Pharm Exam 1 Practice Questions

A solution of 30,000 units of heparin in 500 mL normal saline is infusing at 22 mL/hr. How many units of heparin are being delivered each hour? A. 1320 units/hr B. 1400 units/hr C. 1450 units/hr D. 1600 units/hr

A. 1320 units/hr

7. A solution of 40,000 units of heparin in 1 L of D5W is infusing at 35 mL/hr. How many units of heparin are being delivered each hour? A. 1400 units/hr B. 1500 units/hr C. 1600 units/hr D. 1700 units/hr

A. 1400 units/hr

A solution of 35,000 units of heparin in 500 mL normal saline is to infuse at 2000 units/hr. What is the flow rate? A. 28.6 mL/hr B. 29.2 mL/hr C. 28.2 mL/hr D. 29.6 mL/hr

A. 28.6 mL/hr

13. An IV infusion 1200 units of heparin is ordered. On hand is heparin 20,000 units in 500 mL D5W. What is the mL/hr IV flow rate? A. 30 mL/hr B. 15 mL/hr C. 25 mL/hr D. 35 mL/hr

A. 30 mL/hr

A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication? A. "I can walk a mile a day." B. "I've had a backache for several days." C. "I am urinating more frequently." D. "I feel nauseated and have no appetite."

"I feel nauseated and have no appetite." Rationale: Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity. For walking, improving the client's cardiac output, which in turn will improve the client's exercise tolerance, is a therapeutic response to digoxin. Backaches are not an adverse effect of digoxin. For urinating frequently, improving the client's cardiac output, which in turn will increase blood flow to the kidneys and urination, is a therapeutic response to digoxin.

A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide? A. "Crushing the medication might cause you to have a stomachache or indigestion." B. "Crushing the medication is a good idea, and I can mix it in some ice cream for you." C. "Crushing the medication would release all the medication at once, rather than over time." D. "Crushing is unsafe, as it destroys the ingredients in the medication."

A. "Crushing the medication might cause you to have a stomachache or indigestion." Rationale: The pill is enteric-coated to prevent breakdown in the stomach and decrease the possibility of GI distress. Crushing the pill destroys that protection. Crushing the pill will destroy the enteric coating, and the client should be advised against this. The client should be told not to break, crush, or chew enteric-coated tablets. Crushing the pill will destroy the enteric coating, and the client should be advised against this, but the enteric coating does not prevent the release of medication. Sustained release preparations disburse the medication over time. Many medications can safely be crushed to make them easier to swallow. The client should check with his provider for information about which medications can be safely crushed.

A nurse is caring for a client who is on warfarin therapy for atrial fibrillation. The client's INR is 5.2. Which of the following medications should the nurse prepare to administer? A. Epinephrine B. Atropine C. Protamine D. Vitamin K

D. Vitamin K Rationale: Vitamin K reverses the effects of warfarin. Epinephrine treats anaphylaxis or cardiac arrest. It does not reverse the effects of warfarin. Atropine treats bradycardia. It does not reverse the effects of warfarin. Protamine reverses the effects of heparin, not warfarin.

A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching? A. "I have started taking ginger root to treat my joint stiffness." B. "I take this medication at the same time each day." C. "I eat a green salad every night with dinner." D. "I had my INR checked three weeks ago."

A. "I have started taking ginger root to treat my joint stiffness." Rationale: Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. This statement indicates the client needs further teaching. The client should take warfarin at the same time each day to maintain a stable blood level. Green leafy vegetables are a good source of vitamin K, which can interfere with the clotting effects of warfarin. Clients who are taking warfarin do not need to restrict dietary vitamin K intake but rather should maintain a consistent intake of vitamin K in order to control the therapeutic effect of the medication. Clients who have been taking warfarin for more than 3 months should have their INR level checked every 2 to 4 weeks.

A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make? A. "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." B. "I will call the provider to get a prescription for discontinuing the IV heparin today." C. "Both heparin and warfarin work together to dissolve the clots." D. "The IV heparin increases the effects of the warfarin and decreases the length of your hospital stay."

A. "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." Rationale: Heparin and warfarin are both anticoagulants that decrease the clotting ability of the blood and help prevent thrombosis formation in the blood vessels. However, these medications work in different ways to achieve therapeutic coagulation and must be given together until therapeutic levels of anticoagulation can be achieved by warfarin alone, which is usually within 1 to 5 days. When the client's PT and INR are within therapeutic range, the heparin can be discontinued. For calling the HCP to discontinue heparin, discontinuing the IV heparin is not indicated at this time. Neither medication dissolves clots that have already formed. Neither medication increases the effects of the other.

A nurse is preparing to administer metoprolol 5 mg IV bolus to a client for heart rate control. Available is metoprolol injection 1 mg/mL. How many mL 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.) A. 5 mL B. 2.5 mL C. 1.75 mL D. 4.5 mL

A. 5 mL Rationale: STEP 1: What is the unit of measurement the nurse should calculate? mL STEP 2: What is the dose the nurse should administer? Dose to administer= Desired 5 mg STEP 3: What is the dose available? Dose available = Have 1 mg STEP 4: Should the nurse convert the units of measurement? No STEP 5: What is the quantity of the dose available? 1 mL STEP 6: Set up an equation and solve for X.Have/Quantity = Desired/X1 mg/1 mL = 5 mg/X mLX = 5 STEP 7: Round if necessary. STEP 8: Reassess to determine whether the amount to administer makes sense. If there is 1mg/mL and the prescription reads 5 mg, it makes sense to administer 5 mL. The nurse should administer metoprolol 5 mL IV bolus.

