Pharmacology Quiz 1

A nurse is administering mannitol to the client with increased intracranial pressure. What supplies are necessary when administering this medication? Select one: a. Syringe, filter needle, IV filter tubing b. Alcohol wipe, syringe, 18 gauge needle c. Pressure cuff, 1000mL bag of normal saline d. Pill cup, glass of water, straw

. Syringe, filter needle, IV filter tubing CorrectCorrect: Mannitol is an osmotic diuretic, indicated for treatment of increased intracranial pressure, increased intraocular pressure and in certain cases of acute kidney injury. Mannitol is an injectable medication, given slow IV push or via continuous IV infusion. Mannitol may crystalize (form white or icy looking precipitate) in the vial if exposed to extreme temperatures, and this precipitate could be dangerous to the client. For this reason, all mannitol must be drawn up with a filter needle, and then the nurse should remove the filter needle and use the injection port to administer the medication.

A client is prescribed phenytoin 5 mg/kg/day in 3 divided doses. The client weighs 36 lb. The drug is available at 50mg/mL. What is the total daily dosage in milliliters for this client? Select one: a. 0.5 mL b. 7.8 mL c. 2.6 mL d. 1.6 mL

36 /2.2=16.4kg 5 X 16.4 = 82 mg/day 82/50=1.64 mL/day

A surgical client in the post anesthesia care unit is receiving intravenous patient controlled analgesia (PCA) of morphine sulfate. Which of the following findings would be evidence of an interaction of anesthetic agents and the PCA infusion? Select all that apply. Select one or more: a. SpO2 89% b. Respirations 10/min c. Urine output 60 mL/hr d. BP 154/86 e. Temperature 97.2F

Anesthetic agents and opioids are both respiratory depressants. The post-operative client may experience excessive sedation in the early post-operative period due to the interaction of these two agents. The most profound initial symptoms will be a slow (and perhaps shallow) respiratory pattern and a fall in arterial oxygenation. A respiratory rate of 10/min is excessively slow, and the pulse oximeter reading of 89% reflects an arterial oxygenation of approximately 60%. The client needs to be (1) stimulated to wake up and breathe deeply immediately, (2) have supplemental oxygen, and may need naloxone (Narcan) to reverse some of the sedation unless vital signs improve. The correct answer is: Respirations 10/min, SpO2 89%

A client with Type 1 diabetes has the following values from the morning laboratory testing: fasting plasma glucose = 115 mg/dL and HgA1C = 7.5%. How would a nurse interpret these values with regard to the client's glucose control? Select one: a. Short term values normal, long-term values elevated b. Short term values normal, long term values normal c. Short term values elevated, long-term values normal d. Short term values elevated, long term values elevated

Correct answer: short term values normal, long term values are elevated Fasting plasma glucose is normal. Normal fasting plasma glucose range for the diabetic client is 90-130 mg/dl. HgA1C level is elevated. HgA1C normal level range is less than 7% with the optimal range being 4-6% in the diabetic. HgA1C level indicates the client's glucose average over the last 120 day period and is considered to be the best indicator of long term glycemic control.

A nurse is caring for a client receiving total parenteral nutrition (TPN). Which of the following outcomes best demonstrates that TPN therapy is effective? Select one: a. The client maintains an albumin level of 5.0 g/100mL. b. The client gains one kilogram per day. c. The client's urinary output increases by 800 mL per day. d. The client reports less frequent bowel movements.

Correct. A. maintain an albumin level of 5.0g/100ml When clients are on TPN therapy, laboratory values such as electrolytes, CBC, BUN, and plasma glucose should be monitored closely. All laboratory values should be within normal range. Normal range for albumin is 4.5-5.0 g/100ml.

