NCLEX-Pharm
The nurse is caring for a preoperative client who received intravenous lorazepam 5 minutes ago and is now requesting to void. What is the appropriate nursing action? 1. Ask the unlicensed assistive personnel to assist the client to the bathroom. 2. Insert a indwelling urinary catheter since the client is going to surgery. 3. Place the client on a bedpan. 4. Allow the client to go to the bathroom.
3. Correct: Placing the client on a bedpan is the safest and least invasive choice. Lorazepam can cause drowsiness and the client should not be allowed to ambulate.
A client with the diagnosis of mild anxiety asks the nurse why the primary healthcare provider switched medications from lorazepam to buspirone. What should the nurse tell the client? 1. "Lorazepam takes longer to start working than buspirone so the primary healthcare provider decided to switch medications." 2. "Buspirone can be stopped quickly if neccessary." 3. "Buspirone does not depress the central nervous system like lorazepam does, so you should not have as much sedation." 4. "You need to ask your primary healthcare provider why the medication was changed from lorazepam to buspirone."
3. Correct: Buspirone does not depress the CNS system and is believed to produce the desired effects through interaction with serotonin, dopamine, and other neurotransmitter receptors.
What information should the nurse include in teaching an oncology client the purpose of taking epoetin? 1. Emergency treatment of anemia. 2. Improves quality of life. 3. Used for the prevention of pure red cell aplasia (PRCA). 4. Decreases the need for transfusion.
4. Correct: Epoetin is prescribed to treat a lower than normal number of red blood cells (anemia) caused by chronic kidney disease in clients on dialysis, in HIV clients receiving zidovudine and in cancer clients receiving chemotherapy that develop anemia. Epoetin stimulates the bone marrow to produce more RBCs.
What instruction would the nurse give a client about a newly prescribed salmeterol inhaler? 1. "Use the inhaler immediately if wheezing and shortness of breath occur during exercise." 2. "Use the inhaler when you experience a stuffy nose due to seasonal allergies." 3. "Carry the inhaler with you at all times and take 2 puffs anytime you experience an exacerbation." 4. "This inhaler should be used routinely as prescribed even when free of symptoms."
4. Correct: Salmeterol is a maintenance medication. It can prevent asthma attacks and exercise induced bronchospasm. Salmeterol acts as a bronchodilator. It works by relaxing muscles in the airways to improve breathing.
The nurse is caring for a client in the emergency department. In what order would a nurse correctly administer an intravenous push (IVP) medication through a continuous IV infusion of normal saline? 1.) Check medication label with healthcare provider's prescription 2.) Stop IV pump 3.) Adminisiter medication while assessing IV site 4.) Draw up ordered dose of medication aseptically. 5.) Cleanse port closest to IV insertion site with an alcohol wipe. 6.) Restart IV pump
1,4,2,5,3,6 First, check medication label with healthcare provider's prescription. Second, draw up ordered dose of medication aseptically. Third, stop the infusion pump. Fourth, cleanse the port closest to the IV insertion site with an alcohol wipe. Fifth, administer medication while assessing IV site. Sixth, restart IV pump.
A client diagnosed with hypertension has been prescribed metoprolol. Which statement by the client indicates that the client's medication instruction for metoprolol has been effective? 1. "I should not stop taking this drug immediately." 2. "I will need to rinse my mouth with water 3 times a day." 3. "I can decrease my aerobic exercises from 3 to 2 times per week." 4. "I will report irregular heartbeats, if they continue for more than 3 days."
1. Correct: Metoprolol, a beta-adrenergic antagonist, should not be discontinued abruptly. This action may have the serious result of precipitating angina. Metoprolol should be gradually discontinued.
The nurse educates a client that the prescribed medication indomethacin is used to manage which symptoms? Select all that apply 1. Pain 2. Inflammation 3. Fever 4. Cough 5. Urticaria
1.,2., & 3. Correct: Indomethacin is a non-steroidal anti-inflammatory agent used to treat pain, inflammation, and fever. 4. Incorrect: Indomethacin does not have any cough suppressant actions. 5. Incorrect: Urticaria is a side-effect associated with indomethacin use.