A nurse is preparing to administer dextrose 5% in water (D5W) 150 mL IV to infuse over 3 hr. The drop factor of the manual IV tubing is 10 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.) A. 8 gtt/min B. 12 gtt/min C. 4 gtt/min D. 20 gtt/min

A. 8 gtt/min Rationale: STEP 1: What is the unit of measurement the nurse should calculate? gtt/min STEP 2: What is the volume the nurse should infuse? 150 mL STEP 3: What is the total infusion time? 3 hr STEP 4: Should the nurse convert the units of measurement? Yes (min does not equal hr) 1 hr/60 min = 3 hr/X min X = 180 min STEP 5: Set up an equation and solve for X. Volume (mL)/Time (min) x drop factor (gtt/mL = X 150 mL/180 min x 10 gtt/mL = X gtt/min X = 8.3333 STEP 6: Round if necessary. 8.3333 = 8 STEP 7: Reassess to determine whether the amount to administer makes sense. If the prescription reads D5W 150 mL IV to infuse over 3 hr, it makes sense to administer 8 gtt/min. The nurse should set the manual IV infusion to deliver D5W IV at 8 gtt/min.

A nurse is assessing an older adult client who is receiving digoxin. The nurse should recognize that which of the following findings is a manifestation of digoxin toxicity? A. Anorexia B. Ataxia C. Photosensitivity D. Jaundice

A. Anorexia Rationale: Anorexia, vomiting, confusion, headache, and vision changes are manifestations of digoxin toxicity. Ataxia (lack of muscle coordination) is a manifestation of benzodiazepine toxicity. Digoxin toxicity causes halos around lights. Photosensitivity is a manifestation of NSAID toxicity. Jaundice is a manifestation of sulfonylurea toxicity.

A nurse is providing dietary teaching for a client who takes furosemide. The nurse should recommend which of the following foods as the best source of potassium? A. Bananas B. Cooked carrots C. Cheddar cheese D. 2% milk

A. Bananas Rationale: The nurse should determine that bananas are the best food source to recommend because 1 cup of bananas contains 806 mg of potassium. In addition to the potassium supplements the provider might prescribe, the client should increase his daily intake of foods that have high potassium content, such as bananas, orange juice, and spinach. The nurse should recommend a different food because there is another choice that contains more potassium for all other options.

1. A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first? A. Check the client's vital signs. B. Request a dietitian consult. C. Suggest that the client rests before eating the meal. D. Request an order for an antiemetic.

A. Check the client's vital signs. Rationale: It is possible that the client's nausea is secondary to digoxin toxicity. By obtaining vital signs, the nurse can assess for bradycardia, which is a symptom of digoxin toxicity. The nurse should withhold the medication and call the provider if the client's heart rate is less than 60 bpm. While the dietitian might be able to assist the client with making appropriate food choices, this is not the first action the nurse should take. For resting before eating, this intervention might be appropriate, this is not the first action the nurse should take. For ordering an antiemetic, this intervention might relieve the client's nausea, this is not the first action the nurse should take.

A nurse is providing teaching to a client who has renal failure and an elevated phosphorous level. The provider instructed the client to take aluminum hydroxide 300 mg PO three times daily. For which of the following adverse effects should the nurse inform the client? A. Constipation B. Metallic taste C. Headache D. Muscle spasms

A. Constipation Rationale: Constipation is a common side effect of aluminum-based antacids. The nurse should instruct the client to increase fiber intake and that stool softeners or laxatives may be needed. Clients report that antacids have a chalky, rather than metallic, taste. Headache is not an adverse effect of aluminum hydroxide. Muscle spasms are not an adverse effect of aluminum hydroxide.

1. A nurse is caring for a client who is taking lisinopril. Which of the following outcomes indicates a therapeutic effect of the medication? A. Decreased blood pressure B. Increase of HDL cholesterol C. Prevention of bipolar manic episodes D. Improved sexual function

A. Decreased blood pressure Rationale: Lisinopril, an ACE inhibitor, may be used alone or in combination with other antihypertensives in the management of hypertension and congestive heart failure. A therapeutic effect of the medication is a decrease in blood pressure. The rest are not intended effects of Lisinopril.

A nurse is providing teaching to a client who has hypertension and a new prescription for captopril. Which of the following instructions should the nurse provide? A. Do not use salt substitutes while taking this medication. B. Take the medication with food. C. Count your pulse rate before taking the medication. D. Expect to gain weight while taking this medication.

A. Do not use salt substitutes while taking this medication. Rationale: Captopril, an ACE inhibitor, can cause hyperkalemia due to potassium retention by the kidney. The client should avoid salt substitutes, as most of them are high in potassium. The client should take captopril on an empty stomach, 1 hr before or 2 hr after a meal, in order to not reduce the medication's absorption. It is not necessary to count a pulse before taking captopril. Weight gain is not an adverse effect of captopril.