A nurse is caring for a client who is in diabetic ketoacidosis (DKA). Which of the following outcomes would the nurse expect to find in this client? Select all that apply. Select one or more: a. Increased urinary sodium b. Increased serum potassium c. Decreased serum pH d. Decreased blood glucose e. Kussmaul breathing

General Feedback: During diabetic ketoacidosis potassium shifts out of the cells to compensate for the increased hydrogen ion concentration which leads to an increase serum potassium. In acidosis the pH is decreased to less than 7.35. As the respiratory system attempts to compensate for the metabolic acidosis, the respiratory rate will increase blowing off the C02. Kussmaul breathing is the body's attempt to blow off as much carbon dioxide as possible in order to compensate for the metabolic acidosis from DKA. The correct answer is: Increased serum potassium, Decreased serum pH, Kussmaul breathing

A nurse is caring for a client with chronic renal failure. When assessing this client, the nurse should be alert for which of the following that may indicate hypocalcemia? Select all that apply. Select one or more: a. Fractures b. Seizures c. Decreased clotting time d. Constipation e. Trousseau's sign

General Feedback: Hypocalcemia can lead to brittle bones and pathologic fractures. Hypocalcemia causes increased neuromuscular irritability which can progress to seizure activity. Hypocalcemia causes increased neuromuscular irritability and repetitive muscle spasms. Signs and symptoms of hypocalcemia include Trousseau's sign. Positive Trousseau's sign: hand/finger spasms with sustained blood pressure cuff inflation. The correct answer is: Fractures, Seizures, Trousseau's sign

A nurse is reviewing the morning laboratory results while preparing to administer a client their dose of digoxin. Which result would the nurse need to report to the primary care provider? Select one: a. Calcium level of 11mg/dl b. Digoxin level of 0.5 ng/ml c. Potassium level of 3.4 mEq/l d. Sodium level of 133 mEq/l

Potassium level of 3.4 mEq/l normal digoxin level is 0.5-0.8

A nurse is providing care for an older adult client. Which of the following findings indication fluid imbalance? Select all that apply. Select one or more: a. Sunken eyes b. Oliguira c. Tenting of skin on back of hand d. Moist mucous membranes e. Capillary refill greater than 5 seconds

Sunken eyes are a sign of dehydration. Oliguria (decreased production of urine) is a sign of dehydration. Diminished capillary refill is a sign of dehydration. The correct answer is: Sunken eyes, Oliguira, Capillary refill greater than 5 seconds

A client has been prescribed spironolactone for treatment of heart failure. Which statement made by the client would indicate a need for further teaching? Select one: a. "I will need to have routine labs drawn while taking this medication. b. "I will limit the use of salt in my diet and use a salt substitute instead." c. "I should take my medication at the same time each day in the morning." d. "I will weigh myself daily and report any changes in weight."

The correct answer is: "I will limit the use of salt in my diet and use a salt substitute instead." Routine labs to monitor electrolytes, especially potassium, are required when receiving a potassium sparing diuretic

A client experiencing pain has been prescribed meperidine 30mg IM every three hours, as needed for pain. The vial available is merperidine 75mg/1 mL. How much merperidine should the nurse administer? Select one: a. 1.4 ml b. 0.4 ml c. 2.5 ml d. 0.5 ml

The correct answer is: 0.4 ml

A client with a recent myocardial infarction is prescribed digoxin. Which of the following findings indicate to the nurse that a therapeutic response to this medication has been attained? Select one: a. A decrease in urinary output. b. A decrease in pulmonary crackles. c. An increase in apical pulse rate d. A rise in central venous pressure.

The correct answer is: A decrease in pulmonary crackles. Digoxin slows the heart rate by depressing conduction through the bundle of His and facilitating the vagal effect on the SA node.

A client diagnosed with bipolar disorder and prescribed lithium carbonate is being discharged from the hospital. Which of the following medication prescriptions should the nurse should question? Select one: a. Furosemide 20 mg by mouth twice per day b. Ranitidine 150 mg by mouth daily c. Valproic acid 250 mg by mouth three times per day d. Captopril 25 mg by mouth twice per day

The correct answer is: Furosemide 20 mg by mouth twice per day Valproic acid is an anticonvulsant and not contraindicated with a Bipolar disorder.

A client admitted with an acute exacerbation of asthma has been prescribed methylprednisolone sodium succinate IV. Which of the following findings should the nurse report to the provider immediately? Select one: a. Increased hunger b. Oral temperature of 100.5 F◦ c. Blood glucose 120 mg/dL d. Mild wheezing

The correct answer is: Oral temperature of 100.5 F◦ Mild wheezing is an expected finding during an acute exacerbation of asthma. The prescribed medication will address this clinical finding.

