Pharmacology

A nurse is reinforcing teaching with a client who is taking benztropine to treat Parkinson's disease. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication?

Difficulty voiding. The nurse should instruct the client to report difficulty voiding as an adverse effect of benztropine, which may indicate urinary retention. Benztropine is an anticholinergic medication that helps decrease the rigidity and tremors of Parkinson's disease.

A nurse is caring for a client who is taking levothyroxine for hypothyroidism. Which of the following indicates the client's dose is too high?

Tachypnea A client who has thyrotoxicosis from excessive amounts of thyroid hormone will have increased metabolic processes, which will increase cardiac output and oxygen demand. The client's respiratory and cardiac rate increase dramatically and the client can have weakness, insomnia, tremulousness and agitation.

A nurse is reinforcing teaching for a client who is depressed and has a prescription for fluoxetine 20 mg PO twice daily. The nurse should identify that which of the following statements by the client demonstrates an understanding of the teaching?

"I'lI need to report weight loss or gain to my provider while taking this medication." Fluoxetine can cause anorexia, nausea, and vomiting early in treatment, possibly causing weight loss. Over the course of therapy, weight gain is common. The client should monitor weight regularly and report significant changes to the provider.

A nurse is caring for a client who has a prescription for 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 make?

"Take the daily dose at bedtime." Taking the dose at bedtime will allow the client to obtain the benefit of maximum relief of symptoms and rest without itching.

A nurse is preparing to administer orlistat to a client for treatment of obesity. For which of the following adverse effects should the nurse monitor?

-Oily fecal spotting. Because the medication reduces the gastrointestinal tract's absorption of fat, oily fecal spotting is an adverse effect of orlistat

A nurse is caring for a client who is receiving IV tobramycin and has a prescription for peak and trough blood levels with the next dose scheduled for 1800. The nurse should expect the lab to draw blood samples at which of the following times?

1745 and 1830 Timing of the peak and trough is based on the pharmacokinetics of absorption and the half-life of the medication. The trough level is the lowest serum level after the pharmacokinetic effects have taken place. Correct timing for the trough is just prior to administering the next dose. The peak is the highest serum level of the drug; if this level is too low, then the drug will not be effective. Correct timing for the peak is 30 min after the dose finishes infusing.

A nurse is reinforcing teaching with a client who is to start taking calcium carbonate as a calcium supplement. Which of the following foods should the nurse instruct the client to consume to increase the absorption of calcium?

2% cottage cheese ½ cup (4 oz). Cottage cheese is high in lactose, which promotes calcium absorption.

A nurse is collecting data from an older adult client who has been taking digoxin for the past several months. For which of the following manifestations of digoxin toxicity should the nurse monitor?

Anorexia. Clients who take digoxin are at risk for toxicity due to the medication's narrow therapeutic range. Anorexia, nausea, and vomiting are some of the early manifestations of digoxin toxicity in adults. In children, cardiac dysrhythmias are often the first manifestation of digoxin toxicity.

A nurse in a provider's office is collecting data from a client who has systemic lupus erythematosus (SLE) and takes hydroxychloroquine to reduce skin inflammation. The nurse should identify that which of the following is an adverse effect of this medication?

Blurred vision An adverse effect of hydroxychloroquine is retinopathy.

A nurse is caring for a client who has hypertension and is to start taking atenolol. The nurse should instruct the client to monitor for which of the following findings as an adverse effect of this medication?

Bradicardia. Atenolol is a beta-adrenergic blocking agent, which slows the heart rate and can lead to bradycardia. The nurse should instruct the client to check his heart rate before each dose and to notify the provider if the rate is below his usual rate.

A nurse in a provider's office is reinforcing teaching with a client who is to start taking colchicine orally for gout. The nurse should tell the client that which of the following findings is an adverse effect of colchicine?

Diarrhea. The nurse should instruct the client that he should discontinue the medication immediately if gastrointestinal effects occur, such as nausea, vomiting, and abdominal pain.

