-aged client. Which of the following actions should the nurse plan to take? (Select all that apply.) A. Spread the cream over the lateral surface of both forearms. B. Apply to intact skin. C. Apply the medication an hour before the procedure begins. D. Cleanse the skin prior to procedure. E. Use a visual pain rating scale to evaluate effectiveness of the treatment.
B. Apply to intact skin. C. Apply the medication an hour before the procedure begins. D. Cleanse the skin prior to procedure. E. Use a visual pain rating scale to evaluate effectiveness of the treatment. Rationale: A. The nurse should apply the smallest amount of cream to the smallest area required to reduce the risk for systemic toxicity. Systemic effects of the anesthetic include bradycardia, heart block, and seizures. B. The nurse should apply cream over intact skin to reduce the risk for systemic toxicity. The nurse should wear gloves while applying the cream to reduce the risk of absorbing the anesthetic. C. The nurse should allow 30 min to 1 hr for the topical analgesic to take effect. D. Apply the topical analgesic to clean skin to increase absorption. E. A child's response and understanding of pain depends on the child's age and stage of development. A preschooler might be unable to describe pain due to a limited vocabulary. Use a visual scale (FACES or OUCHER Scale) with faces or colors to assess evaluate the effectiveness of the treatment.
A nurse is teaching an adolescent about medication therapy with oral acetylcysteine. Which of the following information should the nurse include in the teaching? A. "You should avoid eating eggs." B. "Your mouth will become dry." C. "It is necessary to monitor your serum electrolyte levels." D. "This medication has a very unusual odor."
D. "This medication has a very unusual odor." Rationale: A. There are no dietary restrictions when taking acetylcysteine. B. Increased oral secretions occur when taking this medication. C. ABG levels and pulmonary function might be monitored when taking this medication. D. This medication has an odor similar to rotten eggs due to the presence of disulfide linkages.
A nurse is preparing to infuse 1 L of 0.9% sodium chloride IV over 8 hours with a tubing set that delivers 15 gtts/mL. The nurse should set the manual IV infusion to delivery how many drops per minute? (Round to the nearest whole number.)
31 gtts/min Rationale: 1. (15 gtts/mL) x (1,000 mL/8 hours) x (1 hour/60 minutes) = x 2. x = 31.25 gtts/min 3. x = 31 gtts/min
A nurse is preparing to administer 0.9% sodium chloride IV infusion 1 L bag at a rate of 200 mL/hour for a client who has rhabdomyolysis. The nurse should expect the IV pump to infuse over how many hours?
5 hours Rationale: 1. 200 mL/1 hour = 1,000 mL/x hours 2. 200x = 1,000 3. x = 5 hours
A nurse is preparing to administer liquid mycostatin 600,000 units PO TID. Available is mycostatin 100,000 units/mL. How many mL should the nurse administer per dose?
6 mL Rationale: 1. 100,000 units/1 mL = 600,000 units/x mL 2. 100,000x = 600,000 3. x = 6 mL
A nurse is caring for a client who is prescribed diphenhydramine to relieve pruritus. The client asks the nurse how he can minimize the daytime sedation he is experiencing. Which of the following responses should the nurse give? A. "Gradually decrease the dose once tolerance to the effect is reached." B. "Distribute the doses evenly throughout the day." C. "Take most of the daily dose at bedtime." D. "Take the medication with meals."
C. "Take most of the daily dose at bedtime." Rationale: A. A nurse should not instruct a client to change the prescribed dose of a medication. B. Taking the medication throughout the day will not reduce the sedative effect. C. Taking most of the dose at bedtime will allow the client to obtain the benefit of maximum relief of manifestations and rest without itching. D. Taking the medication with meals does not alter the sedative effect.
A nurse is providing teaching to a client who has a new diagnosis of Parkinson's disease. On which of the following medications should the nurse prepare to instruct the client? A. Piperacillin/tazobactam B. Levothyroxine C. Levodopa/carbidopa D. Carbamazepine
C. Levodopa/carbidopa Rationale: A. Piperacillin/tazobactam is a broad spectrum anti-infective used in the treatment of moderate to severe infections. It is not used in the treatment of Parkinson's disease. B. Levothyroxine is a thyroid hormone used in the treatment of hypothyroidism. It is not used in the treatment of Parkinson's disease C. Levodopa/carbidopa is the cornerstone of Parkinson's treatment. The nurse should prepare to instruct the client on the use of this medication. D. Carbamazepine is an anticonvulsant used in the treatment of seizures, trigeminal neuralgia, bipolar disorder, and diabetic neuropathy. It is not used in the treatment of Parkinson's disease.
A nurse is caring for a client who has a central venous catheter and develops acute shortness of breath. Which of the following actions should the nurse take first? A. Clamp the catheter. B. Position the client in left lateral Trendelenburg. C. Initiate oxygen therapy. D. Auscultate breath sounds.