A client is prescribed lisinopril. Which of the following is most important for the nurse to assess before administering this medication to the client? a. Breath sounds. b. Peripheral edema. c. Body temperature. d. Serum electrolytes.

The correct answer is: Serum electrolytes. Lung sounds are not a priority assessment. ACE Inhibitors may be given to improve heart failure and while lung sounds need to be assessed this is not the priority.

A client diagnosed with depression has been prescribed fluoxetine. Which of the following information should the nurse emphasize? Select one: a. Take the medication at bedtime b. Maintain an adequate fluid and sodium balance c. Take the medication in the morning d. Avoid foods high in tyramine

The correct answer is: Take the medication in the morning Avoid food high in tyramine is important for MAOIs, not SSRIs

A nurse is caring for a client who is prescribed gentamicin sulfate. Which of the following side effects would indicate an adverse reaction to this medication? Select one: a. Pruritis in the forearms and upper arms. b. Urinary output of 185 mL in an 8 hour shift. c. Fine tremors in the fingers and hands. d. Muscular cramping in the lower extremities.

The correct answer is: Urinary output of 185 mL in an 8 hour shift. Tremors are a side effect of the medication that should resolve once the medication has been completed.Tremors are not an adverse effect.

A nurse has just taught a client about the side effects of levodopa. Which client statement would indicate to the nurse that further instructions is needed? Select one: a. "I still can drive." b. "I will not eat bananas." c. "I will get out of bed slowly." d. "I will administer the medication with food."

a. "I still can drive." CorrectCorrect: This medication may cause sudden onset of sleep, drowsiness and dizziness. Instruct client to avoid driving and other activities that required alertness.

A nurse is providing education for a client prescribed digoxin. Which of the following statements by the client demonstrates an understanding? Select all that apply. Select one or more: a. "I will contact my provider if I experience excessive nausea" b. "I understand I need weekly laboratory testing. c. "This medication will cause my heart to beat slower." d. "I will contact my provider if I experience visual changes." e. "This medication will change the color of my urine."

a. "I will contact my provider if I experience excessive nausea". CorrectThe client will need to seek medical attention right away if experiencing severe or excessive nausea. This is a severe side effect of the medication and could mean that the client is receiving too much of the medication. b. "I understand I need weekly laboratory testing." IncorrectThe client will not need weekly laboratory testing. The test to measure digoxin is ordered at the beginning of drug therapy to ensure correct dosage. Digoxin takes approximately one to two weeks to reach a steady level in the blood. Once the dosage level is determined, digoxin levels are monitored routinely, at a frequency determined by the provider. Digoxin levels will need to be monitored if the client has changes in health status or when toxicity is suspected. c. "This medication will cause my heart to beat slower." d. "I will contact my provider if I experience visual changes." CorrectThe client will need to seek medical attention right away if experiencing visual changes. This is a severe side effect of the medication and could mean that the client is receiving too much of the medication. Digoxin will cause the client's heart rate to beat slower. Digoxin slows electrical conduction between the atria and the ventricles of the heart and is useful in treating abnormally rapid atrial rhythms such as atrial fibrillation, atrial flutter, and atrial tachycardia. The client will need to seek medical attention right away if experiencing visual changes. This is a severe side effect of the medication and could mean that the client is receiving too much of the medication. The client will need to seek medical attention right away if experiencing severe or excessive nausea. This is a severe side effect of the medication and could mean that the client is receiving too much of the medication. The correct answer is: "This medication will cause my heart to beat slower.", "I will contact my provider if I experience visual changes.", "I will contact my provider if I experience excessive nausea".

A client is prescribed digoxin. Which of the following statements by the client indicates to the nurse the need for further teaching? Select one: a. "If I see halos around lights there is no need to notify my provider." b. "I should eat bananas and drink orange juice when I am on this medication." c. "I will check my pulse every day before taking my medication." d. "I will take my medication at the same time each day."

a. "If I see halos around lights there is no need to notify my provider." CorrectCNS effects such as blurred vision, diplopia and white halos around objects are a sign of drug toxicity and client should notify provider immediately.

