Pharm II exam 4 ATI questions

A nurse is caring for a client who was recently diagnosed with rheumatoid arthritis. The nurse should expect the provider to prescribe methotrexate at which of the following times? A. Within 3 months of the initial diagnosis B. When NSAIDs have not provided pain relief C. During an exacerbation of symptoms D. Once bone degeneration progresse

A. Within 3 months of the initial diagnosis The nurse should identify that current guidelines recommend starting a disease-modifying antirheumatic drug (DMARD) such as methotrexate within 3 months of a diagnosis of rheumatoid arthritis to prevent or delay joint degeneration.

A nurse is teaching a client who is about to start taking propylthiouracil to treat hyperthyroidism. Which of the following statements should the nurse identify as an indication that the teaching has been effective? A. "I will need laboratory tests to check my liver function." B. "I should take this medication once daily." C. "If I get a rash, I am probably having an allergic reaction." D. "If I have difficulty sleeping, it is probably because of this medication."

A. "I will need laboratory tests to check my liver function." Propylthiouracil is hepatotoxic and can cause severe liver injury. The nurse should instruct the client to report dark urine and yellowing of the eyes, which can indicate an injury to the liver.

A nurse is caring for a client who has a new prescription for tamoxifen. The nurse should recognize that tamoxifen has which of the following therapeutic effects? A. Anti-estrogenic B. Antimicrobial C. Androgenic D. Anti-inflammatory

A. Anti-estrogenic Tamoxifen is an anti-estrogen medication used to treat cancer of the breast in both premenopausal and postmenopausal women. It is also used to prevent breast cancer in women who are at an increased risk.

A nurse is caring for a client who developed hypoglycemia following an insulin injection. The client is conscious and responds appropriately to verbal stimuli. Which of the following medications should the nurse plan to administer first? A. Oral glucose tablet B. 50% dextrose intravenously C. Glucagon intramuscularly D. Epinephrine intravenously

A. Oral glucose tablet Evidence-based practice indicates that a client who has mild hypoglycemia and is conscious and able to swallow should receive an oral agent such as an oral glucose tablet. If the client is unresponsive to the oral glucose tablet, another, more invasive form of treatment can be initiated.

A nurse is monitoring a client who has diabetes insipidus and was administered desmopressin. Which of the following findings should indicate to the nurse the client is experiencing an adverse effect of this medication? A. Thirst B. Nocturia C. Headache D. Heart palpitations

C. Headache Headaches are an indicator of the adverse effect of water intoxication, which can occur as a result of taking desmopressin. This medication causes fluid retention and places the client at risk of water intoxication.

A nurse is assessing a client who has hypothyroidism and takes levothyroxine. Which of the following findings indicates that the client is experiencing acute levothyroxine overdose? A. Bradycardia B. Cold intolerance C. Tremor D. Hypothermia

C. Tremor Tremors and anxiety are expected findings in acute levothyroxine overdose. These findings are similar to those seen in hyperthyroidism.

A nurse is preparing to administer levothyroxine 12.5 mcg PO daily to a client who has hypothyroidism. Levothyroxine 25 mcg/1 tablet is available. How many tablets should the nurse administer per dose? (Fill in the blank with the numeric value only, round the answer to the nearest tenth, and use a leading zero if applicable. Do not use a trailing zero.)

0.5

A nurse is preparing to administer desmopressin 0.3 mcg/kg in 0.9% sodium chloride 50 mL IV over 30 min to a client who weighs 154 lb. How many mcg of medication should the client receive? (Fill in the blank with the numeric value only, round the answer to the nearest whole number, and use a leading zero if applicable. Do not use a trailing zero.)

21

A nurse is preparing to administer 150 units/hr of regular insulin to a client. Regular insulin is available at 1,500 units in 0.9% sodium chloride 500 mL. The nurse should set the IV pump to deliver how many mL/hr? (Fill in the blank with the numeric value only, round to the nearest whole number, and use a leading zero if applicable. Do not use a trailing zero.)

50

A nurse is preparing to administer iron dextran IV to a client. Which of the following actions should the nurse plan to take? A. Administer a small test dose before giving the full dose. B. Infuse the medication over 30 seconds. C. Monitor the client closely for hypertension after the infusion. D. Administer cyanocobalamin as an antidote if iron dextran toxicity occurs.