A. Clamp the catheter Rationale: A. The greatest risk to this client is injury from further air entering the central venous catheter; therefore, the first action the nurse should take is to clamp the catheter. B. The nurse should position the client in the left lateral Trendelenburg to prevent the air from entering the coronary arteries; however, the nurse should take another action first. C. The nurse should initiate oxygen therapy to treat any hypoxia the client may be experiencing; however, the nurse should take another action first. D. The nurse should auscultate breath sounds to determine if there is air movement within the lungs; however, the nurse should take another action first.
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. Rationale: A. The client's serum potassium level is below the recommended reference range. The nurse should administer the KCL as prescribed. B. The nurse should not omit the ordered medication. C. The client's serum potassium level is below the recommended reference range. The nurse should not hold the medication. There is no indication that the provider should be notified, as a prescription for the low level of potassium has been given. D. The nurse has already received the lab values from the lab, so notifying the laboratory is not indicated.
A nurse is preparing to administer phenytoin IV to a client who has a seizure disorder. Which of the following actions should the nurse plan to take? A. Administer the medication at 100 mg/min. B. Administer a saline solution after injection. C. Hold the injection if seizure activity is present. D. Dilute the medication with D5W.
B. Administer a saline solution after injection. Rationale: A. The nurse should administer phenytoin IV slowly, not faster than 50 mg/min, to reduce the risk of hypotension. B. The nurse should flush the injection site with a saline solution after the injection of phenytoin to reduce and prevent venous irritation. C. The nurse should administer phenytoin to prevent and to abort seizure activity. D. The nurse should dilute phenytoin in 0.9% sodium chloride solution to prevent precipitation of the medication.
A nurse is reviewing the medical record of a client who reports drinking three to four glasses of wine each night and taking 3,000 mg of acetaminophen daily. Which of the following laboratory values is the priority for the nurse to assess? A. Amylase B. Creatinine C. Aspartate aminotransferase (AST) D. Antidiuretic hormone (ADH)
C. Aspartate aminotransferase (AST) Rationale: A. The nurse should evaluate the client's amylase level to assess for pancreatitis. However, there is another laboratory value that is the nurse's priority. B. The nurse should evaluate the client's creatinine level to monitor renal function. However, there is another laboratory value that is the nurse's priority. C. The greatest risk to this client is liver injury from the combined adverse effects of alcohol and acetaminophen. Therefore, the priority laboratory value for the nurse to evaluate is AST because an elevated level is an indication of liver damage. D. The nurse should evaluate the ADH level of the client to assess for syndrome of inappropriate ADH, CNS infections, hypovolemia, and dehydration. However, there is another laboratory value that is the nurse's priority.
A nurse is caring for a client whose serum potassium level is 5.3 mEq/L. Which of the following scheduled medications should the nurse plan to administer? A. Lisinopril B. Digoxin C. Furosemide D. Potassium iodide
C. Furosemide Rationale: A. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. This class of antihypertensive interferes with the action of ACE and results in a decreased production of aldosterone. The medication causes the kidneys to possibly retain potassium, which would elevate the value further. The provider needs to be notified of the elevated potassium level prior to administration of the scheduled dose. B. Potassium competes with digoxin in binding with other electrolytes and cells. When the potassium level is elevated, digoxin is not therapeutic in normal doses. The nurse should notify the provider of the laboratory value and expect to administer the medication when the value has returned to within the expected reference range. C. Furosemide results in loss of potassium from the nephron as part of its diuretic effect. This medication can be given when a client has an elevated potassium level and can lower the potassium level. For this client, the depletion of potassium is a beneficial effect. For a client who has a therapeutic potassium level, there would be a risk for hypokalemia due to the excretion of potassium. D. Potassium iodide is prescribed for the treatment of Grave's disease. The iodine results in a decrease of thyroxine production. The potassium in the medication contributes to the overall potassium level and should not be given at this time.
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 Rationale: A. Adverse effects of clarithromycin include an altered taste. Phenytoin can cause gingival hyperplasia. B. Adverse effects of phenytoin include constipation. C. Phenytoin is an antiepileptic medication used to treat partial seizures and generalized tonic-clonic seizures. Phenytoin can cause a rash that can progress to Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). If a rash develops, the client should notify the provider immediately and stop the use of phenytoin. D. Adverse effects of phenytoin include suicidal tendencies and aggression.
A nurse is providing 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? A. "I will notify my doctor before taking any other medications." B. "I have made an appointment to see my dentist next week." C. "I know that I cannot switch brands of this medication." D. "I'll be glad when I can stop taking this medication."
