ATI Pharmacology Practice Test A

A nurse is assessing a client who has myasthenia gravis and is taking neostigmine. Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect? a. Tachycardia b. Oliguria c. Xerostomia d. Miosis

Miosis, which is pupillary constriction, is a common adverse effect of neostigmine due to the excessive muscarinic stimulation that causes difficulty with visual accommodation.

A nurse is preparing to administer PO sodium polystyrene sulfonate to a client who has hyperkalemia. Which of the following actions should the nurse plan to take? a. Hold the client's other oral medications for 8 hr post administration. b. Inform the client that this medication can turn stool a light tan color. c. Keep the client's solution in the refrigerator for up to 72 hr. d. Monitor the client for constipation.

Monitor the client for constipation: The nurse should monitor the client for the adverse effect of constipation and report it to the provider because this can lead to fecal impaction. The nurse should hold the client's other oral medications for 6 hr before and after administration of sodium polystyrene sulfonate.

A nurse is assessing a client 1 hr after administering morphine for pain. The nurse should identify which of the following findings as the best indication that the morphine has been effective? a. The client's vital signs are within normal limits. b. The client has not requested additional medication. c. The client is resting comfortably with eyes closed. d. The client rates pain as 3 on a scale from 0 to 10.

The client rates pain as 3 on a scale from 0 to 10: The client's description of the pain is the most accurate assessment of pain. Vital signs can be within normal limits for clients who have pain. Clients often do not request medicine even when they are experiencing pain. The client might rest with their eyes closed as a method to try to manage pain. However, this does not indicate that the pain is controlled.

A nurse is assessing a client who is postoperative following an outpatient endoscopy procedure using midazolam. The nurse should monitor for which of the following findings as an indication that the client is ready for discharge? a. The client's capnography has returned to baseline. b. The client can respond to their name when called. c. The client is passing flatus. d. The client is requesting oral intake.

The client's capnography has returned to baseline: The nurse should identify that the client is ready for discharge when the capnography level indicates that gas exchange is adequate.

A nurse is caring for a client who is taking acetazolamide for chronic open-angle glaucoma. For which of the following adverse effects should the nurse instruct the client to monitor and report? a. Tingling of fingers b. Constipation c. Weight gain d. Oliguria

Tingling of fingers: The nurse should instruct the client to report the adverse effect of paresthesia, a tingling sensation in the extremities, when taking acetazolamide.

A nurse at an urgent care clinic is collecting a history from a female client who has a urinary tract infection. The nurse anticipates a prescription for ciprofloxacin. The nurse should identify that which of the following client statements indicates a contraindication for administering this medication? a. "I have tendonitis, so I haven't been able to exercise." b. "I take a stool softener for chronic constipation." c. "I take medicine for my thyroid." d. "I am allergic to sulfa."

"I have tendonitis, so I haven't been able to exercise.": The nurse should identify tendonitis as a contraindication for taking ciprofloxacin due to the risk of tendon rupture.

A nurse is teaching a client about the use of risedronate for the treatment of osteoporosis. The nurse should identify which of the following statements as an indication that the client understands the teaching? a. "I will drink a glass of milk when I take the risedronate." b. "I will take the risedronate 15 minutes after my evening meal." c. "I should take an antacid with the risedronate to avoid nausea." d. "I should sit up for 30 minutes after taking the risedronate."

"I should sit up for 30 minutes after taking the risedronate.": Sitting upright for at least 30 min after taking risedronate will reduce the adverse gastrointestinal effects of esophagitis and dyspepsia. Risedronate is contraindicated for a client who cannot sit or stand upright for this length of time. The nurse should reinforce that risedronate should be taken with a full glass of water, rather than any other liquid. Although the delayed release form of the medication can be taken after eating, the immediate release form of the medication should be taken at least 30 min prior to consuming food or other liquids. Both forms of medication should be taken in the morning. The absorption of risedronate, a bisphosphonate, will be reduced if it is taken with antacids containing calcium, aluminum, or magnesium. The nurse should instruct the client to take the antacid 2 hr after taking risedronate.

A nurse is providing discharge instructions to a client who has heart failure and a new prescription for captopril. Which of the following client statements indicates an understanding of the teaching? a. "I should take the medication with food." b. "I should take naproxen if I develop joint pain." c. "I should tell my provider if I develop a sore throat." d. "I should expect the medication to cause my urine to look orange."

"I should tell my provider if I develop a sore throat.": The client should report a sore throat to the provider because this can indicate neutropenia, a serious adverse effect of captopril. Neutropenia can be reversed if it is identified early and the medication is promptly discontinued. The client should take captopril on an empty stomach because food reduces absorption of the medication. The nurse should instruct the client to take the medication 1 hr before or 2 hr after a meal. Naproxen and other NSAIDs can interact with captopril, which can decrease the effect of the antihypertensive and increase the risk of kidney dysfunction. Captopril affects the urinary system by causing dysuria, urinary frequency, and changes in the normal amount of urine. However, captopril does not affect the color of the urine.