A. Administer a small test dose before giving the full dose. A serious adverse effect of iron dextran is anaphylaxis caused by hypersensitivity to the medication. A small test dose should be administered over 5 minutes before giving the full dose. The client should be monitored carefully for an allergic reaction during and for a period of time following the test dose.

A nurse is teaching self-administration of NPH insulin to a client who has type 2 diabetes mellitus. Which of the following instructions should the nurse include? A. Alternate injecting doses between the abdomen and the thigh B. Shake the vial before withdrawing the dosage C. Rotate injection sites within the same area D. Discard the vial if the insulin is cloudy

C. Rotate injection sites within the same area To prevent lipodystrophy, the client should rotate injection sites and keep them about 2.5 cm (1 in) apart within the same anatomical area.

A nurse is teaching a client who is taking levothyroxine for hypothyroidism about a new prescription for a calcium supplement. Which of the following pieces of information should the nurse include in the teaching? A. The calcium supplement will enhance the effect of the levothyroxine. B. The calcium supplement will accelerate the metabolism of the levothyroxine. C. Take the medications together at 1700 for the greatest effect. D. Take the calcium supplement 4 hr after taking the levothyroxine.

D. Take the calcium supplement 4 hr after taking the levothyroxine. Levothyroxine should be taken in the morning on an empty stomach, and the calcium supplement should be taken at least 4 hours later. Food or supplements containing iron, magnesium, or zinc also bind to levothyroxine and prevent complete absorption of the medication.

A nurse is planning to administer epoetin alfa to a client who has chronic kidney failure. Which of the following should the nurse plan to review prior to administering this medication? A. Blood pressure B. Temperature C. Blood glucose levels D. Total protein level

A. Blood pressure Epoetin alfa often causes hypertension, which can lead to stroke or other cardiovascular complications. The nurse should monitor the client's blood pressure and notify the provider about increases. A client who receives epoetin alfa frequently requires concurrent use of an antihypertensive medication.

A nurse is caring for a client who has a new prescription for levothyroxine to treat hypothyroidism. Which of the following findings should the nurse identify as an indication that the client requires intervention? A. Heart rate 106/min B. Dry skin C. Oral temperature 36.8°C (98.2°F) D. Lethargy

A. Heart rate 106/min Tachycardia can be a manifestation of hyperthyroidism, possibly due to excessive hormone replacement. The client might require a lower dosage of levothyroxine.

A nurse is teaching a client who has chemotherapy-induced anemia and a prescription for epoetin alfa. The nurse should instruct the client to report which of the following findings as an adverse effect of epoetin alpha? A. Hypertension B. Leukocytosis C. Bone pain D. Neutropenia

A. Hypertension The nurse should instruct the client to report hypertension, which is an adverse effect of epoetin alfa. Other adverse effects can include headaches, seizures, heart failure, and thromboembolic events related to increased hemoglobin levels.

A nurse is assessing a child who has acute lymphocytic leukemia and is receiving vincristine sulfate. Which of the following findings is the nurse's priority? A. Paresthesia B. Alopecia C. Stomatitis D. Constipation

A. Paresthesia The nurse should apply the safety and risk-reduction priority-setting framework, which assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client.

A nurse is teaching a client who has type 1 diabetes mellitus about a new subcutaneous insulin infusion pump. Which of the following pieces of information should the nurse include in the teaching? A. Plan to use a type of short-duration insulin in the infusion pump B. Replace the infusion pump set every 4 days C. Turn off the infusion pump for at least 3 hours each day D. Move the infusion pump catheter 1.27 cm (0.5 in) away from the old site

A. Plan to use a type of short-duration insulin in the infusion pump The client should plan to use short-duration insulin such as regular, lispro, aspart, or glulisine insulin in the infusion pump to deliver a baseline infusion of insulin. The client should also administer bolus doses of insulin before each meal.

A nurse is caring for a client with diabetic ketoacidosis who has a prescription for an intravenous infusion of insulin. The nurse should document that which of the following types of insulin was administered intravenously to treat ketoacidosis? A. Regular insulin B. Insulin lispro C. Insulin aspart D. Insulin glargine

A. Regular insulin Treatment for diabetic ketoacidosis is directed at correcting hyperglycemia and acidosis. Therefore, the client's insulin levels are restored with an initial IV bolus of regular insulin followed by continuous infusion.