A nurse collecting a medication history from a client who takes herbal supplements and is scheduled for a surgical procedure in 10 days. The nurse should inform the client that which of the following dietary supplements increases the risk of bleeding?

Feverfew. The nurse should explain that feverfew interferes with platelet action and can therefore cause bleeding.

A nurse is caring for a client who has osteoporosis and is taking calcium carbonate. The nurse should monitor the client for which of the following adverse effects?

Flank pain. The nurse should monitor the client for flank pain, which can indicate renal calculi, an adverse effect of calcium carbonate.

A nurse is preparing a presentation for coworkers about the various herbal remedies clients might report using. Which of the following should she include as an herbal supplement clients might use to treat osteoarthritis of the knee, hip, and wrists?

Glucosamine. Clients who have osteoarthritis of the knee, hip, and wrists can use glucosamine to stimulate synthesis of cartilage and synovial fluid and decrease joint inflammation and degradation of cartilage.

A female client who has rheumatoid arthritis asks the nurse if it is safe for her to take aspirin. Which of the following is a contraindication to this medication?

History of gastric ulcers. Aspirin impedes clotting by blocking prostaglandin synthesis, which can lead to bleeding. A side effect of prednisone is gastric irritation, also leading to bleeding. Therefore, a history of gastric ulcers is a contraindication to the use of aspirin.

A nurse is caring for a client who is to start taking tamoxifen as a treatment for breast cancer. The nurse should instruct the client to expect which of the following findings as an adverse effect of the medication?

Hot flashes. The client will experience hot flashes as an adverse effect of the medication because tamoxifen is an antiestrogen medication that blocks estrogen receptors.

A nurse notes that a client's laboratory findings reveal agranulocytosis. The client is taking propylthiouracil to treat hyperthyroidism. The nurse should monitor the client for which of the following?

Infection. Agranulocytosis is a failure of the bone marrow to make enough WBC, which can cause neutropenia and lower the body defenses against infection.

A nurse is preparing to administer potassium chloride to a client who has a potassium level of 5.8 mEq/L. Which of the following actions should the nurse take?

Inform the provider of the client's potassium level. The nurse should notify the provider and inform her of the client's potassium level.

A nurse is reviewing medications for a client who has just been diagnosed with a small bowel obstruction. The nurse should withhold senna prescribed orally based on understanding of which of the following?

Laxatives are contraindicated in clients who have a small bowel obstruction. Senna is a stimulant laxative and, like other laxatives, is contraindicated in clients who have fecal impaction, bowel obstruction, and acute abdominal surgery to prevent perforation. Because the bowel does not allow for any passage of stool with a complete small bowel obstruction, laxatives will cause increased abdominal cramping and discomfort and might cause perforation of the bowel.

A nurse is reinforcing teaching with a client who is to start taking atorvastatin. The nurse should instruct the client that she will need which of the following baseline examinations prior to starting therapy?

Liver function tests. Statins such as atorvastatin can cause liver damage and liver disease is a contraindication for taking the medication. The client should have baseline liver function testing before beginning therapy, then every 1 to 2 months, at 6 and 12 weeks, and then periodically throughout therapy.

A nurse is evaluating the morning laboratory reports of a client who has bipolar disorder. The laboratory report indicates a serum lithium level of 2 mEq/L. In responding to this report, which of the following actions should the nurse anticipate?

Monitoring the client for signs of lithium toxicity. This level indicates lithium toxicity. Lithium has a very narrow therapeutic range and should be kept below 1.5 mEq/L so serum lithium levels must be monitored at regular intervals. Even at slightly

A nurse is caring for a client who has a detached retina and is scheduled for surgical repair. Preoperatively the nurse should prepare to administer which of the following medications?

Phenylephrine hydrochloride (AK-Dilate) Mydriatic drugs such as phenylephrine hydrochloride are used preoperatively so that the pupil is widely dilated.