A nurse is instructing a client on the application of nitroglycerin transdermal patches. Which of the following statements by the client indicates an understanding of the teaching? a. "I should apply a patch every 5 minutes if I develop chest pain." b. "I will take the patch off right after my evening meal." c. "I will leave the patch off at least 1 day each week." d. "I should discard the used patch by flushing it down the toilet."

"I will take the patch off right after my evening meal.": Clients should remove the patch each evening for a medication free time of 12 to 14 hr before applying a new patch to avoid developing a tolerance to the medication's effects.

A nurse is teaching a client about cyclobenzaprine. Which of the following client statements should indicate to the nurse that the teaching is effective? a. "I will have increased saliva production." b. "I will continue taking the medication until the rash disappears." c. "I will taper off the medication before discontinuing it." d. "I will report any urinary incontinence."

"I will taper off the medication before discontinuing it.": The client should taper off cyclobenzaprine before discontinuing it to prevent abstinence syndrome or rebound insomnia.

A nurse is providing teaching to a client who has a gastric ulcer and a new prescription for ranitidine. Which of the following instructions should the nurse include? a. "Take the medication on an empty stomach for full effectiveness." b. "You may discontinue this medication when stomach discomfort subsides." c. "Report yellowing of the skin." d. "Store the medication in the refrigerator."

"Report yellowing of the skin.": Ranitidine can be hepatotoxic and cause jaundice. The nurse should instruct the client to monitor for and report yellowing of the skin or eyes to the provider. The client can take ranitidine with or without food because food does not affect the medication's effectiveness. For clients who have a gastric ulcer, ranitidine is prescribed to inhibit gastric secretion and must be taken for the full course of therapy to be effective. The client should store ranitidine at room temperature.

A nurse is providing teaching to a client who is to start treatment for asthma with beclomethasone and albuterol inhalers. Which of the following instructions should the nurse include in the teaching? a. "Take beclomethasone to avoid an acute attack." b. "Use beclomethasone 5 minutes before using albuterol." c. "Limit your calcium and vitamin D intake when taking beclomethasone." d. "Rinse your mouth after inhaling the beclomethasone."

"Rinse your mouth after inhaling the beclomethasone.": The client should rinse their mouth after using beclomethasone, a glucocorticoid inhaler, to prevent oropharyngeal candidiasis and hoarseness. The client should take albuterol, a short-acting beta2-adrenergic agonist, to avoid an acute asthma attack. The client should use the bronchodilator, albuterol, prior to taking beclomethasone, a glucocorticoid inhaler, to enhance its absorption. The client should increase the intake of calcium and vitamin D to minimize bone loss while taking beclomethasone, a glucocorticoid inhaler.

A nurse is providing teaching to a client who has a prescription for ergotamine sublingual to treat migraine headaches. Which of the following information should the nurse include in the instructions? a. "Take one tablet three times a day before meals." b. "Take one tablet at onset of migraine." c. "Take up to eight tablets as needed within a 24-hour period." d. "Take one tablet every 15 minutes until migraine subsides."

"Take one tablet at onset of migraine.": The client should take one tablet immediately after the onset of aura or headache.

A nurse is caring for a client who received 0.9% sodium chloride 1 L over 4 hr instead of over 8 hr as prescribed. Which of the following information should the nurse enter as a complete documentation of the incident? a. IV fluid infused over 4 hr instead of the prescribed 8 hr. Client tolerated fluids well, provider notified. b. 0.9% sodium chloride 1 L IV infused over 4 hr. Vital signs stable, provider notified. c. 1 L of 0.9% sodium chloride completed at 0900. Client denies shortness of breath. d. IV fluid initiated at 0500. Lungs clear to auscultation.

0.9% sodium chloride 1 L IV infused over 4 hr. Vital signs stable, provider notified.: The nurse should document the type and amount of fluid, how long it took to infuse, provider notification, and the client's physical status. The nurse should only chart factual information in the client's medical record without indicating the error that occurred. This documentation is not complete because it does not include the amount of fluid that was infused over the amount of time.

A nurse is preparing to administer a scheduled antibiotic at 0800 to a client and discovers the antibiotic is not present in the client's medication drawer. The nurse should identify that administration of the medication can occur at which of the following time periods without requiring an incident report? a. 1000 b. 0900 c. 0830 d. 1200

0830: The nurse should identify that an antibiotic can be administered 30 min before or after the scheduled time to maintain therapeutic blood levels without requiring an incident report.