Which comment made by a new nurse regarding sodium polystyrene sulfonate indicates to the charge nurse that the new nurse understands the effects of this medication? 1. "Sodium is exchanged for potassium in the blood." 2. "Fluids will need to be encouraged after administration." 3. "This medication will increase potassium and decrease sodium." 4. "Sodium polystyrene sulfate is only given as an enema."
2. Correct: Sodium polysterene sulfonate (kayexalate) is used to treat hyperkalemia, and it works by helping your body get rid of the extra potassium by exchanging sodium ions for potassium ions in the intestines. Sodium level increases after administration and this increase causes some dehydration. Pushing fluids will offset the dehydration.
A preeclampsia client is being treated with magnesium sulfate. The nursing assessment shows a respiratory rate of 10 with deep tendon reflexes of 0. What is the nurse's priority action? 1. Place client in Trendelenburg position and apply oxygen. 2. Stop magnesium and prepare to give calcium gluconate. 3. Ask another nurse to verify the deep tendon reflexes. 4. Prepare client for an emergency cesarean section
2. Correct: The nurse's findings indicate the client's central nervous system has been overly depressed, with a respiratory rate of 10 and absent deep tendon reflexes. The nurse's priority intervention is to stop the magnesium, which is the cause of the problem, and prepare to reverse the situation with calcium gluconate.
A child with acute lymphocytic leukemia (ALL) is receiving chemotherapy through a single lumen Groshong catheter. During the infusion, the child reports nausea and has vomited. The primary healthcare provider has prescribed ondansetron IV. What action should the nurse take? 1. Ask primary healthcare provider for an oral antiemetic. 2. Give ondansetron IVPB with the chemotherapy. 3. Wait until chemotherapy is complete to infuse ondansetron. 4. Stop chemotherapy temporarily and flush line to give ondansetron
4. Correct: A Groshong catheter is implanted when other venous access sites are no longer useable. The child has begun to react to the chemotherapy and needs medicated now. Because this implanted device has only one lumen, the nurse must stop the chemotherapy infusion temporarily, flush the port, administer the ondansetron, flush again and restart the chemotherapy infusion.
A client has been started on intravenous gentamicin for osteomyelitis. The nurse informs the client frequent blood work will be done to monitor the amount of medication in the body. The nurse knows what labs are a priority to check every three days for the client? 1. BUN and creatinine. 2. Liver function studies. 3. Hemoglobin and hematocrit. 4. Peak and trough levels.
4. Correct: Peak and trough levels help to determine the amount of medication in the body system at specific times. Gentamicin is a very potent antibiotic; therefore, it is crucial to keep track of blood levels of this medication. Too low a level of this drug would be ineffective against the bacteria while too high a level increases the potential for severe side effects or toxicity from this antibiotic.
Which medication should the nurse administer first after receiving the morning shift report? 1. Levothyroxine to the client with hypothyroidism and a thyroid stimulating hormone (TSH) level of 2.8 mU/L 2. Amlodipine to the client with hypertension and a blood pressure of 150/86 3. Regular insulin sliding scale dose to the client with diabetes and a 210 blood glucose level. 4. Cefotaxime intravenous piggyback to the newly admitted client with a diagnosis of pneumonia and a white blood cell count (WBC) of 12,000mm3
4. Correct: The first dose of intravenous antibiotic medication is the priority since the WBCs are elevated and the antibiotic should be administered first.
A client has been prescribed a decongestant. The nurse identifies that the client has a diagnosis of glaucoma. Which nursing intervention would the nurse implement after identifying the client's diagnosis of glaucoma? 1. Administer the decongestant. 2. Reassess the client in 4 hours. 3. Identify when the client was diagnosed with glaucoma. 4. Notify the primary healthcare provider regarding the glaucoma diagnosis.
4. Correct: The primary healthcare provider should be notified of the client's diagnosis of glaucoma. Glaucoma is the result of elevated eye pressure due to a buildup of aqueous humor that flows throughout the inside of your eye. Decongestants can cause the pupil to dilate. This response can result in an acute glaucoma attack in a client diagnosed with narrow-angle glaucoma or angle-closure glaucoma.