A nurse notes the following prescription for a client with thrombophlebitis: Heparin sodium 25,000 units in 500 mL of D5W to infuse at 1,200 units/hour. What is the flow rate in mL per hour? Select one: a. 24 ml/hr b. 50 ml/hr c. 25 ml/hr d. 10 ml/hr

a. 24 ml/hr CorrectHave 25000 units in 500 mL D5W 25000 divide by 500cc = 50 units/mL Need to infuse at 1200 units/hr 1200 divide by 50 = 24 ml/hr

A nurse is providing education to a client diagnosed with glaucoma. The nurse should instruct the client to avoid which of the following medications? Select all that apply. Select one or more: a. Acetazolamide b. Timolol maleate c. Scopolamine d. Methylphenidate e. Diphenhydramine

a. Acetazolamide IncorrectUsed to treat glaucoma: carbonic anhydrase inhibitor; decrease the rate of aqueous humor production b. Timolol maleate IncorrectUsed to treat glaucoma: beta-adrenergic receptor antagonists decrease aqueous humor production d. Methylphenidate CorrectMethylphenidate is a sympathomimetic amine; cholinergic inhibition Atropine derivative, causes pupil dilation, anticholinergic. Methylphenidate is a sympathomimetic amine; cholinergic inhibition. Diphenhydramine blocks the action of acetylcholine; anticholinergics. The correct answer is: Diphenhydramine, Methylphenidate, Scopolamine

A client in the behavioral health unit began taking fluoxetine 20 mg per day three days ago for depression. Which of the following should the nurse immediately report to the health care provider? Select one: a. Agitation and fever b. Sexual dysfunction c. Weight gain d. Headache and nausea

a. Agitation and fever CorrectAgitation and fever are symptoms of serotonin syndrome, a potentially life-threatening condition that can develop in client's taking SSRIs such as fluoxetine. These symptoms develop within 2-72 hours after starting treatment and may also include mental confusion, anxiety, hallucinations, tremors, and hyperreflexia. .

A client is prescribed 10 units of regular insulin and 30 units of NPH daily. What order will the nurse complete the below insulin administration steps. (Place the following steps in the correct order). A. Inject air into the vial of regular insulin B. Using the same syringe, withdraw 10 units of regular insulin C. Wash hands and roll the vial of NPH D. Wipe the top of the vials with an alcohol pad E. Using the same syringe withdraw 30 units of NPH a. C, D, A, B, E b. E, B, C, A, D c. A, C, D, E, B d. B, E, A, C, D

a. C, D, A, B, E CorrectThe American Diabetic Association (ADA) recommends that when withdrawing insulin and injection of air is for the prevention of the formation of a vacuum inside the bottle, which would make it difficult to withdraw the proper amount of insulin. When a mixture is prepared, the short-acting insulin should be drawn into the syringe first. This would avoid contaminating of the insulin. Insulin mixtures are stable for 28 days.

A nurse is teaching a client with gout who is starting allopurinol. Which of the following should the nurse include in the client teaching? Select one: a. Drink 2-3 liters of fluid per day b. Do not take allopurinol within 2-3 weeks of an acute gout attack. c. Sudden onset of muscle pain can result with initiation of this therapy. d. Take allopurinol on an empty stomach.

a. Drink 2-3 liters of fluid per day. CorrectCorrect: The client should be encouraged to drink 2-3 liters of fluid per day to prevent kidney injury, an adverse effect of this medication therapy.