A nurse is preparing to administer dextrose 5% in water (D5W) 400 mL IV to infuse over 1 hr. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

100 gtt/min Follow these steps to calculate the infusion rate using the Dimensional Analysis method of calculation: Step 1: What is the unit of measurement the nurse should calculate? (Place the unit of measure being calculated on the left side of the equation.) X gtt/min = Step 2: Determine the ratio that contains the same unit as the unit being calculated. (Place the ratio on the right side of the equation, ensuring that the unit in the numerator matches the unit being calculated.) 15 gttX gtt/min = 1 mL Step 3: Place any remaining ratios that are relevant to the item on the right side of the equation, along with any needed conversion factors, to cancel out unwanted units of measurement. 15 gtt400 mLX gtt/min = × 1 mL60 min Step 4: Solve for X. X gtt/min = 100 gtt/min Step 5: Round if necessary. Step 6: Determine whether the amount ot administer makes sense. If the prescription reads D5W 400 mL IV to infuse over 60 min with a drop factor of 15 gtt/mL, it makes sense to administer 100 gtt/min. The nurse should set the manual IV infusion to deliver D5W IV at 100 gtt/min.

A nurse is caring for the parent of a newborn. The parent asks the nurse when their newborn should receive the first diphtheria, tetanus, and pertussis vaccine (DTaP). The nurse should instruct the parent that their newborn should receive the immunization at which of the following ages? a. At birth b. 2 months c. 6 months d. 15 months

2 months: The CDC recommends that newborns receive the first dose of the five-dose series of the DTaP immunization at 2 months of age.

A nurse is preparing to administer ciprofloxacin 15 mg/kg PO every 12 hr to a child who weighs 44 lb. How many mg should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

300 mg/dose Follow these steps for the Dimensional Analysis method of calculation: Step 1: What is the unit of measurement the nurse should calculate? (Place the unit of measure being calculated on the left side of the equation.) Step 2: Determine the ratio that contains the same unit as the unit being calculated. (Place the ratio on the right side of the equation, ensuring that the unit in the numerator matches the unit being calculated.) 15 mgX mg/dose = 1 kg Step 3: Place any remaining ratios that are relevant to the item on the right side of the equation, along with any needed conversion factors, to cancel out unwanted units of measurement. 15 mg1 kg44 lb12 hrX mg/dose = × × × x2.2 lb12 hr1 dose Step 4: Solve for X. X mg/dose = 300 mg/dose Step 5: Round if necessary. Step 6: Determine whether the amount to administer makes sense. If the prescription reads 15 mg/kg every 12 hr and the child weighs 20 kg, it makes sense to give 300 mg/dose every 12 hr.

A nurse is teaching a group of unit nurses about medication reconciliation. Which of the following information should the nurse include in the teaching? a. The client's provider is required to complete medication reconciliation. b. Medication reconciliation at discharge is limited to the medication ordered at the time of discharge. c. A transition in care requires the nurse to conduct medication reconciliation. d. Medical reconciliation is limited to the name of the medications that the client is currently taking.

A transition in care requires the nurse to conduct medication reconciliation: The nurse should conduct medication reconciliation anytime the client is undergoing a change in care such as admission, transfer from one unit to another, or discharge. A complete listing of all prescribed and over-the-counter medications should be reviewed.

A nurse is caring for a client who has acute acetaminophen toxicity. The nurse should anticipate administering which of the following medications? a. Vitamin K b. Acetylcysteine c. Benztropine d. Physostigmine

Acetylcysteine: Acetylcysteine is a specific antidote for acetaminophen toxicity. It can prevent severe injury when given orally or by IV infusion within 8 to 10 hr.

A nurse is preparing to administer heparin subcutaneously to a client. Which of the following actions should the nurse plan to take? a. Administer the medication outside the 5-cm (2-in) radius of the umbilicus. b. Aspirate for blood return before injecting. c. Rub vigorously after the injection to promote absorption. d. Place a pressure dressing on the injection site to prevent bleeding.

Administer the medication outside the 5-cm (2-in) radius of the umbilicus: The nurse should administer the heparin by subcutaneous injection to the abdomen in an area that is above the iliac crest and at least 5 cm (2 in) away from the umbilicus. The nurse should not aspirate by pulling back on the plunger of the heparin syringe to check for a blood return, because this will cause the injection site to bruise. The nurse should apply firm pressure to the injection site for 1 to 2 min after the administration of the heparin to prevent bruising. The nurse does not need to apply a dressing over the injection site if pressure is held for at least 1 min to prevent bleeding.

A nurse in an emergency department is caring for a client who has myasthenia gravis and is in a cholinergic crisis. Which of the following medications should the nurse plan to administer? a. Potassium iodide b. Glucagon c. Atropine d. Protamine

Atropine: A cholinergic crisis is caused by an excess amount of cholinesterase inhibitor, such as neostigmine. The nurse should plan to administer atropine, an anticholinergic agent, to reverse cholinergic toxicity. Potassium iodide is a thyroid hormone antagonist used in the treatment of radioactive iodine exposure. Glucagon is an antihypoglycemic medication used in the treatment of low blood glucose levels. Protamine is a heparin antagonist that is administered to reverse heparin toxicity evidenced by an aPTT greater than 70 seconds.