The nurse is caring for a poorly controlled type 2 diabetic client. Lab results include a BUN of 22mg/dL (7.85 mmol/L) and a creatinine of 1.9 mg/dL (0.67 mmol/L). The nurse checks the client's blood sugar and it is 218mg/dL (12.09 mmol/L). Current medications include metformin and exenatide. What is the priority concern with this client taking metformin? 1. Inadequate blood glucose control 2. Concomitant administration of metformin and exenatide 3. Reports of headache 4. Renal function impairment
4. Correct: This is the priority response. Why? Because metformin is eliminated primarily by the kidneys, and if the kidneys are not working properly, as evidenced by the elevated BUN and creatinine levels, administration of metformin can lead to toxicity and increased lactic acidosis risk.
During a physical assessment of a client who was started on haloperidol 5 days ago, the nurse notes restlessness, muscle weakness, drooling, and a shuffling gait. What should be the nurse's first action? 1. Hold the next haloperidol dose. 2. Administer the prn benztropine mesylate. 3. Notify the primary healthcare provider to discontinue the haloperidol. 4. Draw a blood sample for drug level.
2. Correct: Benztropine mesylate is an anticholinergic that counteracts the extrapyramidal symptoms (EPS) seen with the use of haloperidol.
Place the steps in order that the nurse should take to administer a subcutaneous injection. 1.) Inject the needle and administer the medication 2.) Perform hand hygiene 3.)Dispose the syringe in sharps container 4.) Hold syringe and pinch the skin with nondominant hand 5.) Cleanse site with antiseptic swab 6.)Remove the needle cap by pulling it straight off 7.)Apply gloves and locate the injection site
2,7,5,6,4,1,3 First perform hand hygiene. Then apply gloves and locate injection site using anatomical landmarks. Start at the center of the site and rotate outward in a circular direction to cleanse the site. Remove the needle cap by pulling the cap straight off. Next, hold the syringe and pinch the skin with nondominant hand. Inject the needle quickly then administer the medication slowly. Finally, dispose of the syringe in the sharps container.
A 9 month old with asthma symptomology has montelukast sodium oral granules prescribed. What is the most appropriate way for the nurse to instruct the parent on how to administer the medication? 1. Mix the granules with a spoonful of baby food such as applesauce. 2. Pour the granules directly on the back of the infant's tongue. 3. Dissolve the granules in an 8 ounce (240 mL)bottle of juice. 4. Administer the medication in the morning mixed in a bowl of rice cereal.
1. Correct: Applesauce is an appropriate baby food for a 9 month old infant. The medication is being mixed with a very small amount of baby food to facilitate all of the medication being consumed.
When administering an intravenous push (IVP) medication through a continuous intravenous infusion, which intervention is most important for the nurse to take? 1. Assess for drug and solution compatibility. 2. Clamp the tubing of the large volume infusion above the injection port. 3. Stop the large volume infusion and flush the tubing . 4. Use the port nearest the client to administer the IVP medication.
1. Correct: This would have the most life threatening affect on a client if it is not done and an incompatibility exists. Checking for incompatibility between the large volume solution and the medication is a safety issue.2. Incorrect: This is an action that can be taken when administering an IVP medication; however, clamping the tubing does not have to be done. If the tubing is not clamped when administering the IVP medication, the medication would first go up the tubing toward the large volume container, then go toward the client when the pressure from the push is stopped.3. Incorrect: This needs to be done if the large volume infusion solution is incompatible with the IVP medication. The action would not have to be implemented when administering all IVP medications. If incompatible, then it should be flushed.4. Incorrect: This is recommended when administering IVP medication, but would not cause the greatest life-threatening consequences. Using the port closest to the client minimizes the distance the medication must travel, so that the medication gets to the client's circulation faster.