A client is admitted to the hospital with a diagnosis of diabetic ketoacidosis (DKA). An intravenous infusion of regular insulin has been started. Which of the following nursing interventions is most appropriate for this client? Select one: a. Ensure glucagon is readily available b. Add the prescribed dose of NPH insulin to the IV infusion c. Monitor blood glucose levels every 4 hours d. Obtain an arterial blood gas every 2 hours

a. Ensure glucagon is readily available Glucagon and D50 are used for rapid treatment of hypoglycemia which can occur when insulin is administered intravenously

A client is a Jehovah's Witness and is scheduled for an elective hysterectomy secondary to prolonged and heavy menses. Which medication would the nurse anticipate being ordered prior to surgery for this client? Select one: a. Epoetin Alfa b. Interferon c. Methylergonovine d. Retrovir

a. Epoetin Alfa CorrectCorrect: Epoetin Alfa is a growth factor used to treat anemia related to renal disease, chemotherapy, HIV / AIDS treatment and for clients who are anemic undergoing elective surgery. Jehovah's Witness' clients generally do not accept blood transfusions, and this client has had prolonged and heavy menstrual bleeding and is likely anemic. In this case, Epoetin Alfa dosing 2-4 weeks prior to surgery (generally once per week for four weeks prior to surgery) would be indicated to raise the hemoglobin to a therapeutic level.

A client is prescribed digoxin 1mg by mouth QID. The client states that the objects in his room have a yellowish tinge and he is nauseated. Select the most appropriate nursing action at this time. a. Hold the drug and call the health care provider. b. Count the apical pulse; if it is regular and above 60, administer the drug as ordered. c. Administer the medication and observe the client for further nausea. d. Hold the medication and count the apical pulse before the next dose is to be given.

a. Hold the drug and call the health care provider. CorrectThis client is showing signs of digitalis toxicity. The most appropriate action is to hold the drug and call the health care provider. Severe arrhythmia may develop if action is not taken.

A nurse is to administer nitroglycerin to a client for the treatment of angina. Which of the following should the nurse first advise the client? Select one: a. To sit or lie down b. Dizziness may occur. c. A headache may occur. d. To rise slowly

a. To sit or lie down. CorrectInform client to sit or lie down. This intervention is priority due to the orthostatic hypotension effects that can occur with nitroglycerin administration; including dizziness, light-headedness, and reduced cardiac output. This can cause a drop in blood pressure. Lying with feet elevated promotes venous return and thereby restores blood pressure. This is a safety concern and action needs to be taken before medication administration

A client has an order for an IV of 1000 ml of lactated ringers with 20 mEq of potassium/L to infuse at 40 ml/hr. The drip factor is 15 drops/ml. The nurse calculates the flow rate to be: ______ gtt/min. Select one: a. 9 drops/min b. 10 drops/min c. 11 drops/min d. 12 drops/min Feedback

b. 10 drops/min

A client asks "Why can't I take Prednisone every day for my arthritis like my grandmother did?" The nurse correctly explains that corticosteroids can have which of the following adverse effects when used continuously? Select all that apply. Select one or more: a. Hypoglycemia b. Osteoporosis c. Bronze coloration of the skin d. Truncal obesity e. Susceptibility to infection

b. Osteoporosis CorrectContinuous administration of high dose glucocorticoids will cause Cushing's syndrome. Cushing's syndrome includes fluid retention, hypertension, weight gain, and fat redistribution with truncal obesity, 'moon face', and 'buffalo hump.' Additional symptoms may include: susceptibility to infection, hyperglycemia, osteoporosis, menstrual irregularities, thin fragile skin, and hirsutism. c. Bronze coloration of the skin IncorrectSymptoms of hypoglycemia, dehydration, and bronze discoloration of the skin are associated with Addison's disease, a deficiency of glucocorticoids. d. Truncal obesity CorrectContinuous administration of high dose glucocorticoids will cause Cushing's syndrome. Cushing's syndrome includes fluid retention, hypertension, weight gain, and fat redistribution with truncal obesity, 'moon face', and 'buffalo hump.' Additional symptoms may include: susceptibility to infection, hyperglycemia, osteoporosis, menstrual irregularities, thin fragile skin, and hirsutism. e. Susceptibility to infection CorrectContinuous administration of high dose glucocorticoids will cause Cushing's syndrome. Cushing's syndrome includes fluid retention, hypertension, weight gain, and fat redistribution with truncal obesity, 'moon face', and 'buffalo hump.' Additional symptoms may include: susceptibility to infection, hyperglycemia, osteoporosis, menstrual irregularities, thin fragile skin, and hirsutism. Continuous administration of high dose glucocorticoids will cause Cushing's syndrome. Cushing's syndrome includes fluid retention, hypertension, weight gain, and fat redistribution with truncal obesity, 'moon face', and 'buffalo hump.' Additional symptoms may include: susceptibility to infection, hyperglycemia, osteoporosis, menstrual irregularities, thin fragile skin, and hirsutism. The correct answer is: Osteoporosis, Truncal obesity, Susceptibility to infection