A nurse is planning care for a client who is receiving mannitol via continuous IV infusion. The nurse should monitor the client for which of the following adverse effects? a. Weight loss b. Increased intraocular pressure c. Auditory hallucinations d. Bibasilar crackles

Bibasilar crackles: Mannitol, an osmotic diuretic, can precipitate heart failure and pulmonary edema. Therefore, the nurse should recognize lung crackles as an indicator of a potential complication and stop the infusion. Mannitol is an osmotic diuretic used to promote diuresis, decrease intracranial pressure, and improve renal function. An expected therapeutic effect of mannitol is weight loss resulting from diuresis. An indication for the use of mannitol is increased intraocular pressure. Mannitol decreases the intraocular pressure by creating an osmotic gradient between the intraocular fluid and the plasma. Mannitol has several neurologic adverse effects, including increased intracranial pressure, seizures, confusion, and headaches. However, it does not cause auditory hallucinations.

A nurse is caring for a client who is receiving heparin therapy via continuous IV infusion to treat a pulmonary embolism. Which of the following findings should the nurse identify as an adverse effect of the medication and report to the provider? a. Vomiting b. Blood in the urine c. Positive Chvostek's sign d. Ringing in the ears

Blood in the urine: The nurse should report blood in the urine to the provider because this can be a manifestation of heparin toxicity. Other manifestations can include bruising, hematomas, hypotension, and tachycardia. Vomiting is not an expected adverse effect of heparin therapy. The nurse should assess the client for other causes for vomiting. Chvostek's sign is seen in clients who have hypocalcemia or hypomagnesemia. Ringing in the ears is not an expected adverse effect of heparin therapy. Aminoglycosides, such as vancomycin, are medications that cause ringing in the ears.

A nurse is reviewing the medication list of a client who wants to begin taking oral contraceptives. The nurse should identify that which of the following client medications will interfere with the effectiveness of oral contraceptives? a. Carbamazepine b. Sumatriptan c. Atenolol d. Glipizide

Carbamazepine: Carbamazepine causes an accelerated inactivation of oral contraceptives because of its action on hepatic medication-metabolizing enzymes.

A nurse administers a dose of metformin to a client instead of the prescribed dose of metoclopramide. Which of the following actions should the nurse take first? a. Report the incident to the charge nurse. b. Notify the provider. c. Check the client's blood glucose. d. Fill out an incident report.

Check the client's blood glucose: The first action the nurse should take using the nursing process is to assess the client. The client is at risk for hypoglycemia. The nurse should monitor the client's blood glucose and provide the client with a snack to reduce the risk for hypoglycemia.

A nurse is caring for a client who has cancer and is taking oral morphine and docusate sodium. The nurse should instruct the client that taking the docusate sodium daily can minimize which of the following adverse effects of morphine? a. Constipation b. Drowsiness c. Facial flushing d. Itching

Constipation: Constipation is a common adverse effect of morphine that can be minimized by taking docusate sodium, a stool softener that promotes easier evacuation of stool by increasing water and fat in the intestine. Drowsiness, facial flushing, and ithching are not adverse effects of morphine that can be minimized by taking docusate sodium.

A nurse is teaching a client who is to start taking hydrocodone with acetaminophen tablets for pain. Which of the following information should the nurse include in the teaching? a. The medication should be taken 1 hr prior to eating. b. It takes 48 hr for therapeutic effects to occur. c. Tablets should not be crushed or chewed. d. Decreased respirations might occur.

Decreased respirations might occur.: The nurse should instruct the client that hydrocodone with acetaminophen might cause respiratory depression, which is an adverse effect of the medication. The client should avoid taking over-the-counter medications or newly prescribed medications without consulting their provider to avoid increased respiratory depression. The client should take hydrocodone and acetaminophen with food or milk to decrease gastric irritation. The nurse should instruct the client that they should experience the effects of hydrocodone with acetaminophen within 20 min of administration and that pain relief should last for 4 to 6 hr. The client should avoid crushing, chewing, or breaking the extended release or immediate release hydrocodone tablets to prevent an immediate increase in CNS effects. Hydrocodone with acetaminophen tablets can be crushed if needed.

A nurse is planning care for a client who has hypertension and is to start taking metoprolol. Which of the following interventions should the nurse include in the plan of care? a. Weigh the client weekly. b. Determine apical pulse prior to administering. c. Administer the medication 30 min prior to breakfast. d. Monitor the client for jaundice.

Determine apical pulse prior to administering: Life-threatening bradycardia is an adverse effect that might affect this client. Therefore, the nurse should assess the client's apical pulse prior to administering the medication. If the client's pulse rate is less than 60/min, the nurse should withhold the medication and notify the provider. The nurse should weigh the client daily to monitor for the development of heart failure and weight gain. The nurse should administer metoprolol following meals or at bedtime if orthostatic hypotension occurs.

A nurse is reviewing the medication administration record of a client who has hypocalcemia and a new prescription for IV calcium gluconate. The nurse should identify that which of the following medications can interact with calcium gluconate? a. Felodipine b. Guaifenesin c. Digoxin d. Regular insulin

Digoxin: The nurse should identify that calcium gluconate can cause hypercalcemia, which increases the risk of digoxin toxicity.

