RN Pharmacology Practice 2019 A

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?

I should sit up for 30 minutes after taking the 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?

I should tell my provider if I develop a sore throat (neutropenia)

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?

Ibuprofen (NSAID increase Li level)

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?

1. Report muscle pain to the provider. 2. Avoid taking the medication with grapefruit juice. 3. Expect therapy with this medication to be lifelong.

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?

100 gtt/min gtt/mL x mL/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?

2 months (1st dose)

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. C. Place a pressure dressing on the injection site to prevent bleeding.

A. Administer the medication outside the 5 cm (2 in) radius of the umbilicus. Rationale: Heparin administration should ideally occur in the abdomen at least 5 cm away from umbilicus. Aspiration should not occur as this will cause bruising. Do not rub vigorously, apply firm pressure 1-2 min prior. Do not apply dressing, apply pressure for 1 min to prevent bleeding.

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 medication 1 hr before breakfast. D. Decrease dietary intake of foods containing potassium. E. Grapefruit juice can increase the effects of the medications.

A. Blood glucose levels will be monitored during therapy ( medication increase serum glucose level & require management) B. Avoid contact with people who has known infection (medication decreased immunity putting patient at increased risk for infection) E. Grapefruit juice can increase the effects of the medication

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

A. Constipation (due to morphine) ** sodium will promote increase water and fat in GI **

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. Fila 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.

A. Document the refusal and inform the client's provider

A nurse is providing teaching to a client who is 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. Dry mouth, Blurred vision, Dry eyes Rationale: Oxybutynin is an anticholinergic agent. S/E: Can't see. Can't pee. Can't spit. Can't sh*t.

A nurse at an urgent care clinic is collecting a history from a female client who has a UTI. 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.

A. I have tendonitis, so I haven't been able to exercise Rationale: Tendonitis is a contraindication for ciprofloxacin due to risk of tendon rupture.

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.

A. Obtain the client's blood pressure Rationale: First step of nursing process is to assess. Atenolol is a beta blocker/antihypertensive medication, check the client's BP. All other actions should be performed however assessment is priority.

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 39.7C (103.5F) B. Urinary retention C. Heart rate 56/min D. Muscle flaccidity

A. Temperature of 39.7 (103.5)

A nurse is caring for a client who is taking acetazolamide fr 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

A. Tingling of fingers Rationale: This is an adverse effect of paresthesia when takin acetazolamide. Diarrhea, weight loss, and polyuria are also other side effects.

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.

A. Turn the client to a side lying position Rationale: Reduces risk of uteroplacental insufficiency. All other thing should occur however they are not priority.

A nurse is caring for a client who has acute acetaminophen toxicity. The nurse should anticipate administering which of the following medications?

Acetylcysteine (antidote that prevent injury when given orally or Iv within 8 to 10 hr)

A nurse is 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?

Atropine (reverse cholinergic toxicity)

A nurse is caring for a client who received 0.9% sodium chloride 1L over 4hr instead of over 8hr 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. 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.

B. 0.9 % sodium chloride 1 L IV infused over 4 hr. Vital signs stable, provider notified Rationale: Nurse should document type, amount of fluid, how long it took, and client's physical status.

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 a week. D. I should discard the used patch by flushing it down the toilet.

B. I will take the patch off right after my evening meal Rationale: Clients should remove in evening for medication free time of 12-24 hr before applying new patch to avoid tolerance.

A nurse receives a verbal order from the provider to administer morphine 5 mg 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 5mg subcut every 4 hr PRN severe pain B. Morphine 5mg subcut every 4 hr PRN severe pain C. MSO4 5mg SQ every 4 hr PRN severe pain D. Morphine 5.0mg subcutaneously every 4 hr PRN severe pain

B. Morphine 5 mg subcut every 4 hr PRN severe pain Rationale: Medication name is spelled out and there are no abbreviations from The Joint Commission "Do Not Use" list.

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

B. Presence of U waves Rationale: U waves are a manifestation of hypokalemia. Tall, tented T waves and widened QRS complexes represent hyperkalemia. ST elevation is an indication of ischemia while ST depression could signify hypokalemia.

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

B. Sedation Rationale: It is a central dopamine antagonist. Increase GI motility and prevents nausea. Multiple CNS effects including dizziness, fatigue, and sedation. Another effect is tardive dyskinesia.