A nurse is reviewing laboratory data from a client who has pulmonary embolism and is receiving IV heparin. Which of the following findings should the nurse report to the provider?

Platelets 74,000/mm3 MY ANSWER Heparin-induced thrombocytopenia is a disorder characterized by low platelet counts and is an adverse effect of heparin that causes the activation of platelets, resulting in widespread clot formation and depletion of platelets. A platelet count of 74,000/mm3 is below the expected reference range. The nurse should notify the provider and discontinue the heparin.

A nurse is caring for a newly admitted client diagnosed with diabetes mellitus. The nurse notes that the client is confused, flushed, and has an acetone odor on his breath. Based on her findings, the nurse suspects diabetic ketoacidosis and should anticipate using which of the following types of insulin to treat the client?

Regular (Humulin R) Regular insulin is classified as a short-acting insulin. It has the advantage that it can be given IV with an onset of action of less than 30 min. Regular insulin is the most appropriate insulin to use in emergency situations of hyperglycemia.

A nurse is to administer a rectal suppository to a client. The nurse should instruct the client to lie in which of the following position's while in bed?

Sim's position The Sim's position exposes the anus and helps the client relax the external sphincter while lying in bed. This allows for easier insertion of the suppository.

A nurse is preparing to administer bethanechol to a client who is postoperative. The nurse should explain to the client that which of the following is an expected outcome of the medication?

Stimulate voiding. Bethanechol acts on the muscarinic receptors of the urinary tract. It is used for postoperative and postpartum clients who have urinary retention.

A nurse is reinforcing teaching with a client who uses a nitroglycerine patch to treat angina. The client now has a new prescription for nitroglycerin sublingual tablets. Which of the following instructions should the nurse include?

Take the medication at the first indication of chest pain. The client should take nitroglycerin as soon as he feels pain, pressure, or tightness in his chest and not wait until his chest pain is severe.

A nurse is caring for a client with cirrhosis who has a prothrombin time of 30 seconds. Which of the following medications does the nurse anticipate the provider will prescribe?

​Vitamin K. ​A prothrombin time of 30 seconds indicates the clotting time is prolonged and bleeding could occur. Vitamin K injection increases the synthesis of prothrombin by the liver, therefore; the nurse should anticipate the provider will prescribe Vitamin k

A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client. What is the sequence of events the nurse should follow? (Move the steps of mixing insulin on the left into the box on the right, placing them in the selected order of performance. All steps must be used.)

• Inspect vials for contaminants: With the exception of PH insulin, all insulin available today is supplied as a clear, colorless solution. Insulin that has become colored, cloudy, or has formed a precipitate should not be used. The first step is to observe the characteristics of the regular and PH insulin to determine whether they are safe to use. If they appear abnormal, the nurse should discard them. • Roll PH vial between palms of hands: Because PH insulin is a suspension, the particles must be evenly dispersed by rolling the vial gently between the palms of the hands. This should be done gently because vigorous mixing may cause the solution to become frothy and cause inaccurate dosing. If granules or clumps are present after mixing, the solution should be discarded. This should be done prior to withdrawing the solution into the syringe. • Iniect air into PH insulin vial: This creates a pressure in the vial for accuracy in measuring the amount prescribed. • Inject air into regular insulin vial: The amount of air injected into the vial of short-acting insulin is equal to the amount to be administered. • Withdraw short-acting insulin into syringe: When the prescription requires the administration of two types of insulin, it is generally preferable to mix the solutions into one syringe if they are compatible to prevent the client from receiving two injections. Of the longer-acting insulin available, only NPH insulin is appropriate for mixing with short-acting insulin. When two insulins are to be mixed, it is best to withdraw the short-acting insulin first to avoid contaminating the stock vial with NPH insulin. Add intermediate insulin to syringe: The mixture is stable for 28 days.