A nurse is preparing to administer medications to a client who tells the nurse, "I don't want to take my fluid pill until I get home today." Which of the following actions should the nurse take? a. Document the refusal and inform the client's provider. b. File an incident report with the risk manager. c. Contact the pharmacist to pick up the medication. d. Give the client the medication to take at home and document that it was administered.

Document the refusal and inform the client's provider: The nurse has the responsibility to verify that the client understands the risks of refusing the medication so that an informed decision can be made. The nurse should then document the refusal in the client's medical record and notify the health care provider.

A nurse is administering donepezil to a client who has Alzheimer's disease. Which of the following findings should the nurse report to the provider immediately? a. Dyspepsia b. Diarrhea c. Dizziness d. Dyspnea

Dyspnea: When using the airway, breathing, circulation approach to client care, the nurse should report the adverse effect of dyspnea, caused by bronchoconstriction, to the provider first. Bronchoconstriction, dyspepsia, diarrhea, and dizziness are caused by the increase in acetylcholine levels, which is a primary effect of donepezil.

A nurse is assessing a client after administering a second dose of cefazolin IV. The nurse notes the client has anxiety, hypotension, and dyspnea. Which of the following medications should the nurse administer first? a. Diphenhydramine b. Albuterol inhaler c. Epinephrine d. Prednisone

Epinephrine: According to evidence-based practice, the nurse should administer epinephrine first to induce vasoconstriction and bronchodilation during anaphylaxis.

A nurse in an emergency department is caring for a client whose family reports the client has taken large amounts of diazepam. Which of the following medications should the nurse anticipate administering? a. Ondansetron b. Magnesium sulfate c. Flumazenil d. Protamine sulfate

Flumazenil: The nurse should anticipate administering flumazenil, an antidote used to reverse benzodiazepines such as diazepam.

A nurse is providing teaching to a client who has peptic ulcer disease and is to start a new prescription for sucralfate. Which of the following actions of sucralfate should the nurse include in the teaching? a. Decreases stomach acid secretion b. Neutralizes acids in the stomach c. Forms a protective barrier over ulcers d. Treats ulcers by eradicating H. pylori

Forms a protective barrier over ulcers: Secretions by the parietal and chief cells, hydrochloric acid and pepsin, can further irritate the ulcerated areas. Sucralfate, a mucosal protectant, forms a gel-like substance that coats the ulcer, creating a barrier to hydrochloric acid and pepsin.

A nurse is assessing a client's vital signs prior to the administration of PO digoxin. The client's BP is 144/86 mm Hg, heart rate is 55/min, and respiratory rate is 20/min. The nurse should withhold the medication and contact the provider for which of the following findings? a. Diastolic BP b. Systolic BP c. Heart rate d. Respiratory rate

Heart rate: Digoxin slows the conduction rate through the SA and AV nodes, thereby decreasing the heart rate. The nurse should withhold the medication and notify the provider for a heart rate of 55/min because this is an early indication of digoxin toxicity.

A nurse is teaching a client who is to begin taking tamoxifen for the treatment of breast cancer. Which of the following adverse effects should the nurse include in the teaching? a. Hot flashes b. Urinary retention c. Constipation d. Bradycardia

Hot flashes: The estrogen receptor blocking action of tamoxifen commonly results in the adverse effect of hot flashes.

A nurse is collecting a medication history from a client who has a new prescription for lithium. The nurse should identify that the client should discontinue which of the following over-the-counter medications? a. Aspirin b. Ibuprofen c. Ranitidine d. Bisacodyl

Ibuprofen: Most NSAIDs can significantly increase lithium levels. Therefore, the client should not take ibuprofen and lithium concurrently. Although most NSAIDs interact with lithium to increase lithium levels, aspirin does not interact with lithium.

A nurse is providing teaching to a client who is taking bupropion as an aid to quit smoking. Which of the following findings should the nurse identify as an adverse effect of the medication? a. Cough b. Joint pain c. Alopecia d. Insomnia

Insomnia: Bupropion, an atypical antidepressant, has stimulant properties, which can result in agitation, tremors, mania, and insomnia.

A nurse is assessing a client who is taking propylthiouracil for the treatment of Graves' disease. Which of the following findings should the nurse identify as an indication that the medication has been effective? a. Decrease in WBC count b. Decrease in amount of time sleeping c. Increase in appetite d. Increase in ability to focus

Increase in ability to focus: client who has Graves' disease can experience psychological manifestations such as difficulty focusing, restlessness, and manic-type behaviors. Propylthiouracil is a thyroid hormone antagonist that decreases the circulating T4 hormone, reducing the manifestations of hyperthyroidism. An increased ability to focus indicates that the medication has been effective. Propylthiouracil is a thyroid hormone antagonist used in the treatment of hyperthyroidism, or thyroid storms. A decreased WBC count is an adverse effect of propylthiouracil, which can cause myelosuppression. Therefore, a decrease in WBC count indicates the medication has not been effective. Graves' disease, a form of hyperthyroidism, has neurologic manifestations, including insomnia. Therefore, a decrease in the amount of time sleeping indicates the medication has not been effective. Graves' disease can result in gastrointestinal manifestations such as increased appetite, weight loss, and increased gastrointestinal motility. Therefore, an increase in appetite indicates the medication has not been effective.