A nurse is caring for a client taking captopril. Which finding would require immediate attention for this client? Select one: a. Sodium 133 b. Potassium 5.8 c. Blood pressure 96/48 d. Pulse 56

b. Potassium 5.8 CorrectA potassium of 5.8 is elevated- normal is 3.5-5. One effect of Capoten is elevation of potassium levels because this drug inhibits the formation of angiotensin II and blocks the release of aldosterone. The blocking of the aldosterone results in sodium excretion and potassium retention. Hyperkalemia can result in cardiac arrhythmias and if untreated lead to cardiac arrest.

A client is prescribed linsinopril. Which of the following findings indicates to the nurse that the client is experiencing an adverse effect of this medication? Select one: a. Fasting blood glucose 40 mg/dl b. Serum potassium 5.8 mEq/L c. White blood cell count 10,000mm3 d. Creatine kinase (CK) 120 units/L

b. Serum potassium 5.8 mEq/L CorrectSerum potassium 5.8 mEq/L is the correct answer. ACE inhibitors may cause hyperkalemia. Suppression of angiotensin II leads to a decrease in aldosterone levels. Since aldosterone is responsible for increasing the excretion of potassium, ACE inhibitors can lead to elevated serum potassium. The nurse should monitor potassium levels to maintain normal range of 3.5 - 5.0 mEq/L.

A nurse is monitoring client compliance with the diabetes mellitus treatment regimen. Which of the following values best indicates compliance with the regimen? Select one: a. Fasting blood glucose level of 127 mg/dL b. Pre-meal glucose of 140 mg/dL c. Hemoglobin A1c of 5% d. Blood glucose level of 125 mg/dL

c. Hemoglobin A1c of 5% Correct Glycosylated hemoglobin (HbA1c) is the best indicator of average blood glucose levels for the past 120 days. This test assists in evaluating treatment effectiveness and compliance. The target value is 4-6%. The value given is within the normal range.

A nurse is caring for a client prescribed omeprazole. What information should the nurse provide to the client regarding administration of this medication? Select one: a. Take the medication at bedtime. b. Take the medication in the morning before breakfast c. You may crush the medication for easier swallowing. d. Take the medication after a meal twice daily.

b. Take the medication in the morning before breakfast. CorrectClients should take omeprazole once a day prior to eating in the morning.

A nurse is evaluating a client's understanding of lithium. Which statement by the client indicates a need for further education? Select one: a. "I should have my blood level drawn as directed." b. "I will contact my provider if I develop diarrhea." IncorrectThe client should be instructed to contact their provider any time they develop diarrhea. Diarrhea can cause significant sodium loss which will lead to lithium toxicity. c. "I should take the medication on an empty stomach." d. "I will drink 8-12 glasses of water a day."

c. "I should take the medication on an empty stomach."

A nurse is caring for a client who is beginning a warfarin regimen. What education should be provided to the client about this medication? Select all that apply. Select one or more: a. Oral contraceptives will decrease anticoagulant effects. b. Concurrent use of glucocorticoids should be avoided while taking warfarin. c. Intake of foods that are high in Vitamin K should be monitored d. Warfarin can be used safely in pregnancy. e. Protamine sulfate will be administered in cases of warfarin overdose.

c. Intake of foods that are high in Vitamin K should be monitored. Correct CORRECT. Foods high in Vitamin K, such as dark green leafy vegetables, cabbage, broccoli, mayonnaise and canola may decrease anticoagulant effects of warfarin with excessive intake. A client who is beginning a warfarin regimen should be provided with a list of foods that are high in Vitamin K. Protamine sulfate is the antidote for heparin sodium. Vitamin K would be administered in the event of a warfarin overdose. Concurrent use of oral contraceptives decreases anticoagulant effects of warfarin and should be avoided if possible. Foods high in Vitamin K, such as dark green leafy vegetables, cabbage, broccoli, mayonnaise and canola may decrease anticoagulant effects of warfarin with excessive intake. A client who is beginning a warfarin regimen should be provided with a list of foods that are high in Vitamin K. The correct answer is: Oral contraceptives will decrease anticoagulant effects., Intake of foods that are high in Vitamin K should be monitored., Concurrent use of glucocorticoids should be avoided while taking warfarin.