A nurse is preparing to administer levothyroxine to a client who has hypothyroidism. The nurse should identify which of the following laboratory results as supporting the administration of this medication? A. Thyroid-stimulating hormone (TSH) 8 microunits/mL B. Free triiodothyronine (T3) 300 pg/dL C. Free thyroxine (T4) 7 mcg/dL D. Thyroxine-binding globulin 2.3 mg/dL

A. Thyroid-stimulating hormone (TSH) 8 microunits/mL The expected reference range for TSH is 0.3 to 5 microunits/mL. When a client has primary hypothyroidism, the TSH level becomes elevated in an attempt to normalize the thyroid gland's function. When the client has had a therapeutic response to treatment, the TSH level returns to the expected reference range.

A nurse is teaching a client who has primary adrenal insufficiency (Addison's disease) and a prescription for hydrocortisone. Which of the following statements should the nurse include in the teaching about this medication? A. "You may need to take a lower dosage when you are ill or experiencing stress." B. "Take this medication before going to bed because it will make you tired." C. "Carry a supply of pills and a single-use injectable preparation with you at all times." D. "You will need to stop this medication before routine procedures such as a colonoscopy."

Answer: C. "Carry a supply of pills and a single-use injectable preparation with you at all times." The nurse should tell the client to carry an emergency supply of the medication to take during times of unexpected stress. The client should carry an adequate supply at all times, which should include an injectable preparation plus a supply equal to the regular oral dosage. The single-use injectable preparation should be administered IM if the client has an emergency and needs an extra dose of the glucocorticoid.

A nurse is administering insulin glulisine 10 units subcutaneously at 0730 to an adolescent client who has type 1 diabetes mellitus. The nurse should anticipate the onset of action of the insulin at which of the following times? A. 0800 B. 0745 C. 0900 D. 1030

B. 0745 Insulin glulisine has a very short onset of action of 15 minutes. The nurse should expect the onset of action around 0745 and ensure the client eats breakfast immediately following the administration of the insulin.

A nurse is caring for a client who has been taking taken metformin for 6 months. Which of the following findings should the nurse identify as an expected therapeutic effect of the medication? A. Decreased vitamin B12 levels B. Decreased blood glucose level C. Abdominal bloating and diarrhea D. Decreased LDL level

B. Decreased blood glucose level A client who has taken metformin for 6 months should experience the expected therapeutic effect of a decrease in blood glucose levels. Metformin is a non-insulin medication for clients who have type 2 diabetes mellitus.

A nurse is providing teaching to a client who has type 2 diabetes mellitus and a new prescription for metformin. Which of the following adverse effects of metformin should the nurse instruct the client to watch for and report to the provider? A. Weight gain B. Myalgia C. Hypoglycemia D. Severe constipation

B. Myalgia Myalgia, malaise, somnolence, and hyperventilation are manifestations of lactic acidosis, which rarely occur while taking metformin due to the blockage of lactic acid oxidation. The nurse should instruct the client to report these findings promptly to the provider.

A nurse is reviewing the laboratory results for a client who has a prescription for filgrastim. An increase in which of the following values indicates a therapeutic effect of this medication? A. Erythrocyte count B. Neutrophil count C. Lymphocyte count D. Thrombocyte count

B. Neutrophil count Filgrastim increases neutrophil production. It is given to treat neutropenia and reduce the risk of infection in clients who are receiving chemotherapy for cancer or who have undergone bone marrow transplant.

A nurse is monitoring the laboratory values of a male client who has leukemia and is receiving weekly chemotherapy with methotrexate via IV infusion. Which of the following laboratory values should the nurse report to the provider? A. BUN 18 mg/dL B. Platelets 78,000/mm^3 C. Hemoglobin 14.2 g/dL D. Aspartate aminotransferase (AST) 35 units/L

B. Platelets 78,000/mm^3 The nurse should monitor the platelet count of a client who is taking methotrexate because the medication can cause thrombocytopenia. This client's platelet count is very low and puts the client at risk of severe bleeding. The nurse should report this finding promptly to the provider.

A nurse is teaching a client who has type 2 diabetes mellitus about a prescription for insulin lispro. Which of the following statements should the nurse include in the teaching? A. "The effects of the insulin lispro can last for 8 to 12 hours." B. "Administer insulin lispro 30 to 60 minutes before eating." C. "Insulin lispro has an onset of about 15 minutes." D. "This insulin can be given as a continuous intravenous bolus."

C. "Insulin lispro has an onset of about 15 minutes." Insulin lispro is a rapid-acting insulin and has an onset of 15 to 30 minutes.