A nurse receives a verbal order from the provider to administer morphine five milligrams every 4 hours subcutaneously for severe pain as needed. The nurse should identify which of the following entries as the correct format for the medication administration record (MAR)? a. MSO4 5 mg subcut every 4 hr PRN severe pain b. Morphine 5 mg subcut every 4 hr PRN severe pain c. MSO4 5 mg SQ every 4 hr PRN severe pain d. Morphine 5.0 mg subcutaneously every 4 hr PRN severe pain

Morphine 5 mg subcut every 4 hr PRN severe pain: The nurse should identify this entry as the correct format for the MAR. The medication name is spelled out and there are not any abbreviations from The Joint Commission's "Do Not Use" list included in the transcription.

A nurse in an emergency department is caring for a client who has heroin toxicity. The client is unresponsive with pinpoint pupils and a respiratory rate of 6/min. Which of the following medications should the nurse plan to administer? a. Methadone b. Naloxone c. Diazepam d. Bupropion

Naloxone: The nurse should administer naloxone, an opioid antagonist, to a client who has heroin toxicity to reverse the respiratory depressive effects of the heroin. However, the nurse should not administer naloxone too quickly because naloxone can cause hypertension, tachycardia, nausea, vomiting, and might cause the client to enter a state of opioid withdrawal.

A nurse is planning to teach about the use of a spacer to a child who has a new prescription for a fluticasone inhaler to treat chronic asthma. The nurse should include that the spacer decreases the risk for which of the following adverse effects of the medication? a. Oral candidiasis b. Headache c. Joint pain d. Adrenal suppression

Oral candidiasis: Dysphonia and oral candidiasis are adverse effects of inhaled corticosteroids. Using a spacer and rinsing the mouth after inhalation will minimize the amount of medication remaining in the oropharynx, preventing the development of these adverse effects.

A nurse is reviewing the laboratory results for a client who is receiving heparin via continuous IV infusion for deep-vein thrombosis. The nurse should discontinue the medication infusion for which of the following client findings? a. Potassium 5.0 mEq/ L b. aPTT 2 times the control c. Hemoglobin 15 g/dL d. Platelets 96,000/mm3

Platelets 96,000/mm3: A platelet count of 96,000/mm3 is below the expected range of 150,000 to 400,000/mm3. A platelet count less than 100,000/mm3 while receiving heparin can indicate heparin-induced thrombocytopenia, a potentially fatal condition that requires stopping the infusion.

A nurse is reviewing the laboratory results of a client who is taking digoxin for heart failure. Which of the following results should the nurse report to the provider? a. Calcium level 9.2 mg/dL b. Magnesium level 1.6 mEq/L c. Digoxin level 1.1 ng/mL d. Potassium level 2.8 mEq/L

Potassium level 2.8 mEq/L: A potassium level of 2.8 mEq/L is below the expected reference range of 3.5 to 5 mEq/L. The nurse should notify the provider if a client has hypokalemia prior to administration of digoxin due to the increased risk of developing digoxin toxicity and cardiac dysrhythmias.

A nurse is caring for a 20-year-old female client who has a prescription for isotretinoin for severe nodulocystic acne vulgaris. Before the client can obtain a refill, the nurse should advise the client that which of the following tests is required? a. Serum calcium b. Pregnancy test c. 24-hr urine collection for protein d. Aspartate aminotransferase level

Pregnancy test: The nurse should instruct the client that isotretinoin has teratogenic effects; therefore, pregnancy must be ruled out before the client can obtain a refill. The client must provide two negative pregnancy tests for the initial prescription and one negative test before monthly refills. The client should have a laboratory test for aspartate aminotransferase levels prior to starting isotretinoin, 1 month after starting the medication, and periodically thereafter. However, a laboratory test for aspartate aminotransferase is not required to renew a prescription for isotretinoin.

A nurse is reviewing the ECG of a client who is receiving IV furosemide for heart failure. The nurse should identify which of the following findings as an indication of hypokalemia? a. Tall, tented T-waves b. Presence of U-waves c. Widened QRS complex d. ST elevation

Presence of U-waves: The nurse should identify the presence of U-waves as a manifestation of hypokalemia, an adverse effect of furosemide. The nurse should identify a widened QRS complex as a manifestation of hyperkalemia. The nurse should identify tall, tented T-waves as a manifestation of hyperkalemia. Flattened or inverted T-waves are a manifestation of hypokalemia. The nurse should identify ST elevation is an indication of ischemia. ST depression is a manifestation of hypokalemia.

A nurse is caring for a client who is experiencing acute alcohol withdrawal. For which of the following client outcomes should the nurse administer chlordiazepoxide? a. Minimize diaphoresis b. Maintain abstinence c. Lessen craving d. Prevent delirium tremens

Prevent delirium tremens: The client should take chlordiazepoxide to prevent delirium tremens during acute alcohol withdrawal.