A nurse is caring for a client who is taking digoxin for heart failure and develops indications of severe digoxin toxicity. Which of the following medications should the nurse prepare to administer? A. Fab antibody fragments B. Flumazenil C. Acetylcysteine D. Naloxone

A. Fab antibody fragments Rationale: Fab antibody fragments, also called digoxin immune Fab, bind to digoxin and block its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity. Flumazenil, a benzodiazepine antagonist, reverses the effects of benzodiazepines. Acetylcysteine, a mucolytic, reduces the risk of hepatotoxicity after acetaminophen overdose. Naloxone reverses the effects of opioid analgesics.

A nurse is obtaining a medical history from a client who is to start warfarin therapy and currently uses herbal supplements at home. The nurse should inform the client that which of the following herbal supplements can interact adversely with warfarin? A. Feverfew B. Black cohosh C. Echinacea D. Flaxseed

A. Feverfew Rationale: The nurse should instruct the client to avoid taking feverfew while taking warfarin because it will increase the anticoagulant effect. Although evidence is inconclusive, clients can use black cohosh to decrease menopausal symptoms, such as hot flashes, vaginal dryness, and irritability. There are no interactions between black cohosh and warfarin. Although evidence is inconclusive, clients can use echinacea to boost the immune system, decrease inflammation and treat common viral infections. This action may result from the body's ability to mobilize phagocytes and stimulate T-lymphocytes and interferon. There are no interactions between echinacea and warfarin. Flaxseed provides soluble plant fiber and will mimic the action of a bulk-forming laxative to treat constipation. In addition, flaxseed reduces total cholesterol and LDL cholesterol levels but has no effect on HDL cholesterol or triglycerides. There are no interactions between flaxseed and warfarin.

A nurse in a coronary care unit is admitting a client who has had CPR following a cardiac arrest. The client is receiving lidocaine IV at 2 mg/min. When the client asks the nurse why he is receiving that medication, the nurse should explain that it has which of the following actions? A. Prevents dysrhythmias B. Slows intestinal motility C. Dissolves blood clots D. Relieves pain

A. Prevents dysrhythmias Rationale: Lidocaine is an antidysrhythmic medication that delays the conduction in the heart and reduces the automaticity of heart tissue. Lidocaine does not have anticholinergic properties, as do some other antidysrhythmics such as procainamide and quinidine. Also, clients who have cardiac problems should prevent constipation. An anticholinergic medication would increase the risk for constipation. A fibrinolytic medication, such as alteplase, dissolves blood clots via the conversion of plasminogen to plasmin. Topical lidocaine is a local anesthetic that produces numbness or loss of feeling before surgery or another painful procedure, but this is not the reason for administering it to this client.

A nurse is monitoring a client who received epinephrine for angioedema after a first dose of losartan. Which of the following data indicates a therapeutic response to the epinephrine? A. Respirations are unlabored. B. Client reports decreased groin pain of 3 on a 1 to 10 scale. C. The client's blood pressure when arising from resting position is at premedication levels. D. The client tolerates a second dose of medication with no greater than 1+ peripheral edema.

A. Respirations are unlabored. Rationale: Losartan is an angiotensin receptor blocker (ARB). Both ARBs and angiotensin converting enzyme (ACE) inhibitors have the adverse effect of angioedema. The primary symptom of angioedema is swelling of the tongue, glottis, and pharynx. This results in limitation or blockage of the airway. Angioedema causes the capillaries to become more permeable, resulting in fluid shifting into the subcutaneous tissues. Although the mouth and throat are most often affected, any area may be involved in the process. Untreated, angioedema can result in death. Improvement of respiratory effort following the administration of epinephrine is the most important therapeutic indicator. For groin pain, although edema can occur in any area, the groin is not affected specifically by the disorder. Angioplasty and angiograms most often utilize the femoral vessels, but the prefix "angio" is a general term for blood vessel rather than a reference to the femoral area. Regarding blood pressure, hypotension is a common side effect of angiotensin II receptor blockers (ARBs) such as losartan. For this side effect, the nurse should monitor blood pressure when the client changes position. However, angioedema is an adverse reaction that can result in swelling of the lips, tongue, and glottis. The client experiences extreme respiratory distress. Peripheral edema is not usually associated with angioedema. The edema that is significant in this client occurs in the lips, mouth, and throat, causing airway obstruction. Once the client has this response, the client must know to never take any medication in the angiotensin II receptor blocker classification.

A nurse is teaching a client about taking diphenhydramine. The nurse should explain to the client that which of the following is an adverse effect of this medication? A. Sedation B. Constipation C. Hypertension D. Bradycardia.

A. Sedation Rationale: Diphenhydramine can cause sedation. It is used to treat rhinitis, allergies, and insomnia. Diphenhydramine causes diarrhea not constipation, hypotension not hypertension, and palpitations, not bradycardia.

