Pharm final study guide

A client receiving morphine is being monitored by the nurse for adverse effects of the drug. Which clinical findings warrant immediate follow up by the nurse? A. Polyuria B. Sedation C. Bradycardia D. Dilated pupils E. Slow respirations

B, C, E B. Sedation C. Bradycardia E. Slow respirations Reason: The central nervous system (CNS) depressant effect of morphine causes sedation. The CNS depressant effect of morphine causes bradycardia and bradypnea. Morphine does not increase urine output. Morphine causes constriction of pupils.

Which drug increases the risk of Reye syndrome in children? A. Aspirin B. Naloxone C. Ibuprofen D. Acetaminophen

A. Aspirin

Which medications are associated commonly with upper gastrointestinal (GI) bleeding? Select all that apply A. Aspirin B. Ibuprofen C. Ciprofloxacin D. Acetaminophen E. Methylprednisolone

A. Aspirin B. Ibuprofen E. Methylprednisolone

A client will be taking nitrofurantoin (Macrobid) 50 mg orally every evening at home to manage recurrent urinary tract infections. What instructions should the nurse give to the client? A. Increase the intake of fluids. B. Strain the urine for crystals and stones. C. Stop the drug if urinary output increases. D. Maintain the exact time schedule for taking the drug.

Increase the intake of fluids. RationaleTo prevent crystal formation, the client should have sufficient intake to produce 1000 to 1500 mL of urine daily while taking this drug. Straining urine is not indicated when the client is taking a urinary antiinfective. Urinary decrease is of concern because it may indicate renal failure. If fluids are encouraged, the client's output should increase. The drug need not be taken at a strict time daily.

A nurse is teaching an older adult client about managing chronic pain with acetaminophen. Which client statement indicates that the teaching is effective? A. "I can drink beer with this, but not wine." B. "I need to limit my intake of acetaminophen to 650 mg a day." C. "I should take an emetic if I accidentally overdose on the acetaminophen." D. "I have to be careful about which over-the-counter cold preparations I take when I have a cold."

"I have to be careful about which over-the-counter cold preparations I take when I have a cold." Reason: Many over-the-counter cold preparations contain acetaminophen the amount of acetaminophen in cold preparations must be taken into consideration when the total amount of acetaminophen taken daily is calculated. A typical single dose is 650 mg a day for adults. Acetaminophen should not exceed 3 to 4 g a day, with a lower dose preferred in older adults. An emetic is contraindicated because it may reduce the client's ability to tolerate oral acetylcysteine, the antidote for acetaminophen toxicity. Alcohol of any type, when taken with acetaminophen, increases the risk of liver injury.

Acetaminophen 15 mg/kg is prescribed for a child with a temperature of 102° F (38.9° C). How much will the nurse tell the parent to administer if the child weighs 9.6 kg and the acetaminophen strength is 160 mg/5 mL? Record your answer using one decimal place. ___ mL

4.5 To determine the dose, multiply 15 mg × 9.6 kg = 144 mg. Use the "Desire over Have" formula of ratio and proportion to solve this problem:

A client with rheumatoid arthritis is to begin taking ibuprofen 800 mg by mouth three times a day. The nurse provides education about the medication's side effects. The nurse concludes that the teaching was effective when the client makes which statement? A. "I need to have my blood work checked periodically." B. "I need to balance exercise with rest." C. "I need to change positions slowly." D. "I need to take the medication between meals."

A. "I need to have my blood work checked periodically."

A nurse is caring for an older adult who is taking acetaminophen for the relief of chronic pain. Which substance is most important for the nurse to determine if the client is taking because it intensifies the most serious adverse effect of acetaminophen? A. Alcohol B. Caffeine C. Saw palmetto D. St. John's wort

A. Alcohol Reason: Too much ingestion of alcohol can cause scarring and fibrosis of the liver. Eighty-five percent to 95% of acetaminophen is metabolized by the liver. Acetaminophen and alcohol are both hepatotoxic substances. Metabolites of acetaminophen, along with alcohol, can cause irreversible liver damage.

A pregnant woman reports upper back pain and frequent and painful urination. Upon diagnosis, the client has a urinary tract infection and is treated with nitrofurantoin. Which teratogenic effect is likely to occur in the infant? A. Cleft Palat B. Tooth anomalies C. Neural tube defects D. Ebstein anomaly

A. Cleft Palat

Nitrofurantoin used during the fifth week of pregnancy places the neonate at risk for which condition? A. Cleft lip B. Meromelia C. Low set of malformed ears D. Tooth and bone abnormalities

A. Cleft lip

The nurse is caring for an adolescent with dysmenorrhea. What medication does the nurse anticipate to be prescribed as the first line of treatment? A. Ibuprofen B. Guanfacine C. Medroxyprogesterone D. Dextroamphenatmine sulfate

A. Ibuprofen

A healthcare provider prescribes aspirin to be continued at home for a client with severe arthritis. What should the nurse teach the client about taking aspirin? A. Take the medicine with meals. B. See a dentist if bleeding gums develop. C. Switch to acetaminophen if tinnitus occurs. D. Avoid spicy foods while taking the medication.

A. Take the medicine with meals. Reason: Acetylsalicylic acid is irritating to the stomach lining and can cause ulceration, the presence of flood, fluid, or antacids decreases this response.