D. "I'll be glad when I can stop taking this medication." Rationale: A. Many medication interactions can occur with phenytoin; therefore, the client's provider should be notified that the client is taking phenytoin. B. The client understands that phenytoin causes an overgrowth of the gums that makes dental monitoring important. C. The client understands that bioavailability varies with different brands, so no substitutions should be made. D. 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 caring for a client who has a central venous catheter and reports hearing a gurgling sound on the side of the catheter insertion. Which of the following complications should the nurse suspect? A. Catheter occlusion B. Catheter rupture C. Catheter dislodgement D. Catheter migration
D. Catheter migration Rationale: A. Difficulty administering fluids or drawing blood through the line are manifestations of a catheter occlusion. B. Fluid leaking from the site or pain and swelling during infusion are manifestations of a catheter rupture. C. A change in the length of the external catheter is a manifestation of catheter dislodgement. D. A client report of hearing a gurgling sound on the side of the catheter insertion is a manifestation of catheter migration.
A nurse is preparing to administer phenytoin 50 mg by intermittent IV bolus to a client who has a seizure disorder. Which of the following actions should the nurse take? A. Slow the injection if the medication crystallizes. B. Dilute the medication before injecting. C. Follow the IV injection with sterile water. D. Administer the medication over 1 minute.
D. administer the medication over 1 minute. Rationale: A. The nurse should discontinue the medications if it crystalizes. Mixing phenytoin with other solutions can cause a precipitate to form. It should not be added to an existing IV infusion and the tubing should be flushed before and after administration. B. The nurse should not dilute the IV injection before administration, as phenytoin is given undiluted. C. The nurse should follow the IV injection with sterile 0.9% sodium chloride, not water, to prevent a precipitate developing. D. The nurse should administer phenytoin slowly, no faster than 50 mg/min.
A nurse is caring for a client who is prescribed tetracycline 2 grams daily PO in four divided doses every 6 hours. Available is tetracycline 250 mg capsules. How many capsules should the nurse administer per dose?
2 capsules Rationale: 1. 2,000 mg/4 doses = 500 mg/dose 2. 250 mg/1 capsule = 500 mg/ x capsule 3. 250x = 500 4. x = 2 capsules
A nurse is preparing to administer fluoxetine 30 mg PO daily to a client. The amount available is 10 mg/tablet. how many tablets should the nurse administer per dose?
3 tablets Rationale: 1. 10 mg/1 tablet = 30 mg/x tablets 2. 10x = 30 3. x = 3 tablets
A nurse is assessing an older adult client who is receiving IV therapy. The nurse should recognize that which of the following findings indicates fluid volume excess? (Select all that apply.) A. Bounding pulse B. Pitting edema C. Swelling at IV site D. Urine specific gravity greater than 1.030 E. Crackles upon auscultation
A. Bounding pulse B. Pitting edema E. Crackles upon auscultation Rationale: A. Fluid volume excess is due to excessive fluid intake or inadequate fluid excretion. Manifestations include increased blood pressure, pulse, and respirations. With fluid volume excess, the pulse is full and bounding. B. Excess extracellular fluid can lead to pitting edema in dependent areas of the body. C. Edema at the IV site indicates a localized accumulation of fluid due to infiltration. Although this is a concern, this finding does not suggest fluid volume excess. This finding would suggest infiltration. The nurse should discontinue the IV and restarted at another site. D. Urine-specific gravity measures the concentration of all chemical particles in the urine. A therapeutic range is 1.005 to 1.030. A urine-specific gravity greater than 1.030 indicates dehydration, and a gravity of less than 1.010 indicates fluid volume excess. E. Pulmonary edema can occur with fluid volume excess.
A nurse is providing teaching to a client who has seizures and a new prescription for phenytoin. Which of the following information should the nurse include? A. Phenytoin turns urine blue. B. Alcohol increases the chance of phenytoin toxicity. C. Avoid flossing the teeth to prevent gum irritation. D. Take an antacid with the medication if indigestion occurs.
B. Alcohol increases the chance of phenytoin toxicity. Rationale: A. The nurse should include in the home instructions that phenytoin turns the urine pink, red, or red-brown, not blue. B. The nurse should include in the home instructions that alcohol alters the blood level of phenytoin. C. The nurse should instruct the client to floss the teeth to prevent gingival hyperplasia, which is associated with the use of phenytoin. D. The nurse should instruct the client to avoid taking an antacid within 2 hr of administering phenytoin.
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? A. Decrease bulk in the diet to counteract the adverse effect of diarrhea. B. Take the medication with dairy products to increase absorption. C. Reduce sodium intake. D. Drink a glass of water after taking the medication.
D. Drink a glass of water after taking the medication. Rationale: A. The major adverse effect of calcium carbonate is constipation. The nurse should recommend the client increase bulk in the diet. B. Taking calcium carbonate with milk predisposes the client to milk alkali syndrome, which is characterized by headache, confusion, nausea, vomiting, alkalosis, and hypercalcemia. C. Clients who take aluminum hydroxide, not calcium carbonate, antacids should be advised against excessive sodium intake in the diet. D. 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.