A nurse is assessing a client who is receiving dopamine IV to treat left ventricular failure. Which of the following findings should indicate to the nurse that the medication is having a therapeutic effect? A. Systolic blood pressure is increased B. Cardiac output is reduced C. Apical heart rate is increased D. Urine output is reduced

A. Systolic blood pressure is increased Rationale: When dopamine has a therapeutic effect, it causes vasoconstriction peripherally and increases systolic blood pressure. For decreased cardiac output, a therapeutic effect of low-dose dopamine is increased cardiac output. For increased apical HR, tachycardia is an adverse effect, not a therapeutic effect, of dopamine. For reduced urine output, a therapeutic effect of low-dose dopamine is increased urine output. Decreased urine output at high doses is an adverse effect of dopamine.

A nurse is preparing to transfuse one unit of packed RBC to a client who experienced a mild allergic reaction during a previous transfusion. The nurse should administer diphenhydramine prior to the transfusion for which of the following allergic responses? A. Urticaria B. Fever C. Fluid overload D. Hemolysis

A. Urticaria Rationale: For clients who have previously had allergic reactions to blood transfusions, administering an antihistamine such as diphenhydramine prior to the transfusion might prevent future reactions. Allergic reactions typically include urticaria (hives). For fever, an antihistamine will not prevent a febrile, non-hemolytic reaction to a blood transfusion. A possible preventive measure is transfusing leucocyte-poor blood products to avoid sensitization to the donor's WBC. For fluid overload, aAn antihistamine will not prevent fluid overload. Transfusing the blood product slowly and not exceeding the volume that is necessary can reduce this risk. For hemolysis, aAn antihistamine will not prevent hemolysis, which results from incompatibility between the donor and the recipient.

A nurse is caring for a client who has cirrhosis and a prothrombin time of 30 seconds. Which of the following medications should the nurse plan to administer? A. Vitamin K B. Heparin C. Warfarin D. Ferrous sulfate

A. Vitamin K Rationale: 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 plan to administer vitamin k. The nurse should not anticipate that the provider will prescribe heparin and warfarin, as the client's clotting time is prolonged. While clients who have cirrhosis often have anemia, the nurse should not plan to administer ferrous sulfate in response to the prolonged prothrombin time.

Agent(s) may be effective in terminating paroxysmal supraventricular tachycardia (PSVT)? A. adenosine (Adenocard) B. methoxamine (Vasoxyl) C. propranolol (Inderal) D. all of the above

A. adenosine (Adenocard)

A nurse is caring for a client who has poison ivy and is prescribed diphenhydramine. Which of the following instructions should the nurse give regarding the adverse effect of dry mouth associated with diphenhydramine? A. "Administer the medication with food." B. "Chew on sugarless gum or suck on hard, sour candies." C. "Place a humidifier at your bedside every evening." D. "Discontinue the medication and notify your provider."

B. "Chew on sugarless gum or suck on hard, sour candies." Rationale: Clients who report dry mouth can get the most effective relief by sucking on hard candies (especially the sour varieties that stimulate salivation), chewing gum, or rinsing the mouth frequently. It is the local effect of these actions that provides comfort to the client. Administering diphenhydramine with food might minimize gastrointestinal effects, but will not relieve dry mouth. For using a humidifier, this action might help to ease the work of breathing when the client has congestion, but it will not relieve the manifestation of dry mouth. It is not necessary for the client to discontinue the use of diphenhydramine for dry mouth. The nurse should inform the client to notify the provider of any confusion, sedation, or hypotension.

12. Calculate the IV flow rate for a continuous infusion of heparin 25 units/hr. The label on the 500 mL pre-mixed heparin IV bag reads: heparin 1000 units. A. 16 mL/hr B. 12.5 mL/hr C. 10.2 mL/hr D. 8.75 mL/hr

B. 12.5 mL/hr

A nurse is preparing to administer potassium chloride 20 mEq suspension PO daily. The amount available is potassium chloride suspension 10 mEq/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth/whole number. Use a leading zero if it applies. Do not use a trailing zero.) A. 5 mL B. 2 mL C. 7.5 mL D. 2.5 mL

B. 2 mL Rationale: STEP 1: What is the unit of measurement the nurse should calculate? mL STEP 2: What is the dose the nurse should administer? Dose to administer= Desired 20 mEq/mL STEP 3: What is the dose available? Dose available = Have 10 mEq/mL STEP 4: Should the nurse convert the units of measurement? No STEP 5: What is the quantity of the dose available? 10 mEq/mL STEP 6: Set up an equation and solve for X. Have/Quantity = Desired/X 10 mEq/1 mL = 20 mEq/X mL X = 2 STEP 7: Round if necessary. STEP 8: Reassess to determine whether the amount to administer makes sense. If there are 10 mEq/mL and the provider prescribed 20 mEq, it makes sense to administer 2. The nurse should administer potassium chloride 20 mEq suspension PO daily.