A nurse is caring for a client taking captopril who has started experiencing a frequent dry cough. What action should the nurse take? Select one: a. Encourage the client to continue taking the medication as prescribed. b. Instruct the client to decrease the dosage of the medication. c. Notify the provider of the client's symptom. d. Encourage the client to use over the counter cough syrup for the cough.

c. Notify the provider of the client's symptom. CorrectAn adverse effect of ACE inhibitors is a cough related to inhibition of kinase II which results in an increase in bradykinin. The provider should be notified if a dry cough occurs so that the medication can be discontinued.

A client experiences postural hypotension during initial drug therapy with diltiazem. Which of the following would be most important for the nurse to recommend to this client? Select one: a. Lie down for 30 minutes after taking the medication. b. Eat small, frequent meals during the day. c. Rise slowly from a sitting or lying position. d. Drink additional oral fluids each day.

c. Rise slowly from a sitting or lying position. CorrectRise slowly from a sitting or lying position. This will allow them to adjust to the upright position; slowly rising allows the heart to adjust the cardiac output to pump harder to maintain adequate BP to offset any orthostatic hypotension from occurring.

During administration of vancomycin IV, the nurse notices the client's neck and face becoming flushed. Which of the following actions should the nurse take first? Select one: a. Notify the health care provider. b. Obtain an order for an antihistamine. c. Stop the infusion. d. Check the client's temperature.

c. Stop the infusion. CorrectFlushing of the face and neck are symptoms of red man or red neck syndrome occurring with too rapid infusion of Vancomycin. Vancomycin can cause two types of hypersensitivity reactions, the red man syndrome and anaphylaxis. Red man syndrome has often been associated with rapid infusion of the first dose of the drug and was initially attributed to impurities found in vancomycin preparations. First action should be to stop the infusion. Contacting the health care provider is necessary after the infusion is stopped. The client should be monitored for serious reactions such as hypotension, dyspnea, anaphylaxis, renal failure or hearing loss. Other minor reactions are chills, dizziness, fever, pruritis, and tinnitus.

A client with a digoxin level of 2.4 ng/ml has a heart rate of 39. The health care provider prescribes atropine sulfate. Which of the following best describes the intended action of atropine for this client? a.To stimulate the SA node and sympathetic fibers to increase the rate. IncorrectAtropine does not have a direct effect on the SA node. b. To dry oral and tracheobronchial secretions. c. To accelerate the heart rate by interfering with vagal impulses. d. To reduce peristalsis and urinary bladder tone.

c. To accelerate the heart rate by interfering with vagal impulses.

A client diagnosed with preterm labor has been prescribed nifedipine. The client asks the nurse why this particular medication has been prescribed. Which of the following statements by the nurse is correct? a. To promote development of your baby's lungs b. To decrease the intensity of your pain c. To relax your muscles of your uterus d. To lower your blood pressure

c. To relax your muscles of your uterus CorrectThe use of nifedipine for the treatment of preterm labor is an unlabeled use of the drug. Nifedipine, a calcium channel blocker, is more commonly used to treat high blood pressure and heart disease. Smooth muscle tissue, like the uterus, needs calcium to contract. Nifedipine blocks the passage of calcium into certain tissues, relaxing the uterine muscles and smooth muscles of blood vessels throughout the body.

A nurse is to administer morphine sulfate 10 mg intramuscular (IM) to an adult client for post-operative pain. Which injection site is the most appropriate? Select one: a. Epidural b. Deltoid c. Ventrogluteal d. Dorsogluteal

c. Ventrogluteal CorrectThis site is a deep site, situated away from the major nerves and blood vessels. This site is preferred for medications (such as antibiotics) that are larger in volume, more viscous, and irritating for adults, children, and infants. This site is safe for all clients with large muscle development.