A pregnant client who had been on a magnesium drip for severe pregnancy induced hypertension (PIH) has had an emergency cesarean section at 35 weeks. The nursery nurse should anticipate what findings in the newborn related to the magnesium therapy? Select all that apply 1. Hypotension 2. Hypoglycemia 3. Hyperreflexia 4. Flaccid muscle tone 5. Respiratory depression
1., 4. & 5. Correct: When magnesium sulfate is administered to the mother for preeclampsia, the intent is to prevent seizures and decrease blood pressure by suppressing the central nervous system, thus preventing premature labor. The dose of this drug and the length of time administered will determine what side effects might be seen in the newborn, since magnesium crosses the placental barrier. The nurse will most likely note hypotension and some degree of respiratory depression in the newborn. Additionally, the newborn may have flaccid or weak muscles along with poor, or even absent reflexes. Treatment of the newborn will be based on the degree of depression. 2. Incorrect: The use of magnesium sulfate in the mother prior to delivery does not affect the blood glucose level of the fetus/newborn. Magnesium sulfate affects the central nervous system, not the pancreas, so blood sugar should be within normal limits. 3. Incorrect: Magnesium is a central nervous system depressant that crosses the placental barrier. Side effects to the newborn would be similar to those noted in the mother, including depressed or absent reflexes. The nurse would not find hyperreflexia.
client is prescribed phenobarbital to control seizures. Which medication prescribed for the client would the nurse recognize interacts with phenobarbital? 1. Lovastatin 2. Loratadine 3. Lansoprazole 4. Lactulose
2. Correct: Both of these drugs can cause CNS depression. There is a drug to drug interaction between antiseizure medications and antihistamines. Loratadine is the only medication in the answer options that can cause CNS depression. 1. Incorrect: Lovastatin is indicated for the treatment of increased cholesterol and triglyceride levels. There is no drug to drug interaction that exists between phenobarbital and lovastatin. 3. Incorrect: Lansoprazole is a proton-pump inhibitor indicated for the treatment of stomach ulcers and GI complaints. There is no drug to drug interaction that exists between phenobarbital and lansoprazole.4. Incorrect: Lactulose is an ammonia reducer and laxative. It is indicated for the treatment of constipation and to decrease the ammonia level in the treatment of client's with liver disease. There is no drug to drug interaction that exists between phenobarbital and lactulose.
The nurse is teaching a client regarding herbal therapy. What is the main goal of herbal therapy? 1. To treat a specific disease or symptom by taking prescription medications. 2. To restore balance within the body by supporting the client's self-healing ability. 3. To avoid the use of toxic chemicals within the body. 4. To incorporate Eastern healing practices into Western medicine.
2. Correct: The main goal of herbal therapy is to restore balance within the body by supporting the client's self-healing ability. When teaching clients, the main goal should always be included.
The nurse is caring for a client on the post surgical unit. What should the nurse teach the client about short term treatment of post op pain? 1. There are no concerns about addiction from pain medications following surgery. 2. Pain control following surgery rarely results in addiction. 3. The opioid medications typically result in addiction. 4. The primary healthcare provider will not prescribe an addictive medication.
2. Correct: When a person is in acute pain following surgery, the risk of addiction to pain medication is rare. The key is to provide the medication over a short period of time to get the client past the initial pain of surgery. Remember the client will be ambulating early. Ambulation and nonpharmaceutical comfort measures should also be provided by the nurse to decrease the need for narcotics as client recovery continues. 1. Incorrect: There are slight concerns about addiction with administration of opioids; however, it is usually not a concern for the majority of post op clients with short term use in the hospital. The nurse should use alternative methods for providing relief as well. Guided imagery, massage, gradual ambulation, are just a few examples. 3. Incorrect: Use of opioids may result in addiction; however, research shows that only a small percentage of the population is prone to addiction. The goal of postoperative pain management is to relieve pain while keeping side effects to a minimum. This is often best accomplished with a multimodal approach. 4. Incorrect: Opioids are potentially addictive; however, they serve a very useful purpose in the treatment of short-term post-op pain.