1600 units/hr of heparin have been ordered. The pharmacy sends a bag of IV fluid with 25,000 units of heparin in 500 mL D5W. What is the hourly flow rate? A. 30 mL/hr B. 32 mL/hr C. 36 mL/hr D. 38 mL/hr

B. 32 mL/hr

A nurse is preparing to administer a continuous heparin infusion at 1600 units/hr. Available is heparin 25,000 units in dextrose 5% in water (D5W) 500 mL. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) A. 40 mL/hr B. 32 mL/hr C. 36 mL/hr D. 42 mL/hr

B. 32 mL/hr Rationale: STEP 1: What is the unit of measurement the nurse should calculate? mL STEP 2: What is the dose the nurse should administer? Dose to administer= Desired 1,600 units STEP 3: What is the dose available? Dose available = Have 25,000 units STEP 4: Should the nurse convert the units of measurement? No STEP 5: What is the quantity of the dose available? 500 mL STEP 6: Set up an equation and solve for X. Have/Quantity = Desired/X 25,000 units/500 mL = 1,600 units/X mL/ X = 32 mL/hr STEP 7: Round if necessary. STEP 8: Reassess to determine whether the amount to administer makes sense. If there are 25,000 units/500 mL and the amount prescribed is 1,600 units/hr,it makes sense to administer 32 mL/hr. The nurse should administer heparin infusion at 32 mL/hr.

14. A continuous infusion of heparin at 27 units/kg/hr is ordered for a patient weighing 82 kg. On hand is a 500 mL bag of D5W labeled: heparin 50 units/mL. What is the mL/hr flow rate? A. 22.8 mL/hr B. 44.3 mL/hr C. 36.6 mL/hr D. 48.7 mL/hr

B. 44.3 mL/hr

The patient has an infusion of 10,000 units of heparin in 250 mL D5W infusing at 12 mL/hr. How many units are being delivered each hour? A. 260 units/hr B. 480 units/hr C. 350 units/hr D. 120 units/hr

B. 480 units/hr

A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects? A. Hyperglycemia B. Adrenocortical insufficiency C. Severe dehydration D. Rebound pulmonary congestion

B. Adrenocortical insufficiency Rationale: Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids can suppress production of glucocorticoids, and an abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency. Hyperglycemia is an adverse effect of prednisone, especially for clients who have a history of diabetes mellitus. Once the medication is discontinued, however, this adverse effect should not occur. Fluid retention is an adverse effect of prednisone. Once the medication is discontinued, however, this adverse effect should not occur. Rebound pulmonary congestion should not occur with withdrawal of prednisone. Prednisone has no direct effect on the client's pulmonary congestion.

A nurse is providing discharge teaching for a client who has pulmonary edema and is about to start taking furosemide. Which of the following instructions should the nurse include? A. Take aspirin if headaches develop. B. Eat foods that contain plenty of potassium. C. Expect some swelling in the hands and feet. D. Take the medication at bedtime.

B. Eat foods that contain plenty of potassium. Rationale: Furosemide, a high-ceiling (loop) diuretic, can cause potassium loss. The client should add potassium-rich foods to his diet, such as nuts, dried fruits, bananas, and citrus fruits. Furosemide can increase the effects of aspirin and anticoagulants. Furosemide should reduce swelling in the hands and feet. The client should take furosemide early in the day so that the diuretic action will not disturb his sleep.

A nurse is receiving a client who is immediately postoperative following hip arthroplasty. Which of the following medications should the nurse plan to administer for DVT prophylaxis? A. Aspirin PO B. Enoxaparin subcutaneous C. Heparin infusion D. Warfarin PO

B. Enoxaparin subcutaneous Rationale: Enoxaparin is a low molecular heparin that inhibits thrombus and clot formation. Preventive doses of enoxaparin are low and the client does not require monitoring of prothrombin time or activated partial thromboplastin time, making it the preferred treatment for DVT prophylaxis following orthopedic surgery. Aspirin therapy is used for existing thromboembolic disorders, not for DVT prophylaxis. : Heparin therapy by infusion is used to treat existing DVT, not prophylaxis. Warfarin therapy is started after dosing with enoxaparin. Both medications are given to allow the warfarin time to reach therapeutic levels.

A nurse is caring for a client who has heart failure and is receiving IV furosemide. The nurse should monitor the client for which of the following electrolyte imbalances? A. Hypernatremia B. Hyperuricemia C. Hypercalcemia D. Hyperchloremia

B. Hyperuricemia Rationale: The nurse should monitor the client who is receiving IV furosemide for hyperuricemia. The nurse should instruct the client to notify the provider for any tenderness or swelling of the joints. The nurse should monitor the client who is receiving IV furosemide for hyponatremia. The nurse should monitor the client who is receiving IV furosemide for hypocalcemia. The nurse should monitor the client who is receiving IV furosemide for hypochloremia.

A nurse is preparing to administer verapamil by IV bolus to a client who is having cardiac dysrhythmias. For which of the following adverse effects should the nurse monitor when giving this medication? A. Hyperthermia B. Hypotension C. Ototoxicity D. Muscle pain

B. Hypotension Rationale: Verapamil, a calcium channel blocker, can be used to control supraventricular tachyarrhythmias. It also decreases blood pressure and acts as a coronary vasodilator and antianginal agent. A major adverse effect of verapamil is hypotension; therefore, blood pressure and pulse must be monitored before and during parenteral administration. Temperature is not affected by verapamil. Verapamil is not toxic to the ear. Verapamil does not cause muscle pain.