A nurse is planning care for a client who is prescribed metoclopramide following bowel surgery. For which of the following adverse effects should the nurse monitor? a. Muscle weakness b. Sedation c. Tinnitus d. Peripheral edema

Sedation: Metoclopramide has multiple CNS adverse effects, including dizziness, fatigue, and sedation. Metoclopramide is a central dopamine receptor antagonist that increases gastrointestinal motility and prevents nausea. Tardive dyskinesia is an adverse effect of metoclopramide. However, metoclopramide does not cause muscle weakness. Metoclopramide does not cause ringing in the ears. Metoclopramide does not cause peripheral edema.

A nurse at a clinic is providing follow-up care to a client who is taking fluoxetine for depression. Which of the following findings should the nurse identify as an adverse effect of the medication? a. Tingling toes b. Sexual dysfunction c. Absence of dreams d. Pica

Sexual dysfunction: Sexual dysfunction, including a decreased libido, impotence, and delayed orgasm, or anorgasmia, is a common adverse effect of fluoxetine and occurs in about 70% of clients who take this SSRI antidepressant. Fluoxetine is an SSRI that can cause muscle twitching. However, distorted sensations in the extremities are not adverse effects of fluoxetine. Fluoxetine can cause CNS adverse effects including abnormal dreaming, sedation, delusions, hallucinations, and psychosis. However, an absence of dreams is not associated with fluoxetine. Fluoxetine can cause neurologic adverse effects such as agitation, euphoria, and sedation. However, an eating disorder such as pica is not associated with fluoxetine.

A nurse is providing discharge teaching about handling medication to a client who is to continue taking oral transmucosal fentanyl raspberry-flavored lozenges on a stick. Which of the following information should the nurse include in the teaching? a. Chew on the medication stick to release the medication. b. Leave the medication stick in one location of the mouth until melted. c. Allow the medication 1 hr for analgesia effects to begin. d. Store unused medication sticks in a storage container.

Store unused medication sticks in a storage container.: The nurse should instruct the client to store unused, used, or partially used medication sticks in the safe storage container that comes in the kit when the medication is initially prescribed.

A nurse is assessing a client who has schizophrenia and is taking haloperidol. The nurse should report which of the following findings to the provider as a manifestation of neuroleptic malignant syndrome (NMS)? a. Temperature of 39.7° C (103.5° F) b. Urinary retention c. Heart rate 56/min d. Muscle flaccidity

Temperature of 39.7° C (103.5° F): The nurse should report fever to the provider as an indication of NMS, an acute life-threatening emergency. Other manifestations can include respiratory distress, diaphoresis, and either hyper- or hypotension. The nurse should report incontinence as a manifestation of NMS. The nurse should report tachycardia as a manifestation of NMS. The nurse should report severe muscle rigidity as a manifestation of NMS.

A nurse on the acute care unit is caring for a client who is receiving gentamicin IV. The nurse should report which of the following findings to the provider as an adverse effect of the medication? a. Constipation b. Tinnitus c. Hypoglycemia d. Joint pain

Tinnitus: Aminoglycosides, such as gentamicin, are ototoxic, which can manifest as tinnitus and deafness. The nurse should monitor the client for high-pitched ringing in the ears and headaches and should notify the provider if these occur. Aminoglycosides, such as gentamicin, can result in neuromuscular adverse effects such as twitching or flaccid paralysis. However, joint pain is not an adverse effect of gentamicin.

A nurse is caring for a client who is in labor. The client is receiving oxytocin by continuous IV infusion with a maintenance IV solution. The external FHR monitor indicates late decelerations. Which of the following actions should the nurse take first? a. Turn the client to a side-lying position. b. Disconnect the client's oxytocin from the maintenance IV. c. Apply oxygen to the client by face mask. d. Increase the client's maintenance IV infusion rate.

Turn the client to a side-lying position: The greatest risk to the fetus experiencing late decelerations is injury from uteroplacental insufficiency. Therefore, the priority action the nurse should take is to place the client in a lateral position. The nurse should take the other actions, however they are not the priority.

A nurse is providing teaching to a client who is to begin taking oxybutynin for urinary incontinence. Which of the following adverse effects should the nurse include in the teaching? (Select all that apply.) a. Dry mouth b. Tinnitus c. Blurred vision d. Bradycardia e. Dry eyes

a. c. e. Dry mouth is correct. Oxybutynin is an anticholinergic agent that can cause dry mouth. Blurred vision is correct. Oxybutynin is an anticholinergic agent that can cause blurred vision due to an increase in intraocular pressure. Dry eyes is correct. Oxybutynin is an anticholinergic agent that can cause dry eyes and mydriasis, or pupil dilation. Tinnitus is incorrect. Oxybutynin can cause several sensory adverse effects including increased intraocular pressure. The nurse should instruct the client to report eye pain, seeing colored halos around lights, and a decreased ability to perceive light changes. However, tinnitus is not an adverse effect associated with oxybutynin administration. Bradycardia is incorrect. Oxybutynin can cause several cardiovascular adverse effects such as a prolongation of the QT interval, palpitations, hypertension, and tachycardia.