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

B. Sexual dysfunction

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

B. Tinnitus Rationale: Aminoglycosides are ototoxic which can manifest as tinnitus or deafness.

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?

Bibasilar crackles (heart failure and pulmonary edema)

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?

Blood in the urine (heparin toxicity)

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

C. 0830 (30 min before/ after)

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 of 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.

C. A transition in care requires the nurse to conduct medication reconciliation

A nurse administers a dose of metformin for 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

C. Check the client's blood glucose Rationale: First action in nursing process is to access. The client at risk for hypoglycemia.

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

C. Forms a protective barrier over ulcers Rationale: Stomach acid production can further irritate and cause pain. Stomach acid production decreased by H2 receptor antagonists. Antacids (aluminum hydroxide) neutralize acid. Sucralfate is a mucosal protectant. H. pylori is treated with antibiotics such as metronidazole, tetracycline, clarithromycin, and amoxicillin.

A nurses 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

C. Heart rate Rationale: Digoxin decreases heart rate (negative chronotropic). HR needs to be 60+ bpm.

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 urinary incontinence.

C. I will taper off the medication before discontinuing it Rationale: The client should taper off to prevent abstinence syndrome or rebound insomnia. Cyclobenzaprine should be used for muscle spasms. Adverse effect is dry mouth (anticholinergic).

A nurse is reviewing the medication list of a client who wants to begin taking oral contraceptives. The nurses should identify that which of the following client medications will interfere with the effectiveness of oral contraceptives?

Carbamazepine (cause accelerated inactivation of oral contraceptive by action on hepatic medication metabolizing enzymes)

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 chews. D. Decreased respirations might occur.

D. Decreased respiration might occur

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

D. Dyspnea Rationale: Caused by bronchoconstriction due to increased Ach level. Others should be reported as well however acording to ABC priority, dyspnea should be reported first.

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

D. Insomnia Rationale: Bupropion is an atypical antidepressant. It does not cause coughing. It has stimulant properties (agitation, tremors, mania, and insomnia).

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.

D. Monitor the client for constipation Rationale: Client's other oral meds should be held 6 hr before. Sodium polystyrene will not alter color of stool and is stable fir 24 hr when refrigerated. Monitor for adverse effect of constipation which can lead to fecal impaction.

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

D. Platelets 96,000/mm^3 Rationale: Expected range 150,000 - 400,000. Platelet count less than 100,000/mm3 can indicate heparin induced thrombocytopenia.

A nurse is planning care for a client who has hypertension and is to start taking metoprolol. Which of the following intervention should the nurse include in the plan of care?

Determine apical pulse prior to administering (pulse rate less than 60/min - notify provider for bradycardia)

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?

Digoxin (increased toxicity)

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?

Epinephrine (to induce vasoconstriction and bronchodilation during anaphylaxis)

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?

Increase in ability to focus

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 (bone marrow stiumulated)

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?

Miosis (pupillary constriction due to excessive muscarinic stimulation)

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?

Oral candidiasis

A nurse is reviewing the laboratory results of a client who is taking digoxin for heart failure. Which of the following result should the nurse report to the provider?

Potassium level 2.8 (hypokalemia that increase risk of 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?

Pregnancy test (must provide two negative pregnancy tests)

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?

Report yellowing of the skin

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?

Store unused medication sticks in a storage container

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?

Take one tablet at onset of migraine

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?

The client rates pain as 3 on a scale from 0 to 10 (description of pain most accurate)

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?

The client's capnography has returned to baseline (gas exchange is adequate)

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?

hot flashes (due to estrogen receptor blocking action of tamoxifen)

A nurse is 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?

Flumazenil (antidote to reverse benzodiazepine)

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?

Prevent delirium tremens

A nurse is 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?

Naloxone (to reverse respiratory depressive effect of heroin, but not too quick)

A nurse is preparing to administer ciprofloxacin 15 mg/kg PO every 12 hr to a child who weighs 44 Ib. How many mg should the nurse administer per dose?

300 mg

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 age risk of bleeding. C. Acetaminophen may be substituted for aspirin. D. The INR lab work must be monitored more frequently if aspirin is taken.

B. Aspirin will increase the risk of bleeding

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?

Rinse your mouth after inhaling the beclomethasone (to prevent oropharyngeal candidiasis and hoarseness)