A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin? A. Hemoglobin (Hgb) B. Prothrombin time (PT) C. Bleeding time D. Activated partial thromboplastin time (aPTT)

B. Prothrombin time (PT) Rationale: This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation. Warfarin does not affect the hemoglobin level. For bleeding time, tThis test is not used to monitor therapeutic anticoagulation. Abnormal bleeding time results are usually associated with platelet dysfunction. For aPTT, this test is used to monitor heparin, not warfarin, therapy.

A nurse is reviewing the health history for a client who has angina pectoris and a prescription for propranolol hydrochloride PO 40 mg twice daily. Which of the following findings in the history should the nurse report to the provider? A. The client has a history of hypothyroidism. B. The client has a history of bronchial asthma. C. The client has a history of hypertension. D. The client has a history of migraine headaches.

B. The client has a history of bronchial asthma. Rationale: Beta-adrenergic blockers can cause bronchospasm in clients who have bronchial asthma; therefore, this is a contraindication to its use and should be reported to the provider. Beta-adrenergic blockers may mask the symptoms of hyperthyroidism; therefore, they must be used with caution in clients taking propranolol hydrochloride. Beta-adrenergic blockers, such as propranolol hydrochloride, may be used in combination with other medications for the treatment of hypertension; therefore, this is not a contraindication to the use of this medication. Beta-adrenergic blockers, such as propranolol hydrochloride, may be prescribed for the prevention of migraine headaches; therefore, this is not a contraindication to the use of the medication.

A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give? A. "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level." B. "A pharmacist is the person to answer that question." C. "Heparin does not dissolve clots. It stops new clots from forming." D. "The oral medication you will take after this IV will dissolve the clot."

C. "Heparin does not dissolve clots. It stops new clots from forming." Rationale: This statement accurately answers the client's question. The effects of heparin begin within minutes. This response does not accurately answer the client's question. Contacting the pharmacist is not the appropriate answer for the nurse to give. This is not a correct response. Warfarin, a PO medication that is often started after the client has been on heparin, does not dissolve clots.

11. The physician ordered heparin 15 units/kg/hr for a patient who suffered an MI. On hand is 25,000 units of Heparin in 500 mL D5W. The patient weighs 157 lbs. What is the IV flow rate in mL/hr? A. 22.7 mL/hr B. 23.6 mL/hr C. 21.4 mL/hr D. 20.8 mL/hr

C. 21.4 mL/hr

The patient has an infusion of 25,000 units of heparin in 500 mL D5W infusing at 32 mL/hr. The physician leaves the order, "Adjust the IV flow rate to deliver 1200 units of heparin/hr." How should the flow rate of the current infusion be adjusted? A. 10 mL/hr B. 12 mL/hr C. 8 mL/hr D. 4 mL/hr

C. 8 mL/hr Rationale: The current infusion is running at 32 mL/hr. The flow rate needed to deliver 1200 units/hr is 24 mL/hr. Therefore, the flow rate needs to be decreased by 8 mL/hr.

A nurse is caring for a client who has a prescription for potassium chloride (KCL) 20 mEq PO daily. The nurse reviews the client's most recent laboratory results and finds the client's potassium level is 5.2 mEq/L. Which of the following actions should the nurse take? A. Give the ordered KCL as prescribed. B. Omit the KCL dose and document it was not given. C. Call the prescribing physician and inform her of the client's serum potassium level results. D. Call the lab to verify the client's results.

C. Call the prescribing physician and inform her of the client's serum potassium level results. Rationale: As a potassium level of 5.2 mEq/L is above the expected reference range, the nurse should hold the medication and notify the provider of the client's serum potassium level. For giving ordered KCL, as a potassium level of 5.2 mEq/L is above the expected reference range, this is not the action the nurse should take. For omitting KCL dose, it is not an appropriate action for the nurse to omit the administration of an ordered medication. For verifying lab results, the nurse has already received the lab values from the lab, so notifying the laboratory is not indicated.

A nurse is caring for a client who is postoperative following hip arthroplasty. The nurse should anticipate which of the following prescriptions for this client? A. Aspirin B. Clopidogrel C. Enoxaparin D. Alteplase

C. Enoxaparin Rationale: The nurse should anticipate a prescription for enoxaparin as prophylaxis therapy for venous thromboembolism. Clients following hip arthroplasty are usually on anticoagulants for 3 to 6 weeks after surgery. Although aspirin has anticoagulant effects, clients generally take it for ongoing primary prevention of cardiovascular and cerebrovascular events, not for the immediate anticoagulant effects a client who is postoperative hip arthroplasty requires. Clopidogrel is an oral antiplatelet drug clients take to prevent stenosis of coronary stents and for some secondary prevention indications, not for the immediate anticoagulant effects a client who is postoperative hip arthroplasty requires. Alteplase is a thrombolytic agent used in clients experiencing an acute MI, acute ischemic stroke, or acute massive PE.