A nurse is developing a teaching plan for a client who has a new prescription for simvastatin. Which of the following instructions should the nurse include in the teaching plan? (Select all that apply.) a. Report muscle pain to the provider. b. Avoid taking the medication with grapefruit juice. c. Take the medication in the early morning. d. Expect a flushing of the skin as a reaction to the medication. e. Expect therapy with this medication to be lifelong.

a. b. e. Report muscle pain to the provider is correct. Myopathy is an adverse effect of simvastatin that can lead to rhabdomyolysis. The nurse should instruct the client to report this to the provider. Avoid taking the medication with grapefruit juice is correct. When taken with grapefruit juice, simvastatin increases the risk of muscle injury from elevations in creatine kinase. Expect therapy with this medication to be lifelong is correct. If medication therapy is discontinued, cholesterol levels will return to their pretreatment range within several weeks to months. Take the medication in the early morning is incorrect. This medication is most effective when taken in the evening because cholesterol production generally increases overnight. Expect a flushing of the skin as a reaction to the medication is incorrect. The nurse should identify flushing of the skin as an adverse effect of the medication niacin, which can be used to decrease the client's triglyceride levels.

A nurse is teaching a client about warfarin. The client asks if they can take aspirin while taking the warfarin. Which of the following responses should the nurse make? a. "It is safe to take an enteric-coated aspirin." b. "Aspirin will increase the risk of bleeding." c. "Acetaminophen may be substituted for aspirin." d. "The INR lab work must be monitored more frequently if aspirin is taken."

"Aspirin will increase the risk of bleeding.": Aspirin inhibits platelet aggregation and can potentiate the action of the anticoagulant warfarin. Therefore, the client should avoid taking aspirin because it increases the risk for bleeding. Although it is common for clients to consider an occasional aspirin harmless, salicylates inhibit platelet aggregation and increase the potential for hemorrhage. Therefore, the client should avoid taking enteric-coated aspirin. Acetaminophen, an analgesic, can potentiate the action of the anticoagulant warfarin when administered in high doses and is not a safe substitute for aspirin. The client should continue to follow the provider's prescription for monitoring the PT and INR levels to adjust warfarin dosages. However, the nurse should discourage the client from using aspirin products because these medications increase the antiplatelet action of the warfarin and can result in bleeding.

A nurse is caring for a client who is receiving filgrastim. Which of the following findings should the nurse document to indicate the effectiveness of the therapy? Increased neutrophil count Increased RBC count Decreased prothrombin time Decreased triglycerides

Filgrastim: Filgrastim stimulates the bone marrow to produce neutrophils. For clients receiving chemotherapy, the risk of infection is minimized.

A nurse is preparing to administer medication to a client who has gout. The nurse discovers that an error was made during the previous shift and the client received atenolol instead of allopurinol. Which of the following actions should the nurse take first? a. Obtain the client's blood pressure. b. Contact the client's provider. c. Inform the charge nurse. d. Complete an incident report.

Obtain the client's blood pressure: When using the nursing process, the first action the nurse should take to prevent injury to the client is to assess the client for adverse effects of atenolol, such as hypotension. The nurse should contact the provider, who can provide direction to the nurse to prevent injury to the client. However, there is another action the nurse should take first. The nurse should alert the charge nurse about the medication error. However, there is another action the nurse should take first. The nurse should complete an incident report, which is used as part of a facility's quality assurance program. However, there is another action the nurse should take first.

A nurse is providing teaching to a client who has multiple sclerosis and a new prescription for methylprednisolone. Which of the following instructions should the nurse include? (Select all that apply.) a. Blood glucose levels will be monitored during therapy. b. Avoid contact with people who have known infections. c. Take the medication 1 hr before breakfast. d. Decrease dietary intake of foods containing potassium. e. Grapefruit juice can increase the effects of the medication.

a. b. e. Blood glucose levels will be monitored during therapy is correct. The nurse should monitor the client for hyperglycemia while providing methylprednisolone to the client. Glucocorticoids, such as methylprednisolone, increase serum glucose levels and can require management with insulin or antihyperglycemics. Avoid contact with people who have known infections is correct. The nurse should instruct the client to avoid exposure to infectious agents, such as contact with those who have active infections or illnesses. Glucocorticoids, such as methylprednisolone, depress the immune system, placing the client at an increased risk for developing an infection. Grapefruit juice can increase the effects of the medication is correct. The nurse should instruct the client that grapefruit and grapefruit juice can increase the level of methylprednisolone in the body. Take the medication 1 hr before breakfast is incorrect. The nurse should instruct the client to take the medication with food or milk to decrease gastrointestinal upset. Decrease dietary intake of foods containing potassium is incorrect. The nurse should instruct the client to increase dietary intake of potassium-rich foods while taking this medication. Glucocorticoids, such as methylprednisolone, deplete potassium in the body, which manifests as hypokalemia.