A client with a history of duodenal ulcer is admitted to the hospital with status asthmaticus. Which of the following medications should the nurse question? Select all that apply. Select one or more: a. furosemide b. prednisone c. naproxen d. lisinopril e. sucralfate

c. naproxen--> Correct-->NSAIDs such as naproxen can contribute to gastric irritation d. lisinopril --> Incorrect-->ACE inhibitors such as lisinopril are not associated with gastric irritation. NSAIDs such as naproxen can contribute to gastric irritation. Corticosteroids such as prednisone are associated with an increased incidence of peptic ulcers and thus should be questioned if prescribed to a client with a history of duodenal ulcer. The correct answer is: naproxen, prednisone

The nurse is providing client education regarding the combined use of herbal supplements with prescribed medications. Which of the following statements indicates the client correctly understands the interaction of ginkgo biloba and warfarin? Select one: a. "The ginkgo and warfarin work together to help my memory." b. "I should take the warfarin in the morning and the ginkgo at bedtime so that they do not interact." c. "Ginkgo and warfarin should be taken at the same time during the day." d. "Ginkgo increases the effects of warfarin so I will stop taking the ginkgo."

d. "Ginkgo increases the effects of warfarin so I will stop taking the ginkgo." CorrectWhen ginkgo biloba is taken with antiplatelet or anticoagulant medications, the effect of the antiplatelet/anticoagulant drug may be increased, resulting in uncontrolled bleeding.

A client ingested a full bottle of imipramine hydrochloride. Which of the following toxic effects is most important for the nurse monitor? Select one: a. Hypertension b. Blurred vision c. Photophobia d. Arrhythmias

d. Arrhythmias CorrectWith a Tricyclic antidepressant (TCA) overdose, there is a high risk for serious cardiac problems, including arrhythmias, tachycardia and myocardial infarction.

A clinic nurse is preparing to administer a Penicillin IM injection to a client who has never taken the medication before. Which of the following interventions should be included in the plan of care? Select one: a. Inject the client with a small test dose of Penicillin subcutaneously. b. Instruct the client to expect a slight rash to develop at the injection site. c. Ask the client if they are allergic to shell fish before administering. d. Instruct the client to sit in the clinic for 30 minutes after the injection.

d. Instruct the client to sit in the clinic for 30 minutes after the injection. CorrectTo ensure prompt treatment if anaphylaxis should develop, clients should remain in the prescriber's office for at least 30 minutes after drug injection. After 30 minutes, the risk of anaphylactic reaction is reduced.

A nurse is providing discharge instructions for a client who is taking atenolol. Which instructions should the nurse give to the client to prevent postural hypotension? Select one: a. Take the medication with plenty of fluids b. Lie down if dizziness or lightheadedness occurs c. Take the medication immediately after awakening d. Move slowly when changing from lying to standing

d. Move slowly when changing from lying to standing CorrectTaking Tenormin at bedtime will help with symptoms of postural hypotension, which is a common side effect of beta blockers.

A client has been prescribed bupropion to assist with smoking cessation therapy. Which of the following findings would a nurse report to the health care provider immediately? Select one: a. Photosensitivity b. Nausea and Vomiting c. Dry mouth d. Seizures

d. Seizures CorrectCorrect: This is an adverse effect of the mediation and should be addressed immediately.

A nurse is caring for a client with a history of rheumatoid arthritis who is receiving methotrexate. Which of the following should be included in client education? Select one: a. Methotrexate will decrease the risk of developing cancer. b. Daily monitoring of blood glucose is recommended c. Methotrexate can be administered during pregnancy d. The complete blood count (CBC) will be monitored.

d. The complete blood count (CBC) will be monitored. CorrectBone marrow suppression is a common side effect when using methotrexate for long term therapy in the treatment of rheumatoid arthritis. The client will have their complete blood count monitored periodically for evidence of anemia, neutropenia or thrombocytopenia.