A nurse is caring for a client whose serum potassium level is 5.3 mEq/L. Which of the following scheduled medications should the nurse plan to administer? A. Lisinopril B. Digoxin C. Furosemide D. Potassium iodide

C. Furosemide Rationale: Furosemide results in loss of potassium from the nephron as part of its diuretic effect. This medication can be given when a client has an elevated potassium level and can lower the potassium level. For this client, the depletion of potassium is a beneficial effect. For a client who has a therapeutic potassium level, there would be a risk for hypokalemia due to the excretion of potassium. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. This class of antihypertensive interferes with the action of ACE and results in a decreased production of aldosterone. The medication causes the kidneys to possibly retain potassium, which would elevate the value further. The provider needs to be notified of the elevated potassium level prior to administration of the scheduled dose. Potassium competes with digoxin in binding with other electrolytes and cells. When the potassium level is elevated, digoxin is not therapeutic in normal doses. The nurse should notify the provider of the laboratory value and expect to administer the medication when the value has returned to within the expected reference range. Potassium iodide is prescribed for the treatment of Grave's disease. The iodine results in a decrease of thyroxine production. The potassium in the medication contributes to the overall potassium level and should not be given at this time.

A nurse is preparing to administer heparin to a client. Which of the following actions should the nurse plan to take? A. Use a 22-gauge needle to inject the medication. B. Use a 1-inch needle to inject the medication. C. Inject the medication into the abdomen above the level of the iliac crest. D. Massage the injection site after administration of the medication.

C. Inject the medication into the abdomen above the level of the iliac crest. Rationale: The nurse should inject the medication into the abdomen above the level of the iliac crest, at least 2 inches from the umbilicus. The nurse should use a small needle, 25- or 26-gauge, to administer the heparin. The nurse should use a short needle, 3/8 inch or smaller, to administer the heparin. The nurse should apply firm pressure without massage to the site for 1 to 2 min after administration. Massaging the area after injecting heparin can cause bleeding.

A nurse is caring for a client who has atrial fibrillation and receives digoxin daily. Before administering this medication, which of the following actions should the nurse take? A. Offer the client a light snack B. Measure the client's blood pressure C. Measure the client's apical pulse D) Weigh the client

C. Measure the client's apical pulse Rationale: Digoxin decreases the heart rate, so the nurse should count the apical pulse for at least 1 min before administering. The nurse should hold the medication and notify the provider if the client's heart rate is below 60/min or if a change in heart rhythm is detected. The client can take the medication with or without food, although giving it immediately after food can delay absorption slightly. It is not necessary to measure blood pressure immediately before dosing, but the nurse should monitor the client's blood pressure routinely. It is not necessary to weigh the client immediately before dosing, but the nurse should monitor the client's weight routinely.

A nurse is caring for a client who is receiving heparin by continuous IV infusion. Which of the following medications should the nurse plan to administer in the event of an overdose? A. Iron B. Glucagon C. Protamine sulfate D. Vitamin K

C. Protamine sulfate Rationale: Protamine reverses the effects of heparin and is used in the event of an overdose. Iron treats anemia, not a heparin overdose. Glucagon treats severe hypoglycemia from an insulin overdose. Vitamin K reverses the effects of warfarin, not heparin.

A nurse is providing teaching to a client who has asthma and a new prescription for inhaled beclomethasone. Which of the following instructions should the nurse provide? A. Check the pulse after medication administration. B. Take the medication with meals. C. Rinse the mouth after administration. D. Limit caffeine intake.

C. Rinse the mouth after administration. Rationale: Use of glucocorticoids by metered dose inhaler can allow a fungal overgrowth in the mouth. Rinsing the mouth after administration can lessen the likelihood of this complication. For checking pulse, Beclomethasone, an inhaled glucocorticoid, does not cause cardiac side effects. For taking with meals, oral, not inhaled, glucocorticoids should be administered with food. Caffeine does not interact with beclomethasone and is not contraindicated.

A nurse is providing teaching for a client who is on diuretic therapy and has a new prescription for potassium chloride (KCL) 20 mEq extended release PO daily. Which of the following instructions should the nurse provide about the new prescription? A. Take the extended release tablets on an empty stomach. B. Add an antacid if the medication causes indigestion. C. Take the extended release tablets whole. D. Expect urinary output to decrease while on this medication.

C. Take the extended release tablets whole. Rationale: The nurse should teach the client that extended release tablets should be taken whole and should not be broken, crushed, or chewed. The nurse should instruct the client that the medication should be taken with or after meals. The nurse should advise the client to avoid OTC medications, including antacids, without the approval of the provider. Calcium containing antacids can increase the effect of the potassium supplement. The nurse should instruct the client to notify the provider immediately for any decrease in urinary output.

A nurse is preparing to administer enoxaparin to a client. Which of the following actions should the nurse plan to take? A. Insert the needle at a 45o angle. B. Aspirate for a blood return before depressing the plunger. C. The nurse should not expel the air bubble in the prefilled syringe. D. Administer the medication 2.54 cm (1 in) from the umbilicus.

C. The nurse should not expel the air bubble in the prefilled syringe. Rationale: The nurse should not expel the air bubble that is in the pre-filled syringe prior to administering the medication. Enoxaparin should only be injected deep into the fatty layer of the abdominal wall at a 90o angle. The nurse should not aspirate for a blood return when administering enoxaparin. Enoxaparin is a low-molecular weight anticoagulant medication that should be administered in the fatty tissue of the abdomen, avoiding a 2-inch diameter around the umbilicus for best absorption.