The nurse is caring for a trauma client who is receiving a unit of whole blood. The client begins to experience lower back pain. What actions should the nurse take? Select all that apply 1. Administer diphenhydramine. 2. Collect a urine specimen. 3. Stop the transfusion. 4. Take the client's vital signs. 5. Change the IV tubing
2., 3., 4., & 5. Correct: Assume the worst, and stop the transfusion first, then continue with the assessment. Low back pain is a sign of an acute hemolytic reaction. This is the most dangerous and potentially life-threatening type of transfusion reaction. It occurs when the donor blood is incompatible with that of the recipient. Get lab tests such as a urinalysis to check for presence of hemoglobin, which indicates hemolytic reaction. Take vital signs. Change IV tubing to remove all blood and maintain the IV line with normal saline solution, with new IV tubing, at a slow rate.
After drawing up insulin for subcutaneous administration, the nurse receives a return phone call from a primary healthcare provider who wants to give prescription orders on a new admit. The nurse asks a new nurse to administer the insulin dose. What action should the new nurse take? 1. Administer the insulin dose to the client. 2. Consult with the charge nurse about administering the insulin dose to the client. 3. Tell the nurse that whoever draws up the medication has to administer that medication. 4. Offer to take the call from the primary healthcare provider so the nurse can administer the insulin.
3. Correct: A nurse can only administer medication that has been drawn up by that nurse. It is not acceptable practice to administer a medication drawn up by another nurse.
Which medication does the nurse expect will help decrease tremors in a client diagnosed with hyperthyroidism? 1. Steroids 2. Anticonvulsants 3. Beta blockers 4. Iodine compounds
3. Correct: Beta blockers help anxiety and tremors. Beta blockers reduce the effects of adrenaline in the body and help decrease anxiety. In times of stress and emergency the adrenal gland produces adrenaline that acts on various organs in the body to enable us to deal with the situation. For example, the heart beats faster due to adrenaline. In order for adrenaline to be able to do this, various organs have beta receptors to accept the adrenaline and use it to behave differently in times of stress. Beta blockers block these receptors. They stop various organs in the body from accepting adrenaline. Taking them means the heart does less work generally and doesn't get over-worked in times of stress. One of the main symptoms of anxiety is a speeding heart which is part of the fight-or-flight response. In times of danger our body produces adrenaline to stop the heart from beating faster makes us feel calmer. Taking beta blockers for anxiety also makes us feel less shaky. The energy boost to our muscles (from the increased supply of blood and oxygen) which makes us feel 'jittery' and 'on-edge' doesn't happen without a fast heartbeat. 1. Incorrect: Steroids influence the body system in several ways, but they are used mostly for their strong anti-inflammatory effects and in conditions that are related to the immune system function such as arthritis, colitis (ulcerative colitis, and Crohn's disease), asthma, bronchitis. Steroids are used to treat systemic lupus, severe psoriasis, leukemia, lymphomas, idiopathic thrombocytopenic purpura, and autoimmune hemolytic anemia. These corticosteroids also are used to suppress the immune system and prevent rejection in people who have undergone organ transplant as well as many other conditions. 2. Incorrect: Anticonvulsants are used to normalize the electrical activity in the brain which in turn reduces the risk of seizures. But anticonvulsants have also been shown to work on mood disorders such as depression or mania. Anticonvulsants help increase the naturally occurring nerve calming chemical known as GABA while decreasing the nerve exciting chemical known as glutamate. Tremors can actually be a side effect of anticonvulsants. 4. Incorrect: Iodine compounds decrease the production of thyroid hormones in the treatment of hyperthyroidism. It does not have an effect on tremors
The previous shift nurse reported to the oncoming nurse a suspicion that a client's central line has developed a fibrin sheath. Which prescription does the nurse anticipate the healthcare provider will prescribe? 1. Heparin 2. Enoxaparin 3. Alteplase 4. acetylsalicylic acid
3. Correct: If a catheter becomes partially blocked due to a fibrin sheath or loses its blood return, a fibrinolytic is typically prescribed. Currently, alteplase is the preferred thrombolytic to treat thrombotic occlusions.1. Incorrect: Systemic anticoagulation with heparin for treatment of a fibrin sheath has not been proven to be beneficial. 2. Incorrect: Enoxaparin is a low dose molecular heparin and is not beneficial in treating a fibrin sheath.4. Incorrect: One of the effects of acetylsalicylic acid is its inhibition of platelet aggregation. However, these blood thinning effects are not beneficial in treatment of a fibrin sheath.
Which side effect of vincristine should the nurse immediately report to the primary healthcare provider? 1. Nausea 2. Fatigue 3. Paresthesia 4. Anorexia
3. Correct: Paresthesia is a side effect of some chemotherapeutic medications and if it occurs, the primary healthcare provider needs to modify the dosage or discontinue.
The primary healthcare provider prescribed phenytoin for a client with grand mal seizures. What intervention would the nurse plan for the client's care? 1. Offer the client frequent high calorie snacks. 2. Check the apical pulse before each dose. 3. Perform or assist with oral hygiene every shift. 4. Give the medication 30 minutes prior to meal.
3. Correct: Phenytoin is an anticonvulsant. It works by slowing down impulses in the brain that cause seizures. A major side effect is gingival hyperplasia. Oral hygiene is important for decreasing this complication while the client is on phenytoin.
What action by a new nurse who is drawing up a medication from an ampule would require intervention by the supervising nurse? 1. Taps the top of the ampule to remove medication trapped in the top of the ampule. 2. Snaps the neck of ampule away from the body when breaking the top off. 3. Withdraws medication using a 22 gauge needle. 4. Inverts ampule, places needle tip in liquid, and withdraws all of the medication.
3. Correct: This action should be corrected by the supervising nurse. Because tiny pieces of glass could have gotten into the medication, the nurse should attach a filter straw to a syringe. If the syringe has a needle in place, the nurse should remove both the needle and the cap and place it on a sterile surface (e.g., a newly unwrapped alcohol pad still in the open wrapper), and then attach filter straw.
Calculator The primary healthcare provider has prescribed ampicillin and ciprofloxacin piggyback in the same hour, every 6 hours. How will the nurse administer these medications? 1. Administer one of the medications every 4 hours and the other every 6 hours. 2. Administer the medications by combining them into 150 mL of normal saline (NS). 3. Administer the medications at the same time by connecting the secondary tubing to two separate ports on the primary tubing. 4. Administer the medications separately, flushing with normal saline (NS) between medications.
4. Correct: Even though two IV piggyback medications have been ordered at the same time, they can both be infused separately on time. It just takes planning. The nurse must follow the medication rights (right client, right medication, right route, right dose, right time). The antibiotics need to be administered one at a time and normal saline is used to flush the remaining medication of the first antibiotic before the second is administered.
The nurse instructs a client taking isoniazid for the treatment of tuberculosis (TB) regarding appropriate food choices. Which food choices indicate to the nurse that teaching has been successful? 1. Salad with bleu cheese dressing. 2. Smothered liver with onions. 3. Smoked salmon with crackers. 4. Pear salad with lettuce.
4. Correct: Pears are acceptable fruit. Foods high in tyramine can cause headaches, fast or irregular heartbeats, nausea and vomiting and sensitivity to light. Foods high in tyramine such as aged cheeses, certain meats, liver, moked fish, sour cream, raisins, bananas and avocados should not be eaten when taking isoniazid.
A client with nausea, vomiting, and diarrhea for the past three days has been prescribed one liter of normal saline with 40 mEq (40 mmol/L) of potassium chloride to infuse at 250 mL per hour. Which assessment would the nurse report to the primary healthcare provider prior to initiating the infusion? 1. Blood pressure of 106/54 2. Apical pulse of 112 per minute 3. Tenting of the skin over the sternum 4. Urinary output of 148 mL for the past 6 hours
4. Correct: The client's output is below normal. This could indicate a problem with renal perfusion. Potassium is excreted through the kidneys, so if the kidneys are not being perfused, the client would retain potassium. The healthcare provider would need to be aware of the client's low urine output. 1. Incorrect: A client in fluid volume deficit would have a low blood pressure. This is an expected assessment prior to fluid resuscitation. 2. Incorrect: A client in fluid volume deficit would have a fast pulse rate. This is an expected assessment prior to fluid resuscitation. 3. Incorrect: A client in fluid volume deficit would have tenting of skin. This is an expected assessment prior to fluid resuscitation.