A client has received instructions to take 650 mg aspirin (ASA) every 6 hours as needed for arthritic pain. What should the nurse include in the client's medication teaching? Select all that apply A. Take the aspirin with meals or a snack B. Make an appointment with a dentist if bleeding gums develop. C. Do not chew enteric-coated tablets. D. Switch to acetaminophen if tinnitus occurs. E. Report persistent abdominal pain

A.Take the aspirin with meals or a snack C. Do not chew enteric-coated tablets. E. Report persistent abdominal pain

A health care provider prescribes daily docusate sodium for a client. The nurse explains to the client that this drug has what action? A. Lubricates the feces B. Creates an osmotic effect C. Stimulates motor activity D. Lowers the surface tension of feces

ANS: DThe detergent action of docusate sodium promotes the drawing of fluid into the stool, which softens the feces.

A client is scheduled for discharge following surgery. The medical record indicates that the client has not had a bowel movement since before surgery, which was 4 days ago. During the hospital stay, the client received a stool softener daily and an oral laxative the day before discharge. Which one of the prescribed medications should the nurse administer to ensure a bowel movement prior to discharge?

Bisacodyl 10-mg suppository

A nurse is teaching the parents of a child with iron-deficiency anemia how to administer liquid iron to their child. What instructions should be included in the lesson? Select all that apply. A. protect the child from sunlight B. Administer the medication with food C. Anticipate that stools tend to be blackish-green D. Give the medication with a glass of orange juice. E. Have the client drink it through a straw.

C. Anticipate that stools tend to be blackish-green D. Give the medication with a glass of orange juice. E. Have the client drink it through a straw.

A client is receiving morphine sulfate (MS Contin) for severe metastatic bone pain. What will the nurse do to assess for complications from a common serious side effect of morphine? A. Monitor for diarrhea B.Observe for an opioid addiction C. Assess for altered breathing patterns D. Check for a decreased urinary output

C. Assess for altered breathing patterns Morphine sulfate is a central nervous system depressant that commonly decreases the respiratory rate, which can lead to respiratory arrest. Morphine, an opioid, will cause constipation, not diarrhea. Addiction is not a concern for a terminally ill client. Although morphine sulfate may cause urinary retention, it is not a common side effect and is not life threatening.

A terminally ill client in a hospice unit for several weeks is receiving a morphine drip. The dose is now above the typical recommended dosage. The client's spouse tells the nurse that the client is again uncomfortable and needs the morphine increased. The prescription states to titrate the morphine to comfort level. What should the nurse do? A. Add a placebo to the morphine to appease the spouse B. Discuss with the spouse the risk for morphine addiction C. Assess the client's pain before increasing the dose or the morphine D. Check the client's heart rate before increasing the morphine to the next level

C. Assess the client's pain before increasing the dose or the morphine Reason: Over time clients receiving morphine develop tolerance and require increasing doses to relieve pain, thus requiring continuing reassessments. Adding a placebo to the morphine to appease the spouse will not meet the client's need for relief from pain. The client is terminal, and the risk for addiction is of no concern. The respiratory, not heart, rate is the significant vital sign to be monitored; morphine depresses the central nervous system, specifically the respiratory center in the brain.

A healthcare provider prescribes supplemental oral iron therapy for a child with iron-deficiency anemia. What side effect will the nurse tell the parents to anticipate? A. Bloody stool B. Orange urine C. Greenish-black stool D. Straining of the mouth

C. Greenish-black stool

Aspirin is prescribed for a client with rheumatoid arthritis. Which clinical indicators of aspirin toxicity should the nurse teach the client to report? Select all that apply. A. Bradycardia B. joint pain C. blood in the stool D. ringing in the ears E. increased urine output

C. blood in the stool D. ringing in the ears

A client who has been taking ibuprofen (Advil) for rheumatoid arthritis asks the nurse if acetaminophen (Tylenol) can be substituted instead. An appropriate nursing response is: A. "Acetaminophen is the preferred treatment for rheumatoid arthritis." B. "Acetaminophen irritates the stomach more than ibuprofen does." C. "Ibuprofen is an antiinflammatory and acetaminophen is not." D. "Both are antipyretics and have the same effect."

C. ibuprofen has anti-inflammatory properties and acetaminophen does not

A nurse is evaluating a client who received intravenous morphine. which life-threatening response indicates the potential need for naloxone administration? A. blurred vision B. urinary retention C. mental confusiond. D. respiratory depression

D. respiratory depression Reason: Because morphine is a central nervous system depressant, it affects the medulla, the respiratory center in the brain. Respiratory depression may progress to respiratory arrest and death. Naloxone will reverse the effects of an opioid. Although blurred vision, urinary retention, and mental confusion may be responses to morphine, they are not life threatening.

A health care provider prescribes bisacodyl (Dulcolax) for a client with cardiac disease. The nurse explains to the client that this drug acts by: A. Producing bulk B. Softening feces C. Lubricating feces D. Stimulating peristalsis

D. Stimulating peristalsis

What are the desired outcomes that the nurse expects when administering ibuprofen? Select all that apply. a. diuresis b. pain relief c. antipyresis d. bronchodilation e. anticoagulation f. reduced inflammation

b,c,f b. pain relief c. antipyresis f. reduced inflammation