A nurse is preparing to administer heparin 2,000 units by IV bolus. Available is heparin injection 5,000 units/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.) A. 0.2 mL B. 1 mL C. 0.6 mL D. 0.4 mL

D. 0.4 mL Rationale: STEP 1: What is the unit of measurement the nurse should calculate? mL STEP 2: What is the dose the nurse should administer? Dose to administer= Desired 2,000 units STEP 3: What is the dose available? Dose available = Have 2,000 units STEP 4: Should the nurse convert the units of measurement? No (units = units) STEP 5: What is the quantity of the dose available? 1 mL STEP 6: Set up an equation and solve for X. Have/Quantity = Desired/X 5,000 units/1 mL = 2,000 units/X mL X = 0.4 mL STEP 7: Round if necessary. STEP 8: Reassess to determine whether the amount to administer makes sense. If there are 5,000 units/mL and the provider prescribed 2,000 units, it makes sense to administer 0.4 mL. The nurse should administer heparin 0.4 mL by IV bolus.

8. A patient is to receive 650 units of heparin each hour. The solution available is 10,000 units of heparin in 250 mL of normal saline. What is the flow rate? A. 12.6 mL/hr B. 13.4 mL/hr C. 15.2 mL/hr D. 16. 3 mL/hr

D. 16. 3 mL/hr

A patient who is to undergo open heart surgery is to receive a continuous infusion of heparin during the procedure. The order is for 35 units of heparin per kg/hr. The patient weighs 172 lb. The heparin solution available is 20,000 units in 500 mL normal saline. What is the flow rate for the ordered heparin solution? A. 78.8 mL/hr B. 74.6 mL/hr C. 70.2 mL/hr D. 68.4 mL/hr

D. 68.4 mL/hr

15. An IV infusion of heparin is infusing at 22 mL/hr. The label on the 250 mL IV bag reads: heparin 10,000 units. How many units of heparin are infusing each hour? A. 420 units/hr B. 530 units/hr C. 670 units/hr D. 880 units/hr

D. 880 units/hr

A nurse is teaching a client who reports taking gingko biloba to improve his memory. Which of the following adverse effects should the nurse include? A. Bad breath B. Decreased alertness C. Breast enlargement D. Bleeding gums

D. Bleeding gums Rationale: Gingko biloba is an herbal medication used by clients to improve age-related memory loss as well as to decrease leg pain in clients with peripheral arterial disease (PAD). Although gingko biloba is generally well-tolerated, it may suppress coagulation. There have been reports of spontaneous bleeding in clients taking this herbal medication. Clients should be instructed to discontinue use and report increased bleeding, such as nosebleeds, bleeding gums, any cuts that do not stop bleeding, to their provider. The other options are not expected adverse effects of gingko biloba.

A nurse is completing a medication history for a client who reports using over-the-counter calcium carbonate antacid. Which of the following recommendations should the nurse make about taking this medication? A. Decrease bulk in the diet to counteract the adverse effect of diarrhea. B. Take the medication with dairy products to increase absorption. C. Reduce sodium intake. D. Drink a glass of water after taking the medication.

D. Drink a glass of water after taking the medication. Rationale: Calcium carbonate is a dietary supplement used when the amount of calcium taken in the diet is not enough. Calcium carbonate may also be used as an antacid to relieve heartburn, acid indigestion, and stomach upset. The client should drink a full glass of water after taking an antacid to enhance its effectiveness. For decreasing bulk, the major adverse effect of calcium carbonate is constipation. The nurse should recommend the client increase bulk in the diet. For increasing absorption, taking calcium carbonate with milk predisposes the client to milk alkali syndrome, which is characterized by headache, confusion, nausea, vomiting, alkalosis, and hypercalcemia. For reducing sodium, clients who take aluminum hydroxide, not calcium carbonate, antacids should be advised against excessive sodium intake in the diet.

A nurse is completing a medical interview with a client who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the client can potentiate the effects of warfarin? A. The client follows a low-fat diet to reduce cholesterol. B. The client drinks a glass of grapefruit juice every day. C. The client sprinkles flax seeds on food 1 hr before taking the anticoagulant. D. The client uses garlic to lower cholesterol levels.

D. The client uses garlic to lower cholesterol levels. Rationale: The nurse should recognize that garlic can potentiate the action of the warfarin. A low-fat diet should not potentiate the action of warfarin. Grapefruit juice can interfere with the metabolism of statins. Flax seed can affect the absorption of medications and should be taken 1 hr before or 2 hr after medications.

A nurse is caring for a client who has a prescription for digoxin 0.25 mg PO daily. The amount available is digoxin 0.125 mg tab. The client's current vital signs are: blood pressure 144/96, heart rate 54/min, respirations 18/min, and temperature 98.6° F. Which of the following actions should the nurse take? A. Administer digoxin 0.125 mg B. Administer digoxin 0.25 mg C. Withhold the digoxin dose for elevated blood pressure D. Withhold the digoxin dose for decreased pulse rate

D. Withhold the digoxin dose for decreased pulse rate Rationale: The nurse should withhold the prescribed dose of digoxin as the heart rate is less than 60/min, and notify the provider.