A nurse is teaching a client who has been taking an NSAID to treat rheumatoid arthritis. During the client's first month checkup, the provider prescribed methotrexate to be added to the medication regimen. Which of the following statements should the nurse include in the teaching about the purpose of this change in the client's medication? A. "Your current medication was not strong enough to manage this condition." B. "Once your blood levels of methotrexate are within the therapeutic range, the NSAID will be discontinued." C. "This medication was added to delay the disease progression." D. "Treating this disease with 2 medications will help protect you from becoming treatment-resistant."

C. "This medication was added to delay the disease progression." The nurse should inform the client that the provider prescribed methotrexate to be added to the medication regimen along with an NSAID to delay the progression of the disease and to delay joint damage or deformity that can result from the disease.

A nurse is caring for a client who receives gastrostomy tube feedings and insulin. The client is scheduled to receive a tube feeding at 0700. At which of the following times should the nurse plan to administer insulin lispro subcutaneously? A. 0600 B. 0630 C. 0645 D. 0730

C. 0645 Lispro is a rapid-acting insulin with an onset of 15 minutes. The nurse should administer the insulin dose 15 min prior to the feeding.

A nurse is providing teaching to a client who has hypothyroidism and is taking levothyroxine. The nurse should instruct the client that which of the following findings is an indication of thyrotoxicosis? A. Weight gain B. Constipation C. Chest pain D. Fatigue

C. Chest pain Thyrotoxicosis can result if a client takes too much levothyroxine. Manifestations include chest pain, tachycardia, insomnia, tremors, hyperthermia, heat intolerance, and diaphoresis. The client should notify the provider if any of these manifestations are present.

A nurse is caring for a client who was recently diagnosed with Addison's disease and has been placed on long-term mineralocorticoid therapy with fludrocortisone. Which of the following pieces of information should the nurse provide when explaining the purpose of this therapy? A. Mineralocorticoids help the body metabolize carbohydrates, fats, and proteins. B. Mineralocorticoids support secondary sexual development. C. Mineralocorticoids maintain electrolyte and fluid balance. D. Mineralocorticoids reduce the risk of cardiac dysrhythmias.

C. Mineralocorticoids maintain electrolyte and fluid balance. Mineralocorticoids (specifically aldosterone) are necessary for the regulation of fluid and electrolyte balance (particularly for sodium, potassium, and water). Addison's disease results in a deficiency of cortisol and aldosterone production and requires supplementation with glucocorticoids and mineralocorticoids. Fludrocortisone is the only mineralocorticoid available.

A nurse is providing teaching to a client who has chronic kidney failure with an AV fistula for hemodialysis and a new prescription for epoetin alfa. Which of the following therapeutic effects of epoetin alfa should the nurse include in the teaching? A. Reduces blood pressure B. Inhibits clotting of fistula C. Promotes RBC production D. Stimulates growth of neutrophils

C. Promotes RBC production Epoetin alfa stimulates erythropoiesis in the bone marrow to increase RBC production and reduce anemia. Anemia is common in clients who have chronic kidney failure since erythropoietin is produced by the kidney.

A nurse is caring for a client who is taking a prescription for glucocorticoid adrenal replacement medication for the long-term treatment of Addison's disease. Which of the following findings indicates that the client is experiencing an adverse effect of the medication? A. Weight loss B. Hypotension C. Lethargy D. Osteoporosis

D. Osteoporosis Long-term use of steroid medications such as glucocorticoid medication can inhibit bone growth and result in the adverse effect of osteoporosis with long-term treatment.

A nurse is teaching a client who has type 2 diabetes mellitus about storing unopened vials of insulin. Which of the following pieces of information should the nurse include in the teaching? A. Store the vials in the freezer B. Store the vials at room temperature C. Store the vials by a window D. Store the vials in the refrigerator

D. Store the vials in the refrigerator The nurse should tell the client to store unopened vials of insulin in the refrigerator. The client can use the unopened vials of insulin up to the printed expiration date.

A nurse is preparing to administer 100 units of insulin glargine and 4 units of NPH insulin subcutaneously to a client. Which of the following actions should the nurse plan to take? A. Verify with the provider about giving insulin glargine at 1700 B. Ensure the insulin glargine is a cloudy suspension C. Request a prescription for giving insulin glargine twice daily D. Use separate syringes for administering insulin glargine and NPH insulin

D. Use separate syringes for administering insulin glargine and NPH insulin The nurse should not mix insulin glargine with any other insulin. The nurse should administer the NPH insulin and insulin